Kazakhstan is the world’s largest landlocked country, home to over 20 million people and like many countries, faces a significant burden from stroke. Since 2018, the Angel’s Initiative has been active in Kazakhstan, with the aim of helping improving stroke care in the region. A group of researchers have set out to evaluate the effectiveness of the programme so far.
Dr Yerzhan Adilbekov MD1, Dr Gianluca De Rubeis2,6, Associate Professor Aleksandras Vilionskis3, Dr Sabina Garafovna1, Dr Bibigul Adilbekova4, Dr Enrico Pampana2 and Dr Francesca Romana Pezzella5
Kazakhstan is home to more than 20 million people1 and, since 2018, the Angels Initiative has been working with healthcare professionals across Kazakhstan to strengthen stroke care systems and improve access to life-saving treatments. Researchers are now assessing how stroke services have evolved in the years since the programme began.
Healthcare in Kazakhstan is overseen by the Ministry of Health, with a social health insurance system introduced in 2020.2 Recent reviews have identified cardiovascular disease as one of the country's leading causes of death, highlighting the importance of timely and effective stroke care.2
The Angels Initiative is a global programme, now in its tenth year, that aims to support hospitals in becoming stroke-ready and to improve the quality of existing stroke services.3 Through education, training, quality monitoring and expert support, the programme seeks to help healthcare teams deliver faster and more effective care to patients experiencing stroke.4
The Research and Angels Team in Kazakhstan
Since its introduction in Kazakhstan, the initiative has focused on strengthening stroke networks and increasing access to acute stroke treatments such as thrombolysis and thrombectomy. Participating centres engage in ongoing quality monitoring, annual meetings and continuous educational activities. "In order to help improve current systems, the programme required participants to engage in continual quality monitoring, annual congresses and ongoing learning and education," explained Dr Gianluca De Rubeis. "This programme was a collaboration across many individuals and many countries."
Dr Gianluca De Rubeis and Dr Yerzhan Adilbekov set out to explore how the landscape of stroke care in Kazakhstan has changed since the launch of the initiative. In particular, they wanted to understand whether the growth of collaboration between the programme and local healthcare experts corresponded with changes in stroke service provision across the country.
"After eight years of implementation, we wanted to better understand how stroke care has developed in Kazakhstan," said Dr Yerzhan Adilbekov. "The programme has brought together healthcare professionals, institutions and international expertise, and it is important to evaluate the impact of those efforts."
Using data collected through Ministry of Health reports, the researchers are examining trends in stroke service provision over time, including the development of stroke centres and the delivery of acute stroke treatments.
"Our early findings suggest encouraging trends," said Dr De Rubeis. "We hope this work will contribute to ongoing improvements in stroke care and support future development of stroke services in Kazakhstan."
The researchers hope their work will provide valuable insights into how long-term collaboration, education and quality improvement initiatives can support the development of stroke systems and ultimately improve patient care.
Litvinova Y, Eriksen A, Spatayev Y, Rechel B (2025). Health Systems in Action (HSiA) Insights – Kazakhstan, 2024. Copenhagen: European Observatory on Health Systems and Policies, WHO Regional Office for Europe.
Caso V, Martins S, Mikulik R et al. Six years of the Angels Initiative: Aims, achievements, and future directions to improve stroke care worldwide. Int J Stroke. 2023 Oct;18(8):898-907.
National Coordinating Centre for Emergency Medicine of the Ministry of Health of the Republic of Kazakhstan, Astana, Kazakhstan.
Department of Diagnostic and Interventional Neuroradiology, AO San Camillo/Forlanini, Rome, Italy.
Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Department of Internal Medicine, NCJSC "Astana Medical University".
Stroke Unit AO San Camillo/Forlanini, Rome, Italy.
University of Cagliari, Cagliari, Italy.
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