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“Assessment of the participation of women volunteers in the palliative care
system in Kazakhstan”
AUTH ORS
Anel Kireyeva
Gaukhar Kenzhegulova
Zaira Satpayeva
Zhansaya Imangali
Ainur Amirova
ARTICLE INFO
Anel Kireyeva, Gaukhar Kenzhegulova, Zaira Satpayeva, Zhansaya Imangali
and Ainur Amirova (2022). Assessment of the participation of women volunteers
in the palliative care system in Kazakhstan. Problems and Perspectives in
Management, 20(4), 483-495. doi:10.21511/ppm.20(4).2022.36
DOI http://dx.doi.org/10.21511/ppm.20(4).2022.36
RELEASED ON Monday, 19 December 2022
RECE IVED ON Wednesday, 12 October 2022
ACCEPTED ON Thursday, 08 December 2022
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NUMBER OF REFERENCES
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Problems and Perspectives in Management, Volume 20, Issue 4, 2022
http://dx.doi.org/10.21511/ppm.20(4).2022.36
Abstract
Women’s participation and the nature of assistance in the provision of social policies,
especially in healthcare related to socially signicant diseases, is becoming more prom-
inent. e aim of this study is to develop proposals for streamlining the palliative care
system in Kazakhstan based on the analysis of the inuence of women volunteers on
the process of public administration. e paper interviewed two groups of respon-
dents: volunteers and workers (medical institutions and charity organizations employ-
ees). Atlas.ti soware was used to analyze and construct specic feedback on the data
received. e coding results revealed that women volunteers act as an intermediary
between the state administration and the palliative care system. In addition, it was
determined that the prominent participants in developing the palliative care system
are hospitals and charitable foundations. In general, the contribution of women volun-
teers to nancial assistance, organization of training and master classes for doctors in
the eld of oncology, and provision of additional beds for patients and consultations
was revealed. Further, the state’s main shortcomings in organizing palliative care were
identied: poor regional budgeting system, weak legislative system, and inadequate
nancing of hospitals. e ndings imply that women volunteers should be given a
higher status and included in the public administration structure, especially for dier-
ent representations of the needs of minorities.
Anel Kireyeva (Kazakhstan), Gaukhar Kenzhegulova (Kazakhstan),
Zaira Satpayeva (Kazakhstan), Zhansaya Imangali (England), Ainur Amirova (Kazakhstan)
Assessment of
the participation of women
volunteers in the palliative
care system in Kazakhstan
Received on: 12 of October, 2022
Accepted on: 8 of December, 2022
Published on: 19 of December, 2022
INTRODUCTION
Government stands out as the leading actor in implementing and
managing social policies. Nevertheless, in managing and imple-
menting any social policies and healthcare, other agents partici-
pate as individual entrepreneurs, private businesses, non-govern-
mental organizations (NGOs), and private individuals like volun-
teers. Women are primarily involved in promoting social issues
such as pensions, medicine, and education, which could be ob-
served through the early developments of women’s clubs, where
women were raising questions about education and community so-
cial support. One of the healthcare areas where women are actively
engaged is palliative care. Palliative care has been regarded as a
social issue, where the provision of social support by volunteers, in
particular their support of patients who have been diagnosed with
cancer or needed palliative care assistance, as well as bereavement.
Social activities women pioneered in the mid-90s have become part
of public administration functions.
Palliative care system development is especially urgent in develop-
ing countries that lack the basis for institutionalization. This is be-
© Anel Kireyeva, Gaukhar
Kenzhegulova, Zaira Satpayeva,
Zhansaya Imangali, Ainur Amirova,
2022
Anel Kireyeva, Ph.D. in Economics,
Associate Professor, Head of
Department of Information and
Implementation of Research Results,
Institute of Economics of the Ministry
of Science and Higher Education,
University of International Business,
Kazakhstan. (Corresponding author)
Gaukhar Kenzhegulova, Ph.D. Student,
Department of Economics, Narxoz
University, Kazakhstan.
Zaira Satpayeva, Ph.D., Leading
Researcher, Head of Department of
Regional Economy and Innovation
Development, Institute of Economics of
the Ministry of Education and Science,
Kazakhstan.
Zhansaya Imangali, Master of Science,
Loughborough University London,
England.
Ainur Amirova, Ph.D. in Economics,
Associate Professor, Almaty
Management University, Kazakhstan.
is is an Open Access article,
distributed under the terms of the
Creative Commons Attribution 4.0
International license, which permits
unrestricted re-use, distribution, and
reproduction in any medium, provided
the original work is properly cited.
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JEL Classification J16, J18, I18
Keywords management, public management, palliative, healthcare
system, volunteer, social policy
Conict of interest statement:
Author(s) reported no conict of interest
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cause the palliative care system is not regarded as a socially significant issue by governments; this
is the reason women are actively involved in its development.
Most volunteers and essential actors in the delivery of palliative care are women. In Kazakhstan, the
palliative care system is still undergoing changes, managed with assistance from medical institutions
and volunteers. It must be mentioned that there are dierent levels of involvement in volunteering and
the nature of volunteering. us, palliative care in Kazakhstan requires the development of eective
management mechanisms with the involvement of interested ministries and departments and the par-
ticipation of international organizations and NGOs. In developing these relationships, women volun-
teers play an essential role that has not yet been suciently explored. However, the palliative care system
in developed countries is dierent than in developing countries, where palliative care is at an early stage
of development. In developing countries, improvement of the legislative framework, healthcare system,
and budgeting at the regional and national levels is required. In addition, there is a need to improve and
streamline the process of organizing Kazakhstan’s state policy in palliative care.
1. LITERATURE REVIEW
Today palliative care interventions in re-
source-limited settings are rare or poorly devel-
oped. Nevertheless, most women try to participate
in this process of their own free will to preserve
and improve their quality of life. Women’s volun-
teering is a social activity aimed at helping people
and alleviating suering. Women’s volunteers are
more active in healthcare and intend to cooper-
ate with public institutions and assist policymak-
ers in improving and implementing social policies.
