Unofficial translation
In accordance with paragraph 3 of Article 92 of the Code of the Republic of Kazakhstan dated July 7, 2020 "On people's health and health care system" I HEREBY ORDER:
1. To approve the rules for organization of medical care for protection of reproductive and mental health of minors aged ten to eighteen and youth in accordance with the appendix to this order.
2. The Department of maternal and infant health protection of the Ministry of Health of the Republic of Kazakhstan, in accordance with the procedure established by the legislation of the Republic of Kazakhstan, to ensure:
1) state registration of this order in the Ministry of Justice of the Republic of Kazakhstan;
2) posting this order on the Internet resource of the Ministry of Health of the Republic of Kazakhstan after its official publication;
3) within ten working days after the state registration of this order, submission of information to the Legal Department of the Ministry of Health of the Republic of Kazakhstan on implementation of the activities provided for in subparagraphs 1) and 2) of this paragraph.
3. The supervising vice minister of health of the Republic of Kazakhstan is authorized to control the execution of this order.
4. This order comes into effect upon the expiration of ten calendar days from the date of its first official publication.
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Minister of health of the Republic of Kazakhstan |
A. Tsoi |
| Appendix to the order of the Minister of health of the Republic of Kazakhstan dated December 20, 2020 № ҚР ДСМ-285/2020 |
Rules for organization of medical care for protection of reproductive and mental health of minors aged ten to eighteen and youth
Chapter 1. General provisions
1. These rules for organization of medical care for protection of reproductive and mental health of minors aged ten to eighteen and youth (hereinafter - the Rules) are developed in accordance with paragraph 3 of Article 92 of the Code of the Republic of Kazakhstan dated July 7, 2020 "On people’s health and health care system" (hereinafter - the Code) and determine the procedure for organization of medical care for protection of reproductive and mental health of minors aged ten to eighteen and youth.
2. Basic concepts used in these Rules:
1) legal representatives of the child - parents (parent), adoptive parents (adoptive parents), guardian or trustee, foster parent (foster parents), foster caregiver and other persons substituting them, carrying out care, education, upbringing, protection of rights in accordance with the legislation of the Republic of Kazakhstan and the interests of the child;
2) mental health - a state of well-being in which each person can fulfill his or her own potential, cope with normal life stresses, work productively and fruitfully, and also contribute to the life of their community;
3) psychological assistance - a set of measures aimed at: assistance to a person in prevention, resolution of psychological problems, overcoming difficult life and crisis situations and their consequences, contributing to the maintenance of mental and somatic health, optimization of mental development, adaptation and improvement of the quality of life, including by activating a person's own capabilities;
informing people about the causes of psychological problems, ways to prevent and resolve them;
personality development, its self-improvement and self-realization.
4) psychological problem - a state of mental discomfort of a person caused by dissatisfaction with oneself, one's activities, interpersonal relationships, the situation in the family and (or) other problems of personal life.
3. Health care subjects providing medical assistance for protection of reproductive and mental health to minors aged ten to eighteen (hereinafter referred to as minors) and youth aged eighteen to twenty-nine (hereinafter referred to as youth), including medical and preventive care, and also psychosocial and legal services, are the youth health centers (hereinafter - YHC).
4. YHCs provide medical care for protection of reproductive and mental health to minors and youth, in compliance with the anti-epidemic regime in accordance with regulatory legal acts in the field of sanitary and epidemiological welfare of the population.
5. Healthcare subjects providing medical assistance for protection of reproductive and mental health to minors and youth maintain primary medical records and submit reports in the forms and in the manner established by the authorized body, in accordance with subparagraph 9) of paragraph 2 of Article 115 of the Code, including through information systems.
6. YHC is a health care organization in the cities of regional, republican significance and the capital, or a structural subdivision of a health care organization that provides outpatient care.
7. YHC provides medical and preventive care in the form of pre-medical and specialized medical care to minors and youth.
Chapter 2. Procedure for organization of medical care for protection of reproductive and mental health of minors aged ten to eighteen and youth
8. YHC provides medical care to minors and youth on the referral of primary health care specialists, as well as on own initiative (self-referral) of an individual (patient) without a referral from primary health care specialists.
