PRESIDENTIAL DECREE OF THE REPUBLIC OF UZBEKISTAN

of May 19, 2025 No. UP-88

About measures for consecutive continuation of reforming of health sector by enhancement of this system and the principles of rendering medical services to the population in the republic

For the purpose of reforming of health care system on the basis of the best foreign practices, improvement of quality of the medical services provided to the population, I decide forming of modern system of rendering primary health care, and also implementation of new management principles to the sphere:

I. Purposes

1. Determine main objectives of implementation of new system of rendering primary health care to the population on the basis of the best foreign practices:

(a) implementation of new model of rendering the primary health care to the population based on the international experience;

(b) further approach of medicine to the population by the organization of activities of organizations of primary health care, in particular multi-profile central polyclinics, Items of the family doctor and family polyclinics, makhallinsky medical aid stations of areas (cities) on the basis of single approach;

(c) finishing share of family doctors in delivery of health care to the population to 70 percent;

(d) decrease in operational load of health workers to 30 percent by digitalization of health care system and reducing excessive paperwork in the sphere of medicine;

(e) increase in satisfaction of the population with primary health care to level more than 85 percent;

(e) implementation of system of material stimulation of health workers on the basis of activities key performance indicators;

(g) increase in knowledge and skills of workers of medical crews.

II. Pilot project

2. Implement as pilot project new model of the organization of health care system (further - pilot project) since July 1, 2025 - in certain areas (cities) according to appendix No. 1 *, since January 1, 2026 - in all districts (cities) of the Samarkand region.

3. Determine that within pilot project:

(a) based on medical associations of areas (cities) public health departments of areas (cities) are created;

(b) in system of primary health care:

(I) family polyclinics, Items of the family doctor, including the organizations attached to them as branch, and makhallinsky medical aid stations proceeding from quantity of the population attached to them are transformed to family polyclinics with the status of the legal entity and their branches;

(II) in family polyclinics services of the family doctor, the pediatrician, the obstetrician-gynecologist and specialists in diagnostics providing medical care to the population and also dental services - on outsourcing basis will be organized, with providing family polyclinics with the necessary medical equipment;

(III) the population is granted the right to the free choice of the family doctor;

(IV) between medical crew and the population attached to it the agreement determining the rights and obligations of the parties is signed;

(V) it is allowed to perform private family profession of a physician, and also to sign agreements on rendering primary health care between the population and private family doctors;

(VI) medical services to the population within the guaranteed amounts of medical care covered at the expense of means of the Government budget (further - the guaranteed packet), in the direction of the family doctor or medical crew are on free basis (except for rendering emergency and emergency medical service). The additional medical care and medical care which is not included in the guaranteed packet it appear to the citizens who directly addressed without the direction of the family doctor or medical crew on paid basis;

(VII) 3 thousand people are attached to medical crew, if necessary - the population attachment, in addition to the established regulation is allowed. At the same time the attachment to one medical crew at most of 1,7 thousand people is determined by strategic objective till 2030;

(VIII) in case of determination of regular standard rates of health workers in the remote and hard to reach areas, also in cases when population makes less than 3 thousand people, the number of staff of medical personnel at least one established post irrespective of quantity of the attached population is entered, at the same time they are accepted on principle place of employment on complete rate;

(IX) in family polyclinics health workers will perform activities only on complete rate;

(X) between family polyclinics, private family doctors and Fund of national health insurance the agreement of purchase of medical services is signed and financing is performed proceeding from the number of the attached contingent per capita;

(XI) workers of medical crews study according to the four-stage special training program of family health developed on the basis of the best practices, and to the health workers who successfully passed tests the certificate is issued;

(XII) for the population living in descents of citizens makhally, more than 10 kilometers located at distance from family polyclinic rendering exit medical services by health workers takes root;

(c) in the direction of rendering specialized medical services in areas (cities):

(I) multi-profile central polyclinics of areas (cities) are transformed to consulting and diagnostic departments of the relevant central hospitals, for rendering primary health care the population is not attached to them;

(II) planned stationary medical services are rendered to the population based on the direction of the doctor in hospitals according to the procedure, No. PP-311 established by the resolution of the President of the Republic of Uzbekistan of September 5, 2024 "About measures for implementation of mechanisms of national health insurance", according to the procedure of priority on free basis;

(III) between Fund of national health insurance and hospitals the agreement of purchase of medical services is signed and financing is performed for each treated case proceeding from actually executed amount of works;

(IV) the interregional central laboratory service serving departments as a part of hospitals and family polyclinics is created;

(V) control of rendering in hospitals of medical services based on the approved standards of diagnostics and treatment, and also clinical protocols is performed by the Ministry of Health and Fund of national health insurance. At the same time in cases of non-compliance with established procedure of rendering medical services the Fund of national health insurance does not finance expenses, their covering is performed by extrabudgetary funds of the serving medical institution;

(d) the procedure for calculation of the salary of health workers on base wage rates in the sizes approved according to appendix No. 2 * with combination of allowances for qualification category, length of service and other allowances of health workers of organizations of primary health care takes root;

(e) to base wage rates of health workers of organizations of primary health care the additional allowance in the following sizes is paid:

(I) 50 percent of monthly official pay rate or base wage rate to the health workers rendering exit medical services;

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