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PRESIDENTIAL DECREE OF THE REPUBLIC OF UZBEKISTAN

of December 7, 2018 No. UP-5590

About complex measures for radical enhancement of health care system of the Republic of Uzbekistan

(as amended of the Presidential decree of the Republic of Uzbekistan of 12.11.2020 No. UP-6110)

Within implementation of measures for reforming of health care system in the republic the population managed to achieve certain results in forming of modern system of delivery of health care.

For the expired period the system of rendering primary health care by the organization of rural medical Items, city and rural family polyclinics is enhanced, its availability to the population is increased. The single centralized system of the emergency medical care is created, the network of the republican specialized scientific and practical medical centers rendering high-technology medical services to citizens including on places is enhanced.

Number of target national programs for strengthening of reproductive health of the population, health protection of mother and child is realized. Screening centers, the births of children providing the prevention with heritable and congenital diseases are organized republican and regional.

As a result of it for the period 1991 - 2017 the coefficient of general death rate decreased by 20 percent, maternal and infantile death rate - in time 3,1. Life expectancy since 1995 increased by 4,6 of year and made 73,7 of year.

At the same time, the system shortcomings and problems of the organization of activities of health care which collected in recent years interfere with effective solution of tasks on further enhancement of system of protection of public health. Among them:

the first, there are no concept and strategic objectives in planning and management of health sector therefore the undertaken reforms have fragmentary character and also requests of the population on quality of health care do not allow to meet expectations;

the second, the system of estimate financing of health sector is based on the mechanisms which were outdate, not corresponding to the international practice that leads to inefficient use of financial resources and chronic insufficient funding of industry;

third, the low performance of work on prevention and early detection of diseases, to patronage and forming of healthy lifestyle is the reason of increase in requests of citizens for specialized medical care;

the fourth, succession between various levels and stages of delivery of health care to the population, including recovery treatment and rehabilitation is poorly developed;

the fifth, the performed personnel policy does not allow to predict the prospects of providing with specialists at all levels of delivery of health care, especially primary link, and also training of organizers and managerial personnel of health care system;

the sixth, weak integration of medical practice with science and education against the background of the low innovative capacity of the specialized centers reflects the unsatisfactory level of implementation of the advanced achievements of medicine in medical and diagnostic process;

the seventh, there are no single standards in the sphere of electronic health care, the modern software products providing integration and effective management of medical services are not implemented, the existing information systems and technologies are separated and have narrowly targeted character.

For the purpose of the forming of conceptually new models of the organization and financing of health care providing cardinal increase in efficiency, quality and availability of medical care to the population, implementations of modern achievements of medical science and technologies and also according to tasks of Strategy of actions in five priority directions of development of the Republic of Uzbekistan in 2017 - 2021:

1. Consider the most important directions of reforming of health care system of the Republic of Uzbekistan:

enhancement of the legislation in health sector by its unification and adoption of the laws of direct action directed to improvement of quality of medical services and protection of the rights of patients, and also strengthening of responsibility and security of health workers;

forming of modern management system and "cluster" model of the organization of health care of regions providing integration of the best the practician of management and quality management of medical services on the basis of international standards, implementation of accreditation system of the medical and pharmaceutical organizations, licensing of medical and pharmaceutical activities;

enhancement of system of financing of health care, determination of amounts of the free medical care guaranteed by the state, implementation of payment system of medical services for "the treated case" in kliniko-costly groups and new mechanisms of per capita financing, and also step-by-step implementation of compulsory medical insurance;

increase in efficiency, quality and availability of medical care, support of healthy lifestyle and prevention of diseases, including by forming of system of medical standardization, implementation of high-technology methods of diagnostics and treatment, effective models of patronage and medical examination;

enhancement of system of maternity welfare and the childhood on the basis of development of medical genetics, the emergency and specialized medical care to women and children, implementations of modern programs of screening, creation in regions of multi-profile medical complexes and the information systems "Mother and Child";

development of private health care, public-private partnership and medical tourism, creating favorable conditions and improvement of competitive environment for broad investment attraction in health sector;

further development of pharmaceutical industry, enhancement of mechanisms of pricing, expansion of amounts and nomenclature of production of medicines, products of medical appointment and medical equipment;

forming of effective system of preparation, retraining and advanced training of medical personnel, development of medical science, including on the basis of certification (accreditation) of medical scientific and educational institutions on international standards, implementation of modern educational programs, methods and technologies;

widespread introduction of system of "electronic health care", creation of complex of the information systems and databases integrated on the basis of single national standards.

2. Approve:

The concept of development of health care system of the Republic of Uzbekistan for 2019 - 2025 (further - the Concept) according to appendix No. 1;

The program of measures for implementation of the Concept of development of health care system of the Republic of Uzbekistan in 2019 - 2021 (further - the Program) according to appendix No. 2.

Determine that heads of the ministries and departments bear the personal responsibility for timely, complete and high-quality implementation of actions, provided by the Program.

