Health systems in transition : Uzbekistan

2.7 Health information management
2.7.1 Information systems
Despite efforts at modifying the system, the current data collection system 
is fragmented and primarily focuses on structural data, with little effort to 
collect process-related and qualitative data. Public health facilities are required 
to report data to different data collecting agencies. Five major data collection 
mechanisms can be identified (Olson, 2003):
1. 
Ministry of Health
: the Institute of Health and Medical Statistics collects 
data from all public health care facilities through so-called 
tuman
 
organizational and methodological units. The collected data are then 
pooled at the 
viloyat
 branches of the Institute of Health and Medical 
Statistics, and then in turn at its central office in Tashkent;
2. 
Sanitary and epidemiological system
: the data collection for the sanitary 
and epidemiological services operates separately from the Institute of 
Health and Medical Statistics system. It is mainly concerned with data 
related to infectious diseases and hygiene and is the track most often 
used for decision-making purposes at all levels. Data are collected from 
all public health care facilities. They are first pooled at the sanitary and 
epidemiological units at 
tuman
 level, and then at the 
viloyat
 and national 
sanitary and epidemiological departments. 
3. 
Programmes
: national programmes develop their own reporting systems 
for monitoring and evaluation purposes. Examples of such a data 
collection systems are the Republican Specialized Research Centre for 
Phthisiology and Pulmonology with its nationwide dispensary system 
and the nationwide HIV/AIDS network; 
4. 
State Statistics
: the Ministry of Macroeconomics and Statistics requires 
separate reporting of health data through its 
viloyat
 and 
tuman
 branches. This 
data collection system covers indicators on mortality, births and logistics;

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Health systems in transition
  
Uzbekistan
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5. 
Parallel health systems
: parallel health systems maintained by the 
National Security Service, the Ministry of Internal Affairs, Uzbek 
Airlines and other ministries or state companies use separate reporting 
systems. Some of the data collected by these parallel systems might, 
however, at some stage be incorporated into the data collection systems of 
the Ministry of Health or the Ministry of Macroeconomics and Statistics. 
All data collection systems function independently from each other. It is 
not entirely clear how far the data collection systems are coordinated or if any 
data are pooled at the different levels of data collection. The Institute of Health 
and Medical Statistics is the primary data collection agency for the Ministry 
of Health. Although the sanitary and epidemiological services form part of 
the Ministry of Health and Medical Statistics, they collect data relevant to 
their functions of infectious control and health promotion separately from the 
Ministry of Health system.
Based on the collected data, the Institute of Health, which was established 
in 2001, produces a number of different regular reports which are distributed to 
relevant agencies within the Ministry of Health. All these reports are designed 
to facilitate decision- and policy-making at the national or 
viloyat
 levels, with 
little attention to the local (
tuman
 and facility) levels. Data collection heavily 
focuses on quantitative indicators which might be related to the predominant 
use of data for planning and control purposes. Another challenge of the health 
information system is that a number of relevant factors are generally not taken 
into account or integrated during analysis, such as those related to ethnicity, 
income or education. The lack of analytical and statistical training for policy-
makers and high-level managers, as well as the staff of the Institute of Health 
and Medical Statistics, further limits the extent to which health data can be used. 
Data collection and pooling within the health system and by the Institute of 
Health and Medical Statistics is primarily done manually. The data collection 
process conducted by the Institute of Health and Medical Statistics is mostly 
limited to the public sector. At present, there are no effective tools or systems to 
ensure accurate collection of data in the private sector and positive incentives 
for accurate reporting are lacking. In addition, although the government has 
streamlined the data collection process in recent years, the range of indicators 
for which data are collected is still immense (Streveler, 2004). 
In view of the recent expansion of the private sector, in which little data 
collection is performed, and barriers to accessing care (such as out-of-pocket 
payments and limited pharmaceutical coverage), some health indicators, such 
as on noncommunicable disease, have to be treated with considerable caution. 

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In order to obtain data not well captured by the public data collection system, a 
number of surveys have been conducted. Important examples are the Demographic 
and Health Surveys, conducted jointly by the Ministry of Health and the United 
States Agency for International Development (USAID) in 1996 and 2002, and 
UNICEF Multiple Indicator Cluster Surveys, conducted in 2000 and 2006.