Report prepared by Dr. Kairat Davletov with the assistance and advice from:
B. Amirov, Head of Prevention Department, Republican Institute of cardiology and internal diseases (who drafted chapters 3-5)
Prof. Z. Battakova, Director of Healthy Lifestyle Center, Prof. Sh. Tazhibayev, Vice President of the Kazakh Academy of Nutrition (who provided reports on prevention activities)
National CVD Prevention Coordinator for Kazakhstan:
MD, PhD, MPH
Republican Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
Health care | Risk factors | Prevention methods | Prevention activities | Cardiac Rehab. | Future
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Kazakhstan is a secular, democratic country with a centralised, inherited from the former Soviet Union, pattern of governance in health care, with distorted funding in favour of hospital care. Since recently, the government declared and initiated the shift of focus to primary care in the frame of ongoing health care reform (2011-2015), though the inertia and lobbying of in-patient care is still strong. In addition, the government has declared recently the move to mandatory health insurance system, in an attempt to optimise the health funding because with population of about 17 million and vast territory (over 2.7 million square km, at population density about six people per square km), the country faces the challenge of fair distribution of limited health resources and regional differences across the nation, though it is considered a middle-income country currently.
Kazakhstan has one of the highest cardiovascular mortality rates in the world. According to WHO, age-standardised CVD mortality rates in Kazakhstan were 650 per 100,000 inhabitants in 2008. CVD mortality among men is especially high, the age-standardised CVD mortality rates among men were 859 per 100,000 inhabitants; the age-standardised CVD mortality rates among women, 546 per 100,000 inhabitants, are also much higher than in the developed countries. Kazakhstan has pronounced regional and ethnic differences in all cause and CVD mortality that have never been properly analysed.
Though the available data does not allow to explore the role of all risk factors and that of medical prevention and treatment, it is suggested that the huge regional and sex differences, as well as trends over time, reflect among others (like smoking, obesity, etc.) the levels of “strong” alcohol consumption.
And the higher mortality among urban compared to rural males (that have a comparatively limited access to modern PCI resources) indicates that behaviour risk factors are more important than access to quality health care in Kazakhstan.
Prevention methods and main actors
Healthy lifestyle centre’s network is mainly responsible for the health promotion and prevention in Kazakhstan, including coordination of a national screening program. For the Ministry of Health the screening program is the main element of prevention, primary care centres implement it in practice. Outpatient services are represented with government-funded policlinics, government-funded family medical centres and private medical clinics (mainly in big cities).
It is expected that with the ongoing shift to family practitioners and generalists, the growing role of nursing and social work on primary care level and the redistribution of health resources, the country will strengthen prevention of cardiovascular and other non-communicable diseases.
Thus, the next few years will be critical in establishing effective and efficient preventive care in the country.
Prevention activities are delivered through the network of healthy lifestyle centres, polyclinics and family medicine centres. The ongoing national screening program covers the entire population of age 25 – 64 years for early detection of CVD and diabetes, among other dozen nosologies like screening for mammary gland cancer, colorectal cancer, glaucoma, hepatitis, etc.
Education in CVD prevention, management and treatment is provided through a net of medical universities and post-graduate institutes and chairs under the universities, nursing schools and training centres at research institutions like the Research Institute of Cardiology and Internal Diseases.
Despite the availability of regulating enactments, the provision and sustainability of cardiac rehabilitation activities is still far from ideal. Therefore, in an attempt to systematise the approaches and streamline the cardiac rehabilitation activities, the Institute of Cardiology and Internal Diseases has set up a Centre for Medical Rehabilitation and Balneology. The centre is in charge of formulating both the strategy and practical steps to implement evidence-based models of cardiac rehabilitation. We do hope this can be a start for extending cardiac rehabilitation programs around the country, thus meeting the still unfulfilled needs of patients.
Aims for the future
To establish leadership in the coordination of prevention activities
Systematic assessment of barriers to CVD prevention on the levels of patient, provider, health care system and organisational level
Foreign scientific assistance for applying modern prevention technology in Kazakhstan
Improvement of CVD epidemiology and statistical analysis methods, as well as piloting of various incentives for furtherance of prevention in health care, including the primary care level.
We need to study the experience of other countries which experienced the same transition.
Our main and immediate goal is to introduce a contemporary system of epidemiological surveillance of the main non-communicable diseases and we aim to start a broad research program, at present still subject to governmental approval.
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology