A call for universal health coverage

Русский | Қазақ

As a 2nd year medical student, Almas is perhaps more aware than many her age of the importance of good health, and good healthcare. While she is looking forward to being qualified to administer medical services to the people of Kazakhstan, she is also mindful that if she was to develop diabetes, she couldn’t afford treatment. Despite living legally in Kazakhstan since she was five years old, as a refugee, Almas is considered only a ‘temporarily’ residing foreigner, and as such does not yet have access to the medical assistance under Kazakhstan’s Mandatory Social Health Insurance.  

Universal health coverage critical to sustainable development 

Sustainable Development Goal (SDG) 3, Target 8, calls on States to “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”, by 2030.   

Universal health coverage ensures that everyone has access to quality health services, without suffering financial hardship. Such coverage reduces health disparities and poverty, fosters economic productivity, and promotes social equity, stability and cohesion.  

As shown by the World Health Organization, protecting people from the financial consequences of paying for health services out of their own pockets reduces the risk that people will be pushed into poverty because the cost of needed services and treatments requires them to exhaust their life savings, sell assets, or borrow – destroying their own futures and often those of their children. 

Since the first days of its independence, the Republic of Kazakhstan has worked towards Sustainable Development. Following adoption of the SDGs in 2015, Kazakhstan formed a legal framework to integrate SDGs into the country’s strategic planning, and approved a list of national SDG indicators. In 2022, its second Voluntary National Review on the implementation of the 2030 Agenda for Sustainable Development revealed that, despite the challenges of the COVID-19 pandemic, Kazakhstan had advanced towards achieving the SDGs, including developing measures for targeted social support of the population. 

Health coverage in Kazakhstan 

Kazakhstan introduced Mandatory Social Health Insurance in 2020, thanks to which funding of the sector has more than doubled, enabling improvements to the availability of medical care.  

Participants of the Mandatory Social Health Insurance scheme can receive a wide list of medical services at no additional cost, including specialist consultations, specialized examinations of children, outpatient hospital treatment, diagnostics, and dental care.  

Considered in Kazakhstan as “temporarily residing foreigners”, however, refugees and asylum-seekers are banned from participating in the health insurance system. Refugees have access to only a “minimum” volume of free medical care, such as ambulance services, primary health care, common lab tests, chronic disease treatment. Asylum-seekers have even less access, with healthcare provided only if they contract diseases that pose a danger to others and not, for example, for pre- or post-natal care.  

Health services covered by the Mandatory Social Health Insurance are only available to refugees and asylum-seekers on a paid basis, which they often cannot afford.  

Leaving no one behind 

The SDGs and 2030 Agenda for Sustainable Development commit to “leave no one behind”, emphasizing the importance of ensuring that all individuals, especially those who are vulnerable or marginalized, have the opportunity to benefit from a country’s development.  

Despite adhering to the “leave no one behind” principle, and being a signatory of the 1951 UN Convention relating the Status of Refugees and its 1967 Protocol, Kazakhstan’s unique practice of issuing only one-year temporary residency status falls short of international standards and restricts refugees from exercising their due rights.  

While legally able to study and work, refugees cannot contribute to Mandatory Social Health Insurance or pension funds and cannot receive social benefits. Refugees and asylum-seekers in Kazakhstan are ineligible for public allowances, such as disability and survivors’ benefits, childbirth benefits, care allowances, and benefits for raising a disabled child.  

Refugees and asylum-seekers are being left behind.  

Providing refugees with due access to rights and services 

In 2012, the Human Rights Commission under the President of the Republic of Kazakhstan recommended that refugees be issued five-year permanent residency – in line with Kazakhstan’s obligations as a party to the Refugee Convention. This would give refugees automatic access to public healthcare and insurance, as well as other due socio-economic rights and services.  

As of early-2024, Kazakhstan hosted only 262 refugees recognized by authorities under the national Law on Refugees. Most are from Afghanistan – like Almas – and have been residing in the country for over five years – some for more than 20. They speak local languages, and live, study or work peacefully together with nationals of Kazakhstan and are culturally well integrated.  

In 2022, the government approved its Migration Policy Concept for 2023-2027 which, inter alia, calls for implementation of provisions of the Refugee Convention relating to access to healthcare, employment, education, and social assistance on an equal basis with citizens and permanently residing foreigners. 

UNHCR continues to call on Kazakhstan to amend its Law on the Legal Status of Foreigners and its Law on Refugees, to equate refugee status with the status of a permanent resident from the moment of recognition as a refugee. As a result refugees would be able to duly access universal health coverage, as well as employment, social assistance and local integration. 

Such amendments would help ensure Kazakhstan leaves no one behind, achieves SDGs, and implements its Refugee Convention obligations, while also enabling refugees to contribute to the country’s sustainable development.