3. Accept offers of the Ministry of Health, the Ministry of Finance, the Ministry of Economics and National chamber of innovative health care of the Republic of Uzbekistan about:

implementation since January 1, 2022 according to the procedure of experiment of system of financing of the medical organizations for "the treated case" for kliniko-costly groups and per capita financing (further - new funding mechanisms) in certain areas of the republic according to appendix No. 3;

step-by-step distribution since January 1, 2022 of new funding mechanisms in all regions of the republic on the basis of the critical analysis of results of experiment;

introduction since July 1, 2019 of the mechanism of the mixed financing in stationary organizations regional and district levels (city) health care in case of which the treatment which is not entering amount of the guaranteed free medical care is performed on paid basis;

to transfer since July 1, 2019 of separate treatment and prevention facilities in trust management to investors in accordance with the established procedure on the basis of developed investment projects (further - investment projects);

step-by-step implementation since January 1, 2021 of compulsory medical insurance in the Republic of Uzbekistan.

4. To the Ministry of Health of the Republic of Uzbekistan (further - the Ministry) together with:

a) To provide with the Ministry of Finance, National chamber of innovative health care interested in the ministries and departments till July 1, 2019 development and entering into the Cabinet of Ministers of the Republic of Uzbekistan of the bill of the Republic of Uzbekistan "About compulsory medical insurance", providing:

legal basis, mechanisms and stages of implementation of compulsory medical insurance;

determination of subjects of compulsory medical insurance and authorized body on regulation of legal relationship in this sphere, their rights and obligations;

sources of forming of means of financing of programs of compulsory medical insurance;

b) The Ministry of Foreign Affairs of the Republic of Uzbekistan to take measures for the organization of interaction with the World Health Organization and the international financial institutions for ensuring technical assistance in case of implementation of this Decree, including carrying out the feasibility statement on actions for implementation of compulsory medical insurance.

5. Form the Working commission on implementation of measures, directed to cardinal enhancement of health care system (further - the Working commission) and to approve its structure according to appendix No. 4.

Determine the main objectives of the Working commission the organization of high-quality development and introduction in accordance with the established procedure of drafts of regulatory legal acts, and also acceptance of the practical measures directed to implementation of the Concept.

Working commission (A. A. Abdukhakimov):

in week time to create expert groups on preparation of drafts of regulatory legal acts with involvement of specialists of the ministries and departments, research and educational institutions, representatives of institutes of civil society, the leading foreign consulting companies and international organizations, to organize their effective work;

provide preparation of drafts of the regulatory legal acts provided by the Program on the basis of the critical analysis of the legislation, law-enforcement practice and the best foreign practices;

exercise constant control behind consecutive and high-quality preparation, timely consideration and introduction in accordance with the established procedure of drafts of regulatory legal acts, and also realization of other actions provided by the Program;

till April 1, 2019 to prepare investment projects on transfer of separate treatment and prevention facilities to trust management to investors in accordance with the established procedure and to provide their placement on the Investment portal of the State committee of the Republic of Uzbekistan on investments;

provide monitoring and wide circulation of the best the practician of application of public-private partnership in health sector.

6. Create the Agency of medico-social services under the Ministry of Health of the Republic of Uzbekistan (further - the Agency), having determined it the main objectives and activities:

forming and realization of single policy of the medico-public assistance directed to further enhancement and coordination of the medico-social services rendered aged, to persons with disability and to other socially vulnerable categories of the population;

development of the offers directed to further enhancement of regulatory framework for the purpose of creation of single comprehensive system of determination of disability;

the organization and coordination of activities of medico-social organizations in questions of medico-social servicing aged, persons with disability and other socially vulnerable categories of the population;

the organization and coordination of activities for providing the needing persons with prosthetic and orthopedic products and technical means of rehabilitation;

organizational and methodical management and coordination of activities of service of medico-social examination, rehabilitation of persons with disability.

7. Determine that:

The agency is independent legal entity, has balance, accounts in bank institutions, seal with the image of the State Emblem of the Republic of Uzbekistan;

The agency is headed by the director appointed to position and dismissed by the Cabinet of Ministers of the Republic of Uzbekistan;

the director of the Agency has one deputy appointed to position and dismissed by the Minister of Health of the Republic of Uzbekistan in coordination with the Cabinet of Ministers of the Republic of Uzbekistan;

the director of the Agency of the status, conditions of consumer, medical and transport services is equated to the deputy minister of health care of the Republic of Uzbekistan;

activities of the Agency are financed by the Government budget of the Republic of Uzbekistan and other sources which are not forbidden by the legislation.

8. Transfer in accordance with the established procedure from structure of the Ministry to the jurisdiction of the Agency of the house boarding schools Muruvvat and Sakhovat, the National center of rehabilitation and prosthetics of persons with disability, the regional rehabilitation centers for persons with disability, sanatoria and boarding houses for veterans of war and work, republican specialized professional colleges for persons with limited opportunities, Republican inspection of medico-social examination and its territorial subdivisions, the Republican rehabilitation center for assistance to the victims of human trafficking.

9. To the ministry in two-month time to submit for approval in the Cabinet of Ministers of the Republic of Uzbekistan structures and regulations on the Agency.

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