The Right to Protection of Health and Medical Assistance
The Constitution of the Republic of Kazakhstan ensures the right of citizens to the protection of health, to guaranteed free medical assistance and paid medical care established by the law, and to medical assistance from state and private health care institutions as well as from private medical practitioners for which they pay.
The health of the population is the most important factor that ensures the national safety of the Republic. The main principle and objective of State policy in the field of health care is the observance of the constitutional rights of the citizens of the Republic of Kazakhstan to health protection, obtainment of quality medical services and provision of State guarantees.
The Head of State and the Government pay special attention to these issues considering them as national priorities; therefore, the improvement of the population’s health condition and further development in the field of health care is thought to be the compulsory condition for Kazakhstan to be numbered among the competitive countries of the world.
Currently, the development of health care is entering the stage of institutional reforms, development of the potential of personnel, and security of quality medical services.
Preventive health care and formation of a healthy life-style have become priority, which is expressed in the Message of the Head of State to the People of Kazakhstan on February 6, 2008 “Enhancement of the Welfare of Citizens of Kazakhstan – the Main Objective of State Policy.”
Improvement of citizens’ health implies such goals as the improvement of the health of mother and child, the reduction of the burden of socially significant illnesses and injury, the security of sanitary and epidemiological welfare, and the cultivation of a healthy life-style and correct nutrition.
During the last three years, the birth rate in Kazakhstan has increased by 13%, the total mortality rate has stabilized, and therefore the rate of natural increase of the population is 1.6 times greater.
Along with the implementation of the Program for Reduction of Maternal and Child Mortality, logistical support of organizations for children and obstetrics and their equipment with updated instrumentation (mainly diagnostic and rehabilitative) keeps on improving; the ratio of recovery of sick children detected in the course of preventive inspections is being increased; and pregnant women, sick children and people registered at health centers according to the approved list of illnesses are provided with free medications. There is a trend toward reduction of maternity mortality rate.
Socially significant illnesses result in great economic loss and reduction of life expectancy.
During the last three years, there was a reduction of the illness rate (by 11%) and the tuberculosis mortality rate (by 19%); however, there is a need of further logistical support and intensification of activities related to compulsory treatment and isolation of sick ones with resistant forms of tuberculosis.
According to WHO, Kazakhstan is at the concentrated stage of the HIV/AIDS epidemic – 0.2% of population compared to the world average of 1.1%. With the purpose of stabilization of HIV-infection distribution, the implementation of the Program for Counteraction of AIDS will be continued which will ensure the expansion of preventive activities.
Mortality due to injuries, accidents and poisoning is second ranked of the reasons for mortality of the population in the Republic of Kazakhstan. It is necessary to intensify the coordination of the operation of transport and communication services in regard to traffic safety issues as well as to enhance labor safety protection at the work place.
The stabilization of the sanitary and epidemiological situation and the improvement of public health remains the essential task. With the purpose of the improvement of the drinking water supply to guaranteed quality in compliance with the State Program “Drinking Water,” measures for the modernization and installation of upgraded laboratory equipment are being implemented at existing laboratories of the sanitary and epidemiological offices, which fulfill laboratory control of drinking water.
During the last three years, the amount of medication being sold on Kazakhstan’s market has almost doubled. In spite of this, the availability and quality of medication still remain a problem. With the objective of the improvement of the medication supply to the population, a uniform medication distribution system will be created and the system of outpatient medication supply will be improved.
Every year, the deficit of health care personnel tends to grow, especially in rural localities. In harmony with the commission of the Head of State, a work group for the development of suggestions with regard to the assignment of medical personnel to rural localities and to the determination of social services for young specialists has been created under the Government of the Republic of Kazakhstan. The number of students admitted to medical universities will be raised.
In order to improve the quality of medical and pharmacological education in the Republic, measures for the implementation of the Concept of Reformation of Medical and Pharmacological education in the Republic of Kazakhstan approved by the Enactment of the Government of the Republic of Kazakhstan on April 24, 2006, No. 317 are being taken. The construction of university clinics for four medical universities is planned in order to enhance the quality of clinical practice.
The low level of salary of medical employees affects the quality of services rendered. To solve this problem, the list of specialties where the salary increase ratio will be raised for psychological and physical stress is expanded. In addition, effective motivation and stimulation mechanisms including the improvement of labor remuneration for medical employees will be introduced.
