republican state enterprise on rights for an economic conduct «Republican center of development of health protection»

Z.Sadvokasova

Regional Master-Plan On the development of the laboratory sector in the Republic of

Kazakhstan

Ministry of health and social development of Republic of Kazakhstan Republican State Enterprise the "Republican center of development of health protection"

Creating a multi-level structure of the laboratory network

• The multilevel structure of the laboratory network, as part of a network of hospitals and primary health care organizations, proposed under the relevant master plan will lead to a more rational, efficient and rapid system of laboratory services, based on the principles of international best practice.

• Each region of the Republic of Kazakhstan is considered individually, taking into account regional peculiarities, including socio-economic, geographic, demographic and health, the level of medical care.

Comparison of some of the data of Kazakhstan with Australia and Canada

• Australia and Canada are similar to Kazakhstan for some indicators• The population density in Kazakhstan is higher than in those countries• GDP per capita is lower than Kazakhstan, more than 2 times• Life expectancy is lower by nearly 9 years• Number of beds is higher in 1.5-2 times

Indicators Kazakhstan Australia Canada

GDP per capita, $ 8 514 46 374 45 140

Population million. 17,5 21,3 33,3

Density, people / sq. km 6 3 4

Regions 14+2 8 13

health expenditure,% of GDP 4,5% 8,5% 10%

Life expectancy, years 71,6 81,3 80,2

Beds per 10 000 population 60,4 40 34

The main groups of diseases: Cardiovascular systemrespiratory, digestive, urogenital

Cardiovascular systemRespiratory,oncology, gerontology problems

Cardiovascular system  cancer,respiratory

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The vision of the master plan for the development of laboratory services in the Republic of Kazakhstan

• The active role of laboratory services in the effective management of ambulatory and stationary structures in the optimization of diagnosis and hospitalization

• Timely and affordable laboratory services contribute to improve the overall life expectancy of> 70 years

• Public and private expenses for laboratory services in person must be> $ 30. Per year by 2020 (real costs - $ 6-7. US)

• Creating a system of laboratory experts on standards development process and the quality of training and education based on international standards adapted to the conditions of Kazakhstan

• 2025 on key health indicators for Kazakhstan to enter the 30 developed countries

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The objectives of the master plan for the improvement of laboratory service

Promoting a healthy lifestyle

Supervision

TreatmentPrevention

Diagnostics

Laboratory services

5

The system of referral scheme

On the alleged scheme of movement of the patient affect the determinants of health systems - a possible structure of primary care laboratory diagnostics, hospital, availability of specialized personnel, level of training, organizational communication, cultural, social and political factors

clinicpatient

patient

direction

The regional committee of

the health regions

Portal of the Bureau of hospitalization

hospital

Clinical and diagnostic tests

required for admission

The objectives of the master plan to improve Laboratory services

For all studies provided:AccreditationExcellent infrastructure, equipped with IT technologiesFully integrated logistics systemResearch and development in the field of education and trainingTransparent cost and pricing measuresService agreement / contractClinical testing

The optimal model of services for medical laboratory services

Network Defense, focused on the patient for emergency, routine, long-term care, care for the mother and newborn

Regional / central / national / reference laboratoryimplementation of laboratory diagnosis of the most complex, socially significant and

rare diseases with an educational base

"Emergency" (hot) laboratories in hospitals to assist in the urgent and critical conditions"Routine" (cold), specialized laboratories, including clinical, microbiological, immunological and histopathological studies on the treatment site (IML)

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The objectives of the master plan for the improvement of laboratory service

1. Analysis of the situation2. Vision, infrastructure, LIS, structure, time, produce a result

(optimization of waiting times of laboratory results), logistics, service plans, financing,

3. The financial and geographical accessibility, fast, efficient and easy service

4. Lower the cost of services by increasing productivity5. Reliability and quality (accreditation, transparent, credible and reliable

results)6. The approach to streamline the parameters of laboratory tests to avoid

duplication7. The centralization and automation of laboratory services

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Analysis of the situation

• Around 2200 laboratories in the Republic of Kazakhstan (Beschastnykh), 6-19 tests / person. - A range of laboratory tests by regions

• Laboratory (hematology, immunology, biochemistry, microbiology, histology, etc.):

-Lack of coordination, standardization-Spraying powers and resources-Duplication of laboratory studies (in outpatient and inpatient), often discrepancies indicators-Invalid research quality at a low level of automation technology-Low levels of credibility and reliability of results due to outdated equipment and techniques, the limited list of results-The low level of the development of drug information system-The lack of infection control and management of data-Lack of centralization of laboratory tests, reagents and consumables, waste management-The lack of a common approach to ensure quality and safety in the lab

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Laboratory Service in Kazakhstan

• Clinical Laboratory provides practical health care for about 80% of the diagnostic information needed for timely diagnosis and monitoring the effectiveness of the treatment.

