The mission of the Academy of Preventive Medicine is to study socio-economic determinants of health and to provide a powerful voice and organizational structure for the advancement of measures for the promotion of health, the prevention of disease, the care of sick, and the rehabilitation of the disabled, improve the quality of personal and community health of the people of Kazakhstan through introducing the best international and local expertise in healthcare.

 

The Academy presents to government, professional, and other bodies the consensus of public health workers’ opinions on healthy policy matters and serves to advance the professional position and interests of public health personnel.

The vision of the Academy of Preventive Medicine is a strong and well-supported national public health system in Kazakhstan. The Academy is a platform for advocacy and collective action in addressing public health challenges and opportunities.

The Academy is involved in the coordination of healthcare organizations, government agencies, private organizations, and educational institutions to improve the efficiency of health care provision, medical education, and healthcare management.

Academy of Preventive Medicine has a track record in organizing important health-related national events, trainings and surveys in Kazakhstan. Over the last fifteen years, the Academy experts have been involved and implemented the following projects:

1. Assessing the economic efficiency of healthcare programs funded by Kazakhstan Ministry of Health.
2. 1995 Demographic and Health Survey funded by US Agency for International Development. The 1995 DHS survey was based on a nationally representative sample of 4,800 households and covered many issues of reproductive health, childhood illnesses, and nutrition. The Academy organized a national seminar with more than 100 participants to present and disseminate the results of the survey.
3. 1999 Demographic and Health Survey funded by US Agency for International Development. The 1999 DHS survey was based on a nationally representative sample of 4,800 households and covered many issues of reproductive health, childhood illnesses, and nutrition. The Academy organized a national seminar with more than 150 participants to present and disseminate the results of the survey.
4. In 2012 the Academy conducted a nationally representative household health survey in Kazakhstan covering 10,000 respondents. The survey was funded by the World Bank and Kazakhstan Health Ministry and covers many health-related issues, including access to healthcare services, adult health, lifestyle questions.
5. The Academy developed and implemented the national telemedicine network program by providing technology and training in more than 50 rural telemedicine sites.
6. One of important areas of concentration is publishing. The Academy is responsible for the content development of www.zdrav.kz, which is one of the most advanced Russian language websites on health and disease prevention.
7. The Academy has conducted numerous training sessions on a number of health-related topics, including evidence-based medicine, healthcare management, nutrition, health information technologies.

One of important area of activities of the Academy of Preventive Medicine is consolidation of efforts of academic healthcare organizations of Kazakhstan. With this goal, the Academy functions through the Consortium of academic healthcare organizations of Kazakhstan (CAHO), which is a national alliance of country’s leading academic centers: medical universities, academies, National Medical Holding and research centers.

CAHO provides the lens through which the organization assesses all it does. CAHO’s mission is to create knowledge, foster collaboration, and promote change to help members succeed. It supports evidence-based medicine and development of clinical protocols for diagnosis and treatment. CAHO helps its members to attain national leadership in health care by achieving excellence in quality, safety, and cost-effectiveness.

CAHO’s vision of the future is to help members attain national leadership in health care by achieving excellence in quality, safety, and cost-effectiveness.

CAHO offers an array of performance improvement products and services. Powerful databases provide comparative data in clinical, operational, faculty practice management, financial, patient safety, and supply chain areas. CAHO’s programs offer opportunities for knowledge sharing and education, allow members from across Kazakhstan to share information and demonstrate the power of collaboration.

Thanks to the powerful voice of its outstanding members, among whom are the Kazakhstan's most influential and respected healthcare managers, physicians and researchers, the Academy is now able to present its views of national priorities and to affect legislation and policy making at international, national and local levels. Because of reputation and contacts the Academy has the unique ability to advocate in a positive manner among Kazakhstan’s government agencies and non-governmental organizations and businesses on various health-related issues.

The Academy plans to play important role in international arena and is aspired to establish strategic alliances with international organizations, such as the World Health Organization and to become a members of the World Federation of Public Health Association and International Association of National Public Health Institutes. Such international partnerships will help to catalyze support for and investment in the national public health system and optimization of delivery of core public health functions.

 

Household Health Surveys

The Academy of Preventive Medicine implemented two nationwide household health surveys in Kazakhstan: the 1995 Kazakhstan Demographic and Health Survey (1995 KDHS) and the 1999 Kazakhstan Demographic and Health Survey (1999 KDHS). The 1995 KDHS and 1999 KDHS were funded by US Agency for International Development (USAID) and United Nations Children Fund (UNICEF). Technical assistance for the program was provided by the MEASURE DHS+ project of Macro International Inc. in the U.S.

Currently, the Academy is implementing a new nationally representative household health survey, 2012 HHS. It is funded by the World Bank and Kazakhstan Health Ministry.

The purpose of the 1995 and 1999 KDHS surveys were to develop a single integrated set of data for the government of Kazakhstan to use in planning effective policies and programs in the areas of health and nutrition. The 1995 and 1999 KDHS surveys were designed to provide current data on women’s reproductive histories; knowledge and use of methods of contraception; breastfeeding practices; and the nutrition, vaccination coverage, and episodes of diseases among their children under the age of five. Information on knowledge of and attitudes toward HIV/AIDS and other sexually transmitted infections, as well as data on men’s reproductive behavior, were also collected in the 1999 KDHS. The survey also included the measurement of the hemoglobin level in the blood to assess the prevalence of anemia, and measurements of height and weight to assess nutritional status (funded by UNICEF).

Both, 1995 KDHS and 1999 KDHS surveys contributed to the growing international database on demographic and health-related variables.

