Transforming Uzbekistan’s Health System: A Roadmap to Universal Coverage by 2030

The World Bank's Strategy 2030 for Uzbekistan outlines a comprehensive reform plan to achieve universal health coverage by strengthening primary care, financing, quality, and governance. It aims to make healthcare more equitable, efficient, and accessible through systemic, data-driven changes.

The World Bank’s landmark document, Accelerating Progress Towards Universal Health Coverage in Uzbekistan: A Proposal for a National Health System Strategy 2030, outlines a bold and evidence-based vision for reforming Uzbekistan’s health sector. Developed with extensive input from national stakeholders such as the Ministry of Health and the Ministry of Investment and Foreign Trade, and supported by international partners including the World Health Organization (WHO), the United States Agency for International Development (USAID), the German Development Bank (KfW), the United Nations Population Fund (UNFPA), the German Agency for International Cooperation (GIZ), and UNICEF, the strategy is a collaborative blueprint for ensuring equitable, efficient, and quality health care for all by the end of the decade.

A System Strained by Underfunding and Inequity

The foundational analysis of the health system reveals deep structural problems that undermine its ability to deliver care. Uzbekistan's primary healthcare (PHC) services are hampered by chronic underfunding, insufficient human resources, and a lack of basic diagnostic and therapeutic tools. These constraints have led to widespread patient dissatisfaction and the bypassing of family doctors in favor of overcrowded specialty polyclinics and national hospitals. This behavior reflects a broader fragmentation in the system, where inefficient resource use and overlapping functions among various levels of care exacerbate both operational costs and health inequities.

Government health expenditure, at just US$41 per capita in 2019, falls drastically short of global recommendations. The World Bank underscores that this figure is insufficient to fund even a basic health benefit package. As a result, over 60 percent of total health spending in Uzbekistan comes directly from patients through out-of-pocket (OOP) payments. These high OOP rates significantly burden the poor and create financial barriers to accessing even the most essential services, including maternal care and chronic disease management.

Reimagining Primary Care as the Foundation

Central to the strategy is a reconfiguration of service delivery, with primary care positioned as the cornerstone of the health system. The vision is to ensure that 80 percent of outpatient and 85 percent of inpatient needs are managed at the district level. To achieve this, PHC facilities must be equipped to handle prevalent conditions such as cardiovascular disease, diabetes, and chronic respiratory illnesses. This entails not only the provision of medications and diagnostics but also the retraining of healthcare workers to deliver comprehensive, patient-centered care.

Currently, family doctor clinics and polyclinics are understaffed and lack sufficient infrastructure, prompting patients to bypass them. The strategy recommends a combination of infrastructure upgrades, performance-based incentives, and workforce development to boost service quality and patient trust. For example, integrating outpatient specialist services into district hospitals and introducing teleconsultations between PHC and higher-level specialists are among the measures proposed to strengthen the primary care network.

Financing for Universal Health Coverage

The financial reform component of the strategy is equally ambitious. It advocates for the government to uphold its commitment to allocate at least 15 percent of total expenditure to health by 2025 and maintain that level through 2030. Rather than introducing payroll-based health insurance, which could burden informal workers and disrupt recent fiscal reforms, the strategy promotes a tax-funded model for universal health coverage. A phased financing plan is proposed to ensure full funding of high-impact services at the PHC level, starting with the top 20 outpatient and 10 inpatient conditions.

To further support financial sustainability and improve efficiency, the strategy proposes the rollout of DRG (Diagnosis-Related Group) payment systems at the regional level. This will replace rigid line-item budgeting with performance-linked reimbursement, encouraging hospitals to focus on cost-effective and evidence-based care. At the same time, targeted increases in salaries for PHC physicians and nurses are deemed essential to improve workforce morale, retention, and service quality.

Enhancing Quality and Safety Without Punishment

Quality of care is another critical pillar. The report notes that while numerous clinical guidelines exist, adherence is poor, and outcomes data are largely unavailable. Currently, the system relies heavily on punitive approaches to adverse events, including criminal prosecution of doctors—a method that discourages error reporting and undermines improvement efforts. The strategy calls for a shift toward a “just culture” where providers are encouraged to report mistakes and focus on systemic improvement rather than fear retribution.

Key reforms include the creation of structured clinical documentation, standardized quality indicators, and mandatory quality improvement training for health workers. A national Health Information Unit is proposed to oversee data quality and ensure that evidence-based practices are adopted across facilities. The integration of digital health solutions such as electronic medical records, patient registries, and telemedicine is expected to further enhance the system’s ability to monitor performance and support clinical decision-making.

Governance, Public Health, and the Private Sector

The strategy doesn’t overlook the role of public health and private sector engagement. A new National Public Health Center is proposed to unify the currently fragmented network of laboratories and disease surveillance entities. This body will be responsible for data-driven monitoring of communicable and noncommunicable diseases, antimicrobial resistance, and road traffic injuries. Meanwhile, private healthcare providers, who play an increasingly significant role in the system, will be brought under stricter regulatory oversight. Private facilities will be required to report standardized data, and public-private partnerships (PPPs) will be strategically aligned with national health priorities.

Finally, institutional governance reforms include the establishment of a Strategic Planning Unit within the Ministry of Health and the evolution of the State Health Insurance Fund into a national purchasing agency, possibly renamed to reflect its tax-based funding model. These bodies will play a crucial role in ensuring policy continuity, budgetary discipline, and long-term planning.

The proposed National Health System Strategy 2030 is a far-reaching roadmap for transforming Uzbekistan’s health sector. Grounded in rigorous research and extensive stakeholder consultation, it addresses not only the technical shortcomings of the current system but also its cultural and institutional challenges. If implemented effectively, this strategy promises to deliver a more equitable, efficient, and sustainable health system that serves the entire population, regardless of income or geography.