Analysis of the current state and prospects of nursing in primary health care in the Republic of Kazakhstan

Introduction. Primary health care underpins equitable access and continuity of services, forming the cornerstone of sustainable health systems. Nursing is central to Primary Health Care delivery, encompassing preventive services, patient care, and chronic disease management. Despite reforms in Kazakhstan, significant challenges persist, including workforce shortages, uneven distribution of personnel, insufficient educational standards, and limited career advancement opportunities.

Aim. To analyze the current state of nursing in Kazakhstan’s Primary Health Care system, identify systemic barriers, and outline development prospects in line with international benchmarks.

Materials and methods. A narrative review was conducted of official reports from the Ministry of Health, national regulatory documents, and peer-reviewed publications (2010 – 2025). Comparative analysis with global advanced nursing practice models was performed.

Results and discussion. Kazakhstan employs about 121,000 nurses, including 65,000 in Primary Health Care, but faces a shortage of nearly 3,800 mid-level staff. In rural areas, one nurse may serve up to 2,500 patients, leading to burnout. From 2020 – 2023, nurses’ salaries rose by 20%, 45 SOPs were introduced, and graduate nursing programs expanded. Yet advanced practice remains limited: in Almaty, only 0.4% of nurses provide independent consultations. In 2024, over 1,100 professionals (including 82 nurses) were trained for new PHC facilities, and 2,850 staff completed updated training. In 2025, the Ministry of Health declared the Year of Primary Health Care, mandating continuous training and digital integration. Positive shifts include simulation centers, distance learning, and digital tools that enhance education and broaden nurses’ roles.

Conclusion. Strengthening nursing in Kazakhstan’s Primary Health Care requires a comprehensive strategy: raising salaries, updating curricula to international standards, expanding nurses’ scope of practice, and integrating digital health solutions. Government support and international collaboration are critical to stabilizing the workforce and improving Primary Health Care quality and accessibility.

1. Bejsenova G.S., Ajdarbekova Zh.D., Ahmetova R.L. Vysshee sestrinskoe obrazovanie v Kazahstane: problemy i perspektivy razvitija. Medicinskaja nauka i obrazovanie. 2020; 1 (15): 25- 31.

2. Dzhajnakbaev N.T., Aldijarova M.A., Ibrajmzhanova Zh.E. Sestrinskoe delo v Kazahstane i v mirovyh sistemah zdravoohranenija. Aktual’nye problemy teoreticheskoj i klinicheskoj mediciny. 2020; 1 (1): 23-30.

3. Ob utverzhdenii Pravil okazanija pervichnoj mediko-sanitarnoj pomoshhi: Prikaz Ministra zdravoohranenija RK ot 24.08.2021 № ҚR DSM-90. https://adilet.zan.kz/rus/docs/V2100024094

4. Ob utverzhdenii Standarta organizacii okazanija PMSP v Respublike Kazahstan: Prikaz i.o. Ministra zdravoohranenija RK ot 30.03.2023 № 49. https://adilet.zan.kz/rus/docs/V2300032160

5. Mjasnikov A.O., Novikov A.Ju., Sadovskaja M.A. Pervichnaja mediko-sanitarnaja pomoshh’ kak bazovyj jelement sistemy zdravoohranenija: osnovnye principy i kljuchevye zadachi. The Scientific Heritage. 2020; 43: 43-48.

6. Sadovskaja M.A., Novikov A.Ju. SWOTanaliz v zdravoohranenii kak instrument povyshenija ustojchivosti i jeffektivnosti sfery okazanija medicinskih uslug. Voprosy organizacii i informatizacii zdravoohranenija. 2023; 10 (2): 45-52.

7. Smyljaev A.V., Mel’nikov Ju.Ju., Sadovskaja M.A. Vnedrenie novogo podhoda v upravlenii medicinskimi organizacijami v ramkah proekta «Moskovskij standart polikliniki». The Scientific Heritage. 2019; (40): 52-58.

8. Hajdarova T.S., Nurmuhanbetova R.N. Sovershenstvovanie profilakticheskoj dejatel’nosti v sisteme PMSP. Problemy social’noj gigieny, zdravoohranenija i istorii mediciny. 2011; 3: 44-46.

