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HepeueHb Ta6JIHU

Ta6nHua 1: HloKa3aTenu no TB no o6nacTAM, 2002 r. 4Ta6nHua 2: KOJIHHeCTBO 3aperUCTpHpOBaHHbIX cjiyqaeB TB H YPOBeHb 5cMepTHOCTH Ha 1 00 TbIC. MqenOBeK rpaaHcKOFO HaceieHHS B Ka3axcTaHe

Ta6inHua 3: Pe3ynbTaT nemeHHHS HeKOTOpblx TB HOJlO)KHTenbHbIX cny'aeB fplH 5noMomH AOTC, Ka3axcTaH, 2000- 2002 (%)Ta6nuHa 4: KoJnimecTBo 3aperHCTPHpoBaHHbX cnyqaeB TB H YpOBeHb 6cMepTHOCTH Ha 100 TbIC., enOBeK B TIOpbMaX B Ka3axcTaHe, 1997-2001 rr.

Ta6jiHua 5: BH4H/CIFIAJ B Ka3aXcTaHe 7Ta6nHua 6: BH4/CHflll B T1OpbMaX 8Ta6nHua 7: LjeneBbie rpynnbI 12Ta6inHua 8. Fny6HHHble HHTepBb1O 13Ta6nHUa 9. THllbi o6cneayeMbIX yqpex:eHHHr H pacnpeaeneH4e no pero4Ham 14Ta6juHUa 10. HpOTHBOpeIqHA MexcKy HCTOMHHKaMH aaHHbIX 15Ta6iuia 1: IpoLueHT nOJIO)KHTenIbHbix aHanH3OB Ma3Ka MOKPOTbl H3 o6wero 19qHc.na 06Hapy)KeHHblX cnyqaeB

Ta6nHua 12: 3a6oneBaeMocTb TB 25Ta6jnua 13: HoKa3aTeji no TB no o6JiacTTM 27Ta6nHua 14: Pecypcbl: KoJIHMeCTBO Bpaqeri-DTH3HaTpoB 29Ta6muna 15: CpeRHHi MeaHUHHCKHr4 nepcoHarl 30Ta6rnHua 16: BWf4/CHrI 3a 1990-2001 rr. 41Ta6rniua 17: BHI4/Cfl4) B TIOpbMaX 1990-2001 rr. 41Ta6imna 18: B144/CrlH, B 2002 r. 41Ta6JiHUa 19: O6cneRioBaHHb1e yqpevxKeHHiA 61Ta6nHua 20: HanHqHe MeHU4HHCKHX pecypcoB 63Ta6nHua 21: HajiHqHe apyrHx pecypcoB 63Ta6nHua 22: HanHMHe nepcoHana Ha 100 TbIC. HaceneHHA 71Ta6nHua 23: HMeiomeec Aja6opaTopHoe o6opyaoBaHHe 72Ta6jiHua 24: HpeRcTaBneHHbIe pe3yflbTaTbl 77Ta6nrnua 25: O6WHe pacXOTIbl H pacXOAbl Ha gyUly HacenJeHHS B 2002 rogy 81Ta6nHua 26: 3aTpaTbl no 6Ko,aKeTHblIM KaTerOPHA1M Ha OaHOrO nauHeHTa 84Ta6rnuna 27. 3aTpaTbl Ha fJIIOOPOCKOnHIO H jIpyrHe KaTeropHH, 2002 r. 85Ta6irniia 28: 3aTpaTbl Ha nemeHHe o6bltHblX nauHeHTOB H naUHeHTOB c MPTB no 86pa3JIHqHblM CueHaPHAM

Ta6nHua 29: F1pMbHiei KOCBeHHbie 3aTpaTbl no o6nacTsM 87Ta6nrna 30: 3aTpaTbl Ha O4Hy npeaoTBpaiueHHyIo cMepTb 91Ta6nrHna 31: 3aTpaTbl Ha OXAHH cnaceHHblrH f-AHHT 91Ta6iniua 32: CpaBHHTeJIbHaM 3KOHoMHqeCKaA 34OeKTHBHOCTb 92Ta6nHUa 33: BbIrOabI OT nOBbIueHH npolueHTa H3jiemeHHA no BceM o6IiacTSM ao 9484%Ta6JiHua 34: Bbiroabi, CBS3aHHbie c ynywieH4em noKa3aTeiei pa6oTbl CHCTeMbi 953gpaBOOXpaHeHHA

Ta6nHua 35: 3KOHOMHB no KaKxoMY 1H3cueHapHeB 95Ta6nHua 36: O6aiHe pacXo4bl H pacXoRbl Ha jUymy HacenJeHHS1 B 2002 rogy 97Ta6jiHma 37: PacnpeaeneHHe 3aTpaT no 6iogpKeTHbIM KaTerOPHAM Ha OaHOrO 100naIiHeHTa c BHWY/CrlI4,Ta6nHaa 38: npIMble H KOCBeHHbie3aTpaTblno o6macTsIM 101Ta6.JHIua 39: CpeaHHe 3aTpaTbI Ha aeqeHHe nauHeHTOB c BI4'1/Cflh4g 102Ta6nrnoa 40: KOHCOnHAHpOBaHHblHi peRTHHr no o6iacTslM Ka3axcTaHa, 2002 rog 122Ta6jHua 41: 14cHoJ]HeHHe MeCTHoro 6toaxceTa Ha npo4HniaKTHKy H TneHeHHe TB 126no o6nacTsM

HepexeHb rpa)HICoB

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FpaqHK 8: YpOBeHb H3JieqeHHA OT TB no cpaBHeHH1O C HOBbIMH CJIYM'aAMH H 28PeUH4HBaMH B 2002 r.Fpa¢HK 9: rlpoueHTHoe CooTHoLeHHe YpOBHA 3a6oJIeBaeMocTH TB 1< o6wueMy 30KOJIHMeCTBY BpaMeH, 2002 r.Fpa¢HK 10: CooTHomueHHe meacecTep H 1TH3HaTpoB H npoueHTa H3J]eleHi4M no 31perHoHaM, 2002 r.Fpa4HK I 1: KojiHeCTBO MeCT Ha 1 TbIC. 6oJIbHbIx TB 32Fpa4HK 12: KOJIHYeCTBO KOjiKO-MeCT H YPOBeHb H3JleeCHHSi 33Fpai¢HK 13: 3a6ojJeBaeMocTb TB H YPOBeHb 6eUHOcTH 34FpaqHK 14: 3a6oneBaeMocTb TB H KoJIHieCTBo 4?TH3HaTpoB 35Fpa¢HK 15: KOjHtieCTBO KOHKO-MeCT ansi 60nbHbix TB H YPOBHeM 353a6o0ieBaeMoCTH

Tpa4HK 16: 3a6oneBaeMocTb/pacnpocTpaHeHHocTb 3a6oJIeBaHHSI H paCXoQbi Ha 36MegHKaMeHTbl

Ipaq)HK 17: Hlpone'eHHbIe cfyl4amH H KOnHYeCTBO KOHKO-MeCT 38Fpaq)HK 18: nIpoueHT H3JeqeHHS H cpeCJIHAS 3apa6oTHar nnaTa Ha ,ayuiy 38HaceneHHSFpa4HK 19: PacnpocTpaHeHHOCT BBIl/CrITa B 2002 r. 40Fpa4HK 20: Cjiy'iaH B14'-/CHr4 no peroHHaM 3a 2002 r. 42Fpa4HK 21: CMepTHOCTb OT CII4I,Aa no BO3paCTHbIM rpynnaM, 2002 r. 43Fpa4HK 22: CMepTHOCTb OT C lHIa B rpynnax pHCKa 43Fpa4HK 23: KojiHqeCTBO Bpaqei no BWT4/CHHI1 Ha 100 TbIC. '-eJioBeK 44Fpa4HK 24: KoJIHeCTBo MeRcecTep no BHL/CfID4 Ha 100 TbIC. MeJIOBeK 44Fpa¢HK 25: HOBble cjiyqaw I4flfffI no B03paCTHbIM rpynlnaM, 2002 r. 46Fpa(HK 26: KOJIHqeCTBO Bpaler1 H11V11l Ha 100 TbIC. Yen. no perHoHam, 2002 r. 46Fpa4HK 27: 06wee KOJIHeCTBO KOHKO-MeCT ,isI 6oJbHblx H141l no peroiHam, 472002 r.Fpa4HK 28: PeCHy6JIHKaHCKHA H MCCTHblH 6ioaKeT B 2002 ro,gy 79rpapHK 29: PacnpeejeneHHe o6UHX 3aTpaT no BHaaM pecypCOB B 2002 rojty 82Fpa)HK 30: PacnpeaeneHHe 3aTpaT no o6niacTAM 82Fpa4HK 31: B1oJKeT no KaTeropHqM B 2002 rogy 84FpatHK 32: CpeaHHe 3aTpaTbl Ha ie4eHKe nauHeHTOB c TB B 2002 rozy 89Fpa¢HK 33: CpaBHHTeJlbHble 3aTpaTbl Ha nIeYieHHe TB naHUHeHTOB 90FpacPnK 34: 3KOHOMHS 3aTpaT Ha nie'-eHHe nauHeHTOB c TB B 2002 roay 93FpaPHK 35: Pecny6.nHKaHCKHii H MeCTHblI 61o0nKeT B 2002 roay 96Fpa4HK 36: TeKylUHe H HHBeCTHUHOHHbie 3aTpaT, 2002 r. 96Fpad2HK 37: PacnpeaeneHHe o6WHX 3aTpaT no BH]aM pecypCOB B 2002 roly 99FpatHK 38: PacnpeaeneHHe 3aTpaT no o6nacTAM 99Fpa4HK 39: FlpOUeHT H3jie1eHHA H 3aTpaTbi Ha oaHoror naueHTa B Ka3axcTaHe 123Fpa4HK 40: YpOBeHb CMepTHOCTH H 3aTpaTbi Ha oaHoro nauHeHTa a Ka3axcTaHe 124Fpa4HK 41: YpoBeHb HeH3jieMeHHSI H 3aTpaTbl Ha OQHoro nauHeHTa B Kca3aXcTaHe 125

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1

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,ReirCTBH.I>».

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oueHKOii Bo3,aeHCTBHsl Him 3oeKTHBHOCTH. B 3TOM KOHTeKCTe aaHHOe HCCiIeaOBaHHe

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oi0eHHBalOTCS BO BCeM OTqeTe InOCpeACTBOM CpaBHeHHM aaHHbIX, KOTOPEIC 6binH o6HapyxeHbl B

Ka3axcTaHe, C ApyrHMH CTpaHaMH H, qTO ewe 6onee Ba)KHO, CpaBHHBaS pa3HbIe o6JiaCTH B

Ka3axcTaHe. HaKOHeu, B aOKyMeHTe npeaCTaBBjeHbl peKOMeH,aaUHH, KOTOpbIe MOryT nOMOqb

TIOBbICHTb 344eKTHBHOCTb npOrpaMM.

2

Ty6epKyJle3 B Ka3aXCTaHe3nuaeMHojlorHs T1

B aaHHOM pa3gene coaep)KHTCq WHpOKHHi 0630p 3nHaeMHonorH4eCKoA cHTyauHm no TB B

Ka3axcTaHe, Ha OCHOBaHH1 14CCcneaOBaHHA BceMi4pHoro 6aHKa no TB B LIeHTpanibHoi A3Min. BOTqeTe o6 3TOM HcciieaOBaH14H BOnPOCbl YHKU4HOHHPOBaHH nporpamm no TB H 0630ppeajH43a4H JaOTC ipeRCTaBBneHbI 6o0iee noapo6Ho.

B Ka3axCTaHe Ha6njloaaeTC3I ORHH 13 caMbIX BbICOKHX YPOBHeHi 3a6oJleBaeMoCTH Ty6epKyne3oMcpe,am CTpaH leHTpajibHor4 A3HHi. rlpHMepHo nOJIOBHHbl (51%) 6o3¶bHblx Ty6epKyJIe3oM - 3TOJHO,H B Bo3pacTe OT 15,ao 35 .ieT. CoOTHomueHHe flHlj My)KCKoro H4 )KeHCKoro rionia COCTaBTh1eT1,3. BoJIbWHHCTBo 6onbHblx TB - CoUHmaJbHO 14 3KOHOMHMLeCKH o6e3,aoneHHble fllo,14, BOCHOBHOM H3 cenJbCKHX TeppHTOpHHi. HaH6o.ree noRBep)KeHHor4 3TOMY 3a6oJIeBaHHIo ABniAeTCsKbl3bu¶op,aruHcKaA o6nacTb, pacriojioKeHHas Ha 6epery ApaRbcKoro MOps, rae 3TOT noKa3aTenbCOCTaBJAeT 291 cnyqaia Ha 100 TbIC. qejiOBeK. CaMblHi HH3KHH YPOBeHb - B ropoge AJIMaTbl, 69cnyqaeB Ha 100 TbIC. qejioBeK. B nepHoa c 1990 no 2001 r. KOJHieCTBO BbIlBJIeHHbix ciy4CaeBTB; H yPOBeHb CMepTHOCTH yBeJiHMq14JIHCb B 2,4 pa3a. OJAHaKO nocne ycnerIiHoro BHe,apeHHqcTpaTer4H )JOTC B pecny6iHKaHCKOM MaclHTa6e B 1998 rogy, npo4eHT ycneWIHoro il3jIe'eHHsBbIPOC ,o 83% B 1999 H 2000 roaax, a CMepTHOCTb OT TB K 2001 rojgy CHH43HJIaCb go 36%.

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L eHTpOM nO KOHTpORIO H npOPHnaKTHKe 3a6oneBaHHri AreHTCTBa MewKRyHapOaHOro pa3BH14THCoe,RHHeHHb1X WIITaTOB (IOCAI4,) 6bIJo nORCqH4TaHO, 4TO peaRH3aLIHS cTpaTeFHH ,ZOTC BKa3aXcTaHe nO3BOJIHjia cnacTH npm6JIH3HTeflbHO 13 TbIC. )KH3HeA 3a nepHoA c 1998 rio 2001FO,R. O,aHaKO pe3yJlbTaTbi C TO4KH 3peHHS H3jie4eHHSl 14 BbISBj1eHHSI HOBbiX 6onbHbIxHeOtIHHaKOBbl B pa3HbIX o6nacTAx. KaK OKa3ajiocb, pe3yJlbTaTbl He Bceraa COOTHOCSTCS CH3paCxoOgOBaHHbIMH pecypcaMH, a 3aBMCIT cKopee OT KaqeCTBa ynpaBneHHS H peaH3aU4HHriporpaMM. YqHTbIBaA nO4TH 1 00%-HblHi OXBaT nporpaMMoii aOTC, TeppHTOP14ajibHbiepaU34l4M yKa3blBalOT Ha OaHH H3 OCHOBHbIX BOnpOCOB gaHHOrO Hcc4Ce4oBaHl4A: riotiemyHeKOTOpbie nporpaMMbi no TB pa6oTaboT xopomo, a ,pyrHe nOKa3blBalOT MeHee KaqeCTBeHHblepe3yiTbTaTbI, H KaKHe MepoTHiHATHS H HHBeCTH14HH CO CTOpOHbl TIpaBHTeCJbCTBa MOrYTHaHjiy'IlHM o6pa3OM YCTpaHHTb 3T14 HeaOCTaTKH B KaE'eCTBe peaJ]H3aLHH?

BBIS6BjieHHe 3a6ojieBaHUH

flocnie o6peTeHHs He3aBHC14MOCTH B 1991 roay, KOJTHheCTBO BbISBjieHHbIX cJy'aeB TByBenJiqHnIOCb 6onee, qeM B4Boe, C 65 B 1991 roay ao 165 cjiyqaeB Ha 100 TbiC. qenjOBeK B 2002ro,qy. B 2000, 2001 H 2002 rogax B Ka3aXCTaHe 6blJIO BblIBJieHO 22 629, 23 090 H 24 483 HOBbIXcnyiqas 3a6ojieBaHHs CoOTBeTCTBeHHO. YpoBeHb BbIABJIACMOCTH B 2003 rogy yBefHi1qH4fCA 1o23943 HJIII Ha 2,2%. B 2002 rOgy B Ka3axcTaHe 6blno 3aperHCTpH4pOBaHo 61 606 6OnbHblX CaKTHBHOH 4 OpMOH TB. HO KJIaccHqeCKOMY oripegeJ1eHHIO, KOTOpoe nPHHSTO B cTpaHax BCC,aKTHBHaSi c~opMa TS BKjiiOqaeT 60JIbHblX, KOTOpbie 6blJIH nponemeHbl ,jBa rojga Ha.3a.HeyzIHBHTenbHo, 'TO 3Ta u4wpa nOqTH B 3 pa3a npeBbliuaeT KOJIHqeCTBO BHOBb BbISBflCHHbIX

3

cJIyHaeB. HenpaBHnbHO paccmaTpHBaTb 3TY Ulf1py KaK nOKa3aTe:b 3a6oneBaeMOcT4 TB, KaK 3TO

HHorga aeJIaeTcs, nOCKOJIbKy nO COBpeMeHHOMY OnpeaeJieHHIO naUIHeHTbI, KOTOpbIC rppowjiH

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BeposATHee Bcero, OTpa)KaeT, XOTA 6bl 'acTIl'Ho, POCT BbIlBneHNsI 3a6oneBaHHi u yny'4umeHHe

OTHeTHOCTU. B 2003 roqy BnepBbie KoJIH4eCTBo 3apeFHCTP14POBaHHbIX cJIy'aeB CH143I4JIOCb, 4TO

MOXKeT CJIYKIHTb nOKa3aTeJIeM TOFO, WITO Ka3axcTaH cTa6IJIH3HpOBan CBOKO

3qH1qeMmoJIorHLieCKYIO cHTyauH0o.

Ta6anHIa 1: HoKa3aTeJiH no TI; no o6aTacTsM, 2002 r.hlBb JBleHHe Ha +/- OT cpezHero CMepTHOCTb +/- OT cpeRHerO

100 TblC. no pecny6anice Ha 100 TblC. no pecny6rncKe

PeCny6fJHKa Ka3aXCTaH 165 0% 24 0%

AKMOnHHcKaA o6iacTb 302 79% 28 14%

AKTio6IiHcKaa o6nacTb 372 120% 33 38%

AjiMaThHCKaA o6naCTh 123 -27% 11 -53%

ATblpayCKasl o6naCTE 241 43% 32 30%

BocToqtno-Ka3axcTaHcKaH 150 -11% 28 14%

)KaM6bIncKa3 o6nacTb 151 -11% 22 -10%

3anaaHo-Ka3aXcTaHcKasi 222 31% 22 -7%

KaparaHnUHHcKaA o6nacTb 173 2% 30 22%

KOCTaHarlCKam O6jIaCTb 291 72% 26 7%

KbI3bIJIOp,aHHCKas o6nTacTb 180 7% 29 19%

MaHrHcTaycKaa o6naCTb 234 38% 44 81%

HaBJIOiapCKaA o6naCTb 196 16% 39 60%

CeBepo-Ka3aXcTaHcKaA 142 -16% 31 28%

O)IKHo-Ka3axcTaHcKaa 119 -30% 15 -38%

r. AjiMaTEI 69 -59% 14 -41%

r. ACTaHa 161 -5% 29 20%

I4CTO4HHK: MHHHCTepCTBO 3JapaBooxpaHeHHa Pecny6iniuK Ka3axCTaH 2002.

rpa(lHK 1. BbISrBJieHHe H CMepTHOCTb, 1990-2003 r.

18 40 5

16 4o 0

14 3_ 5

12 3o 0

10 20 5

8 20 0

6 10 54 10 0

2 -500- 0

199 199 199 199 199 199 199 199 199 199 200 200 200 2000 1 2 3 4 5 6 7 8 9 0 1 2 3

-a-s Notification -.- mortality

I4CT0'iHHK: MHHnICTePCTBO 3,apaBooxpaH1eHwq, 2002 r.

4

CMepTHOCTb

nocne BBeaeHHA cTpaTerHH ,ZOTC CMepTHOCTb CHII3iiJ1aCb. YpoBeHb CMepTHOCTH4 B Ka3axCTaHec 1990 no 1998 roq yBenHqHncsi 6onee qeM B TPH pa3a, u 6bin OaHI4M H3 caMbIX BbICOKHX BEBpa3mACKOM perHoHe: 38 c.IyqaeB Ha 100 TbIC. qeJ1OBeK B 1998 roay. B 1999 roay, BrepBbIenocne 1990 rojga, YPOBeHb CMepTHOCTHi CTaJI CHI4KaTbCA c 38 cJ1yMaeB B 1998 ro.ry Zo 31 cnyqaMHa 1 00 TbIC. qejiOBeK B 1999 roQgy, cpaBHI4TeflbHoe CHH)KeHHme COCTaBHJo 20%. YpoBeHbcMepTHOCTH B 2000 roAZy COCTaBHfl 26 cnyqaeB Ha 1 00 TbIC. q'enoBeK, qTO nOKa3blBaeT CHH)KeHHHeHa 13% Me)Kjy 1999 H 2000 rogaMm. 3a nepHoa c 1998 no 2001 ro,4, YPOBeHb cMepTHOCTHCHM3IJICS Ha 36%. TaKoe CyweCTBeHHOe CHH>KeHHe CMepTHOCTH ABfl51Tc3i riepBbIM Ipi3HaKOMToro, 'ITO nporpamma KOHTpOJ3iH Tb ocymeCTBJsAeTCA ycnewHo.

Ta6aHua 2: KoJIHqeCTBo 3aperHCTppoBaHH]lX cayqaeB TI; H ypOBeCH CMmPTHOCTHHa 100 Tb6C. qejiOBei rpaw9aHCicorO HaceJleHHSI B Ka3aXCTaHe

(6e3 yqeTa 6oJm6Hbix Th; B TIOpbMax)

YPOBeHb /rOA 1990 1995 1996 1997 1998 1999 2000 2001 2002 20033aperHCTpHpOBaHo 65,8 67,1 82,5 91,3 t 118,4 _ 141,0 153,2 155,7 I 165,1 160,4CMePTHOCTb 10,1 26,4 34,6 37,7 38,4 30,7 26,4 24,5 24,2 22,4

IICTOqHHK: MiiHHCTCpCTBO 3qpaBOOXpaHeHHA Pecny6JIHKH Ka3axCTaH, 2004 r. ,aHHbleMHHHCTepCTBa 3apaBOOXpaHeHHq OCHOBaHbl Ha TB 33MMb.

Pe3yJUbTaT ie'eHmi

Hocne peanJH3auHH CTpaTerHH JZOTC (c 1998 roaa) ycnelrHOCTb Jiet4eHHA ro aaHHbIM M3yBeniHmHJIaCb ao 82% B 2002 roay. YpoBeHb CMepTeH COCTaBHJ1 5%, a npoueHT HeH3jieqeHHbIXCOCTaBH1I 10 - 12%.

KorUa jaHHbie, npeaOCTaBjieHHbie M3, 6bEmjH HepeCCHTaHbl no MeTOgaM B03, ypOBeHbyCHelHOCTH H3JieqeHHS COCTaBHJ] HnHMepHo 78%.

Ta6riHna 3: Pe3yJlbTaT JietieHHSI HeKOTOpbIX Tl; [IOJIOICHTeJIbHbIX cjiyqaeB npH flOMOUln,AOTC, Ka3axcTaH, 2000- 2002 (%)

" ' - 'loR1oj1orHm B03.VOn HpojieeHOe io 3aBepmeHo CmePH. H!eMJe04 He3aBe . Hepeog OueHKa2000 75,6 3,0 4,7 10,1 3,3 3,3 87812001 76,2 1,7 4,7 11,6 3,7 2,2 88942002 76,4 1,3 4,8 11,2 4,2 2,1 9191

HCTOtHHK: MHHHCTepCTBO 3apaBooxpaHeHMA PK, 2004 r.JAaHHbie no 2002 r. olieHHBaniHcb no MeTOgaM B03.

3aKpblTHe IOJIOCTH go cHx nop paccmaTpHBaeTCH MHOfHMH BpaqaMH KaK rlOKa3aTejlbH3jieqeHMA. 3aKpblTme nOJIOCTH aOJD)KHo 6blTb rQOfTBep)MwHO peHTreH-TOMOrpalHCeii. B 70%cnyMaeB neroMHbIx 3a6oneBaHHH perHcTpHpyeTcA 3aKpbITH4e nOJIOCTH, a 6aKTepHonorH4ecKaslKOHBepCHH Ha6JnoaaeTcA B 82%. M3 npeaOCTaBlIAeT )IaHHbie no H3JIeqeHHIO, HO He aaHHbie o3aBepLueHHH neweHHA. OweBHaHO, Bce 6o0nbHble nO OKoHqaHHI .emeHMM HpOXOAST aHaIH3MOKpOTbl. rlpoueHT H3ie14eHHA 6onbHblx c fIOflO)KHTeJIbHbiM aHaniH3OM OCHOBbiBaeTCH HaOTPHULaTejbHoM aHaJUH3e 1o OKOHmaHHH jie'ieHH3H, a ciyQaH CMepTHOCTH He BKJHO'eHbl B 3TOTnOKa3aTeflb (B HeKOTOpbIX yMpexC2leHHAX He BKMnioialOTCA H MPTB), B pe3yRbTaTe YPOBeHb

5

H3neLieHH3I yBeJiH'IHBaeTCA TaKHM 06pa3OM, 'TO OH HeCOnOCTaBHM C apyrHMH CTpaHaMH, no

onpegeneHrno B03. COOTHoIuIeHHA TaKXKe B cyMMe aaloT 100%, 'ITO rOBOPHT 0 TOM, 'TO He

TOnbKo rpynna jaHHbIX OTJIHqaeTCA OT Me)KAyHapO,4HbIX CTaH,qapTOB, HO H aHaJ1H3 rpynnbi

aaHHbIX He COBCeM npaBHJIbHO nOHHMaCTCSI.

MPTB

B COOTBeTCTBHH C rOCyaapCTBeHHOA CTpaTerHeH ABJIC, KOJH'iqeCTBO nepBHqHbIX MPTBCOCTaBJIAeT 9,7%, a npHo6peTeHHas cfopma MPTi COCTaBJISieT 18,3%. rocyxapCTBeHHas

rporpaMMa no Ty6epKyne3y (FrITE) OXBaTbIBaeT MPT naHaHeHTOB c 2000 roaa.

rlpaBHTenbCTBO ocyUeCTBHnO 3aKynKy MezuHKaMeHTOB BTOpOH JIHHHH Jiqs 300 naui4eHTOB. B2001 rouy KOAHmeCTBO naILHeHTOB Ha H3neJieHHH coCTaBIASJo 400 qeJ1OBeK. B 2002 rogy

flpaBHTeJIbCTBo npeAOCTaBHflO MeRHKaMeHTbl BTOPOH JnHHHH aISI JIe'eHHA 1.300 raUlHeHTOB c

MPTB. B 2003 rogy nflaHHpyeTCA paCHIII4Tb iieqeHHe MPTB no BceCH pecny6niKe. Ha

OCHOBaHHH HOBbIX HOpMaTHBHbiX aKTOB ELITE Bce naUHeHTbI, npoXoLSAwHe neqeHHe nOBTOpHO,

,Of0)KHbl npOjiTH BHJaaH3 KYJlbTypbl H ABJIC, a o6nacTHble L1eHTpbl AOJIKHbl npe,ROCTaBHTb

ne'ieHHe Me,AHKaMeHTaMH BTOpOH nlHHHH no Mepe nocTynneHHs4.

TEF/BfIf

TB SBJIneTCAI OCHOBHOH OHnHOpTyHHCTH'eCKOii HH4feKUHeH BW-. PaHHee BbIABJseHHe 60JIbHbIX

TB; B CO4eTaHHH C paHHHM H 3c"eKTHBHbIM fleqeHHeM O3HaqaeT, 'TO npeo6naaaHHe

nepe,aaioMHxcA cniyqaeB TB 6yaeT B KOHuC KOHLIOB CHH)KeHO, H 3TO CTaHeT MeHbulerHnpo6neMori AJIS HOCHTenerl BW-. HO,qO6HbIM o6pa3oM, H3BeCTHO, 9TO MPTBS, 'qHCJIO KOTOpbIX B

Ka3axcTaHe Mo)KeT BO3paCTH, nerqe pacnpocTpaHAIoTcsI B TeX perHoHax, rue 3apeFHCTPHPOBaHa

BbICOKaS 3a6oJIeBaeMocTb BHI4.

HOBbli nHJIOTHbIir npoeKT HanpaBneH Ha peelieHHe npo6rIeMbi TB/B'44 B ropojge AJIMaTbi. 17

nawH4HTOB TB/B W- B HacToqiuee BpeMS rIpOXOSAT JIe'eHHe.

TBi B TIOpbMaX

B HacToAIuee BpeM[ ripHMepHo 79 TbIC. 3aKjitomeHHbIx cogepxKaTCs B Cfle,CTBeHHbIX H3OJISTopax

(CH30), TlOpbMaX H nocenHHHAx. Ka3axCTaH 3aHHMaeT TpeTbe MeCTO no KOJIH'eCTBy

3aKjuomeHHbIX nocne CIHA H POCCHH (590 Ha 100 TbIC. qeYIOBeK). 3a6oneBaeMocTb TBCOCTaBJIAeT 3 500 xieJIOBeK Ha 100 TbiC. weJBeK, H CMepTHOCTb COCTaBJSICT 300 Ha 100 TbIC. M3,MIO H MBA COBMeCTHbIMH YCHJHAMM 4IpOBOaAT giHarHOCTHKy, efeHi4HHe H CaHHTapHO-

3nHJaeMHOjiOrHqeCKlA KOHTpOJb.

Ta6riuna 4: KoJIaqeCTBo 3apeFHcTpHpoBaHHbix cciyqaeB TB; H ypOBeBH cMepTHOCTH

Ha 100 TbIC. qejoiBelc B TiopbMaX B Ka3axcTaHe, 1997-2001 rr.ro,bI 1997 1998 1999 2000 200106wee KOJI-BO 3aperHcTpI4poBaHHbIx cjiy,laeB Th 11 903 12 970 13 697 10 061 8 060KoJHIHeCTBO HOBbIX cjy'aeB (Hen.) 5 555 5 061 5 591 2 3 434 3 038

3a6oneBaeMOCTb /100 TbIC. 'ei. 4 721 4 301 4 752 446 3 845

KoJnqHecTBo cMepTeri (Hen .) 1 302 1 218 345 175 174YpOBeHb CMepTHOCTH /100 TbIC. HeJ. 880 820 300 140 130

MCTO'nHHK: MHHHCTepCTBO 3npaBooXpaHeHHq PK, 2002 r.

6

MHHHCTepCTBO IOCTHLHH paccmaTPHBaeT cyteCTBeHHoe CHmDKeHHe YPOBHA BbI5BJIeHH3I3a6OneBaHHH (Ha 41% B nepHoa c 1999 no 2001 rr.) H YPOBHA CMepTHOCTH (85%) KaKpe3yJ1bTaT npHMeHeHHI ,ZJOTC B HCnpaBHTeCJbHOii CHCTeMe B Ka3aXcTaHe. OHO noamepKHYJIOBa)KHOCTb HeCrpepbIBHbIX nOCTaBOK HpOTHBoTy6epKyfle3HblX npenapaToB HpaBHiTeCbCTBOMKa3axcTaHa.

Hae>KHbIX aaHHbIX no MPTB B TlOpbMaX He CymeCCTByeT, HO 3TO COOTHOwIeHHe, BepOSTHO,6y,eT BbICOKHM. 143BeCTHO, 'ITO B JpyrHx cTpaHax perHoHa 6o0iee 50% 6o0jbHbIx TS BHCripaBHTeCJbHbIX yMPpeCKaeHHAX CTpaaaeT OT COHPOTHBJIAeMOCTH MeaHKaMCHTaM OT TB,3a,qacTyIo MPTB.

,TAaHHblx no pacrpOCTpaHeHHOCTH aBOHHO14 HHCKUHH TB H BUM B TiOpbMaX He cyLueCTByeT.Ho B CHTyauHH, KOrga npH cyeCCTBYIOIeHi HHcMeHI4HHOCTH HaceneHHA KOJIHMeCTBO3aKmoO4eHHblx, crpalatoumHx OT TB;, cocTaBnAeT 10-20%, MO)KHO npeInOJIo)KHTb, 'TOpacnpoctpaHeHHOCT6 TB cpeali KOHTaKTHPYIOIUHX nHL aOJDKHa 6biTb HaMHoIo 6o0nee 50%. Bpe3ynJbTaTe BO3HHKaeT B03MO)KHOCTb, 'TO KaK MHHHMyM 50% B144-HHWHUHpOBaHHblx nmogegTaK)Ie HHlmm himpoBaHbI Tb. flo rpy6oMy noacqery nonyqaeTcsi npHMepHo 400 cnyqaeB BI14I H,cneAoBaTejTbHo, HpHMepHo 200 ciyqaeB T/B IL.

B ItI/CHHla H HlHHH B Ka3aXCTaHe

PacnpocTpaHeHHocTb BUN B Ka3axcTaHe 3HaHHTenibHO BblpOCna 3a nocneaMHe 5 ne'r. YpoBeHbpacnpOCTpaHeHHOCTH BWI/TCHU,iMA B Ka3aXcTaHe Bbiwlle, 4eM B lqeTbipeX COCeHHX cTpaHax,BMeCTe B3A6Tb1X. C Tex nop, KaK 6bEJ BbISBJIeH nepBbli CnyHaH B 1987 ro,y, KOJ]H'eCTBOo0HuHaJbHO 3aperHCTPHPOBaHHEIX cnymaeB BU'I4/CfIJ K aeKa6pIo 2004 roaa BbIpOCJIO AOnopsAuKa 5 TbIC. cj]yMaeB. IOH3iiC C4HTaeT, 4TO peaRbHaa UH4pa COCTaBi5AeT 6 TbIC., a nopacLleTam flpaBHTeJbcTBa ipHMepHo 20 TbIC. 'eJIOBeK 6buo HHPHLUHpoBaHo Ha KOHeu 2001ro,aa. OjHaKO flpaBHTenicTBO OTMeTHnJO B Ho5i6pe 2002 roaa, 'ITO 3a nepiog c SAHBaSA noOKTSl6pb BbIABjieHHe HOBbIX CjiymaeB CHH3HJIOCb Ha 37% no cpaBHeHHIO C TeM ACe nepHoaoM2001 roga, 'ITO npOH3OIflfO no ripH'HHC ycneLJHoi peanJ3auUH rocygapCTBeHHOiH nporpammbi60pb6bl C 3nHgeMHeii BlIl/CnHU.

Ta6&ulHa 5: BW/CIHI B Ka3aXCTaHe

BH14/CHHAI 1990 r. 1995 r. 2000 r. 2001 r.- 3 6 15

KoJI-Bo cjiy'aeB CllHI, - 2 8 20C.jyqaH BHl- 4 5 347 1175Cnyqam BH cpeRaH nHH - 3 302 1 050CjnysaHa CHNEHJ]IiCa 242 20 235 23 996 20 577HapKoMaHbi 10 300 10 900 37 812 42 680(3aperFcTpHpoBaHo)HUH 3 000 4 583 26 087 31 390HapKoManbi (pacveT) - - 183 125 180 410HUH (pacseT) - - 130 800 128 900PKC (pacseT) - - - 13 000KoJI-Bo fHlICTOBa oBepHs - - 30 78

CoJI-Bo nporpaMM CHHIIeHHsi - - 3 3BpeJIHOro B03,aeiiCTBHHKoJI-Bo uporpaMM PKC/MCM - - - 2"eHTp6lCHllj 19 19 21 21HepcoHaJI ueHTPOB CnIHH 213 407 458 485HCTO'HHK: Pecny6nHKaHcKHri UeHTp no npo4uHjiaKTRKe H 60pb6e co CHHaOM, 2002 r.

