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FEATURE STORY

Primary Care and Disease Prevention Become Priorities in Uzbekistan

February 12, 2014

Additional financing for the Health System Improvement Project aims to improve access to primary health care and address the rise of non-communicable diseases.

STORY HIGHLIGHTS
  • The Health-2 project (2004-2011) helped equip 2,389 rural health clinics and 25 family polyclinics, and train 3,770 general practitioners, benefitting more than 18 million people in Uzbekistan.
  • The follow-up Health-3 project (2011-2018) aims to improve access to primary health care and address the rise of non-communicable diseases.
  • More than 1,000 doctors have completed general practitioner training as part of the Health-3 project in the past year, while 3,000 are expected to do so by the end of 2018.

Three years ago, Guzal Umirkhanova’s life suddenly got easier.

The mother of two, who had to take her children to different clinics in Tashkent for medical care before, was relieved to find that a clinic had the facilities to treat her and both her children.

The family polyclinic # 23 was one of several that benefited from new, modern equipment and training for all its general practitioners as part of the World Bank’s Health-2 Project (2004-2011) in the country, in line with a broader rural social infrastructure development approach of the Government of Uzbekistan. The World Bank project evolved with the country’s primary health care reform strategy, and focused on streamlining redirecting savings to create a sustainable network of integrated primary care services. It financed several primary health care facilities, and provided for health care on a per-capita basis, which meant that funds were used better to serve the needy.

As part of the project, 2,389 rural health clinics were helped with equipment, while 3,770 general practitioners were trained in 10- month courses, so they could help patients of all ages. One of the most important project’s achievements was its contribution to the health financing reforms through the introduction of per capita financing for primary healthcare.

Today, the family polyclinic #23 that Umirkhanova goes to in Tashkent serves 7,454 families, or nearly 33,000 patients, both children and adults.

 “This clinic was one of the pilot clinics to switch to per capita financing in 2007,” - says one of the health care professionals. “Before that, planning and budgeting were centralized. Our Chief Doctor and accountant have been trained on financial management issues and we can now manage our own budget.  And the amount of per capita financing is growing, too, – in 2008 it was 14,000 soums and now it is 30,000 soums, which is enough to cover our costs and buy necessary equipment”.

“We have everything in place now, - adds representative of the Ministry of Health, - clinics, trained general practitioners, equipment. The only thing is to make people feel responsible for their own health, visit our clinics, take timely examination.  Our focus now should be on preventive care, promotion of sports, and healthy life style.”

Laura Tuck, World Bank Vice President for Europe and Central Asia, visited the polyclinic #23 during her visit to Uzbekistan in early February 2014. “I am very glad to see your focus on preventive care,” she said. “We continue to work in the health sector in Uzbekistan, so please continue to define the challenges and we would continue helping.”

After tracking the progress of the Health-2 project, the World Bank approved the Health System Improvement Project (or Health-3) in 2011 and Additional Financing in 2013, with the objective of improving access to quality health care at the primary level, at Rayon Medical Unions (RMUs), and selected City Medical Unions (CMUs), and to strengthen the government's public health response to the rise in non-communicable diseases (NCDs).

The Health System Improvement Project aims to provide medical equipment to 157 RMUs and 70 family polyclinics as well as to continue training of medical personnel on NCD management around the country by the end of 2018. The World Bank is partnering with the government and other developmental institutions such as WHO to implement the project.

Significant progress has been made in the past two years.

Some 36 RMUs have been rehabilitated by the Government of Uzbekistan’s national program, and over 1,000 doctors have completed a 10-month general practitioner training, among other results. Five new treatment standards for NCDs have also been developed and approved by the Ministry of Health, with the aim of taking that number to 20 by the end of the project in 2018.