9. The YHC provides medical care taking into account the following age characteristics of patients:
1) minors aged ten years and under the full sixteen years are provided with medical assistance with written consent and in the presence of their parents or other legal representatives;
2) minors aged sixteen years and under the full eighteen years are provided with preventive, consultative and diagnostic assistance, with the exception of surgical interventions, artificial termination of pregnancy, which are carried out with the written consent of their parents or other legal representatives;
3) youth between the ages of eighteen and twenty-nine are provided with medical assistance upon their consent.
10. YHC is located in a separate building or has a separate entrance that does not intersect with other flows of patients (visitors), as well as accessible for people with disabilities and other people with limited mobility.
11. In the YHC the minors and youth are provided with comprehensive assistance by medical workers, psychologists, social workers, lawyers.
12. In the YHC, the minors and youth are provided with medical assistance by the following specialists:
1) medical workers with higher medical education in the following specialties:
"Obstetrics-gynecology (gynecology for children, functional diagnostics, ultrasound diagnostics in the main specialty, endoscopy in the main specialty)";
"Urology and andrology (ultrasound diagnostics according to the profile of the main specialty, endoscopy according to the profile of the main specialty) (adults, children)";
"Dermatovenereology (dermatocosmetology) (adult, pediatric)";
"General practice (family medicine)";
"Therapy (adolescent therapy, dietetics)";
"Psychiatry (narcology, psychotherapy, sexopathology, medical psychology, forensic psychiatric examination, forensic narcological examination)";
"Children's psychiatry (children's narcology, children's psychotherapy, children's medical psychology, suicidology, forensic narcological examination, forensic psychiatric examination)";
"Public health";
"Hygiene and epidemiology (general hygiene, occupational hygiene, hygiene of children and adolescents, food hygiene, communal hygiene, radiation hygiene, toxicology, epidemiology, parasitology, bacteriology, virology, microbiology)";
"Nursing";
2) medical workers with post-secondary medical education in the specialty: "Nursing";
3) employees with technical and vocational medical education in the following specialties:
"General medicine (paramedic, paramedic of general practice)";
"Obstetrics (obstetrician, general practice obstetrician)";
"Nursing (nurse (nurse man), nurse (nurse man) of general practice, specialized medical nurse (nurse man))";
“Nursing (younger nurse (nurse man) for nursing)”;
"Laboratory diagnostics (laboratory assistant, doctor-laboratory assistant)".
13. Psychologists of the YHC provide medical and psychological assistance (including psychological diagnostics, corrective support, counseling) in order to maintain mental health, counseling on the psychological well-being of minors and youth.
14. Social workers of the YHC provide information and advice on the issues of receiving social assistance to minors and youth.
15. Informing and consulting on the issues of obtaining legal assistance to minors and youth is provided by the lawyers of the YHC.
16. The following medical and psychological assistance for protection of reproductive and mental health is provided to minors and youth at the YHC:
1) provision of advisory, medical and diagnostic, medical and psychological assistance for protection of reproductive and mental health;
2) promotion and formation of healthy lifestyle skills, including promotion of healthy rational nutrition, physical activity, sports, nutrition; prevention of diseases, behavioral risk factors (prevention of drug addiction, consumption of tobacco products, including products with heated tobacco, hookah tobacco, hookah mix, tobacco heating system, electronic consumption systems and liquids for them, alcohol and other psychoactive substances), informative and explanatory work, hygienic training of minors and youth on health promotion and prevention of diseases associated with lifestyle, including on the issues of preserving of reproductive and mental health;
3) informative and explanatory work among minors and youth on promoting a healthy lifestyle, protecting reproductive health, including the prevention of early sexual activity, family planning, the use of contraceptives, and the prevention of unwanted pregnancy;
4) training and counseling, lectures, trainings, seminars for minors, youth, their parents or other legal representatives, spouses, volunteers, as well as the development of information and educational materials on reproductive and mental health, including:
prevention of behavioral risk factors and formation of healthy lifestyle skills;
psychophysical, psychosocial development in adolescence;
social behavior, forming responsible partnerships and preparing for family life;
psychological problems and solutions to issues related to relationships in a couple, in a family, interpersonal relationships;
issues of prevention, diagnosis and treatment of sexually transmitted infections;
prevention of early sexual (sexual) life, features of the physiological immaturity of the body in adolescence;
