Imashpaev D.M., Тurgambayeva A.K., Gilkaydarova R.

Аstana medical university, Kazakhstan

SOME PROBLEMS OF PREPARATION OF MEDICAL SHOTS IN KAZAKHSTAN

Kazakhstan inherited the Soviet system of preparation and professional development of medical worker. After finding of independence and up to 2004 in this area practically there were no changes, except for the organization of postgraduate training of specialists in the field of family medicine and according to priority programs, including health of mother and the child, and tuberculosis. Ministry of Health in 2004 noted that as a whole quality of preparation and retraining of medical shots in the country remains low. One of the reasons-the imperfect standard and legal base regulating conditions of reception, preparation and quality control in system of medical and pharmaceutical education.

Besides, quality of preparation of medical shots was affected by long-term deficiency of financing. The material base of medical educational institutions long time wasn't updated. Medical schools have no enough the equipped educational and clinical bases, have no the necessary modern equipment for performance of scientific researches.Also the financing provided on training of students by the state educational order in medical schools which doesn't allow to use fully modern technologies , to buy the necessary equipment and visual aids, but in addition on is excluded that being trained entered on a grant in the university, in the subsequent if his progress is unsatisfactory – often to Higher education institution not favourably to deduct the student (the grant has feedback) therefore Higher education institutions try to overestimate progress point that further we receive after all the end of training of the unskilled expert.Further heads of medical schools are compelled to solve a problem of shortage of financial means at the expense of reception on contractual form of education of students often with low level of knowledge. The number of enrollment of students on a paid basis annually grows. All this is reflected in level of preparation of graduates of higher education institutions and influences quality of rendered medical care.

The concept of a development of education in the Republic of Kazakhstan till 2015 provides reorganization of vocational training of all experts with the higher education, including medical. According to this concept in 2003 new obligatory standards in the field of medical and pharmaceutical education in which the bigger attention is given to the principles of continuity of educational programs were entered.Further, in 2003 of function of management of medical education from the Ministry of Education and Science passed to Ministry of Health. The concept of reform of medical and pharmaceutical education for 2006-2010 was developed, and in 2007 new standards of preparation students of medical and pharmaceutical specialties came into force.Except for doctors, dynamics of number of graduates of other medical specialties on the 1000th population during the period after 1990 as a whole was negative, though was characterized by considerable fluctuations. Also experts of medical sector still have opened a question of a salary.In Soviet period the health care sector, unlike other sectors of economy (for example, extracting), wasn't considered as the productive. In this regard earnings of medical workers were below average about the country.Despite numerous increase in a salary to medical workers (only in 2004 - for 20%), the official average monthly salary in branch is twice less, than on the average on the republic.The size of compensation of medical workers depends on their experience and qualification, but doesn't depend on results and quality of services provided by them. However such mechanism of payment in which the end results of work, differentially are considered today is entered.

For example, the profession of the nurse still is considered in Kazakhstan not prestigious and low-paid. And though the official salary of doctors isn't much higher, than at nurses, doctors have opportunity to get various official awards and extra charges. Besides, doctors can occupy not one, and some positions that, respectively, affects and on decrease quality of work, however increases their income.Even after salary increase to workers of the budgetary sphere in 2009 for 30%, since April 1, 2010 a salary in the budgetary sphere for 25%, in 2011 for 25%, its size in health care is 1,6 times less than average by all types of economic activity. Work of doctors of the state medical organizations is stimulated by the differentiated payment (mainly on qualification categories), but also it doesn't justify this work.

In Kazakhstan doctors often carry out those tasks which in the West European countries enter into functions of nurses whereas nurses carry out in what in other countries is engaged serving or technicians.The staffing problem in modern conditions is decisive factor successful functioning of health system in the conditions of reforming.At the heart of reforming of health care acceptance of effective measures to formation of such personnel policy which taking into account occurring in the country and branch of transformations would not allow only to keep available personnel potential lies, but also qualitatively to change it, to adapt for new conditions of social and economic development of the country.

In the majority of all the countries in the world, planning of shots of health care goes in five main directions: 1) definition of an optimum ratio of number of the medical personnel and country population; 2) reception regulation in medical schools and definition of a long-term perspective assessment of number of future workers of health care;3) assessment of demand for the experts occupied in separate areas of health care; 4) assessment of requirement for bed place and duration of stay in hospital; 5) comparison of volumes of used resources and standards with the practice accepted in other countries. Negative impact on the general condition of personnel security also have refusal system of distribution of graduates of medical schools existing once and colleges, the mechanism of fixing of shots.All this, certainly, is the reasons of insufficient staffing of health system, including: insufficient number of the persons rendering primary medical and sanitary help, concentration of medical workers in the cities, first of all, the large regional centers,and as preservations, rather high percent among medical workers of persons of a pre-retirement and retirement age.

Thus, according to the above it is offered to move purposefully on a certain any trajectory as now we have an extraordinary picture in system health care as a whole and in education on preparation of medical shots, as led to the following:preparation of medical shots is carried out according to Bologna Process, but as a result we don't come to this level because of non-compliance with certain principles; preparation of general practitioners - doesn't justify expected result; and other that demands profound revision and preliminary approach as a whole to new reforms more seriously before to undertake them and as far as after all these reforms in our country can be adapted.

So, today, considering a set of introductions in health system, after all, it is necessary to work by the principle: "I came, I saw – help! ", instead of "I came, I saw – punish! ".