Uzbekistan Sets 30% Medical Outsourcing Target as Public Hospitals Prepare for 2027 Rules

Private providers to take a larger role in public hospitals

Uzbekistan plans to raise the share of clinical and support services that medical institutions purchase through outsourcing to 30% by 2030, under a reform that combines longer contracts, private investment in equipment and electronic monitoring of services and payments.

President Shavkat Mirziyoyev signed Resolution PP-392 on November 4, 2026. It took effect that day, with the new purchasing procedures scheduled to begin on January 1, 2027. Public medical institutions will generally be able to sign contracts with private providers for up to five years. Exceptional agreements may last up to 10 years when investment needs justify the longer period and the Ministry of Health gives its assessment.

The resolution also calls for foreign professional management companies or teams to be brought into at least five major medical organisations by 2030. Hospitals needed to deliver care guaranteed by the state will remain in state ownership.

The changes connect three activities: buying services for existing public hospitals, attracting investment into new facilities and changing how selected institutions are managed. For patients, the practical results will depend on where services become available, whether equipment remains operational and how authorities enforce the quality requirements written into contracts.

How the new service contracts will work

Public hospitals will buy specified services from private organisations under public procurement law and procedures established by the Cabinet of Ministers. The Ministry of Health and the Ministry of Economy and Finance must submit draft outsourcing regulations and a list of eligible services to the government within one month of the resolution.

Services under consideration include haemodialysis, laboratory testing, equipment maintenance, sterilisation, medical rehabilitation and physiotherapy. Haemodialysis filters waste from the blood when a person's kidneys can no longer do the job adequately.

A private partner would purchase the necessary equipment with its own money, operate it and arrange its renewal or replacement. The public institution would purchase the resulting service. This gives the contractor responsibility for keeping the equipment usable throughout the agreement, rather than simply delivering a machine.

Contract length will depend on the service and the scale of investment. The longer arrangements follow proposals to move away from annual contracts, giving businesses more time to recover equipment costs through service payments. Contracts lasting up to 10 years will require a Ministry of Health assessment that considers how long the investment takes to pay back.

Existing outsourcing projects whose terms expire before the new procedures begin may continue until the end of 2027. That provision allows services to continue during the transition while institutions prepare new purchasing arrangements.

Public premises come with pricing conditions

State medical institutions may allow private contractors to use buildings, structures or individual rooms without paying rent under outsourcing agreements. The arrangement must have an economic justification, and the benefit of free premises must be reflected in the price charged for services.

For a hospital purchasing laboratory tests, for example, the contractor's costs will differ depending on whether it must rent premises elsewhere or can operate inside the hospital without rent. The resolution requires that difference to enter the service price calculation.

Property arrangements will also face a wider review. The Prosecutor General's Office, the Ministry of Health and the State Assets Management Agency must examine existing leases covering buildings, rooms, structures and land belonging to state medical institutions by April 1, 2027.

Following the review, officials must submit proposals to the Cabinet of Ministers concerning agreements that breach the law, harm state interests or involve property being used for purposes other than those authorised. Spending on the resolution's implementation will come from state budget allocations for healthcare and other permitted sources.

A digital register will track delivery and payment

The Ministry of Health is tasked with introducing an electronic system called Medical Outsourcing by April 1, 2027. It will register outsourced services, projects, providers and contracts, creating a common record of arrangements across medical institutions.

The platform will track service volumes and quality, compliance with contractual obligations, performance indicators, acceptance of completed services and payments. Acceptance is the step at which an institution confirms that a service has been delivered in line with the agreement.

By May 1, 2027, the system is to be connected to electronic public procurement platforms and other government information systems. Details of purchasing procedures, contract prices and contract periods are expected to transfer automatically.

The collected information will be used to prepare reports on the economic performance of projects and the use of public money. The timetable places the new purchasing rules ahead of the dedicated monitoring platform: procurement changes begin in January, the register is due in April and integration follows in May.

Foreign managers will face annual assessments

At least five major medical organisations are to involve foreign professional management companies or teams by 2030. The decision to bring in managers will follow an assessment of each institution's clinical results, finances, management performance and development goals.

Managers will generally be selected through open competitions. Selection criteria will include experience in healthcare, financial stability and management capacity. Their contracts will contain key performance indicators, or KPIs, meaning agreed measures used to judge their work.

Annual assessments against those indicators will guide decisions to continue, revise or terminate management agreements. The reform therefore links the duration of a manager's role to a recurring review of performance.

The resolution does not identify the institutions that will receive foreign managers. The service outsourcing arrangements and the management programme will operate at different levels: a private company may supply a particular hospital service, while a management team may take responsibility for running an institution.

Hospital plans will start with local needs

From 2027, healthcare development will be organised through short and long term master plans that consider demand for services and the capacity already available in public and private facilities. The plans are intended to guide decisions about where investment is needed and which form of private participation to use.

New facilities requiring substantial construction spending will generally be developed through public and private partnerships. Under these arrangements, public authorities and private partners agree how to provide infrastructure or services and divide financial responsibilities and risks.

The Ministry of Health will identify projects, prepare documentation, organise partner selection and arrange agreements. Services needing less capital spending, where enough providers already compete, will instead be purchased through outsourcing. Decisions will consider investment requirements, government financial commitments, risks and economic efficiency.

