Palliative Care in the Republic of Kazakhstan: Current Situation and Legal Regulation
Authors: Zhapparova A. S. , Kunirova G. Z. 
Published: April 2021

It is known that diseases do not choose either the geography, age, or gender of the patient. And when the patient is faced with terrible incurable or progressive diseases, the task arises not only to stop pain, but also to provide maximum supportive psychological assistance to both the patient himself and his relatives. Issues related to the provision of palliative care are relevant for many countries: this is a problem of not one single country or even a group of countries.

When we talk about palliative care, we mean comprehensive care for a patient diagnosed with an incurable disease, including: assessment and control of chronic pain; evaluation and control of other severe symptoms of developing disease and side effects of drugs; nursing and family training in nursing skills; psychological support for the patient and his family members; social and legal assistance.

Even those who know about palliative care not by hearsay, tend to connect it mainly with the provision of care and support to cancer patients. In fact, the range of patients who needs of such care is much wider. And these are not only adults, but also children.

In recent years, palliative care in Kazakhstan has received a new impetus in development. The state, deputies and medical community are ready to discuss emerging issues and problems. The Kazakhstan Palliative Care Association is active. It was established in 2013 to bring together non-governmental and government organizations involved in the provision of hospital-based palliative care (hospices, palliative care centres/units) and multidisciplinary mobile home teams. The ultimate goal of the Association is to fully integrate quality palliative care into the health care system at all levels.

For Kazakhstan, with a population of more than 18 million, palliative care is required for patients with chronic progressive diseases at the terminal stage; tuberculosis; acquired stage 3-4 immunodeficiency syndrome; in the progression of childhood leukemia and malign neoplasm.

In Kazakhstan, patients in need of palliative care receive it in various organizational forms. For many, staying in hospices continues to be the only place where you can get supportive care, anti-cancer therapy, qualified nursing care, psychological support for patients and relatives.

In 1999, the first hospice was opened in Almaty. Later hospices were opened in other cities. The main part of those in hospices is those with cancer. In regions where there are no hospices, hospice departments have been deployed, functioning at multidisciplinary hospitals and oncological dispensaries. The third form of palliative care is multidisciplinary groups, which include a doctor, a medical sister, a psychologist, a social worker, volunteers. The team principle of work provides the maximum medical, nursing and psychological support.

Another form of assistance is seen in providing it at home. Such assistance is provided by mobile teams together with relatives of patients, and medical staff train them to do it correctly.

Regardless of the form in question, the aim is to implement timely measures aimed at improving the quality of life and the general condition of patients suffering from incurable serious, progressive diseases.

Of particular concern is the area of palliative care for children. What problems and difficulties are present in child palliative care in Kazakhstan? There are practically no doctors in the country who have received special training in pediatric palliative care. To date, there are no state children's hospices. Unfortunately, children often do not receive adequate pain relief, since strong drugs are not prescribed to them.

What, in our opinion, should be in focus:

- palliative interventions should begin from the moment of diagnosis, regardless of life prognosis;

- palliative care for children should be available anywhere the child is located;

- palliative care for children should include a wide range of social assistance to the family;

- issues of socialization and psychological condition of sick children (accessibility of education, participation in public life, psychological distress, stigma) should be resolved;

- in the children's palliative, it is important to develop remote methods of working with families - 24-hour telephone support services.

What are the problematic issues in palliative care?

For Kazakhstan, the personnel issue in this area is acute. To date, medical universities do not train specialists for palliative care. There are separate elective courses, but there is no system-based training. At the same time, experts believe that training should be carried out in three areas: a general approach to assistance, non-specialized palliative care and specialized palliative care. The second acute problem remains the availability of opioid analgesics. Pain is the most common and severe symptom of an incurable disease, affecting the quality of life of the patient and his environment. A significant barrier to adequate pain relief is the insufficient level of proficiency of doctors in the pain treatment protocol and regulatory regulations. There is no systematic approach in providing pediatric palliative care, which we have already talked about. There is a shortage of institutions to provide palliative care.

Practical issues cannot be resolved without due legal support in this area. If we talk about legal regulation, we can confirm that in general the republic has a certain legal basis in regulating palliative care. The Comprehensive Plan for the Fight against Oncological Diseases for 2018-2022 and the State Program for the Development of Health Care of the Republic of Kazakhstan for 2020-2025 were approved. The Republic adopted two Codes on the Health of the People and the Health System (2009 and 2020), a number of the most important Government decisions and orders of the Ministry of Health, which regulated such issues as the standard for the organization of palliative medical care; the inclusion of palliative care in the guaranteed volume of free medical care; identification of the categories of population receiving palliative care and nursing; procedure for providing nursing care, etc.

To date, Kazakhstan has all the conditions for the successful development of palliative care: a sufficient regulatory legal framework has been created, clinical protocols are being improved, methodological manuals are being developed, the necessary non-invasive forms of opioids appear, the bed fund is being expanded, palliative care at home is being actively introduced, there is a professional association that protects the interests of patients and caregivers.