7

KaK H B 6onbHHHcTBe CTpaH l"eHTpanbHoH A3HH, B 'HCflO HaH6oJIee Yq3BHMb!X rpynn BXOSIT

noTpe6HTenH HHbeKLUHOHHbIX HapKOTHKOB, pa6oTHHKH KOMMep4eCKoro ceKca, 3aKJIIO4eHHbie H

Mo00o,ae)Kb B ueloM. rHpHMepHo 80% Mo0joae)KH cCCOTaBJSIIOT jiniLia B B03paCTe OT 15 go 29 neT,

80% COCTaBJIAIOT jimUa MY)KCKOrO nona, XOTS paCTeT 3a6oJIeBaeMOCTb cpe,lH )KeHWHH. Hoo0HUi4uJabHbIM aaHHbiM 86% cnyHaeB BHH-HH¢eKU14H npOHCXOaHT no ripHilHHe noTpe6neHHq

HHbeKUHOHHbIX HapKoTHKoB, a riepe,aaqa nOJIOBbIM rIyTem COCTaBJIAeT 9% cnygaeB. Y 153

4eIOBeK B HacTosnuee BpeMS o6HapyxceH CHn",4, H 123 qenoBeKa y)Ke yMepiTH (no pac'IeTam

IOH314JlC OT CHI4Lia yMepJIH ywe 300 qenoBeK); y 89 B141N-HH¢HUHpOBaHHbix )eHLUHH

pO,aHJncs 91 pe6eHOK, npHmleM y 7 H3 HHX o6Hapy)KeH B144. XOTSI cniyHaH BH'-I o6HapyKeHbl BO

Bcex o6nacTAlx, gBe oCHoBHbie o6JiaCTH, rge 3TOT nOKa3aTejib caMblA BbICOKHH, - 3TO

KaparaH,aHHCKai H l aBJIoapcKa5I o6iacTH, Ha KOTOpbIe IpHX0,4HTC5I npHMepHO 50% Bcex

cniymaeB.

Ha KOHeu 2001 roga KORHteCTBO noTpe6HTeneg HHbeKUHOHHbIX HapKOTHKOB, BbIABJieHHbIX

HapKoaHCnaHcepaMH, COCTaBJIAljo 6onee 45 TbIC. OAHaKo 6blcTpaA oLueHKa, BbInOJIHeHHaS OOH

B 1998-2000 ro,gax, rIOKa3aJia, 'iTO KOJIHqeCTBO 11M4H MO)KeT nPeBblulaTb 250 TbIC. leJIOBeK. HooPHUHaAbHbIM pac-4eTaM 3% HaceneHHA Ka3axcTaHa ynoTpe6JIAeT HapKOTHKH B BHqe

HH¶beKIJHR1 a 3TO 03HaHaeT, -TO 'iHcJIo rl1H cocTasBJ1eT npHMepHO 450 TbiC. 'ejioBeK.

EOjibWJHHCTBO HapKoMaHOB COCTaBJISIOT Monogbie JlI0aH B BO3paCTe 20 - 25 nIeT H 85% H3 HHX -

jiHLma MY)KCKOFO riojia. Hlo OiAeHOHblIM qaHHbIM OT 20 TbIC. go 50 TbIC. )KeHMHH npeaOCTaBIASIOT

HHTHM-ycnyrH 3a eHbrH H lpHMepHO 30% ynoTpe6JIAlOT HapKOTHKH, KOTOpbIe OHH riojiy'alOT

B3aMeH Ha CeKC. TaKHe onacHbie npaKTHKH, KaK HcnOJIb3OBaHHme OQHHX H TeX xKe wIUpHLIeB aJIA

HHbeKUIIH, B TOM mcHCie HHbeKLlHH «4no Kpyry>», Korga OjHHM wIInpHLIeM HOIb3yeTCA KOMnaHHS

H3 HeCKOJRbKHX me-JOBeK (3TO npaKTHKyCTC3I KaK MHHHMyM 60% HIH), H HcflOJIb3OBaHHe

menoBeHeCKoH KPOBH WISA npHFOTOBneHHS HaPKOTHKOB CTaBHT HIH B 'HCnO rpynn oco6oro

pHCKa.

Ka3aXCTaH pacnonio)KeH B ieLHTpe HHTeHCHBHbIX MaplupyTOB Tpa¢(HKa HapKOTI4KOB, H 'IHCJO

HaPKOMaHOB npoaoiixKaeT paCTH H3 roaa B ro,. Bo3pacT HapKOMaHOB cTaHOBHTCsl Bce HH)Ke, B

TpaclHKe H noTpe6JIeHHH HapKOTHKOB Bce HaiUe aKTHBHO y4aCTBYIOT )KeHLUHHbi H JReTH.

OCHOBHbIM HapKOTHKOM, nIOTpe6IsieMbIM HHH, BJISAeTCAi repoHH. CHrHanbHbie gaHHbie

HcCJe OBaHHH nOKa3blBalOT CJIa6bie 3HaHHA cpejR HI'H o cnoco6ax npeROTBpameHIAs B44IPH BHYTPHBeHHOM BBeaeHHH HaPKOTHKOB. Boniee TOrO, 60JobnmHHCTBO HI'IH HpHHaaJeIKHT K

caMbIM 6eaHbIM CJIOAM HaceJ]eHHSA, 'TO orpaHHxlHBaeT aSI HHX aOCTyn KO MHOriHM ycJIyraM, B

TOM 'Hcjie K HH4¢OpMauiH H MeLIH11HHCKHM ycJIyraM.

Ta6JIuua 6: BHI'/CIIHj B TlOpiMaX

1990 1995 2000 2001

3aKlnoqeaNble 64 490 65 359 58 424 67 937

BHIM-HH4rNUHpOBaHHbie 0 0 218 446

PacnpOCTpaaHeHHOCTb BHII 0 0 171,6 340,4JIIOAH, HOCTyYHHBMHe B TIOpbMblM 51 018 51 613 54 211 56 785JIIOAN, OCBO60oUHBUHecSl H3 TiOpem 23 895 19 354 33 222 24 544HCnpaBNTe.JHbie yipewReHH5 54 60 74 75TiopbMbm C ytpeCeMHH9MH CIHJ, 4TiopiMhI Co CTaiHOHapaMH I

H4CTOWHHK: MUHHCTePCTBO IOCTT4UHH PK, 2002 r.

8

PacnpOCTpaHeHHOCTb B1-4/CH1g ycyry6nseTcS njoxHHM JieqeHHeM HHHH. 3a6oneBaeMocTbCi4H4J1HCOM B03pOcna c MeHee 10 cjiy'aeB Ha 100 TbIC. 'eWJOBeK B 1986-93 roaax jo 269 B 1997rogy, 3aTeM nOCTeneHHO CHH3Hjiacb ao 161,38 B 2000 rogy (IOH3fAC 2002). Ho OTqeTyOHPICEeD (2002) ypOBCHb 3a6ojieBaeMoCTi4 H Hlll (KOJIHqeCTBO BHOBb 3aperHCTPHPOBaHHbIX

cjiy'aeB c mjrnmca H roHopeH Ha 100 TbIC. -eJIOBeK HaceJIeHHAI) B 2000 ro,y COCTaBBlAfl 323,flpHIeM 3TOT npOuCHT 3IBJICTCS CaMbIM BbICOKHM B perHoHe EBponbl H LjeHTpaflbHor4 A3HH(EL,A) H npeaCTaBJIMeT co6o0H yBe.IHqeHHe 6onee 'eM Ha 200% cH4rnHCa C 1990 roga(Carinfonet 2000).

Ho o0Hu4anjbHbiM zaHHbIM 3a 2000 ro0 aHarHo3 CHcHJ]Hc 6bmii nOCTaBj1eH OAHOMy ripoueHTy,aOHOPOB KPOBH, OaHOMy rpOUCHTy 6epeMeHHbIX )KeHIHH4H H4 BYM npOLeHTaM CTauHOHaPHb1X6ojibHbIx; B 2001 roay y 5% 3aKJHiOqeHHbIX B MCCTaX BpeMeHHoro coaep)KaHHA 5 6blm o6HapyAKeHCH4jmHC. gaHHble aHCriaHCepOB I14JHH nOKa3blBaIOT, qTO y 75% PKC 6bU1o o6HapyKCeHo KaKMHHHMyM O,aHO 3a6oJIeBaHIe, nepe,aaaemoe HOJIOBbIM nyTeM. B 1999 rogy 6onee 19 TbIC.rianHCHTOB C HaIaJIbHbIMH CTagHHMH cwHJHHca 6bijio noMel{eHO B CTaLxHOHapbI, npe6blBaHHeKOTOPbIX COCTaBHJnO 400 TbIC. KOiiKO-,aHeri, B pe3yJIbTaTe qero MHJ1JHOHbl non. 6EJuri nOTpaleHbiHe3doeKTHBHO. OaHaKO npOLIeHT JnojefCi, o6paTHBLU4xcA B MCeHU4HHCKHe yqpeCKeHHB B CB,3HC rIO903peHHeM Ha CH4HJIHC, COCTaBHJIO MeHee 30%, IHOCKOJIbKy 60J]bUIHHCTBO niKoeai MOrYTnOJ1y4HTb aHOHHMHoe H yAOBJIeTBOpHTeJ]bHoe JieMeHHe 6e3 roCoHTaJIH3aUHH, XOTS H rio oHeHb60JIbUlOii LeHe.

B Ka3axcTaHe pa6oTaeT 21 UeHTP C FI4H BO Bcex o6naCTXX H KPYHHbIX ropoziax (6e3CTaLWOHapOB). UeHTpaMH CfU4U opraHH3OBaHO 4yHKUHOHHpOBaHHe 87 HyHKTOB aoBepHs,KOTOpbie npeAocTaBJIqIOT HaH6oJIee yq3BHMbIM rpynnam WfllpHUbl, npe3epBaTHBbl, 6pOIIlOpbl, aTaKcKe nOMOIb aO H nocne aHanH3oB. B nYHKTax aOBepHS1 Ro6poBonbHo pa6oTaIOT 6blBInHeHapKOMaHbl C LUeJblO rpeqoCTaBneHH31 JIy'wero o6pa3oBaHHA H1- HHclopMauHH. Pa6oTa 3THXcny>K6 B pa3Hb1X o6naCTAX HeOaHHaKOBa. HanlpHMep, nlpO¢eCCHOHaJlbl B o6.iaCTT3gpaBooxpaHeHHA C'qHTalOT, '-TO IIyHKT 4OBepHS B raBnoaape pa6oTaeT xopouio, a B AJMaTbl -He OqeHb 3t4CKTHBHO. OCHOBHOHl npo6neMo ABJSACTCS OTCYTCTBHC aOBepHSi Co CTOpOHbl FlIHH )apyFHX HaH6oJIee Y33BHMbiX rpynn HaceneHHA. Korga 3TH cnyAK6bI TOflbKO HaH-aniH(PyHKUHoHHpoBaTb, pa6OTaTb 6bulo oqeHb TpyaHo. Raxce ceMMac MHorHe JuO,gH go CHX nopnpAiyIcsY, a He o6paiualoTCsl B LIeHTpbl CfIH4, HjiH HHlO 3a nOMOWbHO. L|eHTpb1 Cfll4gcoo6uAaloT B npecce, -ITO IllNpHUbl MO)KHO o6MeHATb aHOHHMHO, HO HUH He BCpST 3TOHHH¢OpMauHH.

HIyHKTbl aOBepAHS o6blrHO pa6oTafoT npH aM6ynaTopHAx, HO ueHTpbl CnIUg niIaHHPYtOTHCrnORb3OBaTb H apyrHe noMemeHHA, TaKHe KaK anTeKH, xITO6bl HamaTb B HHX ripOrpaMMbio6MeHa HcHonib3OBaHHbIX HFJr. Boniee TOrO, Heo6xoHHMO lIpOBeCTH OueHKY H pacwHpHTb ceTbIYHKTOB gOBepHsl. Pecriy6nHKaHCKHHr LieHTP no IpO4HJIaKTHKe H 6opb6e Co CHUJ, flHlflbHe,aaBHO Han1aTHJI KOHTaKTbi C aepMaTOBeHepojiorHtIeCKHMH ,gHciaHCepaMH, a FOPH3OHTaJIbHaSHHTerpauH5I OCTaeTCS OrpaHHqeHHOHi. CeTb HapKOJ]OrH4eCKHX AHHCraHCepOB HpOBOAHT JInieHHeH pea6HnHTaiAHio HapKOMaHOB. rlpeanoJIaraeTcq, qTO ueHTpbl penpOAyKTHBHoro 3,aOPOBbA HceMeHiHbIe BpalH TaK>oe 6y4yT HrpaTb onpelenieHHyIo pO.Jb B lpO(¢HJiaKTI4Ke BMI4/CHU)l. CeTbHapKOYOrH4eCKHX flHcnaHcCpOB 3aHHMaeTCSi eMeHHeM H pea6HJIHTauHeg HapKOMaHOB.

CeTb aepMaTOBeHepoYiorHeCKHX aHcnaHcepOB npOBOAHT oueHKY H nemeHHe 1UnII, HO 3THuICHTpbl He HaueCfeHbI Ha BbICOKO yA3BHMbie H yS3BHMb1e rpyrinbl HacenieHHs 1 HeKOOP,jHHHPYIOT CBOIO geATeCJbHOCTb C ueHTpaMH CFIJU H apyrHMH opraHH3aU HSMH,pa6oTaltoUHMH Hag npOHJHnaKTHKOA B1U4/CFJU.l Ho Me)KflyHapORHbIM MeTOllaM paHHeronieqeHHA cH4HJIca, raiUHeHTaM HYIHa JIHUIb ORHa HHbeKUHS 6eH3HJineHHLIHJIJIHHa G, KOTOpblHi

9

MO)KeT fOCTaBHTb rno6as aM6yjiaTOpHaA ciyxK6a. B CBR1314 C HenpaBHJIbHb1MH MeTOjaMm

KnHHI4eCKOH nOMOLH, ripeROCTaBJIseMoi epmaTOBeHePOor4eCKHMH ,aCnaHcepaMm,

noceHuaeMOCTb HX OtleHb H143Ka.

10

2. MeToraoJIorFH5

HHCTPyMeHTbl

Fpynna Hccne oBaTenei HCfOIb3OBana HeCKORbKO KOm4MeCTBeHHbIX H KaqeCTBeHHbIXHHCTpyMeHTOB, KOTOpbIe MO)KHO 6blno aCHfOflb3OBaTb aJ]s c6opa HaH6oJIee Ba)KHbIX 4aHHbIX ocHTyauLHH C npegOCTaBjeHHeM ycnyr no 6opb6e c BI4H/CrIIH4 H Tb B Ka3axcTaHe. CiogaBXOAHT aHaJIH3 Mep, cPHHaHCHpyeMbIX KaK pecny6JIHKaHCKHM, TaK 1H MeCTHblMH 6tojaweTaMm.06mas cxema npeacTaBneHa Ha rpa4HKe BHH3y.

FpajnHc 2: Pa3pa6oTKca HccjieaOBaHuHs no T1;

rlepB3qHbxe aaHHbieMUH3,apaBa/Mm1IocTa/ [teJ1eBbie rpyrnml:npoqHX rio pecypcaM, KaqecTBemHnie aaHHble

nporje,ypaM, pe3ynJbTaTaMH B03AeHcTBiuo

MellBLH

OueHKa MeHU4HHCKHX AHaTH3 ;IOKyMeHTaUHHyqpex)KeHHl

KaqecTBeHHbie MeTOUbl BKHOqxajIH O6cyx(aeHHq C LjejeBb1MH rpynnamH (OIF), B alHcneKOTOpblX 6buia neqe6HbIe yxipe)KaeHHq H H-MO, a TaiKoe rny6HHHble HHTepBblo (rI-I), KOTOpblCHPOBO;IHJIHCb C OTaejTbHbIMH J1IOAbMH, )KHBYMHMH c BW-I/CHHJ; a 6oJIbHbiMH Tb), a TaKwoe c3KCnepTaMH H pa6OTHHKaMH B pa3JIHqHbIX y-pe)KReHHqx. Onpocbi OCHOBHbIX HH4opMaTOpOBnOMOrJH KOHCYJIbTaHTaM pa3pa6oTaTm HHCTPYKUHH H onpeaenimHTb HaH6oJiee Ba)KHble rpynnbl Hyxpe)KZIeHHM, Ha KOTOpbIe aOJnDKHbi 6blTb HanpaBBJeHbl HCCneaOBaHHA. AHanH3 pa3JIHqHbIXHCCRe,aOBaTeRbCKHX AoKyMeHToB, OHHCblBaIoLuHx CTeneHb npo6nieMbi Bff4/CflHJ4 H Tb) BcrpaHe, BHec CyWeCTBeHHbl BKniaa B ripouecc pa3pa6oTKH HHCTPYKUiHH no npOBeaeHHIoo6cyxcgeHHA B ueneBbIx rpynnax H HHTepBbIO. KoiTH'ieCTBeHHbie HHCTpyMeHTbI 6bt¶H3ageHCTBOBaHbl JIAS TOFO, qTO6bl jiy-Uwe IOHSTb npouecc iemeHHAs H noBeaefiHfe HaceiieHHA BOTHOIIIeHHH o6paiUeHaH K Bpwam. 3To TaKoKe noMorno onpeaeRHTb CH.bHbIe H cna6bleCTOPOHbl B npeJOCTaBjieHHH yxoaa JlIOaAM, )KHBymiHM C B14/CHH"g, H gamo B03MO)KHOCTb3arJSHYTb BrJy6b COuHaBjbHbIX H IIHqHOCTHbIX q aKTOpOB, KOTOpbIe OKa3blBaioT BjiHqHHe HaHCOJILb3OBaHHe MeAHUHHCKHX ycjiyr nauiHeHTaMH.

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17

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18

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19

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20

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21

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cpeAHHM ,aOXO,ROM, 3a6o.reBaeMOcTb B Ka3axcTaHe camas Bb1COKaA (178,1 cnyLaeB Ha 100 TbIC.

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3a6ojieBaeMOCTblo. B TOM )Ke rojgy Cpe,4HHA YPOBeHb H3jieqeHHS COCTaBHJ1 66% no BCeM

H3Jie,'eHHbIM CJIyMa3lM, XOTA Ha KOHTHHeHTaJIbHOM YPOBHe OH cocTaBJIji 59%. CpeqH 25 cTpaH,

paccmaTpHBaemblX B KaqecTBe npHMepa, nO YPOBHIO H3neIeHHSI Ka3axcTaH 3aHHMaeT 1 4-eMeCTO.

22

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26

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AKoMojiHHcKaa 1,07 81% 4% 11% 6% 703AKTno6HHcxasq 0,84 76% 6% 15% 5% 633AjiMaTHHCKaR 0,74 83% 2% 10% 5% 729ATblpaycKa3i 0.68 78% 6% 13% 3% 473BocToMHo-Ka3axcTaHcKaA 0,60 79% 4% 15% 6% 738)KaM6bIncKa, 0,56 75% 7% 14% 5% 5323ana"Hno-Ka3axcTaHCKaA 0,53 84% 5% 9% 5% 429KaparaH,9MHcKaA 0.79 79% 5% 13% 7% 824Kbl3bnopwZHcxKaR 0,55 81% 4% 13% 5% 595KocTaHaBcxaA 1,26 88% 2% 8% 4% 862MaHrHcTaycKaa 0,48 73% 8% 16% 4% 262raBnnoaapcKa 0,55 81% 7% 10% 3% 503CeBepo-Ka3axcTaHCKaA 1,44 82% 2% 10% 6% 5411OXtHo-Ka3axcTaHcKaA 0,51 90% 3% 6% 2% 720r. AiMaTmI 0,91 91% 0% 5% 2% 341r. ACTaHa 0.50 87% 3% 9% 7% 193Pecny6a.Iuca Ka3aXCTaH 0,70 82% 4% 11% 5% 9078HICTOqHHK: MHHHCTePCTBO 3,apaBooxpaHeHH5l PK, 2003 r.

B OKOHMaTenIbHOM aHaJ]13e pe3yJ1bTaTOB Iie'eHHA cpaBHHBaeTC1 npoueHT H3JIe'eHHs CKOJIHxiCCTBOM cnyqaeB pelUMAHBOB. B Ta6IHIe noKa3aHo, HTO B TeX o6JiacT3Ix, B KOTOPbIX OqeHbHH3KHI npoUeHT H3JIe'-eHHA, TaKX(e OqeHb BbICOKO KOJIHqeCTBO peUHAHBoB, ITO FOBOPHT 11H6o oHe3ffeKTHBHOCTH nporpaMMbI, 5116o o 6o0iee BbICOKOH cTeneHH coripOTHBJIneMOCTHMe,LlHKaMeHTaM. HecMOTPs Ha TO, 'ITO IpHmlHHOHi peUHWHBOB MOryT 6blTb MeTOjbl JleteHHsl AOBBe,IeHHS1 ,OTC, TOT 4IaKT, ITO MHOrHe peUH,AHBbl npOHCXO.nAlT B TeCeHi4e 2 neT, a ,OTC 6bmiaBBe,jeHa B 1999 rOAy, nO3BOJISeT HaM npOBeCTH TaKOe cpaBHeHHe.

27

rpa(PHIC 8: YpOBeHb H3lexieHHaS OT Th no CpaBHeHHIO C HOBblMH CuyMasMmH

H peUHgHBaMH B 2002 r.

100%

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o2% _~ -- _3 -- -

-21°6 -18°., -21 , -20 -22%.

r Ajm Kbn3 IOKO rIaB CKO AflM AKM Koc PK 3KO ATbi AKT r.AcT )KaM Kap BKO MaHF

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MCTO4HHrc: OUCHKH HCc.ueUOBaHHA OCHOBbIBaioTCH Ha qaHHBIX MHHHCTePCTBa 3ZtpaBOOxpaHeHMsi PK, 2003 r.

PecypCbi npOZMpaM1bi 60pb6bl c TE

B gaaHHOM pa3,gene COaep)KHTCs o6 30p o6tuero KOJIHleCTBa nepcoHaJla, KOHKO-MeCT H

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BbIABHTb pa3nIHMH B BbigejCeHHM pecypcoB.

IHepcoHaJi

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BepTHKaJbHOi CTPYKTypbl B paMKaX HauHOHambHoro ueHTpa npo6ileM Ty6epKyjIe3a.

MoHonpo4HnbHble 6onbHHUbl OCTaEOTCA B LieHTpe nporpaMMbl, H BeCb nepcoHaii 3aHHMaeTCA

HcKYIIoIHTeJIbHo iieqeHHeM TBi. KoHTpoJb TB He B nOj]HOH mepe HHTeFPHPOBaH B CHCTeMbi

IHMCr. B cpegHem no Ka3axcTaHy KOJHieCTBO Bpamerl cocTaBJlAeT 22,4 Ha Ka)K,ltYO 1 TblC.

6onbHblx, npH-iCM pacnpegenelHe no o6niacTAM CpaBHHTenJbHO paBHoMepHoe. 3a HcKnioieHHCM

ropo,iga AJiMaTbi (73 Bpana Ha I TbIC. cjiyiaeB) H 3anagHo-Ka3aXcTaHcKori H rlaBnogapcKOii

o6nacTerl (MeHee 13), no o6nacTAnM Ka3axcTaHa HacqHTbIBaeTC5A OT 17 go 23 BpatieH.

PacnpegeneHHe nepcoHaaa MO)KHO npoaHaJIH3HpoBaTb, B3AB KOJIHMeCTBO Bpam-eH H

COOTBeTCTBYIOIUYIO goJno o6uero KOJIH'eCTBa 60JTbHblX/HOBbIX 60oJbHbix TB no KaxKgorl

o6jiacTH:

a. B o6iacTH HMmeCTcS u33AuweK, ecJiH ,AOJIA Bpa4eHi B HeH npeBbeiIaeT CpaBHHTeJTbHbIi

npoueHT cAytaeB TB no CpaBHeHHIO c o6merocygapcTBeHHbIM COCTOIHHCM

3a6oneBaHHA.

b. TaKHM we o6pa3oM, B o6nacTH HMeeTCS1 6epuium, eciiH npOHCXORHT o6paTHoe.

B meTbipex o6nacTqx OTMe4IaeTCS ABHblH H3JHU4eK: IO)KHo-Ka3aXCTaHCKaA, ropo, AJiMaTl,

KaparaH,aHHcKaA H BocTotHo-Ka3axcTaHcKasI o6naCTH. B aeCCATH permoHax Ha6JllogaeTcs

gePHUHT H TOIbKO B JgBYX (B AjiMaTHHCKOrH H Kbl3bIJIOpgHHCKOA o6nacTA1x) OgJHHaKOBoC

COOTHoUICHHe KOJIH'eCTBa 6oJIbHblx H Bpale'H.

28

Ta6aiua 14: PecypcbI: KoJaHqeCTBO Bpaqeh-4Tk3HaTpoB

_________ _________B paulHPerHoH Koji-Bo Koji-Bo Kon-Bo % OT % OT HlOKa3aTejb

BpaqeH cjiy-aeB HOBbIX o6wero o6mero pecypCOB (HacJIy'aeB KoJi-Ba KOn-Ba 1 TbIC.

Bpa'eH 60obHbIX 6oibHbIX)1. AKMOJIHHCKaA 84 4011 1668 6% 7% 20.9

2. AKTIO6HHcKaA 83 4118 1733 6% 7% 20,03. AnMaTHHCKaB 103 4682 1917 8% 8% 23,14. ATbipaycKaa 60 2931 1091 4% 5% 20,55. BKO 127 5623 2205 9% 9% 22,66. >KaM6blnCICaq 72 4149 1479 5% 7% 17,47. 3KO 48 3484 1333 3% 6% 13.88. KaparaHaHHcKaa 151 5453 2903 11% 9% 27,79. Kbi3bl,nopRHHcKaS 90 4043 1760 7% 7% 22,3I0. KocTaHaAcKaq 67 4026 1683 5% 7% 16,6I . MaHrHcTaycKaA 36 2036 798 3% 3% 17,2

12. HaBnJ]oapcKaa 59 4770 1467 4% 8% 12,413. CKO 40 2968 966 3% 4% 16,914. IOKO 168 5732 2505 12% 9% 29,315. r. AnMaTmI 156 2157 790 11% 4% 72,316. r. AcTaHa 31 2023 810 2% 3% 15.3Pecny6jnmca Ka3axcTaH 1379 61606 24478 100% 100% 22,4

11CTOHHK: MHEHHCTePCTBO 3IpBooxpaHeCHHq PK<, 2003 r.

BTOpbIM noKa3aTeneeM no nepcoHaniy AB.hAeTCA KOJH4eCTBO cpezHero MeCaHLHHCKOro riepcoHajiaHa I TbIC. 6onbHblx. 06tee pacnpegeneHHe euie 6onee HepaBHoMepHoe, 'eM pacnpe,aejeHHeBpaweA Ha I TbIC. 60IbHbIX. CaMbie BbICOKHe K03ccHuHeHTbl Ha6nIoaafOTCA B IO)KHO-Ka3axcTaHcKorl H KbI3blIopaHHcKoA o6nacTAx, rge OHH npeBbilIalOT 100 meacecTep Ha I TbIC.6onbHbIx B o6oHX ciy-qaAx. B KocTaHaicKori H MaHrHCTaycKoH 3TOT nOKa3aTeflb HH)Ke 40.

flo cpaBHeHHio Co CpeaHHMH nOKa3aTeniiMH B cTpaHe, B 'eTblpex o6nacTAX Ha6nLoaaeTCAH3THIMUK (IKAHo-Ka3aXcTaHcKaA, KbI3blInopiHHcKaq, KaparaHaHHCKas H CeBepo-Ka3aXcTaHcKax), 11 HCnbITbIBalOT ge4¢HUHT H TOflbKO B OaHOA (BocToMHo-Ka3axcTaHcKoir)OAHHaKOBOe KOJIHMeCTBO 6oibHblx H CeCTep, TOJIbKO B ,IBYX o6nacTAx HMeeTCS H3JHwLeK BpatleHH MegceCTep.

Pa3iH'qHSA B HaniHqHH f npo(eccHOHanOB B o6niacTH 3gpaBoOXpaHeHHs H npeo6AajaaloWHAYPOBeHb 3a6oJIeBaeMOCTH npeqcTaBneH Ha rpa4rnKe 9. KaK BHAHO H3 rpa¢HKa, B Tpex o6nacTAxC CaMOI4 BbICOKOH 3a6oJieBaeMoCTbio, AKTIO6HHCKOH, Kbl3bInopPAHHcKori H AKMOJIHHCKOHi,KOJIHleCTBO nepcoHania HpHMepHO paBHO Cpe,XHHM IOKa3aTeJ1AM nO CTpaHe, HO HaMHOrO HH)KeypoBHs, Tpe6yeMoro anA nOKPbITHS BHOBb 3aperHCTPHPOBaHHbIX cnyqaeB B rog.

Eiue O,4HH cnoco6 oueHKH pacnpeaeJieHHM nepcoHaiia H pe3yJIbTaTOB HX pa6oTbl 3aKmioqaeTCS BoUCHKe 3aBHCHMOCTH Mm)Key KO3q4HulHeHTOM COOTHOlHeHHA me,icecTep H BpaMeii H npOLUeHTOMH3JIeqeHHS. Fpa¢HK 8 HoKa3blBaeT, 4TO MeCIY HHMH HeT 4eTKOH 3aBHCHMoCTH, KOTOpaS 6blrIO,ATBep)K,qana, 4TO BbICOKOC HJIH HH3KOe COOTHOlueHHe MeJqceCTep/Bpa'ler BJIHSCT Ha npOUeHTH3niemeHHA. HanpHMep, B CeBepHOM Ka3aXCTaHe RpH HanmHHH 5 meUcecTep Ha OgHorO BpaIa, aB ATblpaycKori o6nacTH C 3 MegCeCTpaMH, rpOipeHT H3jieHeHHA OQHHaKOBbIir, 75%.

29

Ta6J]Htla 15: CpeZAHHJU MelHt[HHCKHRi nepcoHaa

MejceC p blPerHoi KOJI-BO KOJI-BO KOJI-BO % OT % OT Hoica3aTeJlb

cecTep 60oJbHbIX C HOBbIX o6uero o6wero pecypCOB (Ha

aKTIIBHOE4 cnyHaeB KOJl-Ba KOJI-Ba I TblC.

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5. BKO 395 5623 2205 9% 9% 70,26. )KaM6blICKaA 241 4149 1479 6% 7% 58,1

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Pecuy6alHKa Ka3aXcTaH 4317,5 61606 24478 100% 100% 70,1MiCTot1HHK: MHHHcTepCTBO 3apaBompaHeH PlK, 2003 r.

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30

rpa4PHK 10: COOTHotueHHe Me,aceCTep H 4TH3HaTPOB H npoueHTa H3JIe'ieHIHI

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31

Fpa4OHK 11: KoJIHqeCTBO MCCT Ha I TblC. 60JIlHbix TB;900 K -3 v .

789800 - 1 M-723 720

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F.ACT BKO 3KO AKM CKO ATEi Koc KbI3 Kap AnM AKT HIaB MaH IOKO )KaM r.AjiM

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KpHTH4eCKH Ba)KHYIO pOJ1b B npouecce rocnHTanH3auHH.

32

Fpa()Hic 12: KojiHHeCTBO ICoHiKo-MeCT H YDOBeHb H3JletHeHHS

90.0%

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pOiLteHT H3fieqeHHs.

33

Fpa4uC 13: 3a6ojleBaeMocTb TB H YPOBeHb 6eaJHOCTH

350.0 - - ----- - 35.0

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rOBOPHT o cna6oA 3aBHCHMOCTH Me)x<y pecypcaMH, B BHae KagpOB, H pe3yJIbTaTaMH. KaK

BHMHO, 6o.nbuHHcTBo o6J1acTeiH cocpeAOTOteHO BOKpyr cpeaiero nOKa3aTenJS no cTpaHe B 22

Bpaqa Ha I TbIC. HenOBeK, IqTo rOBOPHT 0 He3HaqlHTeJIbHOM OTJIHqHH, 4a)Ke HeCMOTPA Ha TO, -ITO

B 3a6OjieBaeMOCTH TaKxce OTMCealOTCSA CHJIbHblC pa3JIHqHSI. 3To oTpa)KaeT HCTOpHteCKOe

pacnpe,eneH4e nepcoHaiia, OCHOBaHHoe Ha KOJIH,.eCTBe KOAKO-MeCT, a He Ha KOJIHMeCTBe

HaUHeHTOB.

34

FparHnK 14: 3a6oJIeBaeMOCTb TI; H ICOJHqeCTBO 4)TH3HaTPos

Y 400.0 R2 0.4045C 350.0 -

Q 300.0

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0.0 20.0 40.0 60.0 80.0Bpaqeii Ha I TblC. qejioBeic

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rpa4PHic 15: KOJIHHeCTBO ICOrICO-MeCT aJ1i 60JbHblx TB H YpOBHeM 3a6oJleBaeMOCTH

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35

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5 1.40 - = ~~~~~~~~~~1.40

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36

.qBJlsieTc$ JIH 6ojiee BbICOICHH upOueHT H3JIeqeHHsI pe3yJbTaTOM npHBjieqeeHHs 6(ooeeBb6COICOFO o6beMa pecypcoB?

OueHKa npoueHTa H3ne'eHHI, OCHOBaHHaSI Ha 3aBHCHMOCTH peCYPCOB H pe3yflbTaTOB CHCnOnb3oBaHHeM, BeAeT K HeKOTOPb1M HHTepeCHb1M pa3JIW1H51M nO CpaBHeHH10 C BblBogaMH,c,a2ejaHHbIMH B npegbUgyumX pa3aeniax. HanpHMep, 3aBHCHMOCTb Me)Kay KOJ1HWeCTBOM KOHKO-MeCT Ha I TbIC. 4eCJOBeK H YPOBHeM H3YieqeHH1 HH3KaS 1H OTpHuaTeYIbHaM, HTO OTJ1H,4aeTCA OT

TOrO, HITO Mbl Ha6nmogaiH B cHTyauHm C pacrpOCTpaHeHHOCTbO H 3a6oIeBaeMOCTblo. Ha caMoMgene, Fpa4,HK 15 nOKa3bIBaeT rHnep6oJIHmecKy1O 3aBHCHMOCTb: rpynna o6nacTeO nornyqaeTBbICOKHH ipoiPeHT H3Jie'eHeHSI fpH HH3KOM KOJnHHeCTBe KOAKO-MeCT Ha 1 TbIC. LejoBeK, a BTOpaSrpyrina, KoTopaa aocTHraeT 6onee BbICOKOIO ripoueHTa H3JIeqeHHsl rpH 6onee BbICOKOMCOOTHOIIICHHH KOriKO-MeCT Ha I TbIC. IejiOBeK.

TaKOIi pe3yJIbTaT, XOTR H BHOCHT HeKOTOPY1O nyTaHHUY BHaMaHe, OKa3blBaeTCS coo6pa3HbiM C

4 aKTOpaMH, KOTOpblC Ha6Ji1ogaJnHCb B I7pyrHx macTix ,aaHHOrO HCCJ1eAOBaHHA, H03TBepYIaeTCA pe3ynbTaTaMH o6cy1KaeHHii c LlefleBblMH rpynnamH H OnpOCaMH nauHeHTOB.

