VZCZCXRO9936
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DE RUEHTA #2250/01 3181121
ZNR UUUUU ZZH
O 131121Z NOV 08
FM AMEMBASSY ASTANA
TO RUEHC/SECSTATE WASHDC IMMEDIATE 3825
INFO RUCNCIS/CIS COLLECTIVE 0801
RUCNCLS/SOUTH AND CENTRAL ASIA COLLECTIVE
RUEHZL/EUROPEAN POLITICAL COLLECTIVE
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RUEATRS/DEPT OF TREASURY WASHDC
RUEAIIA/CIA WASHDC
RHEFAAA/DIA WASHDC
RHEHNSC/NSC WASHDC 0365
RUEKJCS/SECDEF WASHDC 0282
RUEKJCS/JOINT STAFF WASHDC
RHMFIUU/CDR USCENTCOM MACDILL AFB FL
RUEHAST/USOFFICE ALMATY 0908
RUEHPH/CDC ATLANTA

UNCLAS SECTION 01 OF 02 ASTANA 002250 
 
SIPDIS 
 
STATE PASS AID FOR AID/ASIA BWALLIN AND GCOOK, AID/GH CVINCENT 
CDC FOR COGH DCHRISTIANSEN 
 
E.O. 12958: N/A 
TAGS: PGOV PREL EAID SOCI KG TI TX UZ KZ
SUBJECT:  KAZAKHSTAN HOSTS INTERNATIONAL CONFERENCE ON PRIMARY 
HEALTH CARE 
 
ASTANA 00002250  001.2 OF 002 
 
 
¶1.  SUMMARY:  The Government of Kazakhstan recently hosted nearly 
500 participants from 65 countries, including 11 health ministers, 
at the International Primary Health Care Conference dedicated to the 
30th anniversary of the Alma-Ata declaration on primary health care. 
 Dr. Margaret Chan, Director General of the World Health 
Organization and Ann Veneman, Executive Director of UNICEF, joined 
Kazakhstani Minister of Health Anatoliy Dernovoy in hosting the 
conference.  The U.S. Agency for International Development (USAID) 
regional mission in Central Asia sponsored a number of conference 
satellite events to advance primary health care and raise awareness 
of the positive results of U.S. investments in this field.   END 
SUMMARY. 
 
WORSENING HEALTH DISPARITIES, IMPORTANCE OF CIVIL SOCIETY 
 
¶2.  The conference highlighted the many advances made over the last 
thirty years in primary health care, along with subsequent 
improvements in health.  However, conference speakers and 
participants alike were candid in their assessment of the 
significant shortcomings in healthcare and worrisome trends in 
health status.  Of particular concern to many present was the global 
trend of increasing health disparities -- particularly, differences 
in health status or access to good health care based on income, 
social class, race, ethnicity, and gender.  In her opening remarks, 
Dr. Chan emphasized the association between health disparities and 
the impoverishing costs of good care -- factors that can threaten 
social cohesion and stability. 
 
¶3. Although the vast majority of conference participants -- perhaps 
450 out of 500 -- were from the public sector, the conference 
declaration emphasized the importance of engaging civil society in 
the primary health care movement to ensure that health services are 
more responsive to actual health needs.  USAID showed its support 
for this concept by funding a U.S. public health expert from the 
Academy for Educational Development to attend both the conference 
and an NGO satellite event, where she presented findings from recent 
case studies on empowering healthcare consumers. 
 
USAID SUPPORTS SEVERAL SATELLITE EVENTS 
 
¶4. In collaboration with conference organizers, USAID provided 
support for four ministry officials from Central Asia to attend the 
conference or satellite events, along with 13 civil society 
representatives.  Two satellite events were organized and funded by 
USAID:  a regional networking event for non-governmental 
organizations and primary healthcare facility managers, and a 
symposium for medical students on family medicine.  USAID also 
worked with the Museum of Medical History in Kazakhstan to create a 
conference exhibition on the history of health reforms in 
Kazakhstan. 
 
¶5. The symposium for medical students, which was covered by several 
national media outlets, was attended by over 100 students and 
faculty from the Kazakhstan National Medical University.  Two 
medical students from Tajikistan attended as special guests of 
USAID.  The purpose of the symposium was to promote the career track 
of family practitioners among medical students, faculty, and the 
general public.  Representatives from the American Academy of Family 
Physicians, Physicians with Heart (an American NGO), and local 
family practitioners led workshops and panels on topics ranging from 
lower back pain to "a day in the life of family practitioners." 
Students appreciated the opportunity to meet practicing general 
practitioners from both Kazakhstan and the United States.  The event 
appeared to motivate students and renew their commitment to primary 
health care.  As one student from Tajikistan noted, "This (family 
medicine) concentration is new, modern, and becoming prestigious. 
To be a 'narrow' specialist is so boring, especially for young 
doctors.  A general practitioner is more like a 'real' physician." 
 
 
ASTANA 00002250  002.2 OF 002 
 
 
USG INVESTMENT IN PRIMARY HEALTH CARE:  IMPRESSIVE RESULTS 
 
¶6. In Central Asia, the U.S. government, through USAID, has 
concentrated health reform resources on support for the 
cost-effective primary health care (PHC) model since the early- to 
mid-nineties.  This investment has produced impressive results. 
These results vary in scope and depth across the Central Asian 
region, with Kyrgyzstan demonstrating the greatest advances -- as 
well as the greatest potential for capitalizing on positive 
momentum. 
 
¶7. USAID has worked with legislators and public health officials in 
the Central Asian republics to gain high-level support for national 
health reforms, including specific restructuring measures that have 
resulted in many efficiencies and cost savings.  USAID support in 
the primary healthcare policy arena has led to national decrees -- 
and in some cases increased financing -- that allow primary health 
care doctors to expand the scope of their practice.  For instance, 
in Kyrgyzstan, USAID support has contributed to an increase in the 
share of government resources provided for cost-effective primary 
health care.  As a proportion of public health resources, primary 
healthcare resources have grown from 16% when the reforms began to 
38% in 2007. 
 
¶8. USAID has supported the design and implementation of per capital 
payment systems for primary health care that increase transparency 
and accountability, important U.S. foreign assistance objectives. 
USAID funds have supported the decentralization of many 
decision-making authorities to health facility managers to improve 
the responsiveness of health resources to local health problems. 
USAID has also worked with civil society groups and private citizens 
to better inform individuals on how to keep themselves and their 
families healthy, while improving access to information on patient 
rights and responsibilities within the reformed and restructured 
health system. 
 
¶9. Ongoing work on restructuring the health system better enables 
citizens to seek care earlier by visiting out-patient facilities and 
their primary health care physician, rather than seeking care at the 
hospital level.  This has prevented health complications and 
associated costs -- healthcare costs that can sometimes be 
catastrophic, especially for families with few resources. 
 
¶10. COMMENT:  Although U.S. investments have helped secure political 
support for primary health care, the acceptance of primary health 
care is still weak among medical professionals and the general 
public alike.  USAID plans to focus more attention on the important 
role that general practitioners and family medicine professionals 
play in delivering high-quality primary care.  This attention will 
include support for accreditation, licensing and continuing medical 
education programs.  USAID also plans to support more targeted 
information campaigns that better communicate the benefits of health 
reforms -- including primary healthcare services -- to consumers 
across the Central Asia region.  END COMMENT. 
 
HOAGLAND