Research Institute of Skin and Venereal Diseases

The Research Skin and Venereological Institute is one of the oldest scientific medical institutions of the Republic of Kazakhstan. The institute was established according to the order No. 232 dated October 16, 1930 of the People's Commissariat of Health of the Kazakh Autonomous Soviet Socialist Republic on the basis of the Alma-Ata children's dermatovenerologic hospital (the premises of the former Vernensk oblast hospital) and the Alma-Ata dermatovenerologic dispensary called “Regional dermatovenerologic venerologic research institute ". The official opening date, according to the said order, was October 1, 1930. The solemn opening of the institute took place on January 5, 1931. The staff of the institute on the day of education, including practical health workers, consisted of 58 people.

By order No. 306 of November 12, 1932 of the Narkomzdrav of the Kazakh ASSR, the institution was renamed the Kazakh Research Institute of Skin and Venereal Diseases. After the formation of the Kazakh SSR in 1936, the institute was assigned to the Commissariat of Health of the Federal Republic and became known as the Research Institute for Skin and Venereal Diseases of the Narkomzdrav (since 1946 - the Ministry of Health of the Kazakh SSR, since 1998 - the Ministry of Health, Education and Sports of the Republic of Kazakhstan, since 1999 - The Agency of the Republic of Kazakhstan for Health, since 2002 - the Ministry of Health of the Republic of Kazakhstan).

One of the first directors of the institute was AM Mametov - the father of the hero of the Soviet Union Manshuk Mametova. Already at that time, under the leadership of A.Mametov, syphilis was monitored in the nomadic and semi-nomadic regions of the republic, and preventive, sanitary and educational measures were organized among the population of the Republic.

In 1931, the Kazakh Scientific Research Center for Skin and Venereal Diseases included a clinical, organizational, methodological, and laboratory and experimental departments.

In 1931-35 the institute was alternately headed by SNRutkovsky and A.Tatarintsev. In the first years of its existence, the activities of the institute were mainly methodological and practical. The specialists were faced with the task of training regional medical workers in the methods of diagnosis and treatment of genital infections and fungal skin diseases; creating rational approaches to organizing the work of the service in the territory of the Soviet Republic. Thus, in 1937, venereology care was almost universally provided by medical assistants, there were only 70 venereologists in the Republic, and the intensive incidence rate was 66.6 per 10,000 inhabitants, including the early forms of syphilis - 7.0; fresh gonorrhea - 40.5.

The Institute systematically published and sent methodological letters and recommendations to regional institutions, and in 1934 the first issue of the Bulletin of the Regional Dermatovenerologic Institute was published. The bulletin was replicated on a hectograph in 100 copies, among the authors were L. G. Gringot, V. V. Serebryakov, K. V. Artemyev, L. R. Boguslavskaya and others.

In May 1936, an associate professor (later a professor) M.S. Bragin, who previously worked as the head of the syphilitic department, was appointed director of the institute.

The institute organized specialization courses, during which from 1931 to 1940, 102 service specialists, 85 technicians-technicians, 117 medical assistants and 89 nurses were trained.

Since 1936, the institute began to practice the annual decade, where lectures were given to specialists of regional institutions on topical issues of diagnosis, treatment and prevention of skin and venereal diseases. In the same years, the bed capacity of the clinic was expanded to 65, a library appeared in the structure of the institute, the post of deputy director for the scientific unit was established; The number of doctors and researchers at the institute reached 16 people.

In 1937, at the post of the director of the institute, M.S. Bragin replaced B.Yetemisov, among the main results of the work of the team he headed, at this time it is worth highlighting - improving the treatment and prevention of gonorrhea. In 1938, a dispensary was included in the institute; the number of fixed beds has risen to 75.

Anti-epidemic measures, conducted under the direction of the Institute, in 1940 led to a decrease in the incidence of syphilis, gonorrhea, leprosy, dermatophytosis, scabies.

However, the creation of relatively favorable conditions for the workers of the Institute was prevented by the Great Patriotic War. The Great Patriotic War of 1941-1945, which brought incalculable disasters to the people. significantly slowed down the development of dermatovenerology. However, throughout the war, the institute continued to work, assisting the wounded and sick.

In the postwar years, the incidence of venereal and infectious skin diseases increased again, which required the institute to renew its efforts to achieve stabilization of the situation.

