Uzbekistan : Primary Health Care Improvement Project
The project will support the Government of the Republic of Uzbekistan's health service optimization process, which aims to improve and expand primary health care services delivered in the rural areas. The proposed project will strengthen the rural health sector by providing the 793 newly established rural family polyclinics with modern diagnostic equipment and health workforce development to expand their service delivery. This will be supported by tools to monitor the government's broader primary health care reform and the project, and include a pilot of a health management information system in a rural region.
Project Details
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Project Officer
Ramesh, Kirthi
Sectors Group
Request for information -
Country/Economy
Uzbekistan -
Sector
- Health
Related Projects
Project Name | Primary Health Care Improvement Project | ||||
Project Number | 50190-002 | ||||
Country / Economy | Uzbekistan |
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Project Status | Active | ||||
Project Type / Modality of Assistance | Loan |
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Source of Funding / Amount |
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Strategic Agendas | Environmentally sustainable growth Inclusive economic growth |
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Drivers of Change | Gender Equity and Mainstreaming Governance and capacity development Knowledge solutions |
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Sector / Subsector | Health / Health system development |
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Gender | Gender equity theme | ||||
Description | The project will support the Government of the Republic of Uzbekistan's health service optimization process, which aims to improve and expand primary health care services delivered in the rural areas. The proposed project will strengthen the rural health sector by providing the 793 newly established rural family polyclinics with modern diagnostic equipment and health workforce development to expand their service delivery. This will be supported by tools to monitor the government's broader primary health care reform and the project, and include a pilot of a health management information system in a rural region. | ||||
Project Rationale and Linkage to Country/Regional Strategy | The Government of the Republic of Uzbekistan has identified the primary health care sector, particularly in rural and semi-urban areas, as a key focus area for reforms and improvement. They have initiated a health service optimization process, which aims to improve and expand primary health care services delivered in the rural areas. It will bring health services closer to the people and improve early diagnosis, treatment, and chronic care with the goal of improving healthy life expectancy and productivity. | ||||
Impact | Level of hospitalization, incidence, and disability of the population in the service areas reduced |
Project Outcome | |
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Description of Outcome | Availability of primary healthcare services in rural areas expanded |
Progress Toward Outcome | Ultrasound and ECG units have been delivered to all rural family polyclinics. Delivery of IT equipment is ongoing. Training is being carried out. |
Implementation Progress | |
Description of Project Outputs | Health services in family polyclinics in rural areas strengthened Capacity of polyclinic staff enhanced Primary healthcare monitoring tools institutionalized |
Status of Implementation Progress (Outputs, Activities, and Issues) | Ongoing (60% achieved in 10 regions) - Procurement for the different equipment is ongoing. - All RFPs have facility logs on the use of the instruments and operating theaters; and log of patient visits to monitor progress to achieve indicator. - In 3nd quarter of 2021 in 10 regions RFPs were provided 284,734 ECG and USG tests, out of them 169,751 (59.6%) for women Started (15%) - Procurement for the different equipment is ongoing - Equipment supplied under the project will be registered and integrated into the new NMC electronic inventory system (KitActive) after scale up. - On 26th of March NMC provided Excel sheets to collect data on equipment delivered so far for registration. Excel sheets might be further updated. Ongoing (60% achieved) -ECG and ultrasound machines have arrived in Uzbekistan. !ustoms clearance of equipment was carried out. All 801 RFPs received ECG devices and ultrasound machines. -All 7 training centers, and SamMI and AndMI received 1 USG and 1 ECG each, and the Center for the Development of Professional Qualifications of Medical Workers (previously TIPME) received 3 USGs and 3 ECGs. -Bidding documents for G07 package (medical equipment) have been submitted to ADB, MOH later awaited to address comments, advertisement to be done -G08 package (IT equipment) was advertised on 14th April and contracted on 13th September. Delivery of IT equipment in progress -All lung ventilators have been delivered to 269 facilities Ongoing (36.9% achieved) -296 (36,9%) of RFPs have at least both certified 1 ECG technology operator and 1 certified USG operator to operate electrocardiogram and ultrasound machines and read