1. Development of a master plan for the restructuring of the hospital sector of the Republic of Kazakhstan Ministry of health and social development of Republic of Kazakhstan Republican State Enterprise the "Republican center of development of health protection" republican state enterprise on rights for an economic conduct «Republican center of development of health protection» Zh. Ospanova

2. The basis for the restructuring of the hospital sector Message from the President of the Republic of Kazakhstan NA Nazarbayev to people of Kazakhstan "Socio-economic modernization - main direction of development of Kazakhstan" (27.01.12) 4 direction of the State program of Health of the Republic of Kazakhstan "Salamatty Kazakhstan" for 2011-2015 "Improvement of the organization, management and financing of health care in the Unified National Health System" Government Decision on 15.12.09g. № 2131 "On approval of the state standard of the network of health care organizations of the Republic of Kazakhstan" Strategic Plan of the Ministry of Health of Kazakhstan for 2011-2014 2

3. The basis for the restructuring of the hospital sector reduction in hospital beds as part of the Unified National Health System reduce consumption of hospital care before 1172 bed-days per 1 000 population in 2015 improving the efficiency of the work (intensification) inpatient beds review of the hospital network in the appropriate levels of care improving the performance of organizations (autonomy and independence) 3

4. Prerequisites Planning modern hospital network current situation Improving the planning and creation of a modern network of health care organizations that provide inpatient care Irrational use of funding in the construction of medical institutions Excessive operating costs of the building Costs of management of hospitals The slow pace of introduction of modern technologies 63% of hospitals are located in buildings constructed more than 30 years ago; approximately 24.4% of hospitals are located in non-standard buildings; 25% of hospitals have a low bed capacity (from 50 to 100 beds); according to the minimum standards of hospital equipment 1/3 fully provided with the necessary equipment and medical devices irrational planning the construction of MO 4

5. The approaches to the planning of the hospital sector The proposed standards A network of hospitals in terms of medical care: Level 1 - Area; 2nd level multidisciplinary regional (city, district); 3rd level region; 4th level Repablican centers Beds on profiles Personnel by function Basic medical equipment The demographic outlook to 2025 The service area of each hospital (minimum and maximum number of people) Correction factors: geographical location, economic development, health indicators The required number of beds on profiles The required number of staff by function Required basic equipment 5

6. Development and implementation of the necessary parameters for the efficient operation of hospital organizations Planning parameters based on the size, population needs and standards of normative legal act the specification of areas of infrastructure number of beds number of employees Required equipment list 6

7. Standards based on the number of population and the need for services National standards Karaganda South Kazakhstan Akmola East Kazakhstan Beds on the profiles 100,000 population Personnel specialties per 100,000 population The need for high-tech equipment future admissions Modern medical practice Access / geography Access / geography Application Standard + Adjustment factors lead to the provision of the required count of beds, staff and equipment for the field 7

8. The components for the development of the master plan  Age of each hospital  Productivity / efficiency of hospitals in the network  % Depreciation / amortization hospital infrastructure  The presence of the necessary equipment  Streams of community / access roads to the hospital  Plans for the future development of the region corresponding to the regional development programs, as well as the region's economic growth  Compliance with international standards of hospital design  Standard infection control (especially for tuberculosis hospitals) 8

9. Number of hospitals per 100 000 population A comparison with international indicators and the estimated number of Database health for all, 2012г. Sanigest calculations for master plans, 2012г. 9

10. The number of hospitals in the regions of Kazakhstan Per 100,000 population in 2011 In the Republic of Kazakhstan as a whole and in some areas there is a large number of hospitals in international comparison 10

11. Comparison of the hospital sector on an international scale According to the World Health Organization in 1990, the number of hospital beds in Kazakhstan was one of the highest in Europe. Indicators of hospital organizations in the EU and OECD countries account for 2.67 - 2.98 (RK - 4.2) and the beds within the 545 - 490 per 100 000 population (RC - 533), respectively. The index of bunks in Kazakhstan exceeds 1.4 times the figure in Australia, 1.1 times - in the Netherlands, and 1.1 times - in Canada. The mean duration of hospital stay in Kazakhstan - 9.5 days, which is more than 3.8 times of the figure in Australia and 1.8 times - in the Netherlands and Canada. Security in the Republic of Kazakhstan: hospital organizations decreased from 4.7 per 100 thousand. population in 2011 to 4.2 in 2014; beds from 61.4 in 2011 to 53.3 per 10 thousand. us. in 2014 12

