Kazakhstan bears one of the greatest burdens of TB and HIV/AIDS in the Central Asian region (CAR). Distinguished by its large territory and relatively high level of annual per capita income (US $1,200), Kazakhstan has an HIV/AIDS prevalence higher than its four neighboring countries combined. Since the first case was registered in 1987, the number of unofficially reported cases had grown to 2,868 by June 2002. However, UNAIDS estimates that the real number is at least twice as high, and the Government estimates that about 20,000 people were already infected by the end of 2001. Meanwhile, at the end of 2001 there were 48,701 registered cases of active TB. Between 1990 and 2001, notification rates of new TB cases and deaths in Kazakhstan increased 2.4 times.
Over the past few years, the Ministry of Health (MoH) and the Government of Kazakhstan have made important progress in meeting the challenge of TB and HIV/AIDS. DOT (Directly Observed Therapy), a strategy developed by the World Health Organization (WHO), has been formally established as the policy for the entire country and efforts are being made to implement
it nationwide. These efforts have not been without impact. The mortality rate from TB has declined and there is some evidence of improvements in case detection. With respect to HIV/AIDS, early action by the government will potentially ward off any problems in the future. Having obtained support from the Global Fund, it is increasingly important that these resources are well spent.
Combined financing of TB and HIV/AIDS was close to $45 million in 2002 and is likely to surpass $60 million in 2004. At over ten percent of the annual MoH healthcare spending budget, it is imperative that these funds are invested carefully and that impact on the target population is maximized. This is where Sanigest Internacional has been able to lend advice. Investing in prevention and population awareness is important but more so is the issue of ensuring cost-effectiveness in the existing programs and guaranteeing adequate access to all services. While increased funds may be required in the future, the inefficiencies and ineffective aspects of the current programs should be fixed now so that these resources will not be wasted.
Sanigest Internacional has analyzed the efficiency, quality and effectiveness of each of the programs and identified their structure of financing and cost-effectiveness. In addition, the company has identified opportunities to improve performance, specifically analyzing the relationship between inputs and outcomes and highlighting, in the case of the TB program, opportunities to produce significant savings or improved value-for-money in the program.
Problems and Issues:
- The principle findings showed a significant disparity between the resources and achievements of the different oblasts in Kazakhstan.
- There was an urgent need to improve and update buildings and facilities in the country to allow treatment to be more efficiently administered and to prevent the spread of infection among staff and patients.
- Investment in human resources was desperately needed as a lack of properly trained staff was noticed.
- Drug supply required improvement so that hospitals were not forced to ask patients to buy their own medication.
- Cultural acceptance of TB and HIV/AIDS needed to be improved through the media.
- Hospitals needed to be encouraged to employ DOTs in their treatment programs and the role of NGOs needed be strengthened to alleviate the burden on these hospitals.
Outcomes of SANIGEST engagement:
- Assessment of the resources available to combat TB and HIV/AIDS/STIs in Kazakhstan
- Development of a tool which can be applied to programs across the country, having been pilot tested in two areas
- Potential shortages in provision of services assessed and improvements made
- Efficiency and quality evaluated and enhanced
- Potential economic benefits and financial sustainability of investments assessed and improved upon
- Appropriateness of preventative and clinical practices followed by HIV/AIDS/STI services evaluated and developed