NAZARBAYEV UNIVERSITY MEDICINE

School of Medicine

Center for Life Sciences

National Medical Holding

This booklet is about Nazarbayev University Medicine: its School of Medicine, Center for Life Sciences and the National Medical Holding hospitals. The mission of Nazarbayev University Medicine is to improve health, quality of life and longevity through transformation of medicine and healthcare in Kazakhstan, accelerating practical implementation of scientific discoveries, introducing innovative technologies for diagnosis and treatment, training of future generation of leaders in medical research and healthcare, promoting the use of evidence-based, personalized and preventive medicine.

For further information please contact: Almaz Sharman, MD, PhD, Deputy CEO, Nazarbayev University, Chairman of the Board, National Medical Holding; tel: +77172-706005, email: asharman@nu.edu.kz

NAZARBAYEV UNIVERSITY MEDICINE

1. INTEGRATED ACADEMIC HEALTHCARE SYSTEM………………………3 2. SCHOOL OF MEDICINE ………………………………………………………….8 3. CENTER FOR LIFE SCIENCES ………………………………….................11 4. NATIONAL MEDICAL HOLDING…………………………………………....15

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One of the key priorities for Nazarbayev University (NU) is the creation of the Integrated Academic Healthcare System (IAHS). It is comprised of the University Medical School, Center for Life Sciences, and the National Medical Holding. The integration of research, teaching, education and service in the healthcare environment has been the key advantage of leading academic and healthcare institutions worldwide. It is premised on the belief that research, teaching, and delivering care and services in an environment that values rigorous enquiry and evidence-based decisions leads to the best health care. On a wider front, Integrated Academic Healthcare Systems have the potential to lead innovation in the health care sector and transfer that knowledge to the broader health care community.

There are many examples of academic health systems being created by universities or by hospitals in a variety of formats: Mayo Clinic Medical School was created by the Mayo Clinic; Duke University Medical center is wholly owned by university; Amsterdam Medical Centre is a joint venture; Harvard/Mass General Hospital are a federation; Johns Hopkins unifies all matters related to medicine under Johns Hopkins Medicine; Karolinska/Hudinger is a collaboration between count council and University.

Nazarbayev University owns each entity of its IAHS; The National Medical Holding, The School of Medicine, and The Research Center for Life Sciences.

Nazarbayev University

Integrated Academic

Healthcare System

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ORGANIZATIONAL STRUCTURE Nazarbayev University Integrated Academic Healthcare System

National Medical Holding

“Nazarbayev University Integrated Academic

Healthcare System”

Center for Maternal and Child

Health

Center for

Neurosurgery

Diagnos-tic

Center

Center for Emer-

gency Care

School of Medicine

School of Applied Sciences

School of Engineering

School of Humanities

Other schools

Schools of Nazarbayev University

Note: A square indicates a legal entity; a dashed square indicates an incorporated board of division. Nazarbayev University Integrated Academic healthcare System is a consortium with delegated powers from each entity of Nazarbayev University: The National Medical Holding, Medical School and Research Center for Life Science

Center for Child

Rehabili-tation

University Service Management Unit

Interdisciplinary Engineering

Research Center

Center for Energy

Research

Center for

Cardiac Surgery

NAZARBAYEV UNIVERSITY BOARD OF DIRECTORS

Nazarbayev University President

Nazarbayev University Executive Board

Research Center for

Life Science

School of Public Policy

School of Engineering

School of Applied Sciences

NATIONAL MEDICAL HOLDING Dr. Yelzhan Birtanov

Chief Executive Officer Early-age medicine, reproductive

health, safe motherhood, oncology, cardiology,

neurosciences, emergency medicine, rehabilitation

Research partnership: •University of Pittsburgh • Columbia University •MD Anderson Cancer Center

Hospital Management Vamed and Medical University of Vienna (Austria) Duke Medicine – clinical partnership?

NAZARBAYEV UNIVERSITY MEDICINE Almaz Sharman, MD, PhD

Deputy CEO for Health Affairs Chairman of the Board

National Medical Holding

School of Humanities

CENTER FOR LIFE SCIENCE Dr. Zhaksybay Zhumadilov

Executive Director Genomics and personalized

medicine, regenerative medicine, cancer stem cells,

longevity medicine

SCHOOL OF MEDICINE Dr. Arman Saparov

Director Academic Health System US model of medical education (2-4

years undergraduate+4 years graduate), USMLE licensing, dual

degree program

Academic partnership Duke Medicine?

