RESOLUTION OF THE PRESIDENT OF THE REPUBLIC OF UZBEKISTAN

of January 20, 2023 No. PP-12

About measures for further development of service of phthisiology and pulmonology in 2023 - 2026

In the republic purposeful work on public health care and protection against tuberculosis infection, prevention of spread of tuberculosis and nonspecific diseases of lungs is carried out.

In particular, according to the resolution of the President of the Republic of Uzbekistan of February 13, 2019 No. PP-4191 "About measures for enhancement of system of rendering the specialized ftiziatrichesky and pulmonary help" are performed the following events:

by 2021 the indicator of incidence of tuberculosis on 100 thousand of the population constituted 35,2, death rate indicator - 1, that in comparison with indicators of 2019 decreased respectively on percent 9,3 and 16,6;

as a result of rendering the psychosocial help by multidisciplinary groups the number of the patients who were not observing treatment terms in system decreased twice;

preventive treatment completely covers 12 thousand persons entering into risk group at which the latent form of tuberculosis infection is revealed;

in organizations of primary health care of 80 areas in practice the modern express method of molecular and genetic diagnostics is implemented.

At the same time for the purpose of strengthening of measures of prevention of tuberculosis and nonspecific diseases of lungs, and also ensuring execution of the tasks determined within open dialogue of the President of the Republic of Uzbekistan with representatives of health sector who is carried out on March 18, 2022 on the subject "Reforms in Medicine — for Human Dignity":

1. Determine that the Republican specialized scientific and practical medical center of phthisiology and pulmonology (further - the Center) is the main organization in the country on prevention, diagnostics, treatment of ftiziatrichesky and pulmonary diseases, and also providing these spheres with highly qualified specialists.

2. Determine the main objectives of the Center for prevention, screening and early identification, treatment and counteraction of spread of tuberculosis and nonspecific diseases of lungs:

enhancement and upgrade of specialized systems of phthisiology and pulmonology in healthcare institutions on the basis of the best foreign practices;

ensuring system interrelation between regional (republican), district (city) territorial medical institutions in the directions of phthisiology and pulmonology, and also methodical vertical management;

increase in amounts of rendering qualified ftiziatrichesky and pulmonary medical care to the population by the organization under district (city) ftiziatrichesky organizations of day hospitals within the available medical beds and established posts, and also the organization of rehabilitation observation of nonspecific diseases of lungs in the centers of ftiziatrichesky rehabilitation of the republic;

implementation of the regular analysis and monitoring of epidemic situation on tuberculosis and nonspecific diseases of lungs, forecasting of tendencies of spread of diseases, forming of offers and maintaining the national electronic register of patients;

provision of the expert review on the fundamental, applied and innovative projects and scientific research directed to prevention, diagnostics and treatment of tuberculosis and nonspecific diseases of lungs;

development and deployment in practice of screening programs within annual medical examination for early identification of preclinical displays of pathology of lungs;

increase in share of high-technology surgeries in the Center and regions by implementation in practice of high-technology methods of diagnostics and treatment;

support of patients by means of digital technologies and expansion of method of video control of out-patient treatment;

improvement of quality of life and training in bases of prevention of aggravation of patients with nonspecific diseases of lungs, way of the organization in case of multi-profile central polyclinics of "schools of asthma and chronic obstructive diseases of lungs";

the organization under the territorial centers of phthisiology and pulmonology of the centers of innovative distance training and monitoring within the available beds and established posts.

3. Approve Target indicators on development of service of phthisiology and pulmonology in 2023 - 2026 according to appendix No. 1.

4. Agree with the offers of the Ministry of Health directed to enhancement of the systems of phthisiology and pulmonology providing:

a) the organization of ftiziopulmonologichesky departments within the available established posts of the phthisiatrician and pulmonologist based on ftiziatrichesky departments and offices as a part of district (city) multi-profile central clinics for the purpose of creation of district link of complete vertical of system in the sphere;

b) the translation without change of bed fund of organization of the staff of the chief pulmonologist from the regional multi-profile medical centers, in the regional centers of phthisiology and pulmonology.