results. -296 RFPs (36.9.5%) have trained ECG operators and in 785 (98%) RFPs which received ultrasound machines ultrasound operators were hired. -Overall, 871 health technology operators have been certified to use standard (USG/ECG) since 2019. -207 RFP doctors have taken USG training and 51 doctors are currently receiving USG training -664 RFP doctors have taken ECG training -A draft Instruction Letter from the Ministry of Health to fund ECG trainings from the state budget was approved in 2021 Ongoing (80.5% achieved in 8 regions/13 regions) -According to data provided from Andijan, Kashkadarya, Navai, Namangan, Syrdarya, Surkhandarya, Fergana and Karakalpakstan regions, out of the total number of women technical and professional staff of all RFPs in the 8 regions, 80.5% (out of 18,755 female RFP employees, 15,091) have participated in their respective training in 2017-2022 as part of CME. Not yet started - Development of the data visualization tools follows development of PHC framework and indicators and is closely related to outputs 1 and 2. - ITMED, to be contracted, will support development of data visualisation tool. Ongoing (25%) -Initial discussions on PHC framework held with WHO and the Medical Statistics Department of MOH. -Initial mapping of indicators for PHC framework from routine HIS has started. -A draft concept paper for the PHC monitoring tools has been developed and shared with departments in MOH. -Development of a PHC indicator framework and national-level dashboard will be closely coordinated with WHO. -An expert working group of the Ministry of Health on the institutionalization of PHC monitoring tools was established in 2019. This group includes specialists from all relevant departments of the Ministry of Health. Such as, Department of Statistics, Department of Primary Health Care, Department of Economics and Finance, Department of Health Insurance and ITMED. An official letter from the MOH about the participation of a WHO and UNICEF representative in the work of this group has been sent to WHO and UNICEF. -Workshops with working group of MOH were started in February 2022. Working group decided to take as take as a basis PHC indicators that were approved by the MoH order #116 dated 31.05.2021, which were developed with participation WHO experts. PHC indicators were sent to USAID for comments. Started (5%) -RFP issued to ITMed on 8 November 2021. On January 31, 2022 PIU submitted to ADB Evaluation report of ITMed proposal for review. ADB to issue no objection to contract ITMed after PIU addressed all comments. - TA support for the development of an eHealth enterprise architecture was completed. |
Geographical Location | Nation-wide |
Safeguard Categories | |
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Environment | C |
Involuntary Resettlement | C |
Indigenous Peoples | C |
Summary of Environmental and Social Aspects | |
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Environmental Aspects | In compliance with ADB's Safeguard Policy Statement (2009), all the project's safeguard categories are category C. No civil works will be undertaken by the project. Environmental impacts during project implementation are expected to be minimal or none. Minimal healthcare waste may be generated by some of the equipment but the rural family polyclinics have existing healthcare waste facilities, policies, and protocols as well as sterilization equipment, policies, and procedures to manage it. |
Involuntary Resettlement | No involuntary resettlement is envisaged. |
Indigenous Peoples | The project will not impact any indigenous people as defined in ADB's Safeguard Policy Statement (2009). |
Stakeholder Communication, Participation, and Consultation | |
During Project Design | The mandate of community advisers (maslakhatchi) and womens' committee representatives includes responsibility for the health sector. They work in close collaboration with local government (khokimoyat) and regional health departments. Involvement of the community will contribute to the promotion of better primary health care services, national ownership and sustainability of the project, by building an awareness of and co-responsibility for the health matters and monitoring the quality of care. |
During Project Implementation | Continued involvement of the community and its advisers will contribute to the promotion of better primary health care services, national ownership and sustainability of the project, by building an awareness of and co-responsibility for the health matters and monitoring the quality of care. Project documents will be disclosed on the ADB website. |
Business Opportunities | |
