Population Health and Policy review for

Republic of KazakhstanMadina Takenova

Kazakhstan School of Public HealthKazakhstan

APACPH conferenceEarly career network workshopNovember 19-23, 2005 Taipei

Republic of Kazakhstan

Population – 15, 072 millionTerritory – 2724.9 thousand km2Capital –Astana

57% urban population, 43% rural

Life expectancy at birth, Kazakhstan, 1965-2004

616263646566676869707172

1964

-196

5

1969

-197

0

1974

-197

5

1979

-198

0

1984

-198

5

1989

-199

0

1993

-199

419

9519

9619

9719

9819

9920

0020

04

0

5

10

15

20

25

30

1965

1970

1980

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2004

Death rate

Live births

Demographic situation in Kazakhstan

(per 1000), 1965-2004

Leading causes of morbidity and mortality in Kazakhstan

• Overall morbidity – 99 627,7 per 100 000 in 2004• Morbidity incidence : I place- Diseases of

respiratory system, CV diseases; III – Urogenital diseases

• Mortality: Cardiovascular diseases, Neoplasms, Trauma & poisoning

Incidence of socially significant diseases in 2003-2004 (per 100 000 population)

154,3 194,2 196,6 404,1

3988,4

79,3 106,30

50010001500200025003000350040004500

TB

Mali

gnant

neop

lasm

s

Psych

iatric

diso

rder

s

Narcolog

ical d

isord

ers

Traum

a, po

isonin

g

Syphilis

Diabe

tus m

elitu

s

rate

per

100

000

po

pu

lati

on

2003

2004

Reproductive health • Infant mortality – 14,5 per 1000 newborns• MMR is highest among CA countries – 36.9 per

100,000 livebirths• High rate of pregnancy and delivery complications –

60%• Contraceptive prevalence rate on rise – 50.7 (MoH,

2002)• During 10 years the absolute amount of abortions in

RK decreased by 2.3 times• Unmet need for family planning – 8.7% (DHS, 1999)• Access and quality of reproductive health services

poor in rural areas

Main health and socio-economic indicators  1998 2004  

Total population (million) 15,5 15,01  

Human development Index (HDI) 0,742 0.76

Life expectancy at birth 65 66,14  

Population growth rate 4,4 7,9  

Birth rate per 1000 14.8 18,1  

Death rate per 1000 10,2 10,2  

Live births per 1000 population 14,8 15,3  

Infant mortality Rate per 1000 live births 21,4 14,5  

Total Fertility rate 2 2,2  

Maternal mortality (per 100000 live births) 59 36.9  

Under-5 mortality rate (BUCEN) per 1000 live births 35,2 69,6  

TB incidence per 100 000 (all forms) 118.8 154,3  

HIV prevalence 299 698  

 

GDP per capita, $US 1497,2 1995,4  

total allocations for health care, % of GDP 2 2,61  

correlation btw highest income h/hold and lowest income quintile

6 8 

Trends of Tuberculosis in Kazakhstan

449,5

154,3

20,6

0

50

100

150

200

250

300

350

400

450

500

1996 1997 1998 1999 2000 2001 2002 2003 2004

rate

per

100

000

po

pu

lati

on

0

5

10

15

20

25

30

35

40

dea

ths

per

100

000

p

op

ula

tio

n

TB prevalence TB incidence TB mortality

TB urgent issues

• Social factor – interrupted treatment, – MDR TB (1500 cases in 2003; 56.4% previously

treated resistant for 2 or >)

• TB in prisons, amnesty (incidence 30 times higher,

mortality 9 times higher among imprisoned population); 8726 detainees with TB in KZ, 452 with MDR TB

• TB and HIV/AIDS– 99 per 100000 cases of TB HIV+

• Young TB – 15-18 years of age (yearly 1300 teenagers get infected by TB, 60% in families); 1990- 57.1 – 2000-162.2 per 100000 population

• June 2005 - officially 5008 HIV+ (699 cases), including 272 with AIDS.

Men -76% (3823) Women - 24% (1185)• Estimated number of HIV+ people is 13, 000

(according to Sentinel Surveillance data)• Registered drug users – 45000; alleged IVDU -250 000 • AIDS death rate 31.3 (220) • Transmission way: 76.6% - parenteral; 14.6% - sexual•

Trends• HIV/AIDS epidemics is at concentrated stage - prevalence rate among risk groups (IVDUs and CSWs) is steadily above 5%.• There is a trend of sexual transmission rate increase : 2001- 5%, 2002 - 16,7%, 2003 - 21,0%, 2004 - 29,3%.

* Data of the Republican AIDS Center Kazakhstan

HIV/AIDS in Kazakhstan

HIV transmission patterns dynamic

1

161 205

389264

1032

501433

1236330

51228

5

515

295

10238

0-20

200

400

600

800

1000

1200

1990 -1995

1996 1997 1998 1999 2000 2001 2002 2003 2004

sexual transmission 1 parenteral (needles sharing practices) 1

Prognosis for HIV infection in case of untimely activities

14633

22947

34292

48346

56765

77599

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

Kazakhstan Central Asia

Nu

mb

er o

f H

IVca

ses

2002 2005 2010

Sanigest Internacional 2004

Emerging issues of population health

1. Increase of socially significant diseases 1. TB morbidity increased more than twice2. STD3. HIV/AIDS

2. Risk factors -smoking (for 1/3 of population); alcohol consumption, drug use

3. Unhealthy lifestyle, lack of health education and self motivation,

4. Reproductive health5. Environmental pollution; 6. Lack of financing of medical institutions

Causes of unfavorable health status of

population

• Weak preventive activities of PH policy

• Poor attitude & lake of skills toward own health

• Ineffective intersectoral collaboration on PH issues

• Social and economical troubles of transition period

National policy on population health & development

• Developmental strategy “Kazakhstan-2030”• “National Program of Health Sector Reform and

Development in the Republic of Kazakhstan for 2005-2010”

• Program & Law “On health care system of the Republic of Kazakhstan”

• State programme “Population health” -November 1998• National network on health protection and (1998)

• Developer: Ministry of Health • Timeframe: 2005-2010

– 2 steps of implementation : 2005-2007; 2008-2010

• Required resources and sources of funds: – Central and local budgets, as well as other resources

allowed by Law of the Republic of Kazakhstan; – In 2008-2010 there will be an annual increase in health

care financing and by 2010 it will increase to 4% of GDP

National Program of Health Sector Reform and Development in the Republic of Kazakhstan for 2005-2010

National Program of Health Sector Reform and Development in the Republic of Kazakhstan for 2005-2010

• Objective

• to create an effective health care delivery system based on the principles of solidarity of the state and individuals assuming responsibility for health protection, priority development of primary health care aimed at improving the health of population.

Priority tasks: • Real shift of focus to Primary health care; shift of

emphasis from inpatient to outpatient care; • Systemic transition to international standards, new

technologies, advanced treatment methods and medical service;

• Strengthening of maternal/ child health; • Creating a system of independent expertise involving

independent experts; • Training of health care system, health resource and

finance managers; • Prevention, diagnosis and treatment of socially

significant diseases; • Strengthening the technical/ material base of health

facilities;

National Program of Health Sector Reform and Development in the Republic of Kazakhstan for 2005-2010

Expected outcomes of Programme

• As a result of Program implementation, the optimal health care model satisfying needs of the people, the sector and the state will be created…