![[ToC]](../images/cpbanner.gif)
FY 1997 Assistance to the NIS Request: $20,000,000
Introduction
Uzbekistan is situated in the geographical heart of Central Asia, and is the only country that borders on all four other Central Asian republics. It boasts a proud history and lays claim to representing the historical, cultural, and even political core of post-Soviet Central Asia. It has 22 million inhabitants and is the largest of the Central Asian republics (and the third most populous of the former Soviet republics). Over the last four years, the Uzbek leadership has actively sought to assert and strengthen its sovereignty and independence. It also clearly aspires to play a regional leadership role. As for the economic reform process, Uzbekistan has adopted a program of gradual, step-by-step reform in which the state remains dominant. Political power rests almost exclusively with the president and an active opposition is not tolerated. At the same time, the government is sensitive to international perceptions about human rights and other issues and, with growing frequency, responds positively to outside pressures for improvements.
United States interests reflect a combination of commercial and strategic concerns. Uzbekistan remains the largest single market in Central Asia. Its economic base is relatively diverse, reflecting a combination of agricultural, industrial and energy resources. Uzbekistan has emerged as the world's fourth largest producer of cotton (it is also the world's second larger exporter of cotton, trailing only the U.S.). It ranks seventh internationally in terms of gold production, attracting the attention of foreign investors. It is already a significant regional gas exporter, and expects to become self sufficient in crude oil in 1996. It has an extensive, if outmoded industrial sector, based chiefly on the processing of minerals and agricultural commodities. Improving and expanding domestic processing of these commodities, particularly cotton, is a key to economic prosperity. Uzbekistan's regional importance and strategic location will also play an important role in determine regional stability in the years ahead. It has significant interests of its own, has played a role in shaping events and responding to crises in both Afghanistan and Tajikistan, and has an obvious interest in what happens in Iran to the south and Russia to the north. From a U.S. perspective, a democratic and economically sound Uzbekistan that plays a positive and constructive role in world affairs is desirable, both for the well-being of the people of Uzbekistan and for maintaining stability in Central Asia.
The Development Challenge.
Higher cotton prices combined with growth in the oil and gas industry have to some extent cushioned Uzbekistan from the most severe impacts of the breakup of the Soviet Union and the economic dislocations that followed. The country was slow to undertake economic reform in 1992-1994, but the pace has quickened since mid 1994, particularly on the macroeconomic policy front. Inflation, the budget deficit, and consumer subsidies have been cut sharply. The government signed a Transformation Facility with the IMF in January 1995 and a Standby Agreement in December 1995. Progress in privatization has been slower. Housing and small retail shops were almost completely privatized in 1993-1994, but true medium and large-scale privatization has barely begun.
As for the country's debt, Uzbekistan has benefitted from the "zero option" agreement whereby Russia assumes both the debt liabilities and certain assets of the former Soviet Union. Uzbekistan's debt service burden is expected to rise modestly over the medium term because of the short-term nature of its initial financing. Total external debt is projected to rise from about 14% of GDP in 1994 to about 25% of GDP in 1998.
Agriculture accounts for about 35 percent of Uzbekistan's GDP, employs 40 percent of the labor force, and accounts for nearly 75 percent of its foreign exchange earnings, mainly from cotton. Scarce water and land resources make further expansion in cropping acreage difficult, but market-based approaches to pricing and marketing would go a long way toward increasing productivity. 1995 was an exceptional year in terms of both wheat and cotton harvests. Cotton production has stabilized at around 3.9-4.0 million metric tons a year and remains an important source of foreign exchange. Wheat production has increased sharply in recent years, as Uzbekistan shifted irrigated land out of other crops in a drive to reach self-sufficiency by 1997.
Energy represents a second significant sector for future growth. Natural gas provides two-thirds of the country's primary energy supply, and Uzbekistan is the third largest producer of natural gas in the former Soviet Union afterRussia and Turkmenistan. Oil reserves are also believed to be considerable. At this point, energy production is geared mainly toward making Uzbekistan self sufficient. Regional gas sales within Central Asia represent a potential source for energy export growth, but are stymied to some extent by the inability of some potential buyers such as Tajikistan and Ukraine to meet market prices or pay in hard currency. The decision in 1995 to sell off 158 state-
owned petrol stations had a positive impact, at least in terms of enhancing efficiency and introducing the concept of private marketing and distribution channels within the energy sector.
