Development of a master plan for the restructuring of the hospital sector of the Republic of Kazakhstan

Ministry of health and social development of Republic of Kazakhstan Republican State Enterprise the "Republican center of development of health protection"

republican state enterprise on rights for an economic conduct «Republican center of development of health protection»

Zh. Ospanova

The basis for the restructuring of the hospital sector

Message from the President of the Republic of Kazakhstan NA Nazarbayev to

people of Kazakhstan "Socio-economic modernization - main direction of

development of Kazakhstan" (27.01.12)

4 direction of the State program of Health of the Republic of Kazakhstan

"Salamatty Kazakhstan" for 2011-2015 "Improvement of the organization,

management and financing of health care in the Unified National Health

System"

Government Decision on 15.12.09g. № 2131 "On approval of the state

standard of the network of health care organizations of the Republic of

Kazakhstan"

 Strategic Plan of the Ministry of Health of Kazakhstan for 2011-20142

The basis for the restructuring of the hospital sector

reduction in hospital beds as part of the Unified National Health System

reduce consumption of hospital care before 1172 bed-days per 1 000

population in 2015

improving the efficiency of the work (intensification) inpatient beds

review of the hospital network in the appropriate levels of care

improving the performance of organizations (autonomy and

independence)

3

Prerequisites Planning modern hospital network

current situation

Improving the planning and creation of a

modern network of health care

organizations that provide inpatient

care

Irrational use of funding in the

construction of medical institutions

Excessive operating costs of the building

Costs of management of hospitals

The slow pace of introduction of

modern technologies

• 63% of hospitals are located in buildings constructed more than 30 years ago;

• approximately 24.4% of hospitals are located in non-standard buildings;

•   25% of hospitals have a low bed capacity (from 50 to 100 beds);

• according to the minimum standards of hospital equipment 1/3 fully provided with the necessary equipment and medical devices

• irrational planning the construction of MO 4

The approaches to the planning of the hospital sector

The proposed standards

A network of hospitals in terms of medical care:Level 1 - Area; 2nd level multidisciplinary regional (city, district); 3rd level region; 4th

level Repablican centers

Beds on profiles

Personnel by function

Basic medical equipment

The demographic outlook to 2025

The service area of each hospital (minimum and maximum number of people)

Correction factors: geographical location, economic development, health indicators

The required number of beds on profiles

The required number of staff by function

Required basic equipment

5

Development and implementation of the necessary parameters for the efficient operation of hospital organizations

Planning parameters based

on the size, population needs and standards of

normative legal act

the specification of areas of

infrastructure

number of beds number of employees

Required equipment list

6

Standards based on the number of population and the need for services

National standards

Karaganda South Kazakhstan

Akmola East Kazakhstan

Beds on the profiles100,000 population

Personnel specialties per 100,000 population

The need for high-tech equipment

future admissions

Modern medical practice

Access /geography

Application Standard + Adjustment

factors lead to the provision of the

required count of beds, staff and

equipment for the field

7

The components for the development of the master plan

Age of each hospital

  Productivity / efficiency of hospitals in the network

  % Depreciation / amortization hospital infrastructure

  The presence of the necessary equipment

  Streams of community / access roads to the hospital

  Plans for the future development of the region corresponding to the

regional development programs, as well as the region's economic growth

  Compliance with international standards of hospital design

  Standard infection control (especially for tuberculosis hospitals)

8

Number of hospitals per 100 000 population A comparison with international indicators and the estimated number of

Database health for all, 2012г. Sanigest calculations for master plans , 2012г.

9

The number of hospitals in the regions of KazakhstanPer 100,000 population in 2011

In the Republic of Kazakhstan as a whole and in some areas there is a

large number of hospitalsin international comparison

10

Comparison of the hospital sector on an international scale

According to the World Health Organization in 1990, the number of hospital beds in

Kazakhstan was one of the highest in Europe.

Indicators of hospital organizations in the EU and OECD countries account for 2.67 - 2.98

(RK - 4.2) and the beds within the 545 - 490 per 100 000 population (RC - 533), respectively.

The index of bunks in Kazakhstan exceeds 1.4 times the figure in Australia, 1.1 times - in the

Netherlands, and 1.1 times - in Canada.

The mean duration of hospital stay in Kazakhstan - 9.5 days, which is more than 3.8 times of

the figure in Australia and 1.8 times - in the Netherlands and Canada.

Security in the Republic of Kazakhstan:

hospital organizations decreased from 4.7 per 100 thousand. population in 2011 to 4.2 in

2014;

beds from 61.4 in 2011 to 53.3 per 10 thousand. us. in 201412

The proposed levels of hospitals, taking into account the needs of the population and access time

Rehabilitation centers from 150 000 to 1 million. Us., Department - 20 beds per 100 000 of us., Hospices - 27 beds per

100 000 population.

300,000 -1,000,000. Population, including multidisciplinary, oncological,

and others.

50 000 - 300 000 population. Basic + specialty specialized beds (cardiology, neurology, endocrinology and others.)

> 1 million. People.