However, their contribution has not been evaluat-
ed as an essential part of healthcare programs, as
they are measured as extras (Roessler et al., 1999).
Shortage of nancial support is usually relevant in
implementing social programs. Budget reduction
of welfare benets leads to the state’s social service
performance propensity. erefore, the activity
of volunteers in providing social help has an eco-
nomically signicant contribution to the imple-
mentation of social policies (Stadelmann-Steen,
2011; Woitha et al., 2015).
Women are more active in volunteering; they are
involved in the healthcare system and provide
unpaid services. It was noted that in developing
countries, women are more active in volunteering
than men (Glenton et al., 2010; Wymer, 2011; Gil-
Lacruz et al., 2019; Wiepking et al., 2022). However,
there is no access to palliative care and treatment,
which motivates local women to take measures
in the management process – the development
of palliative care services (Loth et al., 2020; Kaba,
2021). erefore, volunteering related to the health
sector, especially palliative care provision, is dom-
inated by women volunteers, which is provided as
a personal will, requires more personal time, and
is a non-paid job (Einolf, 2011; Zana et al., 2020;
Vanderstichelen et al., 2022).
us, volunteering is expected to contribute to
social policy issues, especially in welfare states
(Dahlberg, 2005). For instance, management of
such standard costs as traveling, medicine, and
accommodation when not regarded by local gov-
ernments are covered by volunteers (Hopkins et
al., 2013). In addition, previous studies on volun-
teering in palliative care and assistance to medical
institutions investigated the inuence of volunteers
supporting patients (Weeks et al., 2008; Claxton-
Oldeld et al., 2010; Claxton-Oldeld & Beaudette,
2021). For example, Candy et al. (2015) studied if
families of cancer patients, those who needed palli-
ative care, or patients themselves were satisezhud
with the help of volunteers.
While developing personal and professional skills
through non-governmental organization (NGO)
activities, volunteers can have more inuence in
terms of management of a social policy provision,
better under the ocially regarded social institu-
tion of palliative care (Haski-Leventhal et al., 2010;
Haski-Leventhal et al., 2018). For instance, support
of a political decision of an NGO member is better
regarded than that of a single person. Volunteering
could be provided regularly, which means being a
member of an NGO. However, volunteering on a
discontinuous basis is more oen conducted due
to such factors as lack of time, personal issues (e.g.,
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nancial or health), and negative attitude of sup-
port receivers. At the same time, negative is not on-
ly society’s reaction but also consumption because
recipients are not always satised with the help
provided (Acus, 2018). In the case of institutional-
ized rules, public perception is more positive. is
is because, within an institutionalized structure,
these rules become a part of a social institution
(Khadzhyradieva et al., 2019).
Unlike social workers, volunteers act as a link
between social service receivers and the profes-
sional sta and become active when the govern-
ment is more deliberate in solving the social crisis.
Volunteering has a tremendous economic impact
on implementing social policies, so-called “social
volunteering,” among which the most important
is medicine (Stadelmann-Steen, 2011). Although
volunteering is not paid, it is important to accept
their involvement as positive cooperation, especial-
ly in palliative care development, and put them in
line with public bureaucrats of the 5th grade (Park,
2013). Moreover, women’s NGOs, like voluntary
and charity organizations, have led public admin-
istration development (Scheer, 2002). Women vol-
unteers act as mediators providing people with gen-
eral information on social benets oered by the
government, such as free treatment. ey also pro-
vide another type of help depending on their skills
(Cohen & Numa, 2011; Jack et al., 2012; Park, 2013;
Foster et al., 2018). ere is a list of essential func-
tions like providing psychological support, teach-
ing, and social assistance (Coleman et al., 2022).
For public policy, volunteer involvement has a ben-
ecial role as well. is is reected in saving addi-
tional funds, which is performed in inpatient ser-
vice, mental help, and support of patients or their
families (Burbeck et al., 2014; Scheer, 2002; Bloomer
& Walshe, 2020). For instance, in the Netherlands,
the national policy regards primary care settings as
the place for receiving palliative care. In this regard,
the leading roles of health service providers are at-
tained to general practitioners and district nurses.
However, psychologists and social workers are less
involved in palliative care. us, the cooperation of
general practitioners and district nurses with vol-
unteers shows their importance (Koper et al., 2018).
e presence of good institutions based on public
management ensures investment in human capi-
tal, which is a crucial welfare state. Consequently,
it breeds trust-based relationships between gov-
ernment and society (Acemoglu et al., 2001). In
the case of palliative care, volunteers act as push-
ers having a propensity for legitimacy. us, it in-
uences the perception of hospices as legitimate
institutions. is draws the tendency to apply
the palliative care system in hospitals of region-
al importance. Hence, this leads to the widely oc-
curring nature of palliative care practice conse-
quences. In the interaction between ocial serv-
ants and volunteers as well as members of charity
foundations, coercive and mimetic pressure could
be observed (Rasche et al., 2020). e rst condi-
tion leads to the development of an ocial poli-
cy or practice. is is usually preceded by a list-
ing of existing issues, which is the consolidation
of a roadmap. Second, organizations, particularly
hospitals, are put into the condition of adopting
well-established standards and practices. e in-
teraction between the government, hospitals, and
volunteers develops its structure through perma-
nent practice. It is the development of the ways to
exchange information and enhance its quality.
e government tries to pursue new social poli-
cies to support society. One of the key moments
of social policy implementation is improving sta
qualication. In particular, health policies talk
about salary increases for further motivation of
medical sta and improving their experience and
knowledge by providing training and entitling ed-
ucational grants (Inbadas et al., 2018). is could
be a lop-sided social policy structure when service
receivers fall behind the target of a social policy.