Social policies developed during the Soviet era are unsustainable and increase the need for a more targeted social safety net and an expansion of market-based approaches to social service delivery. Currently, social expenditures account for around 40 percent of government expenditure. The health system is inefficient and highly centralized. The tightening of monetary and fiscal policy means that wage rates have not kept pace with inflation, while progress in economic restructuring is bound to increase unemployment rates, at least over the short term. The Aral Sea and related environmental disasters such as the excessive use of pesticides in cotton production have a large and adverse effect on Uzbekistan. There is a serious lack of potable water in some regions and health indicators point to serious health problems in some of the worst affected areas.
Uzbekistan's relatively large domestic market, combined with its potential in the agricultural and energy sectors, offers a number of attractive opportunities to potential foreign investors. Turkey, South Korea, Germany, Japan and the U.S., along with Russia, are the largest foreign economic players. The South Korea firm DAEWOO has invested several hundred million dollars in an automobile production plant in the Fergana valley and an electronics plant in Tashkent. Total direct foreign investment is probably on the order of $1.5-$2 billion. U.S. direct investment is estimated at $150-
$200 million, with the Newmont Mining Joint Venture ($120 million invested) representing the single biggest investment so far. Other U.S. companies are negotiating joint ventures in such areas as oil and gas, agricultural machinery, aerospace, and so forth. The U.S. has also been a major seller of wheat, agricultural machinery and aircraft to Uzbekistan.
From a USAID perspective, the main goal is to engage reform-minded elements in the Uzbekistan government and assist where possible in putting in place the basic building blocks of a market-oriented economic system. Establishment of these basic structures should in turn facilitate the private trade and investment needed for Uzbekistan to reach its considerable economic potential. Engagement at an international level also means adherence to internationally accepted norms and practices in key areas related to human rights and a civil society. Here too, USAID can play an important role in exposing Uzbek policymakers to a wider world and in suggesting alternative approaches as they shape their own economic and political future.
USAID expects that Uzbekistan will have the institutional and other resources to continue its own transition. Current plans are to phaseout Freedom Support Act (FSA) assistance within the next few years.
Other Donors.
The IMF and the World Bank are both heavily engaged in Uzbekistan on key reform issues. As noted, as a result of progress on the reform front the IMF signed a Standby Agreement with Uzbekistan in December 1995. The World Bank signed a rehabilitation agreement with Uzbekistan in March 1995 and is considering a follow-on enterprise reform credit. It has also signed a cotton sector project loan and a technical assistance loan, and is considering further loans for the agriculture and banking sectors. EU-TACIS has the largest country program after the World Bank, focusing on technical assistance in agriculture, private business development, and energy. The European Bank for Reconstruction and Development (EBRD) portfolio includes loans for textile plants and energy, as well as a small enterprise credit loan.
FY 1997 Program.
USAID programs in Uzbekistan have concentrated in several areas, including the Aral Sea initiative; study tours and technical training in the United States; health and family planning; and a low key but important democratization effort emphasizing the importance of non-governmental organizations (NGOs) in building and sustaining a civil society. As resources are reduced, focus and concentration will become even more important. The 1997 program will likely include a special emphasis on fiscal reform, financial sector restructuring and training. Modest programs in democratization and social sector reform are also envisaged.
Strategic Goal: Economic Restructuring
Although the government's own economic assessment is relatively upbeat, Uzbekistan has still not taken some of the most decisive measures needed to open up the economy and allow a strong private sector to flourish. The IMF and the World Bank have taken a major role in acquainting Uzbek officials with some of the main elements required for such change take place. While USAID has engaged with counterparts on these same issues, it has been reluctant to invest resources without indications from them of a clear commitment to transparency and meaningful reform. In some areas, such as fiscal reform, Uzbek counterparts have expressed a strong interest in using technical advisors to effect needed change.
Fiscal policy is one area in which Uzbek policymakers have demonstrated a commitment to reform. In particular, tight budgetary controls have reduced deficits and helped meet IMF targets. Revenue generation represents the other side of the fiscal coin, and in this area USAID is working closely with counterparts in the Ministry of Finance to draft a new tax code and implement modernized taxation administration systems. Additional technical advice is being provided to draft a new budget law, reorganize budgetary classification systems and to strengthen the budgetary planning and execution process. As new policies are adopted, further hands-on training is needed to ensure that the policies are properly implemented. Sound fiscal management should in turn help maintain macroeconomic stability, an essential precondition for sustained economic growth.
New banking decrees have been issued, but real banking and broader financial sector reform continues to lag. Uzbekistan has yet to establish even the most rudimentary kind of private sector stock exchange and the development of an effective securities market still seems like a long way off. The fact that the government tends to stifle private sector initiative when it appears to undermine or conflict with a state-owned enterprise causes special concern. For example, the country's largest privately owned bank, Uzinbank, was recently closed, by some accounts because of the lead role it was playing in foreign exchange dealings. If the situation allows, USAID anticipates offering technical advice and training aimed at modernizing banking structures in Uzbekistan and paving the way for an efficient, private financial sector.
