This document summarizes Kazakhstan's healthcare reforms since gaining independence in 1991. It discusses four key aspects of Kazakhstan's healthcare reforms: 1) increased funding for healthcare, 2) improvements to healthcare quality, 3) reforms to the human resources sector, and 4) increased partnerships. The reforms have helped modernize Kazakhstan's healthcare system, though continued reform is still needed as the country transitions from the Soviet system.
Senses : any of the physical processes by which stimuli are received, transduced, and conducted as impulses to be interpreted in the brain.
The special senses consist of the eyes, ears, nose, throat and skin.
Each of these organs have specialized functions that make if possible for us to experience our environment and to make that experience more pleasant
This document discusses various respiratory conditions including dyspnea, hypoxia, cyanosis, asphyxia, drowning, and periodic breathing. It defines each condition and describes their causes and characteristics. Dyspnea is difficulty breathing that can be caused by hypercapnia, increased work of breathing, or psychological factors. Hypoxia occurs when tissues do not receive enough oxygen and can be hypoxic, anemic, stagnant, or histotoxic in nature. Cyanosis results in a blue discoloration from reduced hemoglobin levels over 5g/100ml. Asphyxia involves both hypoxia and hypercapnia. Drowning is a form of asphyxia from liquid submersion or immersion that can
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
This document discusses cutaneous circulation and the regulation of blood flow to the skin. It begins by describing the blood vessels of the skin including arterioles, meta arterioles, capillaries, venules, and arteriovenous anastomoses. It then discusses characteristics of cutaneous blood flow such as its main function in temperature regulation, typical resting blood flow rates, effects of exposure to heat and cold, and regional variations. The document also covers neural control of cutaneous blood vessels including the roles of the sympathetic nervous system, parasympathetic nervous system, hypothalamic centers, baroreceptor reflex, and cortical control. Finally, it summarizes several cutaneous vascular responses like the triple response, axon
This document discusses blood coagulation and clot formation. It describes the three main steps in clot formation: 1) a cascade of chemical reactions forms prothrombin activator, 2) prothrombin activator catalyzes the conversion of prothrombin to thrombin, and 3) thrombin converts fibrinogen to fibrin to form a clot. It also discusses the intrinsic and extrinsic coagulation pathways, key coagulation factors, the roles of calcium, platelets and vitamin K, and disorders of coagulation like hemophilia.
Satyagraha is a philosophy of non-violent civil disobedience developed by Gandhi. It is based on the concepts of truth, non-violence, and self-suffering. The goal is to achieve truth through non-violent means even in the face of violence or oppression. Truth is a relative concept defined as resolutions that fulfill human needs for freedom and integrity. Non-violent actions are used to test differing views of truth, and may lead to suffering being imposed on practitioners by opponents, to which practitioners refuse to retaliate and instead invite more suffering upon themselves.
Senses : any of the physical processes by which stimuli are received, transduced, and conducted as impulses to be interpreted in the brain.
The special senses consist of the eyes, ears, nose, throat and skin.
Each of these organs have specialized functions that make if possible for us to experience our environment and to make that experience more pleasant
This document discusses various respiratory conditions including dyspnea, hypoxia, cyanosis, asphyxia, drowning, and periodic breathing. It defines each condition and describes their causes and characteristics. Dyspnea is difficulty breathing that can be caused by hypercapnia, increased work of breathing, or psychological factors. Hypoxia occurs when tissues do not receive enough oxygen and can be hypoxic, anemic, stagnant, or histotoxic in nature. Cyanosis results in a blue discoloration from reduced hemoglobin levels over 5g/100ml. Asphyxia involves both hypoxia and hypercapnia. Drowning is a form of asphyxia from liquid submersion or immersion that can
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
This document discusses cutaneous circulation and the regulation of blood flow to the skin. It begins by describing the blood vessels of the skin including arterioles, meta arterioles, capillaries, venules, and arteriovenous anastomoses. It then discusses characteristics of cutaneous blood flow such as its main function in temperature regulation, typical resting blood flow rates, effects of exposure to heat and cold, and regional variations. The document also covers neural control of cutaneous blood vessels including the roles of the sympathetic nervous system, parasympathetic nervous system, hypothalamic centers, baroreceptor reflex, and cortical control. Finally, it summarizes several cutaneous vascular responses like the triple response, axon
This document discusses blood coagulation and clot formation. It describes the three main steps in clot formation: 1) a cascade of chemical reactions forms prothrombin activator, 2) prothrombin activator catalyzes the conversion of prothrombin to thrombin, and 3) thrombin converts fibrinogen to fibrin to form a clot. It also discusses the intrinsic and extrinsic coagulation pathways, key coagulation factors, the roles of calcium, platelets and vitamin K, and disorders of coagulation like hemophilia.
Satyagraha is a philosophy of non-violent civil disobedience developed by Gandhi. It is based on the concepts of truth, non-violence, and self-suffering. The goal is to achieve truth through non-violent means even in the face of violence or oppression. Truth is a relative concept defined as resolutions that fulfill human needs for freedom and integrity. Non-violent actions are used to test differing views of truth, and may lead to suffering being imposed on practitioners by opponents, to which practitioners refuse to retaliate and instead invite more suffering upon themselves.
The circulatory system, also called the cardiovascular system, transports oxygen, nutrients, and important substances to cells throughout the body via blood and blood vessels. It includes the heart, blood, and blood vessels (veins and arteries). The heart pumps blood through two upper chambers called atria and two lower chambers called ventricles. Blood vessels include veins that return blood to the heart and arteries that carry blood away from the heart, connecting to capillaries. The circulatory system allows for the continuous circulation of blood through the body to provide cells with oxygen and remove carbon dioxide and waste.
The pulmonary circulation involves the movement of blood from the heart to the lungs and back to the heart. Deoxygenated blood enters the right atrium from the body and is pumped to the right ventricle and then into the pulmonary artery to the lungs. In the lungs, the blood releases carbon dioxide and picks up oxygen. It then returns via the pulmonary veins to the left atrium and is pumped by the left ventricle back out to the body. The purpose is to oxygenate the blood through gas exchange that only occurs in the lungs.
Anatomy of heart and physiology of cardiac cycle by simhahchalamLVSimhachalam
The document discusses the anatomy and physiology of the heart and cardiac cycle. It describes the heart as having four chambers that pump blood through two circulations - pulmonary and systemic. The cardiac cycle involves electrical and mechanical events in the atria and ventricles over one heartbeat, including atrial systole, ventricular systole and diastole. Key phases and timing are explained. Heart sounds are produced by valve openings and closings.
The document discusses the local control of blood flow by tissues. It states that each tissue controls its own blood flow proportionally to its metabolic need. There are both acute and long-term mechanisms of control. Acute control involves rapid vasodilation and vasoconstriction through substances like adenosine. Long-term control changes the size and number of blood vessels over months through angiogenesis. The document outlines theories of control like the vasodilator theory and oxygen lack theory. It also discusses special mechanisms in tissues like the kidney and brain.
The document provides an overview of the human cardiovascular system. It describes the structure and function of the heart, including the layers of the heart wall, valves, conduction system, and heart sounds. It discusses the role of arteries, veins, and capillaries in circulating blood throughout the body and exchanging gases and nutrients at the tissue level. It also covers cardiac cycle, heart rate regulation by the autonomic nervous system, effects of ions like potassium and calcium on heart function, and factors influencing blood pressure.
The document discusses microcirculation and the structure and function of capillaries. It defines microcirculation as blood flow through vessels smaller than 100μm, including arterioles, capillaries, and venules. Capillaries function to transport cells, oxygen, and other substances to and from tissues, and regulate body temperature. The capillary wall has a single layer of endothelial cells and pores of different sizes depending on the organ, through which substances diffuse. Interstitial fluid in the spaces between cells contains a gel-like substance that allows fluid to diffuse but not flow.
The document summarizes the human circulatory system. It describes how unoxygenated blood enters the right atrium of the heart from the body, passes to the right ventricle, and is then pumped via the pulmonary arteries to the lungs where it receives oxygen. The oxygenated blood returns to the left atrium via the pulmonary veins and is then pumped by the left ventricle through the aorta to the body tissues, where oxygen is delivered and carbon dioxide picked up, before returning again to the right atrium to restart the cycle. The blood also transports nutrients, wastes, hormones and antibodies around the body simultaneously.
Homeostasis I Negative and Positive Feedback Mechanism I Feedforward Mechanis...HM Learnings
Homeostasis I Negative and Positive Feedback Mechanism I Feedforward Mechanism I General Physiology I
The slide will be about :
1. Definition of homeostasis
2. What is internal environment ?
3. Why ECF is considered as an internal environment for cell ?
4. Homeostatic mechanism
5. Components of homeostatic mechanism
6. Feedback mechanism
7. Negative feedback mechanism
8. Positive feedback mechanism
9. Feedforward mechanism
You can also watch the same topic on HM Learnings Youtube channel.