The purpose of 2012 HHS is to provide data to strengthen evidence base for policy making and management responses based on information on health status, utilization, payments, behaviors, attitudes, measurements of blood pressure and other biometrics and to provide valuable insights into how households interact with the health system and how they perceive issues of critical importance to public health.

The objective of the task is to:

·      adapt the standard World Bank’s survey instrument /questionnaire to ;

·      conduct pre-pilot and finalize the survey instrument;

·      develop the sampling strategy;

·      implement the survey;

·      enter and clean the survey data in a database; and

·      conduct data analysis and prepare a survey report

Household Sampling

The sample for the 1999 KDHS successfully interviewed 4,800 women 15-49 years of age and 1,440 men 15-59 years of age.

The sampling frame for the 1999 KDHS consisted of the lists of health blocks obtained from local health-care departments and the Ministry of Health (for urban areas), and of the lists of villages obtained from the National Statistical Agency.

The 1999 KDHS sample was a stratified two-stage sample. Stratification was achieved by dividing each survey region into urban and rural areas. In the first stage of selection, 251 health blocks and villages were selected as primary sampling units (PSUs) with probability proportional to the population count. A complete listing of the households residing in the selected blocks and villages was carried out. The lists of households served as the sampling frame for the systematic selection of 6336 households in the second stage. Women age 15-49 were identified and interviewed in selected households. Every third household was identified as selected for the male survey, and in those households, all men age 15-59 were interviewed.

The 2012 HHS will be conducted in summer of 2012 through face-to-face interviews in 12,000 randomly selected households, based on a sample frame stratified to be nationally and sub-national representative along a number of key variables including gender, personal and household income, household size and geographical location. 

This HHS will cover households across the Republic of with differentiation by national and sub-national levels, rural and urban areas and income/welfare quintiles. It will include measurements of blood pressure, blood cholesterol and Body Mass Index (BMI).

Questionnaires

For the 1999 KDHS three questionnaires were used: the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire. These questionnaires were based on the model survey instruments developed for the MEASURE DHS+ program and were adapted to the data needs of Kazakhstan during consultations with specialists from the national health system. The questionnaires were developed in English and then translated into Russian and Kazakh. A pretest was conducted in April 1999. Based on the pretest experience, the questionnaires were further modified.

The Household Questionnaire was used to enumerate all usual members and visitors in a sample household and to collect information relating to the socioeconomic position of the household. In the first part of the Household Questionnaire, information was collected on age, sex, educational attainment, and relationship to the head of household for each person listed as a household member or visitor. A primary objective of the first part of the Household Questionnaire was to identify women and men who were eligible for the individual interview. In the second part of the Household Questionnaire, questions were included on the dwelling unit, such as the number of rooms, the flooring material, the source of water, and the type of toilet facilities, and on the availability of a variety of consumer goods.

The Women’s Questionnaire was used to collect information from women age 15-49 on the following major topics:

·      Background characteristics

·      Pregnancy history

·      Outcome of pregnancies, antenatal and postnatal care

·      Child health and nutrition practices

·      Child immunization and episodes of diarrhea and respiratory illness

·      Knowledge and use of contraception

·      Marriage and fertility preferences

·      Husband’s background and woman’s work

·      Knowledge of HIV/AIDS and other sexually transmitted infections

·      Maternal and child anthropometry

·      Hemoglobin measurement of women and children.

The Men’s Questionnaire was used to collect information from men age 15-59 on the following topics:

·      Background characteristics

·      Reproduction

·      Contraceptive knowledge and use

·      Marriage

·      Fertility preferences and attitudes about family planning

·      Knowledge of HIV/AIDS and other sexually transmitted infections.

For 2012 HHS two questionnaires will be used: the Household Questionnaire, and the Health  Questionnaire. The questionnaires will be pretested (piloted) and based on the pretest experience, they will be further modified.

The Household Questionnaire will be used to enumerate all usual members and visitors in a sample household and to collect information relating to the socioeconomic position of the household. In the first part of the Household Questionnaire, information will be collected collected on age, sex, educational attainment, and relationship to the head of household for each person listed as a household member or visitor. A primary objective of the first part of the Household Questionnaire is to identify women and men eligible for the individual interview. In the second part of the Household Questionnaire, questions will be included on the dwelling unit, and on the availability of a variety of consumer goods.

The Health Questionnaire will be used to collect information from people age 15 and over on the following major topics:

·      General health status,

·      Health care services – general topics and recent use of services,

·      Out-of-pocket health expenditures

·      Tobacco, alcohol, diet and exercise,

·      Blood pressure measurement,

·      Socio-economic status

·      Personal data.

Fieldwork and data collection

For the 1999 KDHS sixty-four persons were recruited as field supervisors, editors, health investigators and interviewers and were trained at the Academy of Preventive Medicine for three and a half weeks. Training consisted of lectures and practice in the classroom, as well as interviewing in the field. The training of health investigators, who were responsible for anthropometric measurements (height and weight) and hemoglobin testing of women and children, was accomplished by two days in the classroom and three days in the field.

The 1999 KDHS field staff represented various medical-research and educational institutions in Kazakhstan, including Asfendiyarov National Medical University, Karaganda State Medical Academy, South Kazakhstan State Medical Academy, International Kazakh-Turkish University, National Research Center for Maternal and Child Health, National Research Center for Pediatrics and Pediatric Surgery, National Institute of Nutrition, Institute of Tuberculosis, School of Public Health, National Medical College, and Zhezkazgan Department of Health. The Academy of Preventive Medicine recruited five field coordinators who were responsible for facilitating the communication and coordination between the Academy and the interviewing teams.

