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A New Paradigm of Primary 

Health Care in Kazakhstan:  
Personalized, Community-based, 
Standardized, and Technology-driven 
 

 

Almaz Sharman 
Co-Founder and CEO, HealthCity LLP, 
Almaty, Kazakhstan; President, Academy 
of Preventive Medicine of Kazakhstan 

 

 

 

Vol. 3, No. 1 (2014)   |   ISSN 2166-7403 (online)    

DOI 10.5195/cajgh.2014.186   |   http://cajgh.pitt.edu 

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Central Asian Journal of Global Health 

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Abstract 

This paper discusses the need for change from Kazakhstan’s current disease-centric healthcare paradigm to a new primary health 

and wellness-centric health care paradigm, technology-driven and based on personal relationships within a social context. While 

many different papers have been published about the importance of prevention and primary health care, few have focused on 

healthcare transition in Kazakhstan or other countries in Central Asia. The WHO’s historic 1978 Alma-Ata Declaration signed in 

Kazakhstan promoted the centrality of primary care to the provision of effective, efficient, and equitable health services. Modern 

technologies such as the Internet, social media, and portable medical devices democratize medicine, providing great opportunities 

to rethink the Alma-Ata Declaration and reinvent primary health care on an entirely new platform that is knowledge-based and 

technology-assisted. The new paradigm suggested for the future development of health in Central Asian region emphasizes 

personal relationships and encourages sustainable solutions created by communities. This paper also introduces HealthCity, a 

new project in Kazakhstan aiming at introducing private, community-based and standardized primary healthcare that is driven by 

SmartHealth innovative technology. 

Keywords: HealthCity, SmartHealth, Health and wellness, Healthcare 

 

A New Paradigm of Primary Health 

Care in Kazakhstan:  
Personalized, Community-based, 
Standardized, and Technology-driven 

Almaz Sharman 
Co-Founder and CEO, HealthCity LLP, 
Almaty, Kazakhstan; President, Academy of 
Preventive Medicine of Kazakhstan 

Perspective 

Current Healthcare Paradigm is Disease-centric 

Because of vast hydrocarbon resources 

available in Kazakhstan, this Central Asian country 

experienced tremendous growth and rapid economic 

expansion in recent years. Over the 20 years of 

independence, transformation of Kazakhstan’s 

economy, lifestyle, and social system have influenced 

the burden of both infectious and chronic disease and 

increased demand for health services.
1
 Following the 

break-up of the Soviet Union, Kazakhstan experienced a 

dramatic increase in tuberculosis and other infectious 

diseases.
2
 On the other hand, the health of population in 

Kazakhstan is characterized by high prevalence of 

cardiovascular disorders, cancer, diabetes, and other 

non-communicable diseases. Combined with a rapidly 

aging population and an outdated healthcare 

infrastructure, Kazakhstan’s healthcare provider 

network is facing challenges associated with country’s 

healthcare transition. Significant changes will be 

required, at both the national and regional levels, to 

meet the current and future health needs of its 

population. 

In Kazakhstan, the government owns or has 

control over approximately 80% of medical institutions, 

which include more than 1,000 hospitals and 3,400 

ambulatory care clinics. Although public healthcare 

spending was forecasted to reach $6 billion in 2014 and 

expected to grow at a 4-year Compund Annual Growth 

Rate (CAGR) of 13.4% to $9.1 billion in 2017, it may 

prove difficult to absorb and efficiently allocate the 

government’s increased levels of investment given 

constraints such as shortfalls of skilled healthcare 

professionals.
3
  

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Public and private health expenditures in 

Kazakhstan exceed 4% GDP, of which 2.6% from 

public sources.
4
 Despite such investments, Kazakhstan’s 

healthcare is characterized by insufficient access to the 

latest technology and slow integration of evidence-

based clinical care practices. Addressing the need for 

raising additional healthcare funds, the government of 

Kazakhstan has made a decision to introduce national 

mandatory health insurance system starting 2017. Based 

on previous personal communications with Ms. Tamara 

Duisenova, the Minister of Health and Social Services, 

funding for insurance will be generated from three 

sources: (1) government guaranteed healthcare benefits 

package; (2) individual co-payment, and (3) additional 

payroll taxes. While the government plays a dominating 

role in healthcare, the private sector (households and 

private health insurance) contributes around 34 percent 

of total health expenditures. Households contribute most 

private funds on an out-of-pocket basis.
5
  

Inability of the state-run health care system to 

meet the growing healthcare demands of Kazakhstan 

population has forced people of Kazakhstan to turn to a 

growing array of private health services that operate 

based on fee for service system. As a result, a dual 

health care picture has emerged in Kazakhstan: an 

inefficient old state run system; and a second, loosely 

regulated market–based private system that offers 

competitive solutions to deficiencies of the government 

system.  