OnpezueneHHO cyUeCTByeT rpynna naLHeHTOB, KOTOpa3i Mo)KeT 6biTb aAeKBaTHO nponetleHa BCOOTBeTCTBHH c aOTC B aM6yjiaTOpHOM pe)KHMe, H 3TO 03HaHaeT, MTO HCT Heo6xoIHMOCTI4yBejiqHBaTb KOJIHqeCTBO CTaLI4OHapHbIX MeCT. B TO )Ke BpCMS1 Cy1uCCTByeT H BTOpaA rpynnanaLUHeHTOB, oco6eHHO B cenjbCKO14 MeCTHOCTH, KOTOpaS riPO)KHBaeT B YCJIOBHAX 6oi0ee rny6OKoA6e,AHOCTH H/HJIII HMeeT apyre COuHajibHble npo6neMbl, TaKHe KaK HaPKOMaHHS H aJIKOFOJIH3M,,q1SA KOTOpoHi aM6ynaTOpHas TepanHS1 He nogorlgCT. TaKHe nauIeHHTb1 Hy)KgafoTCA BrOCUHTajiH3aUi4H, H noTpe6yeTCs nOBbliueCHHoe BHHMaHHe K BbIHolnHeHI41O HMH BCCXTpe6OBaHHii c LIeClbIO o6ecneieHHSl co6mnoaeHHs HMH peKKHMa neieHiHsH. TaKOIi BbIBOa, KOTOpblHiMo)KeT npHBeCTH K Heo6xoLWMOCTH BHeCeHH51 H3MeHeHHH4 B npOTOKOJI, 6bEi HO,4TBCpKcAeHiporpaMMaMH B CIIIA (BCTaBKa 1).

C TOHKH 3peHHM 4,HHaHCOBbMX pecypcoB (3apa6OTHaA nriaTa Ha AyWny HacenJeHHM H 3aTpaTbl HaMeZqHKaMeHTbl Ha riaumeHTa) CHTyauHS Cy1eCTBeHHO He OTJIHHaeTCS, XOTS B o6OHX cny4a3ixxapaKTepHCTHKH OTJIHqatOTCA. B OTHOlueHHH 3apa6OTHoA nHJaTbi H npoUeHTa H31nemeHHSaaHHbie nOKa3blBafOT cnierKa OTpHIIaTejTbHyIO 3aBHCHMOCTb MewKay YPOBHeM 3apa60THOi niiaTbIH pe3yJIbTaTaMH. 3TH pe3yJIbTaTbI, KaK HaM KawKeTCs, nOATBep)KafIOT pe3yJIbTaTbl,

npeCTasBjeHHbie B ,pyrHX HeaaBHHX HCCJ1eAOBaHHAX, 0 TOM, HTO pe3yjlbTaTbl KOppCejHpyIOTCSHa HaniHmHe 6ecnJaTHbIx MealHKaMeHTOB ,ais 6oJnbHbix TE. OrpaHHweHHs B paCXoaOBaHHI4Cpe,aCTB Ha RyHy Hacen1eHHS Ha MeAHKaMeHTbl HO)jpblBalOT c44eKTHBHOCTb nporpaMM no Tr.

B o6WHmx tepTax, pe3yJIbTaTbw, rpeCTaBneHHbie B LaaHHOM pa3,aenie, KaK HaM Ka)KeTCS,yKa3blBa}OT Ha HeCKOJIbKO Ba)KHbiX MOMeHTOB, KOTOpbie HOrpblBalOT 34IeKTHBHOCTb

fipOrpaMMbl. 3TH BbIBO,RbI, ipegcTaBneHHbie B JaaHHOM aHaiH3e, TaKAce nO4TBepAKlOTCS,aOnOJHHTeCjbHbiM aHJa1H3OM COCTaBa noKa3aTenierl 3aBHCHMOCTH pecypcoB H pe3yJlbTaTOB,KOTOpbliH npeCcTaBjieH B IpHJIOjKeHHH 4. OcHoBHEie pe3yJEbTaTb16 cJieqyiowHe:

* Bo MHorHx cnytiaAx cyiUeCTByeT nOTpe6HOCTb B nepepacnpeaeieHHe ilepcoHaJa B Teo6JIacTH, B KOTOPbIX YPOBeHb 3a6oJIeBaeMOCTH 6onee BbICOKHH. XoT31 nepeMeueHHenepcoHana 3aTpy,4HeHO, CO BpeMeHeM 3Ty pa3HHL4Y MO)KHO 6yaeT npeoaojieTb qepe3pacnpe,aeneHle 6yaywero HOBoro nepcOHana B Te o6nacTH, KOTOpbhe B HacToAwee BpeMAHeaOyKOMnreKTOBaHbl.

* MHorHe pa3AH1HA B pe3yRbTaTax peanH3aUHH npOrpaMMbl He Ka)KYTCA CBJq3aHHblMH CHaJIHHiHeM MeaHKaMeHTOB, a cKopee C HemaTepHaibHbIMH BOnpOCaMM, TaKHMH KaKKaHeCTBO MeCTHOrO ynpaBJIeHH31. XOTx 6y,aeT Ba)KHO IPOBeCTH IIOnOnIHHTeJ1bHbli alHlaiH3

37

o6nacTePi, ,aOCTHFUllHX 6onee BbICOKHX pe3ynbTaTOB, -ITO6bi nOHSTb, KaK OHH jOCTHra)OT

6onee BbICOKUX pe3yfbTaTOB C MeHbLUJ4M paCXOqLOBaHHeM pecypCOB, pe3YJIbTaTb1 FOBOPSAT

o TOM 4)aKTe. 4TO nOJ1O)KHTeAbHb1X pe3YJIbTaT0B MOACHO ,UO6HTbCsA 6e3 aOnOnHHTenbHbIx

HHBeCTHUHU B HOBbie KOHKO-MeCTa H nepCOHan.

AHanH3 FOBOPHT 0 B3ai4MO3aBHCHMOCT14 Me)Ky paCXOaOBaHHeM Ha 3apa60THyIO nnaTy,paCXw,abl Ha MegHKaMeHTbI Ha O,aHOFO nauiHeHTa H ripOueHT H3JIeLieHHA. bonee BbICOKHUo6'beM pacXO,OB Ha 3apa6OTHyio nnaTy nepcoHana BbiTeCHAeT pacXoAoBaHHe HaMeAHKaMeHTbi H I1O3TOMY orpaHH4HBaeT 3(4eKTHBHOCTb llpOrpaMMbu.

FpatpHIC 17: HlpojieqeHHbie cjiy9aH H ICOJIHxieCTBO iOHCo-MeCT

90% _

85% R = 0.0356

80%- *.

5 75% - * -J

m 70% -4

H *

65%

>. 60%

0.0 0.5 1.0 1.5 2.0 2.5 3.0

KOKICO-MeCT Ha 1 TbIC. qejiOBeC

14

CTOMHUK: OULeHKH HCCJne.OBaHH31 OCHOBbIBalOTCA Ha aaHHbIX MHHHCTCpCTBa 3,apaBOOXpaHeHHJ9 PK, 2003 r.

Fpa4)HK 18: HlpolieHT H3JieqeHHsi H Cpe,gH95l 3apa6OTHasi n.JlaTa Ha lIymy HaCeJ1eHHSl

90%/

S 85%0/ 2 = 0.0277

x 01 80%_

,, a:75% S -*

a) t70% -% 4

65% -

60% - I

- 0.50 1.00 1.50 2.00 2.50

Payroll per capita

I)OH,a 3apa6OTHoH nnaTETI Ha liyLUy HacenICHHS

4CTO4IHHK: OuIeHKH HCCn1e,lOBaHHA1 oCHOBbIBaIOTCq Ha ,aaHHb1X MHHHCTepCTBa

3.fpaBooxpaHeHHsA PK, 2003 r.

38

loaxombi ic CoBepIIueHCTBOBaHHIO C06J101AelHlH Tepan"f fpOTHB TB B Hbio-Hopie H IOrNHOrICaJ1HnopHHH, CILUA

HaUHeHTbi, 6oJIbHble TB, KOTOpbIe He co6JnoIaaoT CTaHaapTHblA KypC TCpanuHu n1poTHB TS, Bce6o0Jbme pHCKYlOT He BhIJ]eqHTbC3, H Mo)KeT CyLueCTBOBaTb onaCHOCTb TOrO, qTO y HHX pa3oBbeTC3IconpoTHBji3jeMoCTb K MeCUHKaMeHTaM. B 1986- 1991 roaax )JenapTaMeHT 3 paBooxpaHeHHS UKOHTpOJIA COCTOAHHA OKpyxKaiolueii Cpeabl 1O)KHoH KajH4iOpHm H eienapTaMeHT 3apaBooxpaHeHH1ropoia HbIo-I4opK BHecCiH H3MeHeHHq B CBOU nporpaMMbi no 6opb6e c TS c uejlio ynlyqleCHHIOco6jnoneHHi. npeimiHCaHHH Bpa'IeH, KOTOpbhe npeAyCMaTpHBalOT HCHOJIh3oBaHHe lporpaMMbi JAOTCH COOTBeTCTBYIOMIHX o6Hi3aTejbCTB Co CTOpOHib pyKOBOaCTBa CTauHOHapOB.

C 1985 roaa 6onbJIlHHCTBo aenapTaMeHTOB 3apaBooxpaHeHHsli CTpaHbIl nOCTOHHHO HCriOYib3yfOT BCBoeH pa6oTe CTHMYJnbl (euy, oaxcKy H KHHrH) H MeTObEI [PHBJTegeHH3 (HanpHMep, 6eCn.naTHbhInpoe31 iao KJIHHHKH), 'ITo6hi rapaHTHpoBaTE co6nioaeHHe npeanHcaHHH BpaqeH ani ne'eHHR TB. C1985 roga B Ib)KHOH KaJmi4OpHHH iipHMeHAeTCSA nporpamma aOTC KaK nepBoo'epewHas 3aLHTa, a3aTeM npHMeHAeTCS roCnHTallH3auHA, xaK Mepa, KOTOpaS ripHMeHAeTCR9 K flauHeHTaM. KOTOpbie HerPpHXO,UAT Ha npHeM Bpa'a B COOTBeTCTBHH c AOTC. MeCTHle pa6oTHKH cCepbl 3apaBooxpaHeHt.yBeIaOMlIAIOT TaKHx 6ojiEHbIx H HH4OpMHpyIOT HX 0 TOM, 'ITO OHH aoJDKHbl npOHTH Jle'eHHe no'aHa6Jio,aeHHeM rOCyZapCTBeHHOri MeCHuHHCKoH ceCTpbI. EcnH OHH lpolOjV)KalOT YKJIOHATbCA OTAe'eHHA, HX HanpaBJIqIOT B 6onbHHLry anJIa JnTenfHoro npe6blBaHHA H yxoaa. CpeawsrsHPO2aOJI>KHTejibHOCTb npe6blBaHHA TaKHx nauHeHTOB B 6onJbHHue CoCTaBJiAeT 68 )Heri.

3a 3TOT nSTHJIeTHHH nCpHOa HCllOlb3oBaHrnl CTHMyJIoB. rioo[PAtPlHIHX Mep H 6o0ee AflHTeCJbHOHrOCnHTaJIH3auHH ajm naiuHeHTOB, He co6juoaioMHX Tpe6oBaHHVi BpaqeeH, yalanOCb yBCe1H'iHTbnpoueHT 3aBepCLeHHOrO Jie4eHHS c 93% go 96% H CHH3HTb KOJ]H'eCTBO BHOBb 3a6ojieBmHxnafHeHTOB C 593 ao 410. 3aTpaTbl CoCTaBHjiH: c 0,95 ao 20 aOJI. Ha Kaw.aoro naiHeHTa Ha CTHMYJ]bl HrloowpeHHM. 653 noxiapa Ha nauHeHTa Ha rlporpaMMy TOTC, 450 IoJi. Ha oTBeTCTBeHHbIxraiOHeHTOB 3a noJIyCTaLHoHapHoe JlneeHHe H 10.700 ,OJI. Ha KawwOFO FOCHHTaniH3HpOBaHHoro60onHoro.

Hoao6&bie pe3yJIbTaTbi 6EmH OCTHrHyTbl H B ropoae HbIO-IopK. 3,aeCb 30% 6ojiHbix TB ABJJHIOTCAHHbeKUHoHHbIMH HapKoMaHaMH H npHMepHo 25% - 6e34OMHbIMH. naaHIeHTaM, KOTOpble He IpOBO;I$TJie'leHHe. npeaRaraeTCA JIeqeHHe Ha aOMy, oaHaKo, HeKOTOpbie narueHTbl, KOTOpbie peryjiapHo Heco6jio,aaloT Tpe6oBaHH31, MOrYT 6blTb HanpasBjeHbl B CTaLIHOHap. 1ITo6bI OUeHHTb 344eKTHBHOCTbJieqeHHA B CTauHoHape , TenapTaMeHT 3apaBooxpaneHHq ropoaa Hbio-HlopK (Ji3HI4) npoBeni oieHKYBcex naUHeHTOB, KoTopbie 6bmnH 3aperHCTpHpoBaHbi c HHBsap 1988 no anpenb 1991 roaa.

Pe3ynbTaTbl nOKa3bIBalOT, qTO riaUHeHTbl, BepORTHee, noniyqaT yCeremHmIH pe3yJTETaT, ecCJHnpO2aoJI)KHTejibHoCTb o6R3aTejbCTBa no yripaBjeHHIO CTaUHOHapaMH COCTaBJlSeT 6o0nee 62 4Heri. HH3J7OynOTpe6neHHe MeaHKaMeHTaMH, HH H3ojiHpOBaHHaa COnPOTHBASeMOCTE MeAHKaMeHTaM nPOTHBTB He CBA3aHEl C BepoqTHOCTbIO yCrCeUHOrO pe3ynbTaTa.

Source: www.cdc.gov/mmwr/preview/mmwrhtml/00019521.htm

39

3IoeKTHBHOCTb peajH3anuH nporpaMMbi no Bffq/CHIIJ H InHU

B Ta6nHuax 16-18 npeA(CTaBBfeHbl aaHHbie no BHH-CIII4AI, i uH FHn B Ka3axcTaHe B 2000-2002rr. KOJIH'eCTBO 60obHbIX H CMepTHOCTb OT C1I14,La H KOJ]HqeCTBO HOCHTeJieH BM'ICymeCTBeHHO B03pOCJIO, oco6eHHo 3a nocneRHHe umeCTb neT. KOjH4qeCTBO 6oJIbHbIx Cr1I4)TJ1

B03pOCJIO B aeCCTb pa3, H o6wee KOJ1iieCTBO yMeplwHX C 1995 no 2001 roa yBei]H'4HJ1OCb B nfTb

pa3, KOJIH'ieCTBO cjiyMaeB CH4HJIHCa BO3POCJIO c 1990 no 2000 roa HO-TH B CTO pa3.

'-hiC.no HoCiTeJieH B1I Bo3pOCJIO C HnSTH ,aO 1 175 cnyqaeB 3a TOT xe riepHoji, 'iTO 03HamaeT,

qTO o6wee KOJIHWeCTBO 6onbHbIlx BO3POCJIO B 235 pa3. PacnpocTpaHeHHocTb BI'IH B 2002 rogy

COCTaBBIJIO 17 cny4aeB Ha 100 TbIC. MejiOBeK. K Had6ojiee y53BHMbIM rpynnam OTHOCSTCA IHH.

K 2001 ro,4y, HaripHMep, 89% 3a6oJIeBJHx npHXORHn4OCb Ha lIIHH, cpegu KOTOpbIX YPOBeHb

pacpocTpaHeHHOCT COCTaBJISji 3,3%. 3aioIMeHMbie, ewne oaHa YA3BHMaA rpynna,

ICnblTblBaIOT cyLueCTBeHHblIi npHpOCT: YPOBeHb BH4-nonoxicTenbHblx aHJaTiH3OB BbIPOC c 218zao 446 cnyiyaeB, a KojH4eCTBO HOCHTeIier BIIT- B03POCJIO c 171 go 340.

rpaj)HK 19: PacnpocTpaHeHHocTb Bff/'IIClHHa B 2002 r.

350 -- 3-23-- 1 60 t.4

___________________ 1.40 _1 27

2C . J 2461 .20 . _

1.00

800150 _ I^.600

c,uj - - 400 407

o~ ~ ~ ~~~. 3o . .zz. -i.z.z-_200

0-1 2-4 5- 15- 25- 35- 45- 55- CTa 0.1 24 5- 15- 25- 35- 45- 55- CTa. . - - .. 4 -1 66 A. - j 1. A. - - J6

Bcero HOBbLx cTjy4aeB BFN Bcero ciyuaeB BHl

12 -- __40 -3

Id 10 10 3530-

25

6 . ~~~~~~~~- ~ ~ ~ -~~~20 161919

210

__ " C5 .oo 0 0

0-1 2-4 5- 15- 25- 35- 4 55- Ca 0-1 2-4 5- 15- 25- 35- 45- 55- CTa65 65

BoerO HOBEIX cjiy'aeB CLH Beero ciiyqaeB CH1

srnsgesnlte cional

HCTOMHHu: UeHTp cnMH, Ka3axcTaH, 2003 r.

40

HecMOTpsI Ha 3TH npo6.neMbl B 1 990-x rogax pecypcbl, BbI,geJmeMbie Ha 60pb6y CpacHpOCTpaHeHHeM H KOHTPOJIb CfIHa, Blf- H i iUiFl, He BceFaa yBenJHqHBalUHCb C TOA WKeCKOpOCTbIO, qTO H 3a6oJIeBaeMoCTb. K 2002 rogy o6tuHA of6eM aCcHrHOBaHHlI, BbAtCJeeHHbWX Ha6Opb6y c BW14/CnIm, cocTaBHJI 2,68 MJIH. goji. CIIUA.

Ta6imua 16. BH'I!CHIM 3a 1990-2001 rr.

1990 1995 2000 2001CMepTHOCTb OT C11l4a - 3 6 15KoJmrIWBnO OTbHm1 C OuM - 2 8 20C.1i iaeC BRII F M 147 13,-BRH4 cpeAH 1111 3 302 1050IOJII.IblX CHI4HJIHCOM 242 20 235 23 996 20 577Hapcomuuon (laperHcIrpmposaao) 10 300 10 900 37 812 42680

HHH 3 Tic. 4583 26087 31390HaPXo°MnIeB (no paceCy ) - - 183 125 180410H11H (no pacveTy) - - 130800 128900PKC (no pacqeTy) - - 13 Twc.Koji-Bo nyHKIroB AoBepHn - - 30 78KOI-no porpIIM CREHH B HOfO - - 3 3BO1metrDuuKOJI-BO npOrpaMM PKCI/MCI - - -UeuTpos CUBA 19 1 9 2 1 21HlepcoHan ueHTpoB Cl lLA 213 407 458 48514CTOmHHK: LleHTp CHrI4,a, Ka3axcTaH, 2003 r.

Ta6JHuLJa 17: BHIICIII,IID B TIopbMax 1990-2001 rr.

1990 1995 2000 20013aKanoqeHHIx 64490 65359 58424 67937BIPJ-m4niumpomaiilie 0 0 218 446P2CIlpOCTpaHeHHOCTb BllI 1i 17I.6 34J.4Abo.a, nocryniaomue a TlophmbI 51 018 51613 54211 56785Ocao6omzeHibie H3 TIOpeM 23 895 19354 33222 24544HcnpaauTenIb me y-paoYeuau 54 60 74 75TIOpMbMI C J1C'ieHHeM CIIIL-ja 4TopmuL co fauzmouapamn IHCTOIHHK: LIeHTP CHHZ", Ka3axcTaH, 2003 r.

Ta6inHua 18: BfI'/CI IA B 2002 r.

rloKa3aTenb 2001 2002Focy,aapcTBeHHbr e accnrHoBaHHn $2.7 MJi.Bpaqn BHUCIWXA 260 292MeacecTepbi BHTVCrII/H 260 257Mea.yqpeAcgeHMA BWICr14L 20 21PacripoCrpaHeHHOCTb BI4q Ha 100 Tbic. He.n. 106.5PadnpoCTpaHeHHocTm BHr4 cpegH ropoacKoroHaceJIeHHs% BI-MHHOHLtHpOBaHHbIX PKC 1%% Blfq-HH4HUHPOBaHHblX HH 3,3%% BffN-HHHIIHPOBaHHblX 3aKYIIOmHmHHbx 0,3%% BlIq-HH4rHnHpOBaHHblX eTeA OT MaTeperi 24%[ll'H,% 71%HCTOHHHK: LeHTp CHHa, Ka3aXCTaH, 2003 r.

Hlo rpynriaM HaceneHHs 6onbInHHcTBo HOCHTenieH BI4H B 2002 ro,Jy 6blRo 3aFHKCHpOBMHOCpe,iH HaceJIeHHS B BO3paCTe OT 15 jio 34 JieT, XOT51 H B apyrom COCTaBe. HarIpHMep,6onbUmlHHcTBo HOBbIX ciiyqaeB cocpeaoTo4eHo cpeaH Bo3paCTHoiH rpynnbi OT 25 ,o 34 neT, HO

41

camyIo 6onibLmyio POnIO OT o6wero 'Hccna B4HH4-uinHUpoBaHHbx COCTaBJIAIOT JlIQOH B

BO3paCTe OT 15 uIo 24 nIeT (6onee 40%). HIo-ApyroMy CHTLTyaJHI 06CTOHT Co CH4llJoM, rje

,JOMHHHpyeT BO3paCTHaS rpynna OT 25 zjo 34 neT B MHcne BHOBb 3a6oneIBIJHx H B o6fueM

KOJIH'-eCTBe, a Ha BTOpOM MeCTe - BO3paCTHaS rpynna OT 35 jo 44 JIeT. B LeJIoM o6e rpynnbi

COCTaBAISOT 60% OT o6iuero l4icna 6onbHblx. BepTHKaJbHbl nepexo, OT MaTepH K pe6eHKy

orpaHHIeH, ripHMeM TOJ1bKO 11 leTeH po)KJeHbl C B14'I, HO 3TO CB53aHO C TeM, 'ITO c60p

aHJanH3OB 6epeMeHHblX KceHLU4H 6bhL HaHaT J1Hllb He4aBHo. B HpHBCeaHHO1 HIIKe Ta6JlHie

nOKa3aHO, HTO YPOBeHb BCpTHKaJlbHO1 TpaHCMHCCHH npH6JH3HTeCJbHO paBeH 24% (% OT BW-I-

HHcTHUHPOBaHHbIX MJIaJeHIeB, poO)KeHHbIX BF-HH¢HUHpOBaHHbMMH MaTepAMH).

rlo o6nacTsM KOJIHHeCTBO cniyqaeB CIHA HMeeT TeHAeHUHIO OjHOpOJHOrO paCnpoCTpaHeHHSi

no perHOHaM. O0lHaKO, cHTyaBLHS c BW-I o6CToHT HHaHe. PerHoHbl C CaMbIM BbICOKHM

npoUeHTOM B14I4 BKnlOHIalOT ATbIpayCKYIO H KaparaHJgHHcKyIo o6naCTH, KOTOpble

HacIHHTbIBaioT 6onee 80% HOBbIX cJymaeB 3a6onJeBaHHS. B HHCne o6naCTeii, Ha KOTOpble

npHXO,1HTCM camas HH3KaS AOJIs 3a6ojieBaeMOCTH, )KaM6blICKaA, ropog AnMaTbi H CeBepo-

Ka3axCTaHCKaA o6naCTb, KOTOpbIe COCTaBJIASOT MCHee 45%. COOTBeTCTBeHHO, o6naCTH C HH3KOH

,aojineH 3aperCTPHPOBaHHlX cjiyaeB - 3TO o6nacTH c 6onee BbICOKHM KOj1HleCTBOM BHOBb

3a6oJIeBInHX.

rpa4Hc 20: CayqaH BRH/CHH4 no pCFHoHaM 3a 2002 r.

AKM AKTr AnM ATbI BKO KaM 3KO Kap KbI3 Koc MaH rlas CKO IOKO r.AnM r.ACT PK

flCymueCTByfEOime BWFI flie BlIq C 'iDi CnmH

san9wtftrnd dSAJHCTMqH4K: MHUHCTePCTBO 3fapaBOoxpaHeHHA, Ka3aXCTaH

BO3paCTHOPi COCTaB CMePTHOCTH OT CrHHJi IPeaCTaBJ1CH Ha rpacpHKe 20. 72% CMCpTHOCTH

cpeXUH BHOBb 3a6oJIeBLHX COCTaBJISIOT JnIO4H B BO3pacTe OT 25 ,ro 34 H OT 35 go 44 neT, a

BO3paCTHaS rpynna OT 15 zo 24 nCT COCTaBnS1eT 14%. CMepTHOCTb OT CfllJa B 3aBHCHMOCTH

OT YS3BHMbIX rpynn noaTBep)KaaeT, TO BCe yMepCIHC Cpe,IH BHOBb 3aperHCTpHpOBaHHbIX

CnyHaeB ABJIAIOTCSA HUH, npHmeM 92% OT o6iwerO KOJ]HMCCTBa 60ibHblX TaK)Ke COCTaBJISIOT

HUIIH H 8% - 3aKJIomeHHbIe (Bo3MOXcHO, B TOM -wcne HUH).

42

rpa4HK 21: CMepTHOCTb OT CnHHla no Bo3paCTHbIM rpynnaM, 2002 r.

40% T - 427b360/ 36%

35% _ __ _______ __. __ _

30% _ __ __ __

25% _ __ __- 22-

20% - -

15%--

10% - -_

0-1 2-4 5-14 15-24 25-34 35-44 45-54 5; CTapine 5- ~-- ~ 65HOBble c.iyiaH CrIMA taO6ftam CMepTHOCTIO OT CnH Ja

I4CTO-HHiK: MHHHCTePCTBO 3XapaBOoXpaHeHHSA, KamaxCTaH,2003 r.

rpaEbHK 22: CMepTHOCTL OT CH a B rpynnax pHcKa

10DI/o ~~~~~~~~~~~PecyPCbl

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B OTHoweIHHHi peCYPCOB pe3yflbTaTEi llOKa3biBi3OT nIpQTHBopeCliBbie TeHigeHim. 14HCjiOueHTPOB CHI4L yBeJIHT4HJOCb C 19 go 21 B HCpM0,a C 1999 no 2001 r. O'qHaKO o6wuaA4HcjieHHOCTb nepcoHaiia B 3THX iueHTpax yBejuimma1cb 6onee, q-eM BJgBoe H npoojionKariayBenH'-1HBaTIbCA c 2001 nio 2002 rQfl, HO TOflbKO B oripeaejieHHbIX peF-HOHax. HaripHmep, o6iueeKOJli4'IeCTBO Bpameig BM-1/CrTAJ4 B03pOCJIO c 260 iao 292 B QLUHH rogr, a KoJiH'-qeCTBO me'aceCTepCOKpaTHiJ]oc C 292 go 260.

Ha rpa4)niKax 22 H 23 rpeanCTbaBeHO pacnpea3eieHHe Bpaqei H mexHceCTep no o6eacTAlm. Bo6iuem J naHe, B 2002 ro3y camoe BbICOKoe COOTHoueHHe 6bOneo 3adM4HKCHPOBaHO B r-opoae

43

AnMaTbl, Ure Ha 100 TbIC. 4eCJOBeK ripiixoA4TCSI HSTb Bpa4eH, nocnie Hero HaeT KaparaHaHHcKas

H 3anaaHo-Ka3axcTaHcKas o6naCTH (TpH BpaT4a). B HH)KHeH qacTTH gwana3oHa CeBepo-

Ka3axcTaHcKasI, BoCTo0Ho-Ka3axcTaHCKas H KI)KHo-Ka3aXCTaHcKas o6nacTH, B KOTOpblX Ha 100

TbIC. HacenieHHA Hp4XOaHTC1 O,HH H MeHbwe OaHOFO Bpa'ia. C 2001 no 2002 roj BOCeMb

o6.nacTeH yRyT-IHII4IH 3TOT pe3yflbTaT, B WeCTHi o6nacTqlx OH OCTaAcS npaKTHHeCKH HeTpOHyTbIM,

aB BByX o6nacTAx COKpaTHniocb KOJIH4eCTBO BpaieH.

rpa(Hic 23: KOJIHqeCTBO Bpaieui no BW1q/ClIJ1,1 Ha 100 Tb6C. qe.joBeKc

6

5 5

4

33 3 33 - -3 3_ _ _ _ _ _ _ _ _ _

2, 3 3 2 22 2

2 2 j -

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2001 . 2DO2

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Kap r.ACT MaH AKM 3KO ATbip AKT WKaM PK r.AniM flaB KbI3 AniM IOKO BKO CKO Koc

2DD1 a 202X

MCTOUIHHK: MUIHHCTCPCTBO 3,PaBOOXPaHCHH$ PK, 2003 r.

44

KojiHHeCTBO MeqaceCTep Ha 100 TbIC. )KHTeiieri nO4qHHAeTCA TOMY wKe npHHLUHny B HHKHeALacCTH WKaJIbI, HO He B BepXHeHi. 3,aeCb B LiHCJIO Tpex .JyLIIHHx o6njaCTeH BXOfaA1T KaparaHRlHHCKaso6iacTb, ropo, ACTaHa H MaHrHCTayCKas o6nacTb, a ropo, AnMaTbi 3aHHMaeT eBslToe MeCTOcpeAH BceX peFHOHOB. B HH)KHeH 'aCT1i Ta6jin4hbl - qeTblpe o6iaCTH: KOCTaHaiiCKaA, CeBepo-Ka3axcTaHCKaA, BOCTO4Ho-Ka3aXcTaHcKas H 1 OvKHo-Ka3axCTaHCKa1, npaKTwtilecK1 Te >Keo6nacT, qTO H4 peFHOHbI C caMbIMH HH3KHMH nOKa3aTeflJMH cpeaH4 Bpaqer4. C 2001 no 2002 ro,rl5Tb o6niaCTeHi yBCeHqHj1H CBOH nOKa3aTeRb no MeaCeCTpaM, B CeMm perHoHax OCTaBJCS TaKOHiKe ypOBeHb H B qeTbipeX permoHax OH CHH3HJICS.

1OxKHo-Ka3axcTaHCKasI o6nacTb npe,cCTaBJsIeT co6orl HHTepeCHbi14 cnyqal4. KaK OTMeqa4jOCbBblwe, B 3TOH o6nacTTH camas 6o0bwIas ,arons 3aTpaT BblaeJj1eTCS3 Ha f OH,3 3apa6OTHOA rmaTbI.OAHaKO no KO1HLeCTBY Bpame'H 1 mececTep Ha 100 TbIC. qeniOBeK OHa OKa3aBjaCb B caMoHiHH)KHeA qaCTH Ta6nHubl. 3To Mo)KeT O3HaqaTb OaHO H3 qByX: nH6o B IO)KHOM Ka3axcTaHeBbflTa'qHBaeTCS CJHLIKOM BblCOKaS 3apa6OTHas ninaTa Me,aHLIHHCKHM pa6oTHHKaM, J1H60 B HeHnpeo6.na,aaeT a,aMHHHCTpaTHBHbl riepCOHan.

OCHOBHble Pe3YJnbTaTbi

O630p HeKOTOPbIX OCHOBHbIX cTpaTerHl, KOTOpble rpHMmeHHJ]4Cb 4o 2002 roga, npHBeni K

cJiCaytowHM pe3yJIbTaTaM:

* Y 98,3% nlauHeHTOB C 14Hf111 6bmI npaBH1JbHO nOCTaBneH aHaFHO3, npasBliJbHOnpOBe,aeHO JIeC'eHHe H npOBeCeHbi 6eceJgbi.

* 76,2% ntojieri B BO3paCTe 15 - 24 JneT cnoco6Hbl npaB4JIlbHO yKa3aTb cnoco6blnpeIoTBpaweHHA nepeaalH BtI HOJIOBbIM nyTeM H yKa3aTb HenpaBHJIbHbie cnoco6blnepe,aaqH B14'.

* Cpeaw PKC 6bIJo pacnpocTpaHeHo 276 TbIC. npe3epBaTHBOB H 502 TbIC.- cpegi I1IHH.* B HacToAmee BpeMSi CyWeCTByeT 25 aPY)KeCTBeHHbIX Ka6HHeTOB, 78 nyHKTOB aOBeprm,

TaK)Ke 6164 BOROHTepOB H3 HiHcfla 3aKJlioeHHb1X H JIHHHoro COCTaBa pa6OTalOT c3aKjHOoeHHbIMH.

Bce eme eCTm psui HanpaBJICHHii, KOTOpbid Tpe6ytOT aornOJIHHTeiTbHOfi Hog;lUep>KKH. Hanp14Mep,TOJbKO O,HH ripoueHT nlogeH C HPO,4BHHyTOr4 CTaRHeH pa3BHTHAS BWiM HH4eKI4HI noriy4aloTTepanHIo OT peTPOBHPYCOB. XOTS3 3TOT ripoUeHT B 6JIHxariwHe rOabl Mo)KeT yBeJiHMHTbcS,HOCKOJbKy Ka3axcTaH peajiH3yeT rpaHT 1hio6anbHoro 4 OHaa, Ba)KHO nOHAETb CTeneHbH3MeHeHHA, KOTOPbie nOTpe6ylOTCA. KpoMe TOrO, 4.5% BR4-HH14UHPOBaHHblx 6epeMeHHblx)KdHWHH nORY4HRH nOJIHblHi KYPC nPOqIHjiaKTHKH OT PeTPOBHPYCOB C 4lenJblO CHH)KeHHSnepe,aaH 3a6OJieBaHHA OT MaTeP4 pe6eHKY. HaKOHei, JIHUb 14% HHbeK4HOHHbIX HaPKOMaHOBBe,yT ce6s ROJDKHbIM o6pa3oM, I4To6bi CH143HTb nepe,aqy 3a6ojTeBaHMA.

rlocJ1efHHr4 pa3,aen OTHOCHTCA K 14frIrfl, XOTS1 npo6JieMbI C HaJIHtiHeM aaHHbIX Cepbe3HOMeLHaIOT IPOBegeHHio aHaJnH3a. Bo-nepBblx, no BO3paCTHbIM rpynnam camoe 6onbmoeKOJIHMeCTBO BHOBb 3aperHCTPHPOBaHHbIx 6onbHbIx HpHXOAHTCS Ha Kogeh B BO3paCTe 18 - 44JleT, cpegu4 KOTOpbIX B 2002 roAy 3aperHcTp4pOBaHo 6onee 27 TblC. HOBblX CJiyqaeB. HHTepeCHO,WTO Ha BO3paCTHyio rpynny CBbiuJe 45 niCT nPHXOaHTCS nOqTH 3 TbIC. cJIy'IaeB, qTO CTaBHT 3Tyrpyriny Ha BTOPYIO Ho3HUHIO.

C TO1IKH 3peHHS peCYPCOB B CTPaHe B CpeTlHeM Ha 100 TbIC. )KHTeJiie npHXO,3MTC HweCTb Bpaqeii141IrIfl. Beayw1HM perHOHOM ABJIqeTCq ropog ACTaHa, re Ha I 00 TbIC. qeJIOBeK npHXOaHTCS 35

45

Bpa-eri. B OCTanJbHbIX perHoHax HacLHITb]BaeTc5I OT Tpex ,ao q>eB5ITH BpaterH Ha 100 TbIC.

qejioBeK.

06luee KOJIIHeCTBO CTaL1HOHapHbIX MeCT aJnsi 6onbHblx HIHIllfl npeCTaBneHO Ha Fpa¢lWe 27.

CaMbli BbICOKHHi rpOLueHT MeCT ,RJS B3pOCflbIX 3apeFHCTpHpOBaH B 1O)KHo-Ka3aXcTaHCKo0

o62iacTH H ropoge AjiMaTbi, a ansJ ,aeTerl - B IOKHO-Ka3axCTaHCKoI H4 BOCTOtIHO-

Ka3aXCTaHCKOr4 o6nacTAx. C apyrOg CTOpOHbl, CaMblIH HH3KHH1 npoueHT MeCT - B 3ana.LHo-

Ka3axCTaHCKOA, ATblpaycKoii H MaHrFlCTayCKOii o6nacTAx, Fae COBCeM HeT MeCT glSI geTeri.