You can also follow HM Learnings on facebook, instagram and twitter for daily updates
The document summarizes the structure and function of blood vessels. It describes the three layers (tunics) that make up arteries and veins, as well as the single-layered endothelium of capillaries. It then compares different types of blood vessels, including elastic and muscular arteries, arterioles, venules and veins. It discusses the roles of each in conducting blood away from the heart in arteries and returning it to the heart in veins. It also describes the structure of capillaries and their role in exchanging materials with tissues.
This document provides an overview of thyroid hormone physiology. It discusses the anatomy and iodine uptake of the thyroid gland. The biosynthesis and secretion of thyroid hormones T4 and T3 is described, including their transport through the bloodstream. The document outlines the activation and degradation of thyroid hormones in target tissues via deiodinase enzymes. It discusses the physiological effects of thyroid hormones in increasing metabolism and temperature. The control and regulation of thyroid hormones by the hypothalamic-pituitary-thyroid axis is summarized. Finally, the document briefly discusses thyroid disease states like hyperthyroidism and hypothyroidism, as well as thyroid function tests and antithyroid medications.
Platelets are minute discs that form in the bone marrow and help with hemostasis. They adhere to damaged blood vessel walls and form platelet plugs to stop bleeding. When a vessel is damaged, platelets activate and aggregate to form the initial plug. They also release substances that cause vasoconstriction and recruit additional platelets. Over time, the platelet plug is stabilized by fibrin threads to form a blood clot. Low platelet counts (thrombocytopenia) can cause excessive bleeding due to an inability to form proper plugs. Conditions involving blood clots in vessels (thromboembolism) are treated using clot-dissolving drugs like tPA.
The cardiovascular system consists of the heart, blood vessels, and blood. The heart pumps blood through the blood vessels, supplying oxygen and nutrients to tissues and removing waste. It has four chambers and is located in the chest behind the sternum. The main components of the circulatory system are the blood, which contains red blood cells, white blood cells, and platelets suspended in plasma; the heart, which pumps blood through the vessels; and a closed system of arteries, veins, and capillaries that carry blood throughout the body.
Homeostasis refers to the maintenance of relatively constant internal conditions in the body despite changes in the external environment. There are three main types of regulation that work together to achieve homeostasis: chemical/hormonal regulation, nervous regulation, and autoregulation of tissues and organs. Homeostatic mechanisms use either negative or positive feedback loops. Negative feedback loops work to reduce any imbalance, while positive feedback loops intensify an initial stimulus over a short period of time, such as during childbirth.
The document summarizes the anatomy and physiology of the cardiovascular system. It describes the location and structure of the heart, including its layers, chambers, and valves. It then discusses the cardiac conduction system, including the sinoatrial node which acts as the pacemaker, and how electrical signals cause coordinated heart contractions and relaxation. It concludes by defining cardiac output and some of the key factors that can influence it, such as heart rate, stroke volume, sympathetic tone, preload and afterload.
This presentation discusses acute myocardial infarction (AMI), also known as a heart attack. AMI occurs when an area of the heart muscle dies due to obstructed blood flow. The presentation covers the objectives, definition, classifications, risk factors, signs and symptoms, investigations, and treatment options for AMI. Key points include that AMI can be caused by a blockage in the coronary arteries, often due to a blood clot, and affects different areas of the heart. Risk factors include age, smoking, diabetes, hypertension, and high cholesterol. Diagnosis involves electrocardiograms, blood tests of cardiac markers, and imaging tests. Treatment involves medications like aspirin and beta blockers, thrombolysis if ST is elevated, and sometimes ang
The document discusses cardiac output, venous return, and their regulation. It can be summarized as follows:
1. Cardiac output is determined by the heart rate and stroke volume, and is equal to the total amount of blood pumped by the heart each minute. Venous return is the total blood flow returning to the right atrium from the veins each minute.
2. Cardiac output is regulated by factors that influence venous return such as blood volume, heart rate, contractility, and metabolic rate. The Frank-Starling mechanism states that the heart pumps all the blood that returns to it via the veins.
3. Pathologically, high cardiac output can result from reduced peripheral resistance from conditions like anemia
Basic Pathology : Introduction To Cells & Tissue DamageSado Anatomist
This document provides an overview of pathology, cell and tissue damage. It defines pathology as the study of diseases and discusses basic terminology like etiology, pathogenesis, diagnosis and clinical manifestation. It also describes different types of cellular adaptation like atrophy, hypertrophy and hyperplasia in response to injury. The document outlines the stages and types of necrosis, or cell death, as well as various causes of cell injury such as oxygen deprivation, chemicals, infections, immune reactions and physical trauma.
Microcirculation refers to the small blood vessels that distribute blood to organs and tissues and allow for gas and nutrient exchange, and disorders in microcirculation can be caused by various factors and lead to a variety of health issues. The document outlines how to test microcirculation by examining the nail beds, provides details on analyzing microcirculation parameters, and describes how to provide tailored advice and recommendations based on test results and a person's health history and symptoms.
The document discusses various dimensions of health including physical, mental, social, spiritual, emotional and vocational. It defines positive health as the highest standard of health and enjoyment of a state of health. Determinants of health include genetic, environmental, lifestyle, socio-economic factors. Environmental factors that influence health are discussed such as air, water, soil, radiation, noise, pollution and their effects. Concepts around prevention of diseases and environmental physiology are also summarized.
The document discusses a training session on the relationship between mental health and exercise, activity, and sport. It covers topics like defining different types of physical activity, the benefits of exercise for both mental and physical health, common barriers to exercise, and developing an action plan. The session aims to help participants recognize how physical activity can be used as a coping strategy for mental health issues and provide tips for establishing a regular routine.
This document discusses sport and exercise psychology. It covers the history and development of the field, key topics studied such as motor performance and psychological development through physical activity. It outlines the roles of sport psychologists and therapists in areas like peak performance, injury rehabilitation, and health promotion. It also discusses how sport and physical activity can benefit mental health and reduce risks of diseases.
The circulatory system, also called the cardiovascular system, transports oxygen, nutrients, and important substances to cells throughout the body via blood and blood vessels. It includes the heart, blood, and blood vessels (veins and arteries). The heart pumps blood through two upper chambers called atria and two lower chambers called ventricles. Blood vessels include veins that return blood to the heart and arteries that carry blood away from the heart, connecting to capillaries. The circulatory system allows for the continuous circulation of blood through the body to provide cells with oxygen and remove carbon dioxide and waste.
The pulmonary circulation involves the movement of blood from the heart to the lungs and back to the heart. Deoxygenated blood enters the right atrium from the body and is pumped to the right ventricle and then into the pulmonary artery to the lungs. In the lungs, the blood releases carbon dioxide and picks up oxygen. It then returns via the pulmonary veins to the left atrium and is pumped by the left ventricle back out to the body. The purpose is to oxygenate the blood through gas exchange that only occurs in the lungs.
Anatomy of heart and physiology of cardiac cycle by simhahchalamLVSimhachalam
The document discusses the anatomy and physiology of the heart and cardiac cycle. It describes the heart as having four chambers that pump blood through two circulations - pulmonary and systemic. The cardiac cycle involves electrical and mechanical events in the atria and ventricles over one heartbeat, including atrial systole, ventricular systole and diastole. Key phases and timing are explained. Heart sounds are produced by valve openings and closings.
The document discusses the local control of blood flow by tissues. It states that each tissue controls its own blood flow proportionally to its metabolic need. There are both acute and long-term mechanisms of control. Acute control involves rapid vasodilation and vasoconstriction through substances like adenosine. Long-term control changes the size and number of blood vessels over months through angiogenesis. The document outlines theories of control like the vasodilator theory and oxygen lack theory. It also discusses special mechanisms in tissues like the kidney and brain.
The document provides an overview of the human cardiovascular system. It describes the structure and function of the heart, including the layers of the heart wall, valves, conduction system, and heart sounds. It discusses the role of arteries, veins, and capillaries in circulating blood throughout the body and exchanging gases and nutrients at the tissue level. It also covers cardiac cycle, heart rate regulation by the autonomic nervous system, effects of ions like potassium and calcium on heart function, and factors influencing blood pressure.
The document discusses microcirculation and the structure and function of capillaries. It defines microcirculation as blood flow through vessels smaller than 100μm, including arterioles, capillaries, and venules. Capillaries function to transport cells, oxygen, and other substances to and from tissues, and regulate body temperature. The capillary wall has a single layer of endothelial cells and pores of different sizes depending on the organ, through which substances diffuse. Interstitial fluid in the spaces between cells contains a gel-like substance that allows fluid to diffuse but not flow.
The document summarizes the human circulatory system. It describes how unoxygenated blood enters the right atrium of the heart from the body, passes to the right ventricle, and is then pumped via the pulmonary arteries to the lungs where it receives oxygen. The oxygenated blood returns to the left atrium via the pulmonary veins and is then pumped by the left ventricle through the aorta to the body tissues, where oxygen is delivered and carbon dioxide picked up, before returning again to the right atrium to restart the cycle. The blood also transports nutrients, wastes, hormones and antibodies around the body simultaneously.