From 1940 to 1946, the institute was headed by Professor S.А. Poplavsky, in the future the Honored Scientist of the Kazakh SSR.

Further, until 1952, the leadership of the institute was entrusted to A.Polyansky, a candidate of medical sciences, who paid great attention to the organization of venereal diseases.

The material and technical base of the time left much to be desired. Thus, the total area of ​​old buildings with partial amenities, which housed a clinical building, a Vendist dispensary, a laboratory, administrative and business premises, was only 1,386.9 square meters. m. Here, later, the Department of Skin and Venereal Diseases of the Kazakh State Medical Institute and the Fungal Diseases Sector of the Research Institute of Regional Pathology were located. The Kozhvenin Institute staff in 1946 was 68.5, the dispensary - 53.5 units.

The 75-bed institute hospital did not fully meet the hospitalization requirements of patients with a dermatovenerological profile, and therefore the order of the Ministry of Health of the Kazakh SSR dated March 14, 1950 No. 81 dispensary of the institute together with the staff, medical and household equipment was transferred to the Alma-Ata city health department. Scientific and methodological guidance dispensary remained at the institute. In fact, the transfer of the dispensary to urban health has led to a drastic reduction of staff. In the clinic of the institute, 12 medical positions remained at that time.

From 1952 to 1958, Professor U.B. Berdybaev worked as the Director of the Institute, and later - Honored Scientist of the Kazakh SSR. His deputy in science in different years was S.А. Poplavsky, B.А. Tokarev. The institute’s team, under the direction of Professor U.B. Berdybaev, devoted a large number of research projects to the study of the fungal flora of Kazakhstan, the characteristics of the dermatophitic clinic in Kazakhstan, and the improvement of their treatment methods.

At the beginning of 1954, a two-storeyed clinical building and an extension of the kitchen (now demolished) was built and put into operation. The number of fixed beds was increased to 100. Several laboratories were housed in a small, adapted structure: biochemical, clinical, serological and bacteriological.

In 1958-1959 the institute was headed by Professor K.A. Kalantaevskaya; in March 1959, she was replaced by I.O. Senkov, in the future, the Minister of Health of the Kazakh SSR.

Then, in 1959, the institute was headed by associate professor MOOmarov. In 1963, Associate Professor ZPPyankova became Deputy Director of the Institute for Science. In 1959, the dispensary department was transformed into a dispensary department, which was turned into one of the scientific divisions of the institute; The sector to combat leprosy, which existed until 1965, was opened. The institute continued to expand. As of January 1, 1964, he numbered 194 full-time positions, including 47 research associates, 8 of whom had a PhD degree in medical sciences.

In 1963, the institute introduced the post of academic secretary, the first secretary was the candidate of medical sciences IGGurin, from 1964 to 1978 this position was occupied by associate professor P.I. Volova. In 1968-1969 the reorganization of the structure of the institute was carried out, which made it possible to enlarge the departments, more economically plan a scientific theme and organize its effective implementation. The organization of the medical and medical-technical information group (G.S.Sokolenko, A.D. Bagautdinova) promoted the fastest introduction of new methods of treatment and medical equipment into the practice of healthcare.

In 1969, the Council created the scientific organization of labor. In the process of timing the cost of working time of doctors of the outpatient department, a reserve of working time was identified, proposals were made that allowed the doctor to restructure the working day.

From 1978 to 1981, the director of NIKVI was Professor R.K. Makasheva.

Since 1981, the institute has been headed by Professor Z.B.Keshileva. Assistant Professors E.R. Fedotov (1981-1984), V.V. Kalugin (1984-1991), A. B. Kosuhin (1991-1999), P. .N. Deryabin. Among the scientific secretaries in different years are L.P. Zimina, I.V. Gerasimenko (1984-1992) and K. B. Kazangapova (1992-2001).

Since 1981, the construction of the institute began, and in 1983, the first modern building was commissioned, where the advisory department of the clinic, various laboratories and the administration were located.

In 1989, the first phase of the clinical building of the institute was adopted, and in 1993 the construction of the in-patient department was fully completed. On the site of demolished dilapidated buildings along Raiymbek Avenue from Potanin Street to ul. L.Hamidi stretched the architectural ensemble of modern buildings, which constitute the current base of the Research Institute of Skin and Venereal Diseases, the total area of ​​the interior premises is 15058 sq.m.