20 000 - 50 000 population.4 basic specialties: internal medicine,

surgery, obstetrics and pediatrics. As an exception, with a population of less than 20 000 or, in the absence within a radius

of 60-120 minutes district hospital created Rural Hospital

Level 3 regional hospitals

Level 4: a highly - holdings, and national research centers

Level 2: inter-district (regional, multi-disciplinary) Hospital

Level 1: district hospitals

rehabilitation and palliative care

13

The master plan for the restructuring of the hospital sector for 10 years

investment project for 10 years

Options for restructuring the hospital sector

The development of rehabilitation services and

hospices

Modernization of medical

organizations

Overhaul and bring to international

standards of medical organizations

Strengthening the material-technical

base

republican budget

local budget

Public Private Partnership

Replacing old construction of

new health organization

Using vacate the building for the needs of the health

system

Merge several medical

organizations

Closing low-power medical

organization

14

Current (left) and recommended (right) Network hospital level(For example, Kyzylorda oblast)

15

The existing and proposed schemes Almaty hospital network

16

Changes to the state standard of the network of health care organizations of the Republic of Kazakhstan

(taking into account the recommendations of the master plan for optimizing the hospital sector and the development of primary health care)

Resolution of the Government of the Republic of Kazakhstan dated December 15, 2009 № 2131 "On approval of the state standard of the network of health care

organizations of the Republic of Kazakhstan"

Future plans for the development of a network of health care organizations of 16 regions for 2015-2025 (developed with the advice of the master plan and

approved by the regional akimats)

» Resolution of the Government of the Republic of Kazakhstan dated February 19, 2014 № 114 "On approval of the state standard of the network of health

care organizations of the Republic of Kazakhstan"

17

Recommended steps a master plan for optimizing the hospital sector and the development of primary health care

Normative legal support ongoing activities

Combining several medical organizations in the unified management

and development of autonomous control of health care

organizations

Ensuring the development of modern traffic and communication

system

18

Events prospective development plan of the network of health care organizations in the years 2015- 2025

Regions

Number of

hospital organizations on 01.01.15

Total for the

region

в том числе:

Number of

hospital

organizations

in 2025

availability of hospita

l organizations

per 100

thousand

population

maintain the status

an associati

on мgeneral hospitals

district hospital

s

Rehabilitation center

hospice

Hospital

nursing care

close / transfer in

primary care

Akmola 35 35 12 1 5 10 1 2 1 3 31  Aktobe 32 32 9 5 4 10 0 2 0 2 25  Аlmaty 81 81 26 15 12 11 4 5 0 8 58  Аtyrau 30 30 11 5 3 3 0 2 0 6 19  East Kazakhstan 76 76 32 12 5 16 1 1 0 9 55  Zhambul 40 40 18 5 6 7 0 0 2 2 33  Western Kazakhstan 35 35 10 7 3 11 0 1 0 3 25  Каraganda 57 57 25 17 5 9 0 0 0 1 39  Коstanay 44 44 16 3 5 14 0 1 0 5 36  Кyzylorda 50 50 25 16 4 4 0 0 1 0 34  Маngistau 23 23 14 3 0 5 0 0 0 1 19  Pаvlodar 30 30 12 5 3 9 0 0 0 1 24  North Kazakhstan 27 27 10 4 2 9 2 0 0 0 23  South Kazakhstan 103 103 26 30 7 15 4 2 1 18 55  Аstana 23 23 22 1 0 0 0 0 0 0 22  Аlmaty 43 43 28 9 3 0 2 1 0 0 34  Total Kazakhstan 729 729 296 138 67 133 14 17 5 59 532  2,5

19

The number of hospitals in the Republic of Kazakhstan by regionsfor 2012, 2015 and 2020

The Republic of Kazakhstan 2012 2015 2020

Number of hospitals 757 729 604

Provision be hospitals 4,5 4,2 3,3

- 2012

- 2015

- 2020

Western Kazakhstan

Atyrau

Mangistau

Aktobe

North KAzakstan

ЮКО

East Kazakhstan

Kyzylorda

Karaganda

Zhambyl

Almaty region

Kostanay Akmola

Pavlodar

Almaty city

Astana city23

23

24

25

24

23

28 27

26

31

32

28

31 3

026

36 35

33

37

47

33

38

35

34

42

43354

242

38

43

30 28

4544 3

2

6657 5

0

79

76 5

3

83

81 6

7

108

103

74 20

ЗКО

Атырауская

Мангистауская

Актюбинская

СКО

ЮКО

ВКО

Кызылординская

Карагандинская

Жамбылская

Алматинская

Костанайская

Акмолинская Павлодарска

я

гАлматы

гАстана

566

3497

4 413

5

387

5 369

04

52 3

894

5

87

05

10

07

8

322

82

969

294

5

95

88 8

73

3 690

2

599

1

539

85

702

430

0

392

935

00

88

02

775

57

003

585

049

27

43

40

528

35

040 4

110

272

5

260

0317

0

55

85

494

93

825

438

9

39

53 32

90

86

42

827

98

519

537

1

53

79

60

76

12

22

4

114

79

13

71

5

КоличествокоеквРКвразрезерегионов 2012, 2015 2020 на и годы

РК 2012 2015 2020

количество коек 100461 92759 91833

обеспеченность койками 59,4 53,3 49,6

- 2012

- 2015

- 2020

21

Thank you for attention!