Nazarbayev University Integrated Academic Healthcare System Leadership

The National Medical Holding is a separate joint stock company with 100 percent of its shares owned by Nazarbayev University. The Holding company owns 5 university teaching and research hospitals with a total of 1200 hospital beds and 5000 employees. The Research Center for Life Sciences is a separate non-for-profit legal entity with its own board and Scientific Council. The School of Medicine will be an incorporated board of division at the Nazarbayev University led by a Dean and governed by the University Academic Council. Nazarbayev University Deputy CEO for Health Affairs is responsible for the overall coordination of NU IAHS. He also serves as Chairman of the Board of the National Medical Holding. CEO of the National Medical Holding, Dean of The School of Medicine, and Director of Research Center for Life Science, all report to the NU Deputy CEO for Health Affairs. Reporting structure at Nazarbayev University Medicine.

The main objectives of integrating medical education, research and clinical practice at Nazarbayev University are as follows:

•Development of mission, strategic plan, and implementation plan for IAHS (strategic framework, priorities) •Continuous reassessment of the marketplace and revision of the strategic plan and implementation plans •Recommendations on capital and operating budgets and investment plans for each IAHS entity •Consolidation of corporate structures, committees and staff functions, shared services, and joint utilization of ancillary services •Joint decisions and evaluation of key personnel in each IAHS entity •Recommendation of merger/consolidations of subsidiaries The creation of NU IAHS provides a unique opportunity to improve health and quality of life in Kazakhstan.

Physician-scientists play a unique role in modern medicine, having received extensive training in both medicine and research. Students entering the NU School of medicine are expected to be among the best and brightest and highly motivated. Graduates of the Medical School and researchers and clinicians at the Center for Life Sciences and the National Medical Holding will be pioneers in their fields. They are the core of a new generation of clinical researchers in Kazakhstan and the former Soviet Union who will spearhead efforts to develop new treatments for diseases and better methods of delivering healthcare. They will also contribute significantly to alleviating the suffering of patients in Kazakhstan and around the world. Partnership with academic centers in the United States and other countries will enhance the long-term positive aspects of the proposed program.

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The long-term goal of the NU IAHS is to create an infrastructure in which innovations are moved quickly along the discovery-care continuum. It is planned that horizontal, functionally integrated organizations that transcend academic departmental structures and promote interdisciplinary collaboration and efficient use of common resources will be created.

It is envisioned that care delivery at NU IAHS should be vertically integrated to develop a continuum from community care to tertiary care, helped by effective clinical information systems. At the moment, there are many barriers to the creation and implementation of an effective integrated care model. For example, reimbursement schemes in Kazakhstan do not reward innovations that support care coordination. Furthermore, human capital constraints are additional challenges.

In the future, the staff of NU IAHS will need to work with communities to support program development, implementation, assessment, and dissemination to overcome such barriers. There is compelling evidence from international experience that integrated academic healthcare systems play crucial role in promoting health and economic development in many countries. The NU IAHS has the potential to transform medicine and improve health in Kazakhstan and in neighboring countries. Achievement of these goals necessitates the development of a continuum that spans discovery and translation sciences to provide quality medical education and integrated care delivery.

New organizational structures, external partnerships, research priorities, models of education, care delivery, and investments in institutional information systems can make the achievement of this goal possible and ultimately allow the Nazarbayev NU IAHS to succeed in its goal of leading innovation in the health care sector and transfer that knowledge to the broader health care of Kazakhstan.

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The NU School of Medicine (SoM) will become one of the graduate schools at Nazarbayev University. The mission of the NU SoM is to create a new generation of physician-scientists to assume leadership positions in research, academia, and healthcare settings.

The NU Medical School will adopt the American model of medical education where students will be studying towards a licensing that is equivalent to USMLE (United States Medical Licensure Examination) licensing. The graduates will have the opportunity to build their careers as scholars in medical research, education, and patient care.

