ADB to Help Improve Woman and Child Health Care in Uzbekistan

MANILA, PHILIPPINES (28 September 2004) - ADB is supporting primary health care reform and building the health care delivery system for woman and child health in Uzbekistan, through a loan approved for US$40 million.

The project, ADB's first for the country's health sector, has put ADB among the leading donor agencies supporting health sector reform in Uzbekistan. The Project will focus on poor rural women and children, and will be carried out in six of the country's 13 oblasts (districts) - Buhkara, Fergana (pilot site), Kashkadarya, Khorezm, and Tashkent, and the Republic of Karakalpakstan - selected for their high poverty rates and health problems.

The national maternal mortality ratio, officially estimated at 34 per 100,000 live births in 2001, has not improved since the 1990s. The infant mortality rate at 62 deaths per 1,000 live births in 2002 has also changed little since the early 1990s. Wide geographical disparities exist, with rural areas reporting almost double the rate of urban areas.

The incidence of communicable diseases is also increasing. HIV/AIDS registered cases have almost doubled in the past two years, while tuberculosis incidence has doubled over the past decade.

The overall goal of the Project is to help the Government achieve health related Millennium Development Goals, including reducing maternal and child mortality and morbidity, and reducing infectious diseases among the rural poor and vulnerable.

To achieve this, the Project has two broad objectives - to support health sector reform initiatives for primary health care, and improve the efficiency of the health care delivery system for woman and child health.

"Investments are designed to shift some resources from hospitals in urban settings to rural clinics servicing less accessible and less prosperous communities," says Karima Saleh, an ADB Health Economist.

While Uzbekistan reports good health coverage, it lacks quality. Woman and child-health services are fragmented and limited at the rural clinic level; a service rationalization and integration plan is needed within a health system framework.

Public sector resource allocation for health as a share of the gross domestic product has also steadily declined since the country's independence from the Soviet Union in 1990. Further, wide inter-regional inequities in financing exist, with poorer regions spending less per capita on health care than the richer ones.

The project will strengthen management of local governments, strengthen quality of care in rural clinics, provide referral links to rural secondary hospitals, optimize human resources, and build institutional capacity for retraining doctors and nurses.

It will also help prevent the spread of blood-borne infectious diseases, including HIV/AIDS, by building a nationwide blood safety program. In addition, the project will support reform efforts in health care finance, and build capacity to manage these reforms to increase health system efficiency.

The project complements the World Bank's Health-II project, which supports the Government's primary health care initiative.

A $300,000 technical assistance grant will accompany the loan to provide training to the Ministry of Health on woman and child-related health issues.

The total cost of the project is $70 million equivalent, of which the Government is providing $30 million. ADB's loan comes from its ordinary capital resources and carries a 25-year term, including a grace period of five years. Interest is determined in accordance with ADB's LIBOR-based lending facility.

The Ministry of Health will implement the project, which is due for completion in December 2009.

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