A first-hand look at patient-centered primary care in Kazakhstan
Study tour delegation © WHO/Jerome Flayosc
From November 18-22, 2019, a 17-person delegation from Kyrgyzstan travelled to Almaty to learn about Kazakhstan’s approach to patient-centered primary health care services for mothers and children. The study tour was organised in cooperation with the Ministry of Health of Kazakhstan and the World Health Organization’s (WHO) European Centre for Primary Health Care in Almaty, with support from GIZ.
The goal of the study tour was to see how reforms to the primary healthcare system in Kazakhstan are enabling the delivery of comprehensive patient-centered primary health care, particularly for pregnant women, new mothers and newborns, and to assess whether elements of this model could be applicable in Kyrgyzstan. In line with the 2018 Astana Declaration, the Government of Kyrgyzstan is working to strengthen primary health care services to ensure that all its citizens are able to enjoy the highest possible attainable standard of health.
The programme for the visit included technical meetings with experts, visits to health facilities in the city of Almaty and the surrounding region, and a high-level round table with representatives of the government of Kazakhstan. The Kyrgyz delegation was led by Dr Anara Eshkhodzhaeva, the head of the Department of Health Service Delivery at the Ministry of Health of the Kyrgyz Republic. Representatives of the Mandatory Health Insurance Fund (MHIF), the E-Health Center, medical training institutions, and regional departments of health and social services also participated. Advisors with the GIZ-implemented Promotion of Perinatal Health project, which is supporting the Ministry of Health to identify best practices on patient-centered integrated care, accompanied the delegation.
A health system oriented on the needs of patients
The Kyrgyz delegation came away impressed by Kazakhstan’s strong commitment to strengthening primary health care, and noted that the focus on patients was immediately apparent in each of the health care facilities they visited. Long opening hours, electronic queues and electronic medical records all contribute to a convenient and efficient experience for patients seeking care.
Registration area at polyclinic, with color-coded pathways for patients with life-threatening, urgent and non-critical conditions © WHO/Jerome Flayosc
A consultation between a nurse and a patient © WHO/Jerome Flayosc
A color-coded triage system for sorting patients based on the urgency of their condition ensures that they are seen in a timely manner and receive appropriate care from the right personnel. By reducing potentially harmful delays, the sorting system helps to improve health outcomes. It also helps health care workers to work more efficiently, thereby increasing the quality of care they provide to patients.
Team work is the basis of primary health services in Kazakhstan. Work processes are well organised and the roles and responsibilities of different cadres are clearly defined. Health system reforms have elevated the role of nurses in Kazakhstan: they are now the main point of contact for members of the public and coordinate health services. Nurses work with a great deal of autonomy, consulting directly with patients and providing them with basic services. This division of labour helps to minimise the routine work performed by family doctors and gives them more time to concentrate on complex cases.
Social workers and psychologists work alongside clinical staff as part of multi-disciplinary primary care teams. Visiting nurses make daily home visits to pregnant women, new mothers and newborns who might otherwise not receive medical and social services, allowing them to identify and act upon issues quickly and efficiently. The inclusion of these other cadres into the primary health model contributes to the goal of Universal Health Coverage in Kazakhstan by extending the reach of health promotion services, encouraging healthy lifestyles and attracting patients for preventive health screenings.
Reflections on a modern system of integrated services
At a round table discussion held at the WHO office on the final day of the study tour, participants from both countries had the opportunity to exchange impressions and to consider opportunities for further cooperation.
Dr. Anara Eshkhodjaeva, MoH KR © WHO/Jerome Flayosc
Nazgul Cholumova, MoLSD KR © WHO/Jerome Flayosc
Dr Anara Eshkhodzhaeva noted that that Kyrgyz delegation was nothing short of amazed by the changes that are currently taking place in Kazakhstan. ‘To see a primary health care system function so effectively is very inspiring,’ she said, ‘The joint teamwork approach you have introduced is bringing about impressive results. This is something our country can adopt.’
Nazgul Cholumova, the head of the Department for the Development of Social Services for Families and Children at Kyrgyzstan’s Ministry of Labor and Social Development, was struck by the difference that an integrated approach to care can make for patients and social workers alike. ‘Social workers in our two countries do the same jobs,’ she said, ‘but in Kyrgyzstan when a child needs a medical examination or a consultation with a psychologist, the social worker and the child have to run around to find these specialists. Here I have seen what an integrated approach can look like, and how it allows the patient to be an equal partner in all aspects of treatment and care.’
‘We’d heard about the positive changes in primary health care in Kazakhstan, but we didn’t imagine that so much had been done,’ said Marat Kaliev, a consultant working with GIZ. ‘We were expecting small changes to the Soviet model, but instead saw a modern system of integrated services, with a multi-disciplinary team working for the benefit of patients.’
On behalf of the WHO Center for Primary Health Care, Dr Arnoldas Jurgurtis thanked the ministries of health from both countries for their commitment to developing primary health care services which put patients in the center. Such approaches make it possible to ‘see the person and his or her social and psychological needs, not only his or her diagnosis and medical needs.’ He welcomed the prospect of further cooperation between the two countries and pledged the Center’s support in future exchanges.