Tashkent, Uzbekistan (UzDaily.com) — A video conference chaired by President Shavkat Mirziyoyev took place, focusing on the key priorities for the next phase of healthcare reform in Uzbekistan.

It was emphasized that over the past seven years, healthcare funding has increased sixfold, reaching 42 trillion soums in the current year.

A comprehensive system has been established to connect primary care at the neighborhood (mahalla) level with specialized medical services. More than 400 high-tech procedures, previously available only in the capital, are now performed in regional and district hospitals. Kidney transplants alone now average two per day.

Uzbekistan currently has 27 doctors per 10,000 residents — a level comparable to the United States, United Kingdom, and Finland. In contrast, Turkey and Canada have 1.5 times fewer doctors per capita.

“As you can see, we have no shortage of medical staff or funding. But what about quality? In this regard, there are many justified concerns,” the President stated.

Estimates show that non-communicable diseases (NCDs) cause approximately US$1 billion in economic losses each year. One in four ambulance calls is for patients with chronic illnesses.

In a study of 12 neighborhoods in the Fergana region, 8 out of 10 patients bypassed local general practitioners and went directly to hospitals or private clinics. In Khorezm, patients prefer calling an ambulance rather than seeing a family doctor. In essence, emergency services are functioning as outpatient clinics.

In the cities of Andijan, Namangan, and Samarkand, polyclinic doctors are seeing 50–60 patients daily — far above acceptable medical standards.

In Bukhara, family doctors have become little more than "dispatchers," directing patients to hospitals instead of providing preventive care, screenings, and treatment.

It was noted that neither healthcare officials nor regional administrators (hokims) had adequately addressed these systemic issues.

Shortcomings were identified in the allocation of doctors, hospital beds, and financial resources across regional and district hospitals.

For example, in Surkhandarya and Kashkadarya, where disease rates are high, there are 25 hospital beds per 10,000 residents, while Navoi has 31 and Syrdarya has 34.

In the city of Kurgantepa, which has a population similar to Namangan district, there are 310 hospital beds, compared to 420 in Namangan. As a result, per capita spending on medications is 3,500 soums in Kurgantepa, while in Namangan it is 16,000 soums.

Another example: in the public hospital of Andijan city, there are 26 state-funded employees for every 10 beds. In a private clinic offering the same services, only five staff are employed.

The President sharply criticized delays in the implementation of the national health insurance system. It was slated to launch in Tashkent last year and expand this year to the Republic of Karakalpakstan and the regions of Navoi, Samarkand, Fergana, Surkhandarya, and Khorezm. However, it was pointed out that the Health Insurance Fund has effectively become a mere distributor of existing budget funds.

“No matter how sound the planned reforms are, if the system is not digitalized, the desired outcomes will not be achieved,” the President concluded.

At the same time, it was criticized that the responsible individuals not only failed to fully digitalize the system but even struggled to implement the basic “electronic prescription” system. There were also serious failures in the implementation of initiatives such as the “Electronic Polyclinic” and “Electronic Hospital.”

“If the ministry leaders do not change their mindset, fail to show commitment, do not feel responsible, and do not enhance control, the reforms will not reach the level of the mahalla,” the President emphasized.

As a result, due to the shortcomings and mistakes, Deputy Minister of Health D. Sultanov and F. Sharipov were dismissed from their positions. Deputy Minister O. Omonov was warned that he would be fired if he does not achieve changes in the field of digitalization within six months.

The President outlined the necessary measures to address the existing problems and proposed new initiatives.

It was noted that the issues discussed at today’s meeting had been prepared over nearly two years, with the involvement of experts from leading international medical centers.

“If we improve the operation of primary care, digitalization, and insurance, increase the knowledge and practical skills of medical professionals, and, most importantly, raise the medical culture of the population, we will be able to achieve the set goals,” said the President.

It was decided that a new system for improving the quality of healthcare services at the primary care level will now be implemented. The President provided a detailed explanation of this using an example from one of the polyclinics in the Ishtikhon district, based on in-depth analytical data.

The “Uzbekistan” polyclinic in the Ishtikhon district serves 7 mahallas. However, 6 family doctors hold 9 positions and are unable to handle the workload. Meanwhile, the polyclinic itself has 6 vacant doctor positions.

Due to the inclusion of 90 types of drugs in the guaranteed medication package without proper analysis, only half of them actually reach the polyclinic. The laboratory tests conducted at the polyclinic are not recognized by any hospitals.

Despite the fact that most of the visits are related to pediatric diseases, due to a lack of skills, family doctors cannot fully perform the duties of a pediatrician. For every 9,000 women of reproductive age, there is only 1.5 full-time gynecologist positions.

35% of the population suffers from chronic diseases—cardiovascular diseases, diabetes, gastrointestinal diseases. The work of medical teams on early detection, prevention, and reducing complications of such diseases remains unnoticed.

As a result, it was decided to change the existing system.

From now on, a bilateral contract will be established between the medical team and the assigned population, defining the rights and obligations of both parties. The population will have the freedom to choose their family doctor, and private family doctors will also be involved in this process.