9. Bahadori K., Doyle-Waters M.M., Marra C., Lynd L., Alasaly K., Swiston J., FitzGerald J.M. Economic burden of asthma: a systematic review. BMC Pulm. Med. 2009; 9: 24. https://doi.org/10.1186/1471-2466-9-24

10. Behera B.K., Prasad R., Shyambhavee. Primary health-care goal and principles. Healthcare Strategies and Planning for Social Inclusion and Development. 2022: 221-239. https://doi.org/10.1016/B978-0-323-90446-9.00008-3

11. Gaglioti A.H., Petterson S., Bazemore A., Phillips R. Access to Primary Care in US Counties Is Associated with Lower Obesity Rates. J. Am. Board. Fam. Med. 2016; 29 (2): 182-190. https://doi.org/10.3122/jabfm.2016.02.150356

12. Glanville J., Kendrick T., McNally R., Campbell J., Hobbs F.D. Research output on primary care in Australia, Canada, Germany, the Netherlands, the United Kingdom, and the United States: bibliometric analysis. BMJ. 2011; 342: d1028. https://doi.org/10.1136/bmj.d1028

13. Hajjar F., Saint-Lary O., Cadwallader J.S., Chauvin P., Boutet A., Steinecker M., Robert S., Ibanez G. Development of Primary Care Research in North America, Europe, and Australia From 1974 to 2017. Ann. Fam. Med. 2019; 17 (1): 49-51. https://doi.org/10.1370/afm.2328

14. ICN (International Council of Nurses). Nursing definitions. https://www.icn.ch/nursing-policy/nursing-definitions

15. McDonald C., Henderson A., Barlow P., Keith J. Assessing factors for choosing a primary care specialty in medical students; A longitudinal study. Med. Educ. Online. 2021; 26 (1): 1890901. https://doi.org/10.1080/10872981.2021.1890901

16. National healthcare development program for 2021 – 2025. https://www.gov.kz/memleket/entities/dsm/documents/details/2021

17. OECD Reviews of Health Systems: Kazakhstan 2018. https://www.oecd.org/publications/oecd-reviews-of-health-systems-kazakhstan-2018-9789264289062-en.htm

18. Rabinowitz H.K., Petterson S., Boulger J.G., Hunsaker M.L., Diamond J.J., Markham F.W., Bazemore A., Phillips R.L. Medical school rural programs: a comparison with international medical graduates in addressing state-level rural family physician and primary care supply. Acad. Med. 2012; 87 (4): 488-492. https://doi.org/10.1097/ACM.0b013e3182488b19

19. Saijo Y., Yoshioka E., Kawanishi Y., Nakagi Y., Hanley S.J.B., Yoshida T. Relationships between road-distance to primary care facilities and ischemic heart disease and stroke mortality in Hokkaido, Japan: A Bayesian hierarchical approach to ecological count data. J. Gen. Fam. Med. 2017; 19 (1): 4-8. https://doi.org/10.1002/jgf2.140

20. Sharma A., Basu S. Does Primary Care Availability Mediate the Relationship Between Rurality and Lower Life Expectancy in the United States? J. Prim. Care Community Health. 2022; 13: 21501319221125471. https://doi.org/10.1177/21501319221125471

21. White F. Primary health care and public health: foundations of universal health systems. Med. Princ. Pract. 2015; 24 (2): 103-116. https://doi.org/10.1159/000370197

22. WHO (World Health Organization). Global strategic directions for nursing and midwifery 2021 – 2025. https://www.who.int/publications/i/item/9789240033863

23. WHO (World Health Organization). State of the world’s nursing 2020: investing in education, jobs and leadership. https://www.who.int/publications/i/item/9789240003279

24. Zhang D., Son H., Shen Y., Chen Z., Rajbhandari-Thapa J., Li Y., Eom H., Bu D., Mu L., Li G., Pagán J.A. Assessment of Changes in Rural and Urban Primary Care Workforce in the United States From 2009 to 2017. JAMA Netw Open. 2020; 3 (10): e2022914. https://doi.org/10.1001/jamanetworkopen.2020.22914

25. Zhang X., Lin D., Pforsich H., Lin V.W. Physician workforce in the United States of America: forecasting nationwide shortages. Hum. Resour. Health. 2020; 18 (1): 8. https://doi.org/10.1186/s12960-020-0448-3