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HealthChallenges

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Population Health and
Policy review for
Republic of Kazakhstan
Madina Takenova
Kazakhstan School of Public Health
Kazakhstan
APACPH conference
Early career network workshop
November 19-23, 2005 Taipei
Republic of Kazakhstan
Population – 15, 072 million
Territory – 2724.9 thousand km2
Capital –Astana
57% urban population,
43% rural
64
19 -19
69 65
19 -19
74 70
19 -19
79 75
19 -19
84 80
19 -19
89 85
19 -19
93 90
-1
99
4
19
95
19
96
19
97
19
98
19
99
20
00
20
04
19
19
65
19
70
19
80
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
04
Demographic situation in
Kazakhstan
(per 1000), 1965-2004
30
25
20
15
Death rate
Live births
10
5
0
Life expectancy at birth, Kazakhstan,
1965-2004
72
71
70
69
68
67
66
65
64
63
62
61
Leading causes of morbidity and
mortality in Kazakhstan
• Overall morbidity – 99 627,7 per 100 000 in 2004
• Morbidity incidence : I place- Diseases of
respiratory system, CV diseases; III – Urogenital
diseases
• Mortality: Cardiovascular diseases, Neoplasms,
Trauma & poisoning
3988,4
2003
2004
404,1
106,3
m
el
itu
lis
s
79,3
be
tu
s
196,6
Sy
ph
i
194,2
Di
a
154,3
al
ig
na
TB
nt
ne
Ps
op
yc
la
hi
sm
at
r ic
s
Na
di
rc
so
ol
rd
og
er
ica
s
ld
is
Tr
or
au
de
m
rs
a,
po
iso
ni
ng
4500
4000
3500
3000
2500
2000
1500
1000
500
0
M
rate per 100 000 population
Incidence of socially significant diseases
in 2003-2004 (per 100 000 population)
Reproductive health
• Infant mortality – 14,5 per 1000 newborns
• MMR is highest among CA countries – 36.9 per
100,000 livebirths
• High rate of pregnancy and delivery complications
– 60%
• Contraceptive prevalence rate on rise – 50.7
(MoH, 2002)
• During 10 years the absolute amount of abortions
in RK decreased by 2.3 times
• Unmet need for family planning – 8.7% (DHS,
1999)
• Access and quality of reproductive health services
poor in rural areas
Main health and socio-economic indicators
1998
2004
15,5
15,01
0,742
0.76
Life expectancy at birth
65
66,14
Population growth rate
4,4
7,9
Birth rate per 1000
14.8
18,1
Death rate per 1000
10,2
10,2
Live births per 1000 population
14,8
15,3
Infant mortality Rate per 1000 live births
21,4
14,5
Total Fertility rate
2
2,2
Maternal mortality (per 100000 live births)
59
36.9
Under-5 mortality rate (BUCEN) per 1000 live births
35,2
69,6
TB incidence per 100 000 (all forms)
118.8
154,3
299
698
1497,2
1995,4
total allocations for health care, % of GDP
2
2,61
correlation btw highest income h/hold and lowest income
quintile
6
8
Total population (million)
Human development Index (HDI)
HIV prevalence
GDP per capita, $US
Trends of Tuberculosis in Kazakhstan
449,5
450
40
35
400
30
350
25
300
20,6
250
200
20
154,3 15
150
10
100
50
5
0
0
1996
1997
1998
1999
TB prevalence
2000
2001
TB incidence
2002
2003
2004
TB mortality
deaths per 100 000 population
rate per 100 000 population
500
TB urgent issues
• Social factor – interrupted treatment,
– MDR TB (1500 cases in 2003; 56.4% previously
treated resistant for 2 or >)
• TB in prisons, amnesty (incidence 30 times higher,
mortality 9 times higher among imprisoned population);
8726 detainees with TB in KZ, 452 with MDR TB
• TB and HIV/AIDS
– 99 per 100000 cases of TB HIV+
• Young TB – 15-18 years of age (yearly 1300 teenagers get infected by
TB, 60% in families); 1990- 57.1 – 2000-162.2 per 100000 population
HIV/AIDS in Kazakhstan
• June 2005 - officially 5008 HIV+ (699 cases), including
272 with AIDS.
