Dr Hans Kluge, World Health Organization’s regional director for Europe, spoke to Gazeta.uz ahead of his visit to Tashkent to participate in the StopTB partnership regional dialogue on 24−25 June, and the Central Asia International Health Investment Forum on 26−27 June in Bishkek, Kyrgyzstan.
— You have been leading the WHO European Regional Office since 2020. Could you please discuss the main achievements during this period that have been implemented in Uzbekistan?
— I would like to start by saying that Uzbekistan was the first country I visited immediately after being elected Regional Director of the WHO European Office. I would like to take this opportunity to express my gratitude to President Shavkat Mirziyoyev and acting minister of health Asilbek Khudayarov for their very close cooperation with the WHO Regional Office for Europe and our office in Uzbekistan, led by Asheena Khalakdina, as well as for supporting our regional health initiatives.
Since 2020, Uzbekistan has significantly advanced its health system with WHO’s support. This includes transforming the health system to a primary healthcare-based approach, emphasizing expanded roles for patronage and practicing nurses working alongside family doctors to deliver integrated, patient-centered services. Key steps have been taken to digitalize the health sector and shift towards prevention, patient empowerment and community engagement, particular to address noncommunicable diseases. Additionally, the establishment of the State Health Insurance Fund marks a critical step in health financing reform, setting the foundation to linking resource allocation to information on provider performance and the health needs of the population they serve. The government’s visionary leadership has been pivotal in enhancing access to quality healthcare based on WHO’s global norms and best practices.
We’ve seen promising results in Syrdarya, where health sector reforms have been piloted and has now successfully scaled to other regions. A landmark achievement has been the introduction of an expanded benefit package in Syrdarya, offering essential medicines at no cost to patients with chronic diseases, thus reducing barrier to care for necessary treatments.
In immunization, Uzbekistan has attained high coverage and has introduced human papillomavirus (HPV) vaccines to combat cervical cancer. During my visit to Tashkent this year, I had the honor of presenting the Ministry of Health with a certificate recognizing their achievement in meeting the Hepatitis B immunization target.
Public health security has also seen advancements with the successful completion of the Joint External Evaluation in 2022, assessing the country’s capabilities to manage health emergencies. The subsequent development of the National Action Plan for Health Security, facilitated by WHO, emphasizes a One Health, all-hazards approach involving multiple sectors and stakeholders to enhance national preparedness and response capacities.
The collaboration with St. Jude Children’s Research Hospital through the Global Platform for Access to Childhood Cancer Medicines has been a milestone in our efforts against childhood cancer, ensuring uninterrupted access to quality-assured medicines and fostering national policy reform in this critical area.
These accomplishments illustrate Uzbekistan’s commitment to ongoing health reform and showcase the substantial progress achieved with the support of WHO and our partners. While challenges remain, the strong foundation laid provides a promising basis for continued advancements and success in the health sector.
WHO.
— One of the objectives of your visit is to participate in the Central Asia International Healthcare Investment Forum in Bishkek on 26−27 June. How relevant are investments in healthcare in Central Asia today? And how much has been invested in healthcare in Central Asian countries, including Uzbekistan, over the past five years?
— Let's be clear from the outset: investing in health is an investment in the future of our countries and societies. The two-day Central Asia International Health Investment Forum, beginning tomorrow in Bishkek, Kyrgyzstan, will serve as a crucial platform for discussing and driving healthcare investments across the region.
The forum has three key objectives: to build new partnerships for health investment projects and technical assistance; to share best practices for achieving health-related Sustainable Development Goals (SDGs); and to emphasize the importance of investing in health as a catalyst for sustainable development, in line with the Roadmap for Health and Well-being in Central Asia.
Central Asia is a unique region, home to 76.5 million people and a demographic powerhouse with 30% of its population aged 14 years or under. This makes investing in healthcare here even more critical, especially after the COVID-19 pandemic exposed the vulnerabilities in both our local and global health systems and economies. With pressing health challenges like the rapid spread of HIV and tough-to-treat tuberculosis, the region needs robust health systems more than ever, which can only be built through strategic investments and strong international cooperation.
