ArticleBMC public health2026
Beyond biomedical control: governance, social protection, and system gaps in tuberculosis control in Kazakhstan - a qualitative study of decision-makers.
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTuberculosis (TB) remains a major public health challenge globally and in Kazakhstan, despite progress in reducing incidence. Increasing evidence highlights the role of social and structural determinants in shaping TB risk, disease progression, and treatment outcomes. However, limited research has explored how decision-makers conceptualize these factors and identify system-level gaps in TB control. This study aimed to examine regional decision-makers' perspectives on TB burden, social protection, health system capacity, and governance in Kazakhstan.
methodsA qualitative study was conducted using in-depth, semi-structured interviews with 12 decision-makers from six regions of Kazakhstan, including representatives of regional health authorities and local governance structures. Participants were purposively sampled to ensure diversity in institutional roles and geographic context. Interviews were conducted between August and December 2020, audio-recorded, transcribed verbatim, and analyzed using inductive codebook thematic analysis supported by ATLAS.ti software. The study followed COREQ guidelines.
resultsSix major themes were identified. Participants consistently framed TB as a condition closely linked to structural inequality rather than solely a biomedical issue. Risk was perceived as concentrated among socially and geographically vulnerable populations, particularly in rural areas with limited access to care. A key finding was the identification of a "biomedical-social gap," whereby strong diagnostic and treatment capacity was perceived as insufficiently connected to social protection, outreach, and governance mechanisms. Participants attributed this gap to fragmented social assistance, uneven support for transport, food, and income-related needs, workforce and infrastructure constraints, inequities in rural access, and insufficient institutionalization of NGO involvement. Sustaining political commitment and non-stigmatizing public awareness was also identified as important for long-term TB control.
conclusionsRegional decision-makers perceived TB control in Kazakhstan as constrained by fragmented linkages between biomedical services, social protection, NGO outreach, rural access support, and intersectoral governance mechanisms. Strengthening patient-centered social support and coordination across clinical, social, and civil society sectors may help reduce perceived fragmentation and support more equitable TB control.
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