Overhauling Medical Care in Rural Uzbekistan

Development of Family Medical Practice Project

Medical care collapsed after independence

The rural areas of Uzbekistan which are home to more than half the country's population faced a medical care crisis following the break-up of the Soviet Union in the early 1990s. The newly independent country inherited a cumbersome and inefficient network of medical offices, clinics, and hospitals that did not function as a cohesive system.

The new government, already struggling with an array of socioeconomic and political challenges, faced the added burden of staffing and funding these medical facilities while also improving and modernizing them. As it stood, the budget barely covered staff salaries, leaving nothing for medicines or equipment. This left people in rural Uzbekistan with little or no access to proper medical care.

World Bank helps to radically reform health care in Uzbekistan

To remedy the situation, the Government of Uzbekistan applied for a World Bank loan, and in 1999 the Development of Family Medical Practice Project came into being. The project strives to simplify the tangle of rural medical services, upgrade the skills of medical personnel by training specialists and general practitioners, purchase the latest medical equipment, and radically reform healthcare financing. This has included the creation of a new type of medical establishment-rural doctor's offices, also known as SVPs.

Specific criteria and standards were developed to make sure that these SVPs were designed with the population in mind and had electricity, water, and heat. Today, when a patient goes to an SVP for treatment, he or she receives primary care from a qualified physician, not a doctor's assistant. The funds provided by the World Bank allow this care to be delivered according to international standards.

Newly trained medical staff and the latest equipment

Over the past three years, a group of family doctors (or general practitioners) from Great Britain trained 86 teachers in Uzbek medical institutions and colleges. The trainees then passed their newly acquired skills on to doctors and nurses from three pilot oblasts (Ferghana, Navoii, and Syrdarya). At this writing, more than 600 family doctors and nurses have been trained.

At the same time, 673 rural medical offices have been, or are in the process of being, equipped with the latest medical equipment-a wave of modernization that goes beyond the pilot oblasts to include the Republic of Karakalpakstan and the Khorezm oblast. Central hospitals have also benefited from this and 36 laboratories have received new diagnostic equipment. And family medical clinics serving remote areas have been given rough-terrain vehicles and radio communication equipment for providing emergency care.

Good primary care helps keep people healthy and reduces costs

Overall, this World Bank project has led to significant improvements in the quality of primary care available to Uzbekistan's rural population. The overhaul of the system has helped to reduce costs as well: the number of rural patients requiring expensive in-patient treatment has been reduced by 25 percent in the three pilot oblasts, thanks largely to prevention through improved primary care.

A follow-up project is set to expand the benefits beyond the pilot areas.