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Intercountry Conference (Round table) on partnership collaboration: Health financing reforms for Universal Health Coverage 19–20 June 2018, Astana, Kazakhstan - P4H Network

Intercountry Conference (Round table) on partnership collaboration: Health financing reforms for Universal Health Coverage 19–20 June 2018, Astana, Kazakhstan

The Nazarbayev University School of Medicine for two days turned into a dialogue platform for 30 Kazakhstani and foreign experts in the field of economics and healthcare. The main topic for discussion was health financing reforms to ensure universal health coverage.

Kazakhstan as a member of the global network

The first intercountry conference on partnerships, organized jointly by the Republican Center for Health Development (RCHD) and P4H, brought together representatives of all member-organizations of the P4H global network at the platform in the capital of Kazakhstan. Among the member-organizations are: the World Health Organization, the World Bank, the International Labor Organization, the African and Asian Development Banks, the Global Fund, and the health institutes of France, Germany, Morocco, Spain, Switzerland and the United States. Kazakhstan, more precisely RCHD, joined this organization only last year, but already claims to be a “focal point”, that is, a kind of a hub for regional network cooperation in Central Asia. With the help of such items, according to P4H network coordinator Claude Meyer, the organization intends to expand its presence in all countries and regions. “We have many partners, and over the years we are just growing. Now applications from the Seoul Public Health School, the Council of Europe Development Bank are under consideration, and negotiations with the Philippines are also under way. Kazakhstan is one of the few who joined the steering committee” Mr. Meyer reported during the conference. The goals of the organization, he said, are relevant for the whole world. This is the provision of health and financial protection of the population, as well as monitoring the quality of health services. One of the main issues at the same time is adequate financing of health care. In this issue, he said, there are many interested parties and people who want to work in this area. But the trouble is that their actions are not coordinated.

“Someone is working on fiscal space, someone is engaged in budget allocation, and very often they all lack cooperation. Our organization was created in order to help solve such problems”, he said. The expert recalled that the “friendly” sectors for health are the sector of social protection and financing. The World Health Organization (WHO), the International Labor Organization (ILO) and the World Bank were the very founders of the P4H global network 11 years ago. At that time, according to the coordinator of the network, no one considered health care in terms of funding and universal coverage, only talking about fighting specific diseases. Therefore, he called the creation of this organization an innovative step. “Now we are considering healthcare in a completely different context. We now have a common goal for all countries of the world – sustainable development. If the focus was previously on developing countries or countries with incomes below the average, today’s agenda is universal for all countries – to achieve better results and universal health coverage. In many countries, including Kazakhstan, health financing and universal coverage are discussed only from a technical point of view, but should be considered politically and economically”, added the foreign expert.

Earlier, in an interview with Atameken Business Channel, Zarina Temekova, head of the Healthcare Economy Center of the RCHD, noted that the P4H site is called upon to provide international cooperation in financing health and health protection, and also to strengthen health systems in participating countries. By the way, the network has its own digital platform, subscribing to which anyone can access the discussion of health financing issues around the world, contact the expert community, where today there are more than 1300 experts.

Germany vs. Kazakhstan

The list of participants of the intercountry conference in Astana was not limited to the partners of the network, the dialog also included the United Kingdom, Estonia, Australia, Poland, Singapore, Turkey, Russia, Thailand, China, Sri Lanka, Mongolia, Kyrgyzstan, as well as representatives of agencies, such as GIZ (German International Cooperation Agency) and TITCK (the Turkish Medicines and Medical Devices Agency). One of the oldest medical insurance systems in the world is recognized by the German system, which started work in 1881 and still operates today. “For 137 years, our system has experienced several regime changes, dictatorship, communism, two world wars, a financial crisis, recessions and high unemployment. Yes, during this time we had fundamental changes in demography, but social health insurance still exists. This shows that a properly aligned system can be flexible and adaptive. I think the whole thing is in the principles of solidarity and joint responsibility, that is, the joint recognition of risks by different groups of people: young people and the elderly, families and singles, healthy and sick. This is a completely different approach than in private insurance, when the insurance payment is calculated in the event of risks. And, if you are a highly developed society, you must take this into account. I think that you, as a country of the former Soviet Union, which always had universal coverage, is easier to understand and accept this concept”, said GIZ program director Jean-Olivier Schmidt. Despite these principles and the “long life” of the system, the expert noted that even today in Germany there is no 100% coverage of the population by insurance, because, in addition to the indigenous population, as migrants and refugees are considered as recipients of services. The reason for the “ineffective” work of the fund in most countries, in his opinion, is not bad healthcare or lack of highly qualified personnel, but the wrong people in the management of the fund. In Germany, this process has been built for years, and to date, have developed three-year programs that give the profession of “clerk for social insurance.  ” More than 85% of the current staff of the insurance fund in Germany, according to Jean-Olivier Schmidt, has been trained specifically for this program. “They calculate all insurance premiums, take into account all requirements and advise employers on legislation, they interact with consumers, that is, with customers. This is their main function. However, the fund is not limited only to lawyers, there are also doctors with medical education in order to assess the incoming requirements and, of course, to exercise control through information technology”, he explained. And if Germany can be proud of their health insurance system, then everything is bad with digital health care.

According to the Professor of Mannheim Institute of Public Health, the University of Heidelberg in Germany, Dr. Konrad Obermann, all attempts to switch to information technology in Germany remain unsuccessful. “Iceland and South Korea show good examples, but, unfortunately, not Germany. A whole galaxy of doctors resists this, because it understands that this leads to increased transparency, which they do not want. Therefore, for 10 years we have not made much progress in e-health. And if you look at the progress of technology, please do not look at the example of Germany”, advised the expert. In addition, in his opinion, universal health coverage is an unattainable goal. Providing one hundred percent of quality assistance and financial protection, according to Dr. Obermann, is a constant political struggle, rather than a momentary technical task or goals. “It is not enough to simply consider some specific issues of the medical nature of health care, they need to be supplemented by strong public health programs in order to achieve a significant improvement in public health”, he added. Konrad Obermann also noted that blind copying of the experience of other countries will not lead to success, on the contrary, can lead to enormous and completely unnecessary expenses. In his opinion, it is necessary to search for a national way – Kazakhstani way – in this matter.