Kazakhstan : Healthcare Operations and Planning Enhancement Project

Health / Health system development

The Government of the Republic of Kazakhstan has established Turar Healthcare as the National Operator with the aim of modernizing state health services. This includes plans to develop university and multidisciplinary hospitals and primary health care (PHC) facilities to be funded either by the state or as public-private partnership (PPP). The Ministry of Health of the Republic of Kazakhstan (MOH) has identified health infrastructure development as a priority and has requested ADB to assist with sector analysis, master planning, hospital design, project scoping, and related capacity building.

In 1991, the government inherited an input-driven, inefficient health system focused specialists and inpatient care. Health sector reforms initiated in 1995 led to major rationalization of hospitals and strengthening of PHC. The country achieved a universal health coverage (UHC) of 80% in 2021, which is high for the region. Social health insurance reached 84% of the population in 2020 and supports a basic benefits package. However, health indicators such as maternal and child health are not commensurate with the country's rapid economic growth of annual average of around 6% of gross domestic product in the past two decades.

While the burden of diseases is declining, demand for and cost of health services are increasing with a shift to non-communicable diseases linked to population aging, and lifestyle and environmental conditions that require a multi-sectoral approach with more effort in prevention. The health sector itself is still in transition with incomplete reforms and investment initiatives. Most hospitals and health centers in Kazakhstan are owned and operated by the public sector, and about half of these require upgrading and renovation. The health system remains biased towards specialist care and inpatient services. Access to and quality of rural health services are insufficient and challenging due to a very low rural population density of about 3 persons per km2. Health services quality is also affected by under-resourced education institutions and teaching hospitals. The country of 19 million people has 12 accredited and globally recognized medical colleges. Kazakhstan's 2020 health spending amounted to 3.8% of gross domestic product (GDP) or $342 per capita, with a government share of 66% and a modest out-of-pocket share of 27%.

As per the national "Healthy Nation project: quality and affordable healthcare for every citizen", the government prioritizes health infrastructure development along with human capital development, technological modernization, digitalization, efficiency improvements through better management, and reducing out-of-pocket expenses. Public infrastructure is to be improved in terms of bed capacity, efficiency, alignment with sustainable development goals (SDGs), and better procurement and maintenance. The government has directed the new construction of up to 5 greenfield hospitals and 300 PHC facilities, and has proposed increasing private investment in healthcare from $260 million to $1,680 million from 2020 to 2025, adding 13,000 health staff, and increasing domestic pharmaceutical production.

Construction of hospitals and PHC facilities may be using the public-private partnership (PPP) facility management model. The private group may design, finance, build, operate, and maintain the new hospital, and provide non-medical services, while the state will provide medical services. Up to September 2022, 228 PPPs were recorded in the health sector, mostly at local level, at a total cost of about $400 million. PPP projects in healthcare may be contracted through MOH for republican projects, local governments for regional projects, and Turar Healthcare. ADB has supported the planning of PPP for the Karaganda Medical University Hospital, possibly to start in 2024. The European Bank for Reconstruction and Development (EBRD) has assisted with the planning of the Kazakh National Medical University Hospital and the Kyzylorda General Hospital, but these are likely to be state-funded. Kazakhstan has retained sufficient fiscal space for public investments. However, government and private sector interests in PPP are improving.

Kazakhstan's transformation to a green economy is challenging given harsh climate conditions, environmental pollution, and high infrastructure cost per capita. The government's Concept for Transition of the Republic of Kazakhstan to Green Economy aims to address climate change and environmental issues by increasing energy efficiency, upgrading existing infrastructure, better waste management, and other measures. Hospitals are a major source of greenhouse gases and wastes. The government has access to various climate funds including climate financing from ADB.

Quality and affordable healthcare for every citizen

Improved healthcare planning that will help establish an integrated, modernized, and climate-friendly health services network to achieve better quality and efficiency of public health services

Health equipment master plans prepared.

Health human resources master plans prepared.