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Kazakhstan
>> Regional Overview >> Kazakhstan Overview Activity Data Sheet
PROGRAM: Kazakhstan
TITLE & NUMBER: Increased Utilization of Quality Primary Health Care for Select Populations, 115-032
STATUS: New
PROPOSED FY 2001 OBLIGATION AND FUNDING SOURCE: $5,700,000 FSA $200,000 CSD
PROPOSED FY 2002 OBLIGATION AND FUNDING SOURCE: $4,950,000 FSA $150,000 CSD
INITIAL OBLIGATION: FY 2001 ESTIMATED COMPLETION DATE: FY 2006Summary: This SO includes funds previously reported on under SO 4.1. The purpose of this objective is to build an effective, affordable, and sustainable primary health care (PHC) system, that meets the health needs of families, and to strengthen programs for the prevention and treatment of infectious diseases (ID). Technical assistance will support select populations to be better informed about personal health care rights and responsibilities; improve the quality of health care including infectious diseases and maternal and child health; improve use of health care resources for primary health care; and improve legislative, regulatory and policy framework. Health professionals are being re-trained to provide quality health care by upgrading clinical and laboratory skills to better diagnose, treat and prevent illness, including infectious diseases, such as acute respiratory infections, tuberculosis (TB), HIV/AIDS and hepatitis. One of USAID's major efforts is assisting Kazakhstan to implement the World Health Organization (WHO)-recommended Directly Observed Treatment Short-course (DOTS) program to treat TB.
Program Categories include support for infectious disease prevention, and maternal/child health.
Key Results: Principal results sought under this objective are: 1) select populations are better informed about personal health care rights and responsibilities; 2) improved quality of health care including infectious diseases and maternal and child health; 3) improved use of health care resources for primary health care; and 4) improved legislative, regulatory and policy framework.
Performance and Prospects: USAID efforts have produced considerable progress. At the heart of USAID's program in the health sector are well-trained family doctors, as an alternative to a variety of unconnected specialists for each family member and each disease. According to the 1999 Demographic and Health Survey (DHS), 37% of Kazakhstani women report that a family group practice is their usual source of health care. This indicates that our program is having a major impact on the shape of the health system in Kazakhstan.
Another important component of USAID-supported health reform efforts involves allowing clients a greater measure of informed choice about their health care. USAID has promoted the client's choice of family doctor, rather than following the old Soviet practice of assigning each person a doctor. In 2000, clients in several major cities -- including Semipalatinsk, Kokshetau and Pavlodar -- were given this choice, in some cases over the objections of local health authorities, as a result of public pressure.
Considerable progress was made in 2000 on quality of care. Treatment guidelines and protocols in Kazakhstan are badly in need of updating and revision, to comply with scientific evidence of effectiveness. However, modifying them requires significant support from senior medical personnel in government, training institutions and research organizations. As a result of an evidence-based medicine workshop, senior scientists will work on selected national guidelines over the next two years. Basing care on well-structured and scientifically based studies, doctors in Kazakhstan will have the opportunity to update their knowledge and better and more appropriately treat their patients. USAID also helped to establish another important mechanism for providing citizens in Kazakhstan with clear and objective information about health. The Reproductive Health Hotline is now operating in 11 major Kazakhstani cities. The hotline provides confidential and reliable information by phone to clients who call the toll-free number for advice. In 2000, the hotline was expanded to Temertau, the city in Kazakhstan with over 1,500 HIV-positive case and epidemic levels of sexually transmitted infections (STIs).
USAID supported a Demographic Health Survey (DHS) to provide a wealth of information about health. At a highly publicized national seminar, survey results were presented based on interviews with 4,800 women and 1,440 men. One of the most important and most controversial pieces of data was the infant mortality rate, which DHS estimates at 55/1,000, double the Agency for Health Affairs estimate. USAID hosted a second day to the national seminar to allow public health specialists, government officials, and national and international organizations to discuss the methodological and clinical issues associated with infant mortality. The agency agreed to pilot the use of the international definition in two regions of Kazakhstan. This agreement was unexpected, and welcomed by both the local doctors and international health organizations.
