Kazakhstan inherited from the Soviet Union a health system based on outdated norms and practices, delivered through an oversized network of state health facilities, managed through direct control, and with few incentives for improved efficiency or quality of services. In 2004, there were more than 8, 000 health facilities, including 1, 666 public outpatient facilities, 1, 101 private outpatient facilities, 894 public hospitals, and 148 private clinics. The distribution of health facilities and provision of health services varies significantly across regions.
The Government of Kazakhstan has recognized that health care is not delivered at a level that meets international standards. The Ministry of Health identified several factors that are contributing to the poor quality of the health system, including: outdated Soviet-era medical curriculum and methods for teaching; a rudimentary system of continuing medical education; a quality control system based on punitive external oversight that results in defensiveness and low transparency; a lack of a modern accreditation system for health facilities; limited use of quality management methods in hospitals; limited use of evidence-based clinical practice guidelines; and limited capacity for evidence based medicine, including the capacity to evaluate the cost-effectiveness of health care technologies.
It is widely recognized that the current system is in need of restructuring and reform.
The Kazakhstan Health Technology Transfer and Institutional Reform Project is an initiative being co-financed by the Government of Kazakhstan and the World Bank. The project has several components and is to be implemented until 2013. Its objective is to introduce international standards and build long-term institutional capacity in the Ministry of Health (MOH) and related health institutions in support of key health sector reforms in the following areas:
â€¢ Health Policy and Financing
â€¢ Health Management
â€¢ Clinical Practice Based on Evidence
â€¢ Accreditation of Health Facilities
â€¢ Laboratory and Blood Services
â€¢ Medical Education
â€¢ Health Research
â€¢ Health Information Systems
â€¢ Food Safety
The fundamental approach of the project is to build capacity in Kazakh institutions and improve their performance. For each of the project components, a twinning arrangement is being established between a highly capable external partner and relevant Kazakh institutions. Under these twinning arrangements, the external partner will provide technical support and knowledge transfer to the Kazakh counterparts.
CSIH in Kazakhstan
CSIH has been selected as the Twinning Partner to implement the following three components of the Kazakhstan Health Technology Transfer and Institutional Reform Project:
1) Health Accreditation System Improvement
2) Upgrading Clinical Practice and Medical Services Standardization Based on Evidence-Based Medicine and Health Technology Assessment