Homeostasis I Negative and Positive Feedback Mechanism I Feedforward Mechanis...HM Learnings
Homeostasis I Negative and Positive Feedback Mechanism I Feedforward Mechanism I General Physiology I
The slide will be about :
1. Definition of homeostasis
2. What is internal environment ?
3. Why ECF is considered as an internal environment for cell ?
4. Homeostatic mechanism
5. Components of homeostatic mechanism
6. Feedback mechanism
7. Negative feedback mechanism
8. Positive feedback mechanism
9. Feedforward mechanism
You can also watch the same topic on HM Learnings Youtube channel.
You can also follow HM Learnings on facebook, instagram and twitter for daily updates
The document summarizes the structure and function of blood vessels. It describes the three layers (tunics) that make up arteries and veins, as well as the single-layered endothelium of capillaries. It then compares different types of blood vessels, including elastic and muscular arteries, arterioles, venules and veins. It discusses the roles of each in conducting blood away from the heart in arteries and returning it to the heart in veins. It also describes the structure of capillaries and their role in exchanging materials with tissues.
This document provides an overview of thyroid hormone physiology. It discusses the anatomy and iodine uptake of the thyroid gland. The biosynthesis and secretion of thyroid hormones T4 and T3 is described, including their transport through the bloodstream. The document outlines the activation and degradation of thyroid hormones in target tissues via deiodinase enzymes. It discusses the physiological effects of thyroid hormones in increasing metabolism and temperature. The control and regulation of thyroid hormones by the hypothalamic-pituitary-thyroid axis is summarized. Finally, the document briefly discusses thyroid disease states like hyperthyroidism and hypothyroidism, as well as thyroid function tests and antithyroid medications.
Platelets are minute discs that form in the bone marrow and help with hemostasis. They adhere to damaged blood vessel walls and form platelet plugs to stop bleeding. When a vessel is damaged, platelets activate and aggregate to form the initial plug. They also release substances that cause vasoconstriction and recruit additional platelets. Over time, the platelet plug is stabilized by fibrin threads to form a blood clot. Low platelet counts (thrombocytopenia) can cause excessive bleeding due to an inability to form proper plugs. Conditions involving blood clots in vessels (thromboembolism) are treated using clot-dissolving drugs like tPA.
The cardiovascular system consists of the heart, blood vessels, and blood. The heart pumps blood through the blood vessels, supplying oxygen and nutrients to tissues and removing waste. It has four chambers and is located in the chest behind the sternum. The main components of the circulatory system are the blood, which contains red blood cells, white blood cells, and platelets suspended in plasma; the heart, which pumps blood through the vessels; and a closed system of arteries, veins, and capillaries that carry blood throughout the body.
Homeostasis refers to the maintenance of relatively constant internal conditions in the body despite changes in the external environment. There are three main types of regulation that work together to achieve homeostasis: chemical/hormonal regulation, nervous regulation, and autoregulation of tissues and organs. Homeostatic mechanisms use either negative or positive feedback loops. Negative feedback loops work to reduce any imbalance, while positive feedback loops intensify an initial stimulus over a short period of time, such as during childbirth.
The document summarizes the anatomy and physiology of the cardiovascular system. It describes the location and structure of the heart, including its layers, chambers, and valves. It then discusses the cardiac conduction system, including the sinoatrial node which acts as the pacemaker, and how electrical signals cause coordinated heart contractions and relaxation. It concludes by defining cardiac output and some of the key factors that can influence it, such as heart rate, stroke volume, sympathetic tone, preload and afterload.
This presentation discusses acute myocardial infarction (AMI), also known as a heart attack. AMI occurs when an area of the heart muscle dies due to obstructed blood flow. The presentation covers the objectives, definition, classifications, risk factors, signs and symptoms, investigations, and treatment options for AMI. Key points include that AMI can be caused by a blockage in the coronary arteries, often due to a blood clot, and affects different areas of the heart. Risk factors include age, smoking, diabetes, hypertension, and high cholesterol. Diagnosis involves electrocardiograms, blood tests of cardiac markers, and imaging tests. Treatment involves medications like aspirin and beta blockers, thrombolysis if ST is elevated, and sometimes ang
The document discusses cardiac output, venous return, and their regulation. It can be summarized as follows:
1. Cardiac output is determined by the heart rate and stroke volume, and is equal to the total amount of blood pumped by the heart each minute. Venous return is the total blood flow returning to the right atrium from the veins each minute.
2. Cardiac output is regulated by factors that influence venous return such as blood volume, heart rate, contractility, and metabolic rate. The Frank-Starling mechanism states that the heart pumps all the blood that returns to it via the veins.
3. Pathologically, high cardiac output can result from reduced peripheral resistance from conditions like anemia
Basic Pathology : Introduction To Cells & Tissue DamageSado Anatomist
This document provides an overview of pathology, cell and tissue damage. It defines pathology as the study of diseases and discusses basic terminology like etiology, pathogenesis, diagnosis and clinical manifestation. It also describes different types of cellular adaptation like atrophy, hypertrophy and hyperplasia in response to injury. The document outlines the stages and types of necrosis, or cell death, as well as various causes of cell injury such as oxygen deprivation, chemicals, infections, immune reactions and physical trauma.
Microcirculation refers to the small blood vessels that distribute blood to organs and tissues and allow for gas and nutrient exchange, and disorders in microcirculation can be caused by various factors and lead to a variety of health issues. The document outlines how to test microcirculation by examining the nail beds, provides details on analyzing microcirculation parameters, and describes how to provide tailored advice and recommendations based on test results and a person's health history and symptoms.
The document discusses various dimensions of health including physical, mental, social, spiritual, emotional and vocational. It defines positive health as the highest standard of health and enjoyment of a state of health. Determinants of health include genetic, environmental, lifestyle, socio-economic factors. Environmental factors that influence health are discussed such as air, water, soil, radiation, noise, pollution and their effects. Concepts around prevention of diseases and environmental physiology are also summarized.
The document discusses a training session on the relationship between mental health and exercise, activity, and sport. It covers topics like defining different types of physical activity, the benefits of exercise for both mental and physical health, common barriers to exercise, and developing an action plan. The session aims to help participants recognize how physical activity can be used as a coping strategy for mental health issues and provide tips for establishing a regular routine.
This document discusses sport and exercise psychology. It covers the history and development of the field, key topics studied such as motor performance and psychological development through physical activity. It outlines the roles of sport psychologists and therapists in areas like peak performance, injury rehabilitation, and health promotion. It also discusses how sport and physical activity can benefit mental health and reduce risks of diseases.
This presentation discusses steps for maintaining a healthy lifestyle. It recommends getting at least an hour of physical activity per day through activities like walking, doing chores, using stairs, and exercise. It also suggests choosing water as a primary drink, eating plenty of vegetables and fruits, and eating whole grains, fish, and other healthy foods while limiting unhealthy fats, sugar, and salt. Maintaining a healthy lifestyle can help reduce stress and promote overall well-being.
This health PowerPoint discusses healthy and unhealthy foods and activities. It notes that apples are healthy, containing nutrients, while lollipops are unhealthy as they only contain sugar. Running is presented as good exercise to stay energized, while watching TV is not healthy and physical activity is better. Water is labeled as a healthy drink choice, while pop is unhealthy and should be avoided. Links are provided for additional information on apples, exercise, and water.
The document discusses the eatwell plate and the importance of eating a balanced variety of foods from its five main food groups: fruit and vegetables; bread, rice, potatoes, pasta; milk and dairy foods; meat, fish, eggs, beans; and foods high in fat and/or sugar. It recommends eating at least 5 portions of fruit and vegetables daily, plenty of breads and starches, 2-3 dairy items, foods from the meat group, and only small amounts of high fat and sugar foods. A balanced diet with moderation is key to health.
2014 strengthening health systems by health sector reforms ghRoger Zapata
This document reviews the interactions between health sector reforms and health systems strengthening, with a focus on systems thinking. It presents a conceptual framework that identifies five points of interaction between reforms and health system functions: governance, finance, health workforce, health information, and supply management. These points contribute to the core function of health services delivery. The review finds that while reforms have improved some areas, like access to services, inequality still exists and quality must be monitored. Reforms to areas like governance, financing, and purchasing require strong institutional capacity. Overall, a systems approach is needed to optimize health systems and ensure populations benefit from reforms.
