Health systems in transition : Uzbekistan

16
Fig. 2.3
Organizational structure of regional health departments  
Every 
viloyat
 consists of a number of rural 
tumans
 and urban territorial 
units. Only cities with a significant population or classified as 
viloyat
 centres 
are considered to be separate urban territorial units. These urban territorial 
units have their own health departments, accountable to the city government 
and 
viloyat
 health authorities. Smaller towns and rural areas are included in 
the 
tuman
 government system and their health institutions are supervised by 
tuman
 health departments. 
State-run health care at 
tuman
 level consists of central 
tuman
 hospitals, 
central multidisciplinary 
tuman
 outpatient clinics (polyclinincs) and a network 
of rural physician centres providing primary care to the population covered. In 
recent reform initiatives, 
tuman
 health departments have been renamed and 
transformed into 
tuman
 medical unions. These 
tuman
 medical unions are now 
expected to comprise central 
tuman
 hospitals, multidisciplinary outpatient 
clinics and primary care units. Previously, outpatient clinics were mostly stand-
alone clinics that were not considered part of a central 
tuman
 hospital. Under the 
 
 
 
 
 
 
 
 
 
Head of Department   
 
 
Control inspection  
(2–3 staff) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
First Deputy Head, 
Organization of Prevention 
and Treatment 
 
 
 
Deputy Head, 
Economics and 
General Affairs 
 
Chief Sanitary Doctor 
of 
viloyat
 
 
 
 
 
 
 
 
 Chief specialists on the 
Organization of Prevention 
and Treatment  
(2 staff) 
 
Chief specialists on 
the Organization of 
Care for Mothers 
and Children 
(2 staff) 
 
Financial and 
Economic 
Service 
(2 staff) 
 
Chief specialists on 
Quality Control of 
Medical Services 
provided by 
nongovernment 
institutions 
(2 staff)  
 
 
 
 
 
 
 
 
 
 
 
 
 
Chief human
resources specialist
 
 
 
 
 
 
 
 
 
 
Tuman
 (city)
medical union
 
Viloyat
 Centre of State 
Sanitary and 
Epidemiological 
Surveillance 
 
 
 
 
 
Viloyat
 emergency
medicine branch, 
viloyat
diversified medical centres,
other specialized medical
institutions, 
viloyat
 blood
transfusion station, branch
of the Institute of Health
and Medical Statistics 
 
Viloyat
 Paediatric
Multi-specialty
Medical Centre,
Viloyat
 Diagnostic
Centre, obstetric
facilities
 
Private health 
care providers 
 
Viloyat
 Centre for
HIV/AIDS Relief
 
 
 
 
 
 
 
Note
: The maximum number of managerial staff allowed in 
viloyat
 health departments is 14–15 persons. 
 Subordinate 
institutions 
 
 
 

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Health systems in transition
  
Uzbekistan
17
new concept, central 
tuman
 hospitals and multidisciplinary outpatient clinics 
are conceptualized as a single functional entity. Multidisciplinary outpatient 
clinics are now being relocated close to central 
tuman
 hospitals; they are 
anticipated to collaborate closely with hospital staff. 
Tuman
 medical unions 
also have an emergency medicine unit within their respective central 
tuman 
hospital. The head of the central 
tuman
 hospital is also the head of the 
tuman
 
medical union and is responsible for the health of the 
tuman
 and its health 
services. This includes sanitary-epidemiological services, as the head of the 
tuman
 unit for sanitary epidemiological services is nominally accountable to 
the head of the 
tuman
 medical union.
City health authorities have been renamed and transformed into City 
medical unions. They are responsible for the management and monitoring of 
state-owned health care institutions within their urban territorial unit. These 
institutions include the central city hospital, city hospitals, multidisciplinary 
outpatient clinics (polyclinics) and urban primary care centres (polyclinics). 
The central city hospital includes outpatient, inpatient and emergency units. 
The head of the city central hospital is also the head of the City medical union. 
Fig. 2.4 shows the organizational structure of 
tuman
 or City medical unions.