Unofficial translation
In pursuance of paragraph 3 of Article 151 of the Code of the Republic of Kazakhstan of July 7, 2020 “On Public Health and the Health Care System”, I HEREBY ORDER:
1. That the rules and conditions for surgical sterilisation shall be approved in obedience to the Annex hereto.
2. That Order of Acting Minister of Healthcare of the Republic of Kazakhstan No. 625 dated October 30, 2009 “On Approval of the Rules of Surgical Sterilization of Citizens” (registered with the Ministry of Justice of the Republic of Kazakhstan dated November 24, 2009 under No. 5881, published in the Collection of Acts of Central Executive and Other Central State Bodies of the Republic of Kazakhstan, 2010, No. 1).
3. That in the order established by the legislation, the Department of Mother and Child Health Care of the Ministry of Healthcare of the Republic of Kazakhstan shall:
1) provide the state registration hereof with the Ministry of Justice of the Republic of Kazakhstan;
2) post this order on the website of the Ministry of Healthcare of the Republic of Kazakhstan after its official publication;
3) within ten working days after the state registration hereof, submit to the Legal Department of the Ministry of Healthcare of the Republic of Kazakhstan the information on the implementation of activities under sub-paragraphs 1) and 2) of this paragraph.
4. That the supervision of execution hereof shall be assigned to the supervising Vice-Minister of Healthcare of the Republic of Kazakhstan.
5. That this order shall be put into effect ten calendar days after the date of its first official publication.
|
Minister of Healthcare of the Republic of Kazakhstan |
A. Tsoy |
| Annex to order of the Minister of Healthcare of the Republic of Kazakhstan No. KR DSM-185/2020 dated November 6, 2020 |
Rules and conditions for surgical sterilization
Chapter 1. General provisions
1. These Rules for surgical sterilisation have been developed in accordance with paragraph 3 of Article 151 of the Code of the Republic of Kazakhstan of July 7, 2020 “On Public Health and the Healthcare System” (hereinafter the Code) and determine the procedure and conditions for surgical sterilisation by healthcare entities licensed to carry out medical activities (hereinafter healthcare entities).
2. Before surgical sterilisation, the attending physician shall conduct an interview to explain the irreversibility of the process, moral and ethical, psychological and negative physiological consequences and complications.
Chapter 2: Procedures for surgical sterilisation
3. Citizens wishing to use surgical sterilisation at the place of attachment shall complete an outpatient medical card in the form approved pursuant to paragraph 31 of Article 7 of the Code.
4. When referring a citizen for surgical sterilisation, obstetricians-gynaecologists and urologists of medical organisations shall carry out an examination to establish that there are no medical contraindications to the operation.
5. Surgical sterilisation of patients shall be carried out within the framework of the guaranteed volume of free medical care and (or) within the system of compulsory social health insurance.
6. Surgical sterilisation of a patient shall be made after written informed consent has been obtained.
7. In order to undergo surgical sterilisation, citizens shall undergo a medical examination regulated for cavity surgery.
8. If there are no medical contraindications to surgical sterilisation and if the patient has given his or her written consent, the patient shall be referred to a healthcare centre via the portal of the hospitalisation office, with an extract from an outpatient's card with the results of the examination of the patient.
9. Medical indications for surgical sterilisation of citizens shall be established in medical organisations by a medical advisory committee (hereinafter referred to as MAC) consisting of the head of the healthcare organisation, an obstetrician-gynaecologist or urologist-andrologist, a doctor of the specialty to which the disease belongs.
10. For medical reasons, citizens shall be issued a report with a full clinical diagnosis, certified by the signatures of the specialists of the medical organisation indicated.
11. When citizens apply to a medical organisation, the following shall be provided
1) a referral via the portal of the hospitalisation office;
2) conclusion of the MAC, in the case stipulated by paragraph 9 hereof;
3) an extract from an out-patient's chart with the results of the examination of the patient.
12. The duration of the patient's stay in a medical institution after surgical sterilisation shall be determined by the attending physician individually, depending on the patient's state of health.
Chapter 3: Conditions for surgical sterilisation
13. The condition for surgical sterilisation as a method of preventing unwanted pregnancy shall be the written consent of a citizen who is at least thirty-five years old or who has two children and, if medically indicated, with the consent of the patient regardless of age and presence of children.