Determinants of Strategic Implementation of Devolved Health Services in Trans...paperpublications3
Abstract: Many organizations, including those in the public health sector, are experiencing and managing change which may be either planned or emergent. The performance of Trans Nzoia County has been reproached particularly in the wake of go-slows and strikes of the health labour force in recent times. The broad objective of the study was to assess the factors influencing the strategic implementation of devolved health services in Trans Nzoia County. The study was guided by the following specific objectives: To establish the effect of budgetary support on strategic implementation of health services, to examine the effect of health policy on strategic implementation of health services, to determine the effect of health legislation on strategic implementation of health services, and to determine how management support affects strategic implementation of health services. The study was guided by both Ansoffian theory and management theory. The study adopted a cross-sectional survey research design. The target population was the 1240 employees working with Trans Nzoia County. A sample of 89 respondents was drawn from the target population using stratified random sampling method. Primary data was collected using a structured questionnaire. The instrument was pilot tested before its use to collect data for the main study. The study assessed both validity and reliability of the instrument. The collected data was processed and analyzed with the aid of the Statistical Package for Social software. The data was analyzed using both descriptive and inferential statistics. The results indicated that budgetary support has a positive significant effect on strategic implementation of health services. Health policy had a significant positive effect on strategic implementation of health services. The study found a positive significant effect of health legislation on strategic implementation of health services in Trans Nzoia County. Management support had a positive and significant effect on strategic implementation of health services in Trans Nzoia County. It was therefore concluded that budgetary support, health policy, legislation on health care, and management support what are the factors that determine strategic implementation of devolved healthcare services.
Keywords: Budgetary support, health policy, legislative process, management support and strategic implementation.
Title: Determinants of Strategic Implementation of Devolved Health Services in Trans Nzoia County
Author: Buchunju, Phoebe, Dr. Iravo, Mike, Mr. Okwaro, Fredrick
ISSN 2349-7807
International Journal of Recent Research in Commerce Economics and Management (IJRRCEM)
Paper Publications
This document summarizes the current status of research on the digital transformation of healthcare through health information technology (HIT). It finds that while HIT has potential to improve quality and reduce costs, evidence of its actual impacts is mixed. Research has focused on HIT adoption issues and its effects on performance, but results are equivocal, finding both positive, negative, and no effects. The document identifies important areas for further research, including HIT design/implementation, quantifying HIT impacts, and extending the traditional realm of HIT.
Running Head LIMITED ACCESS TO HEALTHCARE1LIMITED ACCESS TO.docxwlynn1
Running Head: LIMITED ACCESS TO HEALTHCARE1
LIMITED ACCESS TO HEALTHCARE6
Limited Access to Healthcare
Arnaldo Perez-Frometa
Capella University
Developing a Health Care Perspective
Access to healthcare services is very essential for sustainable level of living and good health. Several scholars have described access as “the timely use of personal health services to achieve the best possible health outcomes”. One of the issues facing many countries across the world including those with systems for universal healthcare is providing appropriate and timely healthcare access for deprived patients. Currently there is limited information on how those patients living in a context of social and material deprivation perceive obstructions in the system of healthcare. In this paper we shall discuss several resources addressing the issue of access to services in the healthcare system.
According to Andersen, Davidson, & Baumeister (2014), in their article titled “improving the access to care”, access refers to the actual utility of individual services for heath as well as everything else that can facilitate or impede their use. In this article they present research and policy issues as well as basic trends which are related to evaluating and monitoring the access to healthcare services. They show how evaluating and monitoring offers the platform for the prediction of health services, promotion of social justice and the improvement of efficiency and effectiveness for the delivery of health services. They analyzed access and healthcare outcomes using a behavioral model which provides a systematic framework of individual and contextual framework
They expanded the behavioral model by emphasizing on two new aspects. They include the life quality as an input and healthcare outcome and genetics as a factor for predisposing. They also examined some examples of access indicators which include efficiency and effectiveness measures, utilization, potential access and healthcare needs. Changes that occurred in these indicators over time were tracked using trend data. Finally they did observations on access and the present status as well as new areas of improving access via ACA which has played a big role in improving access to health care.
Next we are going to analyze the article written by Acharya et al., (2017) titled “Partnerships in mental healthcare service delivery in low-resource settings: developing an innovative network in rural Nepal”. This article provides an understanding on the contribution of mental illness on the worldwide burden diseases which are non communicable. However, the authors note that there has been an extremely limited access to ethnically sensitive, appropriately contextual and high quality service for mental healthcare. Despite the availability for interventions to improve outcomes for the patients, this situation still persists. The authors suggest that there is need for the development of partnerships network for adaptation.
A realist synthesis to develop an explanatory model of how policy instruments...Araz Taeihagh
Abstract
Background
Child and maternal health, a key marker of overall health system performance, is a policy priority area by the World Health Organization and the United Nations, including the Sustainable Development Goals. Previous realist work has linked child and maternal health outcomes to globalization, political tradition, and the welfare state. It is important to explore the role of other key policy-related factors. This paper presents a realist synthesis, categorising policy instruments according to the established NATO model, to develop an explanatory model of how policy instruments impact child and maternal health outcomes.
Methods
A systematic literature search was conducted to identify studies assessing the relationships between policy instruments and child and maternal health outcomes. Data were analysed using a realist framework. The first stage of the realist analysis process was to generate micro-theoretical initial programme theories for use in the theory adjudication process. Proposed theories were then adjudicated iteratively to produce a set of final programme theories.
Findings
From a total of 43,415 unique records, 632 records proceeded to full-text screening and 138 papers were included in the review. Evidence from 132 studies was available to address this research question. Studies were published from 1995 to 2021; 76% assessed a single country, and 81% analysed data at the ecological level. Eighty-eight initial candidate programme theories were generated. Following theory adjudication, five final programme theories were supported. According to the NATO model, these were related to treasure, organisation, authority-treasure, and treasure-organisation instrument types.
Conclusions
This paper presents a realist synthesis to develop an explanatory model of how policy instruments impact child and maternal health outcomes from a large, systematically identified international body of evidence. Five final programme theories were supported, showing how policy instruments play an important yet context-dependent role in influencing child and maternal health outcomes.
Independent study -danika tynes--the road for the healthcare system in ugandaDanika Tynes, Ph.D.
This paper aims to analyze Uganda's institutional capacity and readiness to advance its healthcare system. It will do a historical review of institutional development and the current environment to identify strengths and weaknesses. It will compare Uganda's healthcare system to higher-ranked systems and other African countries that have seen improvements. This comparative analysis will summarize clues about Uganda's existing institutional capacity and what it needs to adopt robust healthcare services for its growing population. Understanding a country's institutions can help predict its development and reforms needed to improve health outcomes.
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Crossing the Quality Chasm: The IOM Health Care Quality Initiative
In 1996, after releasing America's Health in Transition: Protecting and Improving Quality, the IOM launched a concerted, ongoing effort focused on assessing and improving the nation's quality of care.
The first phase of this Quality Initiative documented the serious and pervasive nature of the nation's overall quality problem, concluding that "the burden of harm conveyed by the collective impact of all of our health care quality problems is staggering" (Chassen et al., 1998).
IOM Definition of Quality
The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
This phase built on an intensive review of the literature conducted by RAND to understand the scope of this issue (Schuster) and a framework was established that defined the nature of the problem as one of overuse, misuse and underuse of health care services (Chassen et al). More specifically, the report Ensuring Quality Cancer Care (1999) documented the wide gulf that exists between ideal cancer care and the reality many Americans with cancer experience.
During the second phase, spanning 1999-2001, the Committee on Quality of Health Care in America, laid out a vision for how the health care system and related policy environment must be radically transformed in order to close the chasm between what we know to be good quality care and what actually exists in practice. The reports released during this phase—To Err is Human: Building a Safer Health System(1999) and Crossing the Quality Chasm: A New Health System for the 21st Century(2001)—stress that reform around the margins is inadequate to address system ills.
The series of IOM quality reports have included a number of metrics that illustrate how wide the quality chasm is and how important it is to close this gulf, between what we know is good quality care and what the norm is in practice.
To Err is Human put the spotlight on how tens of thousands of Americans die each year from medical errors and effectively put the issue of patient safety and quality on the radar screen of public and private policymakers. The Quality Chasm report described broader quality issues and defines six aims—care should be safe, effective, patient-centered, timely, efficient and equitable—and 10 rules for care delivery redesign.
Phase three of the IOM's Quality Initiative focuses on operationalizing the vision of a future health system described in the Quality Chasm report. In addition to the IOM, many others are working to create a more patient responsive 21st century health system, including clinicians/ health care organizations, employers/consumers, foundations/research, government agencies, and quality organizations. This collection of efforts focus reform a.
This document summarizes research on the impacts of consolidating local health departments (LHDs). It finds that consolidation can yield cost savings through economies of scale and more efficient service provision. Studies of Ohio LHD consolidations found reduced post-consolidation expenditures and up to $1.5 million in annual savings in one case. Consolidation may also improve public health services by enabling LHDs to better perform essential functions. However, the transition process can be disruptive to LHD operations in the short-term. Overall benefits and costs are specific to each situation, requiring local assessments.
Healthcare management status of indian states aninterstate comparison of th...IAEME Publication
The document is a research paper that analyzes the status of public healthcare management across Indian states using a multi-criteria decision making (MCDM) approach. It ranks the states based on 30 indicators related to healthcare outcomes and resources. The paper uses the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) MCDM method, which identifies ideal and negative-ideal solutions to rank the states based on their distance from these solutions while accounting for the relative weight of each indicator. The paper concludes that states in South India rank higher in terms of public healthcare management compared to other parts of the country.
