Asian development bank

Health

Context

Improvements in health have a multiple effect on reducing poverty, improving learning and productivity, and, consequently, fostering economic growth. Health is a fundamental human capital, and inequities in affordable quality health services undermine inclusive

growth. analyzing the root causes of these inequities allows the identification and shaping of appropriate policies and programs for national and international development programs.
Since 2014, Uzbekistan has made significant progress in several key globally recognized indicators. Maternal and infant mortality rates, as well as the number of children born with malformations, have decreased, and Uzbekistan has achieved the United Nations Millennium development Goal in this area.¹⁸⁶ Maternal and infant mortality rates decreased (20.7 vs. 17.4 per thousand and 24.2 vs. 10.7 per thousand, respectively) in the last 20 years. Moreover,

in 2014–2017 the number of pregnant women with anemia decreased (45.1% vs. 38.2%, respectively.¹⁸⁷

despite significant progress, considerable inefficiencies remain in the health system and require prioritization.¹⁸⁸ Fragmentation of health care from the social protection system is an issue because health care is associated mainly with disease treatment and medication, whereas social welfare is not viewed holistically. about 6% of all state expenditures go to needy families through the makhallya (social assistance) system. the health information system does not integrate parameters related to social welfare (e.g., income, employment, marital status, family structure, and occupation). the primary health care checklist for home visitation does not include social factors like domestic violence or access to clean water.

Major barriers to accessing affordable quality health care, especially in rural areas, include long distances to secondary and tertiary health care; travel and accommodation, including emergency cases; out-of-pocket expenditures; and insufficient quality of health-care services, which are increasingly recognized as a problem. the United Nations Human development

Report identified out-of-pocket expenditure as constituting 43.9% of Uzbekistan’s total health budget.¹⁸⁹ Resource-poor people can afford such expenses only by sacrificing other priorities.¹⁹⁰
the government identified as most acute those issues related to reproductive health: insufficient coverage of women (82%–87%) and children by the patronage nurses’ service; insufficient coverage (only 52% of fertile women) of extra-genital disease diagnostics for

¹⁸⁶ UN Human Rights Office of High Commissioner. 2014. Report of the Working Group on the Universal Periodic Review. Uzbekistan. paras. 53, 92. Geneva.
¹⁸⁷ Ministry of Health of Uzbekistan. 2017. Presentation at the Women’s Committee of Uzbekistan Conference. 14 december. tashkent. Uzbekistan.
¹⁸⁸ Y. Yang. 2015. Health Financing: Summary Review of Central and West Asia Countries and Country Studies of Pakistan, Uzbekistan and Kyrgyz Republic. US: Johns Hopkins University. https://ru.scribd.com/document/280792266/ pReSeNtatION-Health-Financing-in-Central-and-West-asia-Country-Studies-of-pakistan-Uzbekistan-and- Kyrgyz-Republic \
¹⁸⁹ UN development program. 2014. Human Development Report- 2014.
¹⁹⁰ X. Huang and N. Yoshino. 2015. Impacts of Universal Health Coverage: A Micro-funded Macroeconomic Perspective. ADB Working Paper Series. Manila.
Mainstreaming Gender in ADB Operations, by Sector 63
early detection and specialized treatment; scarcity of equipment and low-quality services in rural maternity hospitals, resulting in poor prenatal care; scarcity of medical experts in the field of mother and child health and their insufficient professional level; insufficient level of

gynecological medical care in regional perinatal centers; and lack of hotlines and call centers for teenage girls to consult on their reproductive rights and reproductive health issues.¹⁹¹

Uzbekistan still lacks a social health insurance system, and private health insurance covered only 2.6% of total health expenditures in 2012.¹⁹²

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