Health

1. PROGRESS AND WAY
FORWARD
UNDAF UZBEKISTAN 2016-
2020
Joint UN-Government
UNDAF Results Group on
HEALTH

2. CONTENT
Global mandate
National development context
Some indicators of the health status: where we are and the way forward
UNDAF outcome 4: Key achievements
Lessons learned
Key focus of joint work plans 2018-2020
Actual spending 2016-2017
National stakeholders, international donors and partners
2

3. GLOBAL MANDATE
3
SDG 3: Ensure healthy lives and promote well-being
for all at all ages
WHO guiding policies & acts: WHO Health 2020 policy
framework; WHO resolutions & legally binding documents
(FCTC & IHR)
UNDAF Outcome 4: By 2020, all people
benefit from quality, equitable and accessible
health services throughout their life course
National Priorities:
 Improving public health and reducing the
inequalities in access to health services
 Ensuring adequate financial protection of the
population in obtaining health services
 Ensuring population satisfaction with the health
services

4. NATIONAL DEVELOPMENT
CONTEXTOverarching strategic framework
Government Strategy of Actions for the Development of Uzbekistan
for 2017–2021: an impressive array of institutional health and health
related reforms
HEALTH IS EVERYBODY’S BUSINESS
Progress in UNDAF implementation for 2016-
4

5. SOME INDICATORS OF THE HEALTH STATUS:
WHERE WE ARE AND THE WAY FORWARD
5
The total mortality rate from all causes in 2017
was 5.0 per 1000 of the population. In Russia, the
overall mortality rate was 13.1 per thousand, in
Turkey - 4.7, Great Britain - 8.8, Germany - 10.8.
The maternal mortality ratio was 17.7
cases per 100,000 live births in 2017.
Fig.1 The dynamics of total mortality 1991-
2017
Fig. 2 The dynamics of maternal
mortality

6. 6
SOME INDICATORS OF THE HEALTH STATUS:
WHERE WE ARE AND THE WAY FORWARD
Since 1991 , the infant mortality rate has been
steadily declining (by 3.1 times), and it was
11.3 per 1,000 live births in in 2017.
Fig. The dynamics of infant mortality
1991-2017
The significant improvement in the health of the
population of Uzbekistan over the past decades
has led to an increase in the average life
expectancy.
Fig. The dynamics of life expectancy in 1991-2016

7. 7
The main cause of death are diseases of the
circulatory system, from which 95,952 people
died (59.7% of the deceased in 2017). Of the
total deaths in the population, 9,5 % have been
due to neoplasms , 6,6% - due to external
causes.
SOME INDICATORS OF THE HEALTH STATUS:
WHERE WE ARE AND THE WAY FORWARD
Fig. Structure of incidence in the population
2017
Fig. The average length of the patient's
hospital stay in 1991-2017.
Length of patient's hospital stay in foreign
countries depends largely on the level of the
clinic and the country. Therefore, the average
length of stay in hospitals in Turkey is 4
days, in the UK - 8 days, in Germany - up to
10 days.

8. THE WAY FORWARD
8
HEALTH REFORM
• UZB Concept for health development until 2030
• Improving public health and reducing the
inequalities in access to health services
• Ensuring adequate financial protection of the
population in obtaining health services
• Ensuring population satisfaction with the health
services
• National Health Strategy until 2023
• Operational Plan until 2023

9. KEY ACHIEVEMENTS
Communicable Diseases
• TB
• case notification decreased two times and mortality to three times-2017, since 2002
• HIV
• WHO “Consolidated guidelines on the use of the antiretroviral drugs for treating and preventing HIV infection” adopted
• Support to children living with HIV through a network of seven Day-Care Centers provided. (2,886 boys and 2,178 girls and
their families received psychosocial support, information about HIV, opportunistic diseases associated with HIV/AIDS and
adherence to ARV)
• Procurement of ARV and diagnostic test-system supported
• Republican AIDS Center assumed the role of the Principal Recipient of GFATM grants from July 2016;
• Government moved towards self-financing of programmes to counter communicable diseases;
• Institutionalization of HIV sentinel surveillance (now performed biannually; such surveillance has a central role in decision
making with regard to HIV and AIDS policy);
• 100% of HIV positive pregnant women received ARVT to reduce risk of MTCT.
• Immunization
• Polio-free certified
• Measles and Rubella eliminated
• National Immunization calendar expended to cover 11 vaccines against 13 antigens
• Strengthened safe immunization programme infrastructure at national and regional levels & human resources capacity &
budget forecasting.
9
Progress in UNDAF implementation for 2016-

