population health and policy review for republic of kazakhstan madina takenova kazakhstan school of...
TRANSCRIPT
Population Health and Policy review for
Republic of KazakhstanMadina Takenova
Kazakhstan School of Public HealthKazakhstan
APACPH conferenceEarly career network workshopNovember 19-23, 2005 Taipei
Republic of Kazakhstan
Population – 15, 072 millionTerritory – 2724.9 thousand km2Capital –Astana
57% urban population, 43% rural
Life expectancy at birth, Kazakhstan, 1965-2004
616263646566676869707172
1964
-196
5
1969
-197
0
1974
-197
5
1979
-198
0
1984
-198
5
1989
-199
0
1993
-199
419
9519
9619
9719
9819
9920
0020
04
0
5
10
15
20
25
30
1965
1970
1980
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2004
Death rate
Live births
Demographic situation in Kazakhstan
(per 1000), 1965-2004
Leading causes of morbidity and mortality in Kazakhstan
• Overall morbidity – 99 627,7 per 100 000 in 2004• Morbidity incidence : I place- Diseases of
respiratory system, CV diseases; III – Urogenital diseases
• Mortality: Cardiovascular diseases, Neoplasms, Trauma & poisoning
Incidence of socially significant diseases in 2003-2004 (per 100 000 population)
154,3 194,2 196,6 404,1
3988,4
79,3 106,30
50010001500200025003000350040004500
TB
Mali
gnant
neop
lasm
s
Psych
iatric
diso
rder
s
Narcolog
ical d
isord
ers
Traum
a, po
isonin
g
Syphilis
Diabe
tus m
elitu
s
rate
per
100
000
po
pu
lati
on
2003
2004
Reproductive health • Infant mortality – 14,5 per 1000 newborns• MMR is highest among CA countries – 36.9 per
100,000 livebirths• High rate of pregnancy and delivery complications –
60%• Contraceptive prevalence rate on rise – 50.7 (MoH,
2002)• During 10 years the absolute amount of abortions in
RK decreased by 2.3 times• Unmet need for family planning – 8.7% (DHS, 1999)• Access and quality of reproductive health services
poor in rural areas
Main health and socio-economic indicators 1998 2004
Total population (million) 15,5 15,01
Human development Index (HDI) 0,742 0.76
Life expectancy at birth 65 66,14
Population growth rate 4,4 7,9
Birth rate per 1000 14.8 18,1
Death rate per 1000 10,2 10,2
Live births per 1000 population 14,8 15,3
Infant mortality Rate per 1000 live births 21,4 14,5
Total Fertility rate 2 2,2
Maternal mortality (per 100000 live births) 59 36.9
Under-5 mortality rate (BUCEN) per 1000 live births 35,2 69,6
TB incidence per 100 000 (all forms) 118.8 154,3
HIV prevalence 299 698
GDP per capita, $US 1497,2 1995,4
total allocations for health care, % of GDP 2 2,61
correlation btw highest income h/hold and lowest income quintile
6 8
Trends of Tuberculosis in Kazakhstan
449,5
154,3
20,6
0
50
100
150
200
250
300
350
400
450
500
1996 1997 1998 1999 2000 2001 2002 2003 2004
rate
per
100
000
po
pu
lati
on
0
5
10
15
20
25
30
35
40
dea
ths
per
100
000
p
op
ula
tio
n
TB prevalence TB incidence TB mortality
TB urgent issues
• Social factor – interrupted treatment, – MDR TB (1500 cases in 2003; 56.4% previously
treated resistant for 2 or >)
• TB in prisons, amnesty (incidence 30 times higher,
mortality 9 times higher among imprisoned population); 8726 detainees with TB in KZ, 452 with MDR TB
• TB and HIV/AIDS– 99 per 100000 cases of TB HIV+
• Young TB – 15-18 years of age (yearly 1300 teenagers get infected by TB, 60% in families); 1990- 57.1 – 2000-162.2 per 100000 population
• June 2005 - officially 5008 HIV+ (699 cases), including 272 with AIDS.
Men -76% (3823) Women - 24% (1185)• Estimated number of HIV+ people is 13, 000
(according to Sentinel Surveillance data)• Registered drug users – 45000; alleged IVDU -250 000 • AIDS death rate 31.3 (220) • Transmission way: 76.6% - parenteral; 14.6% - sexual•
Trends• HIV/AIDS epidemics is at concentrated stage - prevalence rate among risk groups (IVDUs and CSWs) is steadily above 5%.• There is a trend of sexual transmission rate increase : 2001- 5%, 2002 - 16,7%, 2003 - 21,0%, 2004 - 29,3%.
* Data of the Republican AIDS Center Kazakhstan
HIV/AIDS in Kazakhstan
HIV transmission patterns dynamic
1
161 205
389264
1032
501433
1236330
51228
5
515
295
10238
0-20
200
400
600
800
1000
1200
1990 -1995
1996 1997 1998 1999 2000 2001 2002 2003 2004
sexual transmission 1 parenteral (needles sharing practices) 1
Prognosis for HIV infection in case of untimely activities
14633
22947
34292
48346
56765
77599
0
10000
20000
30000
40000
50000
60000
70000
80000
90000
Kazakhstan Central Asia
Nu
mb
er o
f H
IVca
ses
2002 2005 2010
Sanigest Internacional 2004
Emerging issues of population health
1. Increase of socially significant diseases 1. TB morbidity increased more than twice2. STD3. HIV/AIDS
2. Risk factors -smoking (for 1/3 of population); alcohol consumption, drug use
3. Unhealthy lifestyle, lack of health education and self motivation,
4. Reproductive health5. Environmental pollution; 6. Lack of financing of medical institutions
Causes of unfavorable health status of
population
• Weak preventive activities of PH policy
• Poor attitude & lake of skills toward own health
• Ineffective intersectoral collaboration on PH issues
• Social and economical troubles of transition period
National policy on population health & development
• Developmental strategy “Kazakhstan-2030”• “National Program of Health Sector Reform and
Development in the Republic of Kazakhstan for 2005-2010”
• Program & Law “On health care system of the Republic of Kazakhstan”
• State programme “Population health” -November 1998• National network on health protection and (1998)
• Developer: Ministry of Health • Timeframe: 2005-2010
– 2 steps of implementation : 2005-2007; 2008-2010
• Required resources and sources of funds: – Central and local budgets, as well as other resources
allowed by Law of the Republic of Kazakhstan; – In 2008-2010 there will be an annual increase in health
care financing and by 2010 it will increase to 4% of GDP
National Program of Health Sector Reform and Development in the Republic of Kazakhstan for 2005-2010
National Program of Health Sector Reform and Development in the Republic of Kazakhstan for 2005-2010
• Objective
• to create an effective health care delivery system based on the principles of solidarity of the state and individuals assuming responsibility for health protection, priority development of primary health care aimed at improving the health of population.
Priority tasks: • Real shift of focus to Primary health care; shift of
emphasis from inpatient to outpatient care; • Systemic transition to international standards, new
technologies, advanced treatment methods and medical service;
• Strengthening of maternal/ child health; • Creating a system of independent expertise involving
independent experts; • Training of health care system, health resource and
finance managers; • Prevention, diagnosis and treatment of socially
significant diseases; • Strengthening the technical/ material base of health
facilities;
National Program of Health Sector Reform and Development in the Republic of Kazakhstan for 2005-2010
Expected outcomes of Programme
• As a result of Program implementation, the optimal health care model satisfying needs of the people, the sector and the state will be created…