Uzbekistan has embarked on an ambitious process to modernize its health system and make progress towards universal health coverage. A new WHO/Europe report outlines a series of recommendations for nationwide reform, supporting the Government’s plans to expand health reforms achieved in the region of Syrdarya. “Transforming the health system in Uzbekistan: two-year implementation review” focuses on 3 key areas:
- transforming primary health care
- implementing health financing reforms
- further developing digital tools in the health sector.
At a national policy dialogue in Tashkent on 15 September 2023, over 100 participants, including representatives from government institutions, regional authorities and development partners, concluded that the plan provides practical guidance and timely recommendations on how to proceed with the health system reform rollout by 2026.
“The lessons learned in Syrdarya are a very promising start, and show us that achieving tangible benefits in other regions is possible,” said Dr Natasha Azzopardi-Muscat, Director of the Division of Country Health Policies and Systems at WHO/Europe. “Our new report highlights the importance of strong leadership and strategies to improve outcomes and ease people’s financial burden. We at WHO/Europe continue to stand ready to support the Government of Uzbekistan on this journey.”
Dr Farrukh Sharipov, Deputy Minister of Health of Uzbekistan, emphasized, “This review of Uzbekistan’s health reforms lays a promising foundation to identify forthcoming challenges and opportunities that we can capitalize on from the experience in Syrdarya. As plans for expansion to other oblasts are on the horizon, we now have solid groundwork to determine the necessary changes and areas of focus, leading to the development of a more sustainable and efficient health-care system.”
Results achieved in Syrdarya
This new initiative began in 2020, when the country adopted a landmark legislation package that it implemented in Syrdarya in 2021. Through its Universal Health Coverage Partnership, WHO supported the development of the legal foundation for the reforms, including a presidential resolution establishing mandatory health insurance.
Key achievements to date include:
- the establishment of a state health insurance fund as a single purchasing agency contracting health facilities and pharmacies;
- better organized primary health-care (PHC) services in Syrdarya;
- new provider payments and contracts with health facilities; and
- advanced electronic health (e-health) information systems used by pharmacies.
These developments have laid a robust foundation for future changes and have increased capacity to develop a more efficient and responsive national health system. In addition to detailing the significant progress accomplished, the report consolidates actionable policy recommendations across the 3 core areas. These recommendations will be pivotal in ensuring effective nationwide rollout and progress towards universal health coverage for the Uzbek population.
A cornerstone of reforms
Now that rollout is set to expand to the city of Tashkent and the region of Karakalpakstan, the new WHO report recommends the establishment of an interagency PHC task force led by the Ministry of Health and involving high-level stakeholders to translate the legislation into action.
“The priority should be to decisively keep building on the initial successes of the PHC reforms in Syrdarya, so these have been fine-tuned and solidified based on accumulated experience and on building capacities at local, oblast and national levels,” said Ms Umida Gazieva, Head of the Department of Organization of Health Care Delivery of the Ministry of Health.
Some notable milestones accomplished in this area include:
- expanded roles and autonomy for practising and patronage nurses;
- capacity for family doctors to devote more time to complex cases;
- evidence-informed clinical guidelines and protocols for priority conditions;
- enhanced teamwork; and
- stronger links between PHC teams and local community organizations (makhallas) through the role of patronage nurses.
The report also emphasizes the importance of strengthening the role of family medicine within the newly established PHC teams. It advocates for reintroducing the family medicine speciality training programme to strengthen family medicine’s competencies, prestige and recognition.
Strengthening health financing
The report praises the role of the state health insurance fund as a crucial transformative force in implementing health system reform in Uzbekistan. It notes that a general tax-funded health insurance system is the most feasible model for the country’s context, and recommends careful monitoring of the impact of newly implemented payment systems.
Other recommendations regarding health financing include:
- continued capacity development of the state health insurance fund to support the nationwide rollout;
- a gradual transition towards a national single finance pool under the state health insurance fund to enhance the value of public funds and equitable resource allocation; and
- increased autonomy for providers, following the establishment of accountability mechanisms.
Progress in the e-health system still requires the definition of clear a governance mechanism and priorities. This will involve establishing a legal framework, clarifying roles and responsibilities among stakeholders, and developing collection and analytical tools to facilitate informed decision-making.
Source: WHO
