ENDING CONSUMPTION: NEW STRATEGIES FOR THE ERADICATION OF TUBERCULOSIS IN UzBEKISTAN

Since the collapse of the Soviet Union in 1991, Uzbekistan has struggled with the burden of a growing tuberculosis (TB) epidemic. A changing healthcare system and the stagnant economy have hindered efforts to produce sustainable, long-term change in the state of the disease. In particular, the emergence of multidrug-resistant tuberculosis (MDR-TB) and HIVassociated TB in prisons has worsened treatment outcomes. In this article, an analysis of previous efforts finds that despite the wealth of technical expertise in treating TB, the lack of public health policy targeting cultural, financial, and infrastructural realities has made the eradication of TB unattainable. The policy recommendations presented in this article encompass a novel multi-pronged approach to managing systemically overlooked aspects of the tuberculosis epidemic both rapidly and inexpensively. I 1996, R.T. Sultanov, the first Deputy Minister of Health of Uzbekistan, stressed the importance of improving disease prevention measures and primary healthcare for Uzbekistan’s changing public health system (Sultanov, 1999). In the aftermath of the dissolution of the Union of Soviet Socialist Republics in 1991, Uzbekistan has encountered economic difficulty transitioning from the Soviet model of healthcare to a more privatized universal healthcare model. As a country that has retained a majority of its Soviet-era officials, Uzbekistan has led Central Asia in certain aspects of healthcare reform, including the rationalization of hospital facilities and personnel, maintenance of robust welfare programs, and the development of a solid domestic pharmaceutical industry (Rose, 1999; Sultanov, 1999). Nevertheless, the current healthcare system still suffers from a lack of funding, weak public health and disease prevention programs, unequal access to healthcare among citizens, and weak policy implementation from governmental bodies to regional and local strata (Klugman & Schieber, 1999). Of urgent concern, however, is the growing tuberculosis epidemic in Uzbekistan, which endures despite the extensive efforts of foreign aid agencies and the World Health Organization. Any steps taken to address TB must make the demand for disease control fit the supply that can be procured by the fragile economy. Uzbekistan must adopt inexpensive and easily implemented policies that target logistical, financial, and cultural obstacles to the efficient eradication of TB without significantly stressing the existing