Dilshod Soliev, 40, has a kidney problem that has required him to undergo hemodialysis on a regular basis for the past few years at the Syrdarya regional hospital in Uzbekistan.
“It was difficult to receive the care I needed. I waited in long queues, and single-use devices and filters were not available. I had to wait a week to receive test results,” Dilshod said.
Now, hope for more effective health care closer to the community is on the way for Dilshod and many others with chronic conditions. The government is promoting a renewed emphasis on population health management where family physicians with a teams of nurses will play a central role in prevention of chronic diseases, early detection and long-term care.
Strengthened primary health care (PHC) teams with rationalized hospital care and the optimal joint use of resources will lead to successful health system reform.
Addressing health inequity
Uzbekistan’s health system required reforms in three areas: quality of services, equity in health financing and efficiency in health spending. From 2019-2025 the government is embarking on a far-reaching and ambitious reform agenda with an overall objective for Uzbekistan to improve the health of the whole population through universal health coverage (UHC).
WHO, through the UHC Partnership, supported the development of a legal foundation for the health system transformation, including a Presidential Resolution establishing mandatory health insurance and a strategy for piloting service delivery reforms in Sydarya Oblast. The government’s intention is to scale up these reforms to the entire country by 2025.
PHC reforms are central to addressing issues of health inequity in Uzbekistan. The country has a large and fragmented network of single-disease hospitals and specialist clinics that complicated efforts to use health resources efficiently. There was a heavy dependence on hospitals for health care services, partly due to under-resourced PHC centres and low uptake of outpatient services. The system needed to enhance quality of care, good management and strategic governance. The limited capacity to deliver services at community level, and to ensure access for vulnerable populations contributed to serious health and financial inequities.
The new service delivery reforms promote the provision of PHC services that are evidence-based. They also expand the role and functions of family physicians, nurses and other health care professionals in early detection and health services for disease prevention.
Health sector reform in the midst of COVID-19
Reforms were underway when the COVID-19 health crisis emerged. Uzbekistan had its first confirmed case on 15 March 2020 and by the start of 2021, had recorded over 77,000 cases with 614 deaths.
WHO worked with the government to develop a strategic preparedness and response plan for COVID-19. WHO and its partners also provide support to the government in the areas of risk communication and community engagement, country operations, logistics and procurement, emergency public health measures, clinical and health interventions, surveillance and laboratory support.
To maintain the momentum of the important transformation of the health system, WHO, in part through the UHC Partnership, participated in high-level meetings, facilitated technical working groups, shared guidelines and good practices, and continued to review and revise draft legislation. To allay government concerns about implementing service delivery and health financing reforms in the midst of a pandemic, WHO provided additional evidence and facilitated several rounds of discussion.
Moving towards people-oriented PHC, with equity in service delivery, supports health security and a resilient health system, and ultimately paves the way for a fairer, healthier society.
Uzbekistan is among the 115 countries and areas to which the UHC Partnership helps deliver WHO support and technical expertise in advancing UHC with a primary health care approach. The Partnership is funded by the European Union (EU), the Grand Duchy of Luxembourg, Irish Aid, the Government of Japan, the French Ministry for Europe and Foreign Affairs, the United Kingdom – Foreign, Commonwealth & Development Office and Belgium.