Decree of the President of the Republic of Uzbekistan

Decree of the President of the Republic of Uzbekistan “On the main directions of further deepening the reforms and implementing the State Program for developing the healthcare system”

It shall be noted that the most important provisions and purposeful objectives of the State Program on Reforming the Healthcare, which were adopted in 1998, are in general being successfully implemented. The system of medical servicing has been almost fully reconsidered, the principally new approaches to the building of new healthcare system in the republic have been elaborated.

The single system of rendering free emergency and high-skill medical aid to the population has been created. It includes specialized regional hospitals and 173 branches in the districts and cities, which meet the highest requirements and international standards, and emergency medical services. Their activities are administered and coordinated by the Republican scientific center for emergency medical aid.

The republican specialized medical centers have been established in the spheres of surgery, cardiology, microsurgery of eye, as well as urology and supplied with the state-of-the-art diagnostic and medical equipment, where the highly skilled specialists perform a complicated, unique high-technology surgeries.

The serious changes have taken place in the primary chain of public healthcare, especially, in rural areas. Over 3,1 thousand rural medical units supplied with modern diagnostic and therapeutic equipment have been established replacing the less effective midwifery centers and rural outpatients’ clinics. The high-qualified general practitioners render primary medical aid there.

The considerable changes have taken place in the system of protection of motherhood and childhood, improving the women’s health. The creation of the diversified network of screening-centers, which systematically control the health of the future mothers and contribute to the birth of healthy children, has an exclusive importance. Significantly improved the material and technical base of obstetric facilities.

The system of remuneration and incentives for medical workers has been thoroughly changed - the amounts of their salaries and mechanism of incentives directly depend on the level of complexity and intensity of their job, quality of rendered medical aid. The funds of material incentive and development of medical organizations have been established at each medical facility. As a result the amounts of salaries of medical workers rose to 2.2-fold for over the last two years.

The private sector is developing gradually in healthcare– more than 1,700 legal entities have received licenses for providing private medical services as well as more than 2,100 doctors have obtained their licenses for employment as a private medical doctor.
The system of educating medical specialists is reformed – the modern two-stage medical education system has been implemented, the Tashkent Medical Academy has been established. Organization of nurses’ education at universities is fundamentally a new trend.

The measures taken in reforming the system of healthcare has allowed to improve the quality of rendering medical service to public and raise the population’s living standards. As a result, the average life expectancy in Uzbekistan rose from 67 in 1990 to 70 years of age in 2006, including men from 66 to 70 years of age and women from 70 to 74,6 years of age. Socially dangerous and infectious diseases such as smallpox, typhoid fever, poliomyelitis, diphtheria, anthrax, bubonic plague, cholera and others have been fully extirpated.
Meanwhile, many issues related to improvement of the level of preventing diseases and the quality of rendering the medical service, especially in regional areas, remain unsolved.
Organizational structure of healthcare management continues to be cumbersome and ineffective, where the stationary healthcare institutions are prevailing. The territorial healthcare management bodies don’t provide necessary organizational and methodical supervising of medical institutions’ activities. The sanitary and epidemiological control over prevention the spread of infectious diseases is not properly provided.

The state experiences urgent need in developing highly specialized medical centers to carry out complex, highly technological surgeries in the fields of neurosurgery, cardio surgery, oncology, gynecology and obstetrics, acute gastrointestinal disturbances and others.
The network of diagnostics centers, which is considered to be the most crucial instrument of detection, prevention and effective treatment of diseases, is organized very poorly around the state.

Despite the established diversified network of screening centers, the system of health patronage of future mothers and pregnancy process, especially in villages, is in need of qualitative improvement.

The sanitary and epidemiological services on prevention of infectious and viral diseases, reliable protection of population from HIV /AIDS need the constant serious attention and fundamental improvement of management.
The system of preparation and training of medical cadres requires further improvement. The quality of cadre preparation in medical colleges seriously rouses censure and strengthening them with modern educational, methodological and laboratorial equipments is being required.
The educational and medical school has significantly weakened, reliable contact lacks between educational research institutions and their implementation to the medical and diagnostic practice. The created high-technological material and educational base at many republic medical institutions is weakly used to improve the qualification of medical workers.

With an aim to further deepen the reforms in the sphere of health, establishing the organizational structures of outstanding requirements, providing the necessary preventive measures against the distribution of disease, coordinal improvement of effectiveness, quality and accessibility of the population to medical care, as well as improvement of the system of preparation and training the medical cadres:

