Transcript /kums_content/media/image/2015/05/57946_orig.ppt

Health Promotion Development:
The Case of Kazakhstan
Altyn Aringazina, Med.Sci.D, Ph.D
Head, Department of Population Health & Social Sciences
Kazakhstan School of Public Health
Member of the WHO Expert Advisory Panel
on Health Promotion
Kermanshah, May 19-21, 2015
Overview
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The capital, formerly Almaty (previously Alma-Ata, the birthplace of
Primary Health Care) from December 1997 moved to Astana in the
North
The population was estimated at 17,458 million in March 2015. As
well as geographic diversity, the country is ethnically diverse. The
main groups are Kazakhs (65,5%), Russians ( 21,47%), Uzbeks
(3,04%), Ukrainians (1,76%), Uyghurs(1,44%), Tatars (1,18%),
Germans (1,06%), and others (4,55%)
The level of literacy of the population is 99.6 % (Source: The World Fact,
2013)
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Kazakhstan is a secular state. The majority of the population are
said to be atheists while the main religions are Sunni
Muslim(70,18%), Russian Orthodox (24,8%), Protestant (2%), other
(3,02%)
Health 2020 was adopted by the WHO
Regional Committee in September 2012
53 Member States:
The European policy framework for supporting action
across government and society for health and well-being
Life expectancy at birth, in years
<= 85
<= 81
<= 77
<= 73
Last
available
European Region
76.41
<= 69
No data
Min = 65
VI Astana Economic Forum,
Kazakhstan Astana, 24 May 2013
4
The economic case for health promotion
and disease prevention
The economic impact of
non-communicable
diseases amount to many
hundreds of billions of
euros every year
Many costs are
avoidable through
investing in health
promotion and
disease prevention
Today governments
spend an average
3% of their health
budgets on
prevention
VI Astana Economic Forum,
Kazakhstan Astana, 24 May 2013
5
Health 2020 documents &
Kazakhstan strategies
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Health 2020 - A European policy framework supporting
action across government and society for health and
wellbeing
Health 2020 – European policy framework and strategy
document
&
Kazakhstan 2050 & Health Code of Kazakhstan (2009)
”Salamatty Kazakhstan”: Healthy Kazakhstan 2011–
2015
20 steps to social modernization of Kazakhstan (2012)
VI Astana Economic Forum,
Kazakhstan Astana, 24 May 2013
6
Health 2020 in Kazakhstan
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Strengthen public health functions
Review all determinants of health including
social and environmental determinants
(intersectoral mechanism in place )
Review link between health, employment and
welfare/social policy
Improve health literacy and empower people
through life course approach
Our History
Our History
Prevention of Diseases
“…Effective chronic disease programs are
highly dependent on well-functioning national
health systems, chronic diseases should be a
litmus test for health-systems strengthening.”
Source: B.Samb, N.Desai et al. The Lancet, Volume 376, Issue 9754, Pages
1785 - 1797, November 2010
WHO Capacity Mapping Initiative (CMI)
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To synthesize key social and economic trends
Map the current capacity of health promotion
systems, with particular emphasis on
responsiveness to the broader determinants of
health
Highlight the implications for health promotion
policy and infrastructure development (WHO,
2005; Mittelmark et al, 2006)
Capacity Mapping Health Promotion in
Kazakhstan
1. Policy integration & partnership mechanisms within government
8. Research,
multidisciplinarity, and
know-how development
В
С
2. Policies & strategies
intended to create the
conditions for good
health
D
E
F
7.Population health promotion:
management information
systems
3.Mechanisms to ensure sufficiency
and quality of population
health promotion actions
matched to condition & needs
4.National/regional level
resources for
population health
promotion: human,
technical and financial
6.Supporting the
development of civil
society
5. Ensuring and enabling local resources
for population health promotion:
human, technical and financial
Structure and key institutions of public health in Kazakhstan
There
is
no
effective
collaboration
between
organizations and
their
precise
responsibility
for
public
health
issues
Medical
Universities
RCHCD
Regional health
care
administrations
Health care
organizations
National
Scientific Centers
MoH
NCHLD
KSPH
CSES
Network of
subdivisions of
prevention and
control
NCHE
NCID
Policy integration and partnership
The aim of the National Coordination Council, governed by the
Minister of Health:
 maintenance of interaction b/w central and local executive bodies,
international and other organizations for conducting activities
according to state programmes
 The objectives:
1. maintenance of performance of actions, assigned by the
programmes
2. improvement of the state policy, legislative documents