The National Medical Holding, based on a medical cluster of 6 modern clinics founded in Astana, will become a scientific and practical base for highly specialized assistance and a center for the training and retraining of medical personnel that meets world standards.
World experience shows that in order to improve the quality of medical services, in addition to training qualified personnel, it is necessary to develop the private sector of health care and to stimulate the competitiveness of medical services. In this regard, it is necessary to secure the right of citizens to the free choice of doctor.
The right to health protection is stipulated by Article 29 of the Constitution of the Republic of Kazakhstan, and the obtainment of qualified medical assistance by the Law of RK of July 7, 2006 No. 170-III “On Health Protection of the Citizens,” by the State Program of Reformation and Development of Health Care in the Republic of Kazakhstan during the years 2005-2010, ratified by the Order of the President of the Republic of Kazakhstan on September 13, 2004 No.1438, by the Strategic Plan of the Ministry of Health Protection of the Republic of Kazakhstan during the years 2009-2011, ratified by the Enactment of the Government of RK on December 23, 2008 No. 1213, and by the List of Guaranteed Free Medical
Assistance during the years 2008-2009, ratified by the Enactment of the Government of the Republic of Kazakhstan on September 28, 2007 No. 853.
With the purpose of implementation of the commission of the Head of State and establishment of a uniform policy in the field of health protection and the improvement of the legislative base, the Draft Law of the Republic of Kazakhstan “On the Health of People and the Health Care System” was developed and submitted for the consideration of the Majilis of the Parliament of the Republic of Kazakhstan. This Law will cover issues such as the rights and duties of patients and medical employees, the responsibilities of health care agents, and issues regarding medical ethics and public health protection. In addition, health protection standards and plans for raising the knowledge of the population and increasing the transparency of the health care system will be developed; and memorandums between the ministry and Akimats will be concluded which will serve as the basis for the implementation of strategical direction of state policy in the field of health care protection.
Codification of legislation in the field of health care will allow the enhancement of the status of medicine, the organization of the large quantity of legislative documents in the sphere of health protection, the harmonization of them with international legislation, the improvement of the level of medical services provided to the citizens, and the changing of the public attitude towards health care issues.
It should be noted that citizens of remote rural localities cannot obtain highly qualified medical assistance. This fact restricts the right of citizens to the receipt of accessible qualified medical care.
On the basis of the above-stated, we recommend that the Government of the Republic of Kazakhstan and the Parliament of the Republic of Kazakhstan implement the following measures during the years 2009-2011:
- Accelerate the adoption of the Code of the Republic of Kazakhstan “On the Health of People and the Health Care System.”
- Implement the programs recommended by WHO for the improvement of medical assistance to women and children.
- Establish departments (hospitals) for nursing the terminally ill.
- Improve the training of medical personnel with regard to medical assistance in accordance with advanced foreign experience.
- Train and retrain managerial personnel in the field of health protection concerning management, resource management, and financing.
- Develop and implement a procedural base in the field of safety and protection of rights of the patient.
- Improve the system of labor remuneration of medical employees with the purpose of improvement of material welfare and motivation. Low labor remuneration of medical employees has resulted in common lack of personnel at the primary level – children’s treatment and ambulatory institutions as well as in rural localities. To attract personnel to work in rural localities and remote regions, it is necessary to revise the system of benefits and incentives for specialists.
- Assess the activity of all levels of antituberculosis services, to implement a system of strict epidemiological control of treatment of people having tuberculosis, and to toughen the quality requirements of purchased antituberculosis medications.
- Ensure the establishment and improvement of a modern food safety control system including effective control as to genetically modified sources of food imported from abroad.
- Ensure the adequate control of implementation of activities in the framework of the Republican Program “For Counteraction of the AIDS Epidemic in the Republic of Kazakhstan During 2006-2010.”
- Implement a new pattern of medication supply to the population at outpatient clinics with the use of fixed prices for medications.
- Ensure the quality and competitiveness of state medical institutions as well as scientific research in the field of health protection.
- Develop and adopt a standard and a legal document on donation and transplantation of human organs and tissues.
- Take measures for the implementation of Article 44 of the Law of the Republic of Kazakhstan of May 19, 1997 “On Health Protection in the Republic of Kazakhstan” to ensure the rights of the citizens to the free choice of medical organization as well of doctor. In this regard, it is necessary to amend the decree of acting Minister of Health Protection of the Republic of Kazakhstan of December 15, 2004 No. 874 “On Approval of Rules of Ambulatory and Clinical Assistance.”