•         Laboratory data are of great importance for physicians in the assessment of the state of health of the patient, accurate diagnosis, treatment plan, and the subsequent monitoring of treatment effectiveness, which ultimately reduce the indicators of preventable morbidity and mortality.

•          In the Republic of laboratory services provided by laboratories that are part of health care institutions: hospitals, clinics, many medical clinics, some FAP- ah.

•         Total in the country as of 01.01.15, the functioning of laboratories in 2145, including 1709 conducted clinical and diagnostic tests, 142 - biochemical, 157 - bacteriological, 69 - serology, 54 - cytological, 14 - radioisotope studies.

•         Laboratories employs more than 1.2 thousand. Doctors, 7.2 thousand. Lab. Staffing doctors to laboratory technicians is 89%.

•         In 2014 it carried out more than 451 million. Parameters of laboratory tests, including 52.8% on an outpatient basis.

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Security lab 100 thousand. Population

АлматыАстанаЮКО

МангистаускаяКостанайскаяЖамбылскаяПавлодарскаяАктюбинская

РКАлматинская

КызылординскаяСКОВКО

КарагандинскаяАтырауская

АкмолинскаяЗКО

0 5 10 15 20 25

Number of laboratory 100 000

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Comparative analysis of laboratory tests

  Ireland USA Australia Kazakhstan

Clinical regionNumber of

tests per year

Number of tests per 100

thousand. Man

Number of test

persons.

Number of tests per year

Number of tests per 100

thousand. Man

Number of test

persons

Number of tests per

year

Number of tests per 100

thousand. Man

Number of test

persons

Number of tests per

year

Number of tests per 100

thousand. Man

Number of test

persons

Chemistry 47.176.764 1.123.256 11,23 3.500.000.000 1.162.791 11,63 46.301.510 200.171 2,00 100.728.753 607.252 6,07

Hematology 7.679.215 182.838 1,83 1.400.000.000 465.116 4,65 17.180.229 74.274 0,74 72.445.982 436.747 4,37

Immunology 461.821 10.996 0,11 369.000.000 122.591 1,23 3.547.985 15.339 0,15 12.978.822 78.244 0,78

Microbiology 2.379.912 56.665 0,57 225.000.000 74.751 0,75 12.844.160 55.528 0,56 1.998.076 12.046 0,12

Histopathology 316.419 7.534 0,08 4.000.000 1.329 0,01 3.052.689 13.197 0,13 4.129.482 24.895 0,25

cell biology 176.623 4.205 0,04 10.000.000 3.322 0,03 2.305.021 9.965 0,10 6.386.081 38.499 0,38

TOTAL 58.190.754 1.385.494 13,85 5.508.000.000 1.829.900 18,30 85.231.594 368.474 3,68 198.667.196 1.197.682 11,98

Population 4.200.000 301.000.000 23.130.990 16.587.642

Collection year 2005 .г 2007 .г 2013 .г 2012 .г

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Pareto analysis of stationary laboratories at institutions

The Organization PercentResult Pareto

REGIONAL MEDICAL CENTER 27% 27%

Kyzylorda CHILDREN diagnostic polyclinic13% 40%

Kyzylorda HOSPITAL 6% 46%

Kyzylorda CENTER 3% 49%

Kyzylorda City Maternity Hospital 3% 52%

Kyzylorda railway hospital 2% 54%

Kyzylorda DENTAL HOSPITAL 1% 55%

Kazalinsky HOSPITAL 9% 64%

Karmakshy DEPARTMENT OF HEALTH 8% 72%

Syrdarya HOSPITAL 7% 79%

Shieli HOSPITAL 7% 86%

URAL HOSPITAL 6% 92%

Zhanakorgan HOSPITAL 5% 97%

Zhalagash CENTRAL HOSPITAL 3% 100%

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The objectives of the regional master plan for the laboratory sector

