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KazakhstanHealth systems in transition

10.1 Re erences

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10 Appendices
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Development or 20052010, approved by presidential decree on 13 September 2004 . Astana, Ministry o Health.Ministry o Health (2006a). Annual fnancial report . Astana, Ministry o Health.Ministry o Health (2006b) [web site]. O sovmestnjh dejstviah Ministerstvazdravoohranenija RK i Detskoto Fonda OON (UNICEF) po predotvrashtenijurasprostranenija VICH/SPIN sredi detej v IUshno-Kazahstanskoj oblasti [On thecurrent activities o the Ministry o Health o the Republic o Kazakhstan and the

United Nations Childrens Fund (UNICEF) to prevent the spread o HIV/AIDSamong children in South Kazakhstan oblast]. Press release, 11 October 2006.Astana, Ministry o Health (http://www.mz.gov.kz/index.php?wakka=Rus/ Media/PressRelizy/23, accessed 12 August 2007).
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Project0In orm1cument1Concept0Stage.pd , accessed 19 September 2007).World Bank (2006b). Kazakhstan: re orming intergovernmental fscal relations.

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10.3 Use ul web sites

European Bank or Reconstruction andDevelopment (EBRD) Kazakhstan homepage

http://www.ebrd.com/country/country/ kaza/index.htm

European Observatory on Health Systems andPolicies

http://www.euro.who.int/observatory

Global Fund to Fight AIDS, Tuberculosis andMalaria (GFATM) (country web site)

http://www.theglobal und.org/programs/countrysite.aspx?countryid=KAZ&lang=en

Government o Kazakhstan http://www.government.kz

International Institute o Modern Policy http://www.iimp.kz/de ault.aspx

Kazakhstan Institute o Management, Economicsand Strategic Research

http://www.kimep.kz/

Kazakhstan Revenue Watch http://www.kazakhstanrevenuewatch.org/

Kazakhstan Stomatological Association http://www.ksa.kz/

Medin orm http://www.medin o.kz/

Ministry o Finance http://www.minfn.kz/

Ministry o Health http://www.mz.gov.kz

National Resource Centre or nongovernmentalorganizations (NGO) in Kazakhstan

http://www.npo.kz/

National School o Public Health http://www.ksph.kz/

National Statistical Agency o the Republic oKazakhstan (Goskomstat)

http://www.stat.kz

Organization or Security and Co-operation inEurope (OSCE) Centre in Almaty

http://www.osce.org/almaty/

President o Kazakhstan http://www.akorda.kz/

Soros Foundation Kazakhstan http://www.soros.kz/

The World Banks Mission in Kazakhstan http://www.worldbank.org.kz/

United Nations system in Kazakhstan http://www.un.kz/

United States Agency or InternationalDevelopment (USAID) (country website)

http://www.usaid.gov/locations/europe_eurasia/car/kzpage.html

World Health Organization (WHO) (country website)

