1. Population Health and Policy review for Republic of Kazakhstan Madina Takenova Kazakhstan School of Public Health Kazakhstan APACPH conference Early career network workshop November 19-23, 2005 Taipei

2. Republic of Kazakhstan Population – 15, 072 million Territory – 2724.9 thousand km2 Capital –Astana 57% urban population, 43% rural

3. Life expectancy at birth, Kazakhstan, 1965-2004 Demographic situation in Kazakhstan (per 1000), 1965-2004

4. 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

6. 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

7. Main health and socio-economic indicators 19982004 Total population (million) 15,515,01 Human development Index (HDI) 0,7420.76 Life expectancy at birth 6566,14 Population growth rate 4,47,9 Birth rate per 1000 14.818,1 Death rate per 1000 10,2 Live births per 1000 population 14,815,3 Infant mortality Rate per 1000 live births 21,414,5 Total Fertility rate 22,2 Maternal mortality (per 100000 live births) 5936.9 Under-5 mortality rate (BUCEN) per 1000 live births 35,269,6 TB incidence per 100 000 (all forms) 118.8154,3 HIV prevalence 299698 GDP per capita, $US1497,21995,4 total allocations for health care, % of GDP22,61 correlation btw highest income h/hold and lowest income quintile 68

8. Trends of Tuberculosis in Kazakhstan

9. 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

10. 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

11. HIV transmission patterns dynamic

12. Prognosis for HIV infection in case of untimely activities Sanigest Internacional 2004

13. Emerging issues of population health 1.Increase of socially significant diseases 1.TB morbidity increased more than twice 2.STD 3.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 health 5.Environmental pollution; 6.Lack of financing of medical institutions

14. 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

15. 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)

16. 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

17. 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.

18. 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

19. 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…