INTRODUCTION

Approximately 40% of Kazakhstan's total population resides in rural areas [1]. Preserving the health of rural populations and ensuring access to medical care is one of the most pressing issues today. The quality and accessibility of medical services in rural regions often remain at a low level due to insufficient infrastructure, a shortage of medical personnel, and transportation difficulties.

For example, according to the Ministry of Health of the Republic of Kazakhstan, the shortage of doctors in rural areas reaches up to 30%, and residents have to travel an average of 15–20 kilometers to reach medical facilities [2].

Outpatient medical care is the primary level of healthcare services, providing disease prevention, early diagnosis, and consistent treatment. Therefore, improving the system of outpatient care for rural populations and increasing its efficiency is crucial for enhancing public health and ensuring equal access to medical services. Progress in this area will have a positive impact on the socio-economic development of rural regions [3].

The objective of this review was to summarize international and Kazakhstan experience in improving outpatient medical care for rural populations and to identify organizational approaches that may be adapted to strengthen accessibility, continuity, and quality of care.

MATERIALS AND METHODS

This article was prepared as a structured narrative review. The analytical material consisted of the 20 sources already included by the authors in the manuscript: official statistical and policy documents, international reports, peer-reviewed studies, institutional materials, and web resources concerning rural healthcare and outpatient service organization.

The review focused on four country contexts represented in the source material—China, India, Nigeria, and Kazakhstan. Information was grouped by the main organizational mechanisms used to improve rural access: healthcare workforce capacity, community-based personnel, mobile services, telemedicine, infrastructure, prevention, and follow-up.

A reproducible database search strategy, search dates, formal inclusion and exclusion criteria, and a risk-of-bias assessment were not documented in the source manuscript. No quantitative pooling was performed. Accordingly, the article should be interpreted as a structured narrative synthesis rather than a systematic review.

RESULTS

International approaches to improving rural outpatient care

In China, improving outpatient medical care in rural areas is a key focus in the healthcare sector. About 42.2% of the country’s doctors work in rural regions; however, the number of doctors per 1,000 people remains lower than in urban areas. In 2021, this figure was 2.42 doctors per 1,000 people in rural areas, compared to 3.73 in cities [4]. There are more than 599,000 clinics operating in rural areas, but only 21.4% of them meet established standards [5]. Moreover, 70% of rural doctors in China are over the age of 40, highlighting the issue of an aging workforce [6]. Only about 52% of rural residents have access to necessary medical services, whereas in urban areas this figure exceeds 80% [5]. The government is providing financial support to improve rural healthcare infrastructure. In addition, training programs are being organized to enhance the professional qualifications of doctors. Incentive measures are also in place to attract young specialists. All these efforts are aimed at improving the health of the rural population.

In India, over 900,000 community health workers are employed to improve the rural healthcare system [7]. The majority of them are specially trained women known as ASHA (Accredited Social Health Activist) workers. These professionals provide counseling on vaccination, maternal and child health, chronic diseases, and mental health issues. Approximately 65% of the rural population receives medical care through ASHA workers. In 2023, the infant mortality rate in rural areas was 28.3 per 1,000 live births, a significant decrease compared to the rate in 2010 [8]. This achievement is the result of preventive measures and active vaccination campaigns. Thanks to the efforts of ASHA workers, the rate of prenatal and postnatal care among women increased to 75%, access to primary healthcare rose by 17%, and institutional deliveries grew by 28% [9]. ASHA workers educate rural residents on managing chronic diseases and encourage them to undergo regular treatment. Special attention is given to preventing complications from conditions such as diabetes and hypertension. The government provides ASHA workers with an average annual bonus of around 300 US dollars. Since 2020, specialized mental health training has been conducted on a regular basis. By 2025, the Indian government plans to improve rural healthcare infrastructure by 30% and increase the number of ASHA workers by 20%.

In Nigeria, in 2009, a national program called the Midwives Service Scheme (MSS) was launched with the aim of reducing maternal and child mortality in rural areas. Under this program, about 2,500 midwives were deployed to remote rural regions of the country [10]. These midwives were placed in 652 primary healthcare centers and 163 district hospitals [11]. After the implementation of MSS in 2010, the level of antenatal care increased by an average of 12%, and overall utilization of healthcare services grew by 6% [12]. In 2008, the maternal mortality rate in Nigeria was 840 cases per 100,000 live births, which decreased to 576 cases per 100,000 live births by 2013 [13]. However, the rate of births attended by skilled healthcare workers did not change significantly and remained at a stable level [11].

Development of rural outpatient care in Kazakhstan

In Kazakhstan, in 2022, more than 67,000 medical workers were employed in rural areas, including 13,000 doctors and 54,000 mid-level specialists. The medical trains "Zhardem" and "Salamatty Kazakhstan" covered 147 stations and provided medical assistance to over 77,000 people, including 20,500 children. Additionally, as a result of preventive screenings, 838,000 people were examined, and more than 29,000 of them were diagnosed with hypertension, diabetes, or kidney problems [14]. Eighty-four percent of district hospitals are equipped with modern CT and X-ray equipment. In 2022, 72 new pharmacies and 161 private pharmacies were opened in rural areas [15]. Telemedicine and mobile medical complexes became widely accessible to rural residents (Prime Minister of Kazakhstan, 2023). As part of a national project launched in 2023, 309 primary healthcare centers were established, and 12 interdistrict hospitals were renovated. These measures have allowed the provision of specialized medical care to rural populations to increase to 2.4 million people [16]. These efforts to develop the healthcare system in rural Kazakhstan have significantly improved the accessibility and quality of medical services.

Table 1 - Dynamics of rural healthcare development in Kazakhstan in 2022–2023

Note. Values marked “estimated” or “approximately” are reproduced from the source manuscript.