The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis.
When Kazakhstan became independent in 1991, it faced many of the same challenges as other countries from the former Soviet Union, including an oversized and inpatient-oriented system of health facilities and a drop in health financing in the early transition years. Although the country embarked on several major health reforms in the second half of the 1990s, these often lacked consistency and clear direction. In the wake of the economic upswing fuelled by oil revenues in recent years, in 2004 Kazakhstan initiated a comprehensive National Programme of Health Care Reform and Development for the period 2005–2010.
One of the key challenges addressed by the reform programme is the considerable inequities in terms of health financing per capita between the country’s oblasts (regions) and between urban and rural areas. Another major challenge is out-of-pocket payments for health services and pharmaceuticals, although the magnitude of these payments remains unknown. Despite an increased emphasis on primary care, the inpatient sector continues to consume the bulk of health funding, and the question of specialized and parallel health services has so far not been addressed by the reform programme. Overall, more attention will need to be paid to the quality and efficiency of health services. A system of monitoring and evaluation, as well as the establishment of clinical practice guidelines, could play an important role in achieving these aims.
Many rural areas are lacking sufficient numbers of health care workers, while an oversupply exists in the major cities. A comprehensive system of human resources planning and the introduction of incentives for health care workers in rural areas might present an avenue for addressing this challenge.