Questionnaires were returned to the Academy of Preventive Medicine for data processing. The office editing staff checked that questionnaires for all selected households and eligible respondents were returned from the field. The few questions that had not been precoded (e.g., occupation) were coded at this time. Data were then entered and edited on microcomputers using the Integrated System for Survey Analysis (ISSA) package, with the data entry software translated into Russian.

For 2012 HHS the Academy of Preventive Medicine will take a team approach to data collection. The advantages of working in teams are many, but the main one is the ability to achieve a higher level of supervision of the work. An additional reason is the need for special means of transportation for most interviewers. In addition, safeguarding the wellbeing of the field staff is another important reason for working in teams.

Data collection will be done by 8 teams comprising one supervisor, five interviewers and one anthropometrist. The fieldwork will take approximately three months. It is expected that each team can complete 1.5 sample points per week. The Academy of Preventive Medicine will ensure that enough questionnaires as well as other field forms will be printed and that household listing forms and cartographic materials will be ready prior to the start of the fieldwork.

Close communication will be maintained at all times between the central office of the Academy of Preventive Medicine and HHS teams during the survey. The details regarding supervision and communications will be discussed during training and will be included in the interviewer and supervisor manuals.

Response Rates

In 1999KDHS survey, a total of 6,301 households were selected in the sample, of which 5,960 were occupied at the time the fieldwork was conducted. Of the 5,960 occupied households, 5,844 were interviewed, yielding a household response rate of 98 per­cent. Interviews were success­fully completed with 4,800 of these women, yielding a response rate of 98 percent. Response rate for men was 94 percent. The principal reason for non-response was a failure to find an eligible woman or men at home after re­peated visits to the household.

Data Processing and Approach to Software Development

The actual development of the software is described below in an easy to follow description of the main characteristics the software will have. These characteristics will facilitate the most efficient field implementation while at the same time improving data quality and safeguarding confidentiality of the information throughout the data entry and database development process

The Academy of Preventive Medicine in partnership with ICF Macro is developing a data capture system that can be used for central or field-based data entry.  The software will be written using CSPro and will support the following:

a.              Range checks for all categorical and quantitative variables.  Ranges will be adjusted dynamically to allow only categories and values that are relevant based on prior questions in the questionnaire, where appropriate.

b.              The software will apply all skip patterns as specified in the questionnaires, ensuring that the correct path through the questionnaire is followed.  The software will support complex checks within or between modules and will permit complete control of the skip pattern. To facilitate the software conversion, there will be a cross-reference listing of all skips showing the variable name where the skip is originated, the target variable name and the program line number of the skip.

c.              The software will check the consistency of responses entered with prior responses or external data as soon as the responses are entered.  Inconsistent data will be flagged for review by central data processing staff.

d.              The software will permit the entry of out of range values, but will flag these values for review by central data processing staff.  These out of range values will be highlighted on screen.

e.              The data entry screens will be designed to reflect the visual appearance of the physical questionnaires in order to assist data entry staff in accurately recording the data collected.

f.               In addition to flagging data problems at the time the field is entered, the software will also produce a report of data errors and inconsistencies that remain in the data at the end of entry of each questionnaire.  This report may then be used by interviewers to return to the interviewed households with the original questionnaires and the report listing to review and correct the errors found.

g.              Summary error reports will also be produced providing a brief summary of the frequency of different types of errors found in the data entered, including frequencies of out of range values by question, frequencies of consistency errors by type of inconsistency.

h.              The software will organize the data in a hierarchical ASCII data file, organized by questionnaire.  In addition to the data entry software, batch processing programs, also written in CSPro, will perform batch consistency checking of key information beyond that checked during the data entry process.  This is to permit more complex checks on the consistency of the data than can be performed during the data entry process.

i.               All of the software will be linked together via a menu system for central data processing staff that provides easy access to the different functionality of the software.

j.               The central software will produce frequency distributions of all categorical or qualitative variables.  For quantitative variables with many different responses, e.g. height or weight of an individual, the responses will be summarized with minimum, maximum and mean values.  Further, the software at the central level will produce field quality control tabulations that permit a review of key elements of the data collection and the quality of the interviewing, including response rates and review of results against expected distributions.

k.              The data file format will permit easy conversion of the data and database portability into analysis files for use with the statistical packages Stata, SPSS and/or SAS, together with all variable and value labels. 

l.               The full source code of the standard and country specific versions of the survey software (applications, dictionaries, forms, etc.) and related documentation will be made available. 

m.            The majority of the survey specific adaptation is carried out in collaboration with the survey teams.  Translation of the software, including variable and value labels, error messages, data capture screens’ text, etc. will be facilitated through the use of simple tools that will permit easy translation into local languages as needed.  The software is in the process of adaptation to fit the local survey requirements, including the incorporation of the adapted and local questions, adaptations to all checks, including range, skip and consistency checks, and the handling of survey specific external databases, including lists of enumerators, IDs, location identifiers, predefined sampling lists, and panel survey data.

n.              Full supporting documentation will be prepared for the survey.  All data dictionaries will be fully documented with all variables having full variable labels, all category codes clearly defined and all categories and values fully labeled.  In addition, an annotated versions of the final questionnaires with explicitly annotated links to all variables created in the resulting datasets will be provided.

Healthmapping and Geographic Information Systems                                  

Kazakhstan Academy of Preventive Medicine has experience in health mapping (creation of electronic maps of healthcare facilities) using Geographic Information Systems (GIS) in various regions of Kazakhstan.

