Tashkent, Uzbekistan (UzDaily.com) — In Uzbekistan, IFC has supported the government to develop a public-private partnership (PPP) that has drastically transformed healthcare for patients with kidney failure.

In 2018, at the request of the government, IFC was asked to evaluate potential PPP projects in the healthcare sector, including improving radiation therapy for cancer patients, imaging diagnostics, dialysis centers, and establishing multidisciplinary clinics. Ultimately, the government opted to launch a pilot project which focused on dialysis services.

For 63-year-old Klara Ziyatdinova, who has Hepatitis C, in addition to her kidney function issues, and now undergoes dialysis three times a week in a specialized unit to minimize the risk of cross-infection. The results have been significant, “after dialysis, I feel on top of the world. I can spend time with my grandson, do all the housework, and visit my second daughter in neighboring Kazakhstan,” she says.

It hasn’t always been this way for Ziyatdinova. In 2021, she was admitted to hospital for emergency dialysis due to complications resulting from COVID-19. While the procedure was free, dialysis was only twice a week for three hours per session, but still left her unwell as the treatment was below international norms.

These are now distant memories for her and many of the population of Uzbekistan, one of the results of the bold partnership to address dialysis care, which was instigated by the Uzbek Ministry of Healthcare.

Along with IFC, the Ministry of Healthcare and Economy and the Ministry of Finance of Uzbekistan partnered with the World Bank Group and donors from the governments of Austria, Germany and Hungary on the country’s first PPP—a project designed to enable more patients with kidney failure to access high-quality dialysis services that meet international standards.

Farkhod Tashpulatov, Deputy Minister of Health of Uzbekistan, explains that “the introduction of PPPs in the healthcare sector required meticulous planning due to the impact on patients’ lives. It was safer to start with a narrow-profile project that would allow us to reform one specific service and provide quality care to patients quickly. Therefore, the choice was made to pursue the dialysis project.”

Wiebke Schloemer, IFC Director for Türkiye and Central Asia highlights that "behind this initiative are real people, struggling with a chronic illness. This project is about giving them a chance at a better life. By upgrading dialysis facilities and investing in state-of-the-art equipment, we support the government in not only improving patient outcomes but also building a healthier future in Uzbekistan.”

IFC also assisted the Ministry of Healthcare and the National Centre of Nephrology in updating the patient referral procedures to ensure transparent and clear selection and approval process for kidney failure patients to receive dialysis funded from the state budget. Under the new system, patients have been added to the national registry, which is now updated monthly.

The project’s private partner was selected through a tender process. To qualify, companies had to demonstrate financial capacity and meet technical requirements for providing life-saving treatment for patients with chronic kidney disease. NephroPlus (India), Asia’s largest dialysis service provider, won an open tender process to identify a partner that could build, equip, and operate four dialysis centers across the country, serving 1,100 patients. The contract was signed in January 2021.

“Our mission is to improve dialysis quality and access in low- and middle-income countries,” says Vikram Vuppala, founder and CEO of NephroPlus. “Uzbekistan has a significant need for quality dialysis. Our goal is to bring treatment up to modern standards, reduce discomfort during the procedure, and enhance patients’ quality of life.”

Today, NephroPlus provides regular dialysis to 700 patients in Tashkent and about 400 patients in Karakalpakstan and Khorezm. Each patient typically undergoes dialysis three times a week for about four hours, in line with international best practice.

The improved services provided by NephoPlus have also had a positive cost benefit, with dialysis sessions at NephroPlus clinics in Uzbekistan now costing the government a lower amount of US$48, compared to US$60 prior to the partnership, surpassing expectations.

NephroPlus also conducts free monthly lab tests for all patients, sending the results to attending physicians at local outpatient clinics to adjust government-subsidized prescriptions as needed. Clinics then notify patients when their medication is ready for pickup.

Nadejda Li, diagnosed with kidney failure in 2019, explains: “We used to buy all the medicines ourselves. Now the government provides many, including vitamins, amino acids, and medications to increase hemoglobin. I still pay for other medicines, but without government support my expenses would be much higher.”

 As part of the project, for the first time in Uzbekistan, NephroPlus introduced peritoneal dialysis, a procedure that can be performed at home, allowing flexibility for treatment of older patients and children. Clinics also now use disposable equipment, including single use dialysis filters to reduce the risk of infection.

Although Uzbekistan’s public benefits program provides free dialysis care to patients with kidney failure, due to the limited dialysis capacity and absence of proper patient referral procedures, before the partnership not all patients had equal access to dialysis care due to issues around limited capacity and referral procedures.

In combination with outdated and overused facilities and equipment, high infection rates, high out-of-pocket expenses, large numbers of unregistered patients, and an absence of dialysis standards this resulted in often poor healthcare outcomes. Private dialysis care was available, but it was limited to a small provider in Tashkent City with limited capacity to meet the growing demand and only catered to patients who could afford the treatment. This environment created numerous challenges for dialysis patients in the country, but this has been significantly improved since the dialysis project was implemented.

Procedures and equipment care have also been significantly improved. Improper cleaning of dialyzers–blood purification filters used to be common practice, with dialyzers, needles, and tubing often being reused up to four times, increasing the risk of cross-infection from viruses such as hepatitis and HIV.

“To sterilize them, equipment was washed in antibiotic solution and then frozen, before reuse” remembers nephrologist Doctor Shakhnoza Abdullaeva.

Doctor Abdullaeva, who joined NephroPlus in May 2023, was transferred from the National Centre of Nephrology along with other medical staff, making the transition smoother for many patients, as their doctors moved with them.

“We’re like family here. Patients spend more time with us than with their relatives. We know everything about them, from who has a wedding coming up to who is expecting a grandchild,” she shares.

Doctor Abdullaeva appreciates the new clinic’s infrastructure, noting that it offers comfortable conditions for both patients and staff, enabling higher quality care. The team, including doctors, nurses, and technicians, receive regular training to ensure they are up to date with the latest advancements and best practices in dialysis care.

Following the pilot project’s success, the Uzbek government is now in talks with dialysis operators from Türkiye and China to extend the initiative to other regions in the country. The project won the Best Social Infrastructure Award in 2023, and it is now part of a broader plan to expand PPPs to other areas of the healthcare system.

The successful implementation of this project has not only enhanced the quality of dialysis care in Uzbekistan but has helped the government identify opportunities to work with private partners to improve public health services, enhance patient care, and improve health outcomes nationwide.

IFC is collaborating with the government on potential PPP projects to provide radiation therapy (commonly referred to as radiotherapy) for cancer patients and to consolidate several outdated mono-profile hospitals into a multi-profile facility. Additionally, a project is underway to establish imaging diagnostic centers.

By Kymbat Ybyshova