prevention of teenage pregnancy, possible complications and consequences of early pregnancy, prevention of artificial termination of pregnancy and childbirth among minors;
family planning, modern methods of contraception, prevention of unwanted pregnancy, indicating possible complications and consequences of artificial termination of pregnancy;
5) provision of information and advice on the prevention of sexually transmitted diseases, the formation of conscious, responsible and safe behavior in the field of reproductive and sexual health;
6) informing and counseling minors in an accessible form on reproductive health issues in order to prevent early sexual (sexual) life; prevention of teenage pregnancy;
7) informing and consulting on prevention of unwanted pregnancy, possible complications and consequences of artificial termination of pregnancy, family planning, modern methods of contraception;
8) provision of medical assistance for protection of reproductive health, family planning, prevention of unwanted pregnancy, contraception, as well as the prevention, diagnosis and treatment of diseases of the reproductive system;
9) upon detection of pregnancy in minors and youth - timely referral of patients (including for registration and further dynamic monitoring during pregnancy) in compliance with the continuity with medical organizations providing primary health care and other medical organizations, notifying parents or other legal representatives upon detection of pregnancy in minors;
10) diagnosis of acute and chronic diseases of the reproductive organs, sexually transmitted infections in minors and youth, treatment and observation, as well as the timely referral of patients to receive medical care in a hospital-substituting and inpatient conditions;
11) creation of psychologically comfortable conditions for minors and youth, provision of individual and group psychological assistance;
12) psychological education, prevention of psychological problems, conducting social and psychological trainings with the aim of teaching self-preservation behavior, self-service skills, behavior in everyday life and public places, communication, mutual support, instilling behavioral skills (equality, respect, mutual understanding, the ability to assess the situation and defend their borders, conflict-freeness and more);
13) provision of psychological assistance, counseling to maintain mental health, prevention of risky behaviors (including self-harm, suicidal behavior), addictions caused by the consumption of tobacco products, including products with heated tobacco, tobacco for hookah, hookah mix, a system for heating tobacco, electronic consumption systems and liquids for them, drug addiction, substance abuse, as well as pathological attraction to gambling;
14) provision of confidential medical and psychological assistance to minors and youth, formation of safe and responsible behavior skills to maintain reproductive and mental health;
15) provision of medical and psychological assistance to develop skills for safe and responsible behavior in the field of mental health;
16) counseling on preparing youth for family life, formation of a responsible partnership, motherhood, fatherhood;
17) provision of medical and psychological assistance, advisory support on issues of obtaining social and legal assistance to minors and youth, with the active involvement of the patients themselves, parents of minors or other legal representatives, with an increase in responsibility for their health in order to improve their quality of life;
18) provision of psychological assistance to minors and youth who applied after sexual violence;
19) conduct of psychological diagnostics, corrective support, counseling and information work with the aim of socio-psychological adaptation;
20) psychological support in provision of medical care if necessary;
21) referral of minors and youth with suspicion of mental, behavioral disorders (diseases) to medical organizations providing medical assistance in the field of mental health.
17. Informing and consulting minors on reproductive and mental health issues is carried out in a form accessible to them.
18. If a teenager, a representative of youth, their parents or other legal representatives have technical capabilities, information and counseling is carried out remotely using telephone, digital and mobile technologies.
19. YHCs carry out activities in cooperation and in compliance with continuity with medical organizations providing primary health care, other medical organizations and specialized services, with republican health organizations.
20. Parents or other legal representatives of patients are notified in writing in cases that threaten their health, as well as requiring their consent in accordance with the current legislation.
21. YHC cooperates with volunteers, representatives of public, nongovernmental and international organizations in carrying out activities to promote healthy lifestyles, advocacy on health promotion and prevention of lifestyle-related diseases, including on issues of preserving of reproductive and mental health.
22. In group work, the YHC uses methods of creating support groups, conducting trainings, working with initiative groups, self-help and mutual help groups.