12. The proposed levels of hospitals, taking into account the needs of the population and access time Rehabilitation centers from 150 000 to 1 million. Us., Department - 20 beds per 100 000 of us., Hospices - 27 beds per 100 000 population. 300,000 -1,000,000. Population, including multidisciplinary, oncological, and others. 50 000 - 300 000 population. Basic + specialty specialized beds (cardiology, neurology, endocrinology and others.) > 1 million. People. 20 000 - 50 000 population. 4 basic specialties: internal medicine, surgery, obstetrics and pediatrics. As an exception, with a population of less than 20 000 or, in the absence within a radius of 60-120 minutes district hospital created Rural Hospital Level 3 regional hospitals Level 4: a highly - holdings, and national research centers Level 2: inter-district (regional, multi-disciplinary) Hospital Level 1: district hospitals rehabilitation and palliative care 13

13. The master plan for the restructuring of the hospital sector for 10 years investment project for 10 years Options for restructuring the hospital sector The development of rehabilitation services and hospices Modernization of medical organizations Overhaul and bring to international standards of medical organizations Strengthening the material-technical base republi can budget local budget Public Private Partnership Replacing old construction of new health organization Using vacate the building for the needs of the health system Merge several medical organizations Closing low- power medical organization 14

14. Current (left) and recommended (right) Network hospital level (For example, Kyzylorda oblast) 15

15. The existing and proposed schemes Almaty hospital network 16

16. Changes to the state standard of the network of health care organizations of the Republic of Kazakhstan (taking into account the recommendations of the master plan for optimizing the hospital sector and the development of primary health care) Resolution of the Government of the Republic of Kazakhstan dated December 15, 2009 № 2131 "On approval of the state standard of the network of health care organizations of the Republic of Kazakhstan" Future plans for the development of a network of health care organizations of 16 regions for 2015-2025 (developed with the advice of the master plan and approved by the regional akimats) » Resolution of the Government of the Republic of Kazakhstan dated February 19, 2014 № 114 "On approval of the state standard of the network of health care organizations of the Republic of Kazakhstan" 17

17. Recommended steps a master plan for optimizing the hospital sector and the development of primary health care Normative legal support ongoing activities Combining several medical organizations in the unified management and development of autonomous control of health care organizations Ensuring the development of modern traffic and communication system 18

18. Events prospective development plan of the network of health care organizations in the years 2015- 2025 Regions Number of hospital organizations on 01.01.15 Total for the region в том числе: Number of hospital organizations in 2025 availability of hospital organizations per 100 thousand population maintain the status an association м general hospitals district hospitals Rehabilitation center hospice Hospital nursing care close / transfer in primary care Akmola35 121510121331 Aktobe32 95410020225 Аlmaty81 26151211450858 Аtyrau30 11533020619 East Kazakhstan76 3212516110955 Zhambul40 18567002233 Western Kazakhstan 35 107311010325 Каraganda57 251759000139 Коstanay44 163514010536 Кyzylorda50 251644001034 Маngistau23 14305000119 Pаvlodar30 12539000124 North Kazakhstan27 10429200023 South Kazakhstan103 26307154211855 Аstana23 221000000 Аlmaty43 28930210034 Total Kazakhstan729 296138671331417559532 2,5 19

19. The number of hospitals in the Republic of Kazakhstan by regions for 2012, 2015 and 2020 The Republic of Kazakhstan 201220152020 Number of hospitals757729604 Provision be hospitals4,54,23,3 - 2012 - 2015 - 2020 Western Kazakhstan Atyrau Mangistau Aktobe North KAzakstan ЮКО East Kazakhstan Kyzylorda Karaganda Zhambyl Almaty region Kostanay Akmola Pavlodar Almaty city Astana city 2323 2323 2424 2525 2424 2323 282727 2626 3131 3232 2828 3131 3030 2626 36 3535 33 3737 4747 3838 3535 34 4242 43 3535 4242 4242 3838 30 2828 45 4 3232 66 5757 5050 79 7676 5353 8383 8181 6767 108 103 74 20

20. ЗКО Атырауская Мангистауская Актюбинская СКО ЮКО ВКО Кызылординская Карагандинская Жамбылская Алматинская Костанайская Акмолинская Павлодарская гАлматы гАстана 566 3 497 4 413 5 387 5 3690 452 3 8945 8705 10 078 3228 29692945 958 8 873 3 6902 5991 53985702 4300 39293500 8802 77557003 5850 49274340 5283 504 0 411 0 2725 260 0 317 0 5585 4949 3825 4389 395 3 329 0 8642 82798519 5371 53796076 12 224 11479 13 715 Количество коек в РК в разрезе регионов на 2012, 2015 и 2020 годы РК 201220152020 количество коек1004619275991833 обеспеченность койками59,453,349,6 - 2012 - 2015 - 2020 21

21. Thank you for attention!