Health Care System
World Health Organization

Health system reform

Targeted reforms of the health care system have been under way in the country for a number of years. In line with the decree issued by the President of the Republic, a government programme was adopted in 1998 on reform of the health care system during the period up to 2006.

The main thrusts of health system reform in Uzbekistan are to:

• organize maternal and child health care;
• improve and develop primary health care;
monitor and prevent infectious diseases;
• and advocate healthy lifestyles

(WHO Liaison Office in Uzbekistan, 1999).

Health care expenditure and health systems funding

In 1998, health care expenditure in Uzbekistan amounted to 3.3% of the GDP. This is higher than the average for the CAR, but lower than the figure for Europe as a whole. Local health care establishments are primarily funded from local budgets. The extensive development of inpatient facilities has been halted, and the budget for inpatient services has been cut down to 60% of the total resources envisaged for health care, while funding for the outpatient service has been increased to 40%. The country currently has a number of private health care establishments, where some 1 million patients are treated each year. More than 2000 physicians have been licensed for individual practice. The pharmacy service has been decentralized. In 1997, the private sector delivered some 10% all medical services.

The limited financial resources available to the state health care system currently dictate the need to seek additional sources of financing.

Outpatient services

According to data from the Ministry of Health, the number of outpatient/polyclinic establishments increased from 3027 in 1991 to 4074 in 1997.

Arrangements for delivering medical care to patients on a day inpatient basis are currently functioning effectively throughout the country. This has reduced the number of patients treated in 24-hour inpatient facilities from 5.1 million to 3.8 million, while the number of those treated in day inpatient units has increased to 2.4 million. The development of outpatient surgical centres has changed the relationship between the numbers of operations carried out in inpatient and outpatient facilities. At present, 55% of operations are done in outpatient settings, including 23% in outpatient surgical centres. The Council of Minister's decree no. 182 of 21 May 1996 on 'A programme for development of the social infrastructure in villages' provides for the organization of rural medical posts (RMPs), together with the introduction of general medical practice. In 1996-1997, 255 RMPs were built and 404 were created by transforming rural district hospitals, rural medical outpatient facilities and feldsher/midwife posts.

Inpatient services

The hospital bed rate in Uzbekistan in 1997 was lower than the average for the Region as a whole. This is a result of the policy on reform of inpatient care in Uzbekistan. Between 1991 and 1997, more than 46% of all hospital beds (i.e. those that were not being used in a rational way) were closed.

The hospital admission rate fell from 24.4 per 100 population per year in 1991 to 16.3 in 1997, a figure that was lower than the average for the European Region.

The average length of stay in hospital also fell from 14.9 days to 13.5 days: this decline was not so significant, however, and the indicator remains higher than the European average.

Medical personnel

The physician/population ratio in Uzbekistan, like in other CAR, has fallen slightly since the early 1990s, and in 1997 it was lower than the European average. In recent years, graduates of the country's medical colleges have been trained following the new curriculum, and they now receive multi-stage training from general practitioner to specialized training at master's degree level. Intermediate-level medical personnel also have a clear gradation of specialties, with priority given to training universal specialists in general practice.