This presentation was made by Valikhan Akhmetov, KazakhstanN, at the 3rd Health Systems Joint Network meeting for Central, Eastern and South-eastern European Countries held in Vilnius, Lithuania, on 25-26 April 2019

1. Public Health in Kazakhstan:
arguments to invest
2019
National Public Health Center
Ministry of Health of the Republic of Kazakhstan

2. 10 leading causes of death in the world
Causes of death
The number of
deaths in the
millions
% of deaths
1. Coronary heart disease (CHD) 7,25 12.8%
2. Stroke and other cerebrovascular diseases 6,15 10.8%
3. Respiratory infections of the lower respiratory tract 3,46 6.1%
4. Chronic Obstructive Pulmonary Disease (COPD) 3,28 5.8%
5. Diarrheal diseases 2,46 4.3%
6. HIV / AIDS 1,78 3.1%
7. Trachea, bronchus and lung cancer 1,39 2.4%
8.Tuberculosis 1,34 2.4%
9. Diabetes 1,26 2.2%
10. Traffic accidents 1,21 2.1%
2

3. The standardized mortality rate for the main reasons in the Republic of Kazakhstan and the OECD countries,
which accounted for 84% of deaths in 2017 in the Republic of Kazakhstan (per 100 thousand people)
KZ
715,22
OECD
514,3
All causes
KZ
85,81
OECD
152,7
Oncological diseases
KZ
174,83
OECD
153,3
Circulatory system diseases
KZ
63,58
OECD
54,91
Including CHD
KZ
65,77
OECD
33,8
Including Stroke
KZ
92,22
OECD
41,3
Respiratory diseases
In Kazakhstan, the average life expectancy in 2017 was 72.3 years
The main causes of premature mortality in the Republic of Kazakhstan

4. Top 10 causes of death in Kazakhstan in 2017 and the percentage change, 2007-2017, all populations*
2
CHD1
3
4
5
6
7
8
9
10
11
2
1
3
4
5
6
7
8
9
10
11
CHD
2007 2017
infectious diseases, diseases of
newborn
NCDs
Injuries
% changes over 10
years
-16,2%
-9,6
22,5%
-1,2%
-0,3%
23,0%
-28,1%
-10,4%
-10,1%
-33,1%
-44,0%
* - data from the Institute of Health Metrics and Evaluation
Cerebrovascular diseases
Cirrhosis and other liver diseases
Cardiomyopathy and myocarditis
COPD
Neonatal disorders
Injuries from traffic accidents
Trachea, bronchus and lung
cancer
Lower respiratory infections
Self-harm
Alzheimer's disease
Cerebrovascular diseases
Self-harm
Cirrhosis and other liver diseases
Cardiomyopathy and myocarditis
COPD
Injuries from traffic accidents
Lower respiratory infections
Neonatal disorders
Alzheimer's disease
Trachea, bronchus and lung
cancer

5. Challenges
• Difference in life expectancy for men and
women over 10 years
• Leading causes of lost years of life from
premature mortality:
• CHD;
• Cardiovascular diseases
• The leading causes of disease burden
(DALYs):
1) Risks related to nutrition;
2) High systolic pressure;
3) High body mass index.
5
Kazakhstan: challenges and targets
Targets in the "Densaulyk" state program (until 2019)
• Increase life expectancy to 73 years
• Reduce total mortality by 30% from level of 2010
Targets in the «Health 2020» (until 2020)
• Reduction of premature mortality by 1.5% per year from
4 NCDs
Global targets for NCDs (until 2025)
• Relative reduction in the risk of premature mortality
from 4 NCDs by 25%
Targets of the SDGs (up to 2030)
• Relative reduction in the risk of premature mortality
from 4 NCDs by 30%

6. The main objective:
Improving public health to ensure sustainable socio-economic development of the country:
TASKS:
1. The development of public health, as the basis of public health;
2. Integration of all health services around the needs of the population based on the modernization and
priority development of primary health care;
3. Quality assurance of medical services;
4. Implementation of the National Drug Supply Policy;
5. Improving the health system through the introduction of solidarity and increasing its financial
sustainability;
6. Improving human resource management in the healthcare industry;
7. Ensuring the further development of health infrastructure based on public-private partnerships and modern
information and communication technologies.
The main directions of the "Densaulyk“ State Program for the Development of
Healthcare

7. Performance Indicators for Public Health Services KPI in 2018 KPI in 2019
Reducing mortality from:
• circulatory diseases;
• malignant diseases;
• injuries, accidents
per 100 thousand
population until
200,2
93,1
79,8
per 100 thousand
population until
200,0
92,9
77,5
Adherence to healthy nutrition
• among adults;
• among children
70% ≤
90% ≤
Reducing the prevalence of obesity 231,4 220 per 100
thousand popul.
Increasing the proportion of citizens involved in physical activities
and sports
29,0 30% ≤
Reduction of alcohol consumption 5 4 liters per person
per year
Reduction of smoking prevalence 19 ≤18%
Achievement of key performance indicators of the State
Healthcare Development Program
16

8. Change of strategy from treatment to disease prevention
How to interrupt
the endless
process?
Treatment
Construction
of hospitals, clinics,
training of doctors,
the production
of drugs
Prevention of
disease,
recovery
Disease
Cheap and
efficient
Expensive and
inefficient
Infectious, parasitic diseases,
and natural carriers of infection
1) circulatory system diseases;
2) malignant neoplasms;
3) injuries, accidents and poisonings;
4) mental disorders;
5) diabetes;
6) respiratory diseases, etc.
Diseases, determined by dangerous
environmental factors:

