Hospital Sector Reform in Uzbekistan : A Policy Note

Abstract

Since the mid-1990s, Uzbekistan has undergone reforms in the health sector focused on restructuring of primary health care in Uzbekistan as well as the establishment of an emergency medical care network. Reform and development initiatives in at secondary and tertiary care level have been limited to gradual downsizing of sub-national hospitals, with the exception of the emergency medical care network, and expansion of Republican specialized tertiary centers. Recent years have seen increases in out-of-pocket payments (both official and informal) for hospital and other health services, which now present a barrier to accessing health services and pharmaceuticals for some patients. The Ministry of Health (MOH) is implementing a program of development of new standards for diagnostic/curative services at each level of care that are intended to modernize practice and increase quality and efficiency. Twenty disease areas have been covered to date. Standards for equipment requirements at each level are also being defined. The Ministry now faces the challenge of developing a strategy to changing clinical and managerial practice in hospitals to bring them into line with the new standards. Uzbekistan has a large and fragmented network of hospitals and specialist clinics, characterized by multiple vertical programs and many single-specialty facilities. There is lack of clarity regarding the specific roles and linkages between the numerous hospitals and specialized care facilities. The Government has pursued a policy of increases in official user fees or "self-financing", alongside offsetting reductions in budget provision for non-salary operating costs in Republican hospitals and many Oblast hospitals in recent years. City and oblast hospitals have self-financing beds. User fees are projected to amount to an average of 18 percent of revenue in 2008 for oblast hospitals (compared to an average of 1.4 percent in 2000). Republican Specialist Centers (tertiary level hospitals) now obtain up to around 65 percent of revenue from user fees, and have a target of 80 percent. By contrast, rayon hospitals collect little user revenue (projected to be a little under 1percent in 2008, a level that is approximately unchanged since 2000). Budget funds for oblast hospital now cover little more than the costs of staff salaries and benefits, following budget reductions that offset increases in user fees.