Healthcare management status of indian states aninterstate comparison of th...IAEME Publication
The document is a research paper that analyzes the status of public healthcare management across Indian states using a multi-criteria decision making (MCDM) approach. It ranks the states based on 30 indicators related to healthcare outcomes and resources. The paper uses the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) MCDM method, which identifies ideal and negative-ideal solutions to rank the states based on their distance from these solutions while accounting for the relative weight of each indicator. The paper concludes that states in South India rank higher in terms of public healthcare management compared to other parts of the country.
Healthcare management status of indian statesiaemedu
This document summarizes a research article that analyzes the status of public healthcare management across Indian states using a multi-criteria decision making (MCDM) approach. The researchers ranked the states based on multiple healthcare parameters using the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) method. A literature review found that most prior work focused on specific healthcare issues rather than comparing progress across states. The study aims to fill this gap by evaluating and ranking states on their public healthcare management performance. The conclusions indicate that states in South India performed better than other parts of the country in terms of public healthcare management.
Healthcare management status of indian statesiaemedu
The document is a research paper that analyzes the status of public healthcare management across Indian states using a multi-criteria decision making (MCDM) approach. It ranks the states based on 30 indicators related to healthcare outcomes and resources. The paper uses the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) MCDM method, which identifies ideal and negative-ideal solutions to rank the states based on their distance from these solutions while accounting for the relative weight of each indicator. The paper concludes that states in South India rank higher in terms of public healthcare management compared to other parts of the country.
An analytical study on investors’ awareness and perception towards the hedge ...iaemedu
The document is a research paper that analyzes the status of public healthcare management across Indian states using a multi-criteria decision making (MCDM) approach. It ranks the states based on 30 indicators related to healthcare outcomes and resources. The paper uses the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) MCDM method, which identifies ideal and negative-ideal solutions to rank the states based on their distance from these solutions while accounting for the relative weight of each indicator. The paper concludes that states in South India rank higher in terms of public healthcare management compared to other parts of the country.
Running head QUALITY IMPROVEMENT FOR PUBLIC HEALTH FACILITIES .docxtoltonkendal
Running head: QUALITY IMPROVEMENT FOR PUBLIC HEALTH FACILITIES 1
QUALITY IMPROVEMENT FOR PUBLIC HEALTH FACILITIES 6
Quality Improvement for Public Health Facilities
Qualitative Research Methods Evaluation
AIU ONLINE
HLTH 335 1701A - 01
UNIT 2 IP
The type of study in the four listed articles include the following. Article one by Chaudhry et al., (2006) was a qualitative study. The authors conducted a system review from expert opinion and literature review to determine the role that information technology had played in enhancing health care quality, efficiency and costs of medical care. The authors hypothesized that information technology had played a significant role in improving the quality of medical care by increasing adherence to medical guidelines, improving disease surveillance and decreasing medication errors. The type of study for the second article was also a qualitative study that examined 260 hospital on the issue of pay for performance strategy. The authors compared their results to other hospital that did not have the current nationwide pay for performance system, (Werner et al., 2010). The authors hypothesized that pay-for-performance system improved quality health care among hospitals in this system. The third article was also a qualitative study where the authors hypothesized that public reporting of hospital quality data and the pay for performance have emerged as the widely advocated tools for these that accelerate health facility’s improvement (Lindenauer et al., 2007). The fourth article was also a qualitative study article. The authors of the article hypothesized that the Keystone ICU project was associated with a significant decrease on the hospital mortality within Michigan as compared to the surrounding areas, (Lipitz-Snyderman, et al., 2011).
Article one utilized data from published expert opinion and literature search from academic data bases. There was no direct involvement of the human subject when collecting data for this article. Article two utilized data from 260 hospitals. The authors chose acute care hospitals that began operating in 2004. The author’s excluded four critical-access hospitals. Researchers of the third article used 2490 health services providers nation-wide who met the criteria for Hospital Quality Alliance (HQA). In the fourth article, the authors chose the patients who were treated in Michigan’s 95 study hospitals from 238, 937 total admissions. All the samples and the populations for these studies were appropriate.
During the study documentation Chaudhry et al., (2006) reported that hospital facilities documented and reported data on costs and contextual factors. Limitations of data in this article is that the systematic review utilized a mixed data of private and public initiatives into hospital systems. The public and private initiatives have different agendas. Werner et al., (2010), study results indicated that the two groups of hospitals were simil ...
The document analyzes health care access in Bangladesh using data from a survey of 664 households. It investigates the determinants of illness, choice of health care provider, and household out-of-pocket health expenditures. The summary is:
- The study uses survey data from 664 Bangladeshi households to analyze factors that influence illness, choice of health care provider, and household health care spending.
- Independent variables include individual characteristics, illness conditions, health facility attributes, household characteristics, environment, and economic status. Dependent variables include illness, choice of provider, and out-of-pocket expenditures.
- Preliminary univariate analysis of the survey data shows that 59% of respondents were young adults
This document provides summaries of several references related to managing change in healthcare IT implementations. The references discuss:
1) Theories of change management, such as Kotter's 8-step model and Bridges' 3 phases of transition, and how they can be applied in healthcare.
2) Why IT failures occur and how effective leadership and change management can help introduce new technologies.
3) Strategies for productively integrating IT systems while reducing user resistance, including technical, project management, and organizational skills.
4) Case studies of health information system development challenges in developing countries and the need for flexible, context-sensitive strategies.
5) A model for evaluating change projects based on how they
Relationship Between Fiscal Decentralization and Health Care Financing in Uas...Triple A Research Journal
ABSTRACT
This study examined the relationship between fiscal decentralization and health care financing in Uasin Gishu County Kenya, the researcher sought to answer the following research questions; To what extend does the adequacy of decentralized funds influence health care financing in Uasin Gishu County Kenya? How effective was health management team in influencing health care financing in Uasin Gishu County Kenya? How does budgeting and allocation of decentralized funds affect health care financing in Uasin Gishu County Kenya? Lastly, what were the effects of decentralized fund expenditure on health care financing in Uasin Gishu County Kenya? The researcher used ex-post facto research design. Both stratified sampling and random sampling technique was used to select the respondents. The target population for the study was 98 employees working in health department with a sample size of 79 respondents whom comprised of permanent health workers working in the major hospitals in the county. Questionnaires were employed as the major data collection tools. Data were analysed through descriptive statistics and hypothesis is tested by use of chi square. The analysis of the data was done with Statistical package for social science (SPSS) version 20 and the data was presented though use of graphs and tables for clear understanding of the results. The findings from the study therefore rejected the null hypotheses and concluded that there exists statistically significant relationship between adequacy of decentralized funds, management effectiveness and budgetary mechanism and the level of health care financing. This means that whenever the health management team are effective in managing the decentralized funds well, there is an increase in the level of health care financing.
Keywords: Fiscal Decentralization and Healthcare financing
Understanding Linkages between Governance and Health: Concepts and EvidenceHFG Project
There is a lack of evidence and understanding of the dynamics of interventions and contexts in which improved health system governance can contribute to improved health outcomes. As donors and governments increase their emphasis on improving the accountability and transparency of health systems, there is an ever increasing need for this evidence. Governance interventions could then more effectively contribute to measurable improvements in health
outcomes such as reduction in maternal or child mortality, or increased coverage of HIV/AIDS treatment.
On September 14, 2016 the USAID Health Finance and Governance Project (HFG) supported the USAID Office of Health Systems (OHS) and WHO to co-sponsor a workshop to launch a major initiative to marshal the evidence of how health governance contributes to health system performance and ultimately health outcomes. The marshaling of evidence activity will culminate in a high level international event in June 2017 to share knowledge and foster dialogue between donors, researchers, health governance practitioners, and policy makers.
The event brings together important USAID and WHO initiatives to elevate the importance of health governance. The HFG workshop included 35 health and governance professionals from across USAID (OHS, the Center of Excellence for Democracy, Rights and Governance, and the Bureau for Economic Growth, Education and Environment), the WHO, World Bank, academic partners, and implementing partners to launch the marshaling the evidence effort.
Data Analysis ....Stepping Towards Achieving Universal Health Coverage(UHC) b...Nazmulislambappy
The document discusses a study on Shasthya Surokhsha Karmasuchi (SSK), a special health care project in Bangladesh aimed at ensuring quality health services without financial hardship. The study aims to assess if SSK can meet universal health coverage requirements and reduce out-of-pocket health expenditures. Interviews were conducted with SSK patients and health providers. Findings indicate SSK successfully eliminates costs for admitted patients but many still face health costs. SSK coverage and services need expansion to better achieve financial protection goals. Challenges include limited treatments covered, scarce resources, and poor infrastructure.