As a result, the government does not always get
sucient policy implementation. Women make
up most employees and entrepreneurs in health-
care, education, and other areas of social welfare
(Satpayeva et al., 2020; Kireyeva et al., 2022).
e systematic cooperation of hospices, charity or-
ganizations, and women volunteers with hospitals
and the local government is observed through in-
volvement in the implementation of palliative care
or assistance to patients diagnosed with cancer.
Khadzhyradieva et al. (2019) discussed the eects
of “behavioral insights,” where great attention is
given to the nudging technologies used by public
policy. e noble combination of ideal society be-
haviors of nudging governments has created the
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conditions for creating public policy functioning
areas. us, the palliative care system could be
operated and promoted as a positive movement
throughout the country by institutionalizing this
system. e creation of specic rules led by the
institutionalized structure prompts the actions to
be taken and the expected behavior of the public
in solving related issues. erefore, local govern-
ments can better inuence society through pal-
liative care institutionalization. is is especially
urgent in remote areas, rural settlements, and are-
as vulnerable to economic downturns and natural
disasters.
e system of palliative care in Kazakhstan re-
quires signicant changes in several aspects. First,
Kazakhstan still lacks information, which pre-
vents it from realizing the actual situation in terms
of the urgent need for palliative care in the coun-
try. Second, the healthcare infrastructure is not
ready to provide palliative care as there is a lack
of beds and qualied sta. ird, the legal system
still needs to be adequately developed to consider
the current situation regarding palliative care pro-
vision. Nevertheless, the government showed that
it is ready to develop a system of palliative care
provision. Management of palliative care system
development in Kazakhstan has been undergoing
fast and signicant changes with the cooperation
of women volunteers and hospitals.
Most women volunteers in healthcare, especially in
the palliative care system, demonstrate a high lev-
el of awareness and professional competence in the
process and procedures of palliative care provision,
as well as the social policy establishment. Women’s
volunteer activism is manifested in the cooperative
form with government and state healthcare struc-
tures. us, it saves time and avoids extra costs.
Participation of women volunteers in the manage-
ment of palliative care system development plays a
signicant role and greatly impacts the process of
palliative care institutionalization. Moreover, their
participation in the management process of social-
ly signicant diseases shied the provision of the
state policy to another level.
e literature review has shown few studies in
Kazakhstan regarding palliative care provision.
ere is still a gap in the studies in the way as-
sistance was provided by volunteers and in the
process of volunteers’ assistance to medical sta.
Revealing current gaps in the process of assistance
between volunteers and medical sta will allow
for investigating the contribution of volunteers
in the provision of palliative care management in
Kazakhstan.
us, this study aims to investigate the impact of
the participation of women volunteers in the de-
velopment of the palliative care system on the pro-
cess of public administration.
2. METHODOLOGY
e primary research method was the interview
conducted on open-ended questions based on
semi-formalized scenarios with the participa-
tion of two groups of respondents: volunteers and
workers (medical institutions and charity organi-
zations employees), lasting about 90 minutes. A
total of 10 people participated in the interview.
e interview provided a preliminary analysis of
the nature of the charity foundation’s involvement
in palliative care delivery. e selection procedure
included two factors:
1) nature of the delivered help – based on the pro-
vided literature review, the foundations which
assisted daily both for medical sta and pa-
tients with their families were chosen for the
provision of the semi-structured interview;
2) location – Almaty city is the pioneer of hos-
pices development and the center for palliative
care delivery in Kazakhstan.
Half of the respondents were leaders of the volun-
teer movement in Kazakhstan. Some were med-
ical sta members, two of them were in manag-
ing positions, and one was in a secondary posi-
tion. Finally, two respondents were volunteers
who assist charity foundations in organizational
processes such as provision of master classes, or-
ganization of training sessions for doctors, and
primary consultation of patients who intend to
travel abroad or need assistance in raising funds
for medical treatment. e number of volunteers
interviewed is conditioned to the saturation point
(Saunders et al., 2018).
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e questions were divided into ten groups, where
some groups included from 2 to 5 questions for
better delivery of the issue. ese groups were
based on the “what is the problem represented to
be” method. e interview questions description
is given in Table 1.
is analysis primarily relies on the experience of
volunteers or participants of this movement in the
palliative care management. Furthermore, for the
processing of primary data in this study, Atlas.ti
was used, which oers functions for the centrali-
zation of all necessary information and has mech-
anisms that allow for qualitative data analysis.
is soware is focused on qualitative data analy-
sis, which allows for studying large amounts of in-
formation, focusing on its content. us, the study
identied connections, hierarchies, and existing
networks between dierent topics and subtopics,
established results, and systematized conclusions.
Data processing was carried out by step-by-step
actions. First, data processing included coding
operations. roughout the interview analysis,
42 codes were developed. Second, the codes were
grouped into three network groups. is allowed
studying and analyzing the palliative care system
development and the role of women volunteers in
this process. ird, three networks were devel-
oped: palliative care system participants, contri-
bution, and palliative care system.
e rst network group presented the main par-
ticipants of the palliative care system development
and the nature of their communication. e net-
work included 15 codes, of which three were the
principal codes. us, the palliative care system
consists of two main participants: hospitals and
women volunteers. Each participant code includ-
ed the main functions. For example, women vol-
unteers’ code included two main functions, and
hospitals had one main function.
e second network group analyzed the moder-
ating role of charity foundations. It included 11
codes, of which three were the primary codes:
contribution, which included main participants:
hospitals and charity foundations. While for hos-
pitals, two main contributions were revealed in
the system of palliative care development; charity
foundations provided six codes.
e third network group revealed the main issues
of palliative care system development at the state
and regional levels. In total, the network included
15 codes, of which three were considered the pri-
mary: palliative care system development, which
included recommendations and public policy
issues.
3. RESULTS
e interview was provided to identify hidden fac-
tors and reveal region-specic experiences. e
developed codes were divided into three major
groups: palliative care system participants, pallia-
tive care system, and contribution. Figure 1 shows
the structure of palliative care system participants.