The NU SoM will be managed in partnership with one of the US’s leading academic centers. The expectation is that the curriculum of the US academic partner is to be adopted and designed to provide students at the NU SoM the flexibility to tailor their research experience to promote their long-term career goals.

The proposed plan for the NU SoM builds on the selection of students for a year-long Foundation Program taught in English, followed by a Premedical year of basic sciences preceding enrollment in formal medical education. New methods of admission to the NU SoM will be established to identify students who are proficient in English, have a solid foundation in the sciences and humanities, and are prepared to become self directed learners.

In the 4-year graduate medical curriculum, the students will devote an entire year to independent scholarship and research in the areas of basic and clinical sciences, while refining and enhancing their clinical skills through a family medicine clerkship that runs concurrently.

School of Medicine

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The curriculum will be designed to foster the development of medical students who will be critical thinkers prepared as life-long learners to meet the challenges of the changing science of medicine, as well as a changing practice environment. In this new curriculum, the lecture format of traditional medical education is minimized as the expectation of student participation is maximized. Small group and interdisciplinary team learning in seminars and tutorials is favored, enabling students to take responsibility for their own and their colleagues’ teaching and learning. Many of the teaching methodologies are based on innovative pedagogic approaches; which include:

•Case-based studies; •Problem-based learning; •Simulation training; •Computer assisted training

The program will employ a mixture of innovative pedagogical methods with some elements of integrated and problem-based learning curriculum. Most of the faculty members at the NU SoM are expected to conduct research and practice at the National Medical Holding hospitals. Similarly, many doctors practicing at the National Medical Holding, including expatriate doctors, are expected to be involved in teaching (graduate, postgraduate and continued medical education) at the Medical School and research facilities of the Center for Life Sciences. Thus, it is important to ensure proper integration and synergy of educational, research, and clinical activities at Nazarbayev University.

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Furthermore, students will be introduced to clinical and community experiences from their first year. During the third and fourth years of medical school, most learning occurs beyond the walls of the medical school in hospitals, ambulatory sites, research centers, and the community. Clearly, these trends in medical education impact not only the curriculum but also the number and types of faculty, the type of medical student, the organization and the administration of the medical schools, and the facilities in which medical students learn.

In addition to graduate medical education, the NU SoM will be

responsible for postgraduate medical education: internship and residency. Those should be strongly related and synchronized with clinical processes at the National Medical Holding hospitals and research programs at the Center for Life Sciences. The Western model of education relies on faculty, clinicians, and residents to train medical students. The development of a robust postgraduate training program prior to the rotation of medical students into the hospitals would be a wise step for assuring that a quality clinical experience will be in place when medical students begin their clinical clerkships in hospitals.

The NU Center for Life Sciences (CLS) was established in December 2010 as a legal entity owned by NU. The CLS mission is to pursue fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to extend healthy life and to reduce the burdens of illness and disabilities. CLS strives to transform medicine and healthcare in Kazakhstan through innovative scientific research, rapid translation of breakthrough discoveries, educating future clinical and scientific leaders, advocating and practicing evidence-based, personalized, and predictive medicine to improve health and quality of life. The main priorities of the Center are as follows:

• Transform medicine and health from a Curative to a Preemptive paradigm • Support basic research to identify the earliest molecular stages of disease in complex biological systems • Accelerate translation of findings from the bench to the bedside to the community • Provide the evidence and knowledge base to allow for a rational transformation of Kazakhstan’s healthcare

system

Center for Life Sciences

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The strategy of CLS has three key approaches: building an infrastructure, development of competence, and translation of research into practice. To build infrastructure it is necessary to develop research environment, establish biomedical research facility and ensure sustainable funding for CLS research activities. Competence will be developed through training, recruitment and motivation of researchers. Finally, one of CLS key priorities is to support translational research in such areas as personalized and regenerative medicine, bioengineering. The CLS’s key priority areas of research are as follows:

•Personalized Medicine and Genomics •Regenerative Medicine and Longevity •Translation Medicine •Global Health

The research projects will be conducted in partnership with world’s leading academic centers: University of Pittsburgh, Duke University, National Institutes of Health, University of Oregon, George Washington University.