http://www.who.int/countries/kaz/en/

ZdravPlus Project http://www.zplus.kz/
http://www.ebrd.com/country/country/kaza/index.htmhttp://www.ebrd.com/country/country/kaza/index.htmhttp://www.euro.who.int/observatoryhttp://www.theglobalfundorg/programs/countrysite.aspx?countryid=KAZ&lang=enhttp://www.theglobalfundorg/programs/countrysite.aspx?countryid=KAZ&lang=enhttp://www.theglobalfundorg/programs/countrysite.aspx?countryid=KAZ&lang=enhttp://www.government.kz/http://www.iimp.kz/default.aspxhttp://www.kimep.kz/http://www.kazakhstanrevenuewatch.org/http://www.ksa.kz/http://www.medinfo.kz/http://www.minfin.kz/http://www.mz.gov.kz/http://www.npo.kz/http://www.ksph.kz/http://www.stat.kz/http://www.osce.org/almaty/http://www.akorda.kz/http://www.soros.kz/http://www.worldbank.org.kz/http://www.un.kz/http://www.usaid.gov/locations/europe_eurasia/car/kzpage.htmlhttp://www.usaid.gov/locations/europe_eurasia/car/kzpage.htmlhttp://www.who.int/countries/kaz/en/http://www.zplus.kz/http://www.zplus.kz/http://www.who.int/countries/kaz/en/http://www.usaid.gov/locations/europe_eurasia/car/kzpage.htmlhttp://www.un.kz/http://www.worldbank.org.kz/http://www.soros.kz/http://www.akorda.kz/http://www.osce.org/almaty/http://www.stat.kz/http://www.ksph.kz/http://www.npo.kz/http://www.mz.gov.kz/http://www.minfin.kz/http://www.medinfo.kz/http://www.ksa.kz/http://www.kazakhstanrevenuewatch.org/http://www.kimep.kz/http://www.iimp.kz/default.aspxhttp://www.government.kz/http://www.theglobalfundorg/programs/countrysite.aspx?countryid=KAZ&lang=enhttp://www.euro.who.int/observatoryhttp://www.ebrd.com/country/country/kaza/index.htm


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10.4 Principal legislation

Laws and regulations may be enacted by Presidential Decree, by an Act o Parliament, by a Government Executive Order or by Ministerial Orders. Theollowing is a list o some o the key initiatives.

1991 Law on Protection o the Peoples Health

21 June 1991 Law on Social Protection o Handicapped and Disabled

1992 Executive Directive The concept o health care re orm

1992 Law on National Budget

9 April 1993 Law on Trade Unions

1994 Law on Sanitary-epidemiological Wel are

5 October 1994 Law on HIV/AIDS Prevention

19 June 1995 Law on State-run Enterprises

1995 Law on Local Sel -government

1995 Presidential Decree on Compulsory Medical Insurance

1995 Presidential Edict on Privatization

1996 Law on Pharmaceutical Aid1996 Law on Psychiatric Care and Entitlement o Citizens

1996 Law on Supplemental Measures to Decrease In ections

1996 Law on Prevention o AIDS

28 March 1996 Decree No. 369 on Financing o Medical Protection o Citizens

1996 Government Decree (No. 246) on Privatization and Restructuring o StateProperty

1997 Government Decree (No. 65) on Sectoral Programmes or Privatization andRestructuring

1997 Government Decree on Measures or Public Administration Restructuring

1997 Decree (No. 1387) on Reorganization o the Mandatory Health InsuranceFund

1997 Presidents Message Kazakhstan 2030

12 March 1997 Government Resolution No. 1678 on the National Healthy Li e Style Centreo the Ministry o Education, Culture and Health

19 May 1997 Law on Health Protection

12 August 1997 Order No. 470 o the Ministry o Education, Culture and Health on the

National Healthy Li e Style Centre o the Ministry o Education, Culture andHealth

1998 Law on Family Practice

18 May 1998 Presidential Decree on Urgent Measures to Improve the Health Status othe Population o the Republic o Kazakhstan


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16 November1998

Presidential Decree No. 4153 on the State Programme Health o thePopulation

31 December1998

Government Decree No. 1387 on the Reorganization o the CompulsoryMedical Insurance Fund

31 December1998

Government Decree No. 1382 on Urgent Measures to Improve theOrganization o Medical and Sanitary Assistance to the Population or thePrevention and Resolution o Extraordinary Situations

26 April 1999 Decree on Measures or Improving Primary Heath Care or the RuralPopulation

30 June 1999 Government Resolution No. 905 on the Healthy Li estyle Programme or theperiod 19992010

1999 Decree No. 70 on the Guaranteed Benefts Package3 December1999

Regulations on the Agency or Health

10 December1999

Law on Compulsory Treatment o Patients with In ectious Tuberculosis

27 January 2000 Government Decree No. 135 approving a Guaranteed Level o Free MedicalAssistance

3 May 2000 Government Decree No. 650 on the Fundamentals o Privatization o HealthCare Institutions or the years 20002005

5 May 2000 Government Resolution No. 674 on the Provision o Drugs by Disease Typeand Specialized Nutrition Products or Children and Certain PopulationCategories

