There have been frequent changes to the structure of the Ministry of Health since transition. Health care remains largely within the Semashko model in which the state provides most health care and health care workers are government employees. Public spending on health represents about 4.5% of GDP. Decentralization is occurring in a gradual manner. There is a reported suspicion of NGOs, which are not clearly represented in law.¹⁷

In 2003, the total per capita expenditure on health care¹⁸ was Intl $159 (5.5% of GDP).¹⁹ Among the Commonwealth of Independent States, this figure falls within a spending range of Intl $ 71 in Tajikistan (4.4 % of GDP) and Intl $570 in Belarus (6.4% of GDP). At 3.5%, the smallest spending as a percentage of GDP is in Kazakhstan (Tables 5 and 6).

The WHO overall health system performance score places Uzbekistan 109/191 countries. This composite measure of overall health system attainment²⁰ is based on a country’s goals relating to health, responsiveness, and fairness in financing. The measure varies widely across countries and is highly correlated with general levels of human development as captured in the human development index.