USAID support for the prevention and treatment of infectious diseases also produced good results. The mortality rate for TB declined by more than 20% in 1999, a remarkable achievement in the fight against a deadly and growing infectious disease. Mortality decreased because of the government's strong support for the TB DOTS program of the WHO, which is implemented by USAID. Morbidity from TB increased in Kazakhstan in 1999. This was unfortunate, but not unexpected news, and at least proof that our efforts in developing a reliable and functional surveillance system are producing results.
Levels of reported STIs have increased in Kazakhstan a hundred-fold over the past 10 years. USAID, in conjunction with the WHO and UNAIDS, initiated a 6-month pilot program in one region to use the WHO-developed Syndromic Management approach for diagnosing and treating STIs. Family doctors now understand this method, and assumed responsibility for a set of illnesses normally treated only by specialists. The positive results of the pilot included a 60% increase in the detection and treatment of gonorrhea.
Through the Centers for Disease Control and Prevention (CDC) training, a network of ID/ epidemiology professionals was established. The main functions of the CAR epidemiology network are epidemiology information exchange, strengthening capacity for surveillance and outbreak investigation, as well as, training of trainers activities.
In summary, USAID's performance under this objective was strong. USAID is planning to initiate work on TB in prisons in 2001. With support from the USAID/Global Infectious Disease team, WHO will place a regional advisor on TB in Kazakhstan. HIV/AIDS continues to increase at a rapid rate in Kazakhstan, mostly among IV drug users, although the total number of HIV cases (1,122) remains small by international standards. The probability for expansion of the epidemic is increased by the existence of illicit drug trafficking, commercial sex work, rapidly rising rates of STIs, amid a general lack of knowledge about the virus. In 2001, with the benefit of additional funds, USAID will develop its program on HIV prevention through a behavioral risk assessment, followed by condom social marketing, a high-level regional conference, prevention interventions with high-risk groups and much-needed information campaigns at the community level.
In FY 2001 USAID intends to obligate, for technical assistance and training, the following amounts per category: Infectious Disease Prevention, $2,400,000 and Maternal/Child Health, $3,300,000. In addition, $200,000 in CSD will be provided.
In FY 2002, USAID plans to continue to support a wide range of health activities to: improve the quality of care, especially in MCH and infectious disease control; improve the use of resources for primary health care; and keep selected populations informed about health care rights and responsibilities.
Beneficiaries: The primary beneficiaries are health professionals working in primary health care and infectious disease. The ultimate customers are users of these health services, who are predominantly women and children.
Possible Adjustments to Plans: At the policy level, the leadership of the Agency for Health Affairs continues to be fluid. The most recent chairman is supportive of USAID-supported reform efforts, including TB DOTS, although not as strongly as we would like. At the implementation level, the reforms are secure, so our oblast-level efforts should experience few effects.
Other Donor Programs: USAID's health sector activities complement the World Bank's large health sector reform loan in Kazakhstan. The United Nations Population Fund (UNFPA) procures contraceptives for the public sector. The British Department for International Development supports family doctor training.
Principal Contractors, Grantees, or Agencies: Abt Associates/ZdravPlus, American International Health Alliance, Center for Disease Control, Counterpart Consortium, and Project Hope.