 

Extensive Hospital Infrastructure  

In most countries, the current healthcare 

paradigm can be described as disease-centric. Medical 

establishment and the general public often believe that 

hospitals and efforts to treat diseases lead to better 

healthcare and more active and productive lives. 

Investing in hospitals and in-patient care still dominates 

the healthcare of Kazakhstan. An extensive hospital 

infrastructure and a neglect of primary health care is one 

of the legacies of the Soviet health system. Even though 

Kazakhstan has undertaken many health related reforms 

over the last 20 years, the inherited public health and 

medical infrastructure still determines provision of care.  

Current public allocations for in-patient 

services in Kazakhstan have doubled within the past 5 

years. According to a report by Oxford Policy 

Management (OPM), a large number of hospitals in 

Kazakhstan still treat patients on an in-patient basis, 

despite the fact that many of them could be effectively 

treated on an outpatient basis. Few years ago, such cases 

collectively amounted to around 15% of hospital 

discharges. Consequently, a significant portion of 

healthcare resources were spent on in-patient services 

instead of funding the primary health care. Overall, less 

than 5% of the national health expenditures are 

allocated to support primary healthcare and disease 

prevention.
6
 This is especially true in the city of Astana, 

the capital of Kazakhstan, where a dozen of new in-

patient facilities (tertiary care hospitals) were built 

during the last 10 years. 

Not only are too many hospitals being built, 

they are also becoming fancier and much more 

expensive to build, equip, and maintain. If in the ancient 

world marble was used to build temples and pyramids 

and in medieval times marble was used to build castles 

and churches, the 20th century used it to outfit banks 

and offices. Where does the marble go now? …To build 

hospitals.   

Equipping the tertiary care facilities introduces 

extra costs that burden the healthcare system in 

Kazakhtan. While most consumer technologies such as 

smartphones and tablet PCs are becoming more 

sophisticated but cheaper and easier to use, medical 

technologies are moving in the opposite direction. They 

have become more expensive, complicated, and often 

very intimidating to patients.  

 

 

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Permanent Battle Against Diseases 

We are in a state of permanent battle with our 

eternal enemy – diseases and maladies. The enemy 

gains more power by engaging weapons of mass 

destruction - debilitating chronic illnesses such as heart 

disease, dementia, diabetes and cancer, as well as 

emerging and re-emerging infections. Inventing new 

drugs and medical technologies has become 

increasingly difficult and resource-intensive. The fruits 

of medical knowledge that grew at the bottom of the 

tree of knowledge have already been picked - all that are 

left are the ones on top, demanding more efforts and 

resources.
7
 Modern medicine deals with almost 14,000 

diseases and operates with about 6,000 different types 

of medications and 4,000 types of medical procedures.
8
 

Despite having this rich arsenal of treatments, we are 

consistently losing our battles against disease because 

our curative strategies are often inefficient and costly. 

Medical mistakes, that are especially common in tertiary 

care facilities kill enough people around the world each 

day to fill many jumbo jets.
9
  

250 years ago, French Enlightenment writer 

François Voltaire wrote, “Doctors prescribe medicine of 

which they know little, to cure diseases of which they 

know less, in human beings of which they know 

nothing.”
10

 We are still focusing on inventing new drugs 

and medical technologies, but what we really do is 

fighting diseases at the point where the body has almost 

been conquered by the disease. Is this really the right 

direction that is being taken by our healthcare systems?  

An alternative to this is a change from the 

current paradigm that is diseases-centric to a new 

paradigm, the one that is health and prevention-centric, 

technology-driven and is based on personal 

relationships within a social context.  

 

 

 

Primary Care is a Backbone of Healthcare System 

In 1946, the World Health Organization 

defined health as: “… a state of complete physical, 

mental and social well-being and not merely the absence 

of disease or infirmity.”
11

 Despite tremendous gains in 

life expectancy achieved in the 20
th

 century, poor 

physical, mental and social well-being continues to 

burdensome and costly issue throughout the world in the 

21
st
 century. One of the key contributing factors to this 

paradox is that we keep forgetting the key role of 

disease prevention and early detection, which is an 

essence of primary health care. 

