By Antoine Blua/Bruce Pannier
The collapse of the Soviet Union led to a deterioration in the availability and quality of health services in its former territory. In Uzbekistan, these problems have been exacerbated by the rapid increase of the rural population. In part three of a five-part series on the state of health care in the former Soviet bloc, RFE/RL correspondents Antoine Blua and Bruce Pannier report the situation has led to a significant growth in mortality rates as well as the spread of chronic and infectious diseases.
Prague, 22 March 2002 (RFE/RL) -- The Central Asian nation of Uzbekistan is the region's most populous country, with 25 million inhabitants. Moreover, that number is expected to double in just 50 years. The country's population explosion is placing great strain on a health-care system that has already been hard-hit by the economic difficulties caused by the collapse of the Soviet Union and the outmigration of many Slavic health-care personnel. The population boom means that even to merely maintain its current level of health care, Tashkent will need to more than double the amount of resources dedicated to health services.
Ali Buzurukov is a program officer at the United Nations Population Fund who works on Central Asian countries. The core activities of the Fund are training, technical assistance, and advocacy in many parts of the world, including various regions of Uzbekistan. Buzurukov believes the Uzbek population will continue to grow for the foreseeable future.
"Around 40 percent of the population in Uzbekistan is younger than 16 years old. So of course this makes the population of the country very young, with only a small fraction of the population older than 60. And it also influences life expectancy in Uzbekistan which is 73.1 for females and 68.2 for males," Buzurukov says.
The consequences of the population explosion are not the only challenges facing the health system of Uzbekistan. Efforts are under way to move away from the wholly state-subsidized Soviet model. Supplies of medicine are inadequate, while sicknesses long overcome in Western countries remain prevalent in Uzbekistan. Infant mortality remains much higher than in the more developed countries, at 72.13 per 1,000 live births compared to about 5 per 1,000 in the European Union.
Buzurukov says: "There is a relatively high infant mortality rate in Uzbekistan compared to European and North American countries. And part of the reason is that there are certain preventable diseases that affect the survival rate of children: acute respiratory diseases, diarrhea and metabolism disorders."
Buzurukov says the rapid population growth will require substantial resources and medical assistance in order to provide adequate medical services to pregnant women and newborns. He stresses the importance of nutrition, the provision of vitamin and mineral supplements, and proper vaccines to prevent the infectious diseases that are on the rise in the region.
According to the European Observatory on Health Care Systems, Uzbekistan's public expenditure on health care has been maintained at about 4.5 percent of the gross domestic product, compared to more than 8.5 percent in the EU. The World Bank noted in its "World Development Indicators" study that other health-care indicators have remained fairly steady in Uzbekistan. The number of hospital beds per 1,000 people has fallen to 8.3 from 11.5 in 1980, but the number of physicians per 1,000 people has increased from 2.9 to 3.3.
Public financing through the state budget is the main source of financing, although international organizations and foreign governments account for about 2-2.5 percent of the funds allocated to health care.
The inability of the state budget to fund the health care system more generously places some of the burden for medical care on foreign organizations who are advising the country's Health Ministry on low-cost preventative measures.
One such organization is the Washington-based United States Agency for International Development (USAID). Since 1992, the USAID Regional Mission for Central Asia (USAID/CAR) has provided more than $650 million in assistance to the five newly independent states of Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan.
Jennifer Adams is the director of the Office of Health and Population for USAID/CAR. She notes that the fertility rate among the country's rural population -- which constitutes more than 60 percent of the total population -- is increasing by more than three percent annually. She adds that although there is an adequate number of medical personnel, they need to improve their skills:
"They also have a very developed and sort of more-than-adequate-in-quantity health system in terms of the amount of facilities and number of doctors. They have probably more doctors per population than Western countries, for example. But one of the problems -- and particularly in rural areas -- over the past 10 years has been the underfinancing and inability of the Ministry of Health to maintain the numerous facilities that are part of its system. [Another problem] is also maintaining, in a certain sense, the continuing of education and the upgrading of skills of all its personnel," Adams says.
Adams says Tashkent is very aware of the need for continued training of doctors. In 1996, the government embarked on a program to upgrade and create facilities in rural areas.
USAID works extensively in the Ferghana Valley, the most densely populated area in Central Asia and also one of its most volatile regions. In 1996, the Uzbek section of the valley had a population density of 400 people per square kilometer, compared with the national average of 52.7. Adams says her organization has targeted the area to start a pilot program, called ZdravPlus, aimed at improving the Uzbek primary care system: "The ZdravPlus program is one of USAID's activities in Uzbekistan. ZdravPlus program is the organization which is working in the Ferghana Valley on the broad-base primary health care promotion and health reform, trying to create a more sustainable, cost-effective and higher-quality primary care system."
With the support of the Uzbek government, the USAID project developed and introduced the concept of medical management to Uzbekistan, designing courses on health-care organization and management, as well as training individuals for the role of practice managers. Practice managers are professionals taught to develop a budget and business plan for the management of health care funds, as well as to take care of the bookkeeping. Previously the only people employed in the health care sector were physicians and other care providers, whose work was almost entirely connected with, and managed by, hospitals.
ZdravPlus has also placed emphasis on clinical training, developing courses to treat nine specific ailments, including hypertension, diarrhea, acute respiratory infections, and reproductive problems.
Between 60 and 80 percent of women and young children in the Ferghana Valley suffer from anemia caused by an iron-poor diet. To call attention to the problem, ZdravPlus created a three-part television series entitled "Simple Truth" that promotes the consumption of meat and other iron-rich foods. At one point in the series, the young heroine faints because of her poor diet; only then do family members and the neighbors discover the hazards of iron deficiency.
Despite such inroads, however, Uzbekistan's health-care system will have to become more creative and flexible -- and better-funded -- to meet the needs of its growing population.