FY 2002 Performance Table
Selected Performance Measures: Increased Utilization of Quality Primary Health Care for Select Populations, 115-032
Indicator FY97 (Actual) FY98 (Actual) FY99 (Actual) FY00 (Actual) FY01 (Plan) FY02 (Plan) Indicator 1: % of sputum smear positive tuberculosis (TB) patients cured through Directly Observed Treatment Short-course (DOTS) approach in pilot sites N/A N/A N/A 83.1% 85% 85% Indicator 2: % of children less than 1 year of age completely vaccinated against hepatitis B virus (HBV) N/A N/A N/A 75% 75% 80% Indicator 3: % of total combined pilot site populations voluntarily enrolled in primary health care practices N/A N/A N/A 5% 5% 6% Indicator Information:
Indicator Level (S)or(IR) Unit of Measure Source Indicator Description Indicator 1: S % of TB patients cured TB health information system Cure rate is the number of TB patients cured as a result of DOTS treatment plus patients that completed treatment divided by the total number of TB smear positive patients minus number of deaths. DOTS is considered effective in treatment sites if at least 85% of patients are cured. (For recently established DOTS programs, it can be lower, e.g. 75%.) Each annual result represents a different group of TB patients who completed treatment. Indicator 2: S % of children less than 1 year vaccinated Official government data on HBV immunization coverage; sera-survey studies and immunization coverage assessment by CDC "Completely vaccinated" is defined as receiving 3 doses of hepatitis B vaccine as reported in official government data. Indicator 3: IR % of populations voluntarily enrolled Health information system at district or rayon level; MOH, national census Voluntary enrollment is defined as the opportunity to select one's own PHC practice during a specific delimited time period. A PHC practice is defined as a unit that: serves a mixed population in which all three basic specialties (pediatrics, internal medicine, obstetrics/gynecology) are represented in the practice; is paid or plans to be paid on a per capita basis; has a score in the ZdravPlus minimum standards assessment that is greater than zero; and has or plans to have a population database or voluntary enrollment. U.S. Financing
(In thousands of dollars)
Obligations Expenditures Unliquidated Through September 30, 1999 0 DA 0 DA 0 DA 0 CSD 0 CSD 0 CSD 997 ESF 997 ESF 0 ESF 0 SEED 0 SEED 0 SEED 9,674 FSA 9,469 FSA 205 FSA 0 DFA 0 DFA 0 DFA Fiscal Year 2000 0 DA 0 DA 0 CSD 0 CSD 0 ESF 0 ESF 0 SEED 0 SEED 4,419 FSA 630 FSA 0 DFA 0 DFA Through September 30, 2000 0 DA 0 DA 0 DA 0 CSD 0 CSD 0 CSD 997 ESF 997 ESF 0 ESF 0 SEED 0 SEED 0 SEED 14,093 FSA 10,099 FSA 3,994 FSA 0 DFA 0 DFA 0 DFA Prior Year Unobligated Funds 0 DA 0 CSD 0 ESF 0 SEED 1,143 FSA 0 DFA Planned Fiscal Year 2001 NOA 0 DA 200 CSD ESF 0 SEED 5,700 FSA 0 DFA Total Planned Fiscal Year 2001 0 DA 200 CSD 0 ESF 0 SEED 6,843 FSA 0 DFA Future Obligations Est. Total Cost Proposed Fiscal Year 2002 NOA 0 DA 0 DA 0 DA 150 CSD 0 CSD 350 CSD 0 ESF 0 ESF 997 ESF 0 SEED 0 SEED 0 SEED 4,950 FSA 0 FSA 25,886 FSA 0 DFA 0 DFA 0 DFA Special Iniatives, 115-032
Obligations Expenditures Unliquidated Through September 30, 1999 0 DA 0 DA 0 DA 0 CSD 0 CSD 0 CSD 528 ESF 528 ESF 0 ESF 0 SEED 0 SEED 0 SEED 38,505 FSA 34,502 FSA 4,003 FSA 0 DFA 0 DFA 0 DFA Fiscal Year 2000 0 DA 0 DA 0 CSD 0 CSD 0 ESF 0 ESF 0 SEED 0 SEED 4,126 FSA 3,854 FSA 0 DFA 0 DFA Through September 30, 2000 0 DA 0 DA 0 DA 0 CSD 0 CSD 0 CSD 528 ESF 528 ESF 0 ESF 0 SEED 0 SEED 0 SEED 42,631 FSA 38,356 FSA 4,275 FSA 0 DFA 0 DFA 0 DFA Prior Year Unobligated Funds 0 DA 0 CSD 0 ESF 0 SEED 0 FSA 0 DFA Planned Fiscal Year 2001 NOA 0 DA 0 CSD 0 ESF 0 SEED 0 FSA 0 DFA Total Planned Fiscal Year 2001 0 DA 0 CSD 0 ESF 0 SEED 0 FSA 0 DFA Future Obligations Est. Total Cost Proposed Fiscal Year 2002 NOA 0 DA 0 DA 0 DA 0 CSD 0 CSD 0 CSD 0 ESF 0 ESF 528 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 42,631 FSA 0 DFA 0 DFA 0 DFA
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Last Updated on: May 29, 2002 |
