Introduction of Family Medicine in Uzbekistan

Matluba Mukhamedova, Communications Officer in the Tashkent Office, offers this story.

Doctor Kahramon Tursunov is well known in his quiet village in the Fergana valley, where he was born and to which he returned after becoming a pediatrician.

"People in my village approached me to get treatment for various diseases; adults or women with traumas, eye or skin diseases and sometimes even cases of contagious diseases," says Dr.Tursunov. He wanted to help, but could not. He was supposed to treat children only.

His wish to help patients of all kinds came true in 2001 when family medicine was introduced in Uzbekistan. Doctor Tursunov retrained as a general practitioner and now heads the village's new clinic. "In 2001 a new building for this rural polyclinic was built, and I became the chief doctor here. I went to Tashkent for a 10-month special training course to become a general practitioner. Now I have consultations with pregnant women and diagnose a number of diseases."

Doctor Tursunov's training and clinic are the result of a World Bank-supported project aimed at improving the quality and effectiveness of health care in Uzbekistan. First reforms were undertaken mostly in rural areas. They are now being extended to urban areas.

"We obtained the facilities for electrocardiogram diagnostics and a biochemical laboratory. We have a modern sterilizing equipment and binocular microscope; we equipped a vaccination room. Moreover, all the general practitioners have been trained to use the newly obtained equipment," says Munira Shakhabova, Chief Doctor of Polyclinic # 23 in Tashkent.

One of her patients, Guzal Umirkhanova, mother of two, says that her family benefits a lot from having a family doctor. "My children are healthy. Previously, I took them to different places, now we get all our services at one place," says Guzal.

Thanks to the project, the idea of financing health care on a per capita basis has been introduced here. All rural primary health care facilities in the country are financed and managed independently with the help of newly hired financial managers. Twenty-nine pilot urban polyclinics are doing the same.

"Under the new system we are funded based on the number of residents. The money stays with us. We now are able to fund additional activities for women and the elderly," says Dr. Shakhabova.

Polyclinics now receive five times more money per patient than before. It is money which they can spend on increasing salaries, buying equipment or medicines.

Polyclinic #23 in Tashkent serves 32,447 people with 22 family doctors and 48 visiting nurses. And they all received special training thanks to the project.

Because family medicine was a new discipline in Uzbekistan, a large scale training center for general practitioners was established in the Tashkent Medical Academy. "The project made a major contribution to the establishment of our center," says Academy Director Otabek Yusupov.

The academy's curriculum combines theory and practice. After two weeks at the training center, students spend the next two weeks applying the knowledge they obtained at their workplaces. Another new aspect of the course is teaching doctors how to communicate with patients about their different diseases. Over the past 10 years, approximately 7,000 physicians have been trained.

Significant progress has been made in health reform in Uzbekistan. The government showed willingness to develop a strong system of rural primary care by introducing family medicine, giving the primary care sector financial independence and providing equipment and training.