Monitoring the implications of health policy changes in Kazakhstan based on the WHO health system framework: a summary of available data and suggestions for the health-related 2020 Strategic Development Goals
| Measurement aspect | Available data | Comments based on the available evidence |
|---|---|---|
| Governance | ||
| Willingness for reform (eg, availability of laws, policy documents) | Salamatty Kazakhstan (2011–2015); Kazakhstan Social Development Concept of 24 April 2014 (Resolution №396); Presidential address from 17 January 2014 | There is no clear consensus on the appropriate values for these indicators in any given health system. Should not be included |
| Trust in government institutions (general/health) | Survey data needed | |
| Public expenditure tracking (PETS) in place | No PETS study carried out so far | To be carried out in order to assess flow of funds |
| Per cent of budget with defined responsibility central/local level | Overall: 62.9% central level, 37.1% oblast level (2013 NHA by MHSD and RCHD) | No added policy value |
| % admin cost of total government health spending | Not available | Helpful indicator, administration cost need to be estimated |
| Corruption Perception Index (general/health-specific) | General: Transparency International 2013: 26 of 100 points, rank no. 140 worldwide. Health: Corruption Perception Index, some older data available37 38 | Rather general; not helpful for policy assessment |
| Use of one purchaser or many | Two purchasers: MHSD and oblast health authorities | A political one-off decision; no need to measure |
| Financing | ||
| Total expenditure on health | As share of GDP: 4.2% (2012)*; 3.5% (2011), 3.8% (2012), 3.5% (2013)—NHA by MHSD and RCHD | To be included; specific target needs to be set |
| GGHE as a proportion of GGE | GGHE/GGE: 10.9 (2012)*; GGHE as % of GGE 12.1% (2011), 12.3% (2012), 11.6% (2013) –NHA by MHSD and RCHD | To be included; specific target needs to be set |
| The ratio of household OOP payments for health to total expenditure on health | OOP as share of THE: 41.7%(2012)* 28.2% (2011), 30.2% (2012), 32.7% (2013) –NHA by MHSD and RCHD | To be included; specific target needs to be set |
| Health Workforce | ||
| Health workers/100 000 population | Physicians: 349.5; Dentists: 41.2; Pharmacists: 80.6; Nurses: 804.5; Midwives: 57.73 (2012)† | To be included; specific targets need to be set |
| Distribution of health workers by occupation/specialisation, region | GPs: 31/100‘000 (2011 WHO HFA-DB) | Data available from some oblasts (regions); collection and publishing of this data should be consolidated. To be included, specific targets need to be set |
| Graduates of health professions institutions/ 100 000 population (level/field of education) | Physicians graduated/100 000: 21.86 (2010)† | Quantity is not a key concern; more important is quality, thus not included |
| Health Information Systems | ||
| Health information system performance index | Not available | The WHO recommends compiling the index based on:
|
| Service delivery | ||
| General Service readiness score for health facilities | Countrywide assessment has been initiated but results are not yet available | The WHO recommends Health Facility Assessment, including:
|
| Proportion of health facilities offering specific services(/10 000 population) | ditto | |
| Specific-services readiness score for health facilities | ditto | |
| Service quality | ||
| Accreditation and external quality management | For providing the SGBP, a health facility must pass accreditation. Accreditation by the Committee for Control of Pharmaceutical and Medical Activities (MHSD), recognised by ISQua Standards for Facilities | To be included; specific target needs to be set |
| Involving public/private providers | At present, limited involvement of private providers via state budget; 811 public and 428 private providers | Unspecific indicator; no optimal level defined |
| Personnel (qualification, number); staffing index/ratio; competency index | Countrywide assessment has been initiated but results are not yet available | In principle, helpful to monitor availability and quality of staff |
| Utilisation | ||
| Use of specific preventive measures | Data currently not available | Already included |
| Benefit catalogue (needs, economic evaluation) | State-guaranteed benefit package (SGBP) very comprehensive, but not yet evaluated | No need for monitoring |
| Support value (% of total cost paid) | Not applicable | Relevant intermediate indicator, especially with the planned SHI (financial protection) |
| Benefit Incidence Analysis (BIA) | Household survey has been conducted, but so far not fully analysed | To be included; specific target needs to be set |
| Accessibility (e.g. geographical; no. of providers; time to get to a provider for Caesarean section) | Household survey has been conducted, but so far not fully analysed | Relevant intermediate indicator for planning |
| Access to essential medicines | ||
| Average availability of selected essential medicines in public and private health facilities | Median availability (private): 70% Median availability (public): 0% (2004)* | 10-year-old data for drug prices and availability; a new survey is required to determine whether performance is still this poor. To be included; specific target needs to be set |
| Median consumer price ratio of selected essential medicines in public and private facilities | Price ratio (private): 3.73 Price ratio (public): 4.84 (2004)* | |
| Health level | ||
| Risk factor prevalence | To be included; specific target needs to be set | |
| Average life expectancy | 69.6 years39 | Already included |
| Maternal mortality | 26/100 000 live-births39 | Already included |
| Infant mortality | 14.6/1000 live-births39 | Already included |
| Overall mortality | Analysis for different ethnicities40 41, regions42 and age groups43 available. Already included | |
| Decrease in specific morbidity, eg, TB, HIV/AIDS | Available from the WHO‡ Already included | |
| Financial protection and equity | ||
| Impoverishment rate due to healthcare expenditures | Household survey has been conducted, but so far not fully analysed | Stratified by wealth quintile, place of residence and gender To be included; specific target needs to be set |
| Kakwani index | Data available for calculation | None |
| Responsiveness | ||
| Customer Satisfaction Rating (facility) | Household survey has been conducted, but so far not fully analysed | To be included; specific target needs to be set |
| Overall satisfaction with health services | Household survey has been conducted, but so far not fully analysed | To be included; specific target needs to be set. Data from 2001 and 2010 available44 |
*Global Health Observatory Data Repository; http://apps.who.int/gho/data/node.main.488?lang=en.
†European health for all database (HFA-DB), WHO Regional Office for Europe, http://data.euro.who.int/hfadb/.
GDP, Gross Domestic Product; GGE, General Government Expenditure; GGHE, General Government Expenditure on Health; MHSD, Ministry of Health and Social Development; NHA, National Health Accounts; RCHD, Republican Centre for Health Development; SGBP, State Guaranteed Benefit Package; SHI, social health insurance.