25 May 2000 Government Decree No. 790 on the Fundamentals o the FurtherDevelopment o Health Care in the Republic o Kazakhstan in the years20002005

27 May 2000 Government Resolution No. 806 on Approval o Rules or Reimbursemento Costs or Health Services

11 July 2000 Government Decree No. 1052 approving the Rules o Privatization o HealthCare Institutions

14 May 2001 Government Decree No. 630 approving the Programme o HealthProtection o Mothers and Children in the Republic o Kazakhstan or theyears 20012005

7 June 2001 Government Decree No. 767 on Approval o Rules o Licensing o MedicalActivity

2002 Law on Preventing and Reducing Tobacco Smoking

January 2002 Government Decree No. 93 on the Sectoral Programme on Drinking Wateror 20022010

11 January 2002 Government Decree No. 41 on the System o Labour Remuneration oPublic Employees who are not Civil Servants

16 May 2002 Law on State Procurement

29 May 2002 Government Decree No. 584 on the Fundamentals o Medical Policy

11 July 2002 Law on Social, Medical and Pedagogical Support or Children with LimitedCapabilities


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13 July 2002 Government Decree No. 773 on the Fundamentals or the Improvement othe Financing o the Health System

25 July 2002 Government Decree No. 828 approving the Rules on Payable MedicalServices in Organizations o the State Health System

1 August 2002 Resolution No. 174 o the Ministry o Labour and Social Protection onImplementation o Legal Acts on the Issue o Social Protection or Disabledand Handicapped

4 December2002

Law on Sanitary-epidemiological Well-being o the Population

2003 Ministry o Health Decree on Mandatory Standards or Medical andPharmaceutical Education

15 January 2003 Presidential Decree No. 1016 to amend and supplement the PresidentialDecree No. 4153 o 16 November 1998, amending the State ProgrammeHealth o the Population with regard to medical assistance and fnancingsources

7 February 2003 Government Resolution No. 138 on Approval o Rules or StateProcurement o Health Services Based on Fixed Tari s

4 June 2003 Law on the Health Care System

27 September2003

Decree No. 988 on Additions and Modifcations to the Law on HIV/AIDSPrevention

14 October 2003 Law on Prevention o Iodine-defciency Conditions

8 January 2004 Government Decree on Approval o Accreditation Rules in the HealthSector

13 January 2004 Law on Pharmaceuticals

21 January 2004 Government Decree No. 60 on the Establishment o Rules or ConductingCertifcations in the Health Sector

16 February2004

Government Decree No. 184 on Standardization in the Health Sector

19 March 2004 Adoption o the development strategy Towards a competitive Kazakhstan,a competitive economy, and a competitive nation

8 April 2004 Law on Quality and Sa ety o Food Products

24 April 2004 Budget Code

16 June 2004 Law on Reproductive Rights

13 August 2004 Governmental Decree No. 850 on the Programme on Strengthening oTuberculosis Control in the Republic o Kazakhstan or 2004-2006

13 September2004

Presidential Decree No. 1438 on the National Programme o Health CareRe orm and Development or 20052010

13 October 2004 Government Decree No. 1050 approving the Action Plan or Implementation

o the National Programme o Health Care Re orm and Development or20052010

28 October 2004 Government Decree No. 1117 on Issues o the Ministry o Health

29 October 2004 Government Decree No. 1124 on Issues o the Pharmacy Committee


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10.5 HiT methodology and production process

The Health Systems in Transition (HiT) profles are produced by countryexperts in collaboration with the Observatorys research directors and sta .The profles are based on a template that, revised periodically, provides detailedguidelines and specifc questions, defnitions, suggestions or data sources, andexamples needed to compile HiTs. While the template o ers a comprehensiveset o questions, it is intended to be used in a exible way to allow authors andeditors to adapt it to their particular national context. The most recent template isavailable online at: http://www.euro.who.int/observatory/Hits/20020525_1.

