# Implementation Gaps in Public Outpatient Drug Programs: A Survey of Physicians in Urban Primary Care in Kazakhstan

## TL;DR

This study explores how physicians in Kazakhstan's urban primary care face challenges in providing publicly funded medicines, showing that poor communication and information are bigger issues than lack of funding.

## Contribution

The study highlights physician-level implementation gaps in outpatient drug programs, emphasizing systemic and informational barriers over financial constraints in an upper-middle-income country.

## Key findings

- Only 44% of physicians confirmed the existence of outpatient drug cost compensation mechanisms in their clinics.
- Half of the physicians advised patients to buy medicines out of pocket due to shortages.
- Physician awareness of drug policies was strongly linked to their experience and specialty.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Outpatient drug provision is a core determinant of treatment continuity and equity in primary healthcare systems, particularly for patients with chronic conditions.This study examines how physician-level awareness and everyday clinical practices shape real-world access to publicly funded medicines in an urban health system.

Outpatient drug provision is a core determinant of treatment continuity and equity in primary healthcare systems, particularly for patients with chronic conditions.

This study examines how physician-level awareness and everyday clinical practices shape real-world access to publicly funded medicines in an urban health system.

Public health significance—Why is this work of significance to public health?
The findings demonstrate that implementation failures in outpatient drug programs are primarily driven by systemic inefficiencies, suggesting that organizational and informational barriers take precedence over insufficient public financing. By focusing on physicians as frontline implementers, the study addresses a critical but underexplored dimension of pharmaceutical governance in upper-middle-income countries.

The findings demonstrate that implementation failures in outpatient drug programs are primarily driven by systemic inefficiencies, suggesting that organizational and informational barriers take precedence over insufficient public financing. By focusing on physicians as frontline implementers, the study addresses a critical but underexplored dimension of pharmaceutical governance in upper-middle-income countries.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
Strengthening internal communication, administrative clarity, and pharmaceutical policy training for physicians may substantially improve the effectiveness of outpatient drug provision without increasing budgets.Physician-level implementation processes should be systematically incorporated into the design, monitoring, and evaluation of pharmaceutical policies in primary care.

Strengthening internal communication, administrative clarity, and pharmaceutical policy training for physicians may substantially improve the effectiveness of outpatient drug provision without increasing budgets.

Physician-level implementation processes should be systematically incorporated into the design, monitoring, and evaluation of pharmaceutical policies in primary care.

Background: Outpatient drug provision is a critical component of primary healthcare systems and a key determinant of treatment continuity, adherence, and equity, yet the effectiveness of publicly funded outpatient drug programs often depends on how policies are implemented at the point of care. This study examined physician awareness, practical experience, and perceived barriers related to outpatient drug provision and drug cost compensation mechanisms in urban primary care settings in Kazakhstan. Methods: A descriptive cross-sectional survey was conducted between September and December 2024 among 380 physicians working in all 33 state-owned urban polyclinics in Almaty, using a structured author-developed questionnaire. Descriptive statistics and Pearson’s chi-square tests were applied to assess associations between physician characteristics and awareness levels. Results: Only 44.0% of physicians confirmed the existence of outpatient drug cost compensation mechanisms in their polyclinics, while 26.0% believed that no such mechanisms existed and 30.0% were unable to provide a definitive answer, indicating that 56.0% lacked accurate awareness. Limited medicine availability and recurrent shortages were frequently reported, with half of physicians advising patients to purchase medicines out of pocket. Physician awareness was significantly associated with professional experience and specialty (p < 0.001). Conclusions: These findings indicate a substantial physician-level implementation gap in outpatient drug provision, suggesting that organizational and informational barriers—rather than insufficient public financing—are the primary drivers, highlighting the need for strengthened governance.