H114Wb ,aeBSTb o6JiacTefi BbflIeJDlIOT KaK MH4HHMYM 15 MeCT JflS R eTeH.

rpacjHiK 25: HoBble ciyqaH HIIHH HO Bo3paCTHbLIM rpynnaM, 2002 r.

18.000--15.530

16.000 -

i4.000 -11.687

12.000 -

10.000

8.000

6.000

4.000

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00-14 15-17 18-44 45 m crapme r

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Rcero nOnThenwcTTetHitT,x c.TivqgeR roRonew

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752625

20

6~~~~~~~4

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w 8 ~7 7 6 6 6 6 E

r.ACT AKT BKO Kap rnaB 3KO PK KbI3 MaHr AKCm r.Anim Koc IOKO CKO)Kam ATbi Anm dmn

itCTOMHIII: MlHHHcTePCTBO 3,apaBooxpaHeHHA PK, 2003 r.

46

Fpa4uHw 27: 06wee KOJIHqeCTBO KOHIICO-MeCT JaS 60JILHbIX 4HIIH no perFoHaM, 2002 r.400-...

350 340

3ou

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KOUiKo-MecTa xxnS * KOAKo-Mec-ra nsi ie-reriB3pOCJ]bfX

MICTOHHHK: MHHHCTepCTBO 3,apaBOOXpaHCeHHHs PK, 2003 r.

47

48

4. MHEHHIA HALUHEHTOB H4 OPFAHH3ATOPOB HOBCJIEJOBAHHE YqPEWCJEHHIf

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Co6paHHaA HH4lOpMaUHM flO3BOJIHjia HCcjieaOBaTenSM pacnpeaenjHTb BbIBOabl Ha OCHOBHbierpynrbl, CBM3aHHbie C:

a. HloBejeHHeM riaUHeHTOB, B OTHOlUleHHH KOTOPbIX paCCMaTpHBaIOTCS pa3Hbie cfaKTOpLI,OKa3blBafoi0He BJIHAHHe Ha OTHOiIIeHHe HaceCJeHHA H MeTO4bI JleIeHHS 3a6oneBaHHH;

b. PecypcaMH tnsi rpeCocTasBjeHHA ycnyr agLeKBaTHOFO Ka'ecTBa;c. flpouegypoH npeaOCTasBjeHHA ycnyr, rge, nO B03MO)KHOCTH, oco6oe BHHMaHHe

y,enieAeTcs cna6biM H CHJIEHbIM CTOpoHaM.

MHeHLA OTHOCHTeJibHO lporpaMMbI no 6opi66e c Ty6epKcyje3oM

B CBS3H C POCTOM 3a6oJIeBaeMoCTH TB B Ka3axcTaHe, rje 3aperHCTPHPOBaH caMbEH BbICOKHHrpOUeHT pacnpocTpaHeHHOCTH 3a6ojieBaHHS cpe,H CTpaH 6blBrnero COBeTCKOI'O CtoI3a,HauHOHanbHaA nporpamma 6opb6bi c TB npeaycMaTp14BaeT yBeJIHIeHHe e)KeroLaHbIXaccHIHOBaHHH H rloJIy'aeT cyU1eCTBeHHbiC cbHHaHCOBbie pecypcbi H3 perHOHajibHblx/MeCTHbIX6io,KeToB. 0,RHaKO, nporpecc C TOHKH 3peHH5I ynyqmueHHs npoUeHTa H3jTeIeHHHR H CMepTHOCTHMO)KeT 6blTb gaKe jiytqUJe, yl4HTblBaA BbICOKHH YpOBeHb HHBeCTHUHH. Pe3yJbTaTblKa'CCTBeHHOrO aHaIH3a BbISBJISAOT HeKOTOpbie aKTOpbl, KOTOpbie MOrYT OrpaHHMHBaTb344eKTHBHOCTb 3THX HHBeCTHUHHi.

IpeJieBbbe rpynmbl: llpOrpaMMbi 60pb6bl c TB

AU CUKPHMHHa IHSI

06Hapy)KHnocb, HTO pa3JIHqHbIe ( aKTOpbl OKa3blBaiOT CYmUeCTBeHHOe BJIHAHHe Ha HIOBgeCHHe6onJbHblx TY no OTHouieHHIO K nieHeHHlo. 3TH 4 aKTOpbl orpaHH4HBaIOT YPOBeHb co6JioaeHHApe)KHMa naHUHeHTaMH H, cneAIoBaTeAbHo, CTaBHT noa cyLeCTBeHHYIO yrpo3y ycrHeUHOCTbpeafH3auHH npOrpaMMbl. CoUHajIbHoe BOCripHMTHe H 6oA3Hb TB 3aCTaBJI$eT 6o0bHbExHpSATaTbCS H H36eraTb HH(¢OPMHPOBaHH5A o CBOe 6one3HH gaxwe 6nH3KHX ,apy3eH.

"EcAu mbl cKadiceUib KoMy-,7u60, imo mbi ietuuubcq om TS, 77o0U Ha'uHalomu36eeamb KoHmaKmof c mo6o0u u 6ajce y6eeawom, KozYa eu&im me6sA. OHUMozym u3pe?JKa no36opo6ambCJ c mo6ofi, a 3amem 6bicmpo yxot)Am ".

"51 18 nem opywmcwia c ae6yUmoKii, Ho Ko?i3a oHa y3Hana, imo y MeHA TE, ouiacmana u36eeamb meHq "

"if CJblutaOJ, tmo .mot)u .oo6opwlu, tmo qytuie He caoumbCs Ha aemo6yc 33MaPUsPYma, KOMOPb1M nOJZb3YiOmCA natueHmbl TS oni npoe36a 6 6o07bHufy ".

"...Kyoa A nozuoy nocne mOoo, KaK 6blfnUWYCb U3 6o0bHutfbl? EcAu q nofi0y Kpy3bpmm u cKa-wy UM, tmo y MeH5A TE, OHU y6ezym om MeH%

49

'Muo2ue MOU po[)cmaeHHUKU u36eza7om meHq, nomomy 41mo OHU 60sfmCM

Obiflb 3apaIceHHbvMU. Po6umeAu -o6op1m CffOUM OemAM, lmo6bl OHU He

uepWlu CO MHOU .

TaK JIO,al OTHOCSITCAI He TOJbKO K naUHeHTaM, HO H K MeaHULHHCKOMy rlepCOHany, KOTOpblH

pa6oTaeT B Tb ne4e6Hblx yqpe)KaeHHl4x.

"TJatfuenmbl U pooumeiiu nprqnymcq om sac, OHU 3aicpblfaiom nepeco HaMUOieepu u H7e nO36O.UllOM HaM eoumu".

"f7ho(u 6oimc3i 6 oAbHblX u Hac (6pavefi). Eamu 6pa' pa6omaem 6 Aeee6Huz,e

TE, ezo penymatfuA 8 onaCHOCmu. KoAAeeu, pa6omaiouque 6 6pyoux o6zacmAx,

mowce 6oszmcA Hac

bOJIbHOi Tb, KOTOpblHr Tpe6yeT ,4JHTenibHOrO CTaLU4OHaPHOrO neMeHHA, OCTaeTCA 6e3pa6oTHbIM

H JIHuIaeTCS ,aoxojga gm coxaepKaHHA CBOeH ceMbH. bOJbHbie He XOTST OCTaBaTbCq B 6OnbHHue,

rIOTOMY HTO OHH 60sTCs IflOTePATb pa6oTy. 143-3a 6onbmoro o6'beMa 6e3pa6OTHubl H

KOHKypeHLUHH Ha PbIHKe Tpy,a JIOJaH H36eraloT noceteHHs Bpaqeri npfH pa3BHTHH 6one3HH. flo

TOH ?Ke npHqHHe MHorHe rauHeHTbl, 3aBepWHHB HHTeHCHBHoe nie4eHHe B CTaiUHOHape, cpa3y

BO3BpaLuaKOTCS K pa6oTe, HeCMOTpS Ha TO, 'ITO OHH He COBCeM BbI3,OpOBeflH. CywecTByIOuIas

CHCTeMa COLuHmabHOri 6e3onacHOcT H TpyXaOBbIX OTHOiueHHH B Ka3axcTaHe pa6oTaeT

He3c4eKTHBHO H He OKa3blBaeT InOJIO)KHTeJlbHOrO BfIHHHSA Ha IOBe,aeHHe HTauHeHTOB TE.

"HHocmpaHHble KOMnafHUU y8OAbHnqOm 607bHblX COMpy&HUKOc, no3moMy

6O0bHbLm npuxo(umcsi cKpbleamb, timo OHu 60AbHbi ".

"'i 6bimu 6o]zeH wUmeJbHoe apeMq. JI 6010Cb 3a C6fOUX oemeui, ecnu imo-mo

npou30cu3em cO MHOU. )I 6oAd/eH pa6omamb, 'mo6bl KOpMUMb oemeui. Ecmu

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60cbHblM TE17boomHylo onmamy ".

OTHowneHHe o6iueCTBeHHOCTH K 60obHblM Tb OCHOBaHO Ha cna6blx 3HaHH5IX HaceneHHs o

3a6oneBaHHH. HeKoTopbie y'aCTHHKH ueJ1eBbIX rpynn FOBOPHJIH aa)Ke, HTO JEOaH BepsT, 'TO Tb- nepegaiouXeecA no HaciieaCTBY 3a6oneBaHHM, KOTOpoe nepelaeTcs H3 riOKOj1eHHS B

nOKOJIeHHe, H KpOMe 3TOrO, 6oJbHbie 3apa)KaIOT qpyrHx. Cna6bie KaMniaHHH no

AH4OpMHpoBaHHo, o6pa3oBaHHlo H o6LUeHHIo (1400), HpOBOLaHMble MeCTHbIMH H

ueHTPaJbHbIMH OpFaHaMH rocyaapCTBeHHOFO ynpaBJleHHM, He H3MeHAIOT HenpaBHJIbHoro

BOCHPHSATHSI 3TOFO 3a6oJIeBaHHS HacenJeHHeM H OTHOIueHHS K 6OJbHbIM:

"ByyOYu oocy6apcmfenuoi meAepa6UOKoMnaHueU, Mbl me paccMampueaem

npo6AeMbl TE OA3NCHblM o6pa3om ".

"V'YacmMofbie fpalu nocetqaiom uWKOhbl, qmo6bl o6ytiumb ytieHUKOG, HO y HUXMano uHi0cpmayuu, numepamypbl u 6pouuop no TE".

"L[enmp npo6neM qbopMupoewaHU 300pO6020 o6pa3a diCU3HU npevccmaeamemHaceJeHc UHcuHOpMaajU1O O TE. BpaCu npo6o6im iieiuuu Ha npeonpuqmuqx Uo6pa3oeamenbHblx yOpe6coeHuqx AoofbHO qbOpMaObHO. XypHWaUCmbl

no.Jyya1om 3apaHee noo2omo8JieHHble 3anucu unu cmamucmuKy om HUX U

50

eK,q7oqaiom 3my uncopmaquio f cqe6yioiquzu HoAfep 0a3eMbl. Cmambunon7yqa7omc.n cyxue u nepe,?py)1ceHHble mexHuqecKuMu mepAtuHaM,u, OHU Henecym Hu1CaKou UHc/lopMazquu O.rn HaceleHwu. Kawecmeo maKux cmameiu oqerbc.a6oe ".

"Ilpo6AeMbl TE He o6cy icoa7omCq Ha meCMHblX pa6uoKaHaJzax. Eciu 6 bl 6bm1XOmb OOUH KaHCa C 601lbUIUM o6beMoM uHnOpMatfuu O TE u ezonocAeecmeuWx, 170o6u 6 bl cuyuiauwu ezo U u3MeHnu7u c6oe omHomeHUe '

XKeJiaHMe CO CTOPOHbl )KYPHaJIHCTOB H Cpe;CTB MaCCOBOH HH(OpMoaumH HrpaTb OnpeaeJneHHyIOPOJlb B llOBbIlUeHHH o6pa3OBaHHOCTH HaCeneHHHM1 CO4eTaeTCA C He)KeCIaHHeM roCyfaapCTBeHHbIXAOJl)KHOCTHbIX JIHU OT 3apaBooxpaHeHHA rIpeROCTaBJIATb Heo6xogHMyio HHPopMauHwO HJIHageKBaTHble CTaTHCTHI4eCKHe ,IaHHbIe XnsI o6pa3oBaHHs 06WeCTBeHHOCTH. aaHHbie OMaCimTa6HOCTH rlpo6neMbl Tb Ha o6JlaCTHOM H rOCyaapCTBeHHOM YpOBHe CKpblBaIOTCA OTo6LueCTBeHHOCTH.

KpoMe TOFO, ,aaKe BpaqH, pa6oTaloLuHe B MeRHUHHCKHX yMpe)KAeHHAX Ha ypOBHe nepBHWHOHMe,RHUHHCKOi riOMOWH, KOTOpbie ,IOJ)KHbl HH¢OPMHPOBaTb HaceCJeHHe o Tb H nOBbIliuaTb HXo6pa3oBaHHOCTb B 3TOM BOripoce, 6OsTCs riauHeHTOB TB. TaKHM o6pa3oM, repeAOBas JTIHHHS5MeCHUHHCKHX pa6OTHHKOB, KOTOPbil aOJ1)KHbl HrpaTb KJIIoMeByO pOJIlb B 6opb6e c TB, HeBHOCHT 6ORbWiOrO BKJ1azJa B 3Ty 60pb6y.

Ha nOBeCeHHe HUaLHeHTOB TaK)Ke OKa3blBafOT CyLeCTBeHHoe BJ]HAiHHe 3KOHoMH'-eCKHe c~aKTOpbl.fo aaHHbIM orpoIueHHbIX, 60.JbLHHCTBo 60JIbHblx TB MBJISIOTCA 6e)KeHuaMH H3 COCeaHHXcTpaH, aJ]KorO.JHKaMH, 6blBIHMH 3aKJUO'4eHHbIMH H 6eRHb1MH 6e3pa6oTHbIMH.

"90% 6aulbHblX U3 CoUuaJlbHO He6Jaon0no0AyLHblX cemeu".

"Ko,7uqecmeo XpOHuteCKUX 60o1bHblX 6 nauiem peouone pacmem. 3mo 6OCHOfHOM awnowC7uKuK, HapKomaHbl, 6blruiue npecmynHuKu, 6e3pa6omHble Uzu

6e6iHoma ".

"eMHoma U nepeCelleHU,bl, npU6bl6alOlque U3 Tal)b/CUKucmaHa U Kblp2bl3CKOfiPecny6AuKu, a maKIce me, Kmo dIcueym 6 cen7ax, pacflno7jlceHHb1X He6aJeKoom pblHK06 pO3HUIHOU MOp00,IU, cocmaejf%iom OCHO6Hble Zpynnbl pUCKa ".

go CHX npHMeHAIOTCS HeKOTOpbiC CTpaTerHH COBeTCKHX BpeMeH, KOTOpbie BHOCST CBOH BKJIaa BOTPHuaTeJlbHOe HOBeaeHHe 6OJIbHbix TB. Heco6rnogeHHe TpyaOBorO 3aKOHoaaTeJ]bCTBanlpHBOaHT K TOMy, 4TO pa6oTOaaTenIH YBOJIbHAlOT 60JIbHbiX TB, a HeKoTOpbleperniaMeHTHpy1oiiWme goKyMeHTbl He nO3BOJIJSOT 6onbHblM TB; pa6oTaTb }VIHTeJlbHbIii nepmogBpeMeHH. HanipHMep, JIIOaH, KOTOpbhe pa6oTaJIw yMHTCeJIMH HJIH Bpa'IaMH RO TorO, KaK3a6oneJIH, He MOryT pa6oTaTb B 3TOH npoeCCcHH B TeMeHHme aByX ieT nocnie npoXoxKReHH5InCe'eHHA. TaKas IIOJIHTHKa 3aCTaBJIAeT JTIOaeH CKpblBaTb CBORO 6oJIe3Hb, tITo6bl He nlOTCeSTbpa6oTy.

DYHKUHOHHPOBaHHe o6iiCcTBeHHbIx ycniyr 3,apaBOOXpaHeHHS eme 6oibmue ycyry6nsieT cTpax60JHbHbIX. 143-3a rOCyaapCTBCHHOri riOJIHTHKH He co06JnoaaeTCs1 KOHiH4CHuHajibHOCTbHHcOpMauHH o 60JbHblIX.

51

o Ka)KqoM cny'ae 3a6oJIeBaH45s TB, BblsBJieHHOM MejHUHHCKHM pa6oTHHKoM, aOJ1KHO 6blTb

aonjo)KeHO B caHHTapHO-3nHaeMHoI4orHiMeCKyIO CTaHU4IO (C3C), KOTOPaS AOJDKHa OTCfleIHTb

KOHTaKTbl H rIPOBeCTH 14HHU4BH4yanJbHOe paccneqoBaHHe. TaKHe eACCTBI4,S HapywaloTKOHcPHLeHuHajibHOCTb neweHNs H HeCYT B ce6e PHCK nOTepH 60rnbHbIM pa6oTbl.

"3mo 3a6o0]e6aHue 3apa3Ho. IlHtOpMaazofu o iac Hanpaezszemcq 6 CJC. OHU

u36eeUaiom pa6omo6amemu?, U 6 smoui cucmeme Hem Konii0neHnuwucbHocmu .

HaJ1HnHe OCHOBH6bIX paCXOLIHbIX maTepHajiOB

XOTS B COOTBeTCTBHI C rocyaapCTBeHHOH cTpaTermeH MeaHKaMeHTbJ H ycnyrii no 6opb6e c TBnpe,qOCTaBR1SHOTCS 6eCnniaTHO, npO'.we 3a6oJIeBaHHS, COnPS)KeHHbIe c T1B, neqaTCA nInaTHo.

OTCyTCTBHe paCXOaHbIX MaTepHajiOB B JIeqe6HHuax TB 3aCTaBJD1eT BpaqeH nPOCHTb iauHeHTOB

npmo6peTaTb MeC4HKaMeHTbl B anTeKax. HeXBaTKa qUHHaHCoBbIX peCYPCOB B ne'.e6Hblx

y4peX)KH4eHHAX JIMS Jle-eHHSA TB HPHBOaHT K nHfoXoMy HHTaHHIO B JIeMe6HHuax, B CB513H C Mem

POACTBeHHHKaM HPpHXOAHTCS HeCTH 3aTpaTbl Ha nHTaHHe 6ojibHbIx. 3aTpaTbl Ha fipoe3, B

neHe6HHlUy H aOMOA HapsAy C 3aTpaTaMH, onHcaHHb1MH BbIwe, genaloT nieQEeHHe HaCTOJbKO

o6peMeHHTenbHbIM, T4TO 60obmUHHCTBo naumeHTOB H36eraloT JIeHeHHU 1 HJTH nepecTaloT

r1HHHMaTb neKapCTBa.

"Foeopsim, qmo 7eqeHue 6ecnlamHoe, HO KOZOa MOU nfleAtlHHUK 3a6o,nen7,

epatiu nompe6oecvzu, qmo6bl Mbl KynufWu uZnpultbl U (ocucmeMbl)) onsBnepeuweaiwq diCU6KUX MeeuUKaMeHmoe. Humanue 6buzo moxuM, u HiaM

npUXo0UWOCb KOPMUMb ez-o caMuM

"HaUluenmbi TB maKdlce ume7om dpy?ue 3a6o}zeeaHuq noqeK, ee,7y6Ka unu

netieHu, HO 3a qmo iieqenue HeO6XO6umO niamumb ".

"B naweUi 6epeeHe Hem 6o0lbuUlbl Jim TE 60nbHblX. Mne HYdiCHO 6blzO 603UMb

MydICa U CblHa 6 paUOHHblU yieHmp, HO y nac He 6buzo 6enee. Ho9moMy Mbl 15

eoHeu He npue3icawu ".

"Ha queimam u3 ceJJbCKOu mecmnocmu npuxooumc%i e3OUMb 6 ZOpOO, tmo6bi

npoxoOumb jeenuue, HO mpaHcnopmnbie pacxo6bl cmaioeqmcq 6ce oopoice ".

"Focy0apcmeO 6bl6eJSzem meotuKaMeHmbl, HO OO Hac OHU He 6oxoosAm. MbL

e3UtW 6 opyzoe cenzo, zoe dicueem epa64 u zoe eCmb MetuKameHmbi. B HawueiceMbe pa6omaio MOJbKO Ri. Y MeHi mpoe MaOetHbKUX oemeui. ,aeHe2, Komopbie

sz 3apa6amblealo, e6ea xeamaem Ha eoy, He 2fOpSI ysice o mpaHcnopmHbix3ampamax

JIeqeHHe TE

CTpax nepeg o6wecTBeHHOcTMo, (SHHaHCOBbie npenSTCTBHS, cna6ble 3HaHHS H MHOrRa

OTCyTCTBHC reorpa(iqecKoro aocTyna 3aCTaBJ1SlOT 6ojmHbIX HCKaTb aSjbTCpHaTHBHble HyTH H1114

OTKJ1a,RbIBaTb nieqieHHe. HeKOTOpbie 6o0bHbie nOflb3ylOTCS TpaaHUI4OHHbIMH MeTOaaaMH JTeLieHHS,

a HeKOTOpble noKynaloT neKapCTBa caMOCTOnTeCJbHO (MHora no COBeTy BpaMa HnH japyra).

TpaqHu4HoHHbie MeTOabl JIeIeHHSI HcrlOJIb3ytOTCS1 ga).e Korga 6OjbHble He yBepeHbl B HX

34X"eKTHBHOCTH, HO CCniH TaKOe neCeHHe PeKOMeHaYeTCq BPwqOM 4jim ,apyrOM, 60IbHOHi

52

npo6yeT ero, n1OCKOJIbKy 3TO - eaHHCTBeHHbilH MeTOa JeMeHHS, KOTOPbIH OHH MOFyT ce6eHO3BOJIHTb.

")I 3Haio O6UH peuenm. ququHaq cKcopiyna nnoc d3e 6VmblIKU 6UHa u omofloaC6UHbU. Dmom peyenm oaem 100% eapaHmuwo 6bl38opoGneHuw. Hi eepio 6Hezo

"o.zbHble eoqm 6apcyquii, pbl6UU, Kyp6ooHbldi 3CUP u Meo6eeky. HacK0MKO3mu cpetcm6a 3.t4JeKmu8Hbl, Mbl He 3Haem "4

"fi nonpo6oeai ;iapo6noe cpe/(cm6o: 35 ZpaUM 6OcKU c MaCACM,0n HO He eepio6 eeo 3cJJ/eKmUeH0Cmb. 1 eM aw20 u no6opoycHUK, Komopble MoJlym u3AequmbJZ2KUe, HO 6aKmepuu ocmaiomc ".

"HeKOmopbze 6cAbHbie 3aHtuMaiomCq cawoueqeHuem. OHu noceUWaiom 6palieU,a nomom noKynaiom met3UKaMeHmbl. .5 3n7aio, imo 6 HeKOMOpblX nlOKUJIUHUKaXnpoaoaom me3UKaMeHmbl om TE ".

CaMoneIeeHHe cyWeCTBeHHO 3aaep)KHBaeT Bbl3IaOpoBjieHHe, H ero pe3yJIbTaTbl o6blqHO o t eHbHH3KHe. CTpax nOTePATb pa6oTy H BblnaCTb H3 o6uecTBeHHoA iKH3HH 3Ha4HTeJIbHo 3aTpyaHAeTpa6oTy MegHLUHHCKHX ytpe)KaeHH1i, OTBeTCTBeHHbIX 3a OTCjIe)KHBaHHe 3a6oJieBaeMoCTH HBbIlBJIeHHe HOBbIX c.Ty4aeB TB. HexKenaHHe HacenfeHHA noriagaTb B O(HUHajbHyio CTaTHCTHKYjaenaeT HeBO3MO)KHbIM OTcje1KHBaHHe KoHTaKTOB. OnpomeHHble BpaqH CKa3aAH, qTO 6blBaJncnyLiaH, Korga JIEOAH He OTKpblBaJH aBepb HJIH BenHd ce6si arpecCHBHO nO OTHOwUeHHIO K BpaMaM,KOTOpbie npHXOHnJIH K HHM ROMOri.

"J1hoeu, KoHmaKmupyiousue u 6o0bHblMu TE (pockcm6euHuKu, compy6HuKu unpowiue), u36eza7om 6patiez ".

CHJnbHoe pacnpocTpaHeHiHe 3a6onieBaHHA cpeCiH 3KOHOMH'eCKH He6JiaronOnyqHbIX HaHTHCOUHanJbHbIX 3J1eMeHTOB eie CHJ1bHee meiuaeT aAeKBaTHOH peanIH3iHH nporpammKOHTPOJIA TB.

Yca7yeu no TE

O[WF H FM, npOBeaeHHbie cpeaH MeJUHKOB H 6oJbHbIx, nOMOFJIH BbISBHTb HeCKOJIbKO cJla6bixCTOPOH, CBS3aHHbIX C ajeKBaTHbIM rpeAoCTaBJeHmem ycnyr. B LuejOM, BO Bcex .reqe6HbIxyqpexQeHn4Ax TB, KOTOpbie 6blnH rpOaHaJH3HpOBaHbl, 6bIlnH o6HapylKeHbl cnieRytowleHeaocTaTKH:

* HH#paCTpyKTypa* O6opyaoBaHHe H pacXOaHbie MaTepHanJbl* MeJwKaMeHTbl

* '4eiIOBe4ecKHe pecypcbi (tIP)

B COOTBeTCTBHH co CTpaTerHiMH, HpHHSiTbIMH B paMKaX HaUHOHaAbHOrl nporpaMMbi 6opb6bl CTb, 60obHbie ripOXO0IT HHTeHCHBHYIO 41a3y cTaUHOHaPHOrO Jie4eHHSI H nocneaytotuyto 4 a3yaM6ynaTOpHoro JieqeHHA. YBCeiH'ieHHe 3a6ojieBaeMOCTH B CTpaHe co3aanio gHc6aJ]aHC Me)KAyCrpOCOM H npe;ijio)KeHHeM KOHiKO-MeCT H aM6ynaTOpHbIX yqpe>KaeHHi4. KpoMe TOrO,HH4¢pacTpyKTypa ycTapena H He oTBeqaeT cTaHgapTam ani o6ecnemeHHq aaeKBaTHorO KOHTPOjSA

53

I~~~~

3nHJaeMHHl/HHHUHpoBaHHA. bonee Toro, nnioxaA KaHallH3auHOHHaA H BeHTHJ1SIUHOHHaI

CHCTeMbI, COBMeCTHbie cToJIoBbie ani5 6olbHhIX Hi MeaiUHHCKOFO riepcOHaila BJIHAIOT Ha

pacripocTpaHeHHe HHcIJeKUHH BHYTpH MeaHUHHCKOFO y'pe)KaeHHR H Ha POCT pwCKa

3a6oJIeBaeMoCTH cpeaH Tex, KTO neiHHT H yxa)KHBaeT 3a 6oJnbHbIMHr.

"Mecm 6 cmazuonapax He xeamaem, 6 C6513U C 4eM 6 6o0zbHuyax cyujecm6yiom

IluCmbl owuoa7Huq ".

"Hauwa 6O0lbHuya nepe?pyYcena. B OOaHoUi naname newcam no nmb uwnuuteCmb 6onbHblx U 90 qe.loeeK Haxooimcuz 6 oenapmaMeHme, a amo HaMHo2o

6o0buse, 'rem mo Konuiecmeo, Ha Komopoe pacctumana nawua 6onbHuya ".

"HaM npuxo.umcAz pa3MeuqaMb xpoHutiecKu 60obHblX p5t0OM C 6HO6b

nocmynu6wwumu. Mbl He moweCM oepacamb 6anbHblX C

My}Zbmupe3ucmeHMHb1MU OpMaMU omoeblbHO. OHU xooqm no 6onbHufue u

3apaacaiom 6pyeux. Heo6xoouMo imo-mo coeilamb. Hanpumep, npoeecmunoJLHyJo u30oJLYulo. MowCHo 6yoem c036amb KOMMyHy, M)e maKue 6o0lbHble

6yoym nequmbcM, dCumb u pa6omamb ".

"Cucmetbl eobocHa6mkeHuu u Kanaizu3az,uu Haueji 60o1bHUlubl He'

oe3uHc1uutpyaomcR. KGHaua3afaUR 3apaaicaem oKpecmHocmu. H3-3a amooo

6bLCOKa 3a6oA7eeaeMoCmb cpeou pa6omiiuKoa. B Hawuei 60nbbHuye Heo6xo6U.Mo60nbuwoe Konuuecm6o Kfapfeffblx naMn u a)eKeamHaq Ge6HmuWL'UuOHHanacucmeMa. Y Hac 6 HJalu'uu uMeemcq nUWb 40% naMn om mpe6yeMoo

KoILuttecm6a. KpoMe mooo, Mbl ucfnOJb3yem mapqeGbie noaf3Ku, a OHU He

3qJbeKmuaHbl. Ham HpiCHbl otHopa3a6ble noitunponufjeHO6ble MaCKU &13S

3aulUmbl 3oopo6b.S1 nepcoHaiia.

"B Haueui 60,7bHuile Ha mpu na.vambl npuxo6umc3i O)UH )yui. Bo6a

6xvnaoaemcq ece2o pa3 6 tieHb Ha napy qacoe. Pe3epeHca eo0a xpaHumcq eemKocmCqx U 6ymbVlKax, -opqsieii 600fbl Hem eoo60ue ".

Hccne,qoBaHHe nOKa3a11o, 'TO Cy1eCTBYIOT reorpa4wl'IeCKHe 3OHbl (cejmcKHe), rge HeT HH

6onbHHU, HH HHcpaCTpyKTypbI. 3To Co3gaeT cepbe3Hbie npenqTCTBHA JSA Tex, KTo HyKlaeTCS3 B

JIe,'eHHH TB. nJIOXOe KaieCTBO TpaHCHIOpTHbIX ycniyr H HH3KaS HOKynaTenbCKasI Cnoco6HocTb

cenbCKorO HaceIieHHS B TaKHX perHoHax He aaeT B03MO)KHOCTH no0yJMeHHS yXoqa ajSA

HaceJieHHAs.

YcTapeBmee H nIoXo pa6oTatowee o6opyRoBaHHe H HegoCTaTOK B paCXoAHbIX maTepHaliax(cTepHJIH3auHoHHbIx )KHAKOCTAX, MacKax, oaexKge H rnpo'eM), C OqHOA CTOpOHbl, BJIHAeT Ha

Ka'eCTBO ycjiyr H, C apyrOA CTOpOHbl, OKa3bIBaeT PHCK HHlHU14POBaHHSa M9 mHUHHCKOFO

nepcoHana TB 60nbHHU.

"Cmapoe o6opy6oeaHue, omcymcm6ue Keqpqef6blX naMn u n'zoxo

tIyHKU,uoHupyiouUe aemoKla6bl 6irswuom na pacnpocmpaHeHue uHiJeKqUU ".

"PeHmoee-ycmauo6Ka pa6amaem, HO OHa oueHb cmapai u Kataecm6o

u3o6paJfceHU? o0eHb nn'oxoe ".

54

"gnoHcKue muKpocKonbi ea,om 6o0butee y6eenuqeHue. MuKpocKonbl, KomopbieMbi noqvqiaeM, umeiom nnioxoe y6ejluteHue, nomaoMyv c.ZOCHO cpa3y 6bljq8UmbTE'.

"Hall nocmoXiHHo ne x6amaem maCOKI U neptiamo1C. Mbl noKynaemcnelqooe,eya)y camtu. Mo7otque 6euiecmea U mbUlO maxicae 3axynaiomcOmpy6(tuKu Uia C6OU 6eHb2U .

FlOCTaBKH MezHmKaMeHTOB HeHOCTOSHHbl, a KaHeCTBO Me,HKaMeHTOB He BcerTga xopoiee.Me,aHLIHHCKHX COTPYAHHKOB 6ecnoKOHT KaMeCTBO MeJAHKaMeHTOB, 3aKynaembix rocyTaapcTBoM,KOTOpbIe HeCyT B ce6e CHflbHbie no6oqHble BO3,aeHCTBHS1 H 3aCTasBjiAOT 6onbHbIx ripeKpaiuaTbnCe7ieHHe H3-3a TOrO, 'ITO OHH AalOT OCJIO)KHeHHA Ha nOqKH H rexieHb.

"Kaqieem6o metouKameHmoG, 3aKynaeMbLX eocy)apcm6oM, nnoxoe.E&poneuicKue MeC)UKaweHmbl HawiHoo Jyquie. Om nocmyna,ozquxMeoUKaMeHmoe qacmbi no6ofiHble s51e,oeuq ".

"oJl bwUHCMGO MeOuKaMeHmOm npoU3600UmCq 6 IIHw)UU. TaKueMweoUKaMeHmbl 6 AmepuKe U AHZJIUU He npumeHq7omc5. Bo-nepeblX, 9muAt6OUKaAteHMbl npe6ocmaeffvu7omcq e euoe 6Aa2om6opumeAbHofi noMouSU u33anaonoHi Eeponbl. OOHUM U3 no6oqHblx ct/4peKmo6 Ae)semcq 6biCOKaq5memAinepamypa. Ho6bie meoUKameHbi U3 IlaKucmaHa U ffHHUU oeweeze, HOoHu uie7om 6o0ee cUlbHble no6o(uble Jcl4eKmbl. CKynoi nnamum ()eaJIc6bl ".

"MHe npUUUZOCb npepeamb JeieHue. MeMUKameumbl, KOMOpble A npuHuMam,6a6amu moKcuqecKUu xj4eKm. MHe U3-3a HUX 6 buo nnoxo ".

3a,epKKuH B nOCTaBKaX Me4HKaMeHTOB H3-3a HpOBO,aHMOFO rOCyaapCTBOM TeHaepHoronpouecca nOBCeMeCTHO OTPHuaTejibHo BniHSeT Ha HerpepblBHbie nOCTaBKH MeTaHKaMeHTOB ansinaUHeHTOB. MeaHKH CqHTaIOT, qTO HH3KOe KaqeCTBO MeaHKaMeHTOB HapsAuy CHepaBHOMepHbIMH nOCTaBKaMH OKa3blBaKOT OTPHULaTenbHoe BJIHAHHe Ha iieqeHHe H MO)KCT 6blTbnpHqHHOI4 yBenHiqHBaIoiterOcA qiHcna 6oIbHbIx C MyJIbTHpe3HCTeHTHbIMH (jopMaMH TB(MPTE).

BbInH BbISBfleHbi npo6neMbl C 14P, KaK B OTHoLieHIH KOJIHqeCTBa, TaK H KaqeCTBa. POCT3a6oneBaeMOCTH 4H HeAOCTaTOqHorO KOJHmeCTBa KagpOB B TB 60JIbHHuax (HTO BCTpe4aeTCSMaCTO) C03,aeT aHc6arIaHc Me)Ky CnpOCOM H npeajio)KeHHeM. 3ToT OTHc6aAaHc CTaHOBHTCA BCe6onee OqeBH,gHbIM, yqHTbIBaM HeMKeJiaHHe Me,aHUHHCKOrO H a1AMHHHCTpaTHBHorO nepcoHaiiapa6oTaTb B CHTyaL1HH C BbICOKHM PHCKOM. Pa6oTa B TB neCie6HHuax CTaHOBHTCAHerpHBneKaTefbHOH H3-3a HH3KOHI ofIiiaTbl H OTCYTCTBHeM OHOIJ]HHTimTeHbIX JlbrOT, KOTOphIerpHMeHA1JHCb B COBeTCKHe BpeMeHa.

"Jjayce 6 ZOpOOCKUX KJlUHUKax U 6o0IbHutlax He xeamaem cneiluazucmo06 noTrb'.