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1. Research on Humanities and Social Sciences www.iiste.org
ISSN 2222-1719 (Paper) ISSN 2222-2863 (Online)
Vol.3, No.7, 2013
88
An Assessment of Healthcare Reforms in Kazakhstan
Francis Amagoh
Department of Public Administration, KIMEP University, Almaty.
famagoh@yahoo.com; famagoh@kimep.Kz
Abstract
This paper examines the state of healthcare development in Kazakhstan since it gained independence from the
Soviet Union in 1991.The paper uses secondary sources to investigate various healthcare reforms instituted by
the Kazakh government. The paper identifies four aspects in the health reform initiatives (funding, quality,
human resources, and partnerships) and their impacts on the country’s healthcare system. In light of the
healthcare reform efforts, this study finds that the four aspects of the reforms examined have been helpful
towards the country’s health system’s modernization efforts. While progress has been made in Kazakhstan’s
health system since its independence, this study observes that healthcare reform is a continuous process,
especially for a country undergoing transitional challenges. The paper sheds light on the issue of health reform
and its impacts on healthcare outcomes, especially in Central Asia.
Keywords: healthcare reform, healthcare systems, Central Asia, Kazakhstan
1. Introduction
Kazakhstan (see Table 1 for selected basic information) is located in central Asian and obtained its independence
from the Soviet Union in December 1991. The country adopted its first post-Soviet constitution in 1993, with a
unitary form of government (Wilson et al., 2002; Makhmutova 2001). The fall of the Soviet Union led to
political and economic transition challenges (government restructuring, policy changes and funding restrictions),
and the healthcare system was characterized by its oversized health facilities and a reduction in financing. The
result was a health system synonymous with poor quality, inefficient health services, uneven distribution of
healthcare workers between urban and rural areas, and inequities in funding between rural regions and large
cities and towns. From its inception, the government of Kazakhstan recognized healthcare as one of the
country’s major priorities, and a prerequisite for sustainable socioeconomic development. With market
liberalization, declining revenues, and declining healthcare indicators for the population in its nascent years of
democratic governance, Kazakhstan had no choice but to embark on reforms efforts to modernize its health
system. As a consequence, a number of health reform initiatives were undertaken, aided by improved economic
conditions and international assistance. The purpose of this paper is to examine Kazakhstan’s healthcare reform
programs, and assess if the reforms have aided the country’s healthcare modernization efforts.
2. Literature Review
Efforts to improve healthcare outcomes have been undertaken by many governments around the world, and
several studies have investigated the issue of healthcare reforms and their impacts on the populations of different
countries.
Analoui (2009) reviewed a number of studies that addressed the challenges faced by governments when
initiating, implementing and evaluating the results of healthcare reforms. The review found similarities in
challenges faced by both developed and developing countries in managing the reforms. These include the need to
have appropriate structure for policy implementation, relevant skills and competencies, legislative support,
appropriate behavior and attitudes, and visionary leadership. Essen (2009) conducted a study on the different
hospital payment systems in Germany, The Netherlands and England. The study found that differences in the
medical strategies in the three countries point towards the importance of institutional and interest configurations.
While the Dutch corporate medical body was willing to resolve conflicts, the German and English corporate
medical bodies seemed to be more confrontational in their approach. Mosebach (2009) investigated the impacts
of market-led reforms on quality and equality of access in the German hospital system.
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Table 1: Kazakhstan: Selected recent basic information
Language: Kazakh is the state language. Russian is commonly spoken
Independence: December 16, 1991 (from the Soviet Union)
National legislature: Bicameral: 77 seats lower house (Majilis) 39 seats upper house
(Senate)
Administrative divisions: 14 provinces (Oblasts) and 2 cities (Almaty and Astana)
Geography: Astana
Population: 17.5 million (2012 estimate)
Population growth rate: 1.235% (2012 estimate)
Unemployment rate: 5.3% (2012 estimate)
Literacy (% of population Age 15+): 100 (2009)
Poverty (% of population below
national poverty line): 8.2 (2009 estimate)
GDP: 232.3 billion US$ (2012 estimate)
GDP growth rate: 5.5% (2012 estimate)
Corruption perception index (CPI): 28 (2012)
Human development index (HDI): 0.761 (2012)
Press Freedom Score: 81 (2012)
Rank of the Failed State: 105 (2009)
Telephones: 4.266 million (2011 main lines in use)
Telephones (mobile cellular): 25.24 million (2011)
Internet hosts: 67,464 (2012)
Internet users: 5.299 million (2009)
Under-5 mortality rate
(per 1,000 live births): 33 (2010)
Under-1 mortality rate
(per 1,000 live births): 29 (2010)
Maternal mortality rate
(per 100,000 live births): 51(2010)
Life expectancy at birth (years): 69.63 (2012)
I-year old children immunization rate: 98 percent
Mortality rate (per 1000) 8.52 (2012)
Health expenditures (percent of GDP): 4.3 (2010)
Hospital bed density (per 1,000 population): 7.6 (2009)
Sources: CIA-The World Factbook, Kazakhstan, (www.cia.gov); UNDP, 2012; unicef (www.unicef.org);
Transparency International, 2012; The Failed States Index Scores for 2009 are from the Fund for Peace website
(www.fundforpeace.org). A higher score indicates a more viable state. Press Freedom Scores (for 2012) are from
Freedom House (www.freedomhouse.org). The CPI is interpreted as a ranking of countries with scores ranging
from 0 (highly corrupt) to 100 (highly clean).
Note: Number in parenthesis indicates year.
The study found that while there are signs that the German hospital sector was commercialized on a regulatory
basis, there was insufficient evidence to prove any negative impact on quality and equality of care provision.
Using the United States as a case study, Kellis & Rumberhger (2010) examined healthcare reforms and found
that majority of the reforms focused on reforming the private healthcare insurance industry, and contained
provisions that begin to address the cost and quality issues plaguing the United States health system. The study
notes that while the recently adopted health reform legislation enacted by the Obama administration significantly
expands access to healthcare, it does not address the market failures in the healthcare system. The study also
found that in order to significantly address the problems of healthcare in the United States, there should be a
single universal standard coverage for Americans; accountable health system leadership; leverage of information
and resources to make utilization decisions and evaluate performance; alignment of physician, hospital, and
payer incentives to focus on care outcomes rather than profit maximization; and the use of “quasi competition”
to allow for consumer choice.
Sammon & Adam 2008) investigated the impacts of the Enterprise Resource Planning (ERP) system in the
implementation of Ireland’s National Health Strategy. The ERP was designed to administer human resources and
payroll issues in a way that gives more visibility on the hiring and allocation of staff in the national healthcare
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system. The study found that the ERP project was a failure because of lack of understanding of what ERP
involves, and a failure to adequately prepare for its implementation.
With regards to developing economies, Ibrahim et al. (2011) compared the outcomes of healthcare reforms in
Nigeria and Malaysia. Results of the study found that reforms helped improve healthcare outcomes in both
countries. However, while there were more access to healthcare affordability and efficiency in healthcare
delivery in both countries, the results indicated greater magnitude of these positive outcomes in Malaysia than in
Nigeria. Also in Africa, Sakyi et al. (2011) examined the barriers to implementation of healthcare
decentralization reform of a district in Ghana. Using data from survey results of interviews from health officials,
the study found that while health officials involved in the implementation of the reforms were knowledgeable
about the objectives of the decentralization process, there were major factors militating against effective
decentralization in the district. These factors include lack of adequate funding, lack of qualified staff, inadequate
logistics and equipment, lack of transparency and a good operational system, political interference, poor
infrastructure and high rate of illiteracy.
Similar studies have been conducted on some Central Asian countries. Mirzoev et al. (2007) investigated the
progress made in health reform in Tajikistan. The study found that progress in Tajikistan’s health system through
the reforms includes a comprehensive health financing strategy, and improved coordination among the various
agencies. However, the study found that there was a need for the Tajikistan’s health system to focus on strategic
issues (such as, formulating an explicit privatization policy, and improving the coordination of external aid). In a
follow-up study, Habibov (2009) examined the impact of socio-economic characteristics on out-of-pocket
expenditures for prescribed medications in Tajikistan. The study found that economic status, disability, number
of small children, inadequate supply of necessary drugs, and cardiac and acute illnesses were the strongest
determinants of spending for prescribed medications in the country. Finally, Ismailova et al. (2010) reviewed the
National Health Reform and Development Program of Kazakhstan. The study found that there need to be a
protocol on rates charged for medical services in order to provide a unified and optimized rates of medical
services throughout the country. Such optimized rates would deliver high quality medical services cost-
effectively, and enhance the rational planning of the national healthcare budget.
3. A Review of Kazakhstan’s Health System
Kazakhstan inherited the Soviet-era health system and began the 1990s with a fully government-funded
healthcare system. The health system was inefficient because of high centralization and lack of incentives to
reduce costs. The fiscal crisis in the early 1990s also led to a decline in government revenues, which negatively
affected healthcare funding. Thus, it is not surprising that after independence Kazakhstan experienced a number
of negative health outcomes. During the first ten years following independence there was a dramatic increase in
mortality rate, from 7.7 per 1,000 people in 1990 to 10.1 per 1,000 people in 2001 (Kulzhanov & Rechel 2007).