3. coordination of central and local bodies’ work
4. definition of main guidelines on health protection

HEALTHY LIFESTYLE SERVICES
AND HEALTH PROMOTION POLICY
Healthy Lifestyles
Development
Primary
Prophylaxis
Secondary
Prophylaxis
Rehabilitation
Health Promoting
Education/Trainings
Motivation
Environment
Monitoring and Evaluation
Process of the Population’s Behavior Change
Governmental, NonGovernmental, and
International
Organizations
Health system (Healthy
Lifestyles Development
Services)
Information
INTERSECTORAL COOPERATION AT LOCAL AND
NATIONAL LEVELS
Ministry
of
Education
Office of
the
President
Ministry
of
Internal
Affairs
Ministry
of
Labour
NGOs
National
Committee
on Family
and
Women’s
Affairs
Ministry
of
Culture
and
Sport
Ministry
of
Ecology
Ministry of
Health
Office of
Prime
Minister
Private
sector
Akimats
Assembly of
Nations of
Kazakhstan
Mechanisms to ensure sufficiency and quality of
population health promotion actions
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Programs:
tobacco control
prevention of drug addiction
social rehabilitation
prevention of tuberculosis
prevention of HIV/AIDS
“Clean water”
Development of preventive medicine
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152 Centers of healthy lifestyle development (regional, city, local)
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252 Centers of health promotion
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87 anti-tobacco centers
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50 Centers for youth health
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751 schools on prevention of arterial hypertension, diabetes control and asthma
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2 278 healthy schools for mother and child ( family planning, preparing for
pregnancy, childbirth preparation and pregnant women, healthy child)
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Family Health Centers work in medical primary health care organizations with
400 psychologists and more than 2000 social workers
18
Screening Programs on the Framework
of the State Health Development for 2011-2015
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1. Screening for early detection of arterial hypertension and cardio
vascular diseases
Since 2009
2. Screening on breast cancer
3. Screeing on cancer of the cervix with the test PAP
4. Screening for early detection of diabetes
5. Screening children for detection of congenital and hereditary
diseases of hearing
Since 2011
6. Screening for early detection of glaucoma
7. Screening of target risk groups on Hepatitis B and C among
children and adults
8. Screening for early detection of colorectal cancer
Screening programs extension for early detection of cancer
2011
1. Breast
cancer
2. Cervical
cancer
3.
Colorectal
cancer
2012
2013
2014
2015
1. Breast cancer
2. Cervical
cancer
3. Colorectal
cancer
4. Prostate
cancer
1. Breast cancer
2. Cervical cancer
3. Colorectal
cancer
4. Prostate
cancer
5. Digestive
cancer
6. Liver cancer
1.Breast cancer
2. Cervical cancer
3. Colorectal
cancer
4. Prostate
cancer
5. Digestive
cancer
6. Liver cancer
1. Breast cancer
2. Cervical cancer
3. Colorectal
cancer
4. Prostate
cancer
5. Digestive
cancer
6. Liver cancer
Pilot project in
East Kazakhstan
oblast (region)
+ ZKO, KZO,
Pavlodarskaya
obl., Almaty,
Astana
+ Aqtobe, Atyrau,
Karaganda,
Kostanai, North –
Kaz. obl.
+ Аkmola,
Zhambyl,
Almatinskaya,
Mangistau, South
–Kaz.obl.
2016
1. Breast cancer
2. Cervical
cancer
3. Colorectal
cancer
4. Prostate
cancer
5. Digestive
cancer
6. Liver cancer
All regions
of the RK
All regions of the
RK
Kazakhstan – highest political commitment
to health
“Healthy lifestyle and
the principle of shared
responsibility for health this is what should be
important both in the
policy on public health,
and in everyday living”
Nursultan Nazarbayev,
President of the Republic
of Kazakhstan
Source: Address to the Nation, January
2012
VI Astana Economic Forum,
Kazakhstan Astana, 24 May 2013
Opportunities for Health Promotion in
Kazakhstan
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Active programs of health education and promotion previously
did not exist and many efforts were mainly the responsibility of
the primary health care services
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The President’s 1997 message in “Kazakhstan 2030”, which set
up a 30-year welfare strategy for the country, emphasized the
importance of public health and also health promotion as a longterm priority. This called for:
The prevention of disease
The promotion of healthy lifestyles
Combating abuse of drugs and the trade in illegal narcotic drugs
Reduction of tobacco and alcohol consumption
Improvement of nutrition, environment and ecology
Now we have a new strategy “Kazakhstan 2050”
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Framework for Developing Effective Health Education Programs
WHY
WHO
Why is this health issue a problem?
