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Out of the many aspects of health care, the concept of physical accessibility is a priority that not only encompasses availability of health care resources, but also requires that they are easily accessible for all. To assess this factor as expressed in terms of the number of available physicians in the north-eastern part of Kazakhstan, we used the enhanced two-step float catchment area in a geographic information system approach. The Gini index and the Lorentz curve were used to evaluate the economic inequality within this region. Based on the data obtained, we developed models to increase the availability of health care considering allocation of additional primary health care resources. A low to zero index was found to be typical for most rural settlements, which currently make up less than 15% of the total population. We also identified a correlation between the index of accessibility and that of inequality, which indicates that areas with high accessibility show a more equitable distribution of resources. The developed location/ allocation models of additional primary health care resources can be useful in implementing government initiatives to improve the availability of primary health care in rural areas.

BACKGROUND: Global health initiatives such as health for all and universal health coverage aim to improve access to health care. These goals require constant comprehensive monitoring to eliminate inequalities in the availability of health care. AIM: The purpose of our study was to assess the physical availability of medical care in Kazakhstan. METHODS: A descriptive study based on a Service Availability and Readiness Assessment (SARA) general availability index calculation that used secondary data as a source of information. RESULTS: The general availability index calculated for the regions of Kazakhstan ranged from 95% to 100%. When considering individual indicators of the index, decrease trends of the volume of inpatient care were identified. Outpatient care had fluctuations with values better than benchmark after 2009. Stable upward trend illustrates positive picture of core health personnel. CONCLUSION: According to the SARA availability index, it can be concluded that health care in Kazakhstan exceeds the threshold values and is available in all regions. Trends for individual indicators of the index should be studied in more detail, taking into account the influence of health policy and other factors.

BACKGROUND: One of the main causes of death is cardiovascular diseases. Among cardiovascular diseases ischemic heart disease is major a cause of death. Emergency medical service and ambulance play the key role in providing timely care. AIM: This study was carried out to investigate the coverage area of calls of acute coronary syndrome (ACS) by ambulance stations in regards to the time using GIS-analyze. METHODS: This was descriptive study which contains secondary data from Semey ambulance service’s database about all 1704 ACS with and without elevation of ST segment emergency calls in Semey city (Kazakhstan) over the period from August 1, 2017 to May 30, 2018. Spatial Analyst and Network Analyst Extensions of ArcGIS 10.7 (ESRI, CA, USA) were used to define high ACS density areas and find 10, 15, and 20 min time response areas. Kernel density tool calculates a magnitude-per-unit area from point or polyline features using a kernel function to fit a smoothly tapered surface to each point or polyline. RESULTS: The distance to the patient for ambulances was from 7 to 15 km. For most calls, the response time was <10 min, which is the recommended national standard for emergency care. Density zones were divided into seven categories from white (from 0 to 3.4 cases/km2) to red (from 59.9 to 86.1 cases/km2). The largest high-density area of ACS cases was located in central part of the city on right-bank of the river. Furthermore, high density of ACS cases was identified in the areas of high rise buildings on the left bank of the river. CONCLUSION: GIS tools are useful tool that can be implemented in planning of emergency medical service. In our study, we determined that the service areas of ambulance stations cover the needs of patients with ACS. But nevertheless, it is necessary to plan the ambulance care to nearby regions and villages. In addition, it needs to consider the development of new areas of city and patterns of emergency calls in planning.

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