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Uzbekistan
Health
As Uzbekistan struggled to revise its Soviet-era health care
system, the physical condition of its population was exacerbated
by severe environmental conditions that were inherited from the
Soviet period and were not addressed effectively in the first
years of independence. Key health indicators showed a correlation
between the high level of air and water pollution and health problems
(see table 5, Appendix).
Health Care System
In the mid-1990s, Uzbekistan continued a health care system in
which all hospitals and clinics were state owned and all medical
personnel were government employees. Although health care ostensibly
was free of change, this rarely was the case in practice. In the
early 1990s, some private medical practices have supplemented
state facilities to a small extent. In 1993 Uzbekistan undertook
a program of privatization that began with the introduction of
health insurance and continued with the gradual privatization
of health care facilities, which is optimistically projected at
about three years. Under the new program, the government would
require private health facility owners to maintain the same standards
as state facilities and to offer minimum free health care for
the indigent. In the first few years of the program, however,
only pharmacies and small clinics were privatized. Plans for 1995
called for privatizing twenty-four dental clinics and twelve prenatal
clinics. In 1995 no plan provided for government divestiture of
medium-sized health care facilities.
The government disburses its funds through the national Ministry
of Health, through the health agencies of local and province governments,
and through specialized facilities serving ministries and state
enterprises. Treatment in the last two categories is generally
better than in general state facilities because staff salaries
and work conditions are better. As in the Soviet system, special
facilities exist for top political, cultural, and scientific dignitaries.
In 1994 some US$79 million, or 11.1 percent of the annual budget,
was allocated for health care. Of that amount, about 60 percent
went to state hospitals, 30 percent to outpatient clinics, and
less than 6 percent to medical research.
Despite marked growth throughout the Soviet era, the public health
care system in Uzbekistan is not equipped to deal with the special
problems of a population long exposed to high levels of pollutants
or with other health problems. Although the numbers of hospitals
and doctors grew dramatically under Soviet rule--from almost no
doctors in 1917 to 35.5 doctors per 10,000 population and to 1,388
hospitals and clinics per 10,000 population in 1991--the increasing
incidence of serious disease raises questions about the effectiveness
of care by these doctors and their facilities.
In 1993 a total of 16.8 million patients were treated, of whom
4.8 million were treated in hospitals and about 275,000 in outpatient
clinics--meaning that the vast majority of patients received treatment
only at home. Experts predicted that this trend would continue
until the level of care in government facilities improved substantially.
Among the serious problems plaguing health care delivery are
the extremely short supply of vaccines and medicines in hospitals;
the generally poor quality of medical training; and corruption
in the medical profession, which exacerbates the negative impact
of changes in the system for the average patient and diverts treatment
to favored private patients. According to a 1995 private study,
the state system provided less than 20 percent of needed medicine
and less than 40 percent of needed medical care, and budget constraints
limited salaries for medical professionals. In 1990 the percentage
of children receiving vaccines for diphtheria, pertussis, measles,
and polio averaged between 80 and 90 percent. That statistic fell
sharply in the first years of independence; for example, in 1993
fewer than half the needed doses of measles vaccine were administered.
The Ministry of Health has recognized that Uzbekistan has a serious
narcotics addiction problem; illicit drug use reportedly stabilized
between 1994 and 1996. The seven substance abuse rehabilitation
clinics treat both alcoholism and narcotics abuse. The Ministry
of Health has identified the following as its priorities, should
expansion of services become possible: improvement of maternal
and infant health care, prevention of the spread of infectious
disease, and improvement of environmental conditions leading to
health problems. In 1995 Uzbekistan was receiving aid from the
United States Agency for International Development (AID), the
United Nations Children's Fund (UNICEF), and the World Health
Organization (WHO) for improving infant and maternal health care
and for storage and distribution of vaccines.
Data as of March 1996
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