A guaranteed package of medical assistance will be approved, within which medical services and medications will be fully covered by the state budget.

Moreover, the number of obstetricians-gynecologists in polyclinics will be doubled. A new pediatrician position will be introduced — one doctor for every 3,000 children.

From now on, there will be no fractional positions at the primary care level — 0.5 or 0.25. All doctors and nurses will work full-time only.

Overall, the operation of mahalla and family doctor’s offices, as well as family polyclinics in the district, will be optimized: 7 major polyclinics, each serving over 12,000 people, will be reorganized, and the remaining 27 institutions will become small polyclinics.

The central district polyclinic will be transformed into a consultative and diagnostic department of the district hospital. All specialized doctors will work there.

In these polyclinics, the basic salary of a family doctor will be US$500, and the salary of a nurse will be US$300. If they have a qualification certificate, both the family doctor and the nurse will receive an additional allowance of the same amount.

If they visit the mahalla, pay attention to patients with chronic diseases, teach them how to live with the disease and manage it, timely detect oncological, diabetic, stroke, and heart attack conditions, prevent severe complications, and reduce calls to emergency services and hospitals, the doctor will receive an additional US$500, and the nurse will receive an additional US$300.

"In other words, we are creating a system where family doctors will earn US$1,500, and nurses will earn US$600–800 per month. This way, we are not just increasing salaries, but also restoring human dignity. But the results must be commensurate," the President stated.

It was also emphasized that now, in the mahalla, even a single case of heart attack, stroke, early maternal or child mortality, or disability due to chronic diseases should be considered an emergency situation.

It was decided that the corrupt system of medical consultation commissions (VKK) for establishing disability will be completely abandoned. From now on, disability will be determined based on documentation completed by the family doctor and the medical-social expertise commission.

The responsible authorities were instructed to implement this system starting June 1 in the city of Tashkent and Navoi region, and by September 1, in all other regions of the country.

At the same time, a new mahalla-based system for early disease detection and reducing complications will be introduced.

For example, doctors from regional centers of cardiology, endocrinology, maternal and child health, as well as from the central district hospital, will be assigned to the Ishtikhon polyclinic and the corresponding mahallas. They will visit the mahallas, conduct full diagnostics of the population, train the attached family doctors in early detection and treatment of diseases locally, and introduce new approaches to diagnostics and treatment directly in the polyclinic.

Professors, lecturers, and graduates of the master’s program at Samarkand Medical University will write their scientific papers here.

If results are achieved by the end of the year, the attached specialists will receive a bonus equal to twice their monthly salary.

The President instructed to implement the aforementioned new system this year in Ishtikhon, as well as in the city of Samarkand, Bulungur district, and one district from each region, and starting next year, to fully implement it in Samarkand region, with phased implementation across the country starting in 2027.

The Ministry of Health was tasked with organizing training for 4,700 family doctors and nurses under the "Family Health" program in 15 districts by the end of the year, as well as conducting management training for leaders in medical institutions.

To implement the new system in polyclinics and hospitals across 15 districts this year, 285 billion soums have been allocated, with an additional minimum of 10 billion soums to be provided by regional authorities.

A new initiative, the “90 Days of Change in Healthcare” program, has been officially launched.

As part of this program, regional governors (hokims) will be responsible for increasing the number of comfortable waiting areas, organizing patient queues, establishing mother-and-child rooms, ensuring accessibility for people with disabilities through convenient entrances and exits, creating inclusive environments in rooms and corridors, and organizing clean restrooms with hot water for handwashing.

“In simple terms, we must bring a culture of order, cleanliness, and a welcoming atmosphere to medical facilities that will instill a positive attitude in people,” the President stated.

Each regional governor will allocate 10 billion soums toward these goals.

Relevant officials have been instructed to carry out these activities nationwide and present a detailed report to the President at the end of the 90-day period.

It was noted that 35–40 percent of infectious diseases arise due to the neglect of basic hygiene rules.

In response, a “Clean Hands” program will be implemented across all schools, kindergartens, technical colleges, universities, polyclinics, and hospitals.

Under this program:

All handwashing stations in educational and medical institutions will be fully supplied with hygiene products;

In 126 schools with poor sanitation, indoor restrooms will be constructed from scratch;

Solar water heaters will be installed in over 6,000 kindergartens;

Water tanks and cisterns will be installed in 4,295 social institutions.

A total of 780 billion soums will be allocated from the state budget this year to support these efforts.

It was emphasized that every social facility must be clean, well-maintained, and provide sanitary and hygienic conditions that ensure comfort for the public.

The importance of launching a large-scale public awareness and educational campaign about the “Clean Hands” program and personal hygiene rules was emphasized.

Despite the availability of high-tech surgical procedures in regional facilities, patients continue to travel to Tashkent. For example, last year, 80 percent of coronary angiography and stenting procedures prescribed for patients with ischemic heart disease were performed in the capital.

Even patients with ischemic heart disease who do not require surgical intervention are still being referred to Tashkent.

Although the outdated paper-based referral system has been abolished and a new “electronic referral” mechanism has been in place for two years for patients in preferential categories, it was noted that none of the republican-level medical centers are incentivized to retain patients for treatment in regional or district hospitals. The reason: the majority of state funding is still allocated to republican institutions.