Figure 1 revealed that women volunteers per-
form-moderating roles between public adminis-
Table 1. Descripon of research queson groups
Source: Compiled by the authors.
No. Queson
group Descripon of queson groups
11-2
Interviewees described the procedures they must go through when vising paents (suppor t receivers) or families.
This group also collected informaon on the vising rules, which also drew limitaons to the interviewees,
especially when providing support to paents or families.
23-4 The informaon about the issues faced by b oth interviewees and suppor t receivers was covered. T his queson
group sought informaon about the nature of assis tance provided to paents and families.
35-7 The recommendaons as well as current issues of the healthcare system were discussed. This part gives a beer
picture of the interviewees’ qualicaons and experience in their elds.
48The challenges in cooperaon were discussed. These challenges are mostly discussed between volunteers, charit y
foundaon members, volunteers-sta, and medical sta.
59The recommendaons were collected. This will help if inter viewees want to add more of their points of view to their
quesons.
610 The interviewees’ visions of current or future development of health policy in Kazakhstan were collec ted.
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tration and the palliative care system. e mod-
erating eect of women volunteers is provided in
the delivery of several necessary actions in terms
of palliative care provision. First, they establish
cooperation with hospitals, which includes nan-
cial assistance, joint solutions, material assistance,
and consulting patients. Financial assistance is
usually provided to cover such expenses as con-
veniences for families who come from the regions
and usually stay in hospitals. Another group of
expenses is purchasing new machines and equip-
ment for medical examinations or treatments.
Usually, such items are unaordable for hospitals;
therefore, volunteers assist in nding investors or
collecting funds. Second, most interviewees stat-
ed that women volunteers oen take joint actions
with hospitals in consulting patients when fami-
lies are against health treatment due to home is-
sues. Such cases are very characteristic of families
from other regions. e medical sta and volun-
teers have noticed that people from the regions
depend on cultural habits. For instance, parents
would prefer to take their child to a local healer
based on religious restrictions such as a prohibi-
tion of surgeries. ird, material assistance diers
from nancial, as it can require parts of emergen-
cy care items such as diapers, clothes, or food.
On the part of hospitals, the interviews showed
that they usually take the function of a mediator
between volunteers and the government in ques-
tions associated with palliative care policy deliv-
ery. However, there are restrictions for volunteers
during natural visits. ere is a strict rule that any
visitor has to follow, but as volunteers deal with
patients and families regularly, they need to pro-
vide a medical record book and pass some medi-
cal examinations. is is done to ensure the safe-
ty of patients, but the relationship with hospitals
sometimes has some adverse outcomes. For exam-
ple, hospitals sometimes prefer large companies
to provide events for children. e issue in such
situations, people not involved in palliative care
organizations are unaware of patients’ diets and
health conditions. Organizations usually bring so-
da drinks or sweets, which are not allowed for pa-
tients, especially those who have just had surgeries.
Figure 2 illustrates the encoding results that describe
the contribution of charitable foundations, which are
managed by women volunteers and hospitals.
As a result of the interviews, the following contribu-
tions provided by charity foundations were revealed.
Charity foundations contributed to ve directions:
private hospice institutions funding, medical train-
ing of the medical sta in palliative care delivery,
management and development of healthcare pro-
jects, consultation of patients, and nancial aid
provision. In addition, they provide nancial assis-
Figure 1. Parcipants of palliave care system
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tance to patients in raising funds. ere are charity
foundations in palliative care, which are supported
by donations of volunteers, with dierent programs
to support one patient or a program to provide nec-
essary things to people in need.
Volunteers have introduced the palliative care
roadmap by establishing private hospices, pro-
viding training for rst psychologists in onco-
logical issues, and organizing health treatment
projects. Moreover, they are constantly working
on improving the palliative care delivery system.
Charity foundations have launched training pro-
grams for medical sta by providing master-class
surgeries in Kazakhstan. For instance, master
classes are provided by international doctors in
oncology. At the same time, the price for surgeries
provided during the master class is reduced, and
there are free-of-charge surgeries. Local doctors
assist during surgeries, allowing them to practice
immediately and improve their skills. e govern-
ment is not expected to cover such expenses as ac-
commodation or travel costs for patients and their
families, as surgeries are provided in the country.
us, they save the budget.
Hospitals participated as donors and mediators
in the process of palliative care development.
First, they provide financial aid for medical
staff training and act as mediators between gov-
ernment and charity foundations by supporting
them. Hospitals, apart from their professional
duties, provide massive assistance to the health-
care system. Most of the doctors and nurses in
Kazakhstan are on the list for blood donation,
as there is a significant lack of blood donors in
Kazakhstan. Second, in terms of palliative care
roadmap provision, hospitals stand out as me-
diators in the dialogue between volunteers and
the government. Such cooperation is provided
in cases of emergency, new laws (such as drugs
distribution system) promotion as well. Finally,
problems and recommendations are presented
in Figure 3.
us, the palliative care system consists of the fol-
lowing categories:
1) palliative care has become a social issue that
was not regarded as one at the governmental
level earlier;
Figure 2. Contribuon of charity foundaons and hospitals to the palliave care system
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2) volunteers started repeating the international
experience of volunteers in palliative care;
3) volunteers started establishing charity
foundations;
4) the government started developing a legisla-
tions system for palliative care provision;
5) a roadmap for palliative care implementation
was developed;
6) volunteers started cooperation with hospitals
establishing the etiquette of communication;
7) development of private hospices is a coercive
pressure, as there is a signicant lack of beds
at hospitals and medical sta who have passed
training in palliative care.
As a result of the analysis of the interviews,
problems of the development of palliative care
were identified: lack of rehabilitation centers
and beds, medical staff workload, reimburse-
ment, and budget set by local authorities. The
palliative care system is currently facing issues
that can be solved by the government and with
women volunteers’ assistance. Moreover, most
interviewees talked about current issues in the
management process of the palliative care sys-
tem. There are direct issues as a great need for
rehabilitation centers for those patients who
are dying and who are in remission. Therefore,
there is a need for an extended stay. This ques-
tion needs to be improved through the improve-
ment of palliative care policy. At the same time,
the workload for medical staff, who deal with
patients with socially significant diseases, must
also be revised.