Infant mortality rate and maternal mortality rate also increased. Furthermore, the healthcare infrastructure was
deteriorating, there was an overemphasis on hospital care, and the public was dissatisfied with the healthcare
system. These factors led to calls for reform of the health sector. There were also calls for reforms by external
donors and agencies, who wanted to see improved quality and access in the health system to justify their funding.
According to the Ministry of Health, by the end of 2011, Kazakhstan had 1064 hospitals and 3,720 short-stay
clinics. Authorities estimate the hospital accommodation capacity to be 120,000. The government owns 80
percent of medical institutions and thus the government plays a key role in medical issues. According to 2010
data, under-5 infant mortality rate is 33 per 1000 live births. Life expectancy is 69.65 years and maternal
mortality is 8.52 as at 2012 (Table 1). The latest figures from the Ministry of Health website show that fertility
rate (i.e. births per 1,000 people) has improved from 21.5 in 1991 to 22.5 in 2010 (Aringazina et al. 2012;
www.mz.gov.kz). These improvements are a result of several reform initiatives undertaken by the government
since its independence.
4. Health Reform Efforts
The healthcare system in Kazakhstan has evolved progressively since its independence. The first health reform
in post-independent Kazakhstan was in 1992 when Parliament enacted the Law on the Protection of the
Population’s Health, and the Ministry of Health produced The Concept of Health Care Reform (a document
which called for a number of reforms). These reforms include: establishment of a health insurance scheme;
decentralization of health administration; reduction of hospital beds; priority for primary healthcare; the right to
private practice for healthcare professionals; patient’s right to choose a doctor; and improved training for
healthcare professionals (Ministry of Health 2004). In 1994, the Ministry of Health developed a strategic vision
for the health system, with an action plan in five major areas: improving the organization and management of
healthcare and its human resources; restructuring health financing; improving quality of care; reforming and
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privatizing medical supply and pharmaceuticals; and increasing scientific research capacity (Ministry of Health
2004). In 1996 a Mandatory Health Insurance Fund was introduced but abandoned in 1998.
The President declared an initiative, known as Kazakhstan 2030 in 1997. The initiative outlines a range of social
policy agenda for the country, including health policy goals (President of Kazakhstan 1997). The health policy
component of the initiative contains such elements as, the development of a healthy lifestyle, and other areas of
health promotion and disease prevention. In line with the Kazakhstan 2030 agenda, the National Center for
Healthy Lifestyles was established in 1998. A Presidential Decree (No. 3956), known as The Health of the
Nation provided a detailed overview of health issues in the country. The decree also identifies the main priorities
in the health system. In 1999, the Decree on Measures for Improving Primary Heath Care for the Rural
Population established minimum standards for the public provision of rural health services (Ministry of Health
2002; www.astanazdorovie.kz). Since 1999, the national budget has been the single major public source of
healthcare financing in the country.
In 2004, a comprehensive healthcare reform act (National Health Reform and Development Program for 2005-
2010) was enacted. The provisions in the reform were rolled out in phases between 2005 and 2010. The National
Health Reform and Development Program was developed as part of a broad national development strategy called
“Towards A Competitive Kazakhstan, A Competitive Economy and A Competitive Nation”. The National Health
Reform and Development Program identified the following priority tasks: a shift towards primary healthcare and
from inpatient to outpatient care; achievement of international standards, and use of new technologies; advanced
treatment methods and medical services; strengthening of maternal and child health; training of health
professionals and health managers; prevention, diagnosis and treatment of “socially significant diseases”; and
improving buildings and equipment of health facilities (Ministry of Health 2004).
The National Health Reform and Development Program also introduced a state-guaranteed basic benefits
package of services provided free of charge, which covers specified health services. This includes emergency
care, outpatient care, inpatient care, and medical assistance to people with “socially significant” diseases. User
fees paid for services included in the basic benefits package are illegal, and are only allowed for services outside
the basic benefits package. Additionally, the reform introduced a new outpatient pharmaceutical benefit system,
with children, adolescents and women of reproductive age entitled to pharmaceuticals free of charge. Health
services which are not included in the basic benefits package could be paid from out-of-pocket; voluntary health
insurance (VHI); employers; or other sources. While inpatients have their pharmaceuticals covered by the
hospitals, ambulatory care patients (except “socially vulnerable groups” and certain diagnostic groups, such as
cancer patients) must buy their own medication.
In 2010, the State Health Development Program (also called Salamatty) was introduced. The Salamatty program
is to be implemented in phases from 2011 to 2015. The program emphasizes healthy lifestyles for the population,
and the development of a quality domestic pharmaceutical industry. It also focuses on a number of intervention
and prevention areas; mother and child health services; vaccination and infection control; incentives for young
medical professionals to practice in rural areas; the creation of Family Health Centers in policlinics; mobile
ambulance, as well as increased air ambulance (www.pm.kz). The Salamatty initiative has ambitious targeted
outcomes, such as: increasing life expectancy to 69.5 years by 2013 and 70 years by 2015; decreasing total
mortality to 8.14 per 1000 by 2013 and 7.62 per 1000 by 2015; decreasing maternal mortality rate to 28.1 per
100,000 by 2013 and 24.5 per 100,000 by 2015; and decreasing infant mortality rate to 14.1 per 1000 by 2013
and 12.3 per 1000 by 2015 (www.mz.gov.kz; http://globserver.cn/en...).
5. Features of Reforms
The various reforms in the Kazakh health system consist of some underlying features which are essential for the
success of the country’s healthcare modernization efforts. These features (funding, quality, human resources, and
partnerships) are necessary for improving the country’s health outcomes.
5.1 Funding
Healthcare funding in Kazakhstan was very poor during the 1990s and early 2000s, mainly because of poor
revenues, and the fact that the country was trying to adapt to the process of transition. The lowest share of GDP
allocated to healthcare was recorded in 2002 at 1.93 percent, however, healthcare spending as a share of GDP
has increased to 4.3 percent in 2010 (www.investkz.com; http://globserver.cn/en...). The government is also
putting more emphasis on primary healthcare in terms of funding. For example, in 2005 primary healthcare
received 28 percent of the total health budget compared to 10 percent in the mid-1990s. This figure increased to
40 percent in 2010 (Aringazina et al. 2012; www.mz.gov.kz).
Reforms in the healthcare sector have led to decentralization of funding mechanisms, even though the central
government has retained considerable authority. This decentralization effort has been mostly achieved through
the devolution of administrative and financial responsibilities from national level to oblast (regional) and
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sometimes rayon (district) levels (Ministry of Health 2004). The devolution of responsibilities was first
enshrined in the 1995 Law on Local Self-government, which delegates health management and financing
functions to the oblast level (Makhmutova, 2001). This allows the oblast akim (governor) to determine the level
of budget consolidation. This means that the 14 oblast and Almaty and Astana city health departments are the
key bodies in administering healthcare, and are responsible for most of the hospitals and polyclinics at the local
level. The decentralization of funding provision was further reinforced in the National Health Care Reform and
Development Program because prior to 2005, there was lack of uniformity in implementing the provision across
all the regions in the country (Ismailova et al. 2010; Aringazina et al. 2012).
Thus, the reforms ensure that the core element of the health financing system is budget consolidation at the
oblast level, whereby the oblast health department serves as the single health purchaser or single payer for all
state health funds. The national government strives to decrease regional differences in health financing and
gives priority in terms of health financing to: primary healthcare services; construction and reconstruction of
primary healthcare facilities and mother and child health facilities; procurement of medical equipment and
means of transportation to primary healthcare, childbirth and emergency care services, according to specified
minimum standards; patients referred for inpatient services by primary healthcare providers; health services to
patients suffering from “socially significant and hazardous diseases”; provision of pharmaceuticals to specified
population and disease categories; and provision of health services in disasters (Kulzhanov & Rechel 2007). To
further improve efficiency in health financing, the government made a number of additional provisions,
including: a methodology for the reimbursement of providers for the provision of the state-guaranteed package
of services; suggestions for different labor remunerations for healthcare professionals based on performance;
rules and regulations for the provision of a fee-for-service scheme in publicly owned health facilities;
suggestions for alternative financing mechanisms for tertiary care providers; and a new system for
reimbursement of primary care providers that takes into account expenditures on facility management and
renewal of assets (Ministry of Health 2004).
5.2 Quality
Kazakhstan’s health reforms’ agenda is focused mainly on improving quality and efficiency in the health system.
