Revolutionizing Primary Health Care in Kazakhstan: A Cost-Effective Model for International Healthcare Systems
The Transformed Primary Healthcare Boom in Kazakhstan:
ASTANA, Kazakhstan - Kazakhstan's revitalized primary healthcare (PHC) system has saved around 270 million tenge (approximately $516,000) in a single region over two years, with potential national savings of up to 32 billion tenge (around $59.2 million) if scaling continues, according to Dr. Melitta Jakab, head of the World Health Organization's (WHO) European Center for PHC. In an interview with The Astana Times, she elaborated on Kazakhstan's innovative model, mental health integration, the role of technology, and its growing leadership in the transformation of global health systems.
Dr. Jakab shared insights on Kazakhstan's evolving model, the integration of mental health services, the importance of technology, and Kazakhstan's burgeoning role as an influencer in global health systems.
"Beyond mere financial efficiency, Kazakhstan's robust PHC system leads to superior health outcomes and greater equity," said Dr. Jakab.
She emphasized that governments need to prioritize primary healthcare, allocate substantial resources to ensure it functions effectively, and offers the best care possible to community members.
Multidisciplinary Approach and Modern Standards:
Discussing the CIS (Commonwealth of Independent States) countries, Dr. Jakab noted that 20 to 30 years ago; they had similar healthcare systems, heavily driven by specialists and hospitalizations. In contrast, Kazakhstan is the country that's drastically changed how primary healthcare operates and significantly bolstered its strength.
She acknowledged Kazakhstan's reforms as a shift from a hospital and specialist-based model toward a people-centered, multidisciplinary approach. The country has expanded the responsibilities of nurses, integrated psychologists and social workers into polyclinics, and established community support to decrease unnecessary hospitalizations and efficiently manage chronic conditions
"This approach goes beyond treating illness by addressing the full range of health and social needs. It supports chronic disease management, prevents unnecessary hospitalizations, and strengthens continuity of care," she stated.
Integration of Mental Health Services:
One of the most significant advancements is mental health services' integration into PHC, historically sidelined or institutionalized.
"People should be supported within their communities for their conditions. This aligns closely with the spirit of the Alma-Ata and Astana Declarations on primary health care, which promote a holistic notion of health and well-being, not just the absence of disease, but fully feeling well mentally and physically," said Dr. Jakab.
She outlines four strategies to achieve this: training general practitioners and nurses to diagnose and manage common mental health disorders, incorporating psychologists into PHC teams, facilitating joint consultations with psychiatrists, and establishing referral links with community-based mental health providers.
Kazakhstan is a trailblazer in this area, employing all these strategies to expand the availability of mental health services in the community, with many countries eagerly following suit.
As an example, she pointed to a youth health center in a former polyclinic in Astana, which features a confidential entrance for young people seeking assistance with issues like bullying, reproductive health, or anxiety.
Affordability and Accessibility:
Dr. Jakab underscored that PHC in Kazakhstan is free of charge and part of the government-funded benefit package. Nonetheless, she recognized ongoing challenges in ensuring equitable access in remote areas, where depopulation and staff shortages persist.
Addressing this, the government is constructing numerous facilities in rural regions. Dr. Jakab emphasized the importance of telemedicine as a prospective next step in strengthening these areas.
"For example, in remote villages, you can visit a community center where there's a booth with a monitor and basic diagnostic equipment-a device to measure blood pressure, temperature, and take small blood samples for blood sugar level analysis. That monitor connects to a nurse located in the next village who is on standby, providing digital consultations," said Dr. Jakab. "In my opinion, accelerating investment in telemedicine for primary healthcare would be a significant next step, complementing the progress already made."
Role of Technology and Artificial Intelligence:
The public's trust in the reformed PHC system has driven increased utilization, but it has also created a higher workload for medical teams. Dr. Jakab observed that while SHC tasks are complex, many are routine and can be supported by technology, particularly AI. She stated that AI is crucial to managing standardized care, thereby enabling family doctors and nurses to focus on patients with more complex health or behavioral needs.
"The next decade should be devoted to incorporating artificial intelligence into primary healthcare, transitioning routine tasks to AI, and reserving time for family doctors, nurses, and multidisciplinary teams to address the more complex cases," she said.
Aging populations with multiple health concerns and social isolation risks will particularly benefit from the application of AI in managing care.
Strengthening the Health Workforce:
Kazakhstan's PHC model features a redefined role for nurses.
"In Kazakhstan, there are three nurses for every family doctor, a remarkable ratio. We're seeing examples of expanded roles for nurses where they independently practice, not solely supporting doctors. In fact, we view Kazakhstan as a model for many countries," said Dr. Jakab.
She addressed ongoing barriers like underfunding, low salaries, and a lack of recognition for PHC roles.
"Globally, we face obstacles in explaining and justifying the importance and value of primary healthcare. Individuals who don't utilize primary care often struggle to appreciate its significance. It's much easier to justify the need for a hospital or medical equipment like an MRI or CT machine," she commented.
"In primary healthcare, much of the value lies in conversation. A high-quality conversation that convinces you, for example, to stop smoking," added Dr. Jakab.
She highlighted that facilities are often unattractive both for patients and health workers, subsequent to low salaries and prestige being lower for general practitioners and nurses than for specialists.