Men -76% (3823)
Women - 24% (1185)
• Estimated number of HIV+ people is 13, 000
(according to Sentinel Surveillance data)
• Registered drug users – 45000; alleged IVDU -250 000
• AIDS death rate 31.3 (220)
• Transmission way: 76.6% - parenteral; 14.6% - sexual
•
Trends
• HIV/AIDS epidemics is at concentrated stage - prevalence rate
among risk groups (IVDUs and CSWs) is steadily above 5%.
• There is a trend of sexual transmission rate increase :
2001- 5%, 2002 - 16,7%, 2003 - 21,0%, 2004 - 29,3%.
HIV transmission patterns dynamic
1200
1032
1000
800
515
600
389
400
200
0-2
0
1
1990 1995
38
5
1996
501
295
264
28
12
1997
1998
sexual transmission 1
102
5
1999
30
2000
63
2001
123
2002
433
205
161
2003
2004
parenteral (needles sharing practices) 1
90000
Prognosis for HIV infection in case
of untimely activities
77599
80000
Number of HIVcases
70000
56765
60000
48346
50000
34292
40000
30000
20000
22947
14633
10000
0
Kazakhstan
Central Asia
2002
Sanigest Internacional 2004
2005
2010
Emerging issues of population health
1. Increase of socially significant diseases
1. TB morbidity increased more than twice
2. STD
3. HIV/AIDS
2. Risk factors -smoking (for 1/3 of population); alcohol
consumption, drug use
3. Unhealthy lifestyle, lack of health education and self
motivation,
4. Reproductive health
5. Environmental pollution;
6. Lack of financing of medical institutions
Causes of unfavorable health status of
population
• Weak preventive activities of PH policy
• Poor attitude & lake of skills toward own
health
• Ineffective intersectoral collaboration on PH
issues
• Social and economical troubles of transition
period
National policy on population
health & development
•
•
•
•
•
Developmental strategy “Kazakhstan-2030”
“National Program of Health Sector Reform and
Development in the Republic of Kazakhstan for 20052010”
Program & Law “On health care system of the
Republic of Kazakhstan”
State programme “Population health” -November 1998
National network on health protection and (1998)
National Program of Health Sector Reform and
Development in the Republic of Kazakhstan for 2005-2010
• Developer: Ministry of Health
• Timeframe: 2005-2010
– 2 steps of implementation : 2005-2007;
2008-2010
• Required resources and sources of funds:
– Central and local budgets, as well as other resources
allowed by Law of the Republic of Kazakhstan;
– In 2008-2010 there will be an annual increase in health
care financing and by 2010 it will increase to 4% of
GDP
National Program of Health Sector Reform and
Development in the Republic of Kazakhstan for 2005-2010
• Objective
• to create an effective health care delivery
system based on the principles of solidarity
of the state and individuals assuming
responsibility for health protection, priority
development of primary health care aimed
at improving the health of population.
National Program of Health Sector Reform and
Development in the Republic of Kazakhstan for 2005-2010
•
•
•
•
•
•
•
Priority tasks:
Real shift of focus to Primary health care; shift of
emphasis from inpatient to outpatient care;
Systemic transition to international standards, new
technologies, advanced treatment methods and medical
service;
Strengthening of maternal/ child health;
Creating a system of independent expertise involving
independent experts;
Training of health care system, health resource and
finance managers;
Prevention, diagnosis and treatment of socially
significant diseases;
Strengthening the technical/ material base of health
facilities;
Expected outcomes of Programme
• As a result of Program implementation, the
optimal health care model satisfying needs
of the people, the sector and the state will
be created…
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