The WHO’s historic Alma-Ata Declaration of 

1978 promoted the centrality of primary care to the 

operation of effective, efficient, and equitable health 

services.
12

 While many countries adopted the 

Declaration, primary health care has been neglected and 

remains underfunded in many countries around the 

world including Kazakhstan. A significant portion of 

national healthcare resources go towards in-patient 

services instead of funding primary health care and 

shifting the balance in favor of the latter.
13

  

An inevitable result of such policies is an 

increase in healthcare utilization, increasing burden of 

chronic disease care, and subsequently, rising healthcare 

costs. Aging populations, environmental issues, as well 

as emerging and re-emerging infections make it even 

more difficult to contain healthcare costs. Focusing on 

primary care and disease prevention is one of the key 

strategies that can be effectively implemented to contain 

increasing healthcare costs.  

Primary health care is not just the first line of 

defense, but an effective gateway that facilitates 

communication with the various components of 

healthcare system. If country's primary health care 

system is strong, hospital admissions are typically 

reduced by 40% and health care costs are reducted by 

30%. Previous research demonstrated that around 70% 

to 80% of health-related episodes in an individual's life 

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can be identified by general practitioners at a primary 

care level outside hospitals.
14

 

Primary care doctors are not superstar 

surgeons, but their role is crucial. They are the ones who 

protect consumers of healthcare from getting ill and 

help them navigate in the ocean of medical knowledge 

and healthcare institutions. Their mission is to organize 

the full range of healthcare services: from individual to 

household to hospitals and from disease prevention to 

treatment and rehabilitation.  

In many countries around the world primary 

care doctors that are considered to be “Cinderellas” of 

healthcare. They don't share the glory of sophisticated 

medical technologies, their salaries are fractions of what 

surgeons get, and their role is not recognized. We need 

to empower them with knowledge and technology, 

while motivating and properly compensating them for 

their hard work.  

 

Community-based and Technology-driven 

Healthcare 

One of the key ways to bridge multiple 

disciplines, professions, and approaches to healthcare is 

to work towards developing patient centered 

personalized medicine. This can be achieved through 

practicing primary health care that is community-based, 

utilizes technology, and incorporates patient wishes and 

values. The seventh tenet of the Alma-Ata Declaration 

says that, “The people have the right and duty to 

participate individually and collectively in the planning 

and implementation of their health care.” The 

Declaration also implies that “primary health care 

…requires and promotes maximum community and 

individual self-reliance and participation…”
12

  

Primary health care emphasizes local 

ownership and encourages sustainable solutions created 

by communities.
15

 The team-based approach that is 

essential in addressing the healthcare needs of a person 

and community.
16

 The key question is how to engage all 

the players – consumers of healthcare, primary care 

doctors and nurses – not just the specialty doctors and 

hospitals.
 
 

Modern technologies provide great 

opportunities to reinvent primary health care on an 

entirely new platform.  Internet and social media as well 

as portable EKG and ultrasound machines, iPhone 

medical apps and devices democratize medicine making 

knowledge and  technology available to the doctors and 

consumers.
7,17

 Dr. Eric Topol described this trend as, 

“creative destruction of medicine.”
10

  

Technology creates a new primary health care 

environment that is more efficient and knowledge-

based. In average, every day we spend 5 hours on 

Internet, and 77% of Internet users rely on this 

technology to search for medical information. In 2013, 

Google registered 30 billion searches for medical 

information associated terms. When analyzed historical 

query-based flu estimates for different countries and 

regions compared against official influenza surveillance 

data, it was determined that estimates based on Google 

search queries about flu are very closely matched to 

traditional flu activity indicators.
18

  

Electronic patient records help to reduce 

unnecessary human intervention and free time for cost-

effective and high quality services. Specialized social 

networks for healthcare professionals such as Doximity, 

enable primary care doctors to easily get on the same 

page with specialists and more effectively collaborate 

by sharing notes, records and other information. 

Technology-driven primary health care is an effective 

way to build collaborations among different healthcare 

sectors. 