Starting in 2027, the ministry must publish a list of priority healthcare investment projects on its website by November 1 each year. The list will include projects involving private investment and public and private partnerships.

A project office within the ministry, operating without separate legal entity status, will review rules governing hospital design and construction. Its work will cover building requirements, sanitary rules and hygiene standards, bringing them into agreement with each other and with international benchmarks.

Samarkand shows why the location of beds matters

An inventory in 10 regions identified 3,499 healthcare facilities, 494 more than appeared in Cadastre Agency records. The findings accompanied proposals to complete a nationwide inventory, create an electronic record for each facility and establish a unified digital register.

Infrastructure proposals presented before the resolution covered master plans for 2026 to 2036. They would consider population changes, demand, existing capacity and the time patients need to travel to care. The plans would guide decisions on retaining, merging, renovating or building facilities, as well as equipment and staffing requirements.

Samarkand Region illustrates the uneven distribution. Districts contain 80% of the region's population but only 41.7% of its hospital beds. The proposed plan would raise the district share of beds to 67%, an increase of 25.3 percentage points.

Plans call for 1,500 additional beds in Urgut, Kattakurgan and Pastdargom by 2030. Construction and renovation projects are also being considered in Samarkand, Ishtikhan and Payarik. Proposals include bringing specialised institutions in the regional centre together around multidisciplinary hospitals and developing central laboratory, sterilisation and diagnostic services.

The planning approach would concentrate complex treatment in designated referral centres while keeping basic and emergency care accessible in districts. Design priorities include infection control, accessible premises for people with disabilities and convenient movement through buildings.

A $3.7 billion pipeline spans hospitals and training

At an October 28 presentation to Mirziyoyev, officials described a portfolio of 35 healthcare investment projects worth $2.7 billion and nine additional proposed projects valued at $1 billion. Together, the two groups amount to 44 projects with a combined stated value of $3.7 billion, with the additional nine still at the proposal stage.

The portfolio includes a National Oncology Centre, a Republican Centre for Neurology and Stroke, a multidisciplinary adult medical centre in Tashkent Region, hospitals in Kashkadarya Region and a maternal and child health centre in Nukus. Medical education programmes are planned for Termez.

Partnership plans include a hospital with 800 beds in Samarkand and a multidisciplinary facility in Bukhara Region. The nine prospective projects cover neurological care, psychological and addiction treatment, childhood cancer and blood disorders, emergency medicine, ambulance replacement and professional training.

Officials also proposed a healthcare infrastructure and investment strategy extending to 2040. Its first stage would review existing projects for relevance and feasibility before selecting investments according to regional needs and assembling a unified portfolio. Mirziyoyev instructed officials to refine the strategy and projects using the master plan and accelerate initiatives already under way.

The investment drive builds on a growing private healthcare sector. Figures cited during the reform discussions put the number of private clinics at more than 9,000 in 2026, compared with 3,500 in 2017, more than two and a half times the earlier figure. Private providers were said to account for 90% of dentistry, 70% of diagnostics and 60% of ear, nose and throat care, urology and ophthalmology. Regional authorities were also instructed to attract $150 million each in healthcare investment and grants.

The dates that will shape implementation

The reform developed through infrastructure and investment presentations in October before the November resolution. Its deadlines extend from the start of the new procurement system in 2027 to the outsourcing and management targets in 2030.

• October 26, 2026: Mirziyoyev reviewed proposals for a unified healthcare infrastructure plan and longer service agreements.
• October 28, 2026: An investment presentation set out the 30% outsourcing target and the healthcare project portfolio.
• November 4, 2026: Resolution PP-392 was signed and took effect.
• January 1, 2027: New outsourcing procurement procedures and planning mechanisms are scheduled to begin.
• April 1, 2027: Deadline for introducing Medical Outsourcing and completing the review of medical property leases.
• May 1, 2027: Deadline for integrating the monitoring platform with procurement and other government systems.
• November 1 each year, starting in 2027: Deadline for publishing priority healthcare investment projects.
• End of 2027: The permitted continuation period ends for qualifying existing outsourcing projects.
• By 2030: Outsourcing is targeted to reach 30% of relevant service procurement, with foreign professional managers involved in at least five major medical organisations.

Public institutions and private contractors will need to turn these deadlines into agreements specifying service quantities, quality, investment responsibilities and payment terms. The electronic register and annual management assessments are the main monitoring tools set out in the reform.

Key Points

• Uzbekistan will introduce new public hospital outsourcing procedures on January 1, 2027.
• Contracts will generally last up to five years, with exceptional agreements of up to 10 years subject to Ministry of Health assessment.
• The government targets a 30% outsourcing share in clinical and support service procurement by 2030.
• Medical Outsourcing is due by April 1, 2027, followed by system integration by May 1.
• Foreign professional managers are planned for at least five major medical organisations by 2030, with annual performance reviews.
• Facilities required for state guaranteed care will remain in state ownership.
• The investment pipeline contains 35 projects worth $2.7 billion and nine additional proposals worth $1 billion.
• Regional planning will guide investment, including a proposed increase in Samarkand districts' share of hospital beds from 41.7% to 67%.