23. YHC specialists in cases of treatment of minors and youth who have been subjected to cruel treatment, violence (physical, sexual, psychological):
1) provide the necessary medical care in accordance with clinical protocols;
2) provide comprehensive assistance in cooperation with psychologists, social workers, lawyers;
3) notify the parents or other legal representatives of the minor;
4) notify law enforcement agencies about the facts of applying of victims and provision of medical assistance to them;
5) transfer the relevant information to the educational authorities, social protection authorities according to their competence.
24. When contacting on issues that are not within the competence of medical workers, representatives of bodies and organizations of other departments within their competence (education, social protection, law enforcement, local executive bodies, non-governmental organizations) are involved.
25. The heads of the YHC ensure inter-sectoral and interdepartmental interaction, coordination of the work of specialists with other bodies and organizations.
26. YHC organizes consultations of specialists for minors and youth by telephone ("hot line", "helpline"), via the Internet, video conferencing (using digital and mobile technologies), on healthy lifestyles, preservation of reproductive and mental health, psychological well-being.
27. YHC uses electronic information resources, electronic health information systems in compliance with the requirements to ensure the protection of personal data of individuals (patients).
28. In the absence of appropriate premises, the functions of the YHC are carried out in the youth health Cabinet as part of a medical organization that provides outpatient care.
29. Activities for formation of healthy lifestyle skills among minors and youth are carried out at the YHC through information and explanatory work, counseling work and hygienic training on the following issues:
1) healthy and rational nutrition;
2) physical activity and sports;
3) prevention of behavioral risk factors (consumption of tobacco products, including products with heated tobacco, hookah tobacco, hookah mix, systems for heating tobacco, electronic consumption systems and liquids for them, alcohol, drugs and other psychoactive substances);
prevention of lifestyle-related diseases;
4) physiology and hygiene of puberty;
5) prevention of early sexual activity;
6) prevention, diagnosis of sexually transmitted infections (hereinafter - STIs).
30. Awareness-raising work is carried out by specialists of the Ministry of Health in electronic and print media, social networks, as well as through the development and publication of information materials.
31. Awareness-raising and hygiene education among minors is carried out in a form accessible to them.
Paragraph 1. Features of organization of medical care for protection of reproductive health of minors aged ten to eighteen and youth
32. The YHC conducts information and explanatory work among minors and youth on reproductive health issues, including the prevention of early sexual (sexual) life by informing about its consequences, prevention of teenage pregnancy, and family planning.
33. The YHC provides information and counseling on methods of preventing unwanted pregnancies, prescribing contraception.
34. Informing and counseling on the formation of responsible and safe behavior in relation to reproductive and sexual health, prevention of sexually transmitted infections is carried out.
35. The YHC carries out activities for prevention, diagnosis and treatment of reproductive health diseases.
36. When pregnancy is detected in minors and youth, the YHC:
1) notifies parents or other legal representatives within 3 hours after detection of pregnancy in adolescents;
2) provides psychological support and counseling to a pregnant woman, as well as her parents or other legal representatives;
3) notifies law enforcement agencies about the fact of pregnancy in a minor within 3 hours after detection;
4) timely refers patients to medical organizations that provide primary health care and other medical organizations immediately after pregnancy is detected in compliance with continuity (including for registration and further dynamic monitoring during pregnancy);
5) provides socio-psychological, socio-legal assistance, legal advice to a pregnant woman, as well as to her parents or other legal representatives.
37. If the minor and her parents or other legal representatives wish to preserve the pregnancy, the YHC specialist refers the patient to the organization of primary health care for registration and further observation.
38. If the minor and her parents or other legal representatives wish to terminate the pregnancy, the specialists of the YHC:
1) together with the heads of the YHC conduct a conversation, inform the pregnant woman, her parents or other legal representatives (in case of a minor) about medical and social indications, contraindications for artificial termination of pregnancy, the procedure for carrying it out, as well as possible complications and consequences of artificial termination of pregnancy;
2) conduct psychological counseling for a pregnant woman, as well as her parents or other legal representatives;
3) send to specialized departments of medical organizations (gynecological departments of hospitals) for artificial termination of pregnancy.