Strategic Goal: Democratic Transition
Political control in Uzbekistan rests almost exclusively with the president. Media outlets are controlled by the government and open dissent is forbidden. Nonetheless, opportunities do exist to address human rights concerns, to engage NGOs to promote grassroots organizational skills, to promote new views about what it means to adhere to the rule of law, and to expose a potential future generation of Uzbek policymakers to more democratic modes of governance.
Activities aimed at introducing new notions of civil society and democratization will continue in a low key but unmistakable way. For example, the program of grants and technical support to local NGOs will continue, as part of an effort to enhance their management capacity and make their own programs more sustainable. Similarly, programs on building relationships with local lawyers represent an important part of a broader effort to introduce new ideas about how legislation is vetted, how laws are introduced, and how a strong judiciary contributes to a functioning democracy. As Uzbekistan prepares for its next elections, similar advice can be offered to show counterparts what is needed to make an electoral process internationally credible.
Strategic Goal: Social Transition
Uzbek counterparts have expressed an interest in new approaches to health care. Some of these have been introduced through the medical partnership programs, others through family planning efforts which make use of market-based marketing and distribution channels. The government on its own has made progress in privatizingsome pharmacies, and USAID programs aimed at improving their effectiveness have also met with some success. Work in other areas that relate to both social transition and economic restructuring is planned. For example, advice on pension reform--an area that has huge financial implications for the government--is planned, with a view toward ensuring both more targeted social sector programs and to introduce great fiscal control.
USAID efforts focus on health, and special emphasis is placed on introducing market-based approaches that increase individual choice and rely when possible on the private sector. Decentralization and a reduced emphasis on curative measures also offers some prospects for change in the area of health care.
Cross-Cutting/Special Initiatives
A high degree of isolation during the Soviet era means that most Uzbek counterparts have not yet been exposed to international ways of conducting business and organizing an economy. The view that the government must play a central role in all aspects of national life is still widely held. Private sector initiative is often viewed with suspicion or mistrust. Uzbekistan's own interest in asserting its independence means it welcomes opportunities to directly observe developments in other countries and is very concerned about how Uzbekistan is perceived outside the former Soviet Union. This in turn enhances the value of training efforts aimed at exposing Uzbeks to the experience of other countries and teaching them technical skills which can be usefully applied on their return.
In Uzbekistan, "special initiatives" refers mainly to Congressional earmarks in the areas of medical partnerships and family planning. There is substantial interest among health professionals in Uzbekistan in participating in such programs. USAID also attempts where possible to ensure that these earmarks are closely integrated with other activities and that they address broader strategic and programming concerns, including in health reform.
The medical partnership between the University of Illinois at Chicago and Tashkent State Medical Institute was established in 1993. Tangible achievements include establishment of a high risk pregnancy center to which the Ministry of Health is contributing $200,000. A new medical journal, "Pathology," is being published, and staff members at the University of Illinois serve on the editorial board. The Ministry of Health regards Tashkent State Medical Institute as a "demonstration site" for new management approaches. Many economies have been achieved, including an increase in out patient services from 0 in 1991 to 143,000 in 1994; the introduction of fee-for-service in some areas; a significant reduction in the average length of hospital stay, from 16 days in 1991 to 11 days in 1994; and reductions in post operative infection rates. Training programs, conferences and seminars offer opportunities to re-enforce and amplify these lessons. In the family planning area, advertising programs have been developed for the commercial sale of contraceptives and more than 200 pharmacist have been trained in modern customer service techniques. Five international pharmaceutical manufacturers have entered the Uzbekistan market, and the number of pharmacies carrying modern, commercial brands of contraceptives has greatly increased. Uzbekistan is also participating in the USAID-funded reproductive program resulting in three training sites, one each in Tashkent, Samarkand and Adizhan. All three are staffed with qualified trainers and service providers.
The medical partnership involves training and people-to-people exchanges between medical staff at the University of Illinois and in Tashkent. As in other areas of the former Soviet Union, the medical partnership also serves as a vehicle for raising additional private American funds and establishing broader networks involving private citizens in both countries. Family planning programs are a combination of advisory services and training which help introduce new approaches and technologies. The contraceptive social marketing program represents an especially innovative effort, one that is based on the power of commercial marketing networks to ensure better service delivery.
Participant training is also part of Cross-Cutting Programs and cuts across all areas of the project portfolio. It offers important opportunities to strengthen ongoing technical assistance programs and allow Uzbek counterparts to directly observe the situation and experience of other countries. These programs will likely continue, though they will be reshaped over time to respond to the changing situation in Uzbekistan.
