Health systems in transition : Uzbekistan

Fig. 5.2
Hospital types in rural and urban areas 
Rural areas
Urban areas
City/regional
hospitals
Tuman
medical unions 
Specialized hospitals 
(such as for children, tuberculosis
patients, sexually transmitted
infections, or emergencies)
Tertiary hospitals
(specialty centres and hospitals
linked to medical schools and
clinical research institutions)
 

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Health systems in transition
  
Uzbekistan
83
Although there are efforts by the government to improve access by the 
population to high quality care through investment in health facilities and 
new equipment, the public sector is clearly under-funded. Introduction of 
fee-for-service arrangements is expected to bring external resources into the 
public sector.
In the majority of public providers of specialized care, medical documentation 
is primarily paper-based. However, a number of specialized facilities in the 
public sector have now started to introduce modern IT systems. 
5.4.1 Quality
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so far, anecdotal evidence suggests that many medical practices are outdated 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 
(Asadov and Aripov, 2009; Mundt et al., 2012).