9. Kazakhstan’s government expenditures on public health 2017,
billion KZT
Costs(billionsoftenge)

10. Premature mortality losses from 4 groups of NCDs, 2017,
bln tenge
Cardiovascular
diseases
Oncological
diseases
Diabetes Chronic
respiratory
diseases

11. Structure of economic damage from NCDs in Kazakhstan, 2017
Government expenditures on
public health
Losses from temporary disability
Losses from formal presence at
work
Premature mortality losses

12. Intervention packages 5 years 15 years
Total costs Overall performance
gain
Return on
investment
Total costs Overall performance gain Return on
investment
Tobacco control measures 5,0 73,9 15,1 15,4 991,1 45,4
Alcohol control measures 10,2 49,3 4,9 69,1 766,3 14,2
Measures aimed at increasing physical
activity 4,7 50,3 10,7 29,2 774,9 33,8
Measures aimed at reducing salt intake *
4,5 228,8 53,4 28,2 2589,1 118,4
Clinical interventions aimed at treating
cardiovascular diseases and diabetes
140,7 95,5 0,7 89.714,6 766,3 0,5
Estimated costs, effect from implementation and return on investment, by
intervention packages, for periods of 5 and 15 years (billion tenge)
(WHO 2018):
* Measures aimed at reducing salt consumption have the highest return on investment: for every 1 tenge invested in a
package of measures to reduce salt consumption, it is expected to receive 53.4 tenge in the first five years and 118.4
tenge in 15 years.

13. COST INCREASE ON HEALTHCARE
35 59 92 128 133 139
119
157
260
422 434 447
117
126
128
130 133 137
112
116
118 121
125
25
46
51
51
Updating of fixed assets in tariffs for medical services
Reimbursement of investment costs for large PPP projects since 2022
Additional amount of guaranteed free medical care / social health insurance to cover the growing need for
services
Salary increase of medical staff
I. Disease prevention:
increase in costs for public health services from
4% of government expenditures to 10% (OECD
indicator)
II. Increasing the availability and
quality of medical services:
a) increase of tariffs for medical services to the
level of their break-even;
b) covering the growing demand of the population
in the volume of certain medical services
(rehabilitation, oncology, high-tech medical
services, palliative care);
III. Sustainable development:
а) reimbursement of investment costs for the
construction of large objects on the mechanisms
of public-private partnership;
b) increased spending on the development of
science and medical education.
2020 year 2021 year 2022 year 2023 year 2024 year 2025 year
Additional public funds:
“Within 5 years, it is necessary to increase expenditures on education, science and health care from all sources to
10% of GDP…” from the Message of the Head of State dated October 5, 2018
additional costs are needed to cover the need for health care;
employer contributions and employee contributions to compulsory social health insurance;
government spending;
private expenses;
the share of expenditures on primary health care and public health in the framework of guaranteed free medical care and compulsory social health insurance
2019 2020 2021 2022 2023 2024 2025

14. Directions and indicators until 2025
Activities Fact 2018 Target 2025 Outcome
Increase per capita
spending per year
270$ 570$ 1. Universal health coverage and
protecting the population from financial
risks (achieving the SDGs)
Increase the average
salary of doctors
380$ 1340$ 1. Provision of competitive medical
personnel;
2. Increase motivation of medical
workers.
Ratio of primary health
care to specialized
medical care
40/60 60/40 1. Increasing the role of primary
health care;
2. Increase technological
effectiveness of specialized medical
care.
Disease prevention 4% 10% 1. Increase in early detection of
diseases;
2. Awareness and commitment to a
healthy lifestyle
Indicator name 2016 by 2021 by 2025 by 2050
life expectancy (number of years) 72,4 73,3 75,0 84,0
OECD 4000$
OECD 8000$
OECD 60/40
OECD 10%

15. Providing the Public Health field with qualified personnel
Enhancing human
resource capacity of
the Public Health
Service
Systematic
actualization of
the system for
increasing the
motivation and
stimulation of
labor of
workers in the
field of public
health.
Updating of
regulatory acts
on the
preparation of
HR capacity
building of
public health
services
Creation of a
competency
map of
specialists in
the field of
health care
Conducting
training on
cascade
technologies in the
field of public
health
(management),
including first aid
DIRECTIONS
•Health promotion practitioner / trainers
(Doctors / Specialists / Nurses in health
promotion)
•Modern approaches in preserving and
strengthening the health of children (school
medicine)
•Improving the school medicine program
•Control Strategies for Communicable
and Non-communicable Diseases
•Integrated industrial hygiene
•School medicine
•Hygiene and epidemiology
•Management
•Laboratory diagnosis
PROFILES

16. «Health literacy study in Kazakhstan»
As part of the development of the public health service for 2019–2023
Purpose:
• Assessment of population health literacy;
• Development of policies and strategies to improve health literacy of the population of the Republic
of Kazakhstan, taking into account cultural and social factors that influence the understanding and
transmission of information on health promotion.
Tasks :
• Analysis of international and domestic experience in the study of literacy of the population in
matters of health and its impact on the state of individual and public health;
• Conduct a population-based study of health literacy of the population of Kazakhstan;
• Collect data and evaluate the results of the survey;
• Create a national health literacy database at the population and system levels;
• Develop recommendations for improving population literacy of the population in health issues of
the Republic of Kazakhstan for different groups of the population, taking into account socio-
cultural and other features.
Provisional budget – 32004,30 thousand tenge