"OmnycKa oqeHb KopomKue. Pa6omHuKu yMcm6eHHo2o mpy6a omt6bixabomfea Mecsl/a. Pa3ee Mbl He 3a"yduCaeM mozo wee? "

" Y Hac 6 xupypou?iecKoM omoeneuuu 6Mecmo wecmu epaieui pa6omaem 6cezompu. He6aeHo Ha pa6omy ycmpouwcq Molo6ou cneu,uanuCm, HO 6CKOpe

55

ymohzwzwz. Ho'emy? HU3KaA 3apnmama, a pa6ombl 6 dea pa3a 6ohzbule, wem eopyzux ieqee6HbIx yqpeedueHux ".

"Hu OOUH Mo6oioU cnez,wuwucm He uoem pa6omamb 6 TE 60JbHunly, nomomyqmo OHi 6oqmzcu ".

"3apnnama y iac oqeHb HU3KaS1. Mbl nOCMO%HHO KoHmaKmupyem c 6onbHblMu,a 3atquu4eHbl nmoxo. Mbl - npocieccuoHaubl. Bpqc) nu Kmo-mO 3axoempa6omaMb 6 maKux ycJio6uqx '

OTCYTCTBHe HenpepblBHOFO o6yMeHHsl H HeaoCTaTot4HOCTb rocyRapCTBeHHbIX cy6cHmai4i Ail

4HHaHCHPOBaHHA npo4ecCHoHajibHOFO pa3BHTHA MeaHUHHCKOro nepcoHaJIa, KaK HaM Ka)KeTCs,

BjiHMeT Ha KaIeCTBO ycnyr. KaK yKa3blBanOCb Bbime, nepcoHan TB 6onbHHU aOJiKeH

oniiaJHBaTb CBoe npofeccHOHaAbHoe pa3BHTHM H3 CBoe HH3KOH 3apa6oTHoH nJlaTbi.

"Patuouio a no0JUK,7UHUKe He 3Haem, KaK iumaMb OIJoOpoopaMMbl ".

"Coe6epeMeHnoe 6bl5e16eHue 3a6oA7e6aHUw 3afucum om 6paqa, KOmOpblU

npoeooum nepeblil OCMOmp. lHHo0oa 607bHnble noiyVaiom netieHue omnpomy6bl, a no6o3penue Ha TE oadwe He paccMampueaemcq. Bpa'u,npeoocmae,sziouue nepeuuuyo nOMOUf b, ne6ocmamoyno 6HUMnaHuo y6eJzJUom

TE. Ecnzu nauueHm boq.oe 6peMt He u3Jzequeaemcq, OHU Hanpaffnuuom ezo K

HaM. K HaM noemynaem MH0doece6fo jcawo6 6 omnouwenuu 6pa'ieUi nepeUQHOcz

MeOUKO-caHUmapH0U nOmOUfU

lOMOIw6b NpiH TF

He,CICTaTKH, onHcaHHbie B rpeabigyLueM pa3,aefle, OKa3blBalOT cy1ueCTBeHHoe BJIHS1HHe Ha

npouecc H Kat4eCTBo peAOCTaBneHHAycjryr yxoAa 3a 60JTbHbIMH Tb. 3TO CO4eTaHHe BeleT K

nHjOXHM pe3yJIbTaTaM H meLuaeT aaeKBaTHOMY KOHTPOJIO pacnpocTpaHeHHM 3a6oJIeBaHHM.

AaHHoe HccJ1eaOBaHHe TaK)Ke noMoraeT BbISiBHTb apyrme npHMHHbI, KOTOpbIe BHSAIOT Ha

npo6neMy H ycyry6nsTIoT ee. 3TH BbIBO,4bl MO)KHO o61beaHHHTb B cnieqyiomHe HeTbipe

KaTerOpHH:

* HeageKBaTHas opraHH3aUHSA rpe6JOCTaBfleHHS ycnyr

* HapymeHHbie CBS3H Me)Ky pa3nHqHbIMH YPOBHA4MH 3ZapaBooxpaHeHHS

* Ciia6arocyaapCTBeHHaAnoJIHTHKa H nnioxas peaJIH3aUH

* OTHoweHHe MeAlHKOB K Jei6eHHIO aOTC

OpraHH3aUHA ripeaOCTaBjieHHA MeAHUIHHCKHX ycnyr no TB B Ka3axcTaHe Tpe6yeT

HHTeHCHBHOrO MeRHUHHCKoro neJeHHA, npeROCTaBJIAeMoro cTaLuHoHapaMH, H nociieRyioulero

JielIeHHMA naiUHeHTa Ha LOMy. KaHeCTBo 6onbHHHHoro yxoga AOBOJIbHO HH3Koe H3-3a

He40ocTaTKoB, KOTOpbie onHCblBaJIHCb paHee. rlpeloCTaBfleHHe ycjiyr BO BTOpOHi (ame TaK)Ke

3aTpy,aHeHO. PeRKO HaceCieHHbIe perHOHbi Ka3axcTaHa He o6ecneLHsBaloTcsA uenleHaripaBBeHHO

TaKHMH ycjiyraMH, TaF)Ke HeT rH6KocTH B o6ecneMeHHH MeaHKaMeHTaMH:

"Metkcecmpa noCbmuaem natiueumoe 6 peouoHaMbHblu 4eHmp, qmo6bl npUHAMb

MeOUKaMeHmbl. EOilbHble O]IWCHbl nauimu 6eHbiU, tmo6bi 6o6pambcq 6o

56

qenmpa, It KadfCi 6ozbnoi 6orniceu npuexamb ca1- 4eUKaveHmbi HHe,b3316blc)a6amb 6py'uMA nA10o&) "

CB5131 Me>Kay neqe6HbIMMH yqpexcgeHH1Mmi TB H o6weii ceTblo rlepBHqHOH MeHWUHHCKOrinOMOMH pa3opBaHbi. locne BblirHCKH 13 6onbHHilbl HH(jopMaLUHsl o 6o0nbHoM He nepe,aaeTcsaOJDKHbIM o6pa3oM B COOTBeTCTBYIOiueC yqpe)KaeHHe nHPBHqHOH Me,UHUHHCKOH HOMOLu4H. H3-3a3TorO BTOpOiH 3Tan JleqeHHA nocne cTaUHoHapa HHor,Fa He npOBO,aHTCq.

"Orncymcm6ue KOH0-OM07 8 cemu co03aem npo6weMbl. Ilocne 6blinUCKUnaqueHMmoe He npo6ooumcq npowepKa, npoxodAm nu OHU npo6oniceuueneqieuuw"

Boniee TOrO, ClJbHblH npOUeHT MHrpaLU4H BHYTPH CTpaHbl MelUaeT Me,aHUHHCKOMy nepcoHanypaCrPOCTpaHMTb MeaHKaMeHTbl, Korga a,gpec nauHeHTa HeH3BeCTeH. KaK cKa3ana o,jHaMe,acecTpa:

"C70oYcHo onpeoenumb natfueHmo0 cpeau 6a3apHblx mopeofeq, nomomy qmoouu ne umeiom nocmo3uuoeo oCuibq u 6cee3a eCmb HO6UqKU ".

DTa npo6neMa CTaHOBHTCqI ewe xy)Ke, Kor,ga nauHeHTbl ABJIASOTCS 6blBlHMH 3aKIO'l-eHHbIMHHnH rpHe3)K4MM 13 COCe,aHMX CTpaH, He 3aperHcTPHPOBaHHbX rOCy,IapCTBeHHbIMHBe,oMcTBaMH. B HeKOTOPbIX CeJ1bCKHX perHOHaX 3HMO1 CTaHOBHTCS HeBO3MO)KHO BOBpeMSHnBO313HTb MeaHKaMeHTbi H3-3a nnjoxoro COCTOSHHS ,ropOr H npCpbIBaHHAI JleeHHSI ATn1ceabCKHX )KHTeneA. 3TH BOnPOCbl HeHMOBePHO BaXKHbl JnSq ne4eH im no CHCTeMe JOTC. BoneeToro, y npeacTaBHTejieA neJee6HbIx yqpe)KAeHHA, KOTOPbIM Heo6XogHMo qo6HpaTbcs ,aO,aaJbHHX MeCT, He XBaTaeT TpaHCnOPTHblX cpeJCTB.

lBOfblbmMe per'MOHbi Ka3axcTaHa Tpe6yfoT HeTpaaHLIHOHHOFO no,axoaa K rpe,aOCTaBneHHIOMe4HUHIHCKOFO yxo4a. OTCYTCTBHe npaKTHiqHOCTH B OTHOHieHH14 npoe3ga ceIIb'laH Ha aJlHHHbiepaCCTOSHHA Tpe6yeT M3MeHefHSA nogxo,ga, qTo6bi MeamKamMHTbl AOCTaBJIAJIHCb fauHeHTaM pa3B Heaenio B mX gIepeBHIO, H 4To6bi riaTiHeHTaM He npHXOaHJIOCb gaieKo e3AHTb aO paHOHHOrOteHTpa.

"Me6cecmpa KoHmponupyem 6o0bHblx, npo.Ncuea7otqux Ha JeKapcmeax. OQa6bldaem mecUKaMeHmbl ua HeieJIO, U Mbi ne 3naeM, KoHmpo,7upyem ona uxnpueM unu Hem

"Y Hac na zpynny 6buzo nlRMb unu uwecmb 7eOKo6bLx a6moMo6uweu, HaKOMOpblX Mbl e30unU a y6adeHHble pe?uOHbl. CezCac y HaC MO,7bK OOUHa6moMo6U,b, KOmopbli, KaK J cqumaio, notimu ymep. A6eK6amHoenpo6eoeeue neuenwu JOTC He6o3mohno ".

OpraHH3aLUiOHHbie npo6nieMbi c I0OTC paccmaTPHBaEOTCA MeRHIM4HCKHM HepCOHaJOMHpOTHBOpeMHBO. XOTS HeKOTOPbIe H3 HHX nOJIHOCTbKO nOggePxKmBatOT CHCTeMY ,ZOTC (BOCHOBHOM B 6o0blluHx ropoQax, rge pacCTOAHHe He SABJSeTCcA 6onblwori npo6JleMori), apyr4e)KaJIyIOTCS, xITO JIOTC JIHIflb BbISBJSAeT 3a6oneBaHHe Ha 3Tane, KOrga naLHHeHT yxKe SBJISeTCAHOCHTeneM BK+ H Mo)KeT HH¢HUHPOBaTb OKpy)KaIOiuHX. Torua nepBMHHoe nieqeHHe noTpe6JIseTcylueCTBeHHbIC pecypcbl, a pe3yflbTaTbl He sBJISOTCA 6JIaroHpHSTHbIMH.

57

"CucmeMa JOTC He o'eHb xopowaw, nomomy imo mpe6yem 6on7bzuux3ampam. H3-3a cucmeMbei 4OTC 3a6oAe6aHue ne ebuiejqst7emciz. EO,7bHble

npuxoosm A 6pa'iy Ha amane pacnaia, npuqem y 70% 6wzbnbiX yice HanJUYO

SA6HacL uHn(PUbmpaquw?'".

"Bpa'iu -o6opqm, Jmo ucnOhIb3o6aHue npOZpaMMbl ,IJOTC Heo6ocnoeanHo.

15'ObHble cmpa6aiom om pezpeccuu U 6o03pauWaiomcsi 6 6oRbHuzJbl qepe3 3 - 4Mectu,a. 3mo e)oKa3bl1aem HegtpxIeKmuGUOCmb maKoeo ieqleHUq, HO

2ocy6apcmino He xoqem noHRAtb 3mo Jt

BpalH anI5 Bb1ABjieHHsA TB3 Ha paHHeM 3Tane npeflnO4HTaIOT noBceMecTHbLie npoBepKH rpHrIOMOlLIH 4MHOOpOrpa4+HH, L.To6bi 6blnIo 6onIblme BO3MO)KHOCTe4 ,asIfl Bbl3,aopoBneHHMA.

"Mbl npuebLCIu pa6omamb c qbvoopo2pat.Juefi. Cfcnol7b3yq cucmemy ,/JOTC,Mbl 6bl.%?&LqeM UH/LeK1fU70, HO smO 6O3MO1ICHO MOJlbKO y mex 6oHblixX, y

Komopblx TE 6owen ymce 6o oocmamouno 7zy6oKoh cmatiuu. (nA7opoepaqbus

nO36ouSem 6bl6UflUMb UHqIeK4U/O Ha Hatia/JbHOM amane.

"JeHb2U, KoMOpble 3KOHoAUiACm? Ha vz1oopo2patpuu, nompe6yiom y6eenuiewiU3

(PUHaHCUpOeaHU5? Ha jeueHue ".

rocy,aapCTBOM onpejaeneHbl rpynriib nOBblIUieHHOrO pHCKa, KOTOPbIM c~nlooporpacH

npOBOQaHTCAl 6ecrIlaTHo. OjHaKO MeqHKH cqiHTaIOT, MTO HCKOTOpbie npeRCTaBHTeSH rpynn

nOBblUleHHOFO PHCKa He YqHTbIBaOTCAI - B OCHOBHOM pa6o'-re H nIogrn 6e3 riOCTOSIHHOrO MeCTa

)KHTeRbCTBa H 6e3 nOCTOSIHHOr4 pa6oTbl. TaKHe 6o0zbHble COCTaBJIAIOT Cy1eCTBeHHYIO ,gOflO

60obHbix Tb. HauHeHTbI, He HMelOUHe nOCTOSAHHOrO MecTa pa6OTbl HniH )HTejIbCTBa, 3TOH

nporpamMMoH rocy,aapCTBa He OXBa'IeHbl.

KpoMe nnoxoi opraH43aumHH npeaocTaBJneHHsl ycnyr CyUeCCTByeT Tao*Ke npo6neMa cna6o0H HnIH

He nOlKpeniieHHOH HOpMaTHBHbIMH MepaMH rocyZapCTBeHHOH IOjIHTHKH, qTO meuiaeT

aeKBaTHOMY KOHTPOJIIO paCnpOCTpaHeHHSi 3a6OfleBaHHs. KaK yKa3blBajOCb BbIHJle, BOnPOCbl

KOH4MHgeHUHaAbHOCTH 3aCTaBJIAIOT 6onblUoe KOJU4HeCTBO pa6oTaiotHx 60obHblX H36eraTb

O4HLHIaIbHOH MeaHUHHbl, KOrga y HHX o6Hapy)KHBaeTCA TB. TaKoe nOBefeHHe meuiaeT

OTCRe)KHBaHHIO aKTHBHbIX KOHTaKTOB H paHHeMy BbIABjieHH1O 3a6ojieBaHHH rOCyaapCTBeHHbIM

3LRpaBooxpaHeHHeM.

B COOTBeTCTBHH C HOpMaTHBHbIMH aOKyMeHTaMH Ka3axcTaHa, CyweCTBY1OT rpyriHibi npO¢eCCHH

(pa6oTHHKH o6iueCTBeHHOrO nHTaHHA, yqHTeJSI, BpaqH, pa6oTHHKH PbIHKOB

CenHCKOXO3.qriCTBeHHOH ripOjYKUMHH H apyrHe), KOTOpbIe AOJDKHbl IIpOXOa)HTb MeaHUHHCKHH

OCMOTp HeCKOJTbKO pa3 B roJ, 'ETO6bl nOaTBepAHTb, 'TO OHH He SqBJISIOTCA1 HOCHTeJISIMH

HHCeKUHOHHbIX 3a6oJieBaHHri. Y Ka)KLOrO pa6oTHHKa eCTb CaHHTapHaqS KHH)KKa, B KOTOpOHi

nlpeACTaBJIeHbl AaHHbie H pe3yYlbTaTbl nocnieaHero OCMOTpa. Be3 TaKOH KHH)KKH jiOgASM

3arIpeueHO pa6oTaTb Ha HCKOTOPbIX aOJ])KHOCTSqX. OAHaKO lIUHpOKO pacnpoCTpaHeHHaSI

KOPPYnIUHS B CO'EeTaHHH C HH3KOH 3apa6OTHOH niIaTOH nepCOHaJila CDC (areHTCTBa,

OTBMelaEouerO 3a Bbiaaxiy TaKHX KHH)KeK) 03HamaeT, qTO CaHHTapHbi KHH)KKH MO)KHO KyHHTb, He

npOXOzap OCMOTpa, TaKHM o6pa3oM, JIIOgm MOrYT pa6oTaTb H pacHpOCTpaHSITb 3a6oJIeBaHHe.

"CaHumapHbze KHU3?CKU npuo6pemaiomcst e CJC. JTliokm c maKUMUKHUdICKaMU pa3pezueo pa6omamb, xomst OHU MOZYM 6bzmb 60,ubHbl TE. H3-3a

gmozo 6o]ze3Hb pacnpocmpanRemcAs euie 6blcmpee"

58

HpHHMTbie npaBHna ripe,lycMaTpHBalOT, 'To6bi MeaHULUHCKHH nepcoHan pacnpejaen]inMeJRHKaMeHTbl H KOHTPOJHPOBaiJ HX npHeM B npaBHJ]bHOr aO3HPOBKe H B npaBIjIbHoe BpeMs,KaK npeanncaHo Bpa4oM. 3TO M3BeCTHO KaK CTpOrO co6lIoaeMbiH KOMnOHeHT CTpaTerHH,1OTC npeHa3HaqeHo ,ansl o6ecneqeHinl npoXo)KaeHHSM naLHeHTOM ronIHoro Kypca J1eCeHHSI,Heo6Xo,aHMoro Aj1i3 H3CieqeHHA.

O'eBHI4HO, 'ITO B TB 6onbHi-uax Ka3axcTaHa He XBaTaeT KaqpOB. HeKoTopble cTpaTerHH ewe60Joblne ycyry6iiqioT 3TY HeXBaTKy, npeAsiBnIA OFPOMHbie Tpe6oBaHHA K JIIOaqM, pa6oTatowHMB 3TOM ceKTope. OTCYTCTBHe BpeMeHH Ha pa6oTy BnHMeT Ha KameCTBO HHc¢opMauHH, KOTOpyKononytaeT HaceJieHHe. llnoXoe Ka'eCTBO HH(OpMpauHH mewlaeT nOJIHTHKaM a,JeKBaTHOpearHpoBaTb, ocyLeCTBflS1Tb nHJaHHPOBaHHe H pa3pa6aTblBaTb cTpaTerHH.

M Znutuem omtembi aoma noc7e pa6ombl, nomovy imo 6 60Abnutfe Abismo2o oenamb He modIceM. Mbl nepezpywceHbl pa6omou. ,qSf HanucaHu5om4ema mpe6yemcx 6ea qaca. HHoooa Mbl ao6ce He cnpae,3eAcq ".

CyIueCTBeHHO BJIHqIOT Ha pacnpOCTpaHeHHe 3a6ojieBaHHA cpexa HaceiieHHA npo6neMbl,KOTOpbie Ha6juoafOTcs cpeRH 6blBWUHX 3aKnKO'qeHHbIX H aHTHCOIHJanbHbiX 3n1eMCHTOB C MPTB.B CBS3H C 3THM 6blIH flpHHSTbi 3aKOHbl, o6A3blBaiouwe TaKHX nlioaeki npOXO,IHTb IieqeHiHe.O,aHaKO, co6JlogeHHe 3THX 3aKOHOB He Bcerua naaOKHbIM o6pa3oM KOHTpOflHpyeTCSi.

"CyuJecmeyem 3aKOH o6 o6l3ame3bHoM 7leqenuu, ec7u Heo6Xo8UMo, acy6e6&oM nopqoKe. fIe'eHue omuaOJo 6blmb Hamamo 6 meqeHueonpe6eAeHHo,-o epemenu c MoMeHma 6blq6AelHuq 3a6oJle6aHuw, HO Ha CaMOM6ene yxocum noqmu MecRLJ. 7o0nuu,WZ He xotem noMo.ambt, nomomy qmo uM 3a30mo He niiamitm. MeY)UKu noKynaiom ece Heo6xo6uLMoe (nsl ancaiu3o3 3a ceouc'iem. Bce gmo meuiaem a6eKeamHofl pea)iu3ayuu -ocy6apcmeeHHOunon7umuKu

OCHOBHble BbISIBJieHHbe 4aKJTbI

(DaKTbl, 06HapyIKeHHbie B xoge KaqeCTBeHHOFo HccneoBaHHa1, IaCTHtHO o6¶bsCH3IOTnpo6neMbl, C KOTOpblMH CTanKHBaeTCS rocyaapCTBeHHaA nporpamma no 60pb6e c TB:

> POCT 3a6oneBaeMOCTH H PaCTyLuHe npo6nJeMbI C MPTB> MegneHHoe CHH)KeHHe cMepTHOCTH no HpHqlHHe TB

F FocyjgapcTBeHHas nporpaMMa no 60pb6e c TB) He qaeT O)KHaaeMbIX pe3yJIbTaTOB.

4Ccne,oBaHHe noKa3ano HaJiH'eHe aeKBaTHOCTH pellueHHH no HHBeCTHUHAM, HaripaBjieHHbIMHa:

* Pa3BHTHe H COBepweHCTBOBaHHe HH#paCTpyKTypbl, KOTOpaS y)Ke ceHiqaC HaXoaHTCs BnnaIeBHOM COCTOSHHH, MTO cnoco6CTByeT paCHpOCTpaHeHHKO 3a6oJieBaHHs cpeUHMe,HUHHCKOFO nepcOHana B iieqe6HbIx yMpeKrZeHHAx, a TaKoKe cpeaM HaceiieHHq. 3TOTaKwe BeaeT K POCTY 'iHcJIa 60oiHbIX c MPTB cpegm rnauHeHTOB 60JbuHHU.

* Pa3BHTHe Ka,poB ,gq riporpaMMbI no 6opb6e c TB H CHCTeMbi nepBH'4HOi MeeAHKO-CaHHTapHOH HOMOriom , KOTOpaS HrpaeT Ba,KHYIO pOnb B KOHTOpj]e paCHPOCTpaHeHHSI3a6oneBaHH.q, oco6eHHO B CeflbCKOH MeCTHOCTH. ECJIH B 4eJIOBeqeCKHe peCypCbi He

59

6y,ayT BKYiaablBaTbCS CpeUCTBa, MaJIOBepOSTHO, ITO 6yAyT npegocTaBSITbCA ycsIyr

;IOCTaTO4HO BbICOKOFO Ka4ecTBa, qTo6bl YJ]YHlqlTb pe3yflbTaTbl 1ee-liHHA.

* Heo6xoaHiMo pa3pa6oTaTb CHCTeMy, KOTOpams nO3BORHT KOHTPOflHpOBaTb KaMeCTBO

Me,aHKaMeHToB. Heo6xo,aMbI TaKeKe HHBeCTHtjHH B CO3n,aHHe aaeKBaTHOfi CHCTeMbi

pacnpege,neHHs Me,4HKaMeHTOB, qTo6bi rapaHTHpOBaTb HerfpepblBHble nOCTaBKH

Me,AHKaMeHTOB no BCeH CTpaHe H rapaHTHPOBaTb HenpepblBHoe iieMeHHe.

* flpeaocTaBneHHe ycnyr B HacTOAiwee BPCM5 opraHH3OBaHo nnoXo, OHH He

aaarITHPOBaHbl K YCJIOBHAM C ero OrpOMHbIMH paCCTOSHHAMH H HH3KOH HJIOTHOCTbIO

HaceneHHA B ceIbCKHX perHoHax. Cna6aA HHTerpaLHAS pa3JIHHbIX YpOBHeH

npeOCTaBnjeHHsl ycnyr TaKwe meluaeT HCnpepblBHOMY iieqeHHio 60JobHbix TB. ECJIH He

pauHOHaJIH3HpOBaTb npegoCTaBJIeHHe ycnyr H eCJIH He 6yaeT JaOCTHFHYTa a<eKBaTHas

HHTerpaUHA, ManOBePOSTHO, 'TTO npo6neMa TB B Ka3aXcTaHe 6yAeT pelieHa.

* KYJIbTypHbIM H COLHajibHbiM acneKTaM He yOenAeTC OJI)KHOrO BHHMaHHS Ha YPOBHe

rlOJIHTHKOB, a MeXaHH3Mbl y'leTa 3THX aCneKTOB ewe He pa3BHTbl. Heo6xomHMo

H3MeHHTb OTHouJeHHe HaceJIeHHS K TE. CpeaCTBa MaCCOBOH HH4OpMauHH H apyrHe

Cpe,aCTBa KOMMYHHKauHH B nepByIO olepeAb aOJnDKHbl yaeniATb BHHMaHHe 3THM

BOnpOCaM H HanpaBJATb H3MeHeHHe o6weCTBeHHOrO Co3HaHHA. Heo6xomHMo

pa3pa6oTaTb XOpOWlO CnHiaHHPOBaHHYIO CTpaTerHIO, YBS3aHHYIO C YCJIOBHSIMH CTpaHbl H

perHOHOB, C BbuteiieHHeM pecypCOB H3 pecny6nHKaHcKoro H MeCTHblX 6io,a1eToB.

Heo6Xo,aHMo CjOMaTb Te 6apbepbl, KOTOpbIe B HaCTOAIwee BpeMS OCTaHaBJIHBalOT

60JIbHbIX OT oGpalUeHHA K Bpaly.

* lOJInHTHKa KOHTpOJIA pacnpOcTpaHeHHsi TB H couHajlbHOH 3aWHTbl Tex, KTO cTpaaaeT OT

3TOrO 3a6ojieBaHl4, - ewe OaHa npo6neMa. OTCyTCTBHe COuHaJibHOQ 3awHTbl He

nO3Boni.qeT MHOFHM 6onbHbIM o6paLuaTbcA B MeJHUHHCKHe y'pe)KaeHHs4. CTpaTerH4A,

3anpemaioiiaA 60nbHbiM TB pa6oTaTb B HeKOTOPbIX ceKTOpaX, TaKoAe cHoco6cTByeT

3TOMy. Ka3aXcTaHy Heo6xo)iHMo H3MeHHTb 3TO OTHOlueHHe, MTo6bI o6ecne'lHTb

344eKTHBHyIo noa,4epXCKy anIA 60JobHbix TB, npoxoqAiuHx neteHHe, H 3aiHTHTb HX

pa6o'qHe MecTa. Heo6XoxgHMo H3MeHHTb rOcyaapCTBeHHYIO nOJIHTHKy B o6nacTH

3,paBooxpaHeHH o ps,D,y HaH6ojiee Ba)KHbIX HanpaBjieHHii.

* OTCYieKHBaHHe aKTHBHbIX KOHTaKTOB H BbISBjieHHe 3a6ojieBaHHHi qOJDKHo 6blTb

OpraHH3OBaHO TaKHM o6pa3oM, '-To6bI 3ai1jHTHTb KOHcPWWHuHaJlbHOCTb naUHeHTa.

oimOublioe KOJ1H'eCTBO cTpaH ycnemIHo peaBjH3yeT 3:b4eKTHBHbie CTpaTeFHH, H Ka3axcTaH

MOr 6bl H3BneHb ansi ce6.q nOlOb3y H3 HX OnblTa.

* CyIIeCTByioWHe MexaHH3MbE 4IHHaHCHpoBaHHS nporpamm no 6opb6e c TB (HH3KaA

3apa6OTHasi nnaTa, HegoiHHaHcHpOBaHHe ne'e6Hblx ynpe)xKeHHri, cnia6as MOTHBauHSI

MeAHUHHCKOFO nepcOHana gis pa6oTbl B Jle4e6HbIx yqpe)KgeHHMX no TB) Heo6xoaHMo

nepecMoTpeTb H OTKoppeKTHpOBaTb.

06cjie,aBoaHHe HpOTHBoTy6epKyJIe3HblX y'Ipex(eHHH

HCCneaOBaHHe neqe6HbIx yqpe)KAeHHH TB, npH KOTOPOM npOBOaHfCSc aHaniH3 o6wHX yCjiOBHHi

pa6oTbl, COCTOSHH3 O6OpyfOBaHHS H KJIHHHMeCKHX yCJIOBHH gLq peaauH3aUHH CTpaTerHH ,TOTC,

B TOM qHcjie B03MO)KHOCTH AHaFHOCTHKH H pacnpOCTpaHeHHA MeaHKaMeHTOB, ;BJ]O Ba)KHbie

60

pe3yflbTaTbl B OTHOlUeHHH HpO3HJIqS yCJlyr, npeAOCTaBjiAeMbIX rpOTHBOTy6epKyjle3HbIMI4,aHcraHcepamm B HeKOTOpbIX perHoHax. B pe3yRbTaTe HccJie,aOBaHHs 23npOTHBOTy6epKyny3HbIx yi-pexcKeHHM npeUCTaBjieHbl Ba)KHbie BbIBOabl B OTHOHeHHH npoWHnIycJyr, npeaoCTaBflSeMbJX B TB; xicnaHcepax B OTO6paHHbIx perHoHax. MHorme H3 3THXBblBO,aOB nOTBep)KaaOT Ha6itoJgeHHA, cgenfaHHbie B xoge o6cyK?aeHHA C ueJIeBbIMH rpynnaMu.B gaHHOM pa3,qeie CYMMIIPYIOTCs BblBO,abl HCCfle,OBaHHiA nefe6HHU nO TpeM OCHOBHbIMHanpaBneHHMlM: pecypCbl (B TOM qHcne Ka.apbi, MeJAHKaMeHTbl H pacXOaHbie MaTepHaJbi,o6OpyraOBaHHe H TeXHOJIOrHH), npouegypbi H .aOCTyn. OcHoBHble npo63eMHbie BOHpOCbInpeCTasBfeHbl B KOHuea aHHO4 rnIaBbl.

YqpewceIeHus TB

Bcero 6b0o HccfleJOBaHo 23 neqe6HElx yqpeKcLeHHS Tl, cpeR14 KOTOpblX 15 6OnbHHU H,aHcnaHcepOB H 8 1eHTPOB nepBHMHoH MeaHTUHHCKOP nOMOWH. flpHBeaeHHaq HIVKe Ta6jiHuaCYMMHPYeT pacripe,eneHne HCCJIeCOBaHHbIX y4pe)KaeHHi4.

Ta6alnua 19: 06cJIezaoBaHHbJe yqpeAcaeHHn

Koj1HqeCTBo % PeaJIbHbub % CoBoKynHblfl %lpo0TBoTy6eplcy.ie3Hblrl nH cnaHcep I 0 43,5 43,5 43,5BoJnbHnua o6iuero npo¢Hsi 5 21,7 21,7 65,2Yqpemc,geHHe IIMCH 8 34,8 34,8 100Bcezo 23 100 1100

143 23 HCCfIleOBaHHbIX yqpe)KgeHHH B 20 HMenJaCb Jla6opaTopHA, HO JIHHWb B 47% B yqpeX(VeHHHHMenaCb pa6oTalouian anTeKa. 06wee COCTOSHHe 3aaHHH o'eHb nnoxoe, npHqem 6onbuJHHcTBy32aaHHHi 6onblne 10 nieT, H BO MHOI'HX H3 HHX B nocnieuHHe nSTb neT peMOHT He HpOBOIHJICs. BLjeJoM BceFO B 87% ympewaeHHH HMeeTCA riHTbeBaSi BOaa, H B 6o0iee 90% pa6oTamH TyaIeTbl.rIOMTH BCe yqpe)KaeHH5 MOryT BbSIBHTb rpynnbl BbICOKOrO pHCKa H Hnpe,OCTaBHTb 6a3OBbieCTaTHCTH'eCKHe gaHHbie nO KOJIHLeCTBy 6OnbHbIx, paCnpocTpaHeHHKO 3a6oJIeBaHHSA,CMepTHOCTH H o6mwM coUHaJ1bHO-3KOHOMHleCKHM YCJIOBHAM.

BO3MO)KHOCTH npeaocTaBjieHHs 6a3oBblx ycnyr 6bi.nH pa3HbIMH. B 96% yqpexKaeHHri eCTbB03MO)KHOCTH aJIAI rPOBeaeHHS aHanJH3a peaKuHIH MaHTy, B 87% y1 pe)CIeHHH B03MO)KHOHpOBegeHHe aHaJH3a MOKpOTbI. JIHIIIb B 35% ,aHcnaHcepOB H 6onbHHU HHTaHHe no, Haa3OPOMcieuHaniHCTa no rIHTaHHIo. 1cCcAegOBaTeJIH ROJIO)KHJIH o6 aHTHCaHHTapHbIX YCJIOBHAX B 30%nOCeeHHblIX LIeHTPOB, H JHIflb B 50% LUeHTPOB Ha MoMeHT HccJieROBaHH4 6bulo MHCToenOCTeIbHoe 6enbe H ripHMepHO B TaKOM wKe KOJ]HqeCTBe (50%) yqpexCqeHHA 6bljia ropAqa3iBOga. JIHInIb B 34% yqpe)KLeHHH 6bmJI pa6oTaioiiiH reHepaTop Ha cjiyqari OTKJnOqeHHS3JIeKTpO3HeprHH. HeCOOTBeTCTBy1OuLtHe pa6oqHe YCJIOBHA HOaMepKHBatOTCs TeM ( aKTOM, qTOHOqTH B 10% UeHTPOB npezblayLmeH 3HMOH He pa6OTajio OTOnneHHe.

AOCTyn K IIHTepHeTy H CpegCTBaM CBA3H OCTaeTCS HH3KHM. JIHIJJb y 34% IeHTpOB HMejicSJOCTyn K I4HTepHeTy H 40% - AOCTyn K TenJeBHKeHH}O H BHaeOCHCTeMaM. OaHaKO 75%yqpe)K,eHHri HMeJH aOCTyI K CpeACTBaM CBSI3H 11aIA CpO'IHOrO Bbl3OBa.

61

Pecypcbl yqpewneHHHi TB

HepcoHajl

Pe3ynbTaTbl noaHiepKHBalOT 45aKTbI, BblABJieHHbie B pe3yflbTaTe o6cy,gfeHH9 C LenjeBbIMH

rpynnamH H aiarnHa aaHHbIX Ha o6nacTHoM ypoBHe, KOTOpbIe noKa3bIBaioT, 'ITO YPOBeHb

YKOMniieKTOBaHHOCTH Ka,aPaMH CHJ1bHO OTnH9iaeTCSI B yHpexKLAeHHSIx. Bo MHOrHX y4peXCVAeHHIAX

HMeeTCSA HeXBaTKa nepCOHana B CpaBHeHHH c pa6o0eil HaFpy3KOH, H YCJIOBHAl no o6ecneqeHrno

6e3onacHocTH Ha HH3KOM ypOBHe.

Pe3ynbTaTbl HccnejaoBaHHfi nOKa3bIBaloT, qTO 6onee 95% nepcOHana 6buio o6ymeHo cTpaTerHH

,AOTC, XOTSI MHOrHe H3 HHX Bblpa3I4J1I COMHeHHA5 B OTHoIueHHH uenecoo6pa3HocTH

npMeHeHHAl H 3IMeKTHBHOCTH 3Toro rroaxoga. 3TH pe3yflbTaTbi nO4qepKHBalOTHeo6xo,amMOCTb yjiyqueHAs o6yqeHHwl B 3aBeBeHHSlX BTOpOH cTyreHH, KOTOpbie Heo6xoaHMbi

,aJA ycnexa nporpaMMbi. B nocnejaHHe 12 MecAI4eB TOJIbKO 35% Bcero onrpoIeIHHoro nepCOHananpOWnH o6ymeHHe no BonpocaM TB H COnIYTCTBYIOIHM BOnpocaM, TaKHM KaK BI'4/CflI4m..lHLb 52% COTPYqHHHKOB llpOUiH 06y'eHHe no CHH)KeHHIO CTHrMblaJnA pemieHAs COUHaJIbHbiX

BOnpOCOB, CBSI3aHHbIX c TE. HOqTH B 50% cJIy'laeB nepcoHani He npoinen o6yqeHHe BonpocaM

BI4N/CfIHJI0 B nOcne,iHHe 12 MeCALeB. flpIMepHO TaKHe lKe pe3yJlbTaTbi 6bulwH o6Hapy)KeHbl B

OTHouJeHHH TeXHHIeCKOFO o6yqeHHSI B Bonpocax na6opaTopHoro aHamH3a (65%). BblCOKHHi

YPOBeHb o6yMeHisl3aIMHKCHpOBaH cpeaH TeXHHieCKoro nepcoHania (y6opuHu), 6onee 85%.