The construction of the new NIKVI building and the renewal of the material and technical base led to a dramatic increase in human resources, the range of research areas expanded, and new departments and laboratories were organized.

So, in November 1982, the Department of Occupational Dermatosis was organized with a staff of 5 people, in 1999 the Department of Occupational Pathology was merged with the Department for the Study of Hereditary Skin Diseases.

In September 1980, an immunology group was created at the institute, which was then transformed into an immunology laboratory. The personnel potential of the laboratory was represented by 14 specialists, including 5 scientists. For the first time in NIKVI, on the basis of the immunology laboratory, in 1987, a group for diagnosing HIV infection was organized, which still exists today.

In 1987, a laboratory of physical and chemical medicine was organized with a group of pathomorphology (originally it was called the biophysical laboratory). The laboratory united specialists of various scientific profiles: biochemists, biophysicists, pathologists.

In 1997, a paid department was opened, providing medical services to patients outside the compulsory, guaranteed amount of medical care. In 1998, a branch of the institute was opened in Astana; for many years and now the director of which is G. R. Batpenova.

In January 2000, a group of urogenital infections was allocated to an independent department, which included 4 research assistants.

From 2001 to March 2005, the institute was headed by Professor M.T. Shakirov. GP Kasimov (2001-2002) and KSAkyshbaev (2002-2005) were deputy directors for scientific work in different years.

In 2002, the department of urogenital infections was abolished, the clinical diagnostic laboratory was merged with the laboratory of physical and chemical medicine.

From 2005-2009 The director of the institute was Professor G.K. Askarova. A.I.Baev, Candidate of Medical Sciences, was the Deputy Director for Research, A.T. Abishev, Candidate of Medical Sciences, was Deputy Director for Medical Work, and Scientific Secretary

From 2009-2010 The institute was headed by Academician T.A.Muminov, who for many years worked as the rector of KazNMU. S.D.Sfendiyarov. From 2010-2011 Professor A.D. Duysekeev, from 2011-2012. the duties of the director of the institute were temporarily assigned to the candidate of medical sciences A.I.Baev.

From February 2012 to August 2014, the Director of the Institute was A.E. Eshimov, Candidate of Medical Sciences, who previously headed the Almaty Regional Dermatovenerologic Dispensary. Candidate of Medical Sciences A.I.Bayev, then Candidate of Medical Sciences G.Ye.Abilkasimova, and Candidate of Biological Sciences M.Kh. Dzhusupgaliyeva were the Deputy Directors for Research in this period.

Since August 2014, the candidate of medical sciences Islamov E.N., who previously worked as the chief physician of the Atyrau regional dermatovenerologic dispensary, was appointed acting director of the institute.

From 2015-2017 The institute was headed by M.S. Shakirov, MD, who previously worked as the Director of the Hospital of the Disabled of the Patriotic War.

From November 2017 to 2018, the Acting Director of the Institute was A. Abishev, Candidate of Medical Sciences, who previously held the position of Deputy Director General for Medical Work at the Republican Center for the Prevention and Control of AIDS.

Currently, in the dermatovenereological service, measures are being taken to improve the quality of medical services, the transition to low-cost forms of medical care.

NIKVI is a scientific, organizational, methodical, educational and clinical center of Kazakhstan in the field of STIs and skin diseases and has 128 employees (including the management staff and support staff). Today, the institute has the following main divisions: the department of strategic development, headed by Candidate of Medical Sciences Ospanova S.A., the Department of Dermatovenereology - the head of the candidate of medical sciences Islamov E.N. biochemistry with skin pathology and paraclinical studies, serology, clinical immunology and immunocorrection, microbiology, organizational and methodological and statistical -terrorist departments, besides the Institute has an internal audit service.

In 2018, the Accreditation Council of the Independent Kazakhstan Agency for Quality Assurance in Education NIKVI passed institutional and primary specialized accreditation in the specialty 6R111400 - Dermatovenereology, including children. Reception and training in residency in the specialty 6R111400 "Dermatovenereology, including children." Currently, 23 residents of the 1st year of study and 3 residents of the 2nd year are undergoing training in NIKVI.

There are 2 professors, doctors of medical sciences, 1 associate professor, candidate of medical science, 9 candidates of medical and biological sciences, 2 masters of medical sciences among the Institute’s employees.

