Despite numerous state-run health programs, Kazakhstan continues to struggle with high rates of cardiovascular diseases. With a broad spectrum of causes responsible for the ongoing crisis, the question arises whether the Central Asian nation is capable of making a breakthrough.
Following the collapse of the Soviet Union, the healthcare sector in Kazakhstan witnessed a radical downturn that lasted for more than a decade. Top medical professionals left in large numbers; limited funding made it difficult to repair medical equipment. Limited funding also made it difficult to keep up with skill sets and adopt emerging medical practices. This decline has had far-reaching consequences.
According to the World Health Organization’s 2014 data, 84 percent of deaths in Kazakhstan were caused by noncommunicable diseases. A full 54 percent of those deaths were due to cardiovascular diseases (CVDs) in particular.Enjoying this article? Click here to subscribe for full access. Just $5 a month.
Reports referring to official data suggest that more than 12 percent of the economically active population or about 2 million people suffer from CVDs, with more than 350,000 diagnosed with chronic heart failure conditions. Kazakhstan holds a top position in cardiovascular mortality rates among nations of the European Union, Central and Eastern Europe, and Central Asia.
Although the situation is claimed to be improving, it is still one of the major challenges to the local healthcare system. Densaulyk (2016-2019), a state program for the development of healthcare, acknowledges that CVDs cause the most deaths; meanwhile, an increase in the primary incidence surpassed 15 percent during the period of 2010-2014. Furthermore, CVDs are characterized as the biggest factor behind early disabilities.
There is a variety of other causes leading to high levels of CVDs. One of the most common is diabetes, which is particularly widespread in urban areas. Other major factors are obesity, hypertension, and high cholesterol (dyslipidemia). Similarly to many post-Soviet states, Kazakhstan’s health situation is heavily influenced by the impacts of alcohol consumption, which is higher than in neighboring Central Asian nations, as well as smoking. Finally, Kazakhstan has one of the highest rates of sodium consumption in the world.
With the issue of CVDs attracting public attention, there are cautious hopes for consequent improvements. Based on official ministry data, the numbers of cardiac operations have increased by 10 percent annually and totaled 36,027 in 2016. Health Ministry data claims that clinics are witnessing improvements in the number of personnel and have better access to modern equipment. Gaukhar Igimbayeva, director of the University Clinic at Karaganda State Medical University, says, “Innovative measures helped to achieve previously unattainable standards in combating cardiovascular diseases and improve treatments.”
Improvements in training standards also have been noticed. More than 300 specialists were sent for additional training to Israel, Russia, and Japan in 2016. The data from the Institute of Cardiology and Internal Diseases suggests that in 2016 death rates from acute myocardial infarction (heart attack) decreased by 11.6 percent. Implementation of an integrated model of care for noncommunicable diseases is another program contributing to treating heart attacks and strokes.
“The state programs allowed [us] to open cardiovascular hubs in almost every regional center,” says Symbat Abzalieva, deputy director for Research Innovation of Graduate School of Medicine, Al-Farabi Kazakh National University. “Though still lots has to be done, I believe that we were capable of breaking the ice,” she added.
According to officials, past healthcare programs were able to improve the situation. There are have been quite a few of these programs: Reform and Development of Healthcare (2005-2010), Development of Cardiac and Cardiac Surgery Assistance (2007-2009), and Salamatty Kazakhstan (2011-2015). The pilot project Disease Management Program was introduced in 2013 and since then teams of doctors have been traveling across the country and promoting screenings. Officials suggest that programs altogether helped to reduce mortality from CVDs from 535.5 per 100,000 people in 2005 to 200.26 in 2015. But the declared effectiveness is still somewhat debatable.
Another major highlight has been implementation of compulsory health insurance. Earlier the system operated on a voluntary basis, while introduction of a compulsory system bears substantial upgrades. Under the new system, employers became responsible for paying contributions to a special fund that should cover treatment of medical services, while financing of healthcare has become more sustainable, ensuring adequate and more efficient allocation of funds.
The situation with cardiovascular diseases in Almaty might shed light on the contrasting nature of achievements in Kazakhstan more broadly. Although the former capital is the most economically developed part of the country with arguably the best quality of healthcare service, its rates of CVDs have been on the rise. According to the findings of Kazakhstan’s Medical University “KSPH,” cardiovascular diseases grew by 5 percent nationwide during 2013-2016, while numbers in Almaty jumped by 22 percent. The difference reflects better detectability, availability of screenings, and improved awareness among the public. As a result, the situation across the country and particularly throughout rural and remote areas might be much worse — with the lower nationwide rise in CVDs a product of less robust detention and not a healthier population.
The positive official attitudes do not seem to be shared by those who face the realities of local healthcare every day. Aizhan Nurgazinova, a journalist, says, “Although the society is optimistic about the new insurance program, there are serious debates about safety of the fund and whether it could cover required amounts of services and meet the quality.”
Nurgazinova further compares new state-run programs to a many years struggle with chronic diseases. “Progressive reforms are being adopted, the best international experience introduced, but the output is not exactly what society is waiting for,” she adds. “Even though new measures improve the overall situation, positive changes happen too slowly. There is still a deficit of qualified personnel that pushes some patients to wait for months; many doctors almost never write prescriptions with foreign medicines and choose local ones instead. As a result, those who could afford apply to private healthcare services,” she concludes.
Some specialists that asked to stay unnamed expressed doubts. “Although such program as Disease Management looks great on the paper, it faces hurdles when applied within settings of rural or remote areas. Only 12 minutes are allocated for a reception of one patient and doctors don’t have enough time to listen to the heart properly, measure blood pressure, not to mention convey conversations about health awareness.”
There is also a lack of cardiologists in primary healthcare throughout rural areas, as well as insufficient continuity between different stages of medical care. There are likewise unspoken speculations about available data being allegedly selectively used to correspond with the official narrative of success and achievements, which does not contribute to the fair and impartial discussion of problems. Then there is persisting ineffectiveness in policies for improving socioeconomic factors to combat excessive alcohol and tobacco consumption, as well as levels of sodium intake.
It is also not evident whether officials are prepared to effectively tackle corruption. According to the latest report by Transparency International, Kazakhstan ranks 122nd in the Corruption Perceptions Index. Although there have been a number of high-ranked arrests in the past — former Kazakh Health Minister Zhaqsylyq Dosqaliev was sentenced to seven years in prison for corruption in 2011 and several officials of the ministry detained over allegations of bribery and lobbying in 2017 — a decisive and effective nationwide anti-corruption program is still missing. There is a pressuring need for a solid stance in addressing widespread violations in hospitals and specifically among low-paid staff, who are routinely accused of taking bribes to supply services and prescriptions.
Although multiple problems remain, general attitudes about the nation’s healthcare system are moderately positive. “There is a substantial difference of what we faced 10 years ago; there have been lots of positive changes that are impossible to disregard,” claims Gulnara Kurmanbekova, associate professor of cardiology at Kazakh Medical University of Continuing Education. “We’ve witnessed increased implementation of American and European standards; I’m optimistic about the direction we are heading to,” she added.
Whether the above-mentioned difficulties are going to be tackled or not is still a matter of discussion. It is, however, obvious that further changes are impossible to convey without a more fundamental approach and long-term strategic solutions that would not only epitomize the Central Asian nation’s capacity to break away from a troubled legacy, but establish an effective healthcare system.
Dmitriy Frolovskiy is a political analyst and independent journalist. He is a consultant on policy and strategy in the Middle East and Central Asia.
Special thanks to Inna Lechshinskaya-Popova, a senior lecturer of the Kazakh Medical University of Continuing Education, for helping with data.