Uzbekistan : Primary Health Care Improvement Project

Sovereign Project | 50190-002

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

Related Projects

Project Name Primary Health Care Improvement Project
Project Number 50190-002
Country / Economy Uzbekistan
Project Status Active
Project Type / Modality of Assistance Loan
Source of Funding / Amount
Loan 3600-UZB: Primary Healthcare Improvement Project
Concessional ordinary capital resources lending US$ 45.00 million
Strategic Agendas Environmentally sustainable growth
Inclusive economic growth
Drivers of Change Gender Equity and Mainstreaming
Governance and capacity development
Knowledge solutions
Sector / Subsector

Health / Health system development

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
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
Environment C
Involuntary Resettlement C
Indigenous Peoples C
Summary of Environmental and Social Aspects
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
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
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
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
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
Category Sector Safeguards Social Financial Economic Others
Rating - Satisfactory - Satisfactory - Satisfactory

Project Data Sheets (PDS) contain summary information on the project or program. Because the PDS is a work in progress, some information may not be included in its initial version but will be added as it becomes available. Information about proposed projects is tentative and indicative.

The Access to Information Policy (AIP) recognizes that transparency and accountability are essential to development effectiveness. It establishes the disclosure requirements for documents and information ADB produces or requires to be produced.

The Accountability Mechanism provides a forum where people adversely affected by ADB-assisted projects can voice and seek solutions to their problems and report alleged noncompliance of ADB's operational policies and procedures.

In preparing any country program or strategy, financing any project, or by making any designation of, or reference to, a particular territory or geographic area in this document, the Asian Development Bank does not intend to make any judgments as to the legal or other status of any territory or area.


Safeguard Documents See also: Safeguards
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.

None currently available.


Evaluation Documents See also: Independent Evaluation

None currently available.


Related Publications

None currently available.


The Access to Information Policy (AIP) establishes the disclosure requirements for documents and information ADB produces or requires to be produced in its operations to facilitate stakeholder participation in ADB's decision-making. For more information, refer to the Safeguard Policy Statement, Operations Manual F1, and Operations Manual L3.

Requests for information may also be directed to the InfoUnit.

Tenders

Tender Title Type Status Posting Date Deadline
Accounts Assistant Individual - Consulting Closed
Accountant Individual - Consulting Closed
Medical Equipment Specialist Individual - Consulting Closed
Administrative Assistant/ Interpreter/Translator Individual - Consulting Closed
Project Coordinator - Pilot l/T Individual - Consulting Closed
Procurement Specialist Individual - Consulting Closed
Monitoring & Evaluation Specialist Individual - Consulting Closed
Project Manager Individual - Consulting Closed
Regional PIU coordinators Individual - Consulting Closed
Project Coordinator - Training Individual - Consulting Closed
International Team Leader/Procurement Specialist Individual - Consulting Closed
International Health Information Management Expert Individual - Consulting Closed
International Health Systems Performance monitoring and evaluation expert Individual - Consulting Closed
3600-UZB: Primary Health Care Improvement Project [PHCIP/ICB-G1] Invitation for Bids Closed
Legal Expert Individual - Consulting Closed
Institutional Expert Individual - Consulting Closed
Social and Gender Expert Individual - Consulting Closed
Regional Project Coordinator in Khorezm oblast of the Republic of Uzbekistan Individual - Consulting Closed
Regional Project Coordinator in Tashkent oblast of the Republic of Uzbekistan Individual - Consulting Closed
Regional Project Coordinator in Fergana oblast of the Republic of Uzbekistan Individual - Consulting Closed
Regional Project Coordinator in Namangan oblast of the Republic of Uzbekistan Individual - Consulting Closed
Project Coordinator - Pilot l/T Individual - Consulting Closed
Regional Project Coordinator in Jizzakh oblast of the Republic of Uzbekistan Individual - Consulting Closed
Regional Project Coordinator in Navoi oblast of the Republic of Uzbekistan Individual - Consulting Closed
Regional Project Coordinator in the Karakalpakstan Republic of the Republic of Uzbekistan Individual - Consulting Closed
Regional Project Coordinator in Kashkadarya oblast of the Republic of Uzbekistan Individual - Consulting Closed
Regional Project Coordinator in Syrdarya oblast of the Republic of Uzbekistan Individual - Consulting Closed
Regional Project Coordinator in Samarkand oblast of the Republic of Uzbekistan Individual - Consulting Closed
Regional Project Coordinator in Andijan oblast of the Republic of Uzbekistan Individual - Consulting Closed
Regional Project Coordinator in Surkhandrya oblast of the Republic of Uzbekistan Individual - Consulting Closed
Regional Project Coordinator in Bukhara oblast of the Republic of Uzbekistan Individual - Consulting Closed
Financial Management Expert Individual - Consulting Closed
Selection of Audit Firm (National) for periods ending 31 December 2019, 31 December 2020 and 30 April 2021 (CS10) Firm - Consulting Closed
Social and Gender Expert Individual - Consulting Closed
Regional Project Coordinator in Navoi oblast of the Republic of Uzbekistan Individual - Consulting Closed
Project Coordinator - Pilot l/T Individual - Consulting Closed
Rural Family Polyclinics Patients Satisfaction Survey Firm - Consulting Closed
Administrative Assistant/ Interpreter/Translator Individual - Consulting Closed
Regional Project Coordinator in Khorezm oblast of the Republic of Uzbekistan Individual - Consulting Closed
National Medical Education Expert Individual - Consulting Closed
Behavior Change Communication Consultant Individual - Consulting Closed
Regional Project Coordinator in Tashkent oblast of the Republic of Uzbekistan Individual - Consulting Closed
UZB: 3600-UZB: Primary Health Care Improvement Project [PHCIP/ICB-G8] Invitation for Bids Closed
Medical Equipment Specialist Individual - Consulting Closed
Administrative Assistant/ Interpreter/Translator Individual - Consulting Closed
Medical Equipment Specialist Individual - Consulting Closed
Project Coordinator - Pilot l/T Individual - Consulting Closed
Procurement Specialist Individual - Consulting Closed
Project Manager Individual - Consulting Closed
Administrative Assistant/Interpreter/Translator Individual - Consulting Closed
Regional Project Coordinator in Khorezm oblast of the Republic of Uzbekistan Individual - Consulting Closed
Project Coordinator – Pilot IT Individual - Consulting Closed
Project Manager Individual - Consulting Closed
Procurement specialist Individual - Consulting Closed
Legal Expert Individual - Consulting Closed
Procurement specialist Individual - Consulting Closed
Regional Project Coordinator in Tashkent oblast of the Republic of Uzbekistan Individual - Consulting Closed
Selection of the National Procurement Consultant Individual - Consulting Closed
3600-UZB: Primary Health Care Improvement Project [PHCIP/ICB-G7] Invitation for Bids Closed
the Monitoring and Evaluation Specialist Individual - Consulting Closed
Health Info Management Expert (IT expert) Individual - Consulting Closed
International Health Systems Performance monitoring and evaluation expert Individual - Consulting Closed
the Project Coordinator – Pilot IT Individual - Consulting Closed
the Monitoring and Evaluation Specialist Individual - Consulting Closed
Regional Project Coordinator in Navoi oblast of the Republic of Uzbekistan Individual - Consulting Closed

Contracts Awarded

Contract Title Approval Number Contract Date Contractor | Address Executing Agency Total Contract Amount (US$) Contract Amount Financed by ADB (US$)
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
Primary Health Care Improvement Project: Procurement Plan Procurement Plans Jun 2022