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Reform of primary health care in Kazakhstan and the effects on primary health care worker motivation: the case of Zhezkazgan region.

This paper reports the experiences of primary care reform in the Zhezkazgan region of Kazakhstan. After the collapse of the Soviet regime Kazakhstan undertook a radical program of reform to restructure the health sector making primary care the centerpiece of their health reform agenda. The reforms included the creation of independent family group practices financed on a capitation basis directly from the Ministry of Health allowing free choice of primary care providers through open enrollment and creating a non-governmental primary care physician association. This program has had remarkable success in improving motivation among primary health care workers. Part of this success can be explained by the multiple strategies adopted including communicating and preparing providers and communities for changes providing stronger financial incentives for performance ensuring strong feedback mechanisms from the community to care providers and engendering a stronger sense of professionalism among primary care providers. The paper describes how changes in the overall organizational relationships and economic incentives have led to increased interest in primary care among physicians increased attention to quality and patient satisfaction more rational and creative use of resources and stronger commitment of physicians personal time and resources to improve services for patients. (authors)