For the patient, availability, promptness, quality results of laboratory studies:• sampling tests carried out at the place of medical care (ambulance, hospital) to conduct a certain

(approved) list of research;• All laboratory results are quality assurance and accreditation;• timing of research for 'hot' and 'cold' results are guaranteed by terms of performance, which could have

a potential negative impact on the quality of patient management;• It has timely access to professional advice for laboratory medicine, including guidance on the

appropriate use and interpretation of the analysis that do not meet the clinical pictureFor the responsible person carrying out laboratory tests:• to achieve an appropriate level of learning and understanding of research results;• test at the place of treatment is appropriate, correct and has a guarantee of quality;• direct access to the consultation on clinical pathology helps the patient to feel independent.For medical organization:• in addition to routine laboratory services, it is necessary to ensure the implementation and the

availability of more advanced services of laboratory medicine for the clinical responsibility for complex hematological, metabolic, infectious and other states;

• professional advice, support the process of the clinical management of the patient, including critically ill patients and patients in critical condition;

• consultations and meetings on histopathology, oncology and other specialties.

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Existing problems In the laboratory network

Clinics Hospitals Ambulance

Conventional hospital

Microbiology Other exterior

Difficulty results All basic and standard tests, low complexity standard standard

The waiting period of the test results

1-3 days 15-60 minutes On the same day 2-4 days, 14 days partially

Not applicable

Hygienic processes Nearly all devices used reusable materials, while necessary for the examination of samples to use only disposable materials

Not applicable

Equipment The main laboratory equipment: modern - often semi-automated, more obsolete equipment - still a lot of tests to be performed manually.

Very rare equipment - but it does not have a full load, with him running too many people, in some cases it is not installed correctly or chemicals are outdated

Not applicable

Processes Studies have shown that a lot of duplicate processes prevail simple laboratory tests,.

Basically, the only single-shift process.

Identical processes at all levels

Not applicable

Population served too much of the population, access is not restricted 15

Master Plan - Implementation

Labour Law / Taxes / Fees

The law on data

management

implementation Plan

Technical evaluation /

due diligence State

Tender public-private partnership / outsourcing /

governance

Beginning 2017

Parallel: Quality

Management /

accreditation procedures

Training / education /

association of laboratory

professionals

Checking the lessons learned

during the implementation of the first

examples

Final implementati

on of end 2017

The policy of the Ministry of

Health and Social

Protection of the Republic of

Kazakhstan

Revision of the draft regional

master plan for the

laboratory sector

Deciding on 2-3 areas in

which reform is

implemented

The budget for the

regions and 2-3 overall

budget for laboratory

costs

Ready project for areas

serving modelMid-2016

The new legislation

The Autonomy Act

lab

payment Plans Mid-2016

2-3 as an example of

the field

Decision on areas

Completion of all

programs

Every six months 3-4 additional

areas

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Master Plan - Factors for the introduction and implementation of modern laboratory services

• Fast, efficient and streamlined service• Amendments and additions to laws and regulations (taxes on the import of

chemicals / equipment, permission to export samples (genetics, other tests are rare), warranty list of the analyzes and studies in the framework of SBP at every level of care)

• Training, education and training

• Patient satisfaction with fast and high-quality laboratory research• Reducing the cost of laboratory services through collaboration,

increased productivity• The independence of the activities of laboratory services• Providing accreditation of quality, accuracy, reliability and

transparency of laboratory results• Implementation of logistics, laboratory information system (LIS)

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Master plans for the development of laboratory services in the region up to 2025

(developed in collaboration with the consulting company Sanigest Internacional until 2025)

• Reform of laboratory service in terms of availability, creating a multi-level system, phasing out routine method, automation and centralization of laboratory research, active implementation of laboratory information system.

