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.

Altyn Aringazina, Med.Sci.D, Ph.DHead, Department of Population Health & Social Sciences

Kazakhstan School of Public HealthMember of the WHO Expert Advisory Panel

on Health Promotion

Kermanshah, May 19-21, 2015

Health Promotion Development: The Case of Kazakhstan

Overview

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)

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%)

VI Astana Economic Forum, Kazakhstan Astana, 24 May 2013

4

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

<= 85

<= 81

<= 77

<= 73

<= 69

No data

Min = 65

Life expectancy at birth, in years

Lastavailable

European Region76.41


5

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


6

Health 2020 documents &Kazakhstan strategies 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)

Health 2020 in Kazakhstan

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)

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)

В

С

D

E

F3.Mechanisms to ensure sufficiency

and quality of population health promotion actions matched to condition & needs

5. Ensuring and enabling local resources for population health promotion: human, technical and financial

1. Policy integration & partnership mechanisms within government

7.Population health promotion: management information systems

8. Research, multidisciplinarity, and know-how development

2. Policies & strategies intended to create the conditions for good health

6.Supporting the development of civil society

4.National/regional level resources for population health promotion: human, technical and financial

Capacity Mapping Health Promotion in Kazakhstan

Structure and key institutions of public health in Kazakhstan

There is no effective collaboration between organizations and their precise responsibility for public health issues

National Scientific Centers

Health care organizations

Regional health care

administrations Network of subdivisions of prevention and control

NCHE

NCID

CSES

RCHCD KSPH

NCHLD

Medical Universities

MoH

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

programmes2. improvement of the state policy, legislative documents3. coordination of central and local bodies’ work4. definition of main guidelines on health protection

HEALTHY LIFESTYLE SERVICES HEALTHY LIFESTYLE SERVICES

AND HEALTH PROMOTION POLICYAND HEALTH PROMOTION POLICY

Health PromotingHealth PromotingHealthy Lifestyles Healthy Lifestyles DevelopmentDevelopment

Primary Primary ProphylaxisProphylaxis

Secondary Secondary Prophylaxis Prophylaxis

RehabilitationRehabilitation

InformationInformation

Education/TrainingsEducation/Trainings

MMotivationotivation

Environment Environment

Monitoring and EvaluationMonitoring and EvaluationHea

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Process of the Population’s Behavior ChangeProcess of the Population’s Behavior Change

INTERSECTORAL COOPERATION AT LOCAL AND INTERSECTORAL COOPERATION AT LOCAL AND NATIONAL LEVELSNATIONAL LEVELS

NGOs

Ministry of

InternalAffairs

Ministry of

Education

Ministry of Health

Ministry of

Culture and Sport

Ministry of

Labour

Ministry of

Ecology

Private sector

Assembly of Nations of

Kazakhstan

Office of Prime

Minister

National Committee on Family

and Women’s

Affairs

Akimats

Office of the

President

Mechanisms to ensure sufficiency and quality of population health promotion actions

Programs: tobacco control prevention of drug addiction social rehabilitation prevention of tuberculosis prevention of HIV/AIDS “Clean water”

18

Development of preventive medicine

152 Centers of healthy lifestyle development (regional, city, local)

252 Centers of health promotion

87 anti-tobacco centers

50 Centers for youth health

751 schools on prevention of arterial hypertension, diabetes control and asthma

2 278 healthy schools for mother and child ( family planning, preparing for pregnancy, childbirth preparation and pregnant women, healthy child)

Family Health Centers work in medical primary health care organizations with 400 psychologists and more than 2000 social workers

Screening Programs on the Framework of the State Health Development for 2011-2015

1. Screening for early detection of arterial hypertension and cardio vascular diseases

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 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

Since 2009

Since 2011

1. Breast cancer

2. Cervical cancer

3. Colorectal cancer

All regions of the RK

1. Breast cancer

2. Cervical cancer


4. Prostate cancer

Pilot project in East Kazakhstan oblast (region)

1. Breast cancer

2. Cervical cancer


4. Prostate cancer

5. Digestive cancer

6. Liver cancer

+ ZKO, KZO,

Pavlodarskaya obl., Almaty,

Astana

1.Breast cancer

2. Cervical cancer


4. Prostate cancer

5. Digestive cancer

6. Liver cancer

+ Aqtobe, Atyrau,

Karaganda, Kostanai, North –

Kaz. obl.

1. Breast cancer

2. Cervical cancer


4. Prostate cancer

5. Digestive cancer

6. Liver cancer

+ Аkmola, Zhambyl,

Almatinskaya, Mangistau, South

–Kaz.obl.

1. Breast cancer

2. Cervical cancer


4. Prostate cancer

5. Digestive cancer

6. Liver cancer

All regions of the RK

Screening programs extension for early detection of cancer

2011 20142012 2013 2015 2016


Kazakhstan – highest political commitment to health

Nursultan Nazarbayev,

President of the Republic of Kazakhstan

“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”

Source: Address to the Nation, January 2012

Opportunities for Health Promotion in Kazakhstan

Active programs of health education and promotion previously did not exist and many efforts were mainly the responsibility of the primary health care services

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 long-term 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”

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 groupWhat are the needs and expectations of the group?

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 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?

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?

Framework for Developing Effective Health Education Programs

WHY

WHO

WHAT

HOW

EFFECTIVE

Source: Murphy B. 2002

Knowledge Attitude Behaviour change

Behaviour change intervention

Increased knowledge and improved attitude

Sustained behaviour change

Reverse KAB model for behavior change

KAB model for behavior change

Source: Murphy B, 2002

IEC behavior change model

Information

CommunicationEducation

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

Co-Production of Health

Information TechnologyThe Knowledge Revolution

The Knowledge Revolution

Source: Kickbusch 2011

Source: Kickbusch 2011

Health in All Policies

ALBBLRBULCROCZHESTHUNMDAKAZKOSLVAMKDPOLROMRUSSRBSVKSVNTKMTURUKR

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

ALBARMAZEBLRBULESTKOSLVAGEOKAZMDAMKDMNESVNTJKTKMTURUKRUZB

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

Perspectives of health care system in Kazakhstan

There is need to achieve main goals and objectives of health care system:

Sanitary Epidemiological Service reforms

Strengthening healthy lifestyle development To accent on preventive programs

To solve problems: 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

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)

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

Kazakhstan School of Public Health

Goals of KSPH

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!

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.

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