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.
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.
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