Publication date

Primary care quality management in Uzbekistan.

Boerma, W.G.W., Kringos, D.S., Verschuuren, M., Pellny, M., Baymirova, L. Primary care quality management in Uzbekistan. Kopenhagen: WHO Regional Office for Europe, 2008. 91 p.
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The Uzbek government has a central role in primary care quality management. On paper, many quality management structures and procedures exist. Now, primary care practice should follow, as NIVEL research – done on the initiative of the World Health Organisation (WHO) – has shown. The results have been published in a WHO report.

With donor support, quality improvement in primary care is a national priority. Many laws, decrees and orders deal with the improvement of (primary) health care services. The time has come to further develop and implement a model for comprehensive primary care services. According to the project leader Wienke Boerma: “In former-Soviet countries, the government typically has a central role in steering the health care system leaving little room for input from stakeholders. When tackling quality of care, it is of great importance that doctors, and nurses and others involved in the care process take an active role. It will therefore be a challenge to realise an effective quality policy”.

A top-down approach
Primary care practices in Uzbekistan are led by deputy head district doctors. This is a physician responsible for multiple practices. The final responsibility for the quality of primary care facilities is with the Ministry of Health, but within this ministry the responsibilities seem to be fragmented. As a result of this top-down approach, the position of non-governmental organizations –such as patient organizations or medical professional associations– in laws and in health policy development is weak. In a strong primary care system, these stakeholders would require a more embedded position.

A Primary Care Quality Management Instrument
In an agreement with WHO, the Uzbek Ministry of Health declared primary care quality management and improvement to be a national priority. In 2007, the WHO asked her Collaborating Centre NIVEL to develop a quality management instrument. This instrument, the Primary Care Quality Management Instrument, has been tested in three provinces in Uzbekistan (Fergana, Syrdarya en Tashkent). The Instrument consisted of three questionnaires that were completed by national experts from different stakeholder organizations in the health system, and by managers and GPs from the three regions.
The report provides assistance and focused recommendations to improve managing care quality in Uzbekistan. The recommended strategies can also be relevant to policy makers and GPs in other countries.