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Provision of services
In the area of public health, the sanitary-epidemiological services have
retained their traditional focus on environmental health services, food safety
and controlling communicable diseases. However, new players have emerged,
including the separate and nationally-organized centres for HIV/AIDS, the
Institute of Health and Medical Statistics, primary health care units, NGOs and
international agencies (such as WHO, UNICEF [the United Nations Children’s
Fund], UNFPA [the United Nations Population Fund] and the World Bank).
Primary care services are provided by public primary care facilities and
outpatient clinics of public secondary and tertiary institutions (as well as private
outpatient clinics). In rural areas, the first point of contact is a rural physician
post (in a shift from previous
feldsher
–midwifery posts), while secondary
outpatient care is provided by outpatient clinics of district hospitals.
In urban areas, primary health care and selected secondary care services
are provided by polyclinics, with catchment populations of between 10 000 and
80 000 people. All types of polyclinics (previously separate for adults, children,
and polyclinics specializing in women’s health) are currently being transformed
into family polyclinics which provide primary care for all groups of the (urban)
population. Specialists in urban family polyclinics are expected to be gradually
replaced by general practitioners (GPs).
Health systems in transition
Uzbekistan
xix
In rural areas, the first points of contact for patients seeking secondary
care from the public sector are district hospitals, the larger ones with multi-
specialty outpatient units. In urban areas, regional and city hospitals deliver
inpatient care for the population. At regional level, many disease categories and
population groups are treated in separate hospitals. These include children’s
hospitals, tuberculosis hospitals, hospitals treating sexually transmitted and
dermatological diseases, neurological and psychiatric hospitals, cardiology
and emergency hospitals. Tertiary inpatient care is generally provided in large
hospitals and research institutes and centres at the national level.
Emergency care services have undergone significant reforms and a network
of emergency departments has been organized throughout the country within
the existing inpatient facilities at the local, regional and national level. Health
reforms introduced the concept of formally free and accessible emergency care
for all, which seems to have led to an overload of emergency services; this
is also because the emergency care system is considered to be much better
provided with equipment, medical aids and devices, and medications than other
public health providers.
Quality evaluations are mainly limited to public facilities and focus mostly
on structural aspects rather than outcomes, while process evaluations are
generally not carried out. Structural evaluations of the state of health facilities
and equipment are undertaken by agencies of the Ministry of Health, but it is not
clear how outcome measures gathered during these evaluations (mostly related
to hospital mortality and complications) are fed back to the facilities which
have been evaluated. Some institutions, especially tertiary-level providers,
have developed their own institutional frameworks for outcome and process
evaluations, and how they can be used to improve the services provided. While
no national study on the quality of inpatient care seems to have been conducted
so far, anecdotal evidence suggests that many medical practices are outdated,
and the quality of care can vary significantly from institution to institution.
In the area of pharmaceutical care, state pharmacies have now been almost
completely privatized. The country has adopted a long-term strategy for
self-sufficiency in essential drugs and blood products to overcome its reliance
on expensive imports. A large share of expenditure on pharmaceuticals is
paid privately.
Health systems in transition
Uzbekistan
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