While the National Health Care Reform and Development Program established new rules for quality control of
services provided by health facilities, the Salamatty program emphasizes the importance of efficiency and
quality in achieving the ambitious health outcomes the country has set for itself by 2015. These reforms give the
Ministry of Health the responsibility for: developing national policies on quality assurance and accreditation;
developing the legislative basis for the accreditation of health organizations; and quality control of health
services, including intra-hospital management and efficiency of health organizations. To this effect, Kazakhstan
has devised mechanisms to reduce duplication of activities and functions, and the inefficient use of resources
available for the health sector. This means reducing the over-reliance on inpatient care which has led to
substantial excess capacity in the hospital sector. In addition, the country has introduced: a quality management
system for all levels of health care; a system of licensing and accreditation of health facilities; training and
retraining of health care workers (including the introduction of courses on evidence based medicine); a single
health information system; a differentiated payment system that takes account of the quality of services provided;
and publication of ratings of healthcare providers in the mass media. Primary healthcare services is also being
improved by upgrading of physician and staff; material and technical improvements of health facilities; and
specifying the guaranteed benefits package for inpatient care. In addition, the reforms aim to advance the
development of telemedicine and the use of aviation to improve health services in remote and inaccessible areas
of the country (Almagambetova 2011; Kulzhanov and Rechel 2007).
To ensure that health quality is in line with international standards, the government has introduced a number of
additional initiatives. This includes adoption of quality indicators that incorporate elements of the UK's
comprehensive performance assessment (CPA) framework to report on the quality of services performance data
(Knox 2008). The government has established the Committee for Health Services Quality Control at the national
level to consider complaints on quality of health services provided, while oblast health departments are
responsible for the protection of patient rights at oblast level. Finally, to reduce time-consuming paperwork,
streamline the work of doctors, and give patients easier access to their records, the government has established
the Unified Health Management Information System (UHMIS) which stores medical information online in a
unified database (Pavlovskay 2013). The main features of UHMIS consist of: generating a medical electronic
passport for patients with all medical information and medical history; sanitary-epidemiological monitoring
system that addresses problems related to collection and analysis of epidemiological information; a medication
supply management system that controls the production, distribution, and use of pharmaceuticals in the country;
and a medical service quality management system which allows authorities to use objective criteria to monitor
medical centers and their staff.
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5.3 Human Resources
The health reform programs are aimed to improve the training of health managers and the coordination of health
delivery functions (Ministry of Health 2004). The responsibility for developing and enhancing the competence of
health workers in Kazakhstan is divided between the Ministry of Health and oblast administrators. The reform
programs provide for the introduction of a comprehensive system of human resource planning in the health
sector by ensuring that medical universities and training institutes are in line with world standards and best
practices. According to the 2003 Law on the Health System, the Ministry of Health is charged with: developing
an overall human resources policy in the health sector; approving forms and training programs for medical
specialties; developing and approving staffing standards of health organizations; conducting the revalidation of
managers of health organizations and health departments; and defining standards for the training of specialists
with higher and postgraduate education. Oblast health departments are responsible for: ensuring the provision of
human resources in health organizations and assessing the expertise of health workers; and ensuring the
continuous education and retraining of medical and pharmaceutical specialists (Ministry of Health 2004;
www.pm.kz). Kazakhstan has six public medical universities, two private medical universities, 29 public nursing
schools and 31 private nursing schools (www.mz.gov.kz). Continuous medical education is conducted by the
Almaty Postgraduate Medical Institute and the School of Public Health. In 2011, Kazakhstan had 60,000 medical
doctors and 139,000 medical personnel (www.egov.kz). Thus far, the reforms have been helpful in training and
retraining of physicians to become general practitioners; implementing the training of professional managers and
health economists; and strengthening the material and technical basis of educational institutions for medical
education. The reforms have also introduced the regular testing of medical teaching staff every five years, and
have provided a means to allocate funds from local budgets for retraining and continuous education courses for
staff in rural areas.
5.4 Partnerships
Kazakhstan’s healthcare reforms encourage collaborations between the government, civil society groups, the
private sector, and international organizations. In Kazakhstan, civil society’s engagement in the health sector
involves collaborating with the Ministry of Health. The reforms empower the Ministry of Health to involve
NGO representatives intensively in the process of professional revalidation of health workers, and the
independent quality control of healthcare (Ministry of Health 2004). Three most active NGOs collaborating with
the Kazakh government in the health sphere are the Diabetes Association of the Republic of Kazakhstan
(DARK), the Kazakhstan Association of Family Physicians (KAFP), and the Family Group Practitioners
Association (FGPAs) which serves as an intermediary between sector health agencies and family group practices
(FGPs). The health reforms have given FGPAs new roles and responsibilities in setting quality-of-care standards,
monitoring performance and accrediting healthcare providers (www.mz.gov.kz; Almagambetova 2011).
The government is also engaging with the private sector in the form of public-private partnerships (PPP). In the
healthcare context, PPP is regarded as a valuable tool in providing a wide array of services, from social
infrastructure to hospitals, hospices, home care, laboratories, diagnostic centers, development of medical and
pharmaceutical industry, supply of medical and nonmedical equipments, etc. A key requirement in this
arrangement is to transfer adequate risk from public to private sector for the provision of high quality and cost-
effective services. The first round table on PPP on healthcare in Kazakhstan was held in Astana on May 2011
(www.pm.kz). The round table was organized by the Ministry of Health and the World Bank to provide insights
into how PPP can help enhance healthcare investment projects in the country. The government plans to build 131
hospitals through PPP by 2016 (www.investkz.com).
To further facilitate health infrastructural development and the provision of essential health services, the health
reforms encourage the Kazakh government to collaborate with international agencies and organizations. These
include the World Bank, World Health Organization (WHO), the United States Agency for International
Development (USAID), the United Nations Development Program (UNDP), the Asian Development Bank, the
European Union, the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM), the International Red
Cross, the United Kingdom Department for International Development (DFID) and so on. A number of donor-
supported initiatives have been undertaken, among which is the World Bank support for the “Health Sector
Technology Transfer and Institutional Reform” project at a cost of $ 296 million. The program aims to accelerate
implementation of key health reforms by bringing international best practices, and building up the capacity of
specialists in health financing, healthcare quality, information systems, and public health (World Bank 2010).
UNICEF supported the creation of a National Program on Improvement of Peri-natal Care, and in 2009, the
Kazakh Ministry of Health and the USAID signed a Memorandum of Understanding on healthcare cooperation
through 2013. Under the agreement, the U.S Government will provide assistance to help the government of
Kazakhstan meet its healthcare goals, including healthcare reform and improvements in the quality of medical
services (www.centralasia.usaid.gov).
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6. Future Prospects
Since its independence in 1991, the Kazakh government has progressively made efforts to reform and modernize
its health system. Starting from its first healthcare law (the Law on the Protection of the Population’s Health) in
1992, to the Salamatty program enacted in 2010, the aim has been to make gradual reforms that could be
adequately managed and delivered, and upon which further reform efforts can be built. Salamatty, which
implementation is to be completed in 2015 sets some ambitious goals (such as, increasing life expectancy from
the current 65 years to 70 years by 2015 and decreasing mortality rate from the current 10.1 per 1,000 people to
7.62 per 1,000 people by 2015). Between 2009 and 2011, a hundred new medical facilities were built. This is in
line with the President’s 2008 program of “Building a Hundred Medical Facilities on the Basis of State-Private
Partnership”. Kazakhstan is making all efforts to ensure brighter future for its economy and its health system.
The country joined the World Trade Organization (WTO) in 2012, and has already signed bilateral trade
agreements with 24 countries. Efforts are underway by Kazakh authorities to revise its current state investment
program in order to attract foreign investment in key industries, including pharmaceutical. Such measures would
include the promotion of Free Economic Zones, and freedom from VAT and other taxes. Thus, based on its
recent history of health reforms and modernization, it is expected that such efforts would continue in the future
to ensure that the Kazakh health system meets international standards of efficiency, access, and quality.
7. Conclusion
This paper presents an assessment of healthcare reforms in Kazakhstan since its independence. Seeking to bring
about major improvements in the health system, the reform measures have altered the institutional and
procedural aspects of healthcare delivery. Conclusively, health reform in Kazakhstan is an ongoing process.
While the most recent health reform programs (Salamatty and UHMIS) are be implemented through 2015 and
2020 respectively, it is expected that subsequent health reform and modernization efforts will follow.
Considerable efforts have been made by the Kazakh government to improve access to basic healthcare through
the guaranteed basic benefits package, while continuous improvement efforts are in place to bring the Kazakh
health system in line with international standards. The trajectory of health improvement indicators seems
encouraging. Already, life expectancy has increased to 69.63 years in 2012 (see Table 1) surpassing the 69.5
years which the Salamatty program aimed to achieve by end of 2013. In 2012, Kazakhstan ranks 69 out of 187
countries with a score of 0.755, a high list in the “Human Development Index” (HDI). The index is a composite
of indicators developed by the United Nations Development Program (UNDP), with the purpose of analyzing the
level of development across the world. It is composite of three variables: life expectancy, education and average
incomes. Compared to 2009, the Kazakhstan has moved up 15 positions (UNDP 2012). Thus, it is expected that
as the reforms are implemented, the various indicators of health outcomes will continue to improve.
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