Leading and Managing Health Services

Title: Leading and Managing Health Services, HAR682

Business Plan Service: Prevention of High rates of CVDs prevalence in Kazakhstan through setting Weekly Physical Activity Classes and Seminar

 

 

Business Summary outline

1. Background and rationale

Discussing the problem: The problem to be discussed is cardiovascular diseases (CVDs), which involve the blood vessel or heart and include CAD (Coronary artery diseases). This is the most common non-communicable disease across the globe, which is responsible for around a 17.8million deaths in 2017. CVDs have remained a leading cause of mortality in Kazakhstan, which has one of the highest CVD mortality rates across the world. As per the WHO, age-standardized CVD mortality rates in this country were 650 per 100K inhabitants in 2008 and the mortality rate due to this disease among the men are 859 per 100K inhabitants, whereas in women 546 per 100K inhabitants. This can be considered as a problem because 50% of the Kazakhstan people experience CVDs that lead this nation to face the highest mortality rates caused by CVDs (1). The respective nation has pronounced ethnic and regional differences in all causes and the mortality rates by CVDs that have never been analysed effectively and properly (2). In addition, this nation experiences the challenges associated with fair distribution of limited healthcare resources, along with the regional differences across Kazakhstan, yet it is considered a middle-income country presently.

2. Service Delivery/Project operations and management_800
3. Current Operations: Kazakhstan has particular legislative and policy frameworks in place of CVDs, specifically addressing the risk factors, and the Densaulyk Healthcare Development Programme 2016-2019 along with a new Public Health Action Plan 2018-2021 include preventing and controlling CVDs. However, there is yet a gap existing in implementing the WHO-recommended cost-friendly CVD preventive with clinical interventions (3). The respective government applies assessment of individual-level interventions to reduce the mortality rate of CVDs such as effective detection with the management of hypertension, effective primary prevention in a high-risk group, risk stratification in primary care, and many others. However, for example, to reduce the hypertension level, evidence-based hypertensive drugs are prescribed, although some efforts are made for increasing patient’s adherence, however, it is not systematic. When it comes to assessing the risk stratification in primary care across Kazakhstan, incomplete documentation of the risk factors is seen or there is no systematic method applied by the healthcare department and the government of this nation. There are clinical practice guidelines with protocols available, however, the quality of the management is yet unknown. The Gender Equality Strategy 2006-2016 reveals that the health priorities set in this strategy are for reproductive health, however, there is an acknowledgement of premature mortality among Kazakhstan men due to CVDs. It also identifies weak health-seeking behaviour among Kazakhstan men and low priority of men’s health in healthcare services. Furthermore, most of the population interventions in this country have addressed alcohol and tobacco, however, less attention has been paid to physical activity and diet. Thus, actions are needed, specifically in these areas such as physical activity and diet among the Kazakhstan people, as 60.5% of men are overweight and 57.1% of women are obese.
4. Proposed Service: Since, the areas such as physical activity and diet have not been paid attention to, which are also one of the major causes of CVDs in Kazakhstan people, thus the proposed services are based on these areas. This proposed service would be increasing awareness of the importance of PA (Physical Activity) among these people specifically the people of remote rural areas such as Saykhin, the Administrative Centre of Bokeyorda district. The Service is all about providing workout or physical activity seminars, session and classes to these people every three consecutive days of a week. This service is to be partnered with the local club, which could only enhance the knowledge of these people through community seminars. Involvement of these community seminars would target to bring some behavioural changes among this villages adults to cope with the CVDs prevalence. The aim of this service is not only to provide Physical Activity Sessions, but also to make the people aware of CVDs, RFs (Risk-Factors) leading to CVDs, and strategies to reduce the risks of this disease by at least 20%. Moreover, this proposed service further aims at building a health-centric behaviour and habit among these people to be physically fit and lead a healthy life during the first year of this business plan.

Service includes three major areas such as “awareness of CVDs and its risk factors among the adult of Kazakhstan people, arrangement of physical activity seminars, and bringing a healthy change to the habit and behaviour of these people”. These areas to be implemented would result in decreasing the rate of CVDs by around 20%. Since, there is a lack of attention paid to this risk factor, lack of physical activity, and as per the WHO, there is a limited core intervention for addressing physical activity, thus the actions carried out to implement the proposed service would fill this gap. Actions to organize PA Seminar, direct the business executives to obtain permission from the Local Administration for using the local club for the first month of this business. Furthermore, recruitment of two trainers for two different exercise sessions such as morning and evening is to be carried out, then again recruitment of at least two interchangeable medical professionals from the near district hospital is to be conducted for making the adults aware of this disease. Actions such as conducting PA session three times a week in the morning and evening for two hours throughout the first year and enrolment of local adults under the supervision of a doctor at CVD risks along with residents willing to participate are to be carried out.

