Health systems in transition : Uzbekistan

Fig. 2.4
Organizational structure of 
tuman
 or City medical unions  
 
 
 
 
 
 
 
Head of the Union – Chief 
Doctor of the Central 
District (City) Hospital 
 
 
 
 
 
 
 
 
 
 
Chief State
Sanitary Doctor
of District
 
Deputy Chief of Outpatient
Care – Head of the Central
District (City) Multidisciplinary
Health Centre
 
Central District (City) 
Hospital, with Emergency 
Care Unit 
 
 
 
 
 
 
 
Central District (City) 
Multidisciplinary Health Centre
a
 
 
 
 
 
 
 
 
 
Rural medical stations, family 
health centres (in the cities), 
dispensaries (outpatient) 
 
Obstetric complexes, 
specialized hospitals and 
dispensaries (with beds) 
 
 
 
 
 
 
 
a 
Includes adult, child and other specialized outpatient clinics. 

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Health systems in transition
  
Uzbekistan
18
Health authorities at 
tuman
 or city level have little oversight over the private 
sector. However, given the challenges in the quality of care, the Ministry of 
Health and local health authorities (especially at 
viloyat
 level) have been given 
more powers in controlling the quality of care in the private sector. 
While the reorganization of health care at 
tuman
 and city level and the 
establishment of 
tuman
 and City medical unions might improve the integration 
and coordination of care, it has given rise to some unforeseen challenges. The 
number of deputies, for example, was reduced from four to one, which has led to 
difficulties in the management of hospitals, hospital departments and polyclinics. 
An exception to this organization of regional health systems is the City of 
Tashkent, the capital and largest city in the country. Fig. 2.5 illustrates the more 
complex organizational structure of the health department in Tashkent.