Figure 3. Public policy issues and recommendaons
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Interestingly, all respondents talked about the
workload of nurses and the necessity of extra med-
ical sta. It was stated that nancial issues oen be-
come a barrier for patients to receive medical treat-
ment. Apart from the free-of-charge medicines the
government provides, those not on the list are very
expensive. As most of the patients are below the av-
erage income (of large cities), as they are from re-
gions, villages, or remote areas, they cannot aord
the drugs needed. Even though government sets a
budget for healthcare delivery, funds allocation is
done by regional authorities. Moreover, another is-
sue is that the local government does not specify the
budget for palliative care delivery, such as Cargo
200. As a result, the patient’s families address chari-
ty foundations to help collect money to transfer the
body to Kazakhstan. Another urgent issue, which
was mentioned by most respondents, is that the law
on drug distribution, such as morphine and other
painkillers, does not consider the cases of patients
from regions, especially when they leave hospitals
to return to their hometowns.
e study developed recommendations to revealed
issues, including four main topics. First, palliative
care roadmap implementation must be provided
in full, considering several hospital beds for pallia-
tive care, especially in regions. erefore, hospitals
must hire more medical stas, who mostly spend
time with patients and are in regular contact with
volunteers and patients. Consequently, the policy
must be provided in regions (in local hospitals or
new state hospitals needs to be opened). ird, the
system of painkillers distribution and drug supply
must be improved. However, as mentioned above,
there must be a proactive attitude of doctors who
want to enhance their experience in treating social-
ly signicant diseases. Fourth, until the question of
new hospitals and hospices is established, the du-
ration of hospital stays for patients, especially from
regions, must be extended.
erefore, recommendations show the need to de-
velop the palliative care system roadmap and en-
courage a proactive attitude among medical sta.
In addition, it is shown that there is a need for pal-
liative care in regions, extended stay in hospices,
and improvement in the distribution of painkillers.
Moreover, based on the provided coding of the
interviews, a triangle of palliative care partici-
pants was developed, where hospitals stand out
as mediators in the dialogue between the gov-
ernment and volunteers. Volunteers contrib-
ute to policymakers’ objectives, making it eas-
ier to build further steps in palliative care de-
livery. It must be mentioned that according to
the analysis, volunteers are the main pushers of
the palliative care system institutionalization in
Kazakhstan.
Depending on the theory of institutionaliza-
tion, it is known as a (1) process of embedding
a system, rules, or ideas (Acemoglu et al., 2001).
Simply speaking, this is a (2) repetition of action
by many people. Throughout (3) consistency,
the actors (4) start setting rules or limitations
for this action’s performance. This is when (5)
negative effects or outcomes, along with posi-
tive ones, are figured out. At this point (6), val-
ues and standard behavior, are the structure of
a social institution being developed. The next
stage is when (7) workers of this current social
institution appear with a hierarchal structure.
The interviews provided showed consistency in
the actions of volunteers with different patient
situations. In addition, the scope and scale of
appearing issues affect the performance of dif-
ferent actions. For example, there is usually a
group of volunteers who offer routine assistance
by providing patients with a homemade meal
(for instance, if a patient is in a remote hospi-
tal and needs additional help, such as liquid
food (e.g., soup)). Special meal plan for patients
sometimes does not fit into the system of meal
plans in hospitals. Another group of volunteers
assists in managing issues related to purchas-
ing drugs and consulting families and patients.
Sometimes families come from remote regions,
and many are not familiar with the social bene-
fits they can account for. When patients are col-
lecting documents for treatment abroad, volun-
teers assist in this process as well.
4. DISCUSSION
This paper shows that volunteers affect the im-
plementation of social policies, which was not
discussed in previous studies. Previous studies
described the operational actions of volunteers
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as providing physical help and assistance in the
provision of palliative care assistance as coming
nurses (Weeks et al., 2008; Candy et al., 2015;
Loth et al., 2020; Claxton-Oldfield & Beaudette,
2021) or emphasized the impact of volunteering
on the lives of volunteers (Claxton-Oldfield et
al., 2010; Scott et al., 2021; Coleman et al., 2022).
However, they did not consider all the hidden
work volunteers did. For instance, finding the
necessary drugs for treatment is sometimes a
challenge. Therefore, even hospitals must ad-
dress volunteers for assistance in finding the
right medicine or covering financial expenses.
Previous studies considered volunteers regardless
of gender, although some included gender statis-
tics; women’s contribution was not considered a
unique experience (Koper et al., 2018; McCall et
al., 2020). is paper describes volunteers who
participate in the management of social policy de-
velopment. In addition, according to interviews in
Kazakhstan, women represent the majority of vol-
unteers actively involved in developing social pol-
icy in the eld of palliative care.
The significant contribution is that women vol-
unteers assist regardless of distance and quick-
ly establish and develop networks and connec-
tions in remote areas. According to previous
studies, volunteers were assigned by hospi-
tals or social care workers within one region
(Claxton-Oldfield et al., 2010; Candy et al., 2015;
Woitha et al., 2015; Bloomer & Walshe, 2020;
Vanderstichelen et al., 2022).
The current study represents volunteers as ac-
tive participants of state policy provisions. At
the same time, research predominantly shows
that volunteers are regarded as nurses by doc-
tors or the head of a hospital. However, vol-
unteers try to cooperate with the government.
First, they are well-educated in terms of laws
and regulations regarding palliative care and
are aware of different kinds of cancer diagnoses,
treatment structures, and medicines.
The interviews have revealed a striking differ-
ence in how medical staff sees families and pa-
tients’ issues. The medical staff does not usu-
ally discuss the need for a psychologist’s help.