Figure 1: A logical Model

This new service is needed to be implemented in the Western region of Kazakhstan because their government apply most of the population interventions, which address alcohol and tobacco, however do not pay attention to the areas of physical activity with diet. Thus, this service would meet this gap by making the people of Kazakhstan aware of the consequences of physical inactivity, which would encourage them to participate in the PA seminar. Furthermore, their participation in the PA seminars would lead them to know about the effects of PA Seminars as the healthcare professionals would evaluate the participated peoples progress rate reducing the possibility of CVDs among adults.

Resources: The implementation strategy of the Fitness-health program includes resources such as physical activity session based feedback and observation, fitness equipment, session resources, and trainer instruction handbook (5). Resources required to implement the strategy aimed at organizing PA seminar include healthcare professionals, doctor, laboratory, local administrators permission, finance, club, trainer, trainer instruction handbook and equipment for exercising, aerobics, yoga and workouts. Other requirements such as diet-chart, monitoring and feedback, progress chart, high-technology equipment, highly specialized human resources, drugs such as oral anticoagulants and databases to record the performance and improvements of each individual and people at high risks of CVDs.

1. Detailed description: Intervention as organizing PA session with behavioural change in dietary chart directs the participants, specifically the ones, who are at higher risk of CVDs, to reduce intake of salt and salt content, replace the trans-fats with saturated fats, increase intake of fruits and vegetables, and fully indulged into physical activity (4). To evaluate the improvements, a strict and frequent monitoring system on salt intake is to be carried out in every 15 days; Blood-pressure level is to be constantly checked within every 7 days, cholesterol level is to be checked along with blood sugar level. In addition, their weight on the day, the participants start working out, is to be noted and every 7 days, their weight is to be measured, whether it gets decreased or not if the individual is found obese or overweight. At least 100 minutes of aerobic exercise per week has a 14% lower CVD risk, 2 sessions per week of moderate-intensity physical activity reduces CVD risk by 49% (6). Physical activity maintains healthy body weight and body composition, lowers BP, increases fibrinolytic activity, reduces platelet aggregation, and increase urinary sodium excretion (7). These are to be measured to evaluate the improvements among the participants of the PA seminars. For example, a person at high risk of CDVs must feel comfortable talking in a full sentence while walking after improvements.
2. Target users

Beneficiaries: The beneficiaries of this service are men (who are prone to experience CVDs), women as well, adults, who are at higher risk of CVDs, overweight people, diabetic patients, obese women, alcoholic, who wishes to be fit and healthy, and many others. Persons suffering from hypertension, anxiety, high Blood pressure, high cholesterol level, high blood sugar level, insulin is also there, blood platelet aggregation is thick, even people being cancer and HIV survivors can also join. However, the major target is the persons being prone to CVDs, high BP, BS, LDL and women dealing with postpartum conditions as well.

Persons	Characteristics
Men	High Blood Pressure (>140/90), High Cholesterol (>200, and >130 in LDL), High Blood-Sugar (>140mg/dL), insulin and thick blood platelet with overweight (height is 5ft 10 in, and BMI >30)
Women	All same, except BMI, which is 25 to 29.9 in women than obese; postpartum depression, hypertension
Adults	Alcoholic, unhealthy diet, physical inactivity
People at higher risks	Already experienced CDVs such as stroke, heart attack, heart valve complications, arrhythmia and a survivor of cancer

Table 1: Characteristics of the targeted population

Any needs assessment

A Needs Assessment is needed to understand the current conditions of the people living in the selected region. For example, an assessment of their full body-check starting from blood pressure to blood platelet is to be carried out to prioritize them, if the individual is at a higher risk of CVDs, then the individual needs to be taken into account physical health check-up and intervention. Thus, as per their physical health assessment findings, the intensity of physical activity is to be applied. Different intensities such as light, moderate or vigorous can be applied through exercise program impose various effects on human physiology, which results in beneficial effects on various health outcomes (10). 21% of adults in this region are insufficiently active, females are least interested in PA as compared to male, and NCDs in these people are type-2 diabetes, breast with colon cancer and CHD (2). Thus, a need assessment is important to assign the people with different intensity of exercise, thus the quality of life and improvements among these could be achieved at a faster rate with no side effects or complications.

Services to be offered

Services such as Educational Program on CVDs, PA Seminars and diagnosis of people at higher risk are to be provided to the people living in the Western region of Kazakhstan, specifically people of village Saykhin, an administrative centre of Bokeyorda district, which is situated at a distance of 550km away from the regional centre. This area is to be served because 50% of the Kazakh population live in rural areas and have low socioeconomic status (SES), and it is a good fact that there is a strong association between socioeconomic variables and CVD development (11). Furthermore, it is identified that there is a very low level of knowledge about CVD and its RFs among the rural population of Kazakhstan. All these facts lead the business executives to move ahead with this decision to serve this community.

4. Marketing Strategy

Targeting potential service users: People of this village are to be targeted by conducting a survey session and carrying out research in the respective area. Furthermore, the questionnaire is to be framed as per demographic and psychographic aspects such as their age, medical history, weight, height, gender, education, lifestyle, economic condition, physical health concerns (if any), addiction, whether participating in physical activity or not. Based on these aspects, a questionnaire is to be distributed among the entire population of the selected region, thus based on their mismatch between height and weight, lifestyle (healthy/unhealthy intake), any CVDs or other disease records, gender, alcoholic/smoking/none, they would be targeted. USP of this service is to provide “PA” Seminars at the lowest price along with free diagnosis and CVDs education.