"Yet, the new model can offer a far more appealing working environment, specifically for young people. The prospect of a thriving work environment where they collaborate with a team equipped with good digital solutions and can grow professionally is truly motivating," said Dr. Jakab.
Lessons from the COVID-19 Pandemic:
Dr. Jakab affirmed that Kazakhstan's PHC reforms were already underway before the COVID-19 pandemic, but the crisis expedited their implementation and validated Kazakhstan's approach.
"The movement towards multidisciplinarity on a large scale began around 2018. The pandemic demonstrated how right that approach was because countries with that kind of system could quickly identify vulnerable people in the community and provide comprehensive support," said Dr. Jakab.
According to Dr. Jakab, nations with robust PHC systems, including the United Kingdom, Spain, Portugal, and Kazakhstan, were more adept at tackling not only medical needs but also social determinants of health, such as loneliness, food access, and mental well-being.
"The pandemic helped countries with medically oriented primary care realize that health problems often start with social issues-and that mental and physical health are deeply intertwined," she said.
"There's now a significant movement towards the Kazakh and Spanish model of multidisciplinarity. We're working with numerous countries to help them adopt these principles. The pandemic facilitated the spirit of the Astana and Alma-Ata Declarations," Dr. Jakab added.
Demonstration Site for the Region:
Kazakhstan houses the WHO European Center for Primary Health Care in Almaty. Since 2018, the center has supported over 20 countries within the WHO European Region. Dr. Jakab highlighted the demonstration platform initiative, with Kazakhstan selected as one of the first countries to host visiting delegations.
"We launched one in Kazakhstan, one in Spain, and one in Sweden. The Kazakh was the first, and we've hosted seven delegations here. China requested our assistance because they too wanted to observe some characteristics of this model, and we're incredibly proud of this," said Dr. Jakab.
She also spoke about the center's signature webinar series, a talk show-style initiative centered on PHC policy and practice. Over the past four years, the series has gathered an impressive 10,000+ views, reflecting the widespread global interest in PHC and cross-country exchange.
"Our webinar series has amassed over 10,000 views for different episodes. That's quite thrilling, and it reflects the strong interest in discussing primary health care and exchanging experiences across countries," stated Dr. Jakab.
The center's newsletter has also seen a surge in engagement, with over 8,000 followers now up to date on its updates.
Kazakhstan's primary healthcare system is setting a powerful example of innovation, accessibility, and inclusivity in the region and beyond.
- Kazakhstan's PHC reforms have led to substantial savings, with potential national savings of up to 32 billion tenge if scaling continues.
- Beyond financial efficiency, Kazakhstan's PHC system leads to superior health outcomes and greater equity.
- Governments should prioritize primary healthcare, allocate substantial resources, and offer the best care possible to community members.
- CIS countries had similar healthcare systems decades ago, heavily driven by specialists and hospitalizations.
- Kazakhstan is the country that drastically changed how primary healthcare operates and significantly bolstered its strength.
- Kazakhstan's reforms represent a shift from a hospital and specialist-based model toward a people-centered, multidisciplinary approach.
- The country has expanded the responsibilities of nurses, integrated psychologists and social workers into polyclinics, and established community support to decrease unnecessary hospitalizations and manage chronic conditions.
- This approach goes beyond treating illness by addressing the full range of health and social needs.
- Mental health services' integration into PHC is one of the most significant advancements.
- Governments should prioritize mental health services within their communities for better health outcomes.
- Four strategies are employed to achieve mental health services integration: training general practitioners and nurses, incorporating psychologists, facilitating joint consultations, and establishing referral links with community-based mental health providers.
- Kazakhstan is a trailblazer in mental health services integration, with many countries following suit.
- A youth health center in a former polyclinic in Astana features a confidential entrance for young people seeking assistance.
- PHC in Kazakhstan is free of charge and part of the government-funded benefit package.
- The government is constructing facilities in rural regions to enhance equitable access in remote areas.
- Telemedicine is a prospective next step in strengthening rural areas.
- A remote monitoring booth connects to a nurse in the next village for digital consultations.
- Aging populations will particularly benefit from the application of AI in managing their care.
- AI is crucial to managing standardized care, thereby enabling family doctors and nurses to focus on complex cases.
- Kazakhstan features a redefined role for nurses with a remarkable ratio of three nurses to every family doctor.
- Globally, the importance and value of primary healthcare are often hard to justify, as individuals may not appreciate its significance.
- Primary healthcare much of the value lies in conversation and persuading individuals to take steps for their health.
- Facilities are often unattractive both for patients and health workers, resulting from low salaries and prestige for primary care roles.
- The new model can offer a far more appealing working environment, specifically for young people focusing on professionals' growth.
- The COVID-19 pandemic validated Kazakhstan's approach to primary healthcare.
- Countries with robust PHC systems demonstrated adaptation to address both medical needs and social determinants of health during the pandemic.
- Mental and physical health issues often start with social problems, as seen during the pandemic.
- A significant movement towards the Kazakh and Spanish model of multidisciplinary approaches is underway.
- Kazakhstan's primary healthcare system hosts the WHO European Center for Primary Health Care in Almaty.
- Kazakhstan's primary healthcare model demonstrates a powerful example of innovation, accessibility, and inclusivity in the region and beyond.
