Health systems in transition : Uzbekistan

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2. Organization and governance
M
ost health care providers in Uzbekistan are public. The state-run 
health system consists of three distinct hierarchical layers: the 
national (republican) level, the 
viloyat
 (regional) level, and the 
tuman 
(district) or city level. The private sector is still small and mainly comprises 
pharmacies, small practices, and institutions involved in health care delivery or 
the production and supply of pharmaceuticals or medical equipment. 
The key players involved in organizing and managing the public sector 
health system in Uzbekistan are the President, the Cabinet of Ministers, the 
Supreme Assembly (Legislative Chamber and Senate), the Ministry of Health, 
the Ministry of Finance, 
viloyat
 and 
tuman
 health authorities and the network 
of health facilities. The Ministry of Health is the major player in organizing, 
planning and managing the Uzbek health system. Although the Ministry of 
Health to some extent exercises managerial and regulatory functions over all 
actors in the health system, only national-level institutions are directly managed 
by, and accountable to, the Ministry of Health. For all other institutions, these 
administrative and regulatory functions are performed by other agencies, such 
as 
viloyat
, city and 
tuman
 health authorities, which are part of the respective 
subnational administrative layer.
Regulation is almost the exclusive domain of the government, with little 
or no role played by NGOs or professional associations. As the government-
owned health system largely follows the integrated model (with the government 
being the principal provider and purchaser of health services), almost all 
health workers are government-salaried employees. Following an increase in 
unnecessary, unsafe or substandard care in the private sector, the government 
has significantly limited the type of services that can be provided in the private 
sector, in particular with regard to complex surgical procedures, and regulatory 
oversight has been strengthened, allowing the Ministry of Health to conduct 

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Health systems in transition
  
Uzbekistan
10
inspections without prior approval from the Cabinet of Ministers. Patient rights 
and patient choice have been set out by law, but are still not well implemented 
in practice.