“DEVELOPMENT OF CRITERIA FOR PRIMARY CARE ASSESSMENT FRAMEWORK TAILORED TO KAZAKHSTAN”: QUALITATIVE STUDY

Abstract

Kazakhstan’s primary health care (PHC) system faces context-specific challenges not fully captured by existing international assessment frameworks. This study aimed to develop the criteria for the PHC assessment framework tailored to the Kazakhstani context, taking into account specific country’s conditions and the elimination of gaps in existing international assessment frameworks. Additionally, it aims to provide relevant recommendations for the development of the framework for improving PHC assessment and strengthening health policy in Kazakhstan. To achieve this goal, qualitative research was conducted using semi-structured interviews with PHC top managers. A thematic analysis was utilized to classify key issues and compare the findings with the WHO’s PHC assessment framework and the Primary Health Care Assessment Tool (PCET) to identify compliance and gaps. The study revealed four key themes: healthcare workforce and infrastructure constraints, inadequate financing, governance issues, and lack of service quality. These findings encourage the identification of the main criteria for an effective PHC assessment framework tailored to the Kazakhstani context: 1. Resources - aim to evaluate the healthcare workforce density, retention rate, and qualification in the PHC facility. Additionally, it focuses on the infrastructure and equipment availability to address patients’ needs. 2. Financing - evaluates funding from the Government Budget for PHC services, payment for labor of PHC workforce, and expenditures paid by patients out-of-pocket. 3. Governance and structural issues - assess micro and macro management, regulatory framework, and private sector participation in PHC service execution by state order. 4. The quality of PHC services - measure the quality of service delivery for distant areas and socially vulnerable patients. Additionally, it aims to discover the patient's responsibility and awareness of PHC. Although the WHO and PCET frameworks cover some aspects, they do not fully address Kazakhstan's specific challenges. This study proposes evidence-based results and recommendations for policymakers to improve the regulation, management, financing, and provision of PHC services. Future research should aim to include the proposed criteria for the Kazakhstani PHC assessment framework, reveal the quality of PHC, and use the results for the improvement of healthcare policy.