NET provided U.S. short-term training for 292 officials in 1994 and 1995, with an additional 130 participants scheduled for 1996. USAID-funded participants have been instrumental in bringing about changes in tax policy and administration, national budgeting and health reform. This effort benefits Uzbeks at all levels by providing trainingqualified public officials who are able to establish laws and regulations that are transparent and foster the growth of markets and democratic governance. New entrepreneurs will benefit as they establish links with potential future U.S. commercial partners.
NET resources provide for both U.S. short-term training as well as in country follow-on programs. The in-country program revolves around the establishment of an Alumni Center where returning participants can utilize e-mail and fax facilities to keep in touch with U.S. trainers and contacts, as well as duplicating equipment to reproduce reports and other materials. The in-country follow-on program also provides for additional training through seminars and conferences, principally conducted by technical expertise located in Central Asia. The NET program will continue with greater emphasis put on in-country training.
NET has been instrumental in assisting the Government of Uzbekistan in moving ahead in areas related to the reform process. NET is coordinated closely with the program of other donors in Uzbekistan, a number of which also support various kinds of training.
|
Strategic Objectives |
Economic Restructuring |
Democratic Transition |
Social Stabilization | Cross-cutting / Special Initiatives | Total |
| Privatization | |||||
| Fiscal Reform | 2,200,000 | 2,200,000 | |||
| Private Enterprise | |||||
| Financial Reform | 2,200,000 | 2,200,000 | |||
| Energy | |||||
| Citizens' Participation | 1,700,000 | 1,700,000 | |||
| Legal Systems | |||||
| Local Government | |||||
| Crises | |||||
| Social Benefits | 1,200,000 | 1,200,000 | |||
| Environmental Health | |||||
| Cross-cutting / Special Initiatives | 12,700,000 | 12,700,000 | |||
| TOTAL | 4,400,000 | 1,700,000 | 1,200,000 | 12,700,000 | 20,000,000 |
USAID Mission Director, Acting: Patricia K. Buckles
PROGRAM: UZBEKISTAN
TITLE: Fiscal Reform, 110-S001.2
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1997: $2,200,000 Freedom Support Act
INITIAL OBLIGATION: FY 1993; ESTIMATED COMPLETION DATE: FY 1999
Purpose: Increased soundness of fiscal policies and fiscal management practices.
Background: As in all former Soviet republics, Uzbekistan upon independence lacked the systems, procedures and technical know-how needed to formulate and manage a coherent national budget and tax collection policy. However, considerable progress has been achieved. As a result of dramatic reductions in production and consumption subsidies and effective short-term cash management measures, the budget has been reduced to around 3 percent of GDP. Similarly, inflation was reduced from over 1,300 percent in 1994 to approximately 130 percent in 1995, a huge improvement. Also, Uzbekistan has been flexible in considering fiscal policy and administrative reforms designed to bring social safety net expenditures under firmer control. However, much work still remains to be done in terms of establishing a modern budget classification, planning and implementation system. Serious work is also now underway on developing a modern tax code.
USAID Role and Achievements to Date: A USAID-funded advisory team is providing significant support to the Ministry of Finance in formulating improved fiscal policies. USAID advisors also played a lead role in drafting a new tax code which should significantly improve the current highly distortive and inequitable tax system. Additional support is helping to modernize both the indirect and direct tax administration system. Counterparts welcome this assistance, and the Ministry of Finance has proven to be one of the most reform-minded segments of the Uzbek government.
Description: USAID advisors are working with Uzbek counterparts to prepare a new tax code and implement administrative measures to ensure its effectiveness. Additional technical guidance is being provided to help draft a new budget law, modernize the budgetary classification system and strengthen the budgetary planning and execution process. Both overseas and in-country training supports this effort.
Host Country and Other Donors: Ongoing work in the fiscal area is closely coordinated with other donors as part of an effort to amplify impact and stretch scarce aid resources further. For example, the British intend to provide training for Uzbek tax officials in the United Kingdom. The Danes are also considering providing training and equipment as part of an effort to improve tax administration.
Beneficiaries: This effort seeks to benefit tax-paying Uzbeks at all levels by ensuring greater transparency and a more rational revenue collection and budgetary expenditure process. Potential entrepreneurs and foreign investors will benefit as more comprehensible and transparent fiscal systems are adopted. Increased government revenues and a more rational system for allocating their use should also lead to more effective governance and greater macro economic stability.
Principal Contractors, Grantees, or Agencies: USAID activities are implemented through KPMG, a contractor working closely with the Ministry of Finance in Tashkent.