39. After the artificial termination of pregnancy, psychological counseling is carried out, recommendations are given on the post-abortion period, further prevention of unwanted pregnancy and contraception, and contraceptive means corresponding to the physiological state (if any) are provided.
40. The specialists of the YHC carry out information and explanatory work among minors and youth on the prevention of STIs, including the consequences of early sexual activity, safe sexual behavior, and personal protective equipment.
41. YHC specialists diagnose STIs (genital candidiasis, trichomoniasis, ureaplasmosis, mycoplasmosis, chlamydia, genital herpes, papillomavirus infection (anogenital warts), gonorrhea, syphilis (express test), HIV infection (express test), and hepatitis B and C).
42. Before testing for STIs, pre-test counseling is provided for minors and youth.
43. After the examination for STIs, taking into account the age characteristics specified in paragraph 9 of these Rules, post-test counseling of minors and youth on STI prevention is carried out, upon receipt of negative test results.
44. The YHC provides STI treatment, with the exception of syphilis, gonococcal infection, chancroid, inguinal granuloma, HIV infection.
45. The minors and youth suspected of having syphilis, gonococcal infection, chancroid, inguinal granuloma are sent to a health care organization that provides dermatovenerological care.
46. YHC specialists refer minors and youth with suspicion of HIV infection to state healthcare organizations that carry out activities in the field of HIV prevention for subsequent diagnosis, treatment and monitoring.
47. After the completion of STI treatment, psychological counseling is carried out, recommendations on contraception are provided, and the patient is provided with a contraceptive method acceptable for his physiological state (if available).
Paragraph 2. Organization of medical assistance for protection of mental health of minors aged ten to eighteen and youth
48. Informing and counseling on mental health issues is carried out individually, for couples (married couples) or in a group on the following topics:
1) psychophysical, psychosocial development in adolescence;
2) prevention of risky behaviors (prevention of self-harm, suicidal behavior), addictions caused by the consumption of tobacco products, including products with heated tobacco, hookah tobacco, hookah mix, a system for heating tobacco, electronic consumption systems and liquids for them, drug addiction, substance abuse, as well as pathological attraction to gambling;
3) self-preservation behavior;
4) development of behavior skills in everyday life and public places, interpersonal communication, mutual support;
5) psychological problems and solving issues related to relationships in a couple, in a family, interpersonal relationships;
6) features of psychological and physiological immaturity of the body in adolescence, prevention of early sexual activity, possible complications and consequences of early pregnancy, artificial termination of pregnancy and childbirth;
7) issues of social behavior, preparation for family life and formation of a responsible marriage.
49. Informing on the issues of mental health preservation is carried out by employees of the YHC, specialized health organizations, as well as volunteers who have undergone special training, based on information materials developed for the YHC.
50. Mental health education is carried out among:
1) minors under the age of sixteen with the consent of their parents or other legal representatives;
2) minors aged sixteen and under the full eighteen years, youth, their parents or other legal representatives, spouses, volunteers at their request.
51. YHC provides confidential psychological assistance in the following areas:
1) psychological education;
2) prevention of psychological problems,
3) prevention of risky behaviors (self-harm, suicidal behavior), addictions caused by the consumption of tobacco products, including products with heated tobacco, hookah tobacco, hookah mix, a system for heating tobacco, electronic consumption systems and liquids for them, drug addiction, substance abuse, as well as pathological attraction to gambling;
4) development of skills for safe and responsible behavior in the field of reproductive and mental health;
5) preparing minors and youth for family life, the formation of a responsible partnership, motherhood, fatherhood;
6) assistance to minors and youth, including those who find themselves in difficult life situations;
7) assistance to minors and youth who are victims of sexual violence;
8) psychological diagnostics, correctional support, counseling for the purpose of social and psychological adaptation;
9) referral of minors and youth suspected of mental and behavioral disorders to medical organizations providing medical care in the field of mental health.
52. When providing psychological assistance, the YHC provides medical and psychological assistance (including psychological diagnostics, correctional support, counseling) in order to maintain mental health; counseling is provided on the psychological well-being of minors and youth.