060pyzoBaHHe

1Iccne,aoBaHHe yHipe)KjeHHI4 nOKa3blBaeT, 9TO COCTOSIH4He HH4PaCTPYKTypbl BO MHOrHX

Y4P)iCpe)HHAX He OTBeCaeT MHHHMaJnbHbIM CTaH,apTaM, Tpe6yeMbIM ,inSI yYpexmCeHHr4 TB.

JIHHIb B 82% yqpe)KaeHHH HMejICSI MHKpOCKOI (H TOJlbKO B 56% OH pa6OTanl), B 35% 6bimXOJ1OaH4JbHHK, CpeaHHH CpOK cnyxc6bl peHTreH-annapaToB cocTaBJSleT 6onee 10 neT, a

nomeiieHHA 4J1A ae3HH4¢eKIHH HaxofHaHCb B HeaqeKBaTHOM COCTOSIHHH. XOTI 6o0iee 95%ympe)K,jeHHH HMelOT a,aeKBaTHbie CpeCTBa RnSi o6e33apa)KHBaHIsA, B ueHTPaX He,ROCTaTOqHO

XOPOIIO YTHflH3HPYIOTCA OTxoabi (y 62% yqpe)KaeHHfi He 6blnO MmXeaHH3Ma qj1i YT THJH3auiHH).Hlogo6HbIM o6pa3oM, TOnlbKO y 48% LeHTPOB HMeiJaCb aaeKBaTHaSI BeHTHJSI4HSI, y 73% He 6bmJIo

MexaHH3MOB KOHTPOJIs KaxeCTBa BO3JyxaB H y 22% yxpexKgeHHA He 6bino niMan ainsAKBap4eBaHHSA.

JAeKapCTBeHHbie upenapTPTbI H PaCXOgHble maTepUaiibl

I4ccneflOBaHHe ytpe)K,AeHHii nOKa3anO, 'TO OHH HCnIbITbIBaiOT ge(PHUHT B jieKaPCTBeHHblX

CPeACTBaX H PaCXOJIHbIX MaTepHaniax. MHorHe ytipe)KaeHHaI HCnblTbIBaiOT npo6neMbl C

HH#paCTPYKTypOH, KOTOPbIe OnIHCblBanjHCb B npegbigyuem pa3eiene. CJIO)KHOCTH B

rpe,ROCTasBjeHHH a,aeKBaTHoro yxoaa ycyry6nsIOTCsi HeXBaTKOH OCHOBHbIX peCypCOB.

B Ta6nHi4e 20 rpeACTaBneHO HaiiHqiHe OCHOBHblIX peCYPCOB Ha MOMeHT nPOBe,aeHHAHccne,IOBaHHSI. KaK nOKa3aHO Ha Ta6JnH4e, Ha MOMeHT HCCJiTeOBaHHKA JHIIIb B 44% yqpezKaeHHA

HMeniHCb MaCKH. MeHee qeM y 20% y'pe)KgeHHri HMeJIHCb OaHOpa3OBbie UwnpHibi H nePiqaTKH.

62

Ta6JIHua 20: HaJwHqHe MCeaHUHHCICHX pecypcoB

HamiHHme (%)

HanMeHoBaHHe ,LLa HeT He 3iaioMeuHKaMeHTbl 96 4 0(rnepBoH JIHHHH no Th)TeCThI 70 17 13LHnpiHUbl 16 74 10Hep'iaTKH 16 65 19MaCKH 44 44 16

Ta6ntuia 21: HaiiHqHe tpyFrX pecypcoB

HaAuiine (%)HaHMeHoBaHHe Ha HeT He 3HaiorIocTejlbHoe 6eibe 48 40 12WeKaea 17 70 13

AHaJuI3bl 70 17 13FIHTaHHe 35 53 14

HpenIJTCTBHa B ILocTyne

B LjeJoM, y OnpOwIIeHHbIX 6onbHbIx He 6bEo cepbe3HbIX npo6neM C 4H3HMeCKHM JROCTYnOM Knie4e6HblM y4pexKaeHHAM. 30% OripOWeHHbiX mOKm3ajI, qTO HM JI3S TOrO, 4TO6bl Ao6paTbcA UOneqe6Horo yqpexeHHAs Heo6xoqHMo 6o0iee 30 MHHyT. B 6ojibumHHcTBe cniy4aeB cpeaCTBOMnepeaBHBKeHH ABJISeTCS neuHi xoa (40%) H aBTO6yC (42%).

O630p MCIHLIIHHCKHX y4pe)KaeHHii nOKaBan, qTO B 6o0nee 90% H3 HHX MeRHKaMeHTbl HMe;HUHHCKaA nOMOLLb 6OflbHblM TB npeqoCTaBnAlOTCS 6ecnnaTHo. flpH 6o0nee BHHMmaTeJbHOMH3y,ieHHH o6HapyxmKnocb, 'ITO B 6onee 40% yqpexKceHHH B3HMaeTCSI ninaTa 3a ;IpyrHe ycjnyru,TaKHe KaK oJge)Kga, HOCTeRbHoe 6enbe, aHlajH3bl I nHTaHHe, HpHqeM Bce 3TO Heo6xoaHMO ,nsiJIeqeHHsA. H4HEIMH CJIOBaMH, naIHeHTaM Mo)KeT 6blTb rapaHTHpoBaH lOCTyn K MeaHKaMeHTaM,HO CTOHMOCTb r1HTaHHA H inOCTenJbHOFo 6eibq HaCTOJIbKO BbICOKa, qTO MHorHe 6onbHble HeCTpeMATCS Ha-iaTb ieweHHe HJIH He MOFYT npH,OaOfKaTb ero B TelqeHHe IIJCCTH MecALleB.

(4HHaHCOBbie npenSTCTBHq, BeposTHee Bcero, CHH3SlT 3cMeKTHBHOCTb ne'eHH3I. KpoMe qaHHbIX,npe,aCTaBjiCHHbIX BbiwJe, H nOKa3aTeJIA, 'ITO 6onee 20% 6oJbHbIx BbIHyxoeHbi floKynaTbMe;IHKaMeHTbI B EiaCTHbiX anTeKax HIH OTKTa,TbIBaTb JIeqeHHe, iiHiIb 6% onpoLeHHblx 6o0JbHbIxHe OnHaIHBaJIH KOHCyJIbTauHIo. 3To nO;TBepXKaaeT caenaHHbie paHee BbEBOZIbI 0 TOM, '4TO6OJIbWHHCTBo 6onbHblx nony'aeT 6ecnnaTHble MeaHKaMeHTbl, a Bce npoq'e Tpe6yeMble ycniyrirpe;joCTaBJls3IOTCs. nJIaTHO.

OCHoBHbIe BblI5BJieHHbie IjaKCTbi

B OTHOllhCHIH npouecca H BO3MOKHOCTeir, HMelOIUHXCA1 AIAs npeaOCTaBjeHHS4 nOMOmH TInauHeHTaM, 6EiuH yKa3aHbl cJieaytouHe npo6JIeMI:

* CTpaTerHS AOTC CJIO)KHa B HcnoJIHeHHH, yqHTbIBaS ee Heco6nmogeHHe naLjHeHTaMH;* JIHLUb 10% onpow1IeHHbIX nauHeHTOB 6bhIo npenHcaIHo neqeHHe AOTC HJIH OHH 3HanH,

qTO OHH4 cfieleylOT CTpaTerHH ,OTC;* HeperynsApHbie noceMeHi4A yqpe)KaeHHM aM6yjiaTOpHbIMH 60obHbIMH;

63

* Heco6rnojaeHme nauHeHTaM4 npeaniicaHHoro neqeH4sl;

* Hinoxoe FIHTaHH4e npenslTCTByeT H3nevieHRIO;

* 'laCTbie nporymbl Co CTOPOHbl naLuHeHTOB;

* JIHIUb B 39% yqpe)KaeHHM BeaeTCsl aOJ1)KHbIl yqeT cny'qaeB 3a6oneBaHH14;

* BOnblllHHCTBO y4pe)KaeHH14 noKa3aJIo, 'TO OHII He o6MeHHBaIoTcsq HHbopMaU4eri Me>K,ay

y4pe)eHHsIMH Tb H 4MCFI;* BpeMsl, Tpe6yeMoe Ha 3arIOJ1HeH14e ,OKYMeHTaBum 14 OT'eTOB, yaeilAemoe BpaqaMH.

Heo6xo,aHMa ynpoLueHHaq npoueaypa

* JIHWlb B 70% yMpe)KaeHHr4 H4MCKOTC5 B03MO)KHOCTHa ji1 aHlHa3a MOKpOTbl;

* JIHWnb B 50% 6onee ojuHoro pa3a B roa npOBOqHTCA o6ymeHHe HnH4H nepecmoTp

rpOTOKOJIOB;

* YMpexKeHMsI MaJIbl 1 pacnojio)KeHb ,aajieKO OT pal4OHHOrO ueHTpa, orpaHHqHBaSI JOCTYr

H yBeIIH4HBasI CTOH4MOCTb npoe3,aaljHIA nariBeHTOB

* HegOCTaTO4Hoe KOJIH14eCTBO TpaHCriOPTHbIX CpeaCTB;

* HeXBaTKa Bpa1eri;

* OrpaHHiqeHHoe KOJIH4qeCTBO Bpaqem C BblClIHM o6pa3oBaHHeM;

* HH3KaA 3apa6oTHaA niiaTa;

* 4 HeCOOTBeTCTBY}OI1ee OTHOluIeHHe K JIexieHHIO;

MHeHHSI OTHOCHTeJibHO nporpaMMbi HO 60pb6e c BIUCHIIH

OCBeIoMJeHHOCTb HaCeH1eHHU1 H OTHOIueHHe IC BOUpOCy BII/CIIHl

sOJ]bMlHHHCTBO onpoiIIeHHOFO HacenieHHA noaHepKHYJIO, 'TO, HecMOTpsI Ha npOBOaHMYIO

npoc)HJIaKTHqecKyio pa6oTy, HaceneHie Bce ewe He 3HaeT o B4II/CrIll4e, oco6eHHo cTapwee

noKonieHHe. 3TO Mo)KeT flpOHCXOaHTb HOTOMy, qTo 6oJbmuHHCTBo nEioieH CTapiuero nOKoJIeHHs

CtHTaeT, 'ITO 3Ta npo6JieMa HHKorga He KOCHeTCsq MX HnH. i HX ceMeHr. CeJbcKe )KHTeni

IlOJIHOCTbIO HrHOPHpY1OT 3TOT BOnpOC. HeKOTOpble HaH6oJiee THIHt4HbIe OTBeTbl nlpeaCTaBJieHbi

HH)Ke:

o<OceeooMJzeHnoCmb nacemeHunw o BHI/ICHHJI cocmaa'rnem npuuepHo 40%.MoAooediCb 3Maem, 'mo CnHH[ nepe6aemc3i noloebilm nymeM, u timo oHuaoJncHbZ ucnolb3O6aMb npe3ep6amu6bl, 'imo6bi 3au#umumb ce6M. 39mo cce,

jlMo OHU 3naiom>>.

Bpa'qH, KOTOpbie pa6oTaboT c na1LHeHTaMH BWI/CfI, OTMeTHJIH, 'ITO He TOJIbKO HacefleHHe,

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,OCTaTOqHO XOpOImo OCBeaoMjCHbl o6 3TOHl npo6neMe.

?IJIoxo uHqbopMupoeaHHblU MeoUt1UHCKUU nepcoHajz ne 3Haem, KaK eecmuce63 f c6zytiae Heo6xooumocmu CKOpOU noMoufu unu KaK pa6omamb c KpOeblO.

TeM CaMbiM oHu noie)ep2aiom ce6sz pUCKy, KoHmaKmUpyq c nauueHmamu

BHLICf/CHH4.

oOHadlc6bl, KcooAa x 6bma Ha 6ewcypcm6e, 6 6 oAib7uyy npuuien BH'-I-uHqu1 JupoaBaHnblu natjueum. )I eu6eqa, KaK peazupocanu ceCmpbl u epa'u -

OHU 3anauuKo6alu, oyMa?, Iimo OHU 3apa3wuCb, KOrfa noXnJLu, timo naijueHm

uHuluyupoean BJPT,h.

64

as. ce cpeou me6uyuncwoZ nepconaiia cyuiecnmzyom n7o0u, Komopbienpeonhza0om u30.lupoeamb BHI4I/CIH4 naqueHmo0, KaK qyMHblX, KaK 6yfmooHu 6e3HaoeMcHbl, u uem Huie,-o, ieu uMmozno 6bl noAiolb o6uqecmoo>.

Cpe,aH MeAH1U14HCKOFO nepcoHana cyMecTByeT MHeHHe, HTTO nepcoHan, pa6oTalouU4r B o6nacTHCnHga, - 3TO TOJIbKO Te, KTO 3HaeT, KaK peLuaTb 3Ty npo6JleMy. B xoge OUF 6bi1mH cny4aH,KOr,aa BpaHHn, Crleu4HaAH3HpytOLxHeCSA B apyrHx cfepax, OTKa3blBaJIHCb JIe'HTb Bllq-HH(HUHHPOBHHbIX nauHeHTOB H HanpaBJISlJIH HX B uCHTP CrIHA.

(Ecau cytqecmeyem LJeHmp CHHn , oH U oouiceH 3a6omumbCq o BHII/CHH4l,(na4lueHmax. 3mo He Hamaa pa6oma>>

HH3KaA OCBeCoMjieHHOCTb MeaHUlHHCKOFO nepcoHania H nJIoxHe YCAOBHS pa6oTbl BMCeaHUHHCKHX y,4pe)KfeHHAX BJIIAHOT Ha OTHOweHHe K riaLUHeHTaM BI414/C1JHA, H BO3HHKaeTBonpoc aHOHHMHOCTH. MHeHHSi MeAHuHHCKoro nepcoHajia B OTHoLHeHHH KOH(jM4,aeHIHajlbHOCTHpa3gejiHjiHcb:

> HeKOTOpble CqHTalOT, 'TO aHOHHMHOCTb - 3TO HHAHBHWyanbHOe npaBo '4efOBeKa,)KHByUaero c BHM/Cr1H1. MeCTHoe HaceJIeHHe He IOHHMaeT 3T0o0 3a6oJIeBaHHs H,BeposTHee BcerO, 6yaeT OTHOCHTbCA K JI)KBC KaK K H3FOM o6IecTBa.a ,pyrHe JnoaH c'HTaIoT, IqTo aHOHHMHOCTb npe)ICTaBnSIeT yFpo3y JAs o6WecTBa, rioTOMyHITO 6oJbHbie He Bcerga HCnOJIb3yioT npeBeHTHBHbie MepbiaJSA 3aWHTbl oKpy>Kaio1Hx.

f<IHo66epmcueaw npa6a BHLUn-UyuUpOeaHHbzX naz,ueHnmo, Mbl noeepeaemonacHoCmu 3ICU3Hb opyzux izio6efi. Hauca 6e3onacnoCmb He ?apaHmupoeaHa, UHawe .mHuHue 0iOJ2CHO yqumbleambcq. MeoNUUHCKUUi nepcona,z 6OA.1CeH 3nambo 3a60oleeaHuu>>.

B Ka3axcTaHe OTMeHeHa o6I3aTeJIbHas c awia aHaI4H3OB rpynnaMH BbICOKOrO pHCKa H3aKJo,oqeHHbIMH. OTHoiueHHe K 3TOMY Iuary Co CTOpOHbi Jle'Ie6HbIX yqpeleHHA H l Ho6LueCTBeHHOCTH 6bmno ripOTHBopemHBbIM. XOTS HeKOTOpbIe, Ha OCHOBaHHB [P1HHUHnOB npaBqeJIoBeKa, noggepXCHBaEOT ao6pOBOnbHyIO caaqy aHaJIH30B, apyrHe BbICTyriaIOT npOTHB TaKHXnpe,4ro)KeHHH.

off 6bl He ommeH5n o6,q3ameAbHblui oc4omp Ha BI1- Heo6xoduMo npoeepqmbecex, Kmo exooum e zpynny pucKa>>

a... 6epemeHHbre mfCeHufUHb1 aOZJCHbl npoeepqmbc3 Ha BLI/CIJHfJ. Mblnpoeooum o6w3ame,7bHbli4 aHaiw3 Ha cuwpuzuc, 2OHope1o u npoqiue3a6oAe6aHuR, nomomy Cmo OHU oKa3bleaiom 8RURHue Ha pe6eHKa. B peouoHiaxpacnpocmpaHeHunw uWjeKYUU Mbl OcIdlcHbl maKofce 6pamb aHaWU3 Ha BIIV>.

1H3-3a HH3KOA OCBegoMjieHHOCTH HaCenjeHHM JfOaH, XKHBYwHe c BHH/Cfl4Jg, COUHaJbHOH30JIHPyIOTCSA.

(o-7hou OMHOC31MCq K BITI-UHntUZ,uUpO6aHHb1M HeoamuOHo. f pa3zowapuwaw CepaqoMA, Komopbliu 6bm zomoc 6blUmU U3 KoMHambl, ecu 6 ezO Ka6unemeofiem BH•PI-uHOuqupo6auHbibi. CompytHuwy 6aHKa npuLWZOCb h601UMbCq Cpa6ombi u3-3a mozo, 4mo OH 6

bm11 BHJ-uHPuzjupoeauHblM. Fopo) MaaneHbKuu.lHJ2opMaa zUz npocaqueaemciz>.

65

*.B UHCmumymn 3auae. pe6eHoK (BHV-uncUuyupoo3aHunbdU), u ece naanzunoKa3blaaMb Ha HeWo na,7b{iem. Yt'umehlb nfl36OHuWa mamepu u nonpocunia3a6pamb cblHa U3 uncmumyma>).

HH3Kai OCBeaOMJieHHOCTb HaCeileHHM B 60obmo0H CTeneHH o61bsCHAeTCs HH3KHM YPOBHeM 1400

cpe,aH Tex, C KeM IPOBOaHJICS onpoc. Bpa' l nooawepKHBaIOT, 'TO cpeaCTBa MaCCOBOHHH4opMauHH paccMaTPHBalOT 3Ty npo6neMy, HO B 6OJbJIHHCTBe CJny'aeB )KYPHaJIHCTaM He

XBaTaeT OIIbITa B 3TOM Boripoce. Ho3TOMy HmeIomasC5c B HaJIHqHH Ha MeCTHOM YPOBHe

HH4)opMauHH5 He ROXOIHT TO HaceneHHA. AOJDKHO 6bITb BblgeIelHO 3c¢HpHOe BpeMSi H ra3eTHas

nnioLua,qb AnSA 3KcnepTHOH o6pa3oBaTenbHoA pa6oTbl.

* MHo2ue ,70CU He coo6uta,om, qmo OHU UHPU0uUpO6caHbl BLT1 I HeKomopble6paqu He onepupyiom 6onbHblx, ec7u OHU UHtUtfUpOeaHbl BHT-I. OmHoueHue K

maKum 6o0bHbuM nmoxoe. TaKoe omHolueHue o6uiecm6a U3MeHUMb CAoJ0CHO.

Heo6xof3UMbi npotju3waKmutlecKue Mepbl, uteKluu u 6o0ee wuupoKui,

eblcOKOKa'iecm6eHHbIU oxeam eonpoca cpe6cm6aMu macco6o i UHcjbOpMaUuu)>.

((He KaJc)blu 2omoM cmoKIHcymMcb C cjbaKmacvu BHITI e ceoeM oKpydeHuU.

.. HIpo6AeMa 3acuzoqaemcA 6 moM, imo vo1u He 3uaiom o BHTIICHIHIe u o

cnoco6ax ezo nepeoatiu. 3mo co30aem zo6ywuKU)).

Pecypcbl B yqpeameHnMx BRWU/CIIW

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npo4¢HJiaKTHqeCKas riOMOIb OKa3bIBaeTCS I1yHKTaMH aOBepHA, KOTOpbie pa6oTaiOT B COCTaBe

neqe6Ho-npoc¢HnaKTHmecKHx opraHH3aUHH.

Ka3aXcTaH npH rioqAep)Ke pa3JIHxHbIX AOHOPCKHX opraHH3aUHri OTKpbLj1 6onbwoe KoJH4qeCTBO

flg RnIA o6MeHa Hrn, npe;OCTaBBneHHM peKoMeHaaUHH H apyrHx Hpo(JHJIaKTHMeCKHX H

Jieqe6HbIx ycCnyr. Pa6oTy fIl, B HaCTOAWee BpeMSI noep)KHBalOT MeCTHble 61o0KeTbI, npH'eM

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66

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67

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68

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69

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70

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PecypcbI iporpamMbi no 6opi6e c B1P1/CHI2]Hl

HepcoHai

B Ta6nHue 22 noKa3aH OCHOBHOH nepCoHan B o6cneROBaHHbIX yqpe)KaeHHAX. Ko344HUHeHTbIBapbHpyIOT OT 0,07 go 1,21 BpaHeHi o6ruefi npaKTHKH JnsI neexeHAs BI4M/CVIHEI Ha 100 TbIC.)KHTej1erj. KonHueCTBO lHnJ]OMHPOBaHHbIX MegceCTep, 3aHATbIX B nie4ieHHH HaUHCHTOB CB144/CrlH,L, HH)Ke cpeaHeri HHcjieHHOCTH rIO CTpaHe, COCTaBJIqioUeg 1,73 Ha 100 TbIC.)KHTefleri, HO, eCJiH B 3TY rpynny BKTIIOHHTb caHHTapOK, TO 3TO COOTHOweCHHe 6yaeT3HaHHTeJlbHO BbILue. HeM B cpeRHeM no CTpaHe.

Ta6aHua 22: HaJuiHne nepcoHa.ia Ha 100 TblC. HacerieHHiI

ao 3 -= 3 ': S 5: ,= = v0 = =< ^QEQU Xt

Ha3BatHe y'pe)cllefmRPecuy6nrHKaHcKmA UeHTpCHJ,a 0,87 2,27 3,14 0,87 0,87Focy,uapCTMeHHblui [IeHTp

cnI, 1,22 8,45 9,67 0,17 0,09 0,09 0,61 1,48 1,2206nacTHmoi ueHmp CrlH4L 2,79 0,09 2,79LjeHTp CHHJ4 0,44 0,22 1,55 0,22 2,43LIeHTp CrIM4 BKaparaH11HHCKO o6nacTH 1,95 3,45 5,40 0,07 0,07 0,07 0,75 0,67 0,07AeHTp CrA B )Ke3Ka3raHe 10,91 1,21 0,61 3,64 1,21 4,241ICTOtHHK: MHHHCTePCTBO 3,paBooxpaHeHHA PK, 2003 r.

Pe3ynbTaTbl o63opa riOKa3blBalOT, -ITO TOJIbKO 50% Bcero riepcoHana npowno o6yMeHHe noBOnpOCaM, CBA3aHHbIM c BM4/CHUJa, H 6onee 80% yqpe)KaeHHH HCflOJlb3yeT npOTOKOJlbl 'aJ1AAeqeHHs naHaHeHTOB c B1414. 50% yipe)KgeHHA npOBOUHT CeMHHapbl C BpaqaMH H CpeaHHMMeCHUIHHCKHM nepcoHanom no rpeaOTBpaWeHH10O nepegaqH BUM Iqepe3 KpOBb. CeMHHapbIrpOBO,jA5TCA e)KerO2aHO. 80% UCHTPOB e)KemeCAqHO nPOBOUIHT o6yqeHHe y6opMHU.

71

060pyjOBaHHe

B LtenoM 6oIbunWHHcTBo y'pe)xeHHH H4MeeT OCHOBHOe o6opyqoBaHHe, HO pe3yflbTaTbi o630parOBOPA1T o TOM, MTO 6Onbinasl 'laCTb o6OpyAOBaHHw ycTapena. Bce 060py40BaHHe,HCHOflb3yeMoe B JIe'e6HbIX yqpe)KaeHHAx BH4, HaXogHTCA B 3KcInyaTaumH 6onee rSiTm neT.

bonee AByX TpeTbH4X ueHTPOB CHIF11I coo6Hiniu o nporpamme TeKywero TeXHlit'eCKOFO

06CnyxKHBaHHA OCHOBHOFO o6OpyaOBaHmA, a 60% 143 HHX HMeEOT aeACTBylOWyfO nporpaMMyTeKyiuero TeXH-HMeCKoro o6cny)KHBaHHs HJH 3aMeHb1 ManJOFO 060pyaOBaHHA.

B cneayiouei Ta6JH4ue npeacTaBneH nepeHeiib mmeiouierocs na6opaTopHoro o6opyaOBaHHs H

YPOBeHb YKOMni1eKTOBaHHOCTH yEpeIKaeHHH.

Ta6JiiHia 23. 4Meloiueecs rla6opaTopHoe o6opyJoBaHHe

% OCHaiueHNHbIX

THn o6opy2osBaHHI y'peKaeIHHH

CneKTpO0OToMeTpbl 100,0

MOHiKU 83,3TepMocTaTbi 83,3ABTOMaTW4eCKHe MemHuHHCKHe KaflejbHHUbl 100,0ABTOMaTHieCKHe MeaHiUHCKHe KaleCilbHHUbl

(UyHKTbl) 33,3LleHTpHcjyrH 83,3XOJIO,UHJTHHKH 83,3TeCT-CHCTeMbI 100,0

HCTOqHHK: OUeHKH HCCnea1OBaHHW OCHOBbIBalOTCa Ha aaHHbIX

MHHICTepCTBa 3,apaBooxpaHeHHA PK, 2003 r.

Bce y'-ipewcaeHHs, OXBaqeHHbie o63OpoM, H4MenflH KOMri1eKTbl o6OpyaOBaHH5I aniA aHlaAH3a

I4MMyHHoro ( epMeHTa 4 aBTOMaTHqeCKHe ,aW3aTOpbE. 67% LeHTPOB Cr14lJ HCnOJIb3OBanJH

yHHCKaHepbl, MYJIbTHCKaHepbl H cneKTpO(jOTOMeTpbI, HpOH3BceeHHbie Ha 3aBo,ge B AlOWiKap-

One. fiOJIOBHHa yqpe)KaeeHH14 HCnOJb3yeT CHCTeMy TeCTHpOBaHH5I "Organon-Technics", H

TO.bKO B OaHOM ympe)KX(eHHH HcnOiTb3OBanJCA TeCT, flpegnol)KeHHblA B03. TpeTb iAHTPOB

HcHOflb3yCT pOCCHHCKyIO TeXHOIOFH1O InSA CHCTeMbl TeCTHPOBaHHSA (Combi-test).

3a6oTa O 6OJlbHbIX

B aBYX TpeTH uIeHTPOB CfflHJ ,aeHCTByIOT fIYHKTbl qoBepHA, HO TOJIbKO B 17% H3 HHX

rPOBepAlIH OCTaTKH KPOBH B BO3BpaweHHbIX mnpHiLax. 50% yqpexgeHHH coo6WaeT o6

3nuH)eMHH BW1/CflI4) H 14FMrl, ynOTpe6JIeHHH HapKOTHKOB.

boonee 80% y'pe)KeHHA npejanaraeT o6yqeHHe ais 3aKjuoieHHbIX H nepCoHana, HO TOJIbKO 50%npe,aiiaraeT neiqeHHe AJnA HapKOMaHOB. TITO KacaeTCq iieMeHHS nlauHeHTOB C FHVrI, TO nO'TH70% yxipewmeHHA He npOBOaAlT 4IH3H'eCKHe OCMOTpbl CBOHX HaLiHeHTOB-My)K114H. B

OTHOUweHHH )KeHWHH 3TOT lpOUleHT BbIPOC ,Zo 75%.

LlleCTb yqpe?KaeHHH, OXBaqeHHbIX o630poM, perynsipHo npOBOaAT CTpyKTYPHbIlH MOHHTOPHHr

KaLieCTBa Iie'ieHHA, HCHOJ1b3ysi aHaJIHTHmeCKHe MeTO,4bl, H3yqeHHe npo6 H CHCTeMbl

TeCTHpOBaHHA. PYKOBO,4CTBO H4IH KOMHTeT no KaqecTBy npOBepAlOT TaaHHbie MOHHTOpHHra.

80% iteHTpOB, OXBaqCHHbIX o63OpoM, HMenjH rpynnbi 3nHgeMH'qeCKOrO Ha6J11oReHH4A,

COCTOSALLe H3 BpameeH, 3nHmeeMHonorOB, HH4)eKUHOHHCTOB H Rpyrmx Cn3eLiHaJHCTOB. JIBe TpeTH

ytipe)K,4eHHI coo6luunH, 4TO OHH 3a,aIOT OCHOBHbie BOlIPOCbl f1O,SAM C iKano6aMH Ha 141lIH.

72

Bonpocbu B OCHOBHOM KaCalOTCI HMe1OL1Hxcs CHMHTOMOB, I1POAOR)KHTenbHOCTH CHMrITOMOB,He,aaBHHX noJ]OBbIX KOHTaKTOB H TaK ,anee. TeJiecHble OCMOTpbl My)KHHH HJII )KeHWHH 06blHHOHe HpOBOqSTC2 B 3THX ueHTpaX, H TOJIbKO OjHO y'Lpe)KaeHHe coo6LuHflo 0 HajHiHHH nepHaToK,sIA rIpOBegeHHS5 TaKHX OCMOTpOB.

67% yMpe)KLaeHHM HCHOnb3OBanH ogHopa3OBble LHlnpIUbl 1 uLTIbl, HO TOJlbKO TpeTb HpOBO,aHTcneUHaIH3HPOBaHHbie KOHCyJIbTaUHH ,AJf CBOHX naULieHTOB C I4nHln HO TaKHM TeMaM, KaKHeO6xoQaHMOCTb npHHHMaTb Ha3HaHCHHbe MCeRHKaMeHTbl Haaiie)KauLHM o6pa3oM H3H1 coo6iuaTbCBOUM nOJIOBbIM napTHepam 0 Heo6xoaHMOCTH npOHTH ne'eHHe.

He Bceraa B HaIIHIHH eCTb npe3epBaTHBbl. B TpeTH y4pe)KLeHMH, OXBaHCHHbIX 063OpOM, BnpOWJIOM ro)Ay 3aKaH'HBaJIHCb npe3epBaTHBbi, a B O,aHOM yipe;)KgeHHH 3TO cnyiyianoCb 14 pa3 BTe'ieHHe roga.

TOnbKO gBa LteHTpa OTBeTHJH4 Ha BonpoC, KacatoiiHecs npOTOKOJIOB no .JeqeHH1o I4HlVFI, HTOII03BOJISIT npeanOJnO)KHTb, HITO ueHTpbl, OXBaqeHHbie 0630poM, HMei]H npO6nleMbl CrpHMHeHeHHeM HeKOTOpb1x npOTOKOJ1OB aJ1A JieHeHH5 riaUHeHTOB C IHHnrt.

TOJlbKO 17% IieHTPOB CTHH4, coo6wuHi, 9TO y HHX HMeeTCS COOTBeTCTBYIOHuaA oxpaHa RUSIHpeCOTBpau-IeHHS Kpa)KH HapKOTHKOB.

HlpeHITCTBHS K JJOCTYBY

B LenoM npo6neM c o6ecnemeHHeM AOCTyna MeHbLue. Bo Bcex yqpexzeHHAX (Ta6.rHua 22)HMelOTCS Ia6opaTopmH. YcnyrHi, ripeaOCTsNeMbie B aM6yJ]aTOpHbIX yCJ1OBHAX, BKJIIOqaIOTaHaJIH3bl KPOBH H IieleHHe aHTH-peTpOBHpyCHbIMU rpenapaTaMH. 33% ympexcgeHiH coo6wnjvno TOM, HTO HMH llpOBOaUTCA OT I TbIC. ao 3 TblC. KOHCYJIbTaiUHH B roq.67% y'peAKLeHHri yKa3anH, ITO JIeKapCTBa, Bb1lHHCblBaeMbie qjiA Iie'eHSA naLuHeHTOB CB-I4/CI14,Ta, Bbiaa!OTCA 6ecrrnaTHO. Bo Bcex cjiy'asAx aH8aH3bl HPOBogwinCb 6ecrinaTHO.TOnbKo nojiOBHHa (50%) y4pewaeHHi npegOCTaBflMeT CBOHM nauHeHTaM npe3epBaTHBbl H aaeTpa3'bSCHeHHA 0 TOM, KaK HX MCnOJlb3OBaTb.

17% y4pe?KTqeHHi HMeIH4 peryiApHyIo, HerpepblBHYIO nOCTaBKY OCHOBHbiX neKapCTB anSAielMeHHA BW, nOUTH B 85% Bcex y'pe)yaeHHH Ha6JIoIaajaCb HeXBaTKa MeAHKaMeHTOB 3anocne)IHme 12 MecsiueB.

MHeHHH OTHOCHTeJIbHO KaqecTBa MeHUUHHCKOrO o6Cjiy%HBaHKHI

bonee 70% nalUHCHTOB ueHTPOB CHH1T, HMeKOT yaOBjieTBOPHTeJlbHOe MHeH14e 0 KaqeCTBeOCMOTPOB H ripaBHJIbHOCTH oueHOK. TpeTb HMeeT HeBbLICOKoe MHeHHe OTHOCHTeJIbHO 3HaHHA,OnbITa U YPOBHS o6pa3OBaHHA Bpa'er.

HlOqTH 40% nauHeHTOB CKa3aJH, 'TO OHM gyMa1OT, ITO nOJyqeHHOe neqeHHey4OBneTBOpHTeRbHO, H OHH BHSAT HOJIO)KHTenJbHbIe H3MeHeHHA B COCTOAHHH CBoeFO 331OpOBbM.OI,HaKO B OTHOLjieHHH co6nIoaeHrn1 KOH()aeHuHaR1bHOCTH H BHHMaHHS K JlH4Hb1MnOTpe6HOcTAM MHeHHe 6o0iee IByX TpeTeH OKa3aIOCb HeyAOB31eTBOPHTenJbHb1M 134H o'eHbHeyLaOBneTBOpHTejibHbIM.

OKono 62% riauHeHTOB He YUOBjieTBopeHbl CTeneHb1O HHTepeca, npOABJieHHOFO BpaqOM, HOnOqTH ABe TpeTH yaOBjieTBopeHbl OTHoweHHeM H Be<AnHBOCTbIO nepcoHana 6oJIbHHUbl.

73

HppiMepHo 50% nioaere CKa3ami4, TO BpaH npOBOaHT C HHMM OT 5 go 15 MHHyT.

flpe,nHcaHHbie IieKapCTBa OTCyTCTBOBaniH B 45% cnygasix, HO, no MHeHHIO nauIHCHToB, BpaqH

xopoluo pa3bSACHAIJW KaK npHMeHS1Tb 3TH JieKapCTBa.

86% riauHeHTOB COO6IUHJIH, 'ITO HX He no6yKgainH HanpaBHTb cBoero napTHepa Ha

npoxo)KJaeHHe alHaJH3OB H JieMeHHe. 76% He noJIyqanH aReKBaTHbIX HHCTPYKlH( OTHOCHTenjbHO

Ba)KHOCTH 3aBepmiueHHs nORHOFO Kypca neteimi, a 95% He nonyIa.nH HHKaKHX pa3bACHeHHH

OTHOCHTenJbHO HCICfOflb3OBaHHI ripe3epBaTHBOB RnsJ npegoTBpaLueHHs nepega'L.HH11.

