Health systems in transition : Uzbekistan

5.4 Specialized ambulatory care/inpatient care
Specialized care has been defined by the government as care which requires 
special methods of prevention, diagnosis or management and involves the use 
of complex or sophisticated medical technologies. Only specialized physicians 
in health facilities licensed to render this type of care are authorized to provide 
specialized care. The types, volume and quality of specialized care provided 
in health facilities are regulated by the Ministry of Health (President of 
Uzbekistan, 1998).
Since Uzbekistan’s independence, the delivery of public inpatient care has 
undergone important changes in terms of management and financing, with a 
process of decentralization and increased autonomy for health care providers 
(see Chapters 3 and 7). Structural changes were mostly related to the reduction 
of hospital capacities and the establishment of a new framework for the delivery 
of emergency care. The main rationale of hospital reform in Uzbekistan has 
been to introduce a clearer division of responsibilities and to achieve a better 
allocation of resources.
In rural areas, the first points of contact for patients seeking secondary 
care from the public sector are 
tuman
 hospitals or 
tuman
 medical unions 
(previously called central 
tuman
 hospitals) with multi-specialty outpatient 
units. 
Tuman
 hospitals serve a catchment area of 10 000–12 000 people and 
are staffed by paediatricians, specialists in internal medicine and obstetricians. 
They have 15–75 beds, with an average of about 45, and provide first aid and 
basic secondary care. Central 
tuman
 hospitals have about 100–300 beds and 
are staffed by a range of specialists. It should be noted that 
tuman
 hospitals 
and 
tuman
 medical unions are defined as primary care providers; they are 
charged with the provision of the guaranteed package of medical services. The 

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Health systems in transition
  
Uzbekistan
82
number of 
tuman
 hospitals is decreasing rapidly with ongoing reforms, and 
tuman
 medical unions with their multi-specialty outpatient units will eventually 
become the sole provider of public secondary care services in rural areas. 
In urban areas, 
viloyat
 and city multi-profile hospitals deliver inpatient care 
for the population. For emergency care, as well as for specified categories of 
diseases and patients, this inpatient care forms part of the state-guaranteed 
package of services. Regional and city hospitals, located in the main town of 
each 
viloyat
, have between 600 and 1000 beds and offer a range of secondary 
care specialists and more complex services. 
Maternal and child health has been one of the priorities for Uzbekistan’s 
health system. Most postnatal care is delivered in maternity units, the number 
of which has not changed much since 1997. These maternity units also provide 
some antenatal care. In rural areas, maternity units are now integrated into 
tuman
 medical unions. In urban areas, specialized care is typically provided 
by separate stand-alone maternity hospitals. 
At 
viloyat
 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 hospitals for emergency care. 
Tertiary inpatient care is generally provided in large hospitals and research 
institutes and centres at the national level (Fig. 5.2).