The CLS is central to the Nazarbayev University Academic Healthcare matrix organization that promotes aligned research and care delivery and strong integration. The CLS will establish three institutes: Institute for Personalized Medicine, Institute for Regenerative Medicine, Institute for Translational Medicine, and Institute for Global Health. These institutes, which are system-wide and integrate traditional organizational structures, are agnostic about the organ-system orientation of biomedical specialties (e.g., hematology, cardiology), and the academic specialties within clinical departments (e.g., medicine, surgery, psychiatry), basic science departments (e.g., biochemistry, pharmacology), and related specialties (e.g., environmental science, public health, business). Instead, these flexible systems bridge translational gaps and encourage propagation of several types of knowledge along the discovery-care continuum.

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Preclinical research; in-vivo analysis

Basic discovery

Pharmaco- dynamics; toxicology

Proof of concept in man

Clinical develop- ment

Evidence-based medicine

Practice guidelines; practice adoption

Improve community health status

Global health service and research

Care delivery; health-services research

Discovery Translation Clinical research Translation and adoption Global health

RES

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CH

AN

D

CLI

NIC

AL

PR

OC

ESSE

S

Institutes of Personalized and Regenerative Medicine

Institute of Translational Medicine

National Medical Holding Clinical Research Centers

Institute of Translational Medicine

Global Health Institute

CENTER FOR LIFE SCIENCE CENTER FOR LIFE SCIENCE NATIONAL MEDICAL HOLDING

NA

ZAR

BA

YEV

UN

IVER

SITY

IN

TEG

RA

TED

AC

AD

EMIC

H

EALT

HC

AR

E SY

STEM

Basic Science Curriculum and PhD Program

Clinical Science Curriculum, Residency, and Continuous Medical Education

Clinical Science Curriculum, Healthcare Management Program

CENTER FOR LIFE SCIENCES AND NAZARBAYEV UNIVERSITY ACADEMIC HEALTHCARE SYSTEM MATRIX ORGANIZATION*

NAZARBAYEV UNIVERSITY SCHOOL OF MEDICINE

* Adopted from: Victor J Dzau et al. 2009, October 1, DOI:10.1016/S0140-6736(09)61082-5

The NU CLS will appoint 40-50 faculty staff who will be actively involved in research programs in such areas as genomics and personalized medicine, regenerative medicine, organ and tissue transplantation, artificial organs, cancer and stem-cell biology, the science of ageing, and neurosciences.

At least half of these Principal Investigators (PIs) are expected to be residents of

Kazakhstan, while the rest will be recruited internationally. Researchers who are originally from Kazakhstan or the other post-Soviet countries currently running competitive research projects at academic centers in the United States, United Kingdom, and other countries will be considered as priority candidates for such PI positions. Each PI will manage a laboratory of 6-8 research staff, the bulk of which will likely be from the region, and comprised of students in medical (MD), medical-scientist (MD/PhD) training programs, postdoctoral fellows, doctors undertaking research fellowships, and research assistants. Most of the faculty at the Center for Life Sciences will be involved in teaching at Nazarbayev University Medical School and practicing medicine at the National Medical Holding hospitals. One of the goals of the Medical School and the Center for Life Sciences is to train a significant number of clinical researchers, thereby contributing to Kazakhstan’s growing pool of clinical researchers.

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National Medical Holding

The mission of the NMH is to introduce international standards of quality and safety of care and to ensure financial sustainability and growth. The NMH aspires to develop and harness academic medicine to stay at the forefront of patient care, teaching, and research. The vision of the NMH is to ensure the sustainable growth and development of its hospitals, academic institutions, and reference centers and to become the leading healthcare provider in the Central Asian region culminating experience, expertise, and excellence in medicine. The goal of the NMH is to enhance the standard of medical care to the highest level so that Kazakh patients will no longer have to seek treatment outside the region. The NMH strives to develop dynamic outlook, growth potential, medical and financial transparency and to attract investors, both national and international.

