Transforming Rural Primary Healthcare Delivery in Uzbekistan

Uzbekistan has prioritized health system modernization and equitable access to care, particularly for rural populations who comprise nearly half of the country’s citizens. Early reforms improved service delivery but revealed the following persistent systemic constraints:

• highly centralized health system, with resource allocation favoring urban hospitals over rural facilities;
• inadequate equipment, trained staff, and information systems in rural family polyclinics;
• limited public health funding and high reliance on out-of-pockets payments that constrained affordability and utilization, especially for women and vulnerable groups; and
• institutional capacity gaps within the Ministry of Health, fragmented information systems, and weak monitoring frameworks that limited accountability and evidence-based planning.

These limitations, compounded by rising noncommunicable disease burden and demographic pressures, emphasized the urgency of strengthening primary health care infrastructure and capacity.

The Primary Health Care Improvement Project aimed to expand the availability and effectiveness of primary health care in rural areas, thereby reducing hospitalizations, diseases incidence, and disability. It implemented the following programs from 2017 to 2024:

• Upgrading rural family polyclinics: To enable earlier detection and better management of common and chronic conditions, the project provided diagnostic and treatment equipment.
• Strengthening primary health care workforce: To enhance service quality and promote gender-sensitive care, it held targeted training programs for doctors, nurses and technicians.
• Developing a health management information system: To institutionalize quality and performance monitoring, it piloted a health management information system in the Syrdarya Region (central part of Uzbekistan), laying the groundwork for nationwide rollout and digital transformation of primary health care reporting.
• Introducing complementary interventions: To ensure transparency and sustainability, the project initiated improvements in financial management capacity within the Ministry of Health and project implementation unit.

The project’s design reflected lessons from earlier ADB preparatory technical assistance on electronic healthcare development and aligned with Uzbekistan’s National Health Strategy and ADB’s Strategy 2030, particularly its operational priorities on human development and reducing inequalities. ADB supported the government in a nationwide implementation of the solutions instead of fragmented or pilot investments. This approach enabled tangible improvements in rural health infrastructure and service quality, ensuring that rural family polyclinics reach a common standard of diagnostic and preventive care.

It was designed to integrate three mutually reinforcing components: (i) modern equipment provision, (ii) competency-based workforce training, and (iii) rollout of a digital primary health care monitoring information system. Together with the use of digital tools for real-time, sex-disaggregated performance monitoring, this strengthened the culture of accountability and evidence-based planning within the Ministry of Health.

The implementation of the above solutions successfully improved the availability and quality of primary health care services in rural areas. All targeted 801 rural family polyclinics achieved operational readiness with functional electrocardiographs and ultrasonography devices in 99.8% of the health facilities, above the 70% target. Service utilization significantly increased, particularly among women seeking maternal and child health services, following new equipment installation and staff training.

Health facility staff consistently expressed high satisfaction with upgraded equipment, emphasizing that this enabled them to deliver diagnostic and preventive services previously unavailable at the primary health care level. Community members reported improved access and satisfaction, noting shorter travel distances, quicker diagnoses, and higher confidence in local care providers. Service uptake among women rose substantially, with many expressing comfort and trust in receiving services closer to home.

This resulted to stronger collaboration between local governments and the Ministry of Health, which helped ensure stable electricity and maintenance support, and improved staff morale.

The project successfully improved the availability and quality of primary health care services in rural areas. Two of the three outcome indicators exceeded their 2024 targets. All 801 rural family polyclinics achieved operational readiness with functional electrocardiographs and ultrasonography devices in 99.8% of the health facilities, above the 70% target. Service utilization significantly increased, particularly among women seeking maternal and child health services, following new equipment installation and staff training.

Findings from the review mission confirmed these results. Facility staff consistently expressed high satisfaction with upgraded equipment, emphasizing that it enabled them to deliver diagnostic and preventive services previously unavailable at the primary health care level. Community members also reported improved access and satisfaction, noting shorter travel distances, quicker diagnoses, and higher confidence in local care providers. Service uptake among women rose substantially, with many expressing comfort and trust in receiving services closer to home.

Additional positive effects included stronger collaboration between local governments and the Ministry of Health to ensure stable electricity and maintenance support, and improved staff morale. Shortage of health personnel in remote areas and gaps in behavioral change would require full support.

Strengthening human resources: A resilient primary health care system depends on a well-trained, motivated, and equitably distributed workforce. Equipment provision and training yield rapid service gains, but long-term sustainability requires a comprehensive human resource strategy. Recruitment, continuous professional development, and retention of skilled personnel, especially in rural and underserved locations, must be prioritized. Introducing incentives, such as rural service allowances, clear career pathways, supportive supervision, and a focus on staff wellbeing, can help maintain motivation and quality of care.

Optimizing referral pathways: Improving referral systems help ensure that patients receive seamless and timely care, particularly in critical areas such as perinatal, pediatric, cardiology, and oncology services. This requires not only the establishment of clearer, more efficient referral and counter-referral protocols but also the integration and strengthening of health management information systems for smooth transfer of information between providers. Enhanced data sharing and coordination will also reduce delays, minimize errors, and ensure patients are guided to the appropriate level of care as efficiently as possible.

Intensifying public health awareness efforts: Raising public awareness about health, preventive measures, and available primary health care services maximizes system impact. Health promotion campaigns, community engagement, and education initiatives can be scaled up to help people make informed decisions, adopt healthy behaviors, and utilize healthcare services more effectively.

Parallel attention to human resources, referral coordination, and community engagement is essential. Equipment and infrastructure alone deliver visible gains, but enduring impact depends on systemic and behavioral transformation sustained by motivated health workers and informed communities.

Contributions: Jenevieve Javier, Farida Djumabaeva, and Anna De Guzman provided inputs and coordination throughout the preparation process of the project completion report. Kirthi Ramesh shared overall project insights and Hayman Win advised on health systems and related context in Uzbekistan. ADB consultants Tamar Gotsadze, Pingling Yeoh, and Miharu Kimwell supported the project team at various stages of the final report.

Asian Development Bank (ADB). 2025. Aide Memoire: Primary Healthcare Improvement Project Completion Review Mission, 26 May to 2 June.

ADB. 2025. Primary Health Care Improvement Project in Uzbekistan: Completion Report. Asian Development Bank.

ADB. 2017. Primary Health Care Improvement Project: Report and Recommendation of the President. Asian Development Bank.