Global Health Strategies in the Face of the COVID-19 Pandemic and Other Unprecedented Threats.

Global health is evolving as a discipline aiming at exploring needs and offering equitable health services for all people. Over the past four decades, several global initiatives have been introduced to improve the accessibility of primary health care (PHC) and solve most health issues at this level. Historically, the 1978 Alma-Ata and 2018 Astana Declarations were perhaps the most important documents for a comprehensive approach to PHC services across the world. With the introduction of the United Nations Sustainable Development Goals in 2015, developments in all spheres of human life and multi-sectoral cooperation became the essential action targets that could contribute to improved health, well-being, and safety of all people. Other global initiatives such as the Riyadh Declaration on Digital Health and São Paulo Declaration on Planetary Health called to urgent action to employ advanced digital technologies, improve health data processing, and invest more in research management. All these initiatives are put to the test in the face of the coronavirus disease 2019 (COVID-19) pandemic and other unprecedented threats to humanity.

A PROCESS OF PRIORITIZING TOPICS FOR HEALTH TECHNOLOGY ASSESSMENT IN KAZAKHSTAN.

OBJECTIVES: The aim of this study was to develop criteria for the prioritization of topics for health technology assessment (HTA) in the healthcare system of Kazakhstan. METHODS: Initial proposals for criteria were suggested through consultation with Ministry of Health (MoH) policy areas. These were refined through a workshop attended by HTA department staff, persons from medical universities and research institutes, and MoH policy makers. The workshop included discussion on methods used in international HTA practice. Opinions of participants on selection of criteria from those specified in a review of prioritization processes were used to define a list for inclusion in an instrument for routine use. A scoring system was established in later discussion. RESULTS: Selected criteria for HTA prioritization were burden of disease, availability of alternative technology, clinical effectiveness, economic efficiency, budget impact, and ethical, legal, and/or psychosocial aspects. For each criterion, a health technology under consideration is given a score from 3 (High) to 1 (Low). The total score determines whether the technology is of high to medium priority or of low priority. Determination of priorities for assessment, using the instrument, should be carried out by an expert group appointed by the MoH. The process was applied in 2014 to a selection of topics, and three health technologies were chosen for full assessments. CONCLUSIONS: Criteria for prioritization have evolved with development of the HTA program in Kazakhstan. A method for HTA prioritization has been developed that is easy to apply, requires comparatively few resources, and is compatible with processes required by the MoH.

IMPLEMENTATION OF HEALTH TECHNOLOGY ASSESSMENT WORK IN A HOSPITAL IN KAZAKHSTAN.

OBJECTIVES: The aim of this study was to implement health technology assessment (HA) in the First General City Hospital in Astana, Kazakhstan. METHODS: We organized trainings to familiarize hospital staff with the purpose and details of HTA. An HTA committee was established, with representation from hospital physicians and managers, and criteria for prioritization of health technologies determined. Clinical departments of the hospital were asked to prepare applications for new technologies for their services. RESULTS: The HTA committee reviewed five applications and selected a technology from one of these, on single incision laparoscopic surgery (SILS), for assessment. A short HTA report on SILS was prepared, covering its safety, clinical effectiveness, and cost effectiveness. The report was used to support a request to the Department of Health for additional funding to implement this technology within the hospital. This funding was approved and SILS was established in several hospital departments. CONCLUSIONS: This successful initial experience with HTA has paved the way for its routine use by the hospital for informing decisions on the procurement and use of new health technologies.

Trends in ageing of the population and the life expectancy after retirement: A comparative country-based analysis.

BACKGROUND: During the 20(th) century, the share of elderly in the total population of the Earth has increased steadily. It is expected that this trend will continue in the 21(st) century. In 1950, the elderly (persons aged 60 years and older) were 8% of the world population; in 2000, is already 10%; and in 2050, according to United Nations projections, the proportion will reach 21%. This research on Kazakhstan provides demographic analysis from 1989 to 2012 and presents the main features of population' ageing through comparative analysis. MATERIALS AND METHODS: We used information-analytical, content-analysis, mathematical treatment and comparative analysis of statistical data on demographic status in Kazakhstan and some other countries of the world (UK, USA, Turkey, Russia) over the 1989-2012. RESULTS: Age dependency ratio of the Russian federation - >1.7 times, in the USA-up to 1.9 times and the UK has dependency ratio higher than 2.5 times of similar indicators in Kazakhstan in 2010. CONCLUSION: Life expectancy of the elderly population KZ after 65 years in 2010 was only 13.8 years, which is 6-9 years inferior to European and U.S. indices. Thus, increasing the retirement age is inappropriate for the current period.

Assessment of technical equipment supply in healthcare institutions: example of Almaty.