To the Ministry of Health (A. Inoyatov) together with the Ministry of Economics and finance (Sh. Kudbiyev), the Ministry of reducing poverty and employment (B. Musayev) till July 1, 2023 to approve updated regular standard rates for all links taking into account features of ftiziatrichesky diseases and processes of enhancement of systems of phthisiology and pulmonology.

Grant to the Center the right of entering into the Ministry of Health of reasonable offers on redistribution of medical beds of the public medical institutions performing activities in the sphere of phthisiology and pulmonology, including their divisions proceeding from amount of works and the available requirements;

c) the organization of the centers "Apnoe Dream" within established posts and the funds allocated to the regional centers of phthisiology and pulmonology for the purpose of diagnostics and treatment of violations of quality of night dream and respiratory function.

5. Establish procedure according to which since 2023 annually:

a) finishing is provided:

the number of screening inspections on latent tuberculosis infection - to 1 million;

scope treatment of persons with latent tuberculosis infection - to 21 thousand;

scope the express the gene and molecular diagnostics determining resistance of tubercular mikobakteriya to medicines of the 1st row, and also at the same time antitubercular medicines of the 1st and 2nd row - prior to 120 thousand researches;

providing with medicines - to 18 thousand TB patients, including:

medicines of the 1st row (suffering from tuberculosis, sensitive to antitubercular medicines) - to 15 thousand;

medicines of 2nd and 3rd row (patients resistant to antitubercular medicines) - to 3 thousand;

b) till March 1, 2023 district (city) medical associations from among the population assigned to them constitute lists of the persons belonging to risk group, having predisposition to disease of tuberculosis;

c) are carried out by specialists of district (city) medical associations for persons belonging to risk group of disease of tuberculosis:

radiological inspection of teenagers and adults;

immunological inspection of children;

d) for the purpose of early detection of latent tuberculosis infection at the staff of organizations of execution of the punishment and guard troops of the Ministry of Internal Affairs which are in direct contact with the prisoners containing in organizations of execution of the punishment the relevant screening activities within annual routine inspections are held.

To the Ministry of Health together with the Ministry of Internal Affairs for the purpose of radical improvement of process of diagnostics of persons with latent tuberculosis infection in two-month time to make in the Cabinet of Ministers the offers providing purchase test diagnostikumov for screening of risk groups and also approval of the annual schedule of carrying out screening since 2023.

6. To the Ministry of Health (A. Inoyatov):

provide till March 1, 2023 development, and also the subsequent technical and program support by limited liability company "IT Med" under establishment of the Ministry of Health of the Unified electronic register of ftiziatrichesky diseases (further - the Register) at the expense of the funds allocated for digitalization of health care system;

till July 1, 2023 to organize in the Center maintaining the Register, and also implementation of the Register in regional divisions of the Center, in the public institutions performing activities in the sphere of phthisiology on republican, regional and district (city) levels, and also in their divisions, including their mutual integration.

7. Within mobile crew "Pulmonary Health" to hold screening events during free medical examination of the population living in the remote, remote, ecologically adverse territories.

To the Ministry of Health together with JSC Uzavtosanoat to develop and approve technical parameters of the specialized vehicle based on the minibus "Isuzu" intended for the remote, remote and mountain territories.

8. Agree with offers of the Center:

about recovery in the name of the Center of name of the academician Shokir Alimov taking into account its significant contribution to creation of school of treatment of tuberculosis in the country;

about the organization under the Center of the school of sciences of Shokir Alimov accumulating basic and applied innovative researches taking into account current trends on respiratory diseases within the available medical beds and established posts;

about creation as a part of the Center of National referens-laboratory. At the same time to determine that construction expenses of National referens-laboratory are covered at the expense of means of the Government budget, and expenses on equipping - at the expense of means of the international grants;

about the organization of activities of the scientific and practical training center for domestic and international specialists of microbiological laboratories at the expense of means of the Center and sponsor's means;

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