10. KEY ACHIEVEMENTS
NCD:
2012 –WHO Framework Convention on Tobacco Control ratified
& National law on tobacco and alcohol restriction adopted
2015 –Presidential Decree on Nutrition adopted (with integrated
NCD approach measures)
From 2014 –WHO package of NCD Essential interventions (WHO
PEN) implemented
From 2017 – Uzbekistan selected as a demonstration country
for comprehensive cervical cancer prevention and control (UN
joint programme)
10
Progress in UNDAF implementation for 2016-

11. KEY ACHIEVEMENTS
11
Progress in UNDAF implementation for 2016-
Life course approach: Mother and child health
• By 2015 - MDG 4: at national level, under-five mortality rate has decreased by half and reduction of the
proportion of underweight children under five by half.
• By 2013 - MDG 5: maternal mortality ratio has decreased to the levels below the target– more than by one
third, and access to reproductive health services was achieved as universal. (life birth definition is under
this)
• Modeling of District Health System Strengthening resulted in improvement of health system performance
in Surkhandarya and Khorezm regions.
• The first National Nutrition Survey in the country conducted (the analysis of the results ongoing).
• Costing of Perinatal Healthcare Services in two selected regions conducted and funding gap identified to
help Government to improve budget formulation and allocations for delivery of perinatal care.
• Around 99 per cent of 6 to 59 months old children nationwide benefitted from two rounds of UNICEF’s
supported Vitamin A supplementation.
• Sanitation facilities water pipeline were built in seven target schools improving sanitation and hygiene
conditions of more than 6000 children, including conditions for girls to perform menstrual hygiene
practices.
• UNICEF supported production and broadcasting of TV programmes on national television with audience of
almost 20 million people to improve caregivers’ knowledge on immunization, proper nutrition, knowledge
of danger signs, healthcare seeking behaviors and handwashing,

12. KEY ACHIEVEMENTS
Emergency preparedness and response
2007- WHO IHR adopted
2014 - Pandemic Influenza Preparedness Framework partnership
contribution implementation (PIP project) initiated;
2014 - “Better Labs for Better Health” initiative – laboratory capacity
strengthening under IHR-2005 initiated;
2016 - WHO Emergency Reform endorsed, including IHR 2005
reassessment
12
Progress in UNDAF implementation for 2016-

13. ACTUAL SPENDING 2016-2017
13
Progress in UNDAF implementation for 2016-
AGENCY EXPENSES (USD)
WHO 670,000
UNICEF 2.490.000
UNFPA 655,000
UNAIDS 145,000
UNODC 356,000
UNDP 2,457,521
UNV 48,000
IAEA 627,438
TOTAL: 4,958,959

14. Improve country governance capacity to formulate, implement, and review
comprehensive national health policies, strategies and plans (including
"Health for all" policies approaches and equality policies)
 Using UZB Concept for health development until 2030 & National Health
Strategy 2023 as an opportunity:
 To review of all existing strategies and plans and identify the areas for change: scan
and detail the landscape of existing strategies and plans at the national, sub-
national and local levels and then compare against the global SDGs and targets to
identify gaps and provide the basis for areas for change;
 To incorporate the global health-related SDG monitoring framework and indicators
into national frameworks and data platforms through policy action; and
 Formulate NHS & sub-sector strategize and plans using integrated systems thinking:
to incorporate the recommendations and the insights from the above steps into
strategies and plans and matching ambition and commitments with resources and
capacities.
14
Way Forward in UNDAF implementation for 2018-2
KEY FOCUS OF JOINT WORK PLANS
2018-2020LINKED TO SDGS, BASED ON MAPS RECOMMENDATIONS, UN-GOVERNMENT ROADMAP AND
DEVELOPMENT ACTION STRATEGY