Instead, they usually consider patients’ phys-
ical needs. Volunteers and charity foundation
workers underline the necessity of psychologi-
cal help not only to patients but to their fami-
ly members as well. Interestingly, when visiting
patients at hospitals, volunteers have stressed
that they usually do not contact families. All re-
quests about material needs are passed through
nurses (mostly). Thus, research results illustrat-
ed that although volunteers have less commu-
nication with patients or their families, they
are more aware of their needs (such as psycho-
logical help) than medical staff (Burbeck et al.,
2014; Scheer, 2002; Bloomer & Walshe, 2020;
Claxton-Oldfield & Beaudette, 2021).
Volunteers and charity foundation members are
more concerned with social policy implementa-
tion. These are questions of mandatory support
delivery for patients and families, improvement
of public health policies, and the delivery of
them. As volunteers become members of staff,
they limit their engagement with families. In
this regard, they accept all issues addressed to
them as complaints. At the same time, volun-
teers for their information assistance to families
are limited in access by medical staff. As major
expenses, volunteers support hospitals by pro-
viding them with expensive machines for the
provision of medical examinations. Based on
recent research, experience in developed coun-
tries with volunteers’ participation in palliative
care is different and limited to essential assis-
tance (Cohen & Numa, 2011; Jack et al., 2012;
Park, 2013; Foster et al., 2018; Coleman et al.,
2022).
Volunteers have a significant impact on health-
care policy provision. Volunteers should be in-
cluded in the public administration structure.
For the further representation of the needs of
minorities, palliative care should be institution-
alized officially. Doing so will help to create
new workplaces and achieve sustainable devel-
opment goals. Society will trust the palliative
care system and develop a sense of oncological
awareness, which can help reduce the morbidity
rate.
493
Problems and Perspectives in Management, Volume 20, Issue 4, 2022
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CONCLUSION
is study aims to develop proposals for streamlining the palliative care system in Kazakhstan based on
the study of the inuence of women volunteers on the process of public administration. e results indi-
cate that women volunteers prevail in the management process and provision of palliative care. Men’s in-
volvement in volunteering is more of a technical nature, as they receive salaries. On the other hand, women
volunteers establish cooperation with medical institutions and patients. It includes nancial assistance (or
nding investors), medical sta training (master classes with the participation of foreign surgeons, free-
of-charge surgeries, or training of psychologists socialized in oncological issues), or joint solutions (health
treatment projects, events for children patients, transport issues, or transfer the body to Kazakhstan).
Moreover, there is material assistance (medical equipment, medicines, diapers, clothes, or food) and
patient consultation (treatment program, preparation of documents for surgery abroad, or social ben-
ets). Women reduced the time the government would have spent on developing the environment for
palliative care system management in Kazakhstan. Moreover, volunteers have established a way of
communication and objectives delivery to the government, where hospitals play the role of a mediator.
Consequently, the government recognized the signicance of palliative care system development.
However, the system of palliative care in Kazakhstan still requires signicant changes. ere are some
problems with the public management of palliative care (lack of beds and information in terms of the
urgent need for palliative care in the country, low level of healthcare infrastructure, especially in re-
gions, poor regional budget management, deciencies in organizational management, etc.). Palliative
care roadmap implementation must be provided in full (medical sta, monitoring system, the system
of painkillers distribution and drug supply). Consequently, the policy must be provided in regions. It
is recommended that women volunteers should be given a higher status and included in the public ad-
ministration structure. ey should be accepted as ocial policymakers of palliative care system de-
velopment in Kazakhstan regularly because women volunteers know about not only existing problems
but also hidden ones. e level of their decision-making regarding palliative care roadmap development
must be equal to policymakers.
e ndings, recommendations, and suggestions developed during the study can serve as a theoret-
ical and methodological basis for implementing Kazakhstan’s state policy in palliative care. Further
research could involve policymakers in the interview to study the signicance of the involvement of
women volunteers in palliative care system development or any related issue in social policy delivery.
AUTHOR CONTRIBUTIONS
Conceptualization: Anel Kireyeva, Gaukhar Kenzhegulova, Zaira Satpayeva.
Data curation: Gaukhar Kenzhegulova, Ainur Amirova.
Formal analysis: Anel Kireyeva, Gaukhar Kenzhegulova, Zaira Satpayeva.
Funding acquisition: Anel Kireyeva.
Investigation: Gaukhar Kenzhegulova, Zhansaya Imangali.
Methodology: Gaukhar Kenzhegulova, Zaira Satpayeva.
Project administration: Anel Kireyeva.
Resources: Gaukhar Kenzhegulova, Zhansaya Imangali, Ainur Amirova.
Soware: Gaukhar Kenzhegulova, Zaira Satpayeva, Zhansaya Imangali, Ainur Amirova.
Supervision: Anel Kireyeva.
Validation: Gaukhar Kenzhegulova.
Visualization: Zaira Satpayeva, Zhansaya Imangali, Ainur Amirova.
Writing – original dra: Gaukhar Kenzhegulova.
Writing – review & editing: Anel Kireyeva, Zaira Satpayeva.
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ACKNOWLEDGMENTS
is study is funded by the Science Committee of the Ministry of science and higher education of the
Republic of Kazakhstan (Grant “Priorities and mechanisms against rural women of Kazakhstan unequal
access to the resources” No. AP14869297).
REFERENCES
1. Acemoglu, D., Johnson, S., &
Robinson, J. A. (2001). e colonial
origins of comparative develop-
ment: An empirical investigation.
