Health systems in transition : Uzbekistan

Ministry of Health
 
Republican
Research Centre
of Emergency
Medicine
 
Republican-
level
health care
facilities
 
Republican-
level
specialized
medical
centres
Scientific research
institutions, universities,
republican centres,
secondary specialized
educational institutions
(professional colleges)
 
Institute of
Health and
Medical
Statistics
and its
affiliates
Republican
Centre for
HIV/AIDS
Relief 
Blood services
under the
Research
Institute of
Haematology and
Blood Transfusion
 
Republican Centre
of State Sanitary
and Epidemiological
Surveillance
 
Health administrations of regions, cities,
and the Ministry of Health of the
Republic of Karakalpakstan
 
Regional
branches
of the Centre
for Emergency
Medicine
 
Regional
multi-
specialty
medical
centres
 
Regional
specialized
hospitals,
maternity
hospitals,
dispensaries*
 
Regional paediatric
multi-specialty
medical centres 
 
Regional
centres
of medical
diagnostics
 
Regional
centres
for
HIV/AIDS
relief 
 
Regional
blood transfusion
stations
Regional centres of
state sanitary and
epidemiological
surveillance
 
Tuman
 or City Medical Union (central 
tuman
 or city multi-specialty outpatient
clinic, central 
tuman
 or city hospital, with emergency medical services unit)
 
Tuman
 (or city) centres
of state sanitary and
epidemiological
surveillance 
 
Rural physician points, family polyclinics (in the cities), obstetric complexes,
specialized hospitals and dispensaries
 
Private health
care providers
 

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Health systems in transition
  
Uzbekistan
11
2.2 Historical background
In the Soviet health system, almost all health services were delivered through 
the public sector. While all citizens enjoyed access to health care free at the 
point of delivery and a wide range of medical services were available for all, the 
Soviet model of health care contained several structural weaknesses. It proved 
to be effective in tackling infectious diseases, but major system problems 
surfaced with a change in the burden of diseases (Rowland, 1991). Weaknesses 
of the Soviet health system included an emphasis on quantitative indicators, 
with limited attention to outcomes and the quality of care, as well as inflexible 
management and financing arrangements. 
Another weakness of the Soviet health system was related to health 
spending. Soviet health spending had been significantly lower than in other 
developed nations. Furthermore, it was heavily biased towards secondary 
care. In the mid-1980s, Uzbekistan had almost twice as many hospitals per 
100 000 population (7.89 in 1985) than those countries that joined the European 
Union (EU) before May 2004 (the EU15) (3.87 in 1985). Primary care was 
neglected and did not fulfil the role of a gatekeeper for higher levels of care. The 
ineffective use of resources was exacerbated by inefficient hospital procedures, 
with diagnostic investigations requiring hospital stays of up to seven days 
(Rowland, 1991). 
Although the Soviet health system had a comprehensive network of health 
facilities, it faced major problems related to their operation. Facilities were poorly 
equipped and maintained, and a shortage of medical supplies existed throughout 
the system. In rural areas, 27% of hospitals did not have sewerage and 17% did 
not have running water. Health personnel were inadequately trained and poorly 
paid, with physicians receiving about 70% of the average salary of non-farm 
workers (Rowland, 1991). With the dissolution of the Soviet Union, independent 
Uzbekistan was confronted with the legacies of the Soviet health system, 
while undergoing significant economic, social and political transformations.