The Kazakhstan National Medical Holding (NMH) was established in May 2008. The NMH provides the clinical base for Nazarbayev University’s Medical School and the Center for Life Sciences. It is the largest hospital system in Central Asia. With 1200 beds and over 30 specialty centers, the NMH offers a full complement of advanced acute care and outpatient services. The NMH integrates five hospitals clustered on a 20-hectar land of Astana’a left bank region. The NMH is focused on such specialties as women’s health, pediatrics, oncology, cardiology, neurology, emergency care, and rehabilitation. These specialties are supported by a wide range of medical and surgical disciplines, along with the most up-to-date technologies for diagnostic and therapeutic interventions.

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The NMH aspires to become a Nazarbayev University teaching and research hospital system with its faculty having a strong background in teaching and medical research. With these goals, many NMH hospital faculty members are expected to have appointments at the Nazarbayev University Medical School and the Center for Life Sciences. The goal of the NMH as part of Nazarbayev University is to promote synergy between medical education, research, and excellence in medical practices. The vision is to improve the health of the patients and communities that NMH serves through excellence in research, education, patient care, and service.

One of the NMH’s priority goals is rationalization through consolidation and efficiency of the management processes. With this goal, the NMH is creating a value for outsourced services, clinical or non-clinical. The NMH is currently building a comprehensive Hospital Information System to develop and integrate electronic patient records, establish RIS/PACS system, and design financial and operational modules (such as accounting, treasury, human resources, inventory management, and purchasing).

The NMH has recruited on a national and international level leading physicians and surgeons in their respective fields, and for experienced nurses and allied health professionals. The NMH employs more than 4000 staff members, with 1000 full-time and consultant physicians working in NMH hospitals representing more than 30 sub-specialties; many of whom are found only at the largest tertiary centers. The NMH also employs foreign doctors from Germany and Austria who work in NMH hospitals on full-time and rotational basis.

The NMH is expected to become the first hospital system in Central Asia to be accredited by the Joint Commission International (JCI), the international arm of the organization that reviews and accredits American hospitals. JCI’s checklist includes over 350 standards for everything from surgical hygiene and anesthesia procedures to the systems in place to credential medical staff and nurses.

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MEDICAL SERVICES AT THE NATIONAL MEDICAL HOLDING

Current medical services Priority areas for further development

Emergency medical care with triage

system

Diagnostics, including nuclear medicine

(PET), CT, MRI

Surgery – adult, pediatric, neonatal,

fetal

Minimal invasive surgery

Neurology, neuro-rehabilitation

Women’s health (obstetrics and

gynecology, reproductive health,

prenatal diagnostics)

Pediatrics, pediatric surgery

Rheumatology

Oncology, including oncohaematology

Ophthalmology

Child rehabilitation

Neuronavigation surgery and transnasal pituitary

tumor removal

Neurovascular surgery

Prenatal diagnostics of genetic disorders

Fetal surgery

Cancer screening

Invasive reconstructive surgery in the field of

gynecology

HLA typing, organ conservation and transplantation

Neurorehabilitation

Rehabilitation of children with genetic disorders

Gene treatment of mitochondrial DNA diseases

Cancer chemotherapy

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KEY OPERATING AND FINANCIAL INDICATORS OF THE NATIONAL MEDICAL HOLDING

Permanent staff, total 4200, including:

Physicians 705

Nurses 1077

Number of beds 1225

Number of patients discharged 24 406

Babies born (2009) 4 862

Average length of stay, days 10.3 (acute care)

Bed occupancy rate

Total assets

80%

US$440M

A unique feature of the NMH lies in a new system of management based on the principles of corporate governance. This is a new concept for Kazakhstan’s post-soviet healthcare system. The NMH governance structure includes a sole shareholder, which, starting from September 2010, is Nazarbayev University, the Board of Directors, and the Executive Board.

Below is the list of members of the Board of Directors and the Executive Board.