American Economic Review, 91(5),
1369-1401. https://doi.org/10.1257/
aer.91.5.1369
2. Acus, A. (2018). Volunteering in
non-governmental organizations as
social policy expression. Tiltai, 79(3),
149-164. https://doi.org/10.15181/
tbb.v79i3.1897
3. Bloomer, M. J., & Walshe, C.
(2020). ‘It’s not what they were
expecting’: A systematic review
and narrative synthesis of the role
and experience of the hospital
palliative care volunteer. Palliative
Medicine, 34(5), 589-604. https://doi.
org/10.1177/0269216319899025
4. Burbeck, R., Low, J., Sampson, E.
L., Bravery, R., Hill, M., Morris, S.,
& Candy, B. (2014). Volunteers in
specialist palliative care: A survey
of adult services in the United
Kingdom. Journal of Palliative
Medicine, 17(5), 568-574. https://doi.
org/10.1089/jpm.2013.0157
5. Candy, B., France, R., Low, J., &
Sampson, L. (2015). Does involv-
ing volunteers in the provision of
palliative care make a dierence to
patient and family wellbeing? A sys-
tematic review of quantitative and
qualitative evidence. International
Journal of Nursing Studies, 52(3),
756-768. https://doi.org/10.1016/j.
ijnurstu.2014.08.007
6. Claxton-Oldeld, S., & Beaudette,
S. (2021). Hospice Palliative Care
Volunteers’ Attitudes, Opinions,
Experiences, and Perceived Needs
for Training Around Medical Assis-
tance in Dying (MAiD). American
Journal of Hospice and Palliative
Medicine, 38(11), 1282-1290. https://
doi.org/10.1177/1049909120985130
7. Claxton-Oldeld, S., Gosselin, N.,
Schmidt-Chamberlain, K., & Clax-
ton-Oldeld, J. (2010). A survey of
family members’ satisfaction with
the services provided by hospice
palliative care volunteers. American
Journal of Hospice and Palliative
Medicine, 27(3), 191-196. https://doi.
org/10.1177/1049909109350207
8. Cohen, M., & Numa, M. (2011).
Posttraumatic growth in breast
cancer survivors: a comparison of
volunteers and non-volunteers. Psy-
cho‐Oncology,20(1), 69-76. https://
doi.org/10.1002/pon.1709
9. Coleman, H., Sanderson-omas,
A., & Walshe, C. (2022). e
impact on emotional well-being
of being a palliative care volun-
teer: An interpretative phenom-
enological analysis. Palliative
Medicine, 36(4), 671-679. https://doi.
org/10.1177/02692163211064770
10. Dahlberg, L. (2005). Interaction
between voluntary and statutory
social service provision in Sweden:
A matter of welfare pluralism, sub-
stitution or complementarity? Social
Policy & Administration, 39(7), 740-
763. https://doi.org/10.1111/j.1467-
9515.2005.00467.x
11. Einolf, C. J. (2011). Gender
dierences in the correlates of
volunteering and charitable giving.
Nonprot and Voluntary Sector
Quarterly, 40(6), 1092-1112. https://
doi.org/10.1177/0899764010385949
12. Finnparadis, L., & Cummings,
S. (1985). Examining the car-
ing function of hospices: Dif-
ferences between community
based and institutionally based
hospice programs. American
Journal of Hospice and Palliative
Medicine, 2(3), 20-26. https://doi.
org/10.1177/104990918500200312
13. Foster, C., Calman, L., Richard-
son, A., Pimperton, H., & Nash, R.
(2018). Improving the lives of peo-
ple living with and beyond cancer:
Generating the evidence needed to
inform policy and practice. Journal
of Cancer Policy, 15, 92-95. https://
doi.org/10.1016/j.jcpo.2018.02.004
14. Gil-Lacruz, A. I., Marcuello, C., &
Saz-Gil, M. I. (2019). Gender dier-
ences in European volunteer rates.
Journal of Gender Studies, 28(2),
127-144. https://doi.org/10.1080/095
89236.2018.1441016
15. Glenton, C., Scheel, I. B., Prad-
han, S., Lewin, S., Hodgins, S., &
Shrestha, V. (2010). e female
community health volunteer
programme in Nepal: Decision
makers’ perceptions of volunteerism,
payment and other incentives.
Social Science & Medicine, 70(12),
1920-1927. https://doi.org/10.1016/j.
socscimed.2010.02.034
16. Haski-Leventhal, D., Meijs L. C.
P. M., & Hustinx, L. (2010). e
third-party model: Enhancing
volunteering through governments,
corporations and educational insti-
tutes. Journal of Social Policy, 39(1),
139-158. https://doi.org/10.1017/
S0047279409990377
17. HaskiLeventhal, D., Meijs, L. C.,
LockstoneBinney, L., Holmes, K., &
Oppenheimer, M. (2018). Measur-
ing volunteerability and the capacity
to volunteer among nonvolunteers:
Implications for social policy. Social
Policy & Administration, 52(5),
1139-1167. https://doi.org/10.1111/
spol.12342
18. Hopkins, J., Burns, E., & Eden, T.
(2013). International twinning part-
nerships: An eective method of
improving diagnosis, treatment and
care for children with cancer in low-
middle income countries. Journal of
Cancer Policy, 1(1-2), e8-e19. https://
doi.org/10.1016/j.jcpo.2013.06.001
19. Inbadas, H., Carrasco, J. M., Gillies,
M., & Clark, D. (2018). e level of
provision of specialist palliative care
495
Problems and Perspectives in Management, Volume 20, Issue 4, 2022
http://dx.doi.org/10.21511/ppm.20(4).2022.36
services in Scotland: an interna-
tional benchmarking study. BMJ
Supportive & Palliative Care, 8(1),
87-92. http://dx.doi.org/10.1136/
bmjspcare-2016-001301
20. Jack, B. A., Kirton, J. A., Bir-
akurataki, J., & Merriman, A.