The institute brings together scientists of various profiles, which provides an integrated approach to research.

On the basis of NIKVI and beyond its limits (exit cycles), advanced training cycles of dermatovenerologists are carried out, followed by the issuance of certificates of specialization.

In the first years of the institute’s existence, in its scientific activities, epidemiological studies were carried out in the first place, which were carried out using expeditionary methods of work, which made it possible to collect not only extensive material on the foci of venereal and skin diseases in different regions of Kazakhstan, but also to carry out on-site sanitary propaganda .

The first 10 years at the institute studies were conducted in the following areas:

• organization of the fight against syphilis and gonorrhea;
• study of the flora of ringworms and the fight against them;
• development of methods for treating skin and venereal diseases.

During the Great Patriotic War, the institute team dealt with the problems of fighting syphilis, gonorrhea, skin, fungal and parasitic diseases, as well as the study and research of new medicines.

In the post-war period, one of the most important tasks of the institute was “the elimination of sanitary consequences in the fight against venereal and skin diseases in the Kazakh SSR”. According to the Government Decree “On Strengthening the Dermatovenereological Service” in 1946, 24 dermatovenerologic dispensaries were deployed.

Since 1950, a number of scientific fields have been developing at the institute.

1950-1960 characterized by a stage of the most active, developed and effective struggle against fungal skin diseases, the honored scientist of the Kazakh SSR, doctor of medical sciences, professor U.B. Berdybaev became the founder of this direction. During this period, Associate Professor G.A.Mulagulova developed a method of X-ray-free treatment of mycosis of the scalp in the conditions of rural regions of Kazakhstan. Much attention was paid to the study of eczema and eczema-like diseases (R.K. Makasheva, A.I. Martynova, Z. P.Pyankova). Professor S. Poplavsky developed a method for treating patients with eczema, neurodermatitis, psoriasis, trophic ulcers in the Arasan-Kapal resort and criteria for the selection of patients for balneotherapy. A.Polyansky studied the organization of medical care to the population of rural and urban groups in venereal diseases. A large cycle of morphofunctional studies of the sebaceous glands was performed by KA Kalantaevskaya, who first described the histomorphology of human skin appendages in ontogenesis, which studied the involvement of the male genital glands, thyroid gland, adrenal glands in regulating the functions of the sebaceous glands and associated with endocrine regulation disorders a number of skin appendages diseases. O.Zh.Seyketovoy investigated the spread, characterization of purulent cocci and the relationship with these indicators of the incidence of pyoderma. The antibiotic treatment of gonorrhea has been studied by MO Omarov, MM Vishnyak, AD Tselishcheva, K. Kh. Akhmedova. Among the serious experimental studies of these years, the cycle of works by E.I. Shtikkel on the pathogenesis of pyogenic infection deserves attention.

Research conducted by the institute in the 1970s and 1980s made it possible to widely introduce an accelerated method of serodiagnosis of syphilis using a microprecipitation reaction with a cardiolipin antigen. The specificity and sensitivity of the reaction in Kazakhstan’s populations and the effectiveness of its use in outpatient treatment (LA Pshenichnaya, I.A. Zhodzishsky, S.M. Vorobeichik, etc.). A cycle of studies on the adaptive variability of microbes was performed (N.Ye. Soloviev and others). By the beginning of the 80s, the first works carried out at the Institute of Dermatogenetic (Z.B.Keshileva), on the cellular immunology of syphilis and gonorrhea (L.N.Timofeeva), which laid the methodological foundations of those areas in which the Institute is currently developing . During these years, the evolution of the causative agents of syphilis, gonorrhea, trichomoniasis, ureamicoplasmosis, chlamydia was studied: preparations for the treatment of these diseases were evaluated (N.B.Amanbaev, I.M.Omarov, N.A. Shlykova, S.M.Nurusheva), phototherapy of dermatoses with the use of coherent and incoherent red light has been intensively studied (V.V. Kalugin). Conducted a study of new schemes and methods of chemotherapy of syphilis and urogenital sexually transmitted infections (A.M. Maldybaev).

