Since the mid-1990s, Uzbekistan hasundergone reforms in the health sector focused onrestructuring of primary health care in Uzbekistan as wellas the establishment of an emergency medical care network.Reform and development initiatives in at secondary andtertiary care level have been limited to gradual downsizingof sub-national hospitals, with the exception of theemergency medical care network, and expansion of Republicanspecialized tertiary centers. Recent years have seenincreases in out-of-pocket payments (both official andinformal) for hospital and other health services, which nowpresent a barrier to accessing health services andpharmaceuticals for some patients. The Ministry of Health(MOH) is implementing a program of development of newstandards for diagnostic/curative services at each level ofcare that are intended to modernize practice and increasequality and efficiency. Twenty disease areas have beencovered to date. Standards for equipment requirements ateach level are also being defined. The Ministry now facesthe challenge of developing a strategy to changing clinicaland managerial practice in hospitals to bring them into linewith the new standards. Uzbekistan has a large andfragmented network of hospitals and specialist clinics,characterized by multiple vertical programs and manysingle-specialty facilities. There is lack of clarityregarding the specific roles and linkages between thenumerous hospitals and specialized care facilities. TheGovernment has pursued a policy of increases in officialuser fees or "self-financing", alongsideoffsetting reductions in budget provision for non-salaryoperating costs in Republican hospitals and many Oblasthospitals in recent years. City and oblast hospitals haveself-financing beds. User fees are projected to amount to anaverage of 18 percent of revenue in 2008 for oblasthospitals (compared to an average of 1.4 percent in 2000).Republican Specialist Centers (tertiary level hospitals) nowobtain up to around 65 percent of revenue from user fees,and have a target of 80 percent. By contrast, rayonhospitals collect little user revenue (projected to be alittle under 1percent in 2008, a level that is approximatelyunchanged since 2000). Budget funds for oblast hospital nowcover little more than the costs of staff salaries andbenefits, following budget reductions that offset increasesin user fees.
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