In Kyzyl-Orda oblast and Aqmola oblast of Kazakhstan the Academy of Preventive Medicine has developed a comprehensive health map by integrating GIS information and statistical data on all healthcare facilities (census of healthcare facilities).  Such approach provides important tools for regional healthcare administrators, enabling them to better analyze spatial relationships between different factors affecting health of populations residing in the region, to determine the needs for additional resources and to identify challenges and barriers affecting implementation of healthcare programs.

In Kyzyl-Orda oblast the following types of information were collected at healthcare and other types of facilities:

·      Number of full-time and part-time doctors, nurses; availability of medical equipment, drug supply at oblast- and district-level healthcare facilities, rural ambulatories, and feldsher-obstetrics posts;

·      Information on pharmacies, clinical laboratories and other facilities;

·      Education facilities – schools (urban and rural), colleges and universities;

·      Implementation of such programs as TB-DOTS, Integrated Management of Childhood Illnesses (IMCI), family planning;

·      Administrative and government organizations;

·      Industrial facilities;

·      Automobile roads, railroads;

• Social and economic data - demographic indicators, economic infrastructure, agriculture.

In addition to facility survey the Kyzyl-Orda health mapping project developed 3-d models of healthcare facilities, such as Oblast clinical hospital, and Oblast diagnostic center. Such approach helps to better visualize locations, dimensions and other characteristics of healthcare facilities.

Current applications of geographic information systems (GIS) include the following:

·      Uses of GIS in public health

·      Determining the geographic distribution of diseases

·      Analyzing spatial and temporal trends

·      Mapping populations at risk

·      Stratifying risk factors

·      Assessing resource allocation

·      Planning and targeting interventions

• Monitoring diseases and interventions over time

The GIS systems help to strengthen national surveillance, prevention and control activities through the delivery of user-friendly data collection and management and mapping applications. They also strengthen the management, analysis and monitoring of priority diseases through the development of rapid electronic surveillance systems supported by user-friendly web-based mapping.

Using this approach, the Academy of Preventive Medicine can provide the following services:

·        Development of a strategy and concept design for healthmapping of a geographic and administrative region: working with the government on benchmarks and parameters for the data collection

·        Development of methodology for healthmapping: selection of electronic platform (MapInfo, GoogleEarth, ArcView), designing survey instrument (questionnaire) for collection of health, demographic, economic and other types of data; designing a system for integration of data with geographic coordinates

·        Organizing fieldwork for data collection at healthcare facilities, schools and other facilities; establishing a database for integration with geographic coordinates

·        Developing 3-d images of healthcare facilities and integration of 3-d objects into the health maps

·        Design methodology for analysis of statistical, epidemiology data, information on staffing, availability of medical equipment, clinical guidelines, textbooks and computers. Integration of such data into health maps.

·        Training healthcare administrators and local staff how to use health maps and analyze statistical and epidemiological data in order to effectively plan and administer healthcare resources

 

Kazakhstan’s Telemedicine Program and Telemedicine Module

Telemedicine, in the simplest term is information and communication technology in healthcare. It is about exchanging patient information between health professionals that are treating or otherwise taking care of patients. Telemedicine transmits clinical data by use of computer, internet, telephone and other communication methods.  For example, thanks to telemedicine it is possible to diagnose cardiovascular or respiratory diseases and consult patients residing in remote areas of Karaganda or Atyrau oblast of Kazakhstan by a doctor in capital city of Astana or in Almaty, thousands of miles away. And it doesn’t matter where the patient is located – in a city or remote rural hospital, oil platform or remote railway station.

Telemedicine can bring expertise of medical professionals from virtually any place on the Globe that has access to the Internet. Doctors from Johns Hopkins or Mass General in the United States or professors from Germany, Turkey, Almaty or Astana are able to provide quality diagnostic and consulting services to a patient residing in remote areas of Kazakhstan.

Telemedicine can also serve education purpose. Clinical rounds and training sessions from leading academic centers can be transmitted through videoconferencing helping local doctors to improve their knowledge and skills.

Kazakhstan National Telemedicine Program

Starting in 2004, the telemedicine program was introduced in Kazakhstan as part of the government program of rural telemedicine. The Academy of Preventive Medicine is the leading organization responsible for implementation of this program. In more than 50 rural hospitals in Kazakhstan the Academy has installed telemedicine modules and trained local staff on how to use telemedicine equipment.

One of inventions of the Academy of Preventive Medicine inventions is Telemedicine Module, which is a combination of different types of telemedicine equipment integrated by a single platform. Kazakhstan Academy of Preventive Medicine provides counseling and support on how to design a telemedicine system, assemble a telemedicine module and organize telemedicine consultations.

The Telemedicine Module is the joint efforts of experts in medicine, public health, fiber-optic physics and telecommunication technologies. Such collaboration reflects a new paradigm in medicine as a broad discipline. It also reflects evolution from traditional medicine to medicine that is technology-driven - telemedicine.

Kazakhstan Academy of Preventive Medicine organizes trainings, which includes 2 – 3 week courses with didactic materials and demonstration of telemedicine equipment and consultations. Practical training is organized focusing on the technical service of telemedicine module.

Kazakhstan Academy of Preventive Medicine provides advisory services on how to select telecommunication infrastructure that is adequate for telemedicine consultations.  Telemedicine consultations are organized with doctors from leading hospitals in the United States, Europe and other regional academic centers.

