Review of the national tuberculosis programme in Kazakhstan

At the request of the Minister of Health of Kazakhstan, the WHO/Europe tuberculosis (TB) and multidrug- and extensively drug-resistant TB (M/XDR-TB) programme conducted an extensive review of TB prevention, control and care in Kazakhstan from 9 to 18 May 2012. The previous extensive programme review was conducted in 2007. Since that time, the country has received technical assistance missions every year provided by WHO/Europe and its partners, including a Green Light Committee/Europe mission in 2011.

A group of fifteen international experts conducted the country programme review, with assistance from the WHO Country Office and in close coordination with the national TB Control Programme and partners, including the United States Agency for International Development (USAID), the Centers for Disease Control and Prevention (CDC) Atlanta and the Global Drug Facility (GDF). All technical reports, surveillance data, national reports and epidemiologic data were reviewed. 

The review mission was divided into four teams to visit Almaty city, Almatinski Oblast, Akmolinski Oblast and South Kazakhstan Oblast. The teams interviewed governor offices, chief Oblast doctors, chief TB doctors, staff at primary health care level, the Sanitary Epidemiological Station (SES), policlinics, TB laboratory services, HIV/AIDS centres, narcotic centres, nongovernmental organizations (NGOs), institutions for palliative care and forced treatment, country coordination mechanism members and patients. The Akmolinski Oblast team had a meeting with the prison health authorities and the South Kazakhstan Oblast team visited the TB prison services. The review teams spent three to four days for the field visit and one full day visiting the national TB centre, the national reference laboratory and academic and medical education centres.

TB prevention, control and care interventions were assessed based on the six health system building blocks: (1) service delivery, (2) health workforce, (3) information, (4) medical products, (5) vaccines and technologies, finance and (6) leadership/governance. The key findings and challenges and the main recommendations for improvement of the TB programme from the review mission were presented to the Minister of Health on 23 May 2012.

Prevalence

Kazakhstan has the highest TB notification in the WHO European Region with about 28 000 TB cases (123 per 100 000 population) and about 4 000 notified MDR-TB cases (out of an estimated 8 000) per year. Including MDR-TB patients diagnosed in the past year, 5 705 MDR-TB patients are currently under treatment.