(2012). e personal value of
being a palliative care Commu-
nity Volunteer Worker in Uganda:
A qualitative study. Palliative
Medicine, 26(5), 753-759. https://doi.
org/10.1177/0269216311413628
21. Kaba, M., de Fouw, M., Deribe, K.
S., Abathun, E., Peters, A. A., & Belt-
man, J. (2021). Palliative care needs
and preferences of female patients
and their caregivers in Ethiopia: A
rapid program evaluation in Addis
Ababa and Sidama zone. PLoS
ONE, 16(4), e0248738. https://doi.
org/10.1371/journal.pone.0248738
22. Khadzhyradieva, S., Hrechko, T., &
Smalskys, V. (2019). Institution-
alisation of behavioural insights in
public policy. Public Policy and Ad-
ministration, 18(3), 95-113. https://
doi.org/10.5755/j01.ppaa.18.3.24726
23. Kireyeva, A. A., Nurlanova, N. K., &
Kredina, A. A. (2022). Assessment
of the socio-economic performance
of vulnerable and depressed ter-
ritories in Kazakhstan. R-Economy,
8(1), 221-231. Retrieved from
https://ideas.repec.org/a/aiy/journl/
v8y2022i1p21-31.html
24. Koper, I., Pasman, H. R. W., &
Onwuteaka-Philipsen, B. D. (2018).
Experiences of Dutch general prac-
titioners and district nurses with
involving care services and facilities
in palliative care: a mixed methods
study. BMC Health Services Research,
18, 841. https://doi.org/10.1186/
s12913-018-3644-2
25. Loth, C. C., Namisango, E., Powell,
R. A., Pabst, K. H., Leng, M.,
Hamada, M., & Radbruch, L. (2020).
“From good hearted community
members we get volunteers”– an
exploratory study of palliative care
volunteers across Africa. BMC
Palliative Care, 19(1), 48. https://doi.
org/10.1186/s12904-020-00545-w
26. McCall, V., McCabe, L., Rutherford,
A., Bu, F., Wilson, M., & Woolvin,
M. (2020). Blurring and bridging:
the role of volunteers in dementia
care within homes and communi-
ties. Journal of Social Policy, 49(3),
622-642. https://doi.org/10.1017/
S0047279419000692
27. Park, S. (2013). Does gender matter?
e eect of gender representation
of public bureaucracy on govern-
mental performance. American
Review of Public Administra-
tion, 43(2), 221-242. https://doi.
org/10.1177/0275074012439933
28. Rasche, A., Gilbert, D. U., & Schor-
mair, M. J. (2020). e institutional-
ization of responsible management
education. London: SAGE Publica-
tions Inc.
29. Roessler, A., Carter, H., Campbell,
L., & MacLeod, R. (1999). Diversity
among hospice volunteers: A chal-
lenge for the development of a re-
sponsive volunteer program. Ameri-
can Journal of Hospice and Palliative
Medicine, 16(5), 656-664. https://doi.
org/10.1177/104990919901600506
30. Satpayeva, Z. T.,Kireyeva, A.
A.,Kenzhegulova, G., & Yermek-
bayeva, D. (2020). Gender equality
and women business of framework
5Ms in Kazakhstan: Analysis and
basic directions. Journal of Asian Fi-
nance, Economics and Business,7(3),
253-263. https://doi.org/10.13106/
jafeb.2020.vol7.no3.253
31. Saunders, B., Sim, J., Kingstone, T.,
Baker, S., Watereld, J., Bartlam,
B., & Jinks, C. (2018). Saturation in
qualitative research: exploring its
conceptualization and operational-
ization. Quality & Quantity, 52(4),
1893-1907. https://doi.org/10.1007/
s11135-017-0574-8
32. Scheer, T. J. (2002). e “Praxis”
Side of the Equation: Club Women
and American Public Administra-
tion. Administrative eory & Praxis,
24(3), 519-536. https://doi.org/10.10
80/10841806.2002.11029364
33. Scott, R., Goossensen, A., Payne, S.,
& Pelttari, L. (2021). What it means
to be a palliative care volunteer
in eight European countries: a
qualitative analysis of accounts of
volunteering. Scandinavian Journal
of Caring Sciences, 35(1), 170-177.
https://doi.org/10.1111/scs.12832
34. Stadelmann-Steen, I. (2011).
Social volunteering in welfare states:
Where crowding out should occur.
Political Studies, 59(1), 135-155.
https://doi.org/10.1111/j.1467-
9248.2010.00838.x
35. Tolbert, P. S., & Zucker, L. G. (1983).
Institutional sources of change in
the formal structure of organiza-
tions: e diusion of civil service
reform, 1880–1935. Administrative
Science Quarterly, 28(1), 22-39.
https://doi.org/10.2307/2392383
36. Vanderstichelen, S., Cohen, J., Van
Wesemael, Y., Deliens, L., & Cham-
baere, K. (2022). Volunteers in
palliative care: A healthcare system-
wide cross-sectional survey. BMJ
Supportive & Palliative Care, 12(1),
e83-e93. http://dx.doi.org/10.1136/
bmjspcare-2020-002321
37. Weeks, L. E., Macquarrie, C., &
Bryanton, O. (2008). Hospice pal-
liative care volunteers: A unique
care link. Journal of Palliative
Care, 24(2), 85-93. https://doi.
org/10.1177/082585970802400204
38. Wiepking, P., Einolf, C. J., & Yang,
Y. (2022). e Gendered Path-
ways Into Giving and Volunteer-
ing: Similar or Dierent Across
Countries? Nonprot and Volun-
tary Sector Quarterly. https://doi.
org/10.1177/08997640211057408
39. Woitha, K., Hasselaar, J., Van Beek,
K., Radbruch, L., Jaspers, B., Engels,
Y., & Vissers, K. (2015). Volunteers
in palliative care – a comparison
of seven European countries: a de-
scriptive study. Pain Practice, 15(6),
572-579. https://doi.org/10.1111/
papr.12209
40. Wymer, W. (2011). e implica-
tions of sex dierences on volunteer.
International Journal of Voluntary
and Nonprot Organizations, 22(4),
831-851. https://doi.org/10.1007/
s11266-010-9174-0
41. Zana, Á., Kegye, A., Czeglédi, E., &
Hegedűs, K. (2020). Dierences
in well-being and fear of death
among female hospice employees
and volunteers in Hungary. BMC
Palliative Care, 19(1), 58. https://doi.
org/10.1186/s12904-020-00550-z
