Loading in 2 Seconds...
Loading in 2 Seconds...
Financing, Access, Quality and Outcomes in Primary Health Care: The case of the Republic of Kazakhstan. Mr. Aikan Akanov, Director of the Healthy Lifestyle Promotion Centre VII CARK MCH Forum Almaty, Kazakhstan 5 - 7 November 2003. Agenda.
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
Mr. Aikan Akanov,
Director of the Healthy Lifestyle Promotion Centre
VII CARK MCH Forum
5 - 7 November 2003
Official Statistics indicates the Infant Mortality Rate at 18 per 1,000 live births.
While the Demographic and Health Survey indicates 62 per 1,000 live births.
This could be explained by use of different live birth definitions.
Preventive and Diagnostic Services Are Limited
Age standardised death rate, cancer of the cervix, age 0-64, per 100,000
Cervical cancer – a combination of factors
Dx and Therapeutic
Average payment – 2,011 KZT
Average payment – 6,630 KZT
% of income
Average monthly income
% of income
Average monthly income
6 or more = 47%
Q-321 Medicines to
lower blood pressure
Q-321 Diuretics provided
Q-321 Blood pressure
Q-321 Pulse taken
Q-321 Deep tendon
of gross domestic product GDP
Republic of Moldova
2001International Comparison as % GDP on Health
Spending is not allocated to most cost-effective interventions.
No clear budgeting rules across oblasts.
Budget structure does not allow for the clear separation of primary care expenditures, versus secondary and hospital care.Main findings on the financing and budgeting study
Capital spending is very low and is crowded out by spending on salaries and other spending.
Spending on drugs is not standardized to a unique formulary and drug prices are not referenced.Main findings on the financing and budgeting study
Spending per capita is not allocated according to need but has a small, positive impact on IMR.
…with similar results in terms of MMR and…
Total number of FAPs is positively associated with lower levels of IMR and …
…similar results in terms of medical/obstetric units---better access means fewer infant deaths.
IMR is negatively correlated with beds per 10,000. This means that more beds is associated with a higher IMR
Distribution of funds not allocated according to population needs.
Equity in outcomes is limited as a very small % of women in lowest income groups meet standards of care in key protocols
In general people have access to health services…but…
Geographic access to well developed PHC is limited and forces many rural people into hospitals as first line provider.
Financial access is a problem. Out-of-pocket payments, many times in excess of a monthly salary, keep 20% of all patients from obtaining required medical care.
Access to quality medical services in rural areas is impeded as years of under investment have eroded the technical capacity of providers.Assessing overall performance
Observance of treatment protocols is limited. For example, only 50 % of all suspected cases of eclampsia had blood pressure taken.
Over 50 percent of the 62 percent of neonatal deaths could be prevented.
Many of the neonatal deaths are due to a problems in management of high risk births, lack of EOC or lack of timely access to PHC.
Outcomes are limited by problems with the management of programs thereby limiting effectiveness.
MOH should develop improved capacity to monitor and evaluate the use of protocols at all levels of system.
Very little activity related to promotion. PHC focused on minor palliative care.Assessing overall performance
Overall level of financing health care in Kazakhstan is nearly the lowest in CAR and European countries.
Most countries are spending over 5 percent of GDP
Maternal child health care services receive limited resources for true PHC.
At current financing levels, it will be difficult to ensure access to a cost effective basic package and improve existing technological stock.
Problems with risk pooling create a serious financial burden for the population. While majority of the population pays only a small amount per visit, hospitalization is a catastrophic risk.
Problems with budgetary structure and reporting that makes it difficult to estimate national health accounts and make policy decisions regarding allocation of funds.Assessing overall performance
Overall trends in health status are not improving.
Hospitals do not appear to be operating efficiently in terms of producing maximum output with minimum input.
PHC services are not capturing patients in rural areas (at least 25% went directly to hospitals).
Lack of solidarity in the financing model is highly inefficient at the macro level.
Staff productivity is limited by a lack of equipment, drugs and supplies.
There is very limited production and penetration on the key messages of the project or the health insurance fund.Assessing overall performance
Satisfaction levels with care received are high (over 75% of all people very satisfied or satisfied with the doctor).
Nurses receive similar rankings with respect to physicians.
Very limited community participation in the oversight and planning associated with local government..
Need to introduce more outreach programs—school health—to improve information and education.Assessing overall performance
MOH has to strengthen regulation over the quality of care.
Important role of private sector in provision of drugs underscores the need for stronger regulation
Seek initiatives to strengthen influence over direction of local governments
Important standarize indicators across oblasts
Encourage benchmarking among providers and Oblasts
Need to take an active role in health education.Towards strengthening PHC
Introduce resource allocation formula that reflects the population’s health needs and risks
Attempt to strengthen the capacity of PHC and increase the per capita financing PHC/MCH
Link transfer of funds and introduce performance based payment mechanisms that link funds to results.
Efforts need to be made to reduce the financial burden for a basic package of services. This means that all services required to deliver the package are free of charge.
Risk pooling at the national level is highly desireable.Towards strengthening PHC
The introduction of the purchasing function critical to orient resources and actions in the sector.
Purchasing orients funds towards the population’s priority health needs.
Holds Oblasts and providers accountable for improvements in results.
Introduces performance based payments.
Strong monitoring and evaluation function related to productivity, quality and satisfaction.Towards strengthening PHC
Need to orient PHC services to priority health problems and to design package of services that meets the population’s health needs.
This includes consultation, drugs, materials and all services NOT just one aspect.
Examples of services organized around key population groups.
Package of services includes entire spectrum of PHC; not just palliative and curative.
Initiate disease management approach which integrates protocols across levels of care.
Wider use of care guidelines in PHC.
Training in key areas to fill the knowledge gap.Towards strengthening PHC