Obermann Konrad, Chanturidze Tata, Richardson Erica, Tanirbergenov Serik, Shoranov Marat, Nurgozhaev Ali
Mannheim Institute of Public Health, University of Heidelberg, Mannheim, Germany.
Oxford Policy Management Ltd., Oxford, UK.
BMJ Glob Health. 2016 Apr 18;1(1):e000003. doi: 10.1136/bmjgh-2015-000003. eCollection 2016.
Healthcare reforms are often not coupled with a relevant and appropriate monitoring framework, leaving policymakers and the public without evidence about the implications of such reforms. Kazakhstan has embarked on a large-scale reform of its healthcare system in order to achieve Universal Health Coverage. The health-related 2020 Strategic Development Goals reflect this political ambition. In a case-study approach and on the basis of published and unpublished evidence as well as personal involvement and experience (A) the indicators in the 2020 Strategic Development Goals were assessed and (B) a 'data-mapping' exercise was conducted, where the WHO health system framework was used to describe the data available at present in Kazakhstan and comment on the different indicators regarding their usefulness for monitoring the current health-related 2020 Strategic Development Goals in Kazakhstan. It was concluded that the country's current monitoring framework needs further development to track the progress and outcomes of policy implementation. The application of a modified WHO/World Bank/Global Fund health system monitoring framework was suggested to examine the implications of recent health sector reforms. Lessons drawn from the Kazakhstan experience on tailoring the suggested framework, collecting the data, and using the generated intelligence in policy development and decision-making can serve as a useful example for other middle-income countries, potentially enabling them to fast-track developments in the health sector.
医疗改革往往没有配套相关且合适的监测框架，导致政策制定者和公众无法获得有关此类改革影响的证据。哈萨克斯坦已着手对其医疗体系进行大规模改革，以实现全民健康覆盖。与健康相关的2020年战略发展目标体现了这一政治抱负。采用案例研究方法，基于已发表和未发表的证据以及个人参与和经验，（A）对2020年战略发展目标中的指标进行了评估，（B）开展了一次“数据映射”活动，其中使用世界卫生组织的卫生系统框架来描述哈萨克斯坦目前可用的数据，并就不同指标对监测哈萨克斯坦当前与健康相关的2020年战略发展目标的有用性发表评论。得出的结论是，该国目前的监测框架需要进一步完善，以跟踪政策实施的进展和成果。建议应用经修改的世界卫生组织/世界银行/全球基金卫生系统监测框架，以审视近期卫生部门改革的影响。从哈萨克斯坦在调整建议框架、收集数据以及在政策制定和决策中利用所产生的情报方面的经验中吸取的教训，可为其他中等收入国家提供有益范例，可能使它们能够加快卫生部门的发展。