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Board of directors of the National Medical Holding: 1. Sharman, Almaz – Chairman of the Board, Nazarbayev University Deputy CEO 2. Mamashev, Maksat –Nazarbayev University First Deputy CEO 3. Kusain, Erden – Nazarbayev University Deputy CEO 4. Birtanov, Yelzhan –NMH Chief Executive Officer 5. Risk, Ahmad – NMH Independent director, Managing Director and Chief Physician, Prospect Medical

Caspian, Atyrau 6. Sultanov, Serik – NMH Independent Director, President, National Association of Pharmaceutical Industry of

Kazakhstan 7. Saya Mynsharipova - NMH Independent Director, Director Department of Audit and Control, Samruk-

Kazyna National Fund for Sustainable Development

Executive Board of the National Medical Holding: 1. Birtanov, Yelzhan, Chief Executive Officer (CEO) 2. Voshenkova, Tamara, Deputy CEO (Chief Medical officer) 3. Umraliyev, Erbol, Deputy CEO (Corporate Management and Legal) 4. Tazhibayeva, Saule, Deputy CEO (Finance and Accounting)

The National Medical Holding is a pioneer of business-oriented management in Kazakhstan’s hospital sector. The NMH has successfully demonstrated that the combination of capital provided by the government and business-oriented management is a key element where the challenge is to achieve rationalization, thereby effect future-oriented innovation, and develop financing strength for further growth. It is this strength that helps create precisely those structures that support the NMH organizational concept with its emphasis on patient orientation and processes based on the division of labor. The NMH as a holding company is constantly devising new ideas for high quality and cost-efficiency of its hospitals.

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Managed by VAMED Austrian hospital management company and

Medical University of Vienna

Capacity:

- 500 beds (260 ObGyn + 240 pediatrics)

- 36 departments

- 2 out-patient facilities

- 4 laboratories

Services:

- Comprehensive diagnostics

- Women’s health: Obstetrics, gynecology, minimal invasive surgery, uterine artery embolization, fetal surgery, in-vitro fertilization

- Children’s health: outpatient, endocrinology, urology, nephrology,

cardiorheumatology, oncohematology, neurology, trauma and orthopedic surgery.

- Rehabilitation

NMH: Maternal and Child Health

Tel: +7 7172 70 14 14 21

NMH: Emergency Care

Multidisciplinary acute care hospital with an ambulance

station (15 ambulance vehicles)

Capabilities:

- 265 beds

- surgical and therapeutics services

- state-of-the art ambulance cars

- availability of a helipad

- specially trained emergency care brigades

Services:

- emergency care with triage system

- in-patient services: surgery and medicine departments (surgery, trauma, gynecology,

urology, burn unit, toxicology, hemodialysis)

- interventional radiology: coronary angiography, aortography,

- coronary bypass surgery

- cardiac rhythm management (pacemakers)

- organ and tissue transplant

Tel: +7 7172 702-946 22

NMH: Neurosurgery

Hospital provides comprehensive neurosurgical medical care Capabilities: - 160 beds - modern building with amenities – 290,000 SM - specialists, internationally trained - state-of-the art medical equipment - new innovative methods of treatment Services: - brain surgery - spinal surgery - brain vessels malformation surgery - neurotrauma - pituitary tumor removal (intranasal) - navigation neurosurgery - pediatric neurosurgery - comprehensive rehabilitation (after stroke, spine injury)

Tel: +7 7172 511 606 23

NMH: Diagnostics

Capabilities:

- 500 patient daily visits

- new building with amenities - 17, 715 SM

- state-of-the art diagnostic radiology including

Central Asia’s only PET Scan

- comprehensive medical laboratory services

- efficient logistics resulting in expedited service delivery

Services:

- Comprehensive diagnostics

- Medical consultations

- Day hospital

- Service delivery to corporate clients

Tel: +7 7172 701 550 24

NMH: Child Rehabilitation

Open since December 10, 2007

Rehabilitation services for children aged from 1 till 18

Capabilities:

- innovative rehabilitation technologies: medical, social, pedagogic,

and psychological rehabilitation

- schooling facilities

Services:

- diagnostics

- treatment of cerebral pulsy

- social adaptation

- Montessori-system of education

- monitoring and treatment of diabetes

- hippotherapy

- production facility for orthesis devices

Tel: +7 7172 511 555 25

NMH: Cardiac Surgery

Due to open: 2nd quarter of 2011

First-rate comprehensive cardiology and cardiac surgery center, a national referral center for the most difficult cardiac cases.

• Prevention of cardiovascular diseases

• Cardiac function diagnosis, monitoring and treatment

• Cardiac surgery: valve replacement, left ventricular assistance device, bypass surgery

• Interventional cardiology

• Cardiac rhythm disease management

• Pediatric cardiology

• Cardiovascular disease rehabilitation