15. 15

16. 16

17. 17

18. 18

19. KEY FOCUS OF JOINT WORK PLANS
2018-2020LINKED TO SDGS, BASED ON MAPS RECOMMENDATIONS, UN-GOVERNMENT ROADMAP AND
AND DEVELOPMENT ACTION STRATEGYCommunicable diseases
 Reduce the burden of communicable diseases such as HIV/AIDS, Tuberculosis and Hepatitis by enhancing national health care institutions
capacity to provide services for treatment
 Improve the quality family planning based on human rights approach and capacity to deliver quality maternal and newborn care, including
emergency
 Strengthen performance, management, sustainability and demand for immunization services including data collection and reporting for
MCH and preventive services
 Strengthen the access to comprehensive, evidence-based, and gender-responsive services for prevention of drug use and treatment of
substance drug use disorders, including HIV prevention supported in Uzbekistan
 Improve of cold chain capacity through upgrading infrastructure and equipment according to WHO requirements
 Develop and introduction vaccine management information system and streamline to existing e-systems in healthcare
 Assess and build capacities in planning, procurement and logistics in Immunization
 Develop modeling design including implementation plan and M&E framework. Revise/update of all necessary standards and norms, SoPs,
medical documentation and etc. for home visits with the consideration of new model. Development of training materials and job aids for HV
nurses
Non-communicable diseases & life course
 Addressing non-communicable diseases, with a focus on key NCD risk factors, on cardiovascular diseases circulatory system diseases, cancer
and drug dependence
 Reinforce integrated system of identification and management of key NCD risk factors and 4 groups of NCD diseases
 Promote the quality of life-cycle health issues, including maternal, newborn, child, adolescent and reproductive health
 Increase capacity of health managers to develop and implement evidence-based and equity-focused MNCH district health system
strengthening plans, including in emergency.
 Implement communication strategy to promote caregivers ‘positive child health and development practices at national and subnational levels.
Emergency preparedness and response
 Align the National health security programme with WHO Health Emergency Programme and ensure it compliance with international legally
binding documents (International Health Regulations (IHR) 2005; Sendai Framework for Disaster Risk Reduction 2015-2030)
19
Way Forward in UNDAF implementation for
2018-2020

20. BUDGETARY FRAMEWORK, INCL.
FUNDING GAP
20
Way Forward in UNDAF implementation for
2018-2020
Work plan duration:
2018-2020
Total estimated budget (in USD): 37 716 999
Out of which:
1. Funded budget (USD): 2 095 000
2. Unfunded budget (USD): 14 446 999
3. Funding gap (USD): 21 175 000
*Total estimated budget includes both direct programme costs and indirect
support cost.
Anticipated start/end dates:
2018-2020
Breakdown of contribution by funding sources:
Source Contributions (USD)
Government -------------------
UNICEF 15 058 000
UNFPA 303 000
WHO 1 704 999
UNODC 305 000
UNDP 20 125 000
UNV 221 000
TOTAL: 37 716 999

21. STRONG PLATFORM OF NATIONAL STAKEHOLDERS, INTERNATIONAL
DONORS AND PARTNERS
21
National stakeholders (list to be widen beyond the
health sector)
Ministry of Health
Ministry of Emergency
Ministry of Agriculture
Ministry of Finance
Ministry of Economy
Ministry of Education
National Agency for Project Management
Republican AIDS Center
Republican Center for Children
Republican Clinics for neuropsychiatry
Centre for medical education
Institute of Physiatry and Pulmonology
Ministry of Internal Affairs
Women’s Committee
Chief Department of the Execution of Punishments
UN agencies
WHO
UNDP
UNICEF
UNFPA
ILO
Other donors and partners
UNV
IEAE

22. 22