Authors draw on multiple data sources or the compilation o HiT profles,ranging rom national statistics, national and regional policy documents,and published literature. Furthermore, international data sources may beincorporated, such as those o the Organisation or Economic Co-operation andDevelopment (OECD) and the World Bank. OECD Health Data contain over1200 indicators or the 30 OECD countries. Data are drawn rom in ormationcollected by national statistical bureaux and health ministries. The World Bank provides World Development Indicators.

In addition to the in ormation and data provided by the country experts,the Observatory supplies quantitative data in the orm o a set o standardcomparative fgures or each country, drawing on the European Health or All(HFA) database. The HFA database contains more than 600 indicators defnedby the WHO Regional O fce or Europe or the purpose o monitoring Healthor All policies in Europe. It is updated or distribution twice a year rom varioussources, relying largely upon o fcial fgures provided by governments, as wellas health statistics collected by the technical units o the WHO Regional O fceor Europe. The standard HFA data have been o fcially approved by national

governments. With its January 2007 edition, the HFA database started to takeaccount o the enlarged European Union (EU) o 27 Member States.HiT authors are encouraged to discuss the data in the text in detail, especially

i there are concerns about discrepancies between the data available romdi erent sources.

A typical HiT profle consists o 10 chapters:1. Introduction : outlines the broader context o the health system, including

geography and sociodemography, economic and political context, and

population health.2. Organizational structure : provides an overview o how the health system

in a country is organized and outlines the main actors and their decision-making powers; discusses the historical background or the system; and
http://www.euro.who.int/observatory/Hits/20020525_1http://www.euro.who.int/observatory/Hits/20020525_1


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describes the level o patient empowerment in the areas o in ormation,rights, choice, complaints procedures, sa ety and involvement.

3. Financing : provides in ormation on the level o expenditure, who iscovered, what benefts are covered, the sources o health care fnance,how resources are pooled and allocated, the main areas o expenditure,and how providers are paid.

4. Regulation and planning : addresses the process o policy development,establishing goals and priorities; deals with questions about relationshipsbetween institutional actors, with specifc emphasis on their role inregulation and what aspects are subject to regulation; and describes

the process o health technology assessment (HTA) and research anddevelopment.

5. Physical and human resources : deals with the planning and distributiono in rastructure and capital stock; the context in which in ormationtechnology (IT) systems operate; and human resource input into thehealth system, including in ormation on registration, training, trendsand career paths.

6. Provision o services : concentrates on patient ows, organization and

delivery o services, addressing public health, primary and secondaryhealth care, emergency and day care, rehabilitation, pharmaceutical care,long-term care, services or in ormal carers, palliative care, mental healthcare, dental care, complementary and alternative medicine, and healthcare or specifc populations.

7. Principal health care re orms : reviews re orms, policies andorganizational changes that have had a substantial impact on healthcare.

8. Assessment o the health system : provides an assessment based onthe stated objectives o the health system, the distribution o costs andbenefts across the population, e fciency o resource allocation, technicale fciency in health care production, quality o care, and contribution o health care to health improvement.

9. Conclusions : highlights the lessons learned rom health system changes;summarizes remaining challenges and uture prospects.

10. Appendices : includes re erences, use ul web sites and legislation.

Producing a HiT is a complex process. It involves:writing and editing the report, o ten in multiple iterations;


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external review by (inter)national experts and the countrys Ministry o Health the authors are supposed to consider comments provided by theMinistry o Health, but not necessarily include them in the fnal version;external review by the editors and international multidisciplinary editorialboard;fnalizing the profle, including the stages o copy-editing and typesetting;

dissemination (hard copies, electronic publication, translations andlaunches).The editor supports the authors throughout the production process and in

close consultation with the authors ensures that all stages o the process aretaken orward as e ectively as possible.

