The promised national hospice that was unveiled on 11 February 2025 still sits idle, a stark emblem of a system that cannot deliver dignified end‑of‑life care to the thousands of terminally ill Uzbek patients who need it. While the health‑system reform agenda touts universal coverage and modern financing, the hospice sector remains chronically under‑funded, under‑staffed and legally orphaned. The result is a silent crisis that is already costing lives in the form of unmanaged pain and abandoned families.
Across the country only four operational hospices – five if the children’s unit is counted – exist, delivering a meagre 200 palliative‑care beds. Even before the new flagship hospice failed to open, utilisation was abysmal: merely 10 %–20 % of patients who could benefit from palliative services actually receive high‑quality care. The bulk of the population, especially outside Tashkent and Fergana, is left without any structured support for symptom management or psychosocial counselling.
The barriers are systemic and interlocking. Financing is the most visible fault line: although a mandatory health‑insurance fund now purchases services for the whole system, there is no dedicated line‑item for hospice care, forcing projects to compete with higher‑priority programmes. The 2022 concessional loan from the Islamic Development Bank, earmarked for palliative‑care development, has stalled in bureaucratic limbo, illustrating how fragile funding streams can be. Legally, the 2017 resolution guaranteeing palliative care has never been translated into a licensing act or quality‑assurance framework, leaving new facilities – including the 2025 hospice – unable to secure the approvals needed for operation. Workforce shortages are acute; the December 2025 closure of the Tashkent city and regional branches of the Republican Oncology Hospital not only left a waiting list of 249 patients but also stripped the system of oncologists and nurses who could be redeployed to hospice roles. Oncologist Shermuhammad Umirov has publicly urged that the vacated sites be repurposed as a national palliative‑care centre, underscoring the urgency of re‑training displaced staff. Access to essential analgesics is equally dire: Uzbekistan’s morphine consumption in 2020 was a paltry 0.04 mg per capita, versus a global average of around 5 mg, crippling pain relief for terminal patients. Finally, cultural misconceptions continue to cast hospice as a “last resort” rather than an integral health service, limiting both demand and political will.
A realistic pathway forward must weave these strands into a coherent policy package. First, the state health‑insurance fund should create a protected budget line for hospice infrastructure, essential medicines and staff salaries, linked to the forthcoming single finance pool. Second, a national hospice licensing and quality‑assurance act must be drafted, setting minimum standards for staffing ratios, opioid availability and facility accreditation in line with the WHO quality framework. Third, competency‑based palliative‑care modules need to be embedded in family‑medicine curricula and nursing programmes, while scholarships fund rapid re‑training of oncology personnel displaced by the hospital closures. Fourth, a national opioid procurement protocol, coordinated through the insurance fund’s digital pharmacy system, should set clear targets – for example, raising morphine availability to at least 1 mg per capita within three years. Fifth, hospice referral pathways must be integrated into primary‑care protocols, supported by the existing e‑health information system to capture utilisation data and monitor outcomes. Finally, a nationwide public‑awareness campaign, delivered through makhallas, media and civil‑society partners, can dismantle stigma and promote acceptance of palliative care.
Implementation can be staged. In the short term (2024‑2025) the insurance catalogue should be amended to include hospice packages, the licensing law drafted, and opioid procurement reforms launched alongside the first wave of staff re‑training. By 2026‑2028, construction of the flagship hospice and two regional hubs can commence, curricula will be rolled out nationwide, and the e‑health modules for hospice reporting will be live, accompanied by a sustained public‑education drive. A final evaluation phase (2029‑2030) will audit utilisation, adjust financing formulas and expand services to include home‑based palliative care, aiming for coverage of at least 80 % of terminal patients.
Neighbouring Central Asian states are already grappling with similar demographic pressures, yet some have moved further along the integration ladder by embedding hospice units within existing oncology hospitals and establishing clear reimbursement pathways. Their experience demonstrates that when hospice care is treated as a core component of universal health coverage – rather than an afterthought – the system can deliver both clinical effectiveness and financial sustainability. Uzbekistan can learn from these regional examples, adapting proven mechanisms to its own reform agenda.
The stakes are unequivocal: without decisive action, the gap between policy ambition and lived reality will widen, leaving families to shoulder unbearable burdens and patients to endure needless suffering. Embedding hospice care into the fabric of Uzbekistan’s health system is not a peripheral nicety but a fundamental requirement for truly universal, dignified health coverage. The time to act is now, before the backlog of terminal patients turns the silent crisis into a public health tragedy.
Image Source: ehospice.com