Industry analysis: After carrying out the industry (healthcare service) analysis in the selected region, it is identified that only 3.9% of total GDP is accounted for by this sector. The total budget of the intervention program is estimated at USD7.5bn based on the exchange rate of 2020 (12). This business could avail some opportunities offered by the leading subsectors such as electro-medical diagnostic with therapy equipment, equipment for cardio-surgery and cardiology, diabetic supplies, lab equipment, and mobile-health techs. However, social support is provided to the local people through young specialists at the local budget, which sounds competitive, however, PA sessions are not provided. Thus, the service provided by the young specialist may compete with the services, this business would be offering only in terms of budget, however, in terms of service as PA provided by this business can meet the needs of the selected area’s population.

Specific requirements and barriers: Specific requirements to enter into Kazakhstan healthcare sector such as herbal and traditional productions, supplements, Sleep-Aids, Analgesics, obtaining medical certifications, knowledge about nationalities and ethnic groups, their lifestyle, preferences, religion, and traditions also. Barriers such as people’s loyalty, switching cost, patent protections, tax benefits, socio-economic status of the Kazakhstan people are those, which might restrict this business from targeting the people of the selected region. People’s loyalty, switching cost and their lifestyle could be addressed by signifying the importance of PA for CVDs, a positive association between the service and their socio-economic variables; however, tax benefits can be maintained by inducing the least amount of budget into maintenance cost.

5. Partners/Competitors_200

Proposed partners: There is a partner of this business, the “Administrative Centre” of Bokeyorda District and the local club situated in the region. The respective care centre has already been operating in the healthcare system of the region; however, the club contributes in arranging various curricular activities for their people. Thus, the partners involved in this business plan are provided below:

• Administrative Centre
• Local Club

In this context, the administrative centre would be contributing to this business by providing financial support to the equipment, technology and maintenance. Furthermore, it would also be contributing to monitoring the success rate of the services. However, the local club would be contributed by providing the whole space to organize the PA seminars, and by keeping the space maintained, updated and kept clean every time.

Any competitors

• Aetna: Offers a comprehensive global medical coverage and has a network of 1.3million medical providers and provides multiple levels of benefits for choosing from, along with different benefits meeting a customers needs
• Globus: An NGO, improving the healthcare facility and workers skills in the selected region
• Feldsher: A middle-level healthcare provider in Kazakhstan providing training similar to physician assistants in the US (14)

Threats: It includes intense competition by Feldsher, NGOs offering free-of-cost healthcare services and loyalty and trust already gained by private companies like Aetna.

6. Risks

Potential risks: The population of this nation is 16.5million with a growth rate of 1.235%, GDP is 149.06 dollar and GNP per capita is 6280, this raises the risk to the profitability of this business as it seems to be below than average of other European region states. These people are found to be having blood-borne diseases such as TB, HIV, Hepatitis C, and others. The immunization of these people again raises a concern to this business due to low socioeconomic status. Lack of efficient healthcare personnel, imbalance towards a specialist service, to the detriment of primary healthcare facilities are the risks. The major risk is regional inequalities in health financing, health outcomes and healthcare utilization and geographically accessibility of healthcare services in this area is challenging by considering the vast and scarcely populated territory of Kazakhstan. There is a lack of accountability and transparency in the health system of this nation, informal payments for healthcare services along limited involvement of the public in health policy-making (13).

7. Long-term strategy plan
8. Summary of the long-term plan: Long-term plan is to expand the business operations in other regions of Kazakhstan from this region only, the Western region of Kazakhstan. For achieving this, implications of the success strategy, rate and measures associated with the current business plan need to be carried out in the next destination of business. This needs to be achieved within 2 years of the current business operation. This is to be achieved by gaining market recognition in the selected region, grappling the loyalty and trust of the local people, getting an impressive success rate, reducing the rate of CVDs in the region, and providing a better and lifestyle approach to the people living in Saykhin Village, Kazakhstan.
9. Exit plan: Once, the service is well-established, the respective business needs to retain it by improving the quality of their care services, increasing the types of activities in PA seminars, recruiting more healthcare professionals and doctors, and being people-centric throughout the business plan. The concept of primary care is to be adopted, applied and maintained thoroughly.
10. Timeline

Tasks	Jan-Mar	Apr-July	Aug-Oct	Nov-Dec
Market Research (Kazakhstan) by Marketers and researcher
Planning (Product, Targeting, competitors and potential risks) by Marketing Manager and team
Allocation of Budget by Finance Manager
Recruitment of staffs, doctor and trainers by the HR manager and department
Setting-up in the region by the Marketing and Management
Execution of business plan by HRM and Marketing
Promotions by Marketing department

 

 

 

 

8. Brief appendix

 

 

 

 

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