Inside Kazakhstan’s Fight Against Antibiotic Resistance Through Primary Health Care Reform

Kazakhstan faces a growing threat from antimicrobial resistance, driven by antibiotic overuse and low public awareness, but it also has a strong primary health care system that offers a solid foundation for action. With better stewardship, data systems, education and enforcement, the country could turn primary care into a frontline defence against drug-resistant infections.

Health experts from the World Health Organization joined Kazakhstan’s Ministry of Health, the National Centre for Public Health, the WHO European Centre for Primary Health Care in Almaty, the WHO Collaborating Centre at the Public Health Agency of Sweden and the Asia–Europe Foundation to examine a growing but often overlooked crisis: antimicrobial resistance, or AMR. Their mission was to understand whether this global threat could be tackled where most people actually receive care, at the primary health care level. The resulting WHO mission report presents Kazakhstan as a country facing serious risks from drug-resistant infections, but also as one with rare strengths that could turn the tide if used wisely.

A Growing Problem Already Causing Deaths

AMR happens when bacteria change in ways that make antibiotics less effective. In Kazakhstan, this is no longer a future danger. In 2019, resistant infections were estimated to have directly caused about 2 400 deaths and contributed to nearly 9 500 more. Common bacteria such as E. coli, Klebsiella pneumoniae and Staphylococcus aureus are responsible for much of this burden. Like many countries, Kazakhstan has seen antibiotics overused or misused, especially broad-spectrum drugs that should be saved for serious cases. These patterns worsened during the COVID-19 pandemic, when antibiotics were often taken for viral infections, where they offer no benefit.

Strong Primary Health Care, Untapped Potential

What sets Kazakhstan apart is its primary health care system. Built over decades of reform inspired by the Alma-Ata and Astana declarations, the system now includes more than 7 000 facilities offering free services to the population. Multidisciplinary teams, mobile clinics and outreach programmes even reach remote villages. On paper, this makes primary care an ideal place to control antibiotic use, educate patients and prevent infections before they require treatment. The report stresses that few countries have such a solid base for integrating AMR action into everyday care.

Why Antibiotics Are Still Overused

Despite strong laws, antibiotics remain easy to obtain without prescriptions from many pharmacies. Public expectations, weak enforcement and business pressures on pharmacists all play a role. Long waiting times at clinics and limited access to quick diagnostic tests also push people toward self-medication. While public primary care facilities use electronic prescribing systems, these systems often exclude private clinics and retail pharmacies. As a result, health authorities lack a full picture of how antibiotics are used nationwide. This gap makes it hard to monitor misuse or design effective responses.

Low Awareness, Limited Training

The report highlights another challenge: a lack of understanding. Surveys show that many people believe antibiotics work against colds or flu, and most have never heard of antimicrobial resistance. Awareness campaigns exist, but they are usually short and centred on special events. Schools rarely teach children about antibiotics. Among health workers, AMR and proper antibiotic use are not clearly taught in undergraduate education, and ongoing training is often theoretical rather than practical. This means doctors, nurses and pharmacists may lack confidence in managing infections without immediately turning to antibiotics.

A Practical Path Forward

Rather than calling for major overhauls, the WHO report outlines practical steps. These include adding simple AMR indicators to how primary care performance is measured, improving data systems so prescriptions can be tracked across public and private sectors, and updating drug lists and treatment guidelines using WHO’s AWaRe classification. The report also calls for sustained public education, better enforcement of prescription rules, and more hands-on training for health workers. Vaccination, already a strength in Kazakhstan, is highlighted as a powerful way to reduce infections and the need for antibiotics.

The message is clear and hopeful. Antimicrobial resistance cannot be solved only by experts and laboratories. It depends on everyday choices made in clinics, pharmacies and homes. Kazakhstan already has much of what it needs. With focused action at the primary care level, the country could become a model for how to tackle one of the world’s most dangerous but least visible health threats.