ABSTRACT
Background After cessation of initial quarantine in Kazakhstan, the COVID-19 outbreak peaked in July 2020, imposing dramatic stress on the country's healthcare system. This study was focused on calculation of updated epidemiological characteristics, on evaluation of available medical workforce and infrastructure and the impact of workforce density on infected and dead individuals via ArcGIS platform. Methods The national and local incidence rate (IR), mortality (M) and case-fatality rates (CFR) were calculated along with the population-weighted densities of beds, physicians, general practitioners, resuscitators, nurses and healthcare budget. Associations between the density of different health workers, infected and dead individuals were investigated using Poisson regression. Finally, we constructed vector maps of country regions clustered by IR and CFR to depict the density of beds and those health workers that were significantly associated with infection and death rates. Results There is much heterogeneity between the country regions in terms of CFR (range from 0.28 to 2.57) and IR (range from 1.62 to 12.04), while density of beds was characterized by a relatively greater stability (range from 3.47 to 6.66) and so did density of physicians (range from 0.79 to 2.76) and density of nurses (range from 5.73 to 8.26). Densities of beds, physicians, general practitioners, resuscitators, and nurses have been linked significantly with infection and death rates. Conclusions As COVID-19 epidemic is still far from ending, findings of this study could be of interest for policy makers to formulate an appropriate action plan in the view of possible repeated outbreaks. Key messages Available medical workforce and infrastructure were insufficient during the pandemic time in Kazakhstan. Densities of beds, physicians, general practitioners, resuscitators, and nurses are significantly associated with infection and death rates.
ABSTRACT
Introduction. According to the State Program for the Development of Healthcare of the Republic of Kazakhstan for 2020-2025, the provision of doctors in cities is 56.8 per 10 thousand of the population, and 16.1 per 10 thousand of the population in rural areas. Eighty-three percent of all doctors in the country work in urban areas and only 17% in rural areas. The problem of the provision of human resources remains relevant and not fully resolved. To this end, we have conducted a literature review of the available sources to better understand how this problem is being addressed in other countries of the world. The aim of the research is to study the experience of the development of rural medicine in the developed countries of the world. Search strategy. We studied publicly available articles over 30 years using the following databases of scientific publications and specialized search engines: PubMed, Google Scholar, Cochrane Library, Web of Science, Scopus. Information search was carried out by keywords: rural medicine, telemedicine, COVID-19. Inclusion criteria: Publication level of evidence A, B: meta-analyzes, systematic reviews, cohort and cross-sectional studies. Exclusion criteria: expert opinion in the form of short messages, promotional articles. Results. Analysis of international and domestic experience in the development of rural medicine notes a shortage of personnel, including family doctors in rural areas. Mentoring and organization of the educational process in the workplace play an important role in the professional development of a rural specialist. Proper organization of primary health care with elements of distance medicine reduces health care costs and improves public health indicators. Conclusion. In the era of digitalization, the development of family medicine in rural areas can receive an additional impetus due to the use of modern technologies, which should be provided to every medical institution in the countryside.