A new stage in the development of dermatology and venereology of Kazakhstan, associated with the reorganization of the material and technical base and the influx of new personnel began in the mid-80s, which allowed to conduct research at the level of modern requirements. In the serological laboratory of the Institute, a method was developed for obtaining control sera for syphilis (L.A. Pshenichnaya, D.A. Azizov). A liquid nutrient medium was obtained in the bacteriology laboratory for the rapid diagnosis of ureaplasma infection V.V. Kalugin, K.S.Akyshbaeva, G.M.Tonkonogova, N.V.Volkovinskaya) and cultural diagnosis of gonorrhea (O.S.Rudakova). Cellular tests for the early immunodiagnostics of syphilis and gonorrhea (L.N. Timofeyeva, V.L.Rybkina) have been created in the immunological laboratory. In the laboratory of physico-chemical medicine, methods for monitoring chronic bacterial prostatitis using television thermography of enzymatic studies of prostate secretion have been developed (A. B. Kosuhin, R. R. Abdrakhmanova).

Particular attention is paid to the main problem of dermatology - psoriasis. The prevalence of psoriasis is studied, the groups of greatest risk are identified (Z.B.Keshileva, DAArazymbetova, M.L.Nugmanova, S.N. Walter, N.A. Voloschyk). A new, copyright-protected method for the treatment of psoriasis is being developed (Z.B.Keshileva, V.V. Kalugin, S.N. Walter, O.Z.S.Seketova, Z.P.Pyankova, M.L.Nugmanova), method of individual immunocorrection diseases (Z.B.Keshileva, L.N.Timofeeva, V.L.Rybkina, P.I. Volova, V.N.Kemaikina), new links in the pathogenesis of psoriasis are opened.

A new method of treating mycoses of the feet has been developed, which made it possible to significantly shorten the terms of treating patients. Baseline data were obtained characterizing the prevalence of mycoses of the feet among draftees and elderly and elderly people living in different areas of the city according to the level of environmental pollution (TS Kunakbayeva). The clinical efficacy of pulse therapy with itraconazole in the complex treatment of squamous-hyperkeratotic forms of foot mycoses with onychomycosis has been proven (DA Orazymbetova, TS Kunakbayeva).

The Department of Occupational Dermatosis conducted epidemiological studies of pustular skin diseases in workers in the agro-industrial complex. As a result of the development and implementation of preventive measures, a significant economic effect was obtained from reducing the incidence (K.S.Kystaubaeva, Sh.G.Abdrashitov, N.M.Lukina, L.S.Ermagambetova).

Comprehensive methods for the treatment of urogenital chlamydia and mycoplasmosis with spiromycin and doxycycline in combination with an interferon inducer (S.M.Nurusheva, S.A. Valiyeva) are proposed. A method of treating early forms of syphilis using penicillin preparations with the inclusion of hyaluronidase inhibitors, which affects the shortening of the regression time of syphilides and the negativity of the serological complex of reactions (A.T. Abishev), has been developed and proposed.

A new nutrient medium was developed using the human placenta, with elective properties comparable to the Johnson-Trassel medium and exceeding the SDS medium (M.H. Dzhusupgaliyeva) in terms of indicators.

The prevalence of ichthyosiform genodermatosis and the incidence of common autosomal-dominant, autosomal recessive and X-linked ichthyosis in urban and rural populations has been determined. The influence of inbreeding on the structure of morbidity, clinical polymorphism of genodermatosis and the influence of environmental and genetic factors on the occurrence and course of atopic dermatitis in different areas (Z.B. Esengaraeva) were determined.

The immune status of patients with leprosy and contact persons - residents of the Aral Sea region was studied. The problem of establishing basic indicators of the immune system in patients with leprosy complicated by secondary infection has been solved in order to develop methods of treatment and immunorehabilitation (L.N.Timofeeva, E.I. Myrzahmetov).

Since 1994, the Specialized Council of the Kyrgyz Republic 09.17.01 of the Ministry of Health of the Republic of Kazakhstan to defend PhD dissertations, which had 25 Ph.D. dissertations defended, began its work at the Research Skin and Venereological Institute, and at its meetings on 03/03/2000 The Council of CP 09.09.01 for the defense of doctoral theses, at the meeting of which 1 doctoral and 17 master's theses were defended.

Along with this, the staff of NIKVI of the Agency of the Republic of Kazakhstan on health issues were defended in other Councils 7 doctoral and 4 master's theses.

