The Kazakhstan Partnership on Chronic Diseases Management Programs (DMPs) Development and Implementation is a sub-component of the Kazakhstan Health Technology Transfer and Institutional Reform Project (KSTTIRP). The Canadian Association for Global Health worked to implement internationally successful approaches to chronic DMPs for chronic heart failure, hypertension, and diabetes mellitus in two pilot regions in Kazakhstan: Petropavlovsk and Pavlodar.
The KSTTIRP was an initiative co-financed by the Government of Kazakhstan and the World Bank. Twinning external partners with relevant Kazakh institutions, its aim was to introduce international standards and build long-term institutional capacity in support of key health sector reforms pursued by the Ministry of Health (MOH). The following is one of five projects implemented by CSIH.
Kazakhstan faces challenges in restructuring its health care system, especially in regards to its growing burden of non-communicable diseases. Coronary heart disease is now the leading cause of death in the country, and cardiovascular disease and diabetes account for nearly half of the country’s disease percentage. Health systems must respond by adopting new approaches that address the needs of populations with chronic conditions.
To ensure chronic disease care in primary health facilities is more organized, predictable, efficient, systematic, and that patients are engaged in their care.
CAGH worked closely with Kazakhstan’s Ministry of Health (MOH), Centre for Healthcare Standardization, and regional departments to implement a DMP strategy. This strategy incorporates “Plan-Do-Study-Act” cycles -- which evaluate the different ways a change can be implemented -- and provides self-management tools for healthcare providers to engage patients and increase their motivation.
By October 2015, nearly all teams improved. Overall this occurred in process measures, while there was relatively little change in outcome improvements, which was expected due to the short time period. For example, in Pavlodar Polyclinic #5, the percentage of patients whose blood pressure was less than 140/90 went from 10% to 62%; in Petropavlovsk Polyclinic #1, the amount of patients who had an ACR test in the last 12 months went from 14% to 81%; and in Pavlodar Polyclinic #4, the number of patients who had an eye check in the last 12 months went from 20% to 84%.
Successful implementation of DMP strategies relies on frequent evaluations and feedback, which are delivered in a supportive and non-punitive manner. There should be incentives for clinics to participate. During new skills-training, evidence-based methods for adult learning should be applied. Furthermore, a National Steering Committee should be formed to address policy barriers affecting the implementation of this management strategy. Lastly, DMP initiatives should be continued over a multi-year time period so that all 200 polyclinics in Kazakhstan have an opportunity to participate in a one-year DMP Learning Collaborative.