14. Medical indications for surgical sterilisation:
1) present or past malignant neoplasms of all localisations;
2) a repeated caesarean section or the presence of a scar on the uterus after gynaecological operations in the presence of children;
3) diseases of the endocrine system:
thyrotoxicosis;
congenital or acquired hypothyroidism;
severe diabetes mellitus;
diabetes mellitus in both spouses;
hyperparathyroidism, hypoparathyroidism;
non-sugar diabetes;
adrenal diseases (active phase or significant residual effects after specific treatment);
amyloidosis;
4) diseases of the blood and hematopoietic organs:
aplastic anaemia;
thrombopenic and thrombopathic conditions in remission;
haemorrhagic conditions in remission;
5) mental disorders (certified by the psychoneurological organisation in the mother or the father of the unborn child):
psychoses, including alcoholic, drug-induced, schizophrenic and other inorganic psychoses;
transient and chronic psychoneurotic conditions resulting from organic diseases;
schizophrenia;
paranoid conditions;
personality disorders;
chronic alcoholism;
mental retardation;
6) diseases of the nervous system and sense organs:
those having suffered severe inflammatory diseases of the central nervous system (meningitis, encephalitis, myelitis and encephalomyelitis);
hereditary and degenerative diseases of the central nervous system;
all forms of multiple sclerosis, other demyelinating diseases of the central nervous system;
epilepsy - all forms;
catalepsy and narcolepsy - all forms;
inflammatory and toxic neuropathies - all forms, in remission;
muscular dystrophy and other types of myopathies;
retinal detachment iris diseases - severe forms, optic neuritis, keratitis, congenital cataract, progressive reduction in visual acuity;
diseases of the vestibular system;
otosclerosis - all forms, diseases of the auditory nerve in the presence of progressive hearing loss, congenital deafness, deaf-mute;
7) diseases of the circulatory system:
persistently recurrent myocarditis;
chronic pericarditis with signs of heart compression;
malformations of mitral, aortic, tricuspid valve, multi-valve malformations with circulatory insufficiency of 2-3 degrees;
hypertension, stages - grade 11 A with frequent crises, grade 2b-3, malignant;
coronary heart disease - all forms;
presence of pulmonary hypertension - degree 2-3;
cardiac rhythm and conduction disorders: grade 3 atrio-ventricular blocks, atrial fibrillation, paroxysmal tachycardia with frequent attacks;
aortic aneurysm;
arterial embolism and thrombosis;
periarteritis nodosa and similar conditions;
other congenital anomalies of the circulatory system;
conditions after surgical correction of malformations performed for symptomatic pulmonary hypertension, incomplete surgical correction of congenital malformation, recanalisation of septal defects and patent ductus arteriosus;
conditions after prosthetic heart valves with unsatisfactory condition of other heart valves;
8) respiratory diseases:
stenosis of the larynx, trachea or bronchi;
bronchial asthma - severe form;
bronchiectatic disease - severe, hormone-dependent form;
pulmonary and pleural disease with pulmonary heart failure, amyloidosis of internal organs;
polycystic lung disease;
respiratory diseases with respiratory failure grades 2b and 3;
persons with severe pulmonary tuberculosis;
9) diseases of the digestive organs:
narrowing and stenosis of the oesophagus that cannot be boughed;
artificial oesophagus;
gastric and duodenal ulcer with stenosis and bleeding history;
large abdominal hernia with dilation of the anterior abdominal wall;
infectious enteritis and colitis with intestinal bleeding, with frequent exacerbations in remission;
operated stomach syndrome;
chronic liver and biliary tract disease with dysfunction and cirrhosis;
intestinal dysbacteriosis, severe form.
10) diseases of the urogenital system:
chronic recurrent glomerulonephritis;
acute and chronic renal failure;
renal parenchymal disease with renal and other organ dysfunction (persistent hypertension), chronic recurrent pyelonephritis of the single kidney;
hydronephrosis (bilateral, single kidney, congenital) with renal dysfunction;
polycystic kidney disease with renal insufficiency;
fistulas with involvement of the female reproductive organs and conditions after operations for their correction.
11) diseases of the musculoskeletal system and connective tissue:
diffuse connective tissue disease;
rheumatoid arthritis with severe joint dysfunction and other inflammatory arthropathies without exacerbation;
musculoskeletal disorders (ankylosing spondylitis; osteochondropathy);
amputation of leg, foot (total amputation).
12) monogenic hereditary diseases in the absence of prenatal molecular genetic diagnosis.
15. Contraindications for surgical sterilisation:
1) acute (or acute chronic) infectious diseases of any localisation;
2) acute (or acute chronic) inflammatory diseases of any localization;
3) chronic diseases of vital organs in decompensation stage;
4) haemodynamic disorders in diseases of the cardiovascular system;
5) haematological disorders in diseases of the blood and haematopoietic organs.