From 1 January 2022 until 30 March 2024, WHO Regional Office for Europe has mobilized a total of $101.780 million to support health initiatives in the Central Asian region, including $23 million in Uzbekistan. But there is a shared understanding that we need to do much more to strengthen health systems and achieve health-related SDGs.
Investing in health doesn’t just make us healthier — it also makes our economies more stable and ensures regional security. So, this Forum represents a major step toward a healthier and more stable future for everyone in Central Asia.
— You will also take part in the StopTB partnership regional dialogue in Tashkent. In September last year, Uzbekistan also co-facilitated a high-level UN meeting on the fight against tuberculosis. What results have Uzbekistan and WHO achieved in combating tuberculosis? What barriers and challenges remain, and how can they be addressed?
— First and foremost, I would like to extend my congratulations to His Excellency President Mirziyoyev for the country’s active co-facilitation of the second high-level UN meeting on tuberculosis in September 2023 in New York. Regarding the measures taken within the country, I am very pleased to highlight the significant successes Uzbekistan has achieved in combating tuberculosis under the leadership of the Ministry of Health and the Republican Specialized Scientific and Practical Medical Center of Phthisiology and Pulmonology.
In addressing tuberculosis (TB), Uzbekistan has demonstrated significant strides, thanks to the leadership of the Ministry of Health and the Republican Specialized Scientific and Practical Medical Center of Phthisiology and Pulmonology. Over the past decade, Uzbekistan has enhanced its diagnosis, treatment, and monitoring processes for tuberculosis, significantly improving treatment success rates from 84% in 2012 to 89% in 2021 for new and recurrent TB cases.
The country is also forward-thinking in its approach to legislative and health policy frameworks, demonstrated by various presidential decrees aimed at eradicating TB by 2050. This commitment is crucial as we confront the persistent challenges posed by drug-resistant TB, which remain a priority on the political agenda. To combat these, the government increased targeted funding for TB programs, adopted the latest diagnostic techniques and transitioned to WHO-recommended injection-free treatment regimens, which have notably improved outcomes.
For multidrug-resistant TB, treatment success rates have improved dramatically from 49.4% in 2012 to 72% in the 2020. Notably, under a regional initiative, Uzbekistan has achieved a 90% success rate in this field with modified short regimens, benefitting over 600 patients between 2020 and 2023.
In terms of healthcare integration, Uzbekistan maintains robust cooperation with primary healthcare providers and services catering to individuals with HIV and other comorbid conditions. These efforts are underpinned by a patient-centered approach, primarily delivered through outpatient settings.
Additionally, the government has made substantial investments in the procurement of TB and drug-resistant TB medicines, utilizing an international procurement mechanism regardless of funding sources.
I highly value our enduring and effective collaboration with Uzbekistan, which continues to drive progress in combating tuberculosis at both national and regional levels.
— In recent years, Uzbekistan, like many countries, has faced the issue of air pollution. WHO recommendations are usually used to assess air quality. It is known that Uzbekistan is currently developing national air quality standards. Is WHO involved in this work with Uzbekistan?
— While WHO is not currently involved in the revision of Uzbekistan’s air quality standards, our global Air Quality Guidelines are a key reference for shaping and refining these standards.
In 2011, with the support of WHO, two PM2.5 and PM10 samplers were installed at the sanitary-epidemiological stations (SES) of Nukus and Tashkent. Today, we are pleased to learn that this initiative has been expanded to an additional seven stations with the support of the Zamin Foundation.
Additionally, in 2024, we were invited to participate in a roundtable discussion on air quality and health, focusing on National Air Quality Standards in Uzbekistan. This event was organized by the Zamin Foundation and we are pleased to announce that we have recently signed a Memorandum of Understanding with the Foundation.
