VZCZCXRO1357
OO RUEHAG RUEHAST RUEHDA RUEHDF RUEHFL RUEHIK RUEHKW RUEHLA RUEHLN
RUEHLZ RUEHNP RUEHPOD RUEHROV RUEHSK RUEHSR RUEHVK RUEHYG
DE RUEHTA #0109/01 0211044
ZNR UUUUU ZZH
O 211044Z JAN 09
FM AMEMBASSY ASTANA
TO RUEHC/SECSTATE WASHDC IMMEDIATE 4382
INFO RUCNCIS/CIS COLLECTIVE 1055
RUEHZL/EUROPEAN POLITICAL COLLECTIVE
RUEHBJ/AMEMBASSY BEIJING 0453
RUEHKO/AMEMBASSY TOKYO 1159
RUEAUSA/DEPT OF HHS WASHDC
RUCPDOC/DEPT OF COMMERCE WASHDC
RUEAIIA/CIA WASHDC
RHEFAAA/DIA WASHDC
RHEHNSC/NSC WASHDC 0628
RUEKJCS/SECDEF WASHDC 0542
RUEKJCS/JOINT STAFF WASHDC
RHMFIUU/CDR USCENTCOM MACDILL AFB FL
RUEHAST/USOFFICE ALMATY 1088

UNCLAS SECTION 01 OF 02 ASTANA 000109 
 
SENSITIVE 
SIPDIS 
 
STATE FOR SCA/CEN, OES/PCI 
 
E.O. 12958: N/A 
TAGS: PGOV PREL EAID SOCI SENV KZ
SUBJECT:  KAZAKHSTAN:  WORLD BANK HEALTH-CARE SYSTEM REFORM PROJECT 
 
REF:  08 ASTANA 02290 
 
ASTANA 00000109  001.2 OF 002 
 
 
¶1. (U) Sensitive but unclassified.  Not for public Internet. 
 
¶2. (SBU) SUMMARY.  The World Bank's five-year project for reforming 
Kazakhstan's outmoded health-care system is progressing but faces 
considerable difficulties.  Planned reforms include health financing 
and budget planning; health-care quality improvement; an independent 
accreditation system; the production of evidence-based clinical 
practice guidelines; voluntary blood donations; international 
standards for laboratories and blood transfusions; reform of medical 
education and science; health information systems; health-care and 
project management; safe and affordable pharmaceutical products; and 
the introduction of international sanitary standards for food 
safety.  The World Bank is optimistic that it can help Kazakhstan 
become one of the top 50 countries in the world with respect to the 
quality of its health-care system, but it is concerned that the 
government is not spending its money as efficiently as it should. 
While the new health minister, Zhaksylyk Doskaliyev, supports the 
Bank project, he also wants to create a single provider for 
pharmaceutical products.  National Medical Holding is now moving 
rapidly to consolidate health-care centers in Kazakhstan, and the 
Bank is concerned about this development.  END SUMMARY. 
 
WORLD BANK TO REFORM HEALTH-CARE SYSTEM 
 
¶3. (SBU) Regional Environmental Officer (REO) and Environmental 
Specialist recently met with World Bank Health Project Coordinator 
Bibigul Alimbekova, who said that the Bank's project to reform 
Kazakhstan's outmoded health-care system is progressing but faces 
considerable difficulties.  The Ministry of Health is the 
implementing agency and the government of Kazakhstan will be 
contributing 60 percent of the estimated costs (almost $300 million 
spread out over five years, 2008-2013), with the World Bank 
contributing the rest.  One year into the project, the World Bank 
thus far has paid out $26 million. 
 
¶4. (SBU) Alimbekova said the World Bank's project aims to introduce 
international standards by changing the way institutions provide 
health-care throughout Kazakhstan.  The project also seeks to build 
long-term institutional capacity in the Ministry of Health and other 
health-care institutions in support of Kazakhstan's own program of 
health-care reform (the State Health-care Reform and Development 
Program, 2005-2010). 
 
