1. The Ministry of Health and Social Development of the Republic of Kazakhstan Republican Center for Health Development November 2015 Development of a network of health care organizations Republic of Kazakhstan

2. State Program for Development of Health of the Republic of Kazakhstan "Salamatty Kazakhstan" for 2011-2015 The purpose 5.4. Creating an efficient and accessible health care system Strategic Directions Draft State Program of Health of the Republic of Kazakhstan "Densaulyk" for the years 2016-2019 Objective: To strengthen health and longer life of Kazakhstan to sustainable socio-economic development Message from the President of the Republic of Kazakhstan Nursultan Nazarbayev to the people of Kazakhstan 2014 "Strategy" Kazakhstan- 2050 ": a new policy established state" Our main goal - by 2050 to become one of the 30 most developed countries

3. Approaches to planning The proposed standards Providing the population with equal access to health care Staffing medical staff by function Standard equipment of the basic medical equipment and medical devices Determination of needs of the population in the quality of care inpatient care: Level 1 - the Republican Hospital; 2nd-level multidisciplinary District Hospital (city, district); Level 3 - Distribution Hospital (multi-level); Level 4 - republic and scientific organizations; the development of rehabilitation centers, hospitals, palliative care outpatient care: Register Stuck populations, territory and the remoteness of residence, the development of general practice Social and economic development, geographical location, environment, health and demographic indicators Further improvement and implementation of high technologies applied in developed countries The development of general practice, expansion of hospital replacing technologies, ambulatory surgery The definition of economic efficiency of the hospital sector and ambulatory polyclinic organizations The implementation of the planned measures for the restructuring of the hospital sector and the development of primary health care Increased patient satisfaction with medical care

4. Levels of hospital care (In accordance with international experience) Level 3: regional hospitals Level 4: National Centre, research institutes, republican hospital, holding Level 2: inter-district (regional, multi- disciplinary) Hospital Level 1: district hospitals 300,000 -1,000,000. Population, including multidisciplinary, oncological, and others. + Tertiary care 50 000 - 300 000 population. Basic specialty + specialized beds (cardiology, neurology, endocrinology and others.) > 1 million. Population, multidisciplinary + tertiary care + research. 20 000 - 50 000 population. 4 basic specialties: internal medicine, surgery, obstetrics and pediatrics. With a population of less than 20 000 or, in the absence within a radius of 60-120 minutes RB created Sat Taken into account in long- term plans, taking into account the proposals of the Master Plan not reviewed

5. Future plans for the development of a network of health care organizations in the regions 2015-2025 years, taking into account the proposals of the Master Plan for the restructuring of the hospital sector, the development of primary health care and laboratory services The master plan for the restructuring of the hospital sector (16 regions) The master plan for the development of primary health care (16 regions) The master plan for the improvement of laboratory service (16 regions)

6. The network of health care organizations 729 больниц с 95555 койками (90,8%) АПО - 2174 the Ministry of Health and Social Development 34 больницы с 3011 койками (2,8%) АПО - 69 other ministries and agenciesа 148 больниц с 6653 койками (6,4%) АПО-921 private USA33 United Kingdom39 Australia40 Canada34 organization for economic cooperation and development 49 Kazakhstan53,3 -2014 г. 50,0 - к 2020 г. Existing and recommended rates of attachment of the population to primary health care facilities by population typeState normtype recommendations of the master plan МРБП50-800 Medical station300-1200/1500 МSМS50-800 Paramedic obstetric point 800-2000 outpatient clinic 2000Medical general practice1200/1500 Family clinic10,000 >Family Health Center3,000/4,000 Family clinic30,000 The regional center of general practitioners \ family health 4,000-30,000 (+Family Health Care Centre) Family clinic30,000 The city center of general practitioners / family health 30,000 - 150,000 (+Family Health Care Centre) Availability of beds per 10 thous. Population

7. State standard of the network of health care organizations Based on the recommendations on the structure of the network of health care organizations, developed by Sanigest Internacional Ministry of Health and Social Development has been initiated by the adoption of new government regulations network of Health of the Republic of Kazakhstan, approved by the Government of the Republic of Kazakhstan dated February 19, 2014 №114. New government regulations included the following items: main hospital sector became general hospitals (for both adults and children); introduced a fundamentally new type of hospital - interregional multidisciplinary hospital to serve the population in areas inhabited by at least 100 thousand people; specialized hospitals (infectious, drug treatment, psychiatric, dermatological and venereal) remain only at the level of the regional center, allowed the transformation of the regional infectious diseases hospital in the department at the regional hospital multidisciplinary; introduces a requirement for the opening of rehabilitation beds in hospitals or offices, and the establishment of a rehabilitation center was valid only if the population served in a quantity of not less than 150 thousand people; first introduced the requirement to open a hospice beds in hospitals or offices, as well as the opening of nursing homes with a population of not less than 400 thousand people.

8. Activities planned in the long-term plans of development of the network of healthcare organizations of Kazakhstan for 2015 - 2025 years. (according to the state standard of the network of organizations of Health) The existing network of primary health care measures for the reorganization of primary care network ВА в СП СП в ВА ВА в МП и ФАП ФАП и МП в ВА 60268313763 The existing network of hospitals measures for the restructuring of the hospital sector an assoc iatio n RedirectingClosing / Translati ons into primary health care МБР/ РБ РЦхос пис БСУ 72915070/ 131 1420482

9. Prevention of social tension in the restructuring of the hospital sector: - The distribution of flows of patients (in-patient level, day care or other beds around the clock); - Retraining and employment of redundant staff; - Preparation of new technologies in the event of conversion of the medical organization; - The use of vacated buildings and other tangible assets; - Work with the public and the media. Monitoring of the implementation of measures of long-term plans the network of medical institutions in the coming 3 years, taking into account the budget planning for 2015-2017 years Conclusion of the Memorandum with akimats regions, cities of Astana and Almaty with the inclusion of commitments to the implementation of the planned activities on implementation of long-term plans of development of the network of medical institutions in the current year Actualization and realization of perspective plans for development of a network of health care organizations in the region during 2015-2025, taking into account the recommendations of the master plan for the restructuring of the hospital sector and the development of primary health care