Telemedicine Module

Telemedicine module is mobile, portable set of telemedicine diagnostic equipment integrated by special software called Medline.pro. The system is designed to perform emergency and planned diagnosis and consultation of patients with various heart and lung conditions, diseases of eyes, ears, skin and internal organs. Remote consultations and distance learning programs are possible through videoconferencing.

Flexible configuration and the use of various types of telemedicine equipment makes the telemedicine module available for a wide variety of clinical applications. The telemedicine module integrates the following types of diagnostic equipment and peripherals:

·      Telemedicine videoscopes: othoscope to visualize with high resolution and diagnose ear,nose and throat conditions;  ophthalmoscope  to assess eye functions;  dermascope (microscope with low resolution) to diagnose diseases and injuries of skin and mucosal membranes.

·      Illumination camera and light source is a hardware that integrates videoscopes.

·      Telemedicine sthetoscope to assess heart and lung functions.

·      General observation camera to visualize patient.

·      Polycom system is used to conduct videoconferencing.

·      Portable ultrasound machine and EKG are also integrated into the telemedicine module.

·      Telemedicine platform includes computer (CPU with LCD monitor), camcorder, VCR, laser printer and scanner.

·      Telecommunication equipment: modem, router, satellite receiver and other types of equipment.

To ensure that permanent power source is available, the telemedicine module is equipped with power generators and a UPS system.

If necessary, other types of diagnostic equipment, such as gastroenteroscope, laparoscope, colposcope and nasopharingoscope, can be integrated into the telemedicine module. In addition, the module can be equipped with a laboratory system capable of performing basic blood analysis (CBC, blood chemistry).

One of innovations of Kazakhstan Academy of Preventive Medicine is a telemedicine software called Medline.pro. It allows for an effective integration of computer interface with telemedicine equipment.

 Medline.pro (Kazakh version is Medline.kz), has an interface in Russian language. It uses simple commands and instructions. Medline.pro is a user-friendly product, it allows for logical integration of all components of the telemedicine module. Medline.pro is designed to effectively compress files and transmit them through IP communication.

Improving performance and quality of care: developing and applying evidence-based clinical standards

The Academy of Preventive Medicine is committed to improve the quality of health services through the introduction of evidence-based clinical standards.  This includes improving the quality of care, resulting in improved clinical outcomes; improving quality of services (patient satisfaction is one dimension); improving quality of resource use (from stewardship of the system to cost-effectiveness of individual interventions); and improving quality of the health workplace (including compensation and supportive supervision). This requires a multi-step approach.

·           The development of a small number of clinical standards in a high disease priority region for a target area, such as reproductive health or a type of cancer.

·           Applying the clinical standards developed in the pilot to inform policy decisions in a particular setting, such as a regional hospital.

·           Building the technical capacity for clinical epidemiologists, statisticians, health economists, experts in critical appraisal and health technology assessment.

·           Evaluation the impact of standards on quality and efficiency, patient and professional satisfaction.

·           Formalizing standard development methods and processes. The standards could be used, adapted to the local setting, by other regions of Kazakhstan.

Evidence-based medicine (EBM) and evidence based practices are key components of improving the quality of clinical outcomes. EBM is not simply the development of guidelines and standards using reviews of literature and analyses of scientific studies, although this approach can help guide national policy and provide tools for health providers. EBM is also the practice of making decisions about health care at the service delivery level, based on the best available, current, valid and relevant evidence, clinical experience, and ultimately, the patient’s values and wishes.

In general, Kazakhstan’s standards tend to be broader and more inclusive especially of new health technologies, including access to diagnostics and interventional procedures.

Kazakhstan Academy of Preventive Medicine will apply international standards adopted from such databases as:

·      National Institute for Health and Clinical Excellence – UK: www.nice.org.uk

·      Scottish Intercollegiate Guideline Network – UK: www.sign.ac.uk

·      National Guideline Clearing House – US: www.guideline.gov

·      United States Preventive Services Taskforce - US: www.ahrq.gov/clinic/USpstfix.htm

·      DERP- US: http://www.ohsu.edu/drugeffectiveness

·      National Quality Forum – US: http:www.NQF.org

Introduction of international evidence-based standards is a multi-step process.  It requires active participation of stakeholders, doctors, pharmacists, etc.

First Step

The first step is to pilot the development of a small number of clinical standards in a high priority disease areas. The standards should be disease rather than setting/facility-focused and span the whole continuum of care, from prevention targeting individual at high risk of developing the disease, to treatment, both in inpatient and outpatient settings, and rehabilitation and long-term care following discharge from hospital. The standards should also include different technologies (drugs and devices) and diagnostic and therapeutic interventions. 

The Academy’s role is to help build a multi-stakeholder model for standard development that includes a review of international standards in the same disease areas, a systematic review of the evidence base including economic considerations and local data.

Second Step

The second step consists of applying the clinical standards developed in the pilot to inform  policy decisions in a particular setting:

·    Clinical standards can be used as one consideration when making allocative decisions among investments in primary prevention, detection and treatment in outpatient settings, inpatient care, rehabilitation care and long-term care. This will help ensure increased investment is targeted where it is most needed across the continuum of care; for example, it could help inform decisions at to the type of equipment necessary at different levels, with more specialized diagnostic or therapeutic equipment made available taking into account accessibility issues.

·    Clinical standards can form the basis for developing quality indicators in pay for performance schemes in inpatient and outpatient (primary care and polyclinic) settings.