Analyse the health issue/s within the context of a determinants of health model.
Consider what is realistically possible.
Consider the target group
What are the needs and expectations of the group?
WHAT
What do you hope to achieve?
What will be different for this group at the end of the program?
Establish aims and learning objectives for the program.
HOW
How will you implement an effective education program?
What delivery methods best suit the issues and the group?
What resources do you need to run the program?
EFFECTIVE
How will you know your program has been successful?
Have you met your aims and objectives?
What went well and what would you do differently next time?
Source: Murphy B. 2002
KAB model for behavior change
Knowledge
Attitude
Behaviour change
Reverse KAB model for behavior change
Behaviour
change
intervention
Increased
knowledge
and improved
attitude
Sustained
behaviour
change
Source: Murphy B, 2002
IEC behavior change model
Information
Education
Communication
Source: Murphy B, 2002
An empowerment model of Health Promotion
Source: J. Green & K. Tones, 2010
Research Agenda for Public Health Policy
•
•
•
•
•
•
•
Define problems and seek solutions
Reduction of smoking, alcohol, inactivity
Hypertension management
Screening – cancer of cervix, colon, hypertension
Food fortification – folic acid, iron, iodine, vitamin D
Prevent birth defects, e.g., nutrition, infection, genetic
Prevent liver diseases
CoProduction
of Health
Information
Source: Kickbusch 2011
The Knowledge
Revolution
Technology
Health in All Policies
Source: Kickbusch 2011
Articulate policy options for multisectoral
action for the prevention and control of
NCDs through effective partnership
Health in all policies: fiscal policies,
marketing, salt, trans-fat, workplaces &
schools, active mobility
•Development of guidance on fiscal policies,
marketing, salt, trans-fat
•Strengthening of the salt network
•8th Global Conference on Health Promotion,
European Day, 10-14 June 2013, Helsinki
•Support to country specific needs and requests
ALB
BLR
BUL
CRO
CZH
EST
HUN
MDA
KAZ
KOS
LVA
MKD
POL
ROM
RUS
SRB
SVK
SVN
TKM
TUR
UKR
Strengthen health systems
Cardio-metabolic risk assessment &
management and early detection of cancer
•Development of guidance on cardio-metabolic risk
assessment and management in PHC and
strengthening early detection of cancers
•The European Action Plan for strengthening public
health capacities and services presented at RC62
•Support to country specific needs and requests
ALB
ARM
AZE
BLR
BUL
EST
KOS
LVA
GEO
KAZ
MDA
MKD
MNE
SVN
TJK
TKM
TUR
UKR
UZB
Perspectives of health care system in
Kazakhstan
There is need to achieve main goals and objectives of health
care system:
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Sanitary Epidemiological Service reforms
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Strengthening healthy lifestyle development
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To accent on preventive programs
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To solve problems:
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strengthening intersectoral collaboration, leadership in public
health issues
solidary responsibility for health
human recourses management, medical education and
science reforms
implementation of new information technologies
cont
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The health care system is based on the paradigm of public health
care, with consideration the role of social determinants of health,
needs and demands of population, social responsibility for health,
and intersectoral approach
The new public health model for Kazakhstan must move beyond its
current medical orientation and embrace a social-determinants
model of health, if gains in population-wide health status are to be
achieved
Special attention is to be paid to diversity in socio-economic
standing, geography, culture as well as other key determinants
(Aringazina A. et al, 2011)
Kazakhstan School of Public Health
History:
KSPH was established in July 1997 according
to an Agreement between the WHO/ European
Office and the Ministry of Health of Kazakhstan
Mission:
Improvement of health of the population of
Kazakhstan through strengthening of functions
of public health
Goals of KSPH
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Postgraduate training of experts in the field of public health:
short - term courses (two-four weeks) training the specialists
on Public Health
Two years Master’s program in Public Health,
One and half years Master’s MBA program
Three years Ph.D. program in Public Health field
Training scientific and pedagogic personnel of higher
qualification
10 months program on specialty “Health Care Manager”
Research activity
Expert-consultative activity
Expert-Consultative Work,
WHO Technical Meeting
Thank you very much for your attention!