• The new draft Regulation on the activities of organizations and (or) structural units of health care organizations performing laboratory diagnosis, as well as the amount and type of their studies, taking into account international best practices (RoK Government № 1566 of December 21, 2011)

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Multi-level structure of the network laboratory services

19

Stan

dar

d la

bor

ator

y

Express

Rural

Interdistrict

Regional

National

Point fence + basic laboratory

research

Reference laboratory

Spec

ial l

abor

ator

y Microbiology

Diagnotics blood

Cytology

TB

Medical genetic

Future multi-level structure of laboratory services (Draft Regulation on the activities of healthcare organizations performing laboratory

diagnosis)

• Points fence (PP) biomaterial with providing certain basic set of studies on the level of outpatient organizations, some hospitals.

• Centralized medical laboratories type I and type II are organized in clinical diagnostic centers and multidisciplinary hospitals.

• Regional / or central laboratory (reference laboratory) in regional hospitals with the implementation of more sophisticated laboratory tests, including infectious.

• Specialized Laboratory (microbiology / bacteriological, cytological, etc.) - In the regional centers at specialized clinics or in the regional and national laboratories.

• National Laboratory - in the cities of Almaty and Astana with the performance of laboratory diagnosis of the most complex, socially significant and rare diseases, and educational platform for the representatives of other laboratories as telemedicine and online mode.

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Recommended structure laboratories (By level of care)

• Points fence with a list of studies on the treatment site in the ADF,

hospitals needed to ensure further transportation to the central

laboratory.

•  Each regional / multi-profile hospital should have a centralized

laboratory countryside.

• In the regional center there should be one central laboratory (at the

regional hospital and diagnostic center) with the centralization of

microbiology and cytology; or in specialized clinics.

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Terms of transport

Specimen Collection

Packaging and storage

Transportation

Unpacking and storage

Assays

The fence material for laboratory research  Bar coding and registration data to the LIS.

Packing tips with LIS data in a shipping container that is suitable for the environment  Storage: in the refrigerator.  Check availability of samples to be transported

Delivery of the transport containers in a sequence (e.g., 1-10 sampling points in mini / central laboratory for 2-3 hours). Date of the receipt and delivery of samples (the documents on transportation). Driver training transport of dangerous biological materials.

The signing of the receipt of the samples driver.  Check for damage.  Unpacking the transport containers.  Register access via the bar code.  Storage: in the refrigerator.

Analyzing the registered samples.Sending results using bar code by the LIS to the point of sampling (a doctor) and the official database.

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Offered logistics laboratory network

primary fence

primary fence

primary fence

primary fence

primary fence

primary

fence

primary fence

23

centralized

regional /reference

primary fence

primary fence

primary fence

The existing laboratory network Kyzylorda region

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The recommended structure of the laboratory network in the Kyzylorda region

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The implementation of the order of the Ministry of Health and Social Development of the Republic of Kazakhstan approving the Regulations on the activities of organizations and (or) structural units of health care organizations offering laboratory diagnostics

• For further development of sustainable laboratory capacity, by means of which

will be provided access to fast, affordable and high-quality diagnostic tests at all levels of medical care, in addition to measures to restructure the hospital sector, the development of primary health care to include measures to restructure the laboratory sector, providing:

- The creation of a multi-level system of laboratory services,- Activation of the processes of automation and centralization of laboratory research,- The introduction of modern high-quality low-cost methods of laboratory research, accredited

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The future of modern laboratory services in Kazakhstan

• The presence of the laboratory system, which contributes to the effective management of ambulatory and stationary structures (to avoid duplication of laboratory tests on the basis of centralized laboratory diagnostics)

• Organization and storage of laboratory results of the Bank for the analysis of data from epidemiological studies and health planning

• Establishment of the Center laboratory expertise, develops national standards processes and the quality of training and education in line with international standards;

• Implementation of optimal structures and processes laboratory services, in connection with what will be achieved:

- expansion of the scope and range of laboratory research, the- improving the quality and reducing the time waiting for the results of research,- introduction of bonus schemes for the promotion of medical practitioners.• The introduction of the electronic system of management of patients including laboratory

tests in a database of e-health• Expenditure in the budget (public + private expenses) - 30 US dollars per capita per year by

2020• Modern laboratory infrastructure and processes that contribute to achieving the overall life

expectancy of up to 70 years or more;27

Future laboratory - the introduction of innovative technologies

Auxiliary devices for ...... .. fully automated systems ... ...

….. ... .. No longer need in 10-20 years: A system "lab on a chip"

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Thank you for attention !