Third Step

The third step, to be considered in conjunction with step two above, is to build the technical capacity for clinical epidemiologists, statisticians, health economists, experts in critical appraisal and health technology assessment. Kazakhstan Academy of Preventive Medicine will provide appropriate training to assist practicing clinicians in understanding the methods being used to develop the standards and allocate resources; this will allow clinicians to contribute to the standards development process and help gain their support in implementing the standards.

Fourth Step

The fourth step, again to be considered in conjunction with step two above, is to evaluate the impact of standards on quality and efficiency, patient and professional satisfaction. A detailed evaluation plan could be developed to assess the pilot and the implementation of standards in benchmarking and performance management in step two. Input from clinicians and patients is especially critical.

Fifth Step

The fifth step is to formalize standard development methods and processes. This will require the establishment of a dedicated process involving multiple stakeholders along the lines of the pilot, improved based on the evaluation of the pilot results. Having developed the institutional and technical capacity to produce standards in all high priority disease areas, a strong case can be made for national support at the level of the Ministry of Health as it could serve as a model for similar standard-developing activities across Kazakhstan. Alternatively, the newly developed standards could be used, adapted to the local setting, by other regions in the Kazakhstan.

Healthcare Publishing: www.zdrav.kz a website on health and how to prevent diseases                                 

The Academy of Preventive Medicine actively participates in developing www.zdrav.kz, a new Russian-language website dedicated to healthcare and biomedicine. Zdrav.kz is rapidly gaining popularity among broad Internet-user audience. Since its inception last year, Zdrav.kz has already been visited by more than 350,000 users.

At Zdrav.kz we intend to provide credible information and in-depth reference material about health subjects that matters to many people in Kazakhstan and the other Russian-speaking countries. We aspired to become a source for original and timely health information as well as material from well known content providers. Our target audiences are general public and health professionals, mostly Russian speaking.

The Zdrav.kz content staff blends expertise in journalism, content creation, expert commentary, and medical review. And that, we believe, requires dedicated, full-time staff professionals with state-of-the-art expertise in publishing:

·    Health news and resources for the public

·    Health news and resources for health professionals

·    Information on healthy lifestyle, dieting, stress management and longevity

·    Up-to-date medical reference content databases, such as "Medical Dictionary", "All About Diseases".

·    Latest news related to medicine and biomedical research

·    Interactive tools such as "Symptoms-on-line", "Food pyramid".

We are dedicated to providing quality health information and to upholding the integrity of our editorial process. We share our philosophy with that of WebMd, is the leading health portal in the United States.

One of our priorities is to publish information about rating of hospitals and health specialists in Kazakhstan and neighboring countries. It will help our users to find their ways and make informed decisions on health-related issues.

Our key partner is Global Technology Network LLC, a private company that is responsible for developing technical aspects of zdrav.kz. We also work together with the National Medical Holding, a company that comprises six state-of-the-art hospitals in the capital city of Astana. In addition, we plan to establish a partnership with Center for Personalized Medicine, a new company in Kazakhstan focusing on genomics testing, genetic counseling, pharmacogenomics, and health promotion.

We are very proud of recent decisions to support Zdrav.kz made by such global companies as Roche, Medtronic and Astellas. We believe that partnerships with pharmaceutical and healthcare companies are crucial to us. Your help would be essential to support our staff who work hard on developing proper web engine and designing the site as well as to motivate our professionals to constantly update the content of Zdrav.kz.

We are committed to improving Zdrav.kz and will continue to publish even more content to help make people's life better, to assist them find a way when faced with healthcare decisions, and to help them feel better about their health. We will also publish the latest information about biomedical discoveries as well as basic information on many healthcare topics that might be of interest to doctors, researchers and the other healthcare professionals.

 

1995 Kazakhstan National Demographic and Health Survey

Assignment name: 1995  Demographic and Health Survey (1995 KDHS)	Value of the contract: US $590,000
Country: Location within country: Entire country	Duration of assignment: 13 month
Name of Client: US Agency for International Development (USAID)	Total No of staff-months of the assignment: 130 (interviewers and technicians not counted)
Address: 41 Kazbek bi, Almaty,	Value of the services provided: US$ 590,000
Start date: March 1995 Completion date: March 1996	No of professional staff-months provided by associated Consultants: 25
Name of associated Consultant:   MEASURE DHS+ project of Macro International Inc. in the U.S.	Key staff: Team Leader: Dr. Temirkhan Bekbosynov Project Director:  Dr. Nailya Karsybekova Technical Staff: Dr. Bedel  Sarbayev Consultants: Dr. Jerry Sullivan, Dr. Almaz Sharman, Ms. Than Le, Mr. Trevor Croft
Narrative description of the project: The 1995  Demographic and Health Survey (1995 KDHS) was the first national level population and health survey in . The purpose of the 1995 KDHS was to develop a single integrated set of data for the government of  to use in planning effective policies and programs in the areas of health and nutrition. The purpose of the 1995 KDHS was to develop a single integrated set of data for the government of  to use in planning effective policies and programs in the areas of health and nutrition. The survey was designed to provide current data on women’s reproductive histories; maternal care, child health amd mortality, child nutrition practice, breastfeeding, nutritional status and anemia.
Services provided by the staff: Adaptation of the questionnaire - Three questionnaires were used for the 1995 KDHS: the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire. These questionnaires were based on the model survey instruments developed for the MEASURE DHS+ program and were adapted to the data needs of .  Refining of sample in the field Training of sixty four persons recruited as field supervisors, editors, health investigators and interviewers for three and a half weeks. Training consisted of lectures and practice in the classroom, as well as interviewing in the field. The training of health investigators, who were responsible for hemoglobin testing of women and children, was accomplished by two days in the classroom and three days in the field. Fieldwork - A total of 3,771 womes of age 15-49 were selected in the sample and fieldwork was conducted from May to September 1995. Testing of women and children was conducted during the survey. The study involved hemoglobin testing for anemia using Hemoque system.  Data entry Data analysis Writing of the final report