BACKGROUND: The share of healthcare-related expenditure in the Gross Domestic Product of Kazakhstan is relatively small, and it is strategically important to restructure budgetary expenses in favor of healthcare with simultaneous redistribution of resources in accordance with changing demands and prioritization of high-quality medical care. The aim of this study was to analyze resource provision to healthcare organizations in Kazakhstan and its structure and level assessment. MATERIALS AND METHODS: The study is based on a comparative assessment of technical and technological equipment of medical institutions in Almaty, Kazakhstan. We analyzed the scope and structure of the financial component of the resource base in Almaty. We carried out information processing and analysis methods, content analysis, mathematical treatment, as well as conducted case studies. Also, we held opinion poll among medical staff (specialists, managerial staff) (n = 300) P for trend < 0.001 and patients (n = 210) P for trend < 0.001. RESULTS: About 18.8% of patients do not receive medical care because of defects of the equipment, whereas 19.9% of patients claim that the reason of refusal of the provision of medical services is an equipment overload. CONCLUSION: Most of the respondents referred to on poor technical equipment, mismatch with the world standards of performance and competitiveness. Lack of advanced medical technology, inadequate financing, insufficient supply of domestic medical equipment, and inadequate procurement by tender were also noted. The obtained data point to the need for optimization and upgrading medical equipment at various levels of healthcare.

Inequalities in self-rated health among 45+ year-olds in Almaty, Kazakhstan: a cross-sectional study.

BACKGROUND: Self-rated health (SRH) has been widely studied to assess health inequalities in both developed and developing countries. However, no studies have been performed in Central Asia. The aim of the study was to assess gender-, ethnic-, and social inequalities in SRH in Almaty, Kazakhstan. METHODS: Altogether, 1500 randomly selected adults aged 45 years or older were invited to participate in a cross-sectional study and 1199 agreed (response rate 80%). SRH was classified as poor, satisfactory, good and excellent. Multinomial logistic regression was applied to study associations between SRH and socio-demographic characteristics. Crude and adjusted odds ratios (OR) for poor vs. good and for satisfactory vs. good health were calculated with 95% confidence intervals (CI). RESULTS: Altogether, poor, satisfactory, good and excellent health was reported by 11.8%, 53.7%, 31.0% and 3.2% of the responders, respectively. Clear gradients in SRH were observed by age, education and self-reported material deprivation in both crude and adjusted analyses. Women were more likely to report poor (OR=1.9, 95% CI: 1.2-3.1) or satisfactory (OR=1.6, 95% CI: 1.2-2.1) than good health. Ethnic Russians and unmarried participants had greater odds for poor vs. good health (OR=2.3, 95% CI: 1.5-3.7 and OR=4.0, 95% CI: 2.7-6.1, respectively) and for satisfactory vs. good health (OR=1.4, 95% CI: 1.1-1.9 and OR=1.9, 95% CI: 1.4-2.5, respectively) in crude analysis, but the estimates were reduced to non-significant levels after adjustment. Unemployed and pensioners were less likely to report good health than white-collar workers while no difference in SRH was observed between white- and blue-collar workers. CONCLUSION: Considerable levels of inequalities in SRH by age, gender, education and particularly self-reported material deprivation, but not by ethnicity or marital status were found in Almaty, Kazakhstan. Further research is warranted to identify the factors behind the observed associations in Kazakhstan.

Inpatient care in Kazakhstan: A comparative analysis.

BACKGROUND: Reforms in inpatient care are critical for the enhancement of the efficiency of health systems. It still remains the main costly sector of the health system, accounting for more than 60% of all expenditures. Inappropriate and ineffective use of the hospital infrastructure is also a big issue. We aimed to analyze statistical data on health indices and dynamics of the hospital stock in Kazakhstan in comparison with those of developed countries. MATERIALS AND METHODS: Study design is comparative quantitative analysis of inpatient care indicators. We used information and analytical methods, content analysis, mathematical treatment, and comparative analysis of statistical data on health system and dynamics of hospital stock in Kazakhstan and some other countries of the world [Organization for Economic Cooperation and Development (OECD), USA, Canada, Russia, China, Japan, and Korea] over the period 2001-2011. RESULTS: Despite substantial and continuous reductions over the past 10 years, hospitalization rates in Kazakhstan still remain high compared to some developed countries, including those of the OECD. In fact, the hospital stay length for all patients in Kazakhstan in 2011 is around 9.9 days, hospitalization ratio per 100 people is 16.3, and hospital beds capacity is 100 per 10,000 inhabitants. CONCLUSION: The decreased level of beds may adversely affect both medical organization and health system operations. Alternatives to the existing inpatient care are now being explored. The introduction of the unified national healthcare system allows shifting the primary focus on primary care organizations, which can decrease the demand on inpatient care as a result of improving the health status of people at the primary care level.