The largest country in Central Asia, Kazakhstan has a population of just over 18 million people. Kazakhstan also boasts the region’s largest economy thanks mainly to its vast natural resources. Tapping into these resources has unfortunately resulted in severe industrial pollution in some cities, while radioactive or toxic chemical sites associated with former defense industries and test ranges scattered throughout the country pose health risks for humans and animals.
Kazakhstan’s agricultural industry has also caused environmental concerns, including ground pollution from overuse of agricultural chemicals and salination from poor infrastructure and wasteful irrigation practices. In addition, because the two main rivers that flowed into the Aral Sea have been diverted for irrigation, it is drying up and leaving behind a harmful layer of chemical pesticides and natural salts, which are then picked up by the wind and blown into noxious dust storms.
WHO reports that noncommunicable diseases, such as cardiovascular disease, diabetes, and cancer account for nearly 85 percent of all deaths in Kazakhstan. Infectious diseases, including Hepatitis C, TB, HIV, and other sexually transmitted infections also constitute a public health challenge for the country. Although its adult HIV prevalence rate is just 0.19 percent, Kazakhstan currently exhibits a number of factors that create the potential for a dramatic increase, namely increasing levels of injection drug use, commercial sex work, population migration, and marginalization of vulnerable and high-risk groups.
While the country has made a number of marked improvements in the healthcare sector over the past two decades, it still faces significant environmental and public health challenges at the policy, infrastructure, and practice levels.
With support from the U.S. Agency for International Development (USAID), AIHA launched its first partnerships in Central Asia in 1992 as a way to link US healthcare professionals with their counterparts in the five countries of the region. This includes four successful twinning partnerships in Kazakhstan between 1993 and 2004, as well as a number of region-wide projects in medical education, nursing, and community-oriented primary care from 2004 to 2006. AIHA has also implemented technical assistance projects in Kazakhstan with funding from the World Bank, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), and the U.S. Centers for Disease Control and Prevention (CDC). Most recently, our work in Kazakhstan has focused on blood safety, but AIHA has a long history of health systems strengthening projects across a broad range of technical areas, including emergency medicine; primary healthcare; maternal, newborn, and child health; hospital strengthening; HIV/AIDS; infection control and prevention; and non-communicable diseases.
Partnership for Preparation to International Accreditation of Republican Blood Service Reference Laboratory and Building Capacity of Blood Service Specialists
(2014 – 2015)
In October 2014, AIHA negotiated a fixed-price contract with the Ministry of Health of Kazakhstan and the World Bank to provide technical assistance to prepare the Republican Blood Service Reference Lab (RBSRL) in Astana to attain ISO l7043 and ISO 19011 accreditation. Through this project, AIHA was also tasked with designing and coordinating six international training programs for local clinicians, quality managers, nurses, and production staff.
AIHA conducted an initial assessment of ISO 17043 requirements at RBSRL in early November 2014. The first deliverables — including a report of the gap assessment, a plan of work, and the medical laboratory passport — were provided on November 25. AIHA then conducted an initial training on ISO 17043 requirements in November and December, followed by a three-day training of 14 people on the technical requirements for accreditation in January 2015. Two international consultants worked with the RBSRL Work Group assessing current activities and progress on the development of supporting documents. Progress on the project continued with the development and implementation of required policies and procedures. Follow-up visits took place in April and May 2015, including audit training according to ISO 19011.
AIHA conducted the first study tour of the project December 8-19, 2014. A group of 21 quality specialists, oblast blood center directors, and representatives from the Ministry of Health attended a two-week training on quality management held at the Puget Sound Blood Center in Seattle, Washington. Participants learned how quality assurance is integrated into daily operations in the vein-to-vein process. The first week was focused on blood center processes beginning with donor recruitment through storage and distribution of blood components, while the second week focused on clinical processes from clinical assessment of the patient to blood administration and monitoring and reporting of adverse events.
In January 2015, a group of 21 participants specializing in laboratory processing attended a five-day training course at the Oklahoma Blood Institute (OBI) in Oklahoma City. In February, another group of 21 participants focused on component production and, in May, AIHA conducted a third study tour at OBI on the organization of interactions with blood consumers. The final study tour of the project was conducted in June, when AIHA brought a group of 22 nurses to Barcelona, Spain, to attend a training on blood service management for paramedical staff at the Banc de Sang i Teixits.
Project to Strengthen Blood Services in Central Asia, Ukraine, and Cambodia
(2012 – 2015)
Under our CDC-supported Project to Strengthen Blood Services in Central Asia, Ukraine, and Cambodia, AIHA began providing technical assistance to Kazakhstan in January 2014, focusing primarily on improving local infrastructure, quality management capacity, transfusion medicine, donor management, and applied research.
In January 2014, with support from CDC and the World Bank, AIHA conducted an assessment on the computer information management system (CIMS) at the Scientific and Production Center of Transfusiology (SPCT) in Astana and the Republican Blood Center in Almaty.
Based on this assessment, AIHA provided continued assistance with the development of user requirement specifications (URS) for the SPCT in preparation for a request for bids from commercial vendors. After reviewing current processes with local stakeholders, AIHA engaged an international consultant to develop URS, which were provided on the following modules in May 2014: donors; patients; stem cells; cord blood; bone marrow; HLA process, bone marrow donor registry database; data migration; and overall bidding requirements.
AIHA provided finance-related technical assistance, sharing international experiences in the reimbursement of blood centers for the production of donor blood components. An international expert provided advice on financial cost accounting and cost recovery in July 2014. The consultant met with Dr. Burkytbaev and the Vice Minister of Health of Kazakhstan, Dr. Eric Baizhunusov, on July 3 to discuss the financial cost accounting system and primary recommendations, and submitted a final written report.