 

 

 

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The Need for Patient-centered and Personalized 

Care 

According to a population-based representative 

household health survey conducted in 2012 by the 

Academy of Preventive Medicine of Kazakhstan, more 

than 30% residents of Almaty, Kazakhstan aged 25-44 

prefer seeking medical care in private healthcare 

facility. More than 40% among them believe that they 

can be harmed when treated in the government 

ambulatory and in-patient medical facilities.
19

 

Disadvantages of government based medical system in 

Kazakhstan include long waiting lines, need to rely on 

friends and family to know which doctor is good, 

inability to get consistent diagnosis if you go to more 

than one doctor, poor medical record retrieval system, 

and many others. These challenges translated into 

unsatisfied consumers, both on individual and 

community levels. Dissatisfied with poor quality of 

medical services, many Kazakh citizens turn to medical 

tourism to solve their healthcare issues. A study 

conducted a few years ago by Harvard Medical 

International reported $200-250 million that channeled 

annually from Kazakhstan to overseas to cover the costs 

of medical care.
20

 There is an opportunity to capture 

those who travel abroad for medical care by providing 

high quality medical services at home. 

With the emerging middle class in Kazakhstan, 

we are witnessing the evolvement of healthcare market, 

with consumers becoming interested in better 

healthcare. These consumers will ultimately want to be 

empowered to make their own health decisions and be 

in the center of their care, with access to high quality 

services. In the opinion of the author, personalized 

medicine is when doctors practice with the consumer at 

heart, with personal relationships that revolves entirely 

around their needs, time and convenience. With such 

attitudes, doctors will likely be able to actively engage 

consumers in managing their own health. 

 

HealthCity and SmartHealth Technology in 

Forefront of the New Paradigm of Healthcare 

In order to address the health-centric paradigm, 

a new initiative called HealthCity has recently been 

implemented in Kazakhstan.
21

 It aims to create an 

integrated network of private technology-driven and 

patient-centered primary care clinics and diagnostic 

center to serve communities’ healthcare needs at highest 

international standards. To ensure quality in its 

infrastructure, the HealthCity project established 

partnerships with such global technology companies as 

Philips and Medtronic. HealthCity facilities will have 

online medical records and telemedicine activities, 

home health, community systems, among other which 

allow supporting a growing community of 50,000 to 

100,000 people in key cities of Kazakhstan where 

HealthCity will operate. Overall, activities of 

HealthCity lead to transformation of Kazakhstan’s 

healthcare system. 

In order to empower primary care physicians 

and customers of its clinics, the HealthCity project will 

employ a proprietary application called SmartHealth 

comprising of three main components:  

1) Diagnostic algorithms «Symptoms 

Online», designed for web and mobile 

platforms in three languages: Kazakh, 

Russian, and English; 

2) Web resources of zdrav.kz web-portal with 

many years of successful track record of 

providing Internet users with widely 

available information as how to maintain 

health and treat illnesses; and, 

3) Electronic search system helping to locate 

specialized doctors and healthcare 

organizations.  

At the heart of SmartHealth there are more 

than 70 algorithms integrated together as the 

"Symptoms Online” product. They represent a logical 

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process as how to interpret symptoms of many diseases 

allowing users to make informed decisions. These 

algorithms are presented in the form of web and mobile 

applications for Android and iOS integrated with 

zdrav.kz portal containing a wealth of information about 

thousands of diseases and conditions, as well as about 

methods for their prevention, early detection and 

treatment. 

Because of availability of such resources, 

SmartHealth users will be able to solve many common 

medical problems that do not require the participation of 

the medical professional or visit a medical institution. In 

more complex cases SmartHealth provides opportunities 

for informed and targeted search for assistance of a 

general practitioner or a specialist. In such efforts the 

users may be able to utilize SmartHealth resources 

allowing them to find needed healthcare organizations 

and medical professionals. 

This HealthCity project will significantly 

reduce the burden on the health care system, promoting 

active participation of citizens and empowering them to 

make decisions about their own health. SmartHealth - is 

a technology solution that aims at providing 

accessibility and convenience in obtaining knowledge 

about medicine.  

 

Summary 

In summary, the current healthcare paradigm in 

Kazakhstan and many countries around the world is 

centered around hospitals and highly specialized 

medical doctors. It can be described as disease-centric 

medicine, dominated by technology and aggressive 

treatments. An alternative to this is an alliance of 

primary care doctors with consumers, empowered and 

engaged to be active participants in healthcare decisions 

on both sides. Only by building such an effective and 

fully potential ecosystemic healthcare system will we be 

able to successfully prevent diseases and achieve higher 

quality and quantity of life for our citizens. By building 

a healthier and brighter healthcare ecosystem, we have a 

great opportunity to improve quality of life locally and 

globally. 

 

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