Overview

Key points

• The Ministry of Healthcare governs Kazakhstan’s health system and is responsible for policy, legislation and regulation. The Oblast Health Departments play an important role in managing all publicly owned health facilities within their territories.
  
• The Ministry of Healthcare sets policy and has been instrumental in reforms including establishing social health insurance (SHI) and strengthening primary health care (PHC).
  
• Regional and local governments are key to implementing change. Oblast Health Departments manage all local publicly owned health facilities and facility managers exercise increased autonomy.
  
• The SHI system (2020) aims to improve the pooling of public funds and increase the role of private providers in offering care. There is a basic guaranteed package for all, with wider benefits for those who pay contributions (or for whom these are paid by the government).
  
• Per capita spending on health and the share of GDP devoted to health have increased.
  
• The share of health spending from public sources (65%) in 2021 was much higher than in Central Asia overall (40%) and out-of-pocket (OOP) payments as a percentage of health spending declined substantially between 2019 and 2021, from 34% to 25%.
  
• SHI is believed to have contributed to this shift and to have improved inter-regional equity and access although there are concerns about sustainability and whether SHI might be increasing use of specialized services.
  
• There is still an extensive hospital network, with a focus on single-specialty hospitals, although plans for multidisciplinary hospitals seek to optimize efficiency.
  
• PHC is a core commitment and aims to improve access, particularly in rural and remote areas. Initiatives include promoting multidisciplinary teams and mobile care units.
  
• Staffing in rural areas is still challenging, with 82.8% of doctors based in urban areas.
  
• Nationally, physician density is high and the workforce relatively young. Nurse numbers in contrast are lower than on average in the WHO European Region.
  
• Life expectancy has increased, although there are regional and gender disparities. Cardiovascular diseases are the leading causes of mortality and high blood pressure, poor nutrition and smoking are major risk factors. Prevention initiatives are underway to reduce salt and tobacco use.