The AIHA team developed a set of presentations on a quality management course for the SPCT in Astana. The quality management curriculum was based on WHO and WHO/CLST training programs, and further customized by Dr. Tarasova in Astana to include local normative regulations, case studies, and a test to meet state postgraduate education requirements.
Dr. Chursin at the Almaty State Institute for Postgraduate Education developed a course on clinical indications for use of blood in collaboration with the SPCT. AIHA provided a copy of the German guidelines on blood component therapy as a reference, which are considered to be one of the best in the European Union. In March 2015, AIHA sponsored the 10-day training course for 39 physicians, which was conducted in Astana in collaboration with national trainers from SPCT. AIHA also sponsored participants from Tajikistan and Kyrgyzstan to attend the course.
AIHA engaged an international consultant to provide technical assistance on raising public awareness for the recruitment of VNRBD in Astana and later at a regional conference in Almaty. The consultant also provided information on the topic of crisis communication.
An AIHA consultant reviewed a proposal for the “Evaluation of alloimmunization in Kazakh patients with acute myeloid leukemia (AML),” and followed up with a conference call with the proposal authors on December 22, 2014. The authors revised the proposal based on recommendations from the consultant, who provided further feedback.
AIHA concluded its support to Kazakhstan under this PEPFAR-funded blood safety project in 2015.
Community-Oriented Primary Care Project
(2004 – 2006)
AIHA’s USAID-supported Community-oriented Primary Care Program in Kazakhstan was based on the highly effective socio-medical model piloted at Demeu Family Medicine Center in the nation’s capital of Astana. This Center was established in November 2000 through the efforts of our Astana / Pittsburgh partnership, which was part of a larger health partnership program designed to strengthen health system capacity in the region following the collapse of the former Soviet Union.
Key objectives of this two-year replication project were to:
- Develop social work as a profession by strengthening the training capacity of the Demeu Family Medicine Center to better integrate a socio-medical model in primary care throughout the country;
- Engage local and oblast-level health administration in target regions (Almaty, Semey, and Uralsk), along with representatives of family group practices in planning and implementing activities designed to foster use of an integrated socio-medical model in primary healthcare;
- Improve the delivery of primary healthcare services through the integration of social services at selected replication sites; and
- Sustain improvements made in primary healthcare services at replication sites through the development of quality improvement practices.
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Central Asia Regional Nursing Education Project
(2004 – 2006)
Tasked with the overall goals of updating undergraduate and graduate-level nursing curricula, as well as enhancing the leadership skills of nurses, this USAID-supported project included two nursing schools in Kazakhstan: Almaty Nursing College and Astana Nursing College. Five other nursing colleges from Kyrgyzstan and Uzbekistan also collaborated on this regional initiative designed to strengthen nursing education.
In May 2004, AIHA sent a team of six faculty members from University of Minnesota School of Nursing to Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan to conduct site assessments prior to selection of the Central Asian partner institutions for this regional nursing education program.
Specific objectives for this project, which was designed to strengthen nursing education on a regional level, included:
- Enhancing basic level nursing curricula (post 11th grade) at the State Medical College of Astana and Bishkek Nursing College;
- Enhancing nursing curricula at the advanced level (including master’s degree level) at Bukhara State Medical Institute in 2005, and at Almaty Medical College and Kyrgyz State Medical Academy in 2006;
- Increasing the nursing and pedagogical knowledge and skills of nursing faculty;
- Increasing access to educational and informational resources in support of curricular and faculty development objectives; and
- Enhancing the professional independence and leadership capacity of partner faculty.
Working together, partners identified faculty and curriculum development, the provision of technical and equipment support, and the linkage of theoretical education with clinical education and training as key priorities for their collaboration.
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Central Asia Medical Education Initiative
(2004 – 2006)
From 2004 to 2006, AIHA’s Central Asia Medical Education Initiative focused on curriculum and faculty development at the regional level. The overall goal of this multi-institutional partnership was to increase the capacity of medical institutions in Central Asia to produce high-quality graduates who were well prepared to meet the healthcare needs of their populations. Two Kazakh institutions: the Kazakh State Medical Academy in Astana and West Kazakhstan Medical Academy in Aktobe were among the seven schools that participated in this USAID-funded project.
AIHA engaged the University of South Florida as the lead institution in a consortium that included faculty from the University of Nevada at Reno and representatives of various U.S. organizations that oversee medical education, such as the Educational Commission for Foreign Medical Graduates, Foundation for International Medical Education and Research, Association of American Medical Colleges, and the Liaison Committee on Medical Education.
Specific objectives were to:
- Strengthen the capacity of medical institutions in Central Asia, individually and regionally, to plan and implement educational reforms in priority areas;
- Enhance knowledge and skills of faculty to design and implement a curriculum that meets regional standards and is appropriate to the healthcare needs of each country;
- Develop capacity of medical institutions (including faculty and students) to conduct basic and applied research; and
- Build awareness of and programs for student development issues.
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Almaty / Tucson (Arizona) Twinning Partnership
(1993 – 1999)
This highly successful hospital partnership linked the Tucson/Almaty Healthcare Coalition, a broad-based alliance of health and allied institutions in the Tucson community, with the Kazakh Research Institute of Pediatrics and the Almaty City Emergency Medicine Hospital. Together, partners focused on a number of needs-driven public health priorities, including cardiology, neonatology, hematology, oncology, perinatology, pulmonology, toxicology and poison control, emergency medical services, and infection control.