¶5. (SBU) Alimbekova said this reform sets out several major areas 
for improvement: 
 
-- health financing, including investment and budget planning; 
-- health-care quality, to include an independent accreditation 
system, evidence-based clinical practice guidelines, voluntary blood 
donations, and international standards for laboratories and blood 
transfusions; 
-- medical education and medical science; 
-- health-care facility management, with pilots in three oblasts; 
-- safety, quality, and affordability of pharmaceutical products 
that involve procurement, pricing, monitoring, packaging, and 
quality control; and 
-- food safety and international sanitary standards. 
 
¶6. (SBU) Alimbekova said the World Bank has very good partnerships 
with the World Health Organization, USAID, and the United Nations 
Children's Fund (UNICEF), and together they can help build up 
Kazakhstan's health-care capacity.  Although she said this will be 
very challenging, Alimbekova is nevertheless optimistic that the 
World Bank can help Kazakhstan become one of the top 50 countries in 
the world with respect to the quality of its health-care system. 
She cautiously added that, while the government claims to increase 
its health-care spending every year, careful analysis reveals that 
it is often a small increase.  More importantly, she said, it all 
depends on how the money is spent.  The World Bank is now doing 
surveys to show that the government's health-care spending is not as 
cost-effective as formerly believed. 
 
NEW MINISTER SUPPORTS REFORM PROJECT 
 
¶7. (SBU) The Ministry of Health is still coming to terms with the 
 
ASTANA 00000109  002.2 OF 002 
 
 
forced resignation of former Minister Anatoliy Dervonoy and is 
adjusting to life under the new minister, Dr. Zhaksylyk Doskaliyev 
(see reftel).  (NOTE: Dr. Doskaliyev, appointed in November 2008 to 
be Minister, is also well known for heading the Kazakhstani medical 
team that performed the world's first operation to transplant a 
human embryo's nerve cells into a patient suffering from 
myelosyringosis, a disease of the spinal cord.  He is credited with 
pioneering this technique.  END NOTE.).  She said all of the World 
Bank's former partners and ministry counterparts are now gone and 
the Minister is busy installing a new team.  Accordingly, the World 
Bank is retracing its steps and has begun the process of 
"sensitizing" the new members to the Health Reform Project's issues. 
 She is optimistic that the new Minister will be receptive, since, 
as previous Chairman of the Kazakhstani Heath Care Agency, he was 
one of its great supporters.  However, Alimbekova admitted that the 
new Minister also has his own personal agenda -- that there should 
be only a single provider for all medical products and 
pharmaceuticals in Kazakhstan.  For now, the Bank is waiting until 
Doskaliyev has finished reshuffling personnel and made new 
appointments, and then the Bank will start to work again with the 
Ministry on this health reform project. 
 
CONCERNS ABOUT NATIONAL MEDICAL HOLDING 
 
¶8. (SBU) According to Alimbekova, the state-owned National Medical 
Holding (NMH) is moving to consolidate national health centers 
throughout Kazakhstan.  NMH has absorbed six of these national 
health centers and has plans eventually to control ten.  She said 
the World Bank is very concerned about this development, explaining 
that "it is not in Kazakhstan's best interests" since it has the 
potential to result in a health-care monopoly. 
 
¶9. (SBU) NOTE:  The Kazakhstani Government announced the 
establishment of NMH on May 31, 2008, and turned over six medical 
facilities and the Kazakh Medical Academy to NMH as subsidiaries. 
Two of these centers are the National Center for Maternal and Child 
Health and the Child Rehabilitation Center.  In recent conversations 
with USAID staff, some of the chief doctors in these health-care 
centers have noted a lack of staff expertise for the operation of 
some of the high-tech, modern equipment purchased for the centers. 
During a January 15 meeting with the Ambassador, NMH CEO Almaz 
Sharman, a dual U.S.-Kazakhstani national, readily admitted that a 
shortage of medical expertise is a major problem for NMH, as a 
result of which he would like to recruit foreign doctors, including 
Americans, to work in Kazakhstan.  Sharman is also looking for a 
foreign company to manage one of NMH's medical centers, and, per a 
contract with the Kazakhstani government, is seeking a foreign 
partner, such as Harvard Medical International, to provide training 
for 50 Kazakhstani hospital managers, most of whom will work at 
Kazakhstani health-care facilities not connected to NMH.  END NOTE. 
 
HOAGLAND