1999 Kazakhstan National Demographic and Health Survey

Assignment name: 1999  Demographic and Health Survey (1999 KDHS)	Value of the contract:   US $ 678,987
Country: Location within country: Entire country	Duration of the assignment: 24 month
Name of Client: US Agency for International Development (USAID) and United Nations Children Fund (UNICEF)	Total No of staff-months of the assignment: 240 (not included: interviewers and technicians hired separately)
Address: 41 Kazbek bi, Almaty,	Value of the services provided under the contract: US$ 678,987
Start date: April, 1999 Completion date: March, 2002	No of professional staff-months provided by associated consultant: 35
Name of associated Consultant:   MEASURE DHS+ project of Macro International Inc. in the U.S.	Key staff: Team Leader: Dr. Temirkhan Bekbosynov Project Director: Dr. Nailya Karsybekova Team supervisors: Dr. Bedel Sarbayev, Akkumis Salkhanova Consultants: Dr. Jerry Sullivan, Dr. Almaz Sharman, Ms. Than Le, Mr. Trevor Croft
Narrative description of project: The purpose of the 1999 KDHS was to develop a single integrated set of data for the government of  to use in planning effective policies and programs in the areas of health and nutrition. The survey was designed to provide current data on women’s reproductive histories; knowledge and use of methods of contraception; breastfeeding practices; and the nutrition, vaccination coverage, and episodes of diseases among their children under the age of five. The survey also included the measurement of the hemoglobin level in the blood to assess the prevalence of anemia, and measurements of height and weight to assess nutritional status (funded by UNICEF). Since the 1999 KDHS was the second survey, it provided comparable data for analysis of trends in fertility, reproductive health, and child health and nutrition. Both surveys contributed to the growing international database on demographic and health-related variables.
Description of actual services provided within the assignment: · Adaptation of the questionnaire - three questionnaires were used for the 1999 KDHS: the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire. These questionnaires were based on the model survey instruments developed for the MEASURE DHS+ program and were adapted to the data needs of .  · Refining of sample in the field · Training- Eighty people were recruited as field supervisors, editors, health investigators and interviewers and were trained for three and a half weeks. Training consisted of lectures and practice in the classroom, as well as interviewing in the field. The training of health investigators, who were responsible for anthropometric measurements (height and weight) and hemoglobin testing of women and children, was accomplished by two days in the classroom and three days in the field. · Fieldwork - A total of 6,301 households were selected in the sample, of which 5,844 were interviewed, yielding a household response rate of 98 per­cent. Interviews were success­fully completed with 4,800 of these women, yielding a response rate of 98 percent. Response rate for men was 94 percent. · Data entry · Data analysis · Writing of the final report

 

Telemedicine and Mobile Medicine in Almaty, Karaganda, Atyrau, Akmola, Kyzylorda, South-Kazakhstan, and  Zhambyl Regions of Kazakhstan

Assignment name: Telemedicine and mobile medicine in Almaty , Karaganda, Atyrau , Akmola, Kyzylorda, South-Kazakhstan  and  Zhambyl oblasts	Value of the contract:   US$ 4,720, 997
Country: Location within country: Almaty , Karaganda, Atyrau, Akmola, Kyzylorda, South-  and  Zhambyl oblasts of	Duration of assignment: 69 months
Name of Client: Ministry of Health Republic of	Total No of staff-months of the assignment: 185
Address: 010000, Left bank of Ishim river, House of Ministries, 5th entrance, Astana, Republic of	Value of the services provided under the contract: US$ 1,416, 299 (the rest was the cost of medical equipment)
Start date: March 2004 Completion date: December 2008	No of professional staff-months provided by associated Consultants: 98
Names of associated Consultants: MDS company Wycombe, LLC GTNet, LLC	Staff involved in the project: Team Leader: Dr. Bulat Alibekov, Akkumis Salkhanova Project Director: Talgat Sultanov Medical  Director: Dana Sharman Technical Specialists: Alexander Korotkov
Narrative description of project: Starting in 2004, the telemedicine program was introduced in  as part of the government program of rural telemedicine. The main goal of the project iwas to demonstrate improved access to health care services and health information at rural primary health care levels by establishing telemedicine services in 128 sustainable rural districts (raions) in all 14 oblasts of  equipped with state-of-the-art telemedicine equipment and supported by long-distance medical consultation services. The Academy of Preventive Medicine is the leading organization responsible for implementation of this program. In more than 50 rural hospitals in  the Academy has installed telemedicine modules and trained local staff on how to use telemedicine equipment.
Description of actual services provided by your staff within the assignment: ·      Providing counseling and support on how to design a telemedicine system, assemble a telemedicine module and organize telemedicine consultations. ·      Training of 244 specialists and technicians recruited as staff of telemedicine center for two weeks prior to installation of the telemedicine module and for a week after the installation. The training courses included didactic materials and demonstration of telemedicine equipment and consultations. Practical training was organized focusing on technical service of telemedicine module. Telemedicine manual was developed in Russian and Kazakh languages.  ·      Organizing telemedicine consultation between rural hospital and national and regional medical centers. ·      Organizing telemedicine consultation with doctors from leading hospitals in the United States (Children Hospital in Paterson, NJ).

