Health Systems in Action (HSiA) Insights – Kazakhstan

Key points: ● The Ministry of Healthcare governs Kazakhstan’s health system and is responsible for policy, legislation and regulation. The Oblast Health Departments play an important role in managing all publicly owned health facilities within their territories. ● The country’s recent health reforms aim to progress towards universal health coverage (UHC) through strong primary health care (PHC) and family medicine, particularly in rural and remote areas. Regional and local governments lead these changes, with increased autonomy for PHC facility managers. ● Kazakhstan transitioned to a social health insurance (SHI) system in 2020, aiming to address equity, access and service quality by improving the pooling of public funds and enhancing the participation of private providers in publicly funded health care. ● Residents have access to two packages: a government-guaranteed package for all and a SHI package with a wider package of benefits for those who pay contributions or for whom the government pays on their behalf. ● Per capita spending on health has increased in recent years to US$ 1114 in 2021 (adjusted for purchasing power). The share of public spending in overall health spending has also increased (65.3% in 2021) and is now much higher than in the Central Asian countries overall (39.6%). Out-of-pocket (OOP) spending has subsequently declined, from 33.9% of health spending in 2019 to 25.0% in 2021. ● Kazakhstan has an extensive hospital network, with most hospitals being focused on a single specialty. The Ministry of Healthcare aims to optimize efficiency going forward by promoting multidisciplinary hospitals. ● Despite a high physician density of 407 professionally active staff per 100 000 population, rural areas face shortages, with 82.8% of physicians working in urban areas. Nurse numbers have fluctuated but are generally below the average in the WHO European Region. ● Life expectancy at birth in Kazakhstan steadily increased in the last two decades, from 65.7 years in 2000 to 73.3 years in 2019. However, the country experienced a notable decline during the COVID-19 pandemic, to 70.3 years in 2021. Life expectancy for females is 7.6 years higher than that of males. ● The pandemic resulted in a disruption of essential health services and increased mortality rates, including substantial excess mortality. Mental health problems and maternal mortality increased markedly. ● Cardiovascular diseases are the leading causes of mortality, including premature mortality, underscoring the need for continued prevention efforts and improved access to care. ● High blood pressure, poor nutrition and smoking are major causes of deaths and ill-health. Kazakhstan has initiated policies targeting these factors, including initiatives to reduce salt consumption and tobacco use and a ban on vaping products.