TIOpbMbw

I4HTepBbIo npOBOAHJHCb B 6 MY)KCKHX TIOpbMax. fOlnOBHHa rpynnbl OnpOIfleHHbIX HMeJna

cpeuHee o6pa3oBaHHe. Bce HMeEOT 3JieMeHTapHbIe 3HaHH5 OTHOCHTeCjbHO nepeaamH

BHN4/CfIJHJ1 HO He 3HaIoT, KaK npeaOTBpaTHTb 3apa)KeHi4e B1UL4. OnpolmleHHble coo6U14HnH, -ITO

B ympe)KgeHHAX HMeniHCb TyarleTbI, HO TOJIbKO B 70% HMenjicb BaHHbIe, a B 17% cnyTqaeB

OTCYTCTBOBan ayIu. BOJIbEHHCTBO BaHHblX 6blJIH 'HCTbIMI.

OnpomueHHble C'-HTaIOT Ka'IeCTBO OCMOTpa H npaBHJ]bHOCTb OLIeHKH yaOBJIeTBOpHTej1bHbIM, HO

TOJIbKO nOJIOBHHa H3 HHX yaOBjieTBopeHbl nIexleHHeM.

74

5. (DHHaHCHpOBaHHe H 3KOHoMHqecKasi 3q)4)eICTHBHOCTb upor-paMM mno6opb6e c TE H BI/CICHIH

B 3TOM pa3AeRe OnHCblBalOTCSl HImHaHCHpOBaHHe, 3aTpaTbl H 3KOHOMHLeCKaM 31XeKTHBHoCTbnporpamm no 6opb6e c TB H BM4/CHHj B Ka3axcTaHe. B o63ope cjenaH OCHOBHOH yrOp HaYTBep)KVaeHHOM 6IogpKeTe (He Ha 3Tane nnaHHpOBaHHq) pecny6nHKaHcKoro H MeCTHOFO ypoBHeHiJnA KaxKLoo H3 COOTBeTCTBYIOIUHX nporpaMM. )JBA OueHKH 06WHX 3aTpaT Ha nporpaMMbi no

6opb6e c TB H CfHlg, 6bI.IH y'TeHbl 3apnrIaT, MeAHKaMeHTbl, MaTepHaJibl, KOMMYHaBJbHbieycJIyrH, pacXOAbI Ha o6cnyxHBaHHe H apyrHe 3aTpaTbl, Heo6xoaHMbIe ARA peaniH3auHm 3THXrporpaMM Ha MeCTHOM H pecny6nHKaHcKoM ypOBHIX.

B cnyHae pacXOAOB Ha npOTHBoTy6epKyne3Hbie ripenapaTbl, KOTOpbie 3aKynaloTCSI B OCHOBHOMUeHTpaJIH3oBaHHO, o6WHe pecny6nHKaHcKHe paCXOAbl Ha MeaHKaMeHTbi repeC4HTbIBanHCb HaKa)K,aytO o6nacTb Ha OCHOBe COOTBeTCTBYIOWero qHcfla BnepBble BbIABjieHHbIX cJIyqlaeB3a6oJIeBaHHsI TB. 3Ta MeTOgoJiorHs OTflHHaeTCS OT TpaaHUHOHHblX MeTOaOB oueHKH 3aTpaT H3KOHoMHmeCKOri 3ceKTHBHOCTH nporpamm no 60pb6e c TB TeM, HTO Y4HTbiBalOTCA4aKTHm-ieCKHe pacxojbi ASR Bce rpyrnbl nauHeHTOB c TB, a He BbIBO'jATCA TeopeTH4eCKHe3aTpaTbl ARA Ka>KgorO THna nauHeHTOB. DTH JaHHbIe 6bmH nojiyqeHbI no pe3yJIbTaTaMHCnOHHHHSA pecny6inHKaHcKoro 6ioApKeTa, BblaeJIMeMorO Ha M1HH3,qpaB, H 6bIJm npeAripHHHS3TbIycHIHm no c6opy jaHHbIX o6.raCTHOrO YPOBHA no pacXOAOBaHHIo cpeACTB Ha TB, nocpeRCTBOMnoceWeHHA BCex o6uacTeA H nlOAWOTOBKH CTaHgapTHOA OpMbl ARA c6opa 'aaHHbIX(FlpHjioiceHHe 4).

3aTpaT]l BblCOKH no MewgyHapoZgHbM cTaHLIapTaM. CpeAHme 3aTpaTbl Ha neQeHHe OAHOFOnaeHeHTa CTOST B pSAy caMbIX BbICOKHX 3aTpaT, paccMHTaHHb1X ARA CTpaH Co cpeAHHMHAoxoAaMH. Ka3axcTaH pacxoayeT 35,4 MJnH. Aon. CIIA Ha neqeHHe npHMepHo 60 TbIC.nauHeHToB, B TO BpeMA KaK B 22 cTpaHax C BbICOKHM 6peMeHeM, Ha KOTOpbIe HpHXOgHflOCb 6,9MJH. cjiy'iaeB 3a6oneBaHHri, iieqeHme KOTOpbiX HpOBOZH4JIOCb B 2002 roAy, 6blno H3paCXOAOBaHOOKoJIo 500 MjiH. AOJIJI. 1I3 3TOFO cneyeT BblBOJg, qTO Ka3axcTaH TpaTHT nlpHMepHo 7% 6iogpieiacTpaH c caMbIM BblCOKHM 6peMeHeM, HO nIeHHT MeHee 1% naT4HeHTOB. FnaBHbie OTJIH4HSA3aKjHOqalOTCA B TOM, qTO B Ka3axCTaHe npoUeHT H3neHeHHSA HH)Ke cpeAHero, CTOHMOCTbJie4eHH5I 6o0nee BbICOKaA, a npoueHT HeyAaq-HbIx ciyqaeB JIeMeHHA BblUIe cpeAHero.

CpaBHeHHe C epyrHMH CTpaHaMH, HMeiOujMH nOixO6Hble ypOBHH JOXOgOB, FOBOpHT 0 TOM,HTO CytUleCTByeT ewe MHOrO Bo3MoxKHOCTeii aJISI fOBblileHHsi 34XelCTHBHOCTHHCHOJlb3OBaHuH pecypCoB. ,ApyrHe CTpaHbl CO Cpe,AHHMH gOXOgaMH ao6HBafOTcA TaKoro lceHJIH HaMHOFO ny4iiiiero ypOBHA H3JIeqeHHS npm ropa3go MeHblUHX 3aTpaTax, a)iKe npH TOM, qTO3apniiaTa nepcoHana B HHX HaMHOIO BbIWe (HanpHMep, OT 300 gon. B MeCAU ,AJIA Bpa'-a B Flepygo 6onee I TbIC. AoRn. B MeCSAI B 1O)KHO-A#pHKaHCKOrI Pecny6.]HKe). DTo OTpa)KaeT TO faKT,4TO B apyrHx CTpaHax Co CpCeHHMH ,4OxOJAaMH pa36HBKa 3aTpaT nO KaTeCFOpHAM BeCbMaOTJIHqaeTCA OT Ka3aXCTaHCKOA. ,2IA cpaBHeHHS 6bmIH B3STbl TpH cTpaHbI CO cpeAHHMHgoxogaMH. B HX HHCJIO BOIIIJIH IO)KHo-A4DpHKaHCKaS PecHy6JIHKa, rlepy H B)OTCBaHa. B 3THXcTpaHax HJIH Bo6o6we He npOBOAHTCS CTaiHOHapHOe IIeqeHHe, HJIH HpOBOAHTCA HaMHOFO pewKe(CpeAHee npe6blBaHHe B 60J]bHHue COCTaBJ1AeT 17,5 AHA B OgHOM npHMepe), qeM B Ka3axcTaHe.

Ha nIaUHeHTOB c MPTB IPHXOAuHTCS IpHMepHo 10% o6wero KojiH'eCTBa naUHeHTOB C TBH paCxogyeTCH OT 13 go 20% o6wHx 3aTpaT Ha porpaMMbl ICOHTPOJIsi TB. 3aTpaTbl HaAeHeHHe naHHeHTOB C MPTB OTHOCHTeClbHO BbICOKH H B CpeAHeM COCTaBJ]IAOT 5 TbIC. AJo.

75

CLIA, a npOgOJIXKHTenjbHOCTb ne'eHl4s cO3gaeT gOnOJ1HHTenbHYIO HaFpy3KY Ha

pecny6nHKaHcKHA 6fog)KeT, BbifenmeMbIH Ha neqeHHe Tb.

3aTpaTb6 Ha H3JieqeHHe OAHOrO 6onibHoro TB B Ka3aXCTaHe COCTaBJIHIOT 1639 LIo.j., -ITO

HaMHOro npeBblluaeT 3aTpaTbl Ha H3Jie-leHHe OaHOrO naIAHeHTa B APYFHX CTpaHax Co

CpeCHHMH aoxoaaMH. 3aTpaTbl Ha niemef4e o-Horo 6onbHoro Tb COCTaBJSIIOT ripHMepHo 525gon. CLIA B IOKHo-A4pHKaHcKOA Pecny6rnHKe H 1 500 goni. CLIA B POCCHH, npH 3TOM

npoueHT H3JIeqeHHA nauHeHTOB B 3THX cTpaHax HaxOgHTCA B npegeaax OT 52 go 63%. 9To

rOBOPHT 0 TOM, qTO B Ka3axcTaHe HMeeTCA gOCTaTO'HO pe3epBOB gJSI nOBbielHeHHA

344eKTHBHOCTH.

3KoHOMHqecKa2 344eKTHBHoCTb CH.1lbHO OTJIH'iaeTC5I B pa3Hb6X o6JiaCTSlX, BRIcIo'IaHI

pa3JIHxHSI B 3aTpaTax, YPOBHe H3JIe'eHHSI, MexaHH3Max 4JHHaHCHPOBaHHi, a TaiCie B

reorpa@HH H YPOBHHX IOXOaOB. HaripHMep, eCJim yqHTbIBaTb TOJlbKO 3aTpaTbi CHCTeMbI

3apaBOOxpaHeHHs, TO 3aTpaTbl Ha cnaceHHe OgHOH )KH3HH BapbHPYIOT OT 7 632 gon. CLUA B

IO)KHo-Ka3axcTaHCKOH o6nacTH jo 1300 non. CLIA B r. AnMaTbl. 3aTpaTbl Ha CnaCeHHbiH rog

>KH3HH BapbHPYIOT OT 61 0on. CLUA B ropoge AjiMaTbI go 358 gon. CL1A B IO)KHO-

Ka3aXCTaHCKOri o6IiacTH.

3aTpaTbE Ha BbHlBj1eHHe 3a6oJIeBaHHH C HCHOJIL3OBaHHeM 4nUooporpaIjHH 3HaqHTeJIbHb6 H

HMelOT O'ieHb HH3KylO 3KoHoMHqecKyio 3jHeITHBHOCTb. BbIABJIeMOcTE 3a6oJ]eBaHHi4 B

cpegHeM cocTaAnseT 0,28 H BapbHpyeT OT caMOH BbICOKOH 0,68 B )KaM6bife go CaMOH HH3KOA

0,03 B AjiMaTbl. O6tuHe opHeHTHpOBOIHbie 3aTpaTbI Ha 3Ty gHarHoCTHqeCKyIO npouegypy

COCTaBJISIOT HeMHOFHM MeHee 2 MYIH. gOJ1. CLUA B rog npH CpCeHHX 3aTpaTax Ha BbISBJIeHHbIH

c.fyqara 3a6OjieBaHHS, cocTasBJ1IO1IHM 143 gon. CLlA. 3To AsBJIeTCA OHOH H3 npHqHH 6onee

BbICOKHX 3aTpaT B Ka3aXcTaHe no cpaBHeHHiO C cpyrHMH cTpaHaMH.

JIeMeHHe, nO-BHAHMOMy, HPOBOAHTC5 HCOAHHaKOBO B pa3JIHqHblX o6JiaCTBX. 3To

HJIJIOCTpHpyeTCS HepaBHoMepHblM paCnpeqefleHHeM o6lUHX 3aTpaT Ha KOHTpOJib Tb, KaK npH

pa36HBKe nO KaTeFOPHAM 3aTpaT, TaK H HagyuIy HacenjeHH51 IIJIH Ha ogHoro nauHeHTa.

IHpoieHT H3jieqeHHSI HaxogHTCS HHxce npHeMJIeMoro. HpoieHT H3nieqeHHA naUHeHToB c TB B

MacluTa6e CTpaHbl COCTaBJIAeT 75%. TaKoH npoUeHT H3jleqeHHS SABSeTCs

HeyJlOBneTBOpHTeJIbHbIM, aaKe ecIiH OH )gOCTHFHYT rIpH OqeHb He6ojibIuHx 3aTpaTax.

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76

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77

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78

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79

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80

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86

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B Ta6nHue 29 noKa3aHo, 'TO ripAMbie 3aTpaTbl HaxOSATCS B npegenax OT 458 TbIC. aOflfl. BCllIA B AnMaTbi go 6,3 MJIH. Jon. CWA B IO)KHo-Ka3axCTaHCKO9 o6.JacTH.

3aTpaTbl Ha nocemeHi-w H gHH HeTpygOCr1OCo6HOCTH nauHeHTa. B nepBoM cnyqae 3TOHaniHqHbie ruiaTeIKH, a BO BTOPOM 3TO mepa rIOTepSHHOrO BpeMeHH, nepeBegeHHasA B AeHe)KHoeBbIpaxKeHHe (Ta6nHua 29). 4To6bl oUeHHTb 3aTpaTbl, CBs13aHHbie c roceLueHHAIMH, cgeniaHonpe,anojio)KeHHe, qTO HMeeT MeCTO 80 HOceweHHA HJIH KOHCyJlbTauHHi B rog (H Ha OgHOronaui4eHTa), npH 3TOM 3aTpaTbl Ha KaCKJOe H3 HHX COCTaBJIAIOT 0,62 jon. CWA. OqeBHgHO, qTO3aTpaTbl Ha noCei1eHHA COCTaBJIAIOT nOqTH 3,1 MJIH. gou. CIlIA.

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% npfMbiX 06urneO6aiacTb _ lpqMbie 3aTpaTbi KocBeHHbIe 3aTpaTbl 3aTpaT 3aTpaTbl CFH

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FocelieHHA noco6HOCTbl'ToroAKMOnHHCKaS 1 850 287 198 946 232 130 431 076 81% 2 281 363 59,8AKTio6MHcKaR 2 266 591 204 253 253 067 457 320 83% 2 723 911 60,8AJIMaTHHCKaR 2 213 057 232 227 357 812 590 039 79% 2 803 096 81,1ATblpaycKaA 2 117 928 145 378 274 647 420 024 83% 2 537 952 77,7BocToIHHo-Ka3axcTaHcKas 3 082 314 278 901 414 933 693 834 82% 3 776 148 77,7)KaM6bMcKa.l 1 955 227 205 790 221 208 426 999 82% 2 382 226 65,23anaaHo-Ka3axcTaHcKas 1 889 003 172 806 247 899 420 705 82% 2 309 708 71,6KaparaHUHHcKaA 3 422 296 270 469 404 649 675 118 84% 4 097 414 74,5Khl3bulop,uHcKaA 2 968 950 200 533 364 856 565 388 84% 3 534 338 98,6KocTaHaricKaAl 1 786 541 199 690 250 636 450 326 80% 2 236 867 73.0MaHrHcTaycKaA 937 567 100 986 161 639 262 625 78% 1 200 192 59,8HaBJogapcKaA 1 989 467 236 592 317 194 553 786 78% 2 543 252 67,6CeBepo-Ka3axcTaHcKaH 1 529 708 117 453 221 410 338 863 82% 1 868 571 101,4fO)KHo-Ka3axcTaHciaHq 6 341 777 284 307 374 500 658 807 91% 7 000 584 86,9Fopo, AjiMaTbl 458 378 106 987 108 917 215 905 68% 674 283 48,0Fopo, ACTaHa 604 809 100 341 98 338 198 679 75% 803 487 50,0Pecny6nHKa Ka3aXCTaH 35 413 901 3 055 658 4 303 836 7 359 493 83% 42 773 394 76,0

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87

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nlOKa3blBalOT o6iuHe 3aTPaTbl H3 610,a)KeTa Ha JeIeHHC 1aulHCHTOB c TBi.

88

rpajmic 32: CpejHHe 3aTpaTbi Ha iieMeHHe nanHeHTOB c TB; B 2002 ro,y

3,0003aTpaTml Ha neqeHwe BK+ bK- B Ka3axcTaHe

2,500 --- 3aTpaTml Ha neseHwe BK+ BK- B Poccin (BepxHss paHt4L4a)

2,000 - 3aTpaTbI Ha ne4eHme EK+ SK- B Pocc44 (HMKHRI paHi4L4a)

1,500 -

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89

Fpa4Hic 33: CpaBHuTeJibHbie 3aTpaTbl Ha JiCeieHHe TB;nauHeHTOB

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0 200 400 600 800 1000 1200 1400

USS

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90

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91

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cpe,4HHe, rOBOpAT o ee 6o0nee HH3KOH 3KOHOMH4CCKO9 344eKTHBHOCTH. ,ARAs CpaBHeHHSi,

3aTpaTbl Ha OZ14H 1DKHT, CnaCeHHbIH B Ka3aXcTaHe, npCBbIlUalOT 3aTpaTbl B POCCHH H KHTae B

3,4 H 3,7 pa3a COOTBeTCTBeHHO. 3aTpaTbl Ha O,RHY rpe,OTBpaWeHHYIO CMepTb nHOxTH B nATb pa3

Bbillue, qeM B POCCHH.

KaKCHM o6pa3oM MOACHO C31COHOMHTb?

TOT 4IaKT, HTO MHOFHe H3 rpeqblaYMLHX oueHOK 3aTpaT Ha OaHOrO nauHeHTa C TB OKa3aJiHCbBblie, '-eM B POCCHH H apyrtix COriOCTaBHMb1X CTpaHax, yKa3blBaeT Ha TO, -TO CYLUeCTBYIOTnOTCHuHaJTbHbie B03MO)KHOCTH AJ1S1 3KOHOMHH. B 3TOM pa3,geie rpoaHaiH3HpOBaHbl aBa

anJbTepHaTHBHbIX cUeHapHA. B nepBOM MbI npeanojnaraeM, ITO cpeaHHe 3aTpaTbI Ha OgHOro BKIOJ1O)KHTeCfbHoro nauHeHTa MOrFfH 6bl 6blTb COKpaileHbl. Cioga BKnIo'-eHbI 3KOHOMHA Ha

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B j1ytHIuer o6niacTH: 84 npoueHTa ansi ropoaa AniMaTbI. flo o6oHM CueHapHAM 3Ha-HTeflbHbCeB03MO)KHOCTH 1o 3KOHOMHH pecypCOB B CHCTeMe HO3BOJIHIJH 6bl MHH3,qpaBy nepepacnpe,RenHTlCPeCJCTBa B TC 06.iaCTH, KOTOpbIe Hy)KaalOTCR B yKpenieHHA H yaBOeHHH yCHfliHr aJnq peWeHHSA

npo6neMbl TB.

CueHapHil 1: 3KOHOMHSI B cay'iae coicpaiueHHsI 3aTpaT61 Ha TB nallHeHTa

1MTo6bl OUeHHTb nIOTCHU14HafbHY1O 3KOHOMHIO AJSI CHCTCMbl, npe4jiara1oTCM ABa anbTepHaTHBHbIX

CueHapHS, KOTOpbIe CTPOATC31 Ha npe;jnOjio)KeHHH, 4TO paCXoabl Ha O,AHOFO na4HeHTa MOrYT6blTb COKpalleHbl. B nepBoM cLeHapH1 caMbie BbICOKHe o66naCTHbie pacxoJIbi Ha o,HoronauHieHTa c TB ieCPeCqHTbIBatOTCS B COOTBeTCTBHH C CaMbIMH HH3KHMH 3aTpaTaMH cpexamo6naCTerl. Ho 3TOMy cueHapH1o cpeiHHe 3aTpaTbl Ha OaHoro TB riaLHCHTa npHHSiTbl B CyMMe454 IonJI. CMIA, qTO COOTBeTCTByeT 3aTpaTaM Ha neJCeHHe B ropoge AJIMaTbl. Bo BTOPOM

CueHapHH, CylueCTBYIOIHe pacxogbi nepeCqHTbiBaIOTCS B COOTBCTCTBHH CO CpeCHHMI

3aTpaTaMH Ha JieqeHHe BnepBbie BbISBjieHHOFO nauHeHTa C nOflO)KHTejibHbIM Ma3KOM B cTpaHeCO cpegHHMH goxoxaMH, COCTaBHBBHuMH B 1999 rogy 2 390 jgon. CIIIA (4 390 gon. CLHIA B

riepecC1eTe Ha nOKynaTenbHyIo cnoco6HocTb MCCTHOHI Ban0OTbl B LAonnapax CIIIA) cHCnOJIb3OBaHHeM Pe)KHMa ,;OTC. rIOCKOnbKy BTOPOH CueHapHHi, BCpOSTHO, HeaooUeHHBaeTnOnlHbie 3aTPaTbI nPOrPaMMbl nO 6opb6e c TE, peanbHas LHxnpa, CKOPeC BCCrO, HaXO,THTCA1 rjge-HH6yab nocpeRHHe. Ho 3TOMY cueHapHIo cpeRHHe 3aTpaTbi 6bmnH oueHeHbI B CyMMC 430 ,gon.CIHA, BKJI1OqaA 3aTPaTbl Ha BbSABj1eHHe 3a6oneBaHHH.

92

Ho 060UM CcueHapHAM 1OTeHUHanjbHaS 3KOHOMHSA 3HaLH4TeJ]bHa. 06WasA nOTeHCHHanjbHaS3KOHOMHA no nepBOMY cueHapHio COCTaBJnseT 60oiee 21 MJIH. aoji. CILIA B ro,. HIo BTOPOMYcuLeHapito o6maAs rIOTeHLuHaJbHaS 3KOHOMUA 6bula 6bl paBHa nlO4Tm 23 MJIH. non. ClLIA.Cnegytomume aMHHbie oTo6pa)KaloT cpaBHHTenbHbie pe3ynbTaTbl no o6nacTAM.

Fpa4HKc 34: 31COHOMHU 3aTpaT Ha .ieteHHe naiHeHTOB c TB B 2002 roxly

5 fl QCuP-~~~~3pI.Lrl 1

JO-. Kap Kw B-. ATp Am A- naa 3-n )f(aN, A.. C-. Koc Ma rACTrA-A

14CTO9HHK: OUeHKH HCCae2OBaHHR OCHOBbIBalOTCa Ha aaHHbIX MHHHCTepCTBa

32upaBooxpai4eHHs PK, 2003 r.

CieHapHii 2: HlOBbimeHHe npoiieHTa H3JneHieHHu 31COHOMHT zleHbrH

B 3TOM pa3Aene OueHHBaCTCS 3KOHOMi4HeCKHM 3(tq)eKT B CHCTCMe 3,apaBOOXpaHeH14S OT

roBbluieHHA npoueHTa H3jie4eH1HH BO BCeX o6nacTqx. 3a 6a3oBblHi npoueHT H3TeweHHA ripHHTYPOBeHb o6naCTM c jiywiiMIH nOKa3aTeJ]AM14 H3leHeHHsI B 2002 roAy, KOTOPblM COOTBeTCTBOBaJ

ropo, AJIMaTbi C YPOBHeM H3J]eqeHHS 84% (flOKa3aTeJlb OMeHb 6JIH3KHHi K LIenCBOMY

nOKa3aTenJIO B 85%, npeajiO>KeHHoMy B03 B KateCTBe KPHTePHA 3tjeKTHBHOCTH nporpamm

KOHTPOJIS T1B). Bbirogbi 3TOH CMoze.iHpOBaHHOA CHTyauH4H BKjHOualOT ycTpaHeHHe npAMbIX

3aTpaT Ha OaHOFO naumHeHTa H KOCBeHHyIO 3KOHOMHIO 3aTpaT nO nPH4HHe cHH)KeHHA1 ,AHei

HeTpyLRocnoCo6HocTH, HmCna 0CieweHHA H o6pyio 3KOHOMH14eCKYIO UeHHOCTb

fpe,aOTBpaWeHHA JieTajibHbiX HCXOAOB. FnaBHbie pe3yflbTaTbl npoLiecca MOaenJHPOBaHHAn1OKa3aHbE B Ta6nwjue 33.

CleHapHii 3: 3KOHOMHW B cjiyqae IlOBbluieHHsi 344eICTHBHOCTH 6opb6bl c TB Ha 1%

PaCweTbl B 3TOM pa3,aene OCHOBaHbl Ha cLueHapHm, npH KOTOPOM BbIABJSACMOCTb nOBbwlaleTCA Ha

O,RHH npoLjeHT, LITO yBeCIH4HBaeT KOJH-eCTBO nlpOJIeeHHbIX naI4HeHTOB. HpOpueHT H3nemeHHA

aHaJOFH'IHo nOBbllIuaeTCA Ha OJIHH ripOueHT AnsI Bcex o6JiacTeri, a CMepTHOCTb yMeHbwIaCTCA HaO,AHH ripOLueHT B Ka)KZ,OR o6flaCTH. OXBaT nleqeHHeM 6bm paCC4IHTaH KaK OTHOIIIeHHe TeKyltero

KOJ]HtIeCTBa fllo,tHe, noJiy'1atolilHx J1emeHHe, K o6rueMy KOJHIHleCTBy nauHeHTOB c TB), TaKHMo6pa3oM, HOBbllueHHe Ha ORlHH IIpOueHT Morno 6bl yBeJIH'IHTb o6igee KOJIH-eCTBO BnepBble

BbIABfseHHbIX naLHeHTOB, noTiyMaiolUHx iieqeHHe. K 3TOMY HOBOMY KOHTHHreHTY nIauHeHTOBMOrnO 6bi 6blTb ripMmeHeHO fOBb1LueHHe npoueHTa H3JieCeHHAI Ha OmHH rIpOLUeHT H CHH)KeHIeCMepTHOCTH Ha O,14H IIpOueHT.

BriepBble BbIAIBjeHHbie naluHeHTbI, flOJYMHBLumeC nemeHHe H BbIJel'ieHHbie, a TaK)Ke CMepTHble

cnyqaH, KOTOpblX 6bl yqanOCb H36e)KaTb, rpeglCTaBJIS11OT CymeCTBeHHble HpSIMble i KOCBeHHbleBbFOr,abl ,AnIA Pecny6.JHKH Ka3axcTaH. 3TH BbiroFbl B leHe)KHOM Bbipa(KeHHH npe,aCTaBJIeHbl BTa6nHue 34.

93

Ta6.iHuIa 33: Bbi6rogh OT flOBbIUeHH2 npoueCHTa H3JIeeHHMHo BCeM o6j]laCTgM Lo 84% (B AOJ1JI. CIlA)

HpsIMble

Bbl Orabi

06.racTb (non. CLLIA) KOCBeHHble BbIrOqbl (zon. CILA)

floceLue- HHBajiHZE- 3aTpaTbI B CBA3H 06wuHe BbIFOZlbl

HHsA HOCTb Co CMepTb1O I4Toro (oion. CILIA)

AKMoJIHHCKaa 140451 3261 6341 734657 744258 884709AKTto6HHcKa,l 196765 3651 7540 822720 833911 1030676

AjiMaTHHcKaA 158199 3308 8495 745374 757177 915376ATbIpaycKas 97774 1413 4448 318332 324193 421967BKO 365621 6066 15041 1366764 1387871 1753492)KaM6bUicKaA 116601 2000 3582 450541 456123 572724

3K0 125113 2099 5019 472991 480109 605223KaparaH,aHHcKaA 390890 5949 14833 1340316 1361097 1751987Kbl3baropzaHHcKaa 115826 1563 4741 352285 358590 474416KocTaHaflcKaA 140029 4168 8718 939034 951920 1091949MaHrHcTaycKas 88577 1799 4800 405444 412044 500621naBnionapcKaA 255979 4257 9511 959124 972892 1228872CKO 129719 2625 8246 591370 602240 731959I)0KH o-

Ka3axCTaHcKa3 146537 1245 2733 280445 284422 430960opo,a AiMaaTbi 0 0 0 0 0 0

Fopou AcTaHa 39450 893 1459 201198 203550 243000

Pecny6AHKa

Ka3axcTaH 2635532 44295 109130 9980595 10134020 12769551

11CTO'HHK: O1IeHKH HccJieloBaHHlA oCHoBbIBalOTCsA Ha RaHHbIX MHHHCTepCTBa 3JapaBOOXpaHeHHA PK, 2003 r.

CoBoKynHble BbirOaIbi OT 3THX ,aBYX cUeHapi4eB rlpHBeaeHbl B Ta6nJI4e 35. OCHOBHaA 3KOHOMHS

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HeTpy)ocnoco6HocTbIo, H nOBbllHIeHHe npOH3BO,4TenjbHOCTM Tpyaa. Bcero npsMaAi 3KOHOMHS

COCTaBHjia 6bl 6o0iee I MJIH. Aon. CIIIA B roA Ha Ka)KTjbrlH npOLIeHT yj1yqIueHHA HOKa3aTeiieg.

3To nOapa3yMeBaeT, '-TO rIOBbiUieHHe Ha 5% BblSIBJIMeMOCTH, nlpOUeHTa H3jietieHHS H CHH>Ke(HHe

cMepTHOCTH1 Ha 5% n1pHBeJiH 6bl K npSMOiI 3KOHOMHH 5 MJIH. jgon. CllIA B ro,. KOCBeHHbie3aTpaTbl CHH)KalOTCS nIotTH Ha 3 MJIH. RonI. CIlA B ro, npH nOBbILueHHH lOKa3aTeiferH Ha I%.

94

Ta6juiua 34: Bblrozibl, CBM3aHHbIe C yJIy'IMeHHeM noKca3aTeaJIe pa6oTbl CHCTemm

3LApaBoOxpaHeHHSI (goa. CIIIA)

HpaM ble

06JiacTb BbirOlbl KOCBeHHbie BbirO,abi (aoni. CLIHA)1ioceme- HHBa.iHa- 06wme Bbiro6il

(aoni. CILA) HHSI HOCTb CMepTH 1IToro (moi. ClIA)

AKMoJ1HHcKaA 58581 3078 5985 154213 163276 221856

AKTIo6HHcKaSi 68903 3139 6483 164472 174095 242998

AjiMaTHHCKa$1 67023 3746 9619 195181 208546 275568

ATblpaycKaA 60888 2508 7896 142516 152919 213808

BKO 91273 4357 10803 235448 250609 341882lKaM6buIcKaA 61412 3273 5864 167736 176873 238285

3KG 57264 2852 6818 153979 163648 220912KaparalinHHcKaa 102377 4046 10088 210519 224652 327030

KbIbl3bopaHHcKaR 84192 3596 10906 209141 223643 307835

KocTaHaAcKaa 50996 3296 6894 181776 191966 242962

MaHrHcTaycKaa 25811 1712 4567 100849 107128 132939

anaBJoaapcKas 67778 3438 7683 172361 183481 251259

CKO 45037 1902 5977 99585 107464 152500

IOKO 189528 4880 10713 264142 279735 469263

FOpOj AjiMaTLi 15685 1743 2958 87667 92368 108053

FopozIAcTaHa 20996 1459 2382 71021 74862 95857

Pecny6jnKa

Ka3axcTaH 1074686 49061 120872 2610713 2780646 3855332

14CTO1HHK: OIICHKH HCCJ] eIOBaHHa OCHOBbIBalOTCA Ha JaHHb]X MHHHCTepCTBa 3zpaBooxpaHeH5 PK, 2003 r.

Ta6iuTHa 35: 3KOHOMH%i no KawaoMy H3 CUCHapHeB

HOBbIlIweHHe flOKa3aTeJIeH Ha 1% B OXBaTeBce o6iaCTH a0CTHraiOT TieqeHHeM. B YPOBHe H3ieqeHHHs H B CHH)KeHHH

upoueHTa H3jiemeHHA 84% cMepTHOCTH

Hpambie 3aTpaTbw 2635532 1074686

KocBeHHbie 3aTpaTbi 10134020 2780646

HToro 12769551 3855332

14CTO0HHK: ouleHKH HCCjie[OBaHHSI 0CH0BblBalOTCA Ha aaHHbIX MHHHCTepCTBa 3upaBooXpaHeHCHH PK, 2003 r.

(DHHaHCHpOBaHHe lpOrpaMMblI BbISIBJ1eHHM H .Je'eHHs5 BWIICHlI

061UHe paCXOblI Ha HporpaMMy BHiMICHLiHa B 2002 roay COCTaBHjTH nOpsaKa 3 MflH. aon.

CILA. MeHee 10% OT o6Mero o6teMa pacXOOB Ha neMeHHe BM-1/CIIFI riOCTTynHRO H3

UeHTpajIbHOrO 6ioaxKeTa. Bonbmasl laCTb 3aTpaT npHXOaHTCS3 Ha TeKyWH epacXOgbi, paCXORbl Ha

BbIllnIaTy 3apa6OTHoH IlJIaTbl 1 JHarHOCTHHeCKHX MaTepHaJIOB.

CyiUieCTByIOT 3HaqHTenjbHbIe pa3HHUI6 HpH pacnpeienieHHH 3aTpaT i1o o6JaCTIM. 06iuaACTOHMOCTb rlpOrpaMMbi B14/CnM B Ka3axCTaHe BapbiHpyeTCs OT 0.06 MJIH. 0on. CUIA B

ATblpay ,ao 0.34 MHiO aoJi. CIHA B KaaparaHae.

3aTpaTb6 Ha opHForo nallHeHTa c BWI/CMI COCTaBJISlIOT oicorio 675 ,oji. CIIIA. floriaraA,

MTO He Bce nauHeHTbl C B14'I noniyMaloT JlemeHHe, a Bce riaiU4eHTbI C CnI,I, no0iyqaIoT, TO

3aTpaTbl OKa3blBalOTCS HaMHOFO Bblwe, aoxoas ao 6oniee HeM 26TbIC. oRon. CLIA. TaKoKe

HMeEOTCS CyUeCTBeHHbie pa3JIHHSA B 3aTpaTaX Ha OaHOFO nauHeHTa no o6nacTAM.

95

rpa4pHK 35: Pecny6JHxaHcacKH u MeCTHbIH 6toaxceT B 2002 romay

L4eHTpanbHbl0 6NoAweT

7%

MeCTHbie 6I0A)KeTbi

93%

IICTO'tHHK: OUeHKH HccjieaoBaHHq OCHOBbIBalOTCS9 Ha aaHHbIX MHHHCTepCTBa 3,UpaBooxpaHeHHSq PK,2003 r.

FpajnHc 36: TeKyywue H HHBeCTHIjHoHHLie 3aTpaT, 2002 r.

/HBeCTu 4I14

12%

TeKyuL4e

88%

HCTOtHHK: OUeHKH HCCJIeaOBaHHA OCHOBb0Ba1OTCS Ha aaHHbIX MHHHCTepCTBa 34paBooxpaHCHHq PK,2003 r.