1. The main tasks of further deepening of reforming the healthcare shall be defined as follows:
Establishing the outstanding organizational structures of healthcare, which provide for the united organizational and methodological leadership and monitoring the quality of medical services rendered to the population;
Further development of the network and creation of the new republican specialized educational and practical medical centers, which are equipped with modern diagnostic and medical facilities, as well as have highly qualified cadre potential that provide the specialized highly qualified medical aid to the population;
Thorough betterment of the systems of medical diagnostics, broad development of the network of diagnostic services in the territory of the republic, which are equipped with modern facilities of modern standards and staffed with highly qualified specialists;
Improvement of the effectiveness and reliability of the population protection system from viral and infectious diseases, prevention from falling sick with HIV/AIDS thanks to the realization of preventive measures, which are directed, above all, to prophylaxis and neutralization of the sources of infection;
Cardinal improvement of women and child healthcare system, patronization over the health of future mothers, further development and strengthening the material and technical base of the screening centers, obstetrical and pediatric establishments, especially in rural areas;
Improvement of cadres training and retraining systems in view of satisfying the demand of medical institutions in general practitioner and highly specialized doctors, providing conditions for constant improvement of medical workers’ qualification and professionalism;
Assistance to development of private medical institutions, which exploit modern diagnostic and medical equipment, employ the highly skilled medical staff that render the qualitative specialized medical services to the population in strict conformity with approved standards of medical process.
2. The proposals of the Working group established by the Resolution of the President of the Republic of Uzbekistan No.Р-2658 of January 22, 2007, shall be accepted with regard to creating in 2007-2008:
а) The regional (oblast) multipurpose medical centers on rendering medical services on primary treatment directions (planned surgery, therapy, cardiology, urology, etc.) on the basis of working regional hospitals and the particular specialized medical institutions;
b) The regional children's multipurpose medical centers for treatment of children diseases on the basis of operating regional children's medical institutions;
c) The centers of medical diagnostics in the cities of Nukus and Tashkent, and also at each regional center, functioning on a paid basis;
d) The district (city) medical associations on the basis of the central district (city) hospitals, children's polyclinics and adult outpatient clinics in corresponding territories with laying on them the functions of coordination the activities of rural medical centers and family polyclinics and rendering them methodological help to carry out preventive, sanitary - educational actions and rehabilitation medical services;
e) The Republican specialized scientific-practical medical centers:
obstetrics and gynecology on the basis of scientific research institute (SRI) of obstetrics and gynecology with medical base, the centers of reproductive health of women;
pediatrics on the basis of scientific research institute (SRI) of pediatrics with a treatment base;
therapies and medical rehabilitation on the basis of scientific research institute (SRI) of therapy and medical rehabilitation with medical base and the Center of science of gastroenterology;
dermatology and venereology on the basis of Republican scientific research institute of dermatology and venereology with medical base;
phthisiology and pulmonology on the basis of scientific research institute (SRI) of phthisiology and pulmonology with a treatment base;

Endocrinology on the basis scientific and research institute of endocrinology with a medical base.
The Ministry of Finance and Ministry of Health of the Republic of Uzbekistan shall be assigned a responsibility to establish, equip and finance, in accordance with contemporary requirements the aforementioned national specialized scientific and practical health centers.
3. The Ministry of Finance, State Property Committee and Ministry of Health of the Republic of Uzbekistan along with Councils of Centers of Republican Specialized Health Centers within a month shall approve a clear schedule of full transfer over to the new conditions of self-financing and self-repayment of Republican Specialized Centers of eye microsurgery and cardio-surgery in 2007, the Republican Specialized Center of Urology in 2008 and the Republican Specialized Center of Surgery in 2011.
4. Ministry of Health along with the State Architectural Construction of the Republic of Uzbekistan by taking into account the experience of the developed states shall elaborate typical projects of regional diagnosis centers that meet high requirements and provisions of international standards and within three months shall submit them for the consideration to the Government.
The Cabinet of Ministers of the Republic of Uzbekistan in line with the approved typical projects shall make a decision on constructing and reconstructing of the regional (oblast) diagnosis centers, equipping them with necessary diagnosis technology, qualified personnel and sources of financing.
5. The most important directions of activity shall be considered:
a) district (city) medical associations – to carry out the preventive activity to prevent diseases, in particular, the infectious and viral ones, provide the quality first ambulatory and clinical aid to the population, carry out the first emergency medical aid and in-patient treatment, as well as organizational and medical administration of rural health centers, family clinics and other medical establishments in the district (city);
b) regional (oblast) multifunctional health centers – to conduct the patient examination, render them with highly skilled medical and consultative aid, organization of in-patient treatment on main directions of diseases (selective surgery, therapy, cardiology, gynecology and others), as well as methodical implementation of modern methods and technologies of providing medical aid to the medical institutions of the province;
c) territorial bodies for administering the public health:
application of unified standards in diagnostics and treatment, and at rendering the medical services, as well as keeping control on their observance by medical institutions;
carrying out the organizational-methodical management of activity of the medical institutions at the corresponding territories;
providing for the effective sanitary-and-epidemiological control, realization of the effective measures to prevent expansion of infectious and especially dangerous diseases;
carrying out the preventive work among the population aimed at increasing the medical culture in family, promotion of a healthy way of life.
6. The Ministry of Finance together with the Ministry of Health of the Republic of Uzbekistan in a month’s time shall submit to the Cabinet of Ministers the proposals on improvement the funding system of the public health establishments.
7. From October 1, 2007 for the period of 5 years the medical establishments that render to the population the paid medical services (except for stomatological and cosmetological) are exempted from payment of all taxes and other obligatory payments, except for obligatory deductions to the non-budgetary Pension fund from the volume of realization of goods (works, services) and unified social payment with a purposeful channeling of remaining funds to equip the medical establishment with the modern medical equipments.
8. Until January 1, 2013 the medical establishments, regardless of their ownership form (except for stomatological and cosmetological) are exempted from payment of customs duties (except for customs registration duties) for the imported new medical equipment in line with the list approved by the Cabinet of Ministers.
9. The Cabinet of Ministers of the Republic of Uzbekistan in a one week’s time shall prepare the draft of the Government decision on realization of this Decree.
10. The control over the execution of this Decree shall be assigned to deputies of the Prime Minister of the Republic of Uzbekistan - Kasymov R.S. and Azimov R.S.

President
of the Republics of Uzbekistan
Islam Karimov

Tashkent, September 19, 2007