I would like to stress our commitment to support Uzbekistan’s efforts to update and improve its air quality standards, with the ultimate goal of protecting the health of its population.
WHO.
— According to a report prepared by WHO and the Uzbekistan Ministry of Health in 2018, non-communicable diseases (NCDs) are the cause of nearly 80% of deaths in the country. They incur huge direct and indirect costs and lead to significant negative socio-economic consequences. Among the causes are unhealthy eating, alcohol and tobacco use, and a sedentary lifestyle. What needs to be done in Uzbekistan to change the situation?
— To address this critical issue, a comprehensive strategy incorporating legislation, education, and community involvement is essential. Firstly, enhancing legal frameworks to regulate the industries contributing to unhealthy behaviors is crucial. This includes stricter enforcement of existing laws and the introduction of new regulations to limit advertising and accessibility of harmful products such as tobacco and alcohol.
Education plays a pivotal role in changing public health outcomes. It is imperative to invest in training health professionals in preventative care and public health advocacy. They need the skills to navigate and counteract industry interference, ensuring that health policies are evidence-based and effectively implemented.
Equally important is the focus on reducing health disparities. Policies must aim to provide equitable access to healthcare and promote healthy lifestyle options across all sections of society. One practical measure could be the taxation of harmful products like sugary drinks and tobacco, using the revenue generated to fund public health initiatives.
Additionally, working in partnership with media is vital for informing the public about the risks associated with NCDs and promoting healthier lifestyle choices. Media outlets have the power to reach wide audiences and can be instrumental in shifting public perceptions and behaviors.
Earlier this month, WHO/Europe launched a hard-hitting report on the commercial determinants of NCDs showing how just four sectors, namely tobacco, alcohol, fossil fuels and specific foods with unhealthy fats, contribute to some 7,400 deaths each day — 2.7 million each year — in the WHO Europe and Central Asia Region. The insidious marketing of these products, including the targeting of young persons, is a hazard to health that governments and other stakeholders must address urgently.
— Central Asia is one of the most vulnerable regions to climate change in the world. Month after month, meteorologists record climate records around the world, including in Uzbekistan. How will this affect people’s quality of life? WHO has repeatedly said that climate change is already leading to fatalities. What measures, in WHO’s opinion, can countries take now?
— Indeed, Central Asia, including Uzbekistan, is highly vulnerable to the impacts of climate change, which are becoming increasingly apparent as meteorologists continue to document extreme weather events. The region faces rising temperatures and decreasing water availability, placing significant stress on Uzbekistan’s already water-scarce environment. This has led to an uptick in heat-related health issues, including intestinal, cardiovascular and respiratory diseases. Additionally, the prevalence of dust storms, driven by accelerated desertification and land degradation, has compounded health risks, notably affecting approximately 5.5 million people.
The urgency to address these challenges is critical. WHO advocates for all countries, especially those in vulnerable regions like Central Asia, to strengthen their health systems and communities, making them more resilient to the escalating impacts of climate change. This involves enhancing adaptation measures to cope with more severe climate events anticipated in the future.
The situation is particularly dire in the region around the Aral Sea, which as we know was affected by one of the most significant environmental disasters of the 20th century. To improve health outcomes, WHO has been working together with the regional Ministry of Health of Karakalpakstan to strengthen its health system. Key achievements include introducing a new primary health care service delivery model in three districts, enhancing healthcare providers' capacity in NCD prevention and management, and developing digital tools and telecommunication infrastructure.
Moreover, it is imperative that health systems set an example in environmental sustainability. By reducing their climate footprint, health systems not only mitigate the effects of climate change but also safeguard the health of their populations and future generations. This dual approach of adaptation and mitigation is essential to effectively confront the health challenges posed by climate change.
It is important to note that Uzbekistan recently joined the Protocol on Water and Health, demonstrating the country’s leadership in this area (December 2023). However, developing a roadmap for the implementation of the Water Protocol is crucial and will be a significant step towards ensuring water safety in the country.
