Integrating Social Services with Primary Healthcare: Successful Demeu Model to Be Disseminated in Kazakhstan

A Memorandum of Understanding among the Kazakh Ministry of Health, Ministry of Labor and Social Welfare, and AIHA signed on December 3, 2004, marked the launch of a national expansion of the successful community-oriented primary care model (COPC) first pioneered by AIHA's Astana/Pittsburgh partners in 2000 at the Demeu Family Medicine Center in Astana.

At the press conference following the MoU signing ceremony James P. Smith, AIHA's executive director and the Kazakh government officials Yerbolat Dosayev, minister of health, and Gulzhan Karagusova, minister of labor and social welfare talk to journalists. (Photo courtesy of Assel Terlikbayeva.)

According to Kazakh Minister of Health Yerbolat Dosayev, the government's decision to replicate the Astana model was based on its demonstrable success in delivering high-quality primary care services and achieving improved health outcomes in the catchment area through the practice of integrating social services into the comprehensive healthcare programs offered at Demeu.

Thanking AIHA and its partners during the signing ceremony for establishing the Demeu model, which serves as a unique example of a medical facility with a broad range of services that address the overall needs of the population and can be replicated on a broader scale, Dosayev explained. "In striving to improve healthcare in Kazakhstan, we look to model programs such as Demeu to provide examples of viable solutions in which primary care services can be delivered in the most effective and comprehensive way."

Because it combines high-quality clinical services with social programs tailored to the needs of all social groups in the community—including patients of all ages and socio-economic levels and those affected by chronic diseases or physical disabilities, as well as members of high-risk populations such as injecting drug users and commercial sex workers—Demeu stands out as a model of excellence not only in Kazakhstan, but also in most other countries of the former Soviet Union. Multidisciplinary teams of physicians, nurses, social workers, and volunteers from local NGOs collaborate closely with each other to better address the psychological, social, and medical needs of Demeu's diverse patient base. This contributes greatly to the Center's success and its popularity with patients. It also ensures a high level of consistency and efficacy in the care provided at Demeu.

Commenting on the value of the family-based primary care model established at Demeu, AIHA Executive Director James P. Smith noted that the integration of socially-oriented services into primary care settings is a very important step in reforming the healthcare delivery process in Kazakhstan. "Improvements in a population's health status depend not only on the quality of healthcare services available, but also on the local community's capability to effectively address social issues and concerns that can affect a person's well-being," he explained, underscoring the fact that replicating Demeu's comprehensive model is consistent with AIHA and USAID's shared commitment to improve both the quality and availability of integrated primary care services throughout Kazakhstan in the most efficient and cost-effective manner possible.

Smith went on to say that the USAID funding received by AIHA for this project will be used first to open COPC centers in Semipalatinsk and Uralsk then to establish similar centers in Kokshetau and Southern Kazakhstan during the second phase of nationwide replication. AIHA and the Demeu Family Medicine Center will provide technical support, expert consultations, and training for each of the new facilities and are already working to procure necessary equipment and supplies.

From its part, the Kazakh Ministry of Health will provide the pilot sites with a wide range of equipment and benefits that will enable them to offer high-quality primary care services—including early diagnostic screening tests, treatment for various common illnesses and conditions, and prevention and patient education programs—thereby greatly improving the efficiency of clinical service delivery in these communities.

Through its local departments, the Ministry of Labor and Social Welfare will provide the replication sites with social workers and pay their salaries, which will facilitate the integration of social services into the multidisciplinary team approach to care that is the hallmark of the COPC model. These professionals will be educated at a Social Work Training Center that will be established with AIHA's support at the Demeu Family Medicine Center by Columbia University's School of Social Work (CUSSW)—the organization which has been working in Central Asia for nearly a decade with support of the Soros Foundation.

It is expected that as early as March, CUSSW faculty will carry out an assessment of Demeu's training capacity and assist with the development of a curriculum to train social workers for the replication sites. In addition, American experts will conduct a train-the-trainers workshop for the Demeu social workers, who will then assist with building a national cadre of social service professionals in the region and, at the same time, act as mentors for the replication site specialists during the period of the COPC project implementation.

Paying tribute to AIHA's numerous programs in Central Asia following the signing ceremony—which was attended by some 40 people, including US Ambassador to Kazakhstan John Ordway and USAID representative in Kazakhstan Almaz Sharman—Kazakh Prime Minister Daniyal Akhmetov expressed deep gratitude to AIHA for its continuous contribution to the development of highly-qualified medical professionals and primary healthcare sector reform. "AIHA's assistance to the Kazakh healthcare and medical education system has been critical in the past and I am sure that this new project will provide a solid foundation for the successful development of effective primary care delivery in the country," he concluded.

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