The Impact of Healthcare Reforms on the Epidemiology Workforce in Kazakhstan: An Interrupted Time Series Analysis with Predictive Modeling of Nationwide Data Sources from 1998 to 2022

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BACKGROUND: Following its independence, Kazakhstan implemented several reforms, including the adoption of the Entrepreneurial Code in 2008. This study aims to evaluate the impact of these reforms on the number and per capita rates of epidemiologists, nurse epidemiologists, epidemiological surveillance centers, and infectious morbidity from 1998 to 2022. Such an evaluation is critical for informing policy decisions regarding the future of epidemiological services in Kazakhstan. METHODS: An interrupted time series analysis using a best-fit epidemiological model was conducted to assess the impact of key interventions-specifically, the adoption of the Entrepreneurial Code of the Republic of Kazakhstan and subsequent legislation-on the number and per capita rates of epidemiologists, nurse epidemiologists, and epidemiological surveillance facilities with infectious morbidity across the country. RESULTS: Infectious morbidity per million individuals ranged from 4698.14 to 2263.79, with a consistent downward trend observed throughout the study period. Over the study period, the per capita rates of urban epidemiologists exhibited a downward trend, whereas the rates of rural epidemiologists showed an upward trajectory. The per capita rate of epidemiological surveillance centers declined from 26.89 to 15.24 over the study period. Substantial disparities were observed between urban and rural areas, with the epidemiology workforce in urban settings being 3-4 times larger than that in rural areas. CONCLUSIONS: This evaluation is important for informing policy decisions regarding the future of epidemiological surveillance services in Kazakhstan.

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