In this regard, a decision was made that state-funded medical care at republican centers will be limited exclusively to high-tech and complex procedures. If treatment can be provided at the district or regional level, a referral to a republican center will not be issued.

Relevant agencies have been instructed to approve a list of diseases for which referrals will be issued to republican, regional, or district-level facilities.

This year, 1.1 trillion soums have been allocated from the state budget for treatments under the electronic referral system.

A directive has been issued to increase the share of funds allocated to the regions from 14% to 30%. While regions received 100 billion soums last year, this figure will rise to 350 billion soums this year.

The system for issuing and allocating electronic referrals will also undergo a complete overhaul. A unified base cost will be set for medical services related to conditions included in the referral list. Each referral to a republican-level facility will be posted on a single electronic platform.

Republican centers, as well as public and private clinics in other regions, will be able to participate on this platform. A competitive selection process will be conducted: clinics will present their treatment options, conditions for receiving the patient, and, if necessary, may send specialists to the patient’s region for on-site care. Patients will be able to choose the most suitable clinic for themselves.

“In this way, we will foster open competition between republican and regional clinics,” the President emphasized.

A directive was also issued to develop a draft resolution on the comprehensive modernization of the medical insurance system.

Unfortunately, more than half of all pediatric hematologic cancers are diagnosed at advanced stages.

To address this, a five-year national program to combat childhood cancer will be adopted, modeled on the existing oncology program. At least US$110 million will be allocated to this initiative.

An academic hub for pediatric cancer will be established at the Pediatric Oncohematology Center, with the involvement of highly qualified international specialists.

This hub—the only one of its kind in Central Asia—will train regional physicians in the early detection and treatment of pediatric oncology according to international standards.

In addition, oncohematology departments at local children’s hospitals will be equipped with state-of-the-art technology for early diagnosis.

A directive was given to draft a corresponding government resolution.

Each year, the country spends between US$600 and US$700 million on medications whose effectiveness has not been proven or studied. Such drugs account for 42% of pharmaceutical imports.

Developed countries rely on evidence-based medicine and use pharmaceuticals whose safety and effectiveness have been confirmed by large-scale clinical studies.

The Ministry of Health has been instructed to begin removing from clinical protocols any medications that are classified in international sources as "ineffective" or "lacking sufficient evidence."

All medical institutions, especially children’s hospitals, will conduct a comprehensive audit of antibiotic use. In cases of protocol violations, disciplinary measures will be taken against healthcare personnel.

The General Prosecutor’s Office has been tasked with ensuring accountability for the illegal sale of prescription medications.

The electronic prescription system will be fully implemented in the Yunusabad District of Tashkent and will serve as a model for the rest of the country.

Over the past seven years, enrollment in medical universities has increased 4.5 times, with 25,000 students admitted annually—40% of them to private universities.

However, due to the lack of a transparent system for final assessment of knowledge and skills—where graduation exams are conducted by the universities themselves—many graduates enter the labor market with inadequate theoretical and practical training.

Moving forward, proficiency in modern diagnostic and treatment methods will be assessed separately through a transparent system for graduates of both medical universities and technical colleges. This same system will also be applied to practicing doctors and nurses.

To this end, a National Medical Assessment Center will be established, involving a reputable international organization. Both public and private clinics will undergo accreditation.

Responsibility for the professional development of medical personnel will be assigned to public and private medical universities, specialized centers, and regional institutions.

A directive was issued to develop unified qualification standards for the training of physicians and nurses.

It was emphasized that the medical field is especially well-suited for the full implementation of dual education.

However, a major obstacle is that none of the clinics affiliated with medical universities are formally under their financial control.

In this regard, financial autonomy will be granted to the medical universities of Karakalpakstan, Fergana, and Urgench. The clinics of the Karakalpakstan, Bukhara, Samarkand, Tashkent, Fergana, and Urgench medical universities will be officially transferred to their respective institutions.

University departments will directly manage treatment activities within their clinics’ departments.

University rectors will also be held responsible for the renovation and equipping of other facilities used as their clinical bases.

It was emphasized that the implementation of the major healthcare initiatives announced at the meeting must primarily be ensured at the local level—within the primary healthcare system.

It was particularly stressed that if every minister, regional governor (hokim), deputy, and senator personally familiarizes themselves with local conditions and, along with their family members, seeks medical care at family clinics and district hospitals in their place of residence, this would accelerate reform and its implementation at the grassroots level.

Responsible officials have been tasked with maintaining full oversight of reform implementation in the following areas: pharmaceutical production and supply, dispensing of prescription medications through pharmacies, digitalization of all processes, efficient use of healthcare funds, implementation of digital solutions and insurance systems, and the eradication of corruption—in short, ensuring public satisfaction with the healthcare system.

All polyclinics, hospitals, and medical centers must establish proper discipline, a culture of service, and a strong focus on citizen satisfaction. Officials have been appointed to ensure regular review of progress and personal accountability of healthcare managers.

During the meeting, reports were presented by sector and regional leaders, along with their plans for fulfilling the assigned objectives.