10.6 About the authors

Maksut Kulzhanov is Rector o the Kazakhstan School o Public Health inAlmaty, President o the National Association o Public Health and ormerDeputy Minister o Health.

Bernd Rechel is Research Fellow at the European Observatory on HealthSystems and Policies and Honorary Lecturer at the Health Policy Unit at theLondon School o Hygiene and Tropical Medicine.


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T he Health Systems in Transition (HiT) country pro les provide ananalytical description of each health care system and of reform initiativesin progress or under development. They aim to provide relevantcomparative information to support policy-makers and analysts in the develop-ment of health systems and reforms in the countries of the European Regionand beyond. The HiT pro les are building blocks that can be used:

to learn in detail about different approaches to the nancing, organizationand delivery of health care services;

to describe accurately the process, content and implementation of healthcare reform programmes;to highlight common challenges and areas that require more in-depthanalysis; andto provide a tool for the dissemination of information on health systems andthe exchange of experiences of reform strategies between policy- makers andanalysts in countries of the WHO European Region.

The Health Systems in Transition

profles

A series o the European Observatory on HealthSystems and Policies

The publications othe European Observatory

on Health Systems andPolicies are available on

www.euro.who.int/observatory

How to obtain a HiTAll HiT pro les are available in PDF formaton www.euro.who.int/observatory , where youcan also join our listserve for monthly updatesof the activities of the European Observatoryon Health Systems and Policies, includingnew HiTs, books in our co-published serieswith Open University Press, policy briefs, the EuroObserver newsletter and the Eurohealth

journal. If you would like to order a paper copyof a HiT, please write to:

[email protected]
http://www.euro.who.int/observatoryhttp://www.euro.who.int/observatoryhttp://www.euro.who.int/observatorymailto:[email protected]:[email protected]://www.euro.who.int/observatoryhttp://www.euro.who.int/observatory


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HiT country profles published to date:

Albania (1999, 2002 a,g )Andorra (2004)Armenia (2001 g , 2006)Australia (2002, 2006)Austria (2001 e , 2006 e )Azerbaijan (2004 g )Belgium (2000, 2007)Bosnia and Herzegovina (2002 g )Bulgaria (1999, 2003 b , 2007)Canada (2005)

Croatia (1999, 2007)Cyprus (2004)Czech Republic (2000, 2005 g )Denmark (2001, 2007)Estonia (2000, 2004 g,j )Finland (2002)France (2004 c,g )Georgia (2002 d,g )Germany (2000 e , 2004 e,g )Hungary (1999, 2004)Iceland (2003)Israel (2003)

Italy (2001)Kazakhstan (1999 g , 2007)Kyrgyzstan (2000 g , 2005 g )Latvia (2001)Lithuania (2000)Luxembourg (1999)Malta (1999)Mongolia (2007)Netherlands (2004 g )New Zealand (2001)Norway (2000, 2006)Poland (1999, 2005)Portugal (1999, 2004, 2007)Republic o Moldova (2002 g )Romania (2000 f )Russian Federation (2003 g )Slovakia (2000, 2004)Slovenia (2002)Spain (2000 h )Sweden (2001, 2005)Switzerland (2000)Tajikistan (2000)The ormer Yugoslav Republic o Macedonia (2000)Turkey (2002 g,i )Turkmenistan (2000)Ukraine (2004 g )United Kingdom o Great Britain and Northern Ireland (1999 g )Uzbekistan (2001 g , 2007)

Key

All HiTs are available in English.When noted, they are also availablein other languages: a Albanian b Bulgarian

c

French d Georgian e German f Romanian g Russian

h Spanishi Turkish

j Estonian


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