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Kazakstan
Health
The early years of independence have had a disastrous effect
on public health. In the 1980s, Kazakstan had an extensively developed
public health system that delivered at least basic care without
charge even to very remote communities. By 1993, however, Kazakstan
rated below average or lower among the former Soviet republics
in medical system, sanitation, medical industry, medical research
and development, and pharmaceutical supply.
Health System
In 1994 the health system had twenty-nine doctors per 1,000
people and 86.7 other medical personnel per 1,000. There were
1,805 hospitals in the republic, with seventy-six beds per 1,000
people. There were 3,129 general health clinics and 1,826 gynecological
and pediatric clinics. Conditions and services at these facilities
varied widely; it was not uncommon, for example, for rural clinics
and hospitals to be without running water.
The constitution of 1995 perpetuates the Soviet-era guarantee
of free basic health care, but financing has been a consistent
problem. In 1992 funding allotted to public health care was less
than 1.6 percent of GDP, a level characterized by the World Bank
as that of an underdeveloped nation.
Because doctors and other medical personnel receive very low
pay, many medical professionals have moved to other republics--a
large percentage of Kazakstan's doctors are Russian or other non-Kazak
nationalities--or have gone into other professions. Nonpayment
even of existing low wages is a common occurrence, as are strikes
by doctors and nurses.
In the 1980s, Kazakstan had about 2,100 pharmaceutical-manufacturing
facilities; drugs were also available from other Soviet republics
or from East European trading partners within the framework of
the Council for Mutual Economic Assistance (Comecon). Since independence
most such supply connections have been terminated, and many domestic
pharmaceutical plants have closed, making some types of drugs
virtually unavailable. As a result, vaccination of infants and
children, which reached between 85 and 93 percent of the relevant
age-groups in 1990, decreased sharply in the early 1990s. Kazakstan
ran out of measles and tuberculosis vaccine in late 1991, and
the World Health Organization (WHO) estimated that more than 20
percent of children were not receiving basic vaccinations in 1992.
To some extent, the provision of drugs has been taken over by
a government-owned company, Farmatsiya, which purchases about
95 percent of the medical equipment and supplies for the government.
There have been persistent complaints that Farmatsiya pays far
too much for foreign equipment and medicines in return for nonmedical
considerations.
Private medical practice is permitted in general medicine and
in some specialized fields; private surgical practice is forbidden,
as is private treatment of cancer, tuberculosis, venereal disease,
pregnancy, and infectious diseases. Some types of private practice
have been introduced directly into the state clinics, creating
a confusing situation in which identical procedures are performed
by the same personnel, some for state fees and others for higher
private fees. A substantial unofficial market has developed in
the distribution of hospital supplies; patients often are expected
to pay for the bandages, anesthesia, and other materials and services
required for the "free" treatment received at medical facilities.
Kazakstan has no system of medical insurance.
In the mid-1990s, the largest growth area in medicine was in
services not requiring large capital outlays by the practitioner.
This area, which includes acupuncturists, fertility consultants,
substance-abuse therapists, physical therapists, and dentists,
is only lightly regulated, and the incidence of charlatanism is
high.
Kazakstan has negotiated some international agreements to improve
health care. In 1992 an association of scientific organizations
specializing in contagious diseases established its headquarters
in Almaty. The group, which includes doctors and technicians from
Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan, conducts
joint research with scientists in China, Mongolia, and Vietnam.
A 1995 medical cooperation agreement between the Kazakstani and
Iranian ministries of health called for exchanges of medical students
and experts, joint research projects, exchanges of information
on the latest medical advances (with an emphasis on contagious
diseases), and mutual natural-disaster assistance.
Data as of March 1996
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