Health systems in transition : Uzbekistan

2.7.2 Health technology assessment 
In the first years after 1991, health technology assessment was mainly limited 
to the assessment of the safety of pharmaceuticals. The results of these 
assessments have been linked to the licensing procedure which granted access 
to the national pharmaceutical market. Assessments are carried out in two 
steps. First, the product is licensed to gain access to the Uzbek market or to be 
included in the pharmaceutical formulary. In this case, several characteristics of 
the pharmaceutical are taken into account, such as efficiency and effectiveness, 
based on the trials performed by pharmaceutical companies. Second, every lot 
(batch) of pharmaceuticals entering the market is assessed in terms of health 
and safety. Only upon approval will the retailer be allowed to sell it. 
With regard to medical equipment, an assessment is now required for any 
equipment to enter the Uzbek market. When publicly financed purchasing is 
carried out centrally, the Ministry of Health or other relevant public bodies are 
responsible for the registration (licensing) of the equipment. Examples of such 
cases are the purchases conducted within the World Bank project Health II (see 
Chapter 6) or centralized purchasing for emergency centres. In other instances, 
distributors of medical equipment are required to obtain prior permission when 
selling on the Uzbek market.
No data are available on regular systematic assessments of clinical 
procedures. There seem to have been a number of unsystematic assessment 
initiatives at major health care institutions. While they might have affected 
policy-making at the institutional level, it is unclear how these assessments 
were performed and how their results were implemented. 
With quality of care receiving more attention in recent years from 
Uzbekistan’s government and international agencies, several initiatives 
have been directed towards a more systematic process of health technology 
assessment. The launch of the Evidence-Based Medicine Centre within the 
Tashkent Institute for Advanced Medical Education, which had been supported 
by ZdravPlus on behalf of USAID, could contribute to the entry of health 
technology assessments into the clinical arena. Since its launch in April 2004, 
the Centre has produced a number of clinical practice guidelines. 

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Health systems in transition
  
Uzbekistan
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However, unified national definitions and mechanisms for developing and 
implementing clinical standards, guidelines and protocols are still lacking. 
Furthermore, the quality of the produced “guidelines” was, until very recently, 
often questionable. At present, a World Bank supported initiative is expected to 
aid in translating and adapting international guidelines on 25 noncommunicable 
conditions over the project cycle of Health III (see Chapter 6).