Access to quality healthcare remains a critical challenge facing communities in northern Kazakhstan. In the city of Petropavl, a dearth of qualified personnel combined with frequent downtime of medical equipment in the local state-run hospital means patients in critical need of services face long wait times, and often go without.

Petropavl is home to four magnetic resonance imaging (MRI) machines, serving a population of over 200,000 people. Just one of these devices is housed in the local public hospital; the remaining three belong to private clinics, which also receive state funds. More than 57 million KZT (133,000 USD) is spent annually on their maintenance. Patient access to the machines, however, remains limited.

“My neurologist ordered me an MRI at the regional hospital. But the queue for a scan stretched several months. I couldn’t get an appointment until late May, by which point my referral was no longer valid. How can that be?” lamented one patient. “I could go to a clinic, but do I have to then pay out-of-pocket for the scan? This should be included under national health coverage, but it’s not.” With an Innovative Solutions Grant under USAID’s Social Innovation in Central Asia Program, local civic organizations Tugan Zher and the First Anti-Corruption Media Center decided to investigate. The project team sent undercover patients to local medical facilities in search of care.

One patient attempted to make an appointment for an abdominal scan at the local hospital. The scan would be covered under national health guidelines. The patient requested an appointment in April 2021, to no avail. According to hospital staff, the wait list for the month of May was closed, and the hospital was not yet scheduling patients for June. The patient’s only alternative was to seek a scan at a local clinic, where he would be required to pay out-of-pocket. This experience was common throughout the city.

Between March and September 2020, emergency COVID-19 procurement in Kazakhstan amounted to nearly $1 billion. As the crisis deepened and citizens across the country became increasingly dependent on state healthcare, so too did activists begin to question the effectiveness of public health spending. USAID’s Social Innovation in Central Asia program supported Kazakhstani citizens to independently monitor government spending, advocate for improved emergency procurement procedures and champion the public interest during the COVID-19 crisis.

In the Mangystau region of Kazakhstan, as the pandemic dragged on, citizens recognized a dearth of critical medical supplies, including life-saving drugs and medical equipment. With support from a Transparency and Advocacy Grant, members of the Mangystau Oblast Civil Alliance undertook a six-month public spending watchdog campaign. Between October 2020 and March 2021, e-procurement specialists trained citizens across Mangystau region in effective public procurement monitoring. Using open data available through Kazakhstan’s public e-procurement system, combined with a government-supplied filter for COVID-19-related contracts, citizens of Mangystau analyzed high risk, potentially corrupt tenders. The project revealed dubious purchases of various medical devices, including fans and personal hygiene items, by regional agencies.