Currently, NIKVI is a scientific, organizational, methodological, educational and clinical center of Kazakhstan in the field of STIs and skin diseases. The Institute conducts a great deal of organizational and methodological work to coordinate the activities of the entire dermato-venereological service in the Republic.

The researchers of Kazakhstan became full members of the International community of scientists. Our compatriots are represented in a number of international and foreign professional academies, including the European and American Academy of Dermatology and Venereology. The works of Kazakhstani dermatovenerologists have gained fame and recognition in leading research centers in the United States, Europe and Russia.

The last decade is characterized by an especially intensive introduction of new technologies in all parts of the dermatovenerological service of Kazakhstan.

The Institute is actively introducing new approaches to conducting anti-epidemic work, in particular, the WHO-recommended method of sentinel epidemiological surveillance, which provides for priority monitoring of persons belonging to risk groups: sex workers (sex workers), drug addicts, sexually active adolescents, prisoners, employees of certain professions, in particular, truck drivers. This technique allows, at lower economic costs, to more accurately determine the structure of the incidence and eliminate the most active foci of infection that support the epidemic process.

The introduction of new technologies is especially noticeable in the field of laboratory diagnostics. New high-tech methods of immunological and molecular genetic diagnostics come in to replace the routine diagnostic methods, allowing timely diagnosis of diseases such as chlamydia, urea-mycoplasmosis, herpes, chronic and rare dermatoses.

The institute has unique equipment (fluorescent microscope - Axioscop-40, Zeiss, flow cytometer - Becton Dickinson, PCR - Applied Biosystems, gas-liquid chromatograph - Gow-MAC, column with a collector for chromatography - BEKMAN, UV Waldman cabin - UV 1000 Kl, electrolyte analyzer - AVL, Roche, hemostasis analyzer - Minilab 701, automatic bacteriological analyzer -Multiscan, densitometer (Apprise), allowing to introduce modern high-tech methods for the diagnosis and treatment of dermatoses and STIs in NIKVI.

Molecular genetic typing of Neiserria gonorrhoeae strains isolated in the Republic of Kazakhstan was carried out and the mechanisms of resistance to fluoroquinolone were determined by the employees of NIKVI together with the Research Institute of Physico-Chemical Medicine of the Russian Academy of Medical Sciences (Novosibirsk). The main determinants of gonococcal resistance to fluoroquinolone have been identified - spontaneous mutations occur in nucleotide substitutions in areas of the gyrA and parC genes that determine quinolone resistance (QRDR) (T.A.Muminov, A.I.Baev, G.M.Tonkonogova) .

In the laboratory of immunology, a flow cytometer is used to conduct studies on the detection of skin tumors in the early stages (malignant skin T-lymphomas) and the study of systemic immunity in patients with chronic recurrent dermatoses.

In recent years, NIKVI has been actively cooperating with international public organizations (CDC, USAID, WHO) in terms of introducing new innovative technologies in Kazakhstan on the problem of STIs. Using the recommendations of WHO, standards and algorithms of measures for the main nosological forms of STIs are developed: syphilis, gonorrhea, urogenital chlamydia, which are introduced into the system of penitentiary institutions. The protocols for the diagnosis and treatment of STIs have been compiled that meet international requirements and have been approved by the Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan (A.Ye. Eshimov, A.I.Bayev, (G.Ye.Abilkasimova, M.G.Dzhulfaeva).

The subject of the research direction of the institute is determined by the epidemiological situation that has developed in the republic in relation to socially significant diseases, which include a significant part of the whole variety of skin diseases, as well as infections that are transmitted mainly through sexual contact.

The fight against socially significant diseases that pose a danger to others is highlighted among the main priorities in the Law of the Republic of Kazakhstan "On the protection of the health of citizens of the Republic of Kazakhstan", in the State Program of Health Development of the Republic of Kazakhstan "Densaulyk" for 2016-2020, developed in to implement the Decree of the President of the Republic of Kazakhstan dated February 1, 2010 No 922 “On the Strategic Development Plan of the Republic of Kazakhstan until 2020”, the Message of the Head of State to the People of Kazakhstan dated November 11, 2014 “Nur skipol is the path to the future ”and the National Plan“ 100 concrete steps to implement the five institutional reforms ”is a logical continuation of the previous state programs of reforming and developing health care for 2005–2010 and Salamatty Kazakhstan for 2011–2015.