Health systems in transition
Uzbekistan
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to seeking mental health care might deter patients from utilizing the public
sector and give rise to a demand for alternatives, which can include both private
practices and private arrangements with publicly employed physicians.
Officially, the public sector is the only provider of mental health services in
Uzbekistan. It is estimated that about 3% of state health funding
is utilized for
mental health services; of this, 89% is spent on hospital services. Mental health
services in the public sector are free. Medication coverage for mental health
patients is relatively well funded and approximately 80% of medications seem
to be provided for free by the government (WHO-AIMS, 2007).
Since
independence, some efforts have been undertaken to develop a legal
framework for psychiatric care. The
Law on psychiatric services
, adopted by
the Parliament in 2000, defines the minimum government guaranteed package
of psychiatric and social services for mental health patients. Relevant changes
have also been made to the criminal code of the country, to which a new
section related to the involuntary placement of patients
in psychiatric inpatient
institutions has been added.
A number of initiatives were implemented in the public system of mental
health care with the aim of shifting service delivery from inpatient to outpatient
care. New outpatient facilities, such as centres for mental health promotion,
specialized outpatient centres
and child care services, were organized and new
services, such as suicide prevention, were designed. A significant reduction in
mental hospital beds was also implemented.
In many countries, psychologists and social workers contribute significantly
to the delivery of mental health care. In Uzbekistan, social services are not closely
integrated with mental health care. Psychologists, although part of the health
system at the point of delivery, are not fully integrated into the health system.
The training of psychologists falls outside the scope of medical education and
is outside the remit of the Ministry of Health. Health professionals involved in
the delivery of mental health care are included in the category of professions
with occupational hazards. This entitles them to special provisions, such as a
lower
age for retirement, additional vacation and mark-ups on their salaries.
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