Kazakhstan's health care triumphs and concerns by kpn40237


									                 World Report

                                            Kazakhstan’s health care triumphs and concerns
                                            Kazakhstan has largely escaped a post-independence surge in AIDS—but syphilis is instead on
                                            the rise. Whereas Soviet-era accounting systems kept a tight watch on case numbers, new
                                            freedoms mean surveillance is patchy and poor. Ben Aris reports from Almaty, Kazakhstan.

                                         Located in the arid Central Asian steppe,           “Everyone was subject to obligatory           also to have surpassed the Soviet all-
                                         and as far from any sea as it is possible         testing once a year in Soviet times. Now        time economic high set in 1989.
                                         to be, Kazakhstan has largely escaped             we know there is an explosion of                   Health reforms took off early this year
                                         the HIV/AIDS epidemic sweeping across             syphilis, but we have very few facts to         after Kazakhstan’s president, Nursultan
                                         central and eastern Europe. However, it           work with”, says Kanat Shakenov, the            Nazarbayev, made a speech expressing
                                         has suffered from an explosion in other           UN’s HIV/AIDS Project Manager.                  concern about health care. A flurry of
                                         sexually transmitted diseases (STDs)                The HIV/AIDS pandemic has pushed              decrees followed, and more than 300
                                         since independence in 1991, as preven-            the government in Astana to try and             doctors were immediately packed off to
                                         tion is stymied by the government’s               get a handle on the prevalence of STDs.         Israel for advanced training. (Israel is the
                                         vague idea of the state of public health.         It began testing all pregnant women             obvious choice for training as it boasts
                                            In the first chaotic days of freedom,           2 years ago, almost all of whom use             western standard medical care, plus one
                                         unemployment became widespread                    state prenatal facilities. The results were     in five Israelis is a Russian émigré).
                                         and social contact greatly increased as           worrying: 2·9% of pregnant women                   The government has just launched a
                                         workers migrated towards the cities in            were infected with syphilis, more than          new health concept for 2006–2010;
                                         search of work or engaged in “shuttle             10 times the official estimates of 0·2%          the plan was well received by WHO,
                                         trading”—in which entrepreneurs trav-             amongst 15–49 year olds.                        which says the country is on target.
                                         elled to towns to buy scare goods and               One of the reasons why the official            International financial institutions such
                                         sold them again in the local markets.             syphilis numbers are so low is because          as the World Bank have nixed their loan
                                         These bazaars, which have changed                 Soviet-era mandatory registration of            programmes, as the government does
                                         little since the time of Alexander the            syphilis sufferers is still in place, as well   not need the cash any more, turning
                                         Great, also attracted commercial sex              as the obligation to name sexual part-          their attention to technical assistance
                                         workers from villages or the even poorer          ners—or face punishment. Also, once             and advice on best practices. Increased
                                         surrounding countries of Kyrgyzstan,              diagnosed patients are obliged to check         spending on health is “galloping”
                                         Tajikistan, and Uzbekistan. The result            into hospital for the 28-day treatment,         according to the World Bank, but the
                                         has been a surge in syphilis infections.          although outpatient treatment is                authorities still have a lot to learn.
                                                                                           simple and available. Many prefer to               The government has begun pouring
                                                                                           simply ignore their condition than enter        money into re-equipping health facili-
                                                                                           the institutional maw.                          ties and the doctors returning from
                                                                                             “Most of the VD clinics are resisting         Israel brought scuds of new equipment
                                                                                           reform as it means they would lose beds         with them. But of course it is the things
                                                                                           and so funding. We are still groping in         that money can’t buy that are needed
                                                                                           the dark as a surveillance system is still      most. It will take time for the changes to
                                                                                           not in place”, says Shakenov.                   make an impact on public health.
                                                                                             But even as health problems start to             “The plan is comprehensive and well
                   Rights were not granted to include                                      emerge, Kazakhstan is flourishing and            conceived, based on contemporary
                                                                                           the government is at last turning to            ideas to health policy. There was a gen-
                     this image in electronic media.                                       improving health care for its popula-           uine search for international best prac-
                   Please refer to the printed journal.                                    tion. Rapidly rising income levels under-       tices and the government made the
                                                                                           pin the improving health of the                 effort to learn from others mistakes . . .
                                                                                           population. Average incomes have risen          but everything still depends on the
                                                                                           five-fold in the past decade and                 implementation”, says Peyvand Khale-
                                                                                           Kazakhstan now enjoys the highest               ghian, a health specialist with the World
                                                                                           rates of foreign investment of any of           Bank in Almaty. “However, with this
                                                                                           the former Warsaw-pact counties. It is          much in the budget, Kazakhstan can
                                                                                           the only former Soviet republic to not          afford to be ambitious.”

                                                                                           only have won back all the ground lost
          Kazakh President Nursultan Nazarbayev has kickstarted health reforms this year   following the collapse of the USSR, but         Ben Aris

          1348                                                                                                                              www.thelancet.com Vol 366 October 15, 2005

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