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.

Health Conditions

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