 

Electronic Mapping of Health and Education Facilities of Kyzylorda Oblast of Kazakhstan 

Assignment name: Electronic mapping of health and education facilities of Kyzylorda oblast of  Kazakhstan	Value of the contract: US $ 309,524
Country: Location within country: Kyzylorda oblast	Duration of the assignment: 10 month
Name of Client: Akimat of Kyzylorda oblast	Total No of staff-months of the assignment: 35
Address:	Value of the services provided under the contract: US$ 309,524
Start date: March 2007 Completion date: December 2007	No of professional staff-months provided by associated Consultants: none
Name of associated Consultants, if any: None	Staff involved in the project: Project Director: Akkumis Salkhanova Coordinator: Talgat Sultanov Medical Consultant: Dana Sharman IT Manager: Igor Ivanov Fieldwork Coordinator: Alexander Korotkov
Narrative description of the project: In Kyzyl-Orda oblast of  the Academy of Preventive Medicine has developed a comprehensive health map by integrating GIS information and statistical data on all healthcare facilities (census of healthcare facilities).  Such approach provides important tools for regional healthcare administrators, enabling them to better analyze spatial relationships between different factors affecting health of populations residing in the region, to determine the needs for additional resources and to identify challenges and barriers affecting implementation of healthcare programs.
Description of actual services provided within the assignment: ·     Development of a strategy and concept design for healthmapping of a geographic and administrative region: working with the local government on benchmarks and parameters for the data collection ·     Development of methodology for healthmapping: selection of electronic platform (MapInfo, GoogleEarth, ArcView), designing survey instruments (questionnaire) for collection of health, demographic, economic and other types of data; designing a system for integration of data with geographic coordinates ·     Organizing fieldwork for data collection at healthcare facilities, schools and other facilities; establishing a database for integration with geographic coordinates ·     Developing 3-d images of healthcare facilities and integration of 3-d objects into the health maps ·     Design methodology for analysis of statistical, epidemiology data, information on staffing, availability of medical equipment, clinical guidelines, textbooks and computers. Integration of such data into health maps. ·     Training healthcare administrators and local staff how to use health maps and analyze statistical and epidemiological data in order to effectively plan and administer healthcare resources

Improvement of Population’s Knowledge of Healthy Nutrition and Food Safety (in Framework of the State Program “Healthy  People 2011-2015”

Assignment name: Improvement of population’s knowledge of healthy nutrition and food safety (in framework of the State program “Healthy People  2011-2015	Value of the contract: US$ 1,325,670
Country: Location within country:  Entire country	Duration of assignment: 6 month
Name of Client: Ministry of Health Republic of  Kazakhstan	Total No of staff-months of the assignment: 76
Address: 010000, Left bank of Ishim river, House of Ministries, 5th entrance, Astana, Republic of	Value of the services provided by the Academy of Preventive Medicine under the contract: US$ 1,325,670
Start date: July 2011 Completion date: December 2011	No of professional staff-months provided by associated Consultants: None
Name of associated Consultants, if any: None	Staff involved in the project: Project Director: Dr. Akkumis Salkhanova Medical Consultant: Dr.Dana Sharman Staff members: Dr.Igor Tsoy, Dr. Yuri Sinyavski, Dr. Shamil Tazhibayev
Narrative description of the project: The Project is aimed at improving of food safety and population’s knowledge about healthy nutrition. It also addresses prevention of iron-deficiency anemia, iodine deficiency, diabetes, obesity, and other nutrition-related diseases. As part of the project, the Academy promotes activities on the development of food safety standards. The project covered different population groups: schoolchildren, women of reproductive age, healthcare workers, students and others.
Description of actual services provided within the assignment: Developed communication materials for different population groups, manuals for primary healthcare workers, training materials for the food industry, and materials on food safety standards.  Study of public awareness about healthy nutrition and prevention of iron-deficiency anemia, iodine deficiency, diabetes, obesity, and other nutrition-related diseases. Conducting communication campaign to improve knowledge of different population groups. Provided extensive media coverage of healthy nutrition issues throughout the country.

2012 Kazakhstan National Household Health Survey

Assignment name: Kazakhstan National Household Health Survey	Value of the contract: US$ 740,000
Country: Location within country:  Entire country	Duration of assignment: 9 month
Name of Client: Ministry of Health Republic of  Kazakhstan The World Bank	Total No of staff-months of the assignment: 45
Address: 010000, Left bank of Ishim river, House of Ministries, 5th entrance, Astana, Republic of	Value of the services provided by the Academy of Preventive Medicine under the contract: US$ 640,000
Start date: July 2011 Completion date: December 2011	No of professional staff-months provided by associated Consultants: None
Name of associated Consultants, if any: None	Staff involved in the project: Project Director: Dr. Akkumis Salkhanova Medical Consultant: Dr.Dana Sharman Staff members: Dr.Igor Tsoy, Dr. Yuri Sinyavski, Dr. Shamil Tazhibayev
Narrative description of the project: The purpose of Kazakhstan National Household Health Survey is to provide data to strengthen evidence base for policy making and management responses based on information on health status, utilization, payments, behaviors, attitudes, measurements of blood pressure and other biometrics and to provide valuable insights into how households interact with the health system and how they perceive issues of critical importance to public health.
Description of actual services provided within the assignment: Adapt the standard World Bank’s survey instrument /questionnaire; conduct pre-pilot and finalize the survey instrument; develop the sampling strategy; implement the survey; enter and clean the survey data in a database; and conduct data analysis and prepare a survey report