Improving Access to Health Services in Rural Uzbekistan

Uzbekistan is a poor country with a population of about 27 million and a per-person income of about $730. When the country achieved independence from the Soviet Union in 1991, it opted to pursue a policy of slow transition. A policy of high public spending in health and education lessened the deterioration of human capital during this difficult period. However, rural areas of Uzbekistan—which are home to more than half the country's population—gradually confronted a serious medical care crisis.

The new Government, already struggling with an array of socioeconomic and political challenges, confronted the added burden of staffing and funding an inefficient network of medical facilities, while also seeking to improve and modernize them. As the economy stagnated, Uzbekistan’s health budget barely covered staff salaries, which left little room for medicines or equipment. As a result, rural Uzbeks had little or no access to proper medical care.

The Second Health Project was launched in 2004 to improve the quality and overall cost-effectiveness of healthcare services. In partnership with the Asian Development Bank, the project provided primary care centers with a package of equipment. The project also sought to strengthen healthcare financing and management, training in public health, and control of communicable diseases.

The following achievements demonstrate the success of the programme:
 66 percent of Uzbeks report improvements in healthcare quality—namely improved availability and quality of equipment and medicines, and more access to better-trained doctors.

 The proportion of women receiving antenatal care increased from 79 percent in 2004 to 86 percent in 2008.

 The number of visits to rural health facilities increased by almost 20 percent—from 4.1 per person in 2004 to 4.5 in 2008.

 The percent of patients referred from rural clinics to hospitals decreased from 20 percent in 2004 to 8.7 percent in 2008.

 The share of rural clinics equipped increased from 0 percent in 2004 to 87.5 percent in 2008.

 The percent of rural clinics with one or more staff that passed a retraining program increased from 14.5 percent in 2004 to 55 percent in 2008.

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IDA financed US$40 million of The Second Health Project, which started in 2004 and is expected to continue through 2010.
The Government contributed US$75 million, which includes the financing for all construction works for rural health clinics.

The Second Health Project has made significant progress equipping rural primary care facilities nationally. Remaining challenges include the development of a system for maintenance of medical equipment and reforms at the district hospital level. A Third Health Project would pick up on these reforms.

Source: http://go.worldbank.org/F07EXSD9L0