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Consulting Services | All consultants will be recruited in accordance with the ADB's Guidelines on the Use of Consultants (2013, as amended from time to time). Individual consultants will be engaged using individual consultant selection (ICS) method. The least cost selection (LCS) will be used for the engagement of an audit firm with a contract amount of less than $100,000. Single source selection method will be used to engage ITMED (fomerly Uzmedinfo then CDICT; service provider) to expand the existing HMIS tools and develop a clinic management system (based on the existing infrastructure and platform) to monitor project and PHC reforms in the rural polyclinics. ITMED is an independent economic entity created by the MOH. Its charter explicitly mandates it to introduce information and communication technologies for MOH. Advance actions were undertaken for the recruitment of PIU staff. This included advertisement via the consulting services recruitment notices for ADB's prior review and approval. International experts will be hired for assistance in procurement and development of a Health Care Management Information Systems (HMIS) as well as for health systems performance and monitoring. National experts will be needed as legal, financial management, institutional and social and gender specialists. Further, national consultants with expertise in procurement, IT, training, medical equipment, M&E and accounting will be hired for the Project Implementation Unit. |
Procurement | All procurement of goods and works will be undertaken in accordance with ADB's Procurement Guidelines (2015, as amended from time to time). The project will provide various medical equipment, IT equipment and other related accessories to the family polyclinics, equipment related to the development of HMIS, office equipment, furniture and vehicle for the use of the project PIU staff. (i) International competitive bidding (ICB) procedures will be used for the procurement of the medical and IT equipment. (ii) Shopping will be used for the procurement of PIU equipment, furniture and vehicles. Shopping is a procurement method based on comparing price quotations from several suppliers with a minimum of three to assure competitive prices. |
Responsible ADB Officer | Ramesh, Kirthi |
Responsible ADB Department | Sectors Group |
Responsible ADB Division | Human and Social Development Sector Office (SG-HSD) |
Executing Agencies |
Ministry of Health |
Timetable | |
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Concept Clearance | 05 Aug 2016 |
Fact Finding | 14 Aug 2017 to 24 Aug 2017 |
MRM | 15 Sep 2017 |
Approval | 27 Nov 2017 |
Last Review Mission | - |
Last PDS Update | 20 Jul 2022 |
Loan 3600-UZB
Milestones | |||||
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Approval | Signing Date | Effectivity Date | Closing | ||
Original | Revised | Actual | |||
27 Nov 2017 | 09 Nov 2018 | 13 Dec 2018 | 30 Apr 2021 | 30 Jun 2024 | - |
Financing Plan | Loan Utilization | ||||
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Total (Amount in US$ million) | Date | ADB | Others | Net Percentage | |
Project Cost | 58.80 | Cumulative Contract Awards | |||
ADB | 45.00 | 25 Jan 2024 | 39.96 | 0.00 | 89% |
Counterpart | 13.80 | Cumulative Disbursements | |||
Cofinancing | 0.00 | 25 Jan 2024 | 34.63 | 0.00 | 77% |
Status of Covenants | ||||||
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Category | Sector | Safeguards | Social | Financial | Economic | Others |
Rating | - | Satisfactory | - | Satisfactory | - | Satisfactory |
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Safeguard documents provided at the time of project/facility approval may also be found in the list of linked documents provided with the Report and Recommendation of the President.
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ADB to Support Quality Primary Healthcare in Uzbekistan
ADB's Board of Directors has approved a $45 million loan to help improve the quality of rural primary healthcare services in Uzbekistan.
Tenders
Contracts Awarded
Contract Title | Approval Number | Contract Date | Contractor | Address | Executing Agency | Total Contract Amount (US$) | Contract Amount Financed by ADB (US$) |
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Supply of Medical Equipment, Instruments and Accessories (Lot 6: Gynecological Chairs) | Loan 3600 | 15 May 2023 | China Isotope & Radiation Corporation | No. 66 Changwa Zhongjie, Haidian district, Beijing | Ministry of Health | 1,191,472.00 | 1,191,472.00 |
Supply of Medical Equipment, Instruments and Accessories (Lot 3: Dental Units and Basic Dental Equipment) | Loan 3600 | 15 May 2023 | Guanzhou Fengdan Medical Equipment Co. Ltd. | A102 No. 286 Caxin Road, Lanhe Town, Nansha District, Guanzhou | Ministry of Health | 1,788,781.00 | 1,788,781.00 |
Rural Family Polyclinics Patients Satisfaction Survey (CS11) | Loan 3600 | 23 Nov 2022 | ITA FAKT LLC | Tashkent | Ministry of Health | 163,906.59 | 163,660.84 |
Software Service Provider for Primary Health Care Management Information System | Loan 3600 | 23 Nov 2022 | LLC ITMed | 4 Navai str., Shayhanta-hur district, Tashkent city 100011 | Ministry of Health | 602,640.18 | 600,260.66 |
Supply of lot 1: All-in-One Computers and UPS and lot 2: Three-in-One Printers B/W Printers and Thermal POS Printers | Loan 3600 | 15 Sep 2021 | AHA Inc. Co. Ltd. | 67 Hwanggeumro 109 beon-gil Yangchon-eup Gimpo-si Gyeonggi-do 10048 Korea | Ministry of Health | 3,729,639.88 | 3,729,639.88 |
INTERNATIONAL PROCUREMENT EXPERT/TEAM LEADER (PHCIP-IC-CS1) | Loan 3600 | 14 Jun 2019 | EDUARD CHIL-AKOPYAN | 42/2 ADMIRAL ISAKOV AVE. AP 25 YEREVAN ARMENIA, REPUBLIC OF | Ministry of Health | 100,540.00 | 100,540.00 |
Procurement Plan
Title | Document Type | Document Date |
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Primary Health Care Improvement Project: Procurement Plan | Procurement Plans | Jun 2022 |