06iuHe pacxoQlbi Ha nporpaMMy Tb B 2002 rogy COCTasBHJH 2.8 MJIH. gOA. CIJA. flpHMepHo 7%Bcex pacXOgOB Ha 6Opb6y c Tb, Hill rIO4qTI 200 TbIC. ion. CIMIA, riOCTYnHniH H3pecny6nHKaHcKoro 6bo,I)KeTa. C yqeToM pa3,aeneHHAs pacxoAOB ueHTpanbHbIX H MeCTHbIXopraHOB BjiaCTH, CRO)KHO rpegCKa3aTh KaKHM o6pa3oM 6ygeT nojiyqeHo 1)HHaHCHpOBaHHe goTeX nop, HoKa BKjiaa ueHTPaJTbHoro ynpaBneHHA He 6ygeT CHIbHO yBenHqeH. Ciojga 6yneTBXO,gHTb peaJIH3auHS HegaBHO YTBep)KIeHHOFO rpaHTa r3FD, KOTOpblH BHeCCT BKjna, BOBKmagblBaeMbie cpegCTBa.

rpaqHK 35 nOKa3blBaeT, 4TO MeCTHbEe opraHbI BJ]aCTH BbiaenjHJIH Ha c HHaHCHpoBaHHeIPHMCPHO 93% OT o61uHx pecypcoB AJIA neteHim TB) B Ka3aXcTaHe. 3TH pecypcbl HOWJIH Ha

cp HHaHCHpOBaHHe 3apa6oTHorH niiaTbI, aonOJIHHTCeiEHbIX paCXOgOB Ha J1CKaPCTBeHHbie cpe,CTBaH jgpyrFx TeKYWHX 3aTpaT. PacnpegeneHHe pacXOgOB B 2002 rogy nepeBeLiHBanio B CTOPOHYTeKy[lHX 3aTpaT, npH 3TOM 2,2 MJIH. gon. CILIA nouJIO Ha TeKynHe 3aTpaTbI, a 0, 3 MJIH. Aon.CIlIA - Ha HHBeCTHIHH (ctoga He BKjlloqeH pecny6nHKaHCKHit ypOBeHb, riOCKOnbKyOTCYTCTBOBaJIH aHHbie no pacnpeAenerHmopacXoxcoB no KaTeropHAIM).

96

PacrpegeneHHe pacxoAoB no o6nacTsM noKa3blBaeT, 'TO HMelOTCS Cy1eCTBeHHbIe pa3JIHHSH.

PacnpeaejieHHe o6umwx edceroAHbIx 3aTpaT riporpaMMbI B4H/CHFIL B Pecny6nHKe Ka3aXcTaH

BapbHpOBanocb OT 0,06 MJIH. jon. CIIA B AnMaTHHCKOH o6JiacTH AO HlOTI 0,34 MiHi. ntofl.

CUJA B KaparaHAuHcKoA o6iiaacT. AAs ueneri allanH3a 3aTpaT B 3THX pa3aeniax

paccMaTpIlBaIOTCS TOJIbKO TeKylUHe 3aTpaTbl.

06LuHe pacXoQtbl Ha AyLy HacerieHHA C yqeTOM Bcero HaceneHHA o6nacTH BapbHpoBanamb OT

0,04 gon. CLIA Ha ayWy B I()KHo-Ka3aXCTaHcKoA o6nacTT uo 0,46 non. CLUA Ha gymy B

MaHrHcTaycKoH o6nacTH npH CpeAHem no pecny6nHKe AnA 16 o6nacTefi - 0,16 Aon. CL1A

(Ta6JIHua 36). Hpm nepecqeTe Ha AyWy HaceneieHi (c y'eTOM Bcero HaceneHHs Ka)KAloH

o6nacTH) OCHOBHbIe pacxolbi nplHXOAATCA Ha 3apa6oTHyIo nriaTy, AHarHOCTHqeCKHe pacxozlHbie

MaTepHaAbi, TeKyLuHe pacXOAbl Hu ApyrHe pacXojbl, COCTaBJ1SHOIIHe 6o0iee 0,14 gon. CL1A U3

cpeAHIX pacXoAOB B 0,16 gon. CLIA Ha Aymy HaceneHHA.

Ta6JiHUa 36: 061uHe pacxo,abi H paCXOmb1 Ha ayumy HaCenJeHHSI B 2002 roay

HToro Ha AyMy HaceAeHHgBce flauHeHrbl c flIaieHT

06JiacTb TeicyniUe HIHBeCTHUHH HacejieHHe BH4q/CHHlT c CHH,4

AKMOJIHHCKasi 180267 0 0,33 3137 123346

AKTto6lIHcKaa 66915 0 0,14 1035 40699

AjiMaTHHCKam 67357 0 0,04 1727 67920

ATbipaycKasi 62727 24739 0,14 5094 200295

BOCTOHHO-

Ka3axcTaHcKaA 127587 0 0,09 1130 44444

)KaM6bmncKa3 138353 0 0,14 2175 85506

3ananHo-Ka3axcTaHcKax 209833 125640 0,35 1493 58688

KaparaHuRHcKasl 344820 12633 0,26 278 10920

KbIl3lIsopzuHcKaq 74600 21393 0,12 10386 408357

KocTaHaRcKasi 95880 0 0,10 477 18744

MaHruCTayCKaS 155367 41333 0,46 7969 313331

rlaBJ1ogapcKaA 138647 0 0,19 192 7536

CeBepo-Ka3axcTaHcKa51 93815 10131 0,14 1550 60929

)OKtHo-Ka3axcTaHcKaM 76187 1518 0,04 202 7933

Fopoa AnManm 191487 77040 0,17 1009 39661

Fopoa AcTaHa 226313 0 0,45 7352 289060

Pecny6THRKa3axcTaH 2250154 314427 0,16 673 26472

14CTOIHHK: OLieHKH HccJ]e.UoBaHHu OCHOBbIBalOTCA Ha aaHHbIX MHHHCTepcTBa 3,apaBOOXpaHeHHA PK, 2003 r.

3aTpaTb6 Ha npO4)HjiaNTHK-y H 60pb6y C B/CIIE,CH no BHgaaM pecypcoB

Pacnpe,aeneHHe o6WuHx 3aTpaT B o6nacTsix 6blno pa3flH4Hb1M (Ta6nHua 37). Flocnie pa36HBKH Ha

BH,Abl pecypcoB CTaJIO OqeBHWLHo, LITO paCXOjAbl Ha 3apa6oTHyIo nnaTy nepcOHaiia B

y'pe)K,aeHHix BWI/CflHJl COCTacBHJH camyio 6onblmylo ,rAonIo 3aTpaT (38% jAns Pecny6jiHKH

Ka3axcTaHa, Fpa4uIK 37). Ha neKapcTBa npHXOaHJIOCb MeHee 10% O6Dl4X 3aTpaT, a Ha aBa BH;Ia

HHBecTHLHI4, 0 KOTOpbIX 6bunw npe,cCTaBJieHbl ,aaHHbie (HHBeCTH14IHH B o6OpyAloBaHHe H 3,aaHHs,

CTPOHTeSJbCTBO H peKOHCTpYKIHSA o6beKTOB), pllHXOZIIOCb 12% o6mero MeCTHOFo 6ToaweTa,

Bbi,aejieHHOFO Ha ripOrpaMMy 60pb6bl C 311HiAeMmHe BMI/CHIHJ,. ,l14arHOCTHMeCKi4e pacxoAHbie

MaTepHaibl ABJIAIOTCS AOpOrOCTOALeU4 KaTeropHeri paCXOjAOB, Ha KOTOPYIO npHXO0IHTCA 6o0iee

qeTBePTH COBOKYHHOFO MeCTHOrO 6IOiICeTa. 9TO, BepOATHO, OTpa)iKaeT BbICOKyIO CTOHMOCTb

JAmarHOCTHPOBaHHS BHLH/CHIHIJ,Zt HopaBAblBaeT nOBblIuCHHOe BHHMaHHe K CTpaTerHAM

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97

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B Ka3aXCTaHCKOA nporpamme no TBG 3a nOcJieCHHe rOgbi ,aOCTHrHyT 3HaqHTejTbHbIH nporpecc cTOHKH 3peHHA CO3gaaHHM BCeCTOpOHHerH nOJIHTHqeCKOH OCHOBbl. 3Ta OCHOBa opmHHTHPOBaHa HaBHe,LapeHHe cT-paTerHH AOTC, yjiyqwleHHe Kaw1eCTBa JieqeHHs 3aKinloqeHHblx, 6oibHbix TB,o6yqeHHe Me,HLIHHCKOrO nepCOHiiana npe,aOCTaBneHHe 6ecnjiaTHbIx Me,RHKaMeHTOB ,ansHaceJIeHHSI. YaHBHTeJTbHO, 'TO 3TH HHBeCTHLUHH He npHHeCCIH )KeJlaeMbix pe3ynJbTaTOB C TOqKH3peHHS nOBbiweHHS rpoLIeHTa H3jieqeHHq. KaK HaM Ka)KeTCS, OCHOBHOH rIpHqHHOiI TOrO, HTOPC3YJnbTaTbl OTCTaKOT OT yfly1uheHHHi B niiaHe HaiHqHSA peCypCOB, qBJIAeTCA TO, KaK 3TH

pOprpaMMbl peaiH3yfOTCA Ha MeCTaX, H HeO6XO,aHMOCTb aganTauHH CTaHgapTHOi1 CTpaTerHH,ZOTC no, peambHEie reorpaqHqeCK H coLUHajTbHO-3KOHOMH4leCKHe YCJIOBHA Ka3aXcTaHa.

OCHOBHbie npo6meMHbie BOnpOCbi H MepOnpHSTHA BKMjlO4ilOT cflelyIoWHe:

Hpu6epNceuuocmb Hpagumehlbcmea a omuomemuu J4OTC ocmaemcA 6biCOKOU, HOno,uumuKa u HeOocmamKu e cemu Ae'le6Hblx y4pect)eHuu meuwaiom peuweiu,o npo6n7eM,ceA3aHHblX C nobluOeIuetM 3jpb4eKmueHocmu npo2paMM 60pb6bl C Tli.

* HCCMOTPA Ha TO, IITO HpaBHTeJIbCTBO rlpealnpHHHMaeT Ba)KHbie warH, tITo6bl CeCJmTb,iJOTC o)HUlHaflbHOri npaBHTeJIbCTBeHHOH CTpaTerHefi, Ha YPOBHe OTaeelbHbIXMe,XHLIHHCKHX ympe)xweHHHi cyuHeCTByeT PAq c aKTOpOB, rpenSITCTByiOiuHX eepeaJIH3auHH: OTHowleHHe MegHUHHCKoFo nepcoHaiia H HX 3HaHHM; HaiHmlHeMe,l4HKaMeHTOB, CTOHMOCTb JieC'eHHS ,Ln5 naHameHTOB (3a HCKJHO'IeHHeM 6ecnnaTHblxMe,4HKaMeHTOB) H COCTOAHHe HHcPaCTPYKTypbl.

* HpoieHT H3jieLieHHA HH)Ke npHeMJIeMoro. B o6uierocyjgapcTBeHHoM MacumTa6enpoueHT H3jieqeHHM I naIHeHTOB c TB; COCTaBJsIeT 75%. TaKori ipOiLeHT H3jieleHHAI He

103

noJIyqeHllH cornacoBaHnl4 pa3peIHTeCibHOF0 KOMHTeTa 1jIsi HCnOJIb3OBaHHs

Me,IHKaMeHTOB BTOporo psijaa no jibrOTHbIM LieHaM.

PecypeCbl cuemeMbi pacnpede,7AIomcA He a coom6emcmauu Co CnpocoM uacezeuiiu

(naqueHmoa TH), pacnpocmpaHenue cKopee ocHoeano Ha noKa3ameuix nped.ioNCeHuR,

maKux KaK Ko&uqeCMeo KoeK unu 6pa4eui, 'imo eeem K cyuLeSmCeHHb1M pa3n73luqAUM 6

pe3ylbmamax.

* Ba)KHOCTb ynpaBJleHHR H opraHH3auHm Ha MeCTHOM YpOBHe nOKa3aHa aOCTH)KeHHeM

flOnO)K4TefllbHbIX pe3yJlbTaTOB B o6jiacTAx, rae o6fbeM peCYpCOB Ha Aymy HaceJileHHs

MeHbwle, Him rae IOCTaBKH MeHbmIe OCHOBaHbI Ha TaKHX noKa3aTeji5IX, KaK KOJIHqCCTBO

KOeK HJIH nepcOHaJIa.

* C TO4KH 3peHHM pe3yJIbTaTOB xyxce Bcero ie'leHHe ocyHeCTBJsIAeTCA B flaBnoaape,

KaparaH,ae H 3anaiHoM Ka3axcTaHe, a TpeMA CaMbIMH jyqwlHHMH perHOHaMH sABJSOTCAS r.

AjiMaTbl, Kbi3binopaa H IO)KHbiii Ka3axCTaH. CaMble ny4WLuHe o6nacTH pa6oTaloT B 4,7pa3 niyHwe, 'eM o6nacTH C CaMbIMH Xy,liuHMH noKa3aTensIMH. 3To noIalepKHBaeT

6onbl4He pa3jIHAHH B ROCTmrHyTbIX pe3yJIbTaTax no o6nacTsM.

* B HeKOTOPbIX o6JiaCTIX C BbICOKOH 3a6oneBaeMOCTbIO o6beM BbilaenJeMbix pecypcoB

OCTaeTCs HeBbICOKHM. IACTopH'-eCKHe MeTOlbi niiaHHPOBaHHs 61o0)KeTa H OTCyTCTBHC

MOHHTOPHHra Ka'ieCTBa peaj4H3aLHH npHBeCiH K HecooTBeTCTBHIo MeXKRy BJio)KCHHbIMH

pecypcamM B BHae nepCOHania, MeLIHKaMeHTOB H HH4IpaCTpyKTypbl H KOJIHMeCTBOM

H3jieCeHHblX 60nbHblX.

OCHOBHble MePOIPHSlTHSI:

* Heo6xoaHMbl 3HaHHTenjbHble yCHJIHSi ,aJIS TOrO, 4ITO6bi YBS3aTb nepemeHHyylO 'aCTb

onJIaTbI nepcoHania c pe3yJIbTaTaMH H rlOKa3aTeJ]AMH YAOBJIeTBOpeHHOCTH nOCpe,aCTBOM

BBeaeHHA CHCTeMbl onnaTbl, OCHOBaHHOH Ha KaL4eCTBe pe3ynbTaTOB. KaK MHHHMyM,

pecypcbl aOfl)KHbl pacnpereisiTbcs Ha OCHOBaHHH KoJIH4eCTBa naUHeHToB TB uCOMeTaHHA noKa3aTeJIeH no pe3yJibTaTaM B BHae CHCTeMbl onrIaTbi, OCHOBaHHOr4 Ha

KaHeCTBe pa6oTbl.

* aanbHeAwme yjiyqw-eHHS B nporpamme LjOJDKHbi 6blTb COCpCeOTOHeHbi Ha BbIABJneHHH

TCX o6nacTeii, rae XIOCTHralOTCA HaHilymluHe pe3yJIbTaTbl C HaHMeHblHHM

paCXO2aOBaHHCM peCypCOB.

* CyWecTByloT 6o3IbmuHe B03MO)KHOCTH qJ]A LeneHa ipaBeHHOrO HCnoJIb3OBaHHS

pecypcoB aRA KOHTpOJIA, BbIlBJieHHA H nIeHeHHA TB B o6lacTTAx, aeMOHCTpHpylOUWX

caMbie 6onbmHe CouiHanbHO-3KOHOMHHeCKHe noTpe6HoCTH.

HecMompA Ha o6 U,yIO Heo6xotuAMocmb ynpa&7eHuA, nedocmamollocmb UCXOOHblX

pecypcoa, npoye6yp, o6opydo6aHuw, MeduKamenmoe u uHuipacmpyKmypbl eizuwem Ha

npo6,7eMbl c 34qDqeKmU6HoCmbIo npozpaMM.

* 06cReAoBaHHe MeaHUHHCKHX ympe)KTeHHii nOKa3aJIo, 'ITO BO MHOriHX cfyHaAx

HCXO,aHbie pecypcbl, npoLUeypbi, HaBbIKH nepCOHafa, a TaKoKe COCTOSHHe o6opyaoBaHHIA

H HH#paCTpyKTypbl He OTBeCaeT MHHHMaJIbHbIM CTaHIapTaM, Tpe6yeMbIM AnA

ympexiefHHHi no neH4eHHio Tb. HanpHMep, JIHLUb B 82% noCeWeHHbIX HaMH neqe6HbIXyqpexoeHHH HMmJeCA B HaiJHqHH MHKpOCKOr (H JIHWb B 52% yqpe)KaeHHA HMCjiCS

PYHKLIHOHHpyfOWH9 MHKpOCKOI), B 35% HMeJIHCb XOJIOAHJIbHHKH, CpeIHHri CPOK

cjiy)K6bi peHTFeHOBCKHX annapaToB COCTaBJTAJI 10 JIeT, a nomeweHHA aJ1A ,ge3HH4CeKUHH

He OTBe'anlH Tpe6oBaHHIM.

105

* OJHHM H3 HegOCTaTKOB CHCTeMb1 MBJIBCeTCS1 HeCOCTOATeJTbHOCTb B rapaHTHPOBaHHOMo6ecneMeHMl- MeCHUHHCKHX npenapaToB a.IR 6OnbHblx T,) MTO IO UpblBaeT o6wyto31xeKTHBHOCTb CTPaTCriiii ,OTC H rno6bix qpyr4x MeTOROB iieqeHHI TB. HecMOTpsI HaTO, LITO B 60JlbHJI4HCTBe yMpeXCeHHI (78%) 6bmH4 B HajiH'1H MCaHKaMeHTbl nepBoropsA,a gii.S fleqeHHS TE, npenapaTbl BTOPOrO pAaa HMmeCHcb JHllb B 62% 6oJnbHHU. Fo.ieeTOFO, BO MHOrHX 6OJbHHuax HCHOJIb3OBajH4Cb npenapaTbl 3anacOB npowJIoro roua. npHonpoce nauHeHTOB 21% H3 HHX yKa3aJ Ha TO, qTO MeaHKaMeHTOB, KOTOpbIe 6b1Jm HMnponHcaHbl, He 6bulO B HanH4HH Ha MOMeHT rioceWeHHA BpaMa.

* MHOrHX OCHOBHblX pecypcOB 4Jnsi o6ecneqeHHA BbICOKOrO KaLleCTBa nporpamm no TB)HeT B HaJTHqHH Ha peryJIAPHOH OCHOBe. HanpHMep, HCccJICaOBaHHe rIOKa3aJIo, 4TO BHanYHqHH HeT WurIpHUeB, nepi-aTOK H MapnCBb1x nOBI3OK. KaK OKa3aJIOCb, Ha MOMeHTonpoca ROBSI3KH HMeJIHCb B HanHqHH nHlllb B 44% 60JlbHHl. Ha MOMeHT o6cneaOBaHHsyHpe)KgeHHri MeHee, qeM B 20% 6oJlbHHU HMCJIHCb B HaJIHqiHH OaHOpa3OBbie LUnpHLbl Hnep,4aTKH.

OCNOBH6bIe MmeponpHSITnH:

* Heo6xoaiiMo, MTo6bI HHBeCTHuHH 6blnH COCPeAOTOqCHbl Ha o6ecnemeHHH BO BCeXyMpe)KLaCHHSIX HaJ]HLIHA MHHHMajibHOrO Ha6opa o6OpyaoBaHHA H COCTOAHHAHHcPpacTpyKTypbl, Heo6xoxiMoro aJ]A JieMeHHiA TBs. B 3TO CBA3H Heo6xoaiHMopa3pa6oTaTb reHepaJIbHbll nnIaH, B KOTOPOM paccMoTpeTb pellCHHB no YCTpaHeHHJOHeCoCTaTKOB npOrpaMMbi TEB H pa3pa6OTaTb ManO3aTpaTHYIO HHBeCTHUHOHHyfOCTpaTerHIO, KOTOpaS clenaeT yjiyqweHHe pC3yJbTaTOB MaKCHMaTIbHbIM.

• Heo6XogHMo pHpHJIO)KHTb YCHJ4HS3 K TOMy, 'To6bI TIpOBePHTb KaqeCTBO MeRHKaMeHTOB,3aKynaeMbix Ha MeCTHOM ypOBHe.

* Heo6xoaHMa aaeKBaTHaS CHCTeMa MOHHTOPHHra JIAs npOBepKH HaHqHSA OCHOBHbIXpeCYPCOB, B TOM qHcJIe MaTepHaJIOB H MeLIHKaMeHTOB.

H3Oepcjiu ObiCOKU no meNCyupapOOHblM cmallapmam, u no3moMy Heo6xo)uMAonpu.Jo3cUmb yCUzuu COn cdepmcueauwz 3ampam. CpeOiHAu cmouoOmCb npo.ileqeHHozoc,yiafl, no pacqemaM, HaxOOumCA 6 queue caMbIX 8blCOKUX cpeou cmpan Co cpet)n.U3OoxoOOM.

* CpaBHeHHe C apyrHMH CTpaHaMH C aHBajiOrHqHbIM YPOBHeM aOXOaOB, flOKa3blBaeTHaJHqHe 06111HpHblX BO3MO)KHOCTerl 4JUA COBCpLeHCTBOBaHHS nOaXOaZOB KHCHOAb3OBaHHIO PeCYPCOB. B aPYrHX CTPaHaX CO CPeCHHM aOXOJIOM LAOCTHraeTCsnOioo6HblA HnIH 6o0iee BbICOKHH ripOLeHT H3JIeqeHHSl rHi 6o0iee HH3KHX 3aTpaTax, ZaxKeripH 6o0iee BbICOKOIH 3apa6OTHOrl nniaTe MeZHflHHCKOrO nepcoHana (HanpHMep, 300 gon.CIlA B MeCCLA nonyiqaeT BpaM B EIepy H 6onee I TbIC. aon. CUIA B MeC3LI B IO)KHOrtAdjpHKe).

* O6uHe paCXO abl Ha ayWy HaceJieHMA, c yMeTOM o6ujerl qcHCieHHOCTH Hacen]eHHm BO6naCTr4, BaPbHPYIOT OT 0,4 AOJI. Ha 'enoBeKa B A1MaTHHCKOH1 o6JIacTH ao 4,9 faOn. HaqeYioBeKa B KbI3bInopaHHcKOrl o6nacTH, a cpeUHHH nOKa3aTejTb no CTpaHe no 16o6nacTrsM COCTaBHJ] 2,4 aon. CILA (Ta6iHUa 26). 3TH UH14pbI HaMHOFO Bbiwle, LieM 1,6Zoion. Cil1A Ha qenoBeKa B POCCHH B COOTBeTCTBHH C riOCJieaHHM HCC.iegOBaHHeM,ripOBCe,eHHbIM B03.

* 3aTpaTbl Ha OaHOrO naiHeHTa c TB), BbUIeqeHHOrO B Ka3axCTaHe, COCTaBjlq5OT 1639 lion.CILIA, 'qTO HaMHOFO Bblue, MeM 3aTpaTbl Ha H3JIemeHHOrO HaUHeHTa B pyrmHX cTpaHax

106

Co CpetHMM gOXOgOM. B HUX ti3Jep)KKKH Ha H3JieqeHHoro naluleHTa C FOJIO)K4TeCJbHOH U

OTPHIuaTeJIbHO9 peaKUHen COCTaBJHHIOT npHtMepHO 525 ,aon. CLIA B EO)KHOU A4pHKe H 1500 Ajon. ClLIA B POCCHU, 3TO CTpaHbI CO CpCaHHM YPOBHeM ROXO,LOB, rjae npOueHT

143JiC4eH4S COCTaBJIleT OT 52% qo 63%.* CTOHMOCTb BblIqBjeHW1 6onbHbix nOCpeCaCTBOM cjulooporpa41H14 CymeCTBeHHa H

BbICoKo3aTpaTHa. 3To o3Ha'aeT, 'TO Ka3axCTaHy npe,CTOHT ewue MHOrO nopa6oTaTb,

'To6bl YfllYIlHTb CHTyauti1O B CTpaHe.

OOCHOBHble MepOIpUISITH5I BICJ1omalOT:

* H cnoJb3oBaHHe ieeneBbix noKa3aTeneri no o6JiaCTsM c uenubo onpeaeneHIs4

BbCOKO3a-TpaTHbIX o6JIaCTeH H H3blCKaHHSI B03MO)KHOCTH JIAJs 3KOHOMHH B CHCTeMe.

EcJH H31aep)KKH CHH3HTb ,ao Me)KLaYHapOHbIX CTaHRaapTOB Ha OJHH cjiyqag H3nJIeqeHHSA

Hntii neHeHl4A, OHH COCTaBSIT 20 MJIH. aoon. ClIA B ro,4, CHH3HB o6myio CTOHMOCTb

HpOrpaMMbI Ha OqHy TpeTb.

* KoppeKUHrO YPOBHY YKOMnHfeKTOBaHHOCTH Ka,upaMH B BHae KO30iH1ieHTa KOJIHqeCTBa

ripojie4eHHbIX naLJlHeHTOB, a He Ha OCHOBe HCTOPHMeCKOrO pacrpe,aejeHHAI, OCHOBaHHOrO

Ha KOJIH-ieCTBe KoeK.

* YBenWqeHHe HCnOOb3OBaHHSI aM6yjiaTopHoro eMeeHHAl B KameCTBe MeToga 3aMeWeHHMl

,aRMTenbHOrO 6oJbHHw-Horo JieqeHHli, KOTOpOe 06blIHO npeanHcblBaeTcA HpOTOKOjiOM

ne'4eHHM.

* YcmneHHe nOTeHHma4Ha CHCTeMbi nepBH4qHOi MmeaHKO-CaHHTapHOi HOMOWH qjlA

BbIAsBfeHHsl H npeaOCTaBBjeHHAr nocne,ayowero iiemeHHsA TB Ha MeCTHOM ypoBHe.

Yjiy4iuneHHe pe3yJIbTaTOB rOCpeCICTBOM ycHjieHHl4 CHCTeMbl nIMCH H nepeHoca

pecypcoB c aoporoCTOAMHx 6OnbHHlu TB) Ha rMCrl BHeceT CBOR BKjna, B CHH)KeHHe

o6WHX 3aTpaT.

OCHOBHble Hpo6JleMbi H MepOllpH5ITHSI no ycHJ1eHHIOnporpaMMhI no 6opb6e c B1I/CHIL H Hfli

HporpaMMa no 60pb6e c BH4t/CflH,T1 CTaJIKHBaeTC51 C ueJIbIM pSlAOM rlpo6JieM, CBA3aHHbiX C

o6wHM KoHTeKCToM, B KOTOPOM peaJ4H3yeTCS nporpaMMa: nOJHTHxieCKaA BOnS, HaJIHqHe

nO.iHTHKI4, a TaK)Ke nOBeqeHHe naLUHeHTOB H Me,aHUHHCKMX ytpe)KaeHHH, H C orpaHHHieHIlIMH

CHCTeMbi ympeAKTeHHA 3,apaBooxpaHeHHSA. BMeCTe B3sITbie, 3TH XaKTOpbl sABJIAsOTCA OCHOBHOU

npo6nIeMog AJIs CHH)KeHHSl KOJIH'eCTBa 3a6oJ0eBaHHuri.

B 'HCJIO OCHOBHbIX npo6neMHblx BOnPOCOB 14 MeponpHIATHU BXOaSIT cneyowutHe:

Cyu4ecmeyem pid Hau6oaee aaxcub1x opzaHu3alrUOHHblX oonpocoe, a moM qumne:

He0ocmamoYHoCmb lewoeiecKux pecypcoa u OCHO61iblX pecypcoa &vi npo4luhzaKmuKu U

ieqenun, a maKue OpzaHu3aLfUOHRbie cJIa6ble cmopoHbl a cemuyipemcoenufi.

* Hpo¢Hn4aKTHKa H KOHTpOJlb 3nHaeMHOJIOrHMeCKOi CHTyaUHH HO COnYTCTBYIOIHJJM

3a6o0eBaHHsiM Tpe6yeT Cy1ueCTBeHHb[X OpraHH3aLi1OHHb1X H3MeHeHHH, HanpHMep,

4)yHKUHoHaUbHoII HHTerpauHH mep nTo npO()HjiaKTHKe 14 fleqeHHiO, KOTOPbIe B

HacTosAiee BpeMA1 OCyiUeCTBJISIOTCSI OTjefIbHO 'CeTblpbMAl CaMOCTOSITejbHbiliMH

BepTHKaJIbHbIMH CTpyKTypaMH: HaPKOnOrimeCKOA cjIyK6oi, LUeHTpaMH Cn11414,ACpmaTOBeHepoiorHqeCKHMH aHCHaHCepaMH H HHCTHTYTaMH Tb. 3TH CTPYKTypbl

107

npogon)KatOT geHcTBOBaTb He3aBHCHMO jpyr OT gpyra, C He6OIIbIHHM KOJH]meCTBOMHpHMepOB HCHOJnb3OBaHHSi o6WenpHHsTbIx MeTogoB.

* HMeIoiascs roJHTHKa He noggepXCHBaeT ageKBaTHoe o6y'eHHre no BOnpocaMBH4/CH4g. He pewlHB 3TOH 3aga4H, 6ygeT TPYgHO CUOPMHPOBaTb J1O,aCKHe peCypCbl,Heo6xo,aRMbie AIns 6opb6bl C 3nHgeMHeA nocpegCTBOM opraHH3au4H rpegOCTaBAeHHAMegHUHHCKOr4 nOMOUH.

* Hpo6neMbl c pecypcamHi TaK)Ke OrpaHH4HBIaOT 3c"eKTHBHOCTb nporpaMM. OAHa TpeTb(33%) o6cJIegOBaHHbIX y4pe)KJeHHiI CTpajaeT OT HegOCTaTKa ripe3epBaTHBOB 3anocaegHHe 12 mecAueB, a nepcoHan B OgHOM y'pe)KaeHHH yKa3an] Ha TO, -TO 3Tanpo6neMa BO3HHKaJia 14 pa3 3a rog.

* B pacnpegeneHHH i HHaHCHpOBaHH5A MexKy o6nacTsMH Ha6toqaf1oTCA cyLWeCTBeHHbiepa3J]HqHA. 06LuHe rOaOBbie accl4FHOBaHHA Ha peanH3auHIo nporpamMbl no BW4/CnH1lB Pecny6nHKe Ka3aXcTaH BapbHPOBamH OT 0,06 MJIH. goL. B ATbipaycKoA o6nacTH go0,34 MJiH. AonI. B KaparaHgHHcKo o6i6nacTH. 3aTpaTbl Ha OIHOrO iaiHeHTa BHI/CFIHJ;COCTaBinI4H roITH 675 gon. CIA.

* bonee IlOJIOBHHbl PKC He flOJlb3y}OTCS rpe3epBaTHBamm H He 3HaEOT 0 mepaxnpoPHnaKTHKH nepeaaq' B"I4 nOJIOBbIM nyTem, a gpyrme Kllo4eBble nporpaMMbi noCHH>iKeHHIO Bpega OXBaTbIBaIOT JIHILb orpaHHWeHHoe KOjiHHeCTBO rpynri pHCKa.O6cJneAoBaHHe, npOBegeHHoe B ropoge AjiMaTbl, HOKa3ajio, MTO 80% MCM HenOflb3yfOTCA ripe3epBaTHBaMH, y 25% o6HapyxKeHbl MMl1, 10% BBOJgT HaPKOTHKHBHYTPHBeHHO H iHUHb 30% o6niaaafOT ageKBaTHbIMH 3HaHHIMH 0 nepegawe Blf4.

* B 45% npoaHanH3HpOBaHHbIX cJIyHiaeB ripeenHcaHHb,X meHKaMeHTOB He 6bu0o BHajHI'qIHH. OgHaKO naHljeHTbl YKa3aiH Ha TO, HTO BpaHH ganH HM HeTKHe HHCTPYKUIIH 0TOM, KaK nlpHMeHSTb 3TH MegHKaMeHTbl.

OCHOBHble MepOnpHS2THSI:

* PacunIHpHTb nporpamMbl no CHHKeHHIO Bpega Ha 6o0iee BbICOKHH npO"eHT BcexyS3BHMblx rpynn.

* 06ecneMHTb HianH'HIHe npe3epBaTHBOB CpegH rpyrin pHCKa.* YnyqllrHTb KOOpgLIHHaUHto pa6oTbl B CCTH y4pe)KLeHHM. B OTHOIIeHHH jIe4eHHS

ocyweCTBnAeTcAl HegOCTaTO4HaA HHTerpa[W4A/KOOpgHHaUHA MexKy yMpe'KLeHHAMBnepBH4HOA MeAHUIHHCKOH nOMOIWH H cneLUHaiH3HPOBaHHbIMH 6oJbHHwiaMH H Me>KgyueHTpaMH CrHI4,A, HHCTHTYTOM TB; H AmcnaHcepaMH, a TaKwoe cgepmaTOBeHepojorHLecKHmI gHcnaHCepaMH.

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pa6oTalowHe c PKC oco6eHHo c HenpaBHTenIcTBCHHLX opraHH3auJDKBC

114

FopoAcKHe CernbcKHe

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,AmcnaHcepax, tTo6bi peiuHTb, KOrO H3 JaHcnaHcepax, qTo6bi peIIITb, KOrO H3

HHX CJ1eAyeT npHrJaCHTb. HHX cneAyeT npHrAaCHTb.

* OaHa rpynna ZaOJDKHa COCTORTb H3 * OaHa rpynna aOn)KHa COCTOA'Tb H3

raBuHeHTOB C AHarHO3oM TB) B TeMeHHe nauHeHTOB C HaHFHO3oM TS B TCMeHHe

nOCAe,AXHHX Tpex- meTblpex MecxueB, HO nocAeaHHX Tpex- HeTbIpeX MeCAlLueB, HO

KOTOpb1e He Ha'tauIH eieqeHHe KOTOpbIC He HamanuH A eqeHHe

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niocle,aHHX nHTH-uIIeCTH Mec14ueB H IOCJ]eCIHHX nHTH-HIeCTH MecHueB H

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)KeH11mHH

115

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116

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qeLiOBeK.

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- MO)KeTe J114 Bbl KpaTKO onHHCaTb, KaK 3TH4 ycSiyrl OKa3blBaEOTCA HaCeJieHHIO? [BonpOCbl:

tImo KouKpemno Juoou )o0nsCHbl coejlamb, qmo6bi noniyuumb 3mu ycJzy)u? ,ftonzdcHbl nu OHU

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117

OTHomIIeHHe IC llaIHeHTaM TB

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pa3wuqui Meoicoy omnowueuuem uaceienux, epaieu U Me6ceemep].

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118

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HauieHTbl HHorAa npeKpaialoT niieeHHee npe)KgeBpeMeHHO. KaKOBbI rFfaBHbie npHMHHbl

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119

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- B144 HH(DeKUHs ocTaeTcsA eLHHcTBeHHbLIM HaH6ojiee BaxKHbIM (jaKTopoM B 3apa)KeHHH TB.C 3TOH Ljejbio nporpaMMbl KOHTPOJIS TBS ROJIXKHbI 6blTb TeCHO CBS3aHbi c nporpaMMaMHKOHTPOJIS H rlpeCOTBpaeHHA BWC 4. HoKaAygcTa, OnHuIHTe, KaK 3TU HpOrpaMMbICBI3aHbI. [BonpoCbl: npo6yuime 3acmaeumb yiacmtiuKoe onpebe,7umb KoH7KpemHbleMepbl, KOmOpble npuMeHAiomcq o)jzA c6A3u gmux 0e6yx npoepaMM. Ecjiu 6blmemHne6ocmamoK KOoptuHaziuu, nooicaizyficma, onpeoeAume, timo MoxCuO c6eJzamb oJnI eeywytiweHuJu.]

AeIBaTHOCTb IUOJIHTHica B o6jiaCTH TI;

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120

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6oamie 6ajTnOB, meM KocTaHaricKas o6nacTb (17 6anJToB).

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121

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pe3yJlbTaTax, LOCTHrHyTbIX pa3Hb]MH o6iiaCTIMH.

rlpoBepAA o6¶,eRHHeHHbie UHHgeKCbl, o6HapyxHniocb, qTo 56% o6JiacTei (<nnoxo»)cnpaBHJIHCb c peaJIH3alHeri nporpaMMbl, TO eCTb HX periTHHr B peCYPCHOM HHJaeKce HaMHoroJIylMIne, tleM B HHgeKCe pe3yJIbTaTOB. O0,HaKO TaKOHi pe3yflbTaT He ABJIAeTCS CHEbHbIM

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peHTHHr no pe3yJ]bTaTaM

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AjiMaTbl, rOTOMY MITO OH HaxouHTcq B HH)KHeH 4aCTH pei!THHra no pecypcaM, HTO

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PK. 2003 r

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125

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