Major Results Indicators*:
New fiscal policies implemented
Budget deficit as percent of GDP
Revenue collection system in place that is considered equitable and transparent
*These are illustrative indicators. ENI Missions are in the midst of the complex process of developing measurable country-specific indicators and targets, which will be completed by June 1996.
PROGRAM: UZBEKISTAN
TITLE: Financial Reform, 110-S001.4
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1997: $2,200,000 Freedom Support Act
INITIAL OBLIGATION: FY 1993; ESTIMATED COMPLETION DATE: FY 1999
Purpose: A more competitive and market-responsive private financial sector.
Background: Banking systems in Uzbekistan are extremely weak, limiting opportunities for entrepreneurs to borrow capital to finance their investments. Potential foreign firms interested in expanding trade and investment relationships with Uzbekistan also have great difficulty conducting transactions using existing financial networks. The country lags behind its neighbors in establishing a basic legal and institutional framework for market-based capital market development and considerable work is needed to modernize the banking infrastructure. In the absence of such activity, investment opportunities will be limited and prospects for future economic growth will be severely constrained.
USAID Role and Achievements to Date: USAID activities in this area have been modest thus far, including some U.S.-based, short-term training programs for Uzbek bankers and other financial sector officials as well as technical assistance through the International Executive Service Corps and farmer-to-farmer volunteers. Some bankers from Uzbekistan have also participated in regional training programs within Central Asia.
Description: FY1997 funding would be used to launch a modest technical assistance effort aimed at improving the banking infrastructure and developing new laws, guidelines and procedures for ensuring more effective financial market development. Limited training for Uzbek counterparts is also envisaged as part of this initiative. Banking supervision and possibly accounting infrastructure is also anticipated, building in part on work previously conducted in Kazakstan and Kyrgyzstan.
Host Country and Other Donors: USAID work in this area would be closely coordinated with that of other donors. EU-
Tacis has developed a banking training facility in Tashkent, an activity with which EBRD and the Turkish government are also involved. The World Bank has identified the financial sector as a key area and has provided some technical assistance to both the Central Bank and commercial banks.
Beneficiaries: Immediate beneficiaries would include professionals involved in financial development, including private bankers and government officials. Newly emerging entrepreneurs as well as a broad range of Uzbek citizens should benefit from a more effective and efficient banking system.
Principal Contractors, Grantees, or Agencies: USAID activities would likely be implemented through a U.S. commercial contractor working closely with local counterparts at the National Bank and the Ministry of Finance.
Major Results Indicators*:
New laws/guidelines/procedures developed for financial market development
Number/percent of banking sector professionals who support banking sector reform
Level of investment, both domestic and foreign
Purpose: To assist in the economic, political and social transition in Turkmenistan.
Background: In Turkmenistan, "special initiatives" refers mainly to a medical partnership and family planning. Both are part of Congressionally-mandated funding earmarks which are being used to promote broader programming and strategic concerns in Turkmenistan. There is substantial interest in the Turkmen health community in collaborating with U.S. experts, although the emphasis so far has been more on "high tech" curative practices than on basic health care approaches that would make most sense in Turkmenistan. Although the emphasis now is on health earmarks, limited training and technical assistance related to the political and economic transition is possible if funding and thesituation in Turkmenistan permits.
USAID Role and Achievements to Date: The medical partnership between the Cleveland Clinic and the Niyazov Medical Consultative Center in Ashgabat was established in 1993 and is now entering its "graduation" phase. Through June 1995, some 35 short-term exchange trips had been conducted involving individuals from both institutions. Turkmen health staff from thirty other medical institutions have received management training at a number of regional seminars and workshops. Improvements that result from the partnership are designed to provide a good precedent for other hospitals to follow. For example, an examination of cost factors led to the establishment of a cost accounting department that in turn led to a marked reduction in the average length of patient stays. This review also led to the introduction of a number of fee-for-service activities which now account for 10 percent of the Niyazov hospital budget. New infection control procedures resulted in lowered morbidity and mortality rates. Turkmenistan is also participating in a USAID-funded regional family planning program that resulted in the first international meeting to address reproductive health issues in Turkmenistan. The country also participated in the USAID-funded reproductive health program, resulting in two fully equipped service delivery/clinical sites in Asghabat staffed with qualified trainers and service providers.
Description: The medical partnership involves training and people-to-people exchanges between medical staffs in Cleveland and Ashgabat. Often, the partnership becomes a vehicle for raising additional private American funds and for providing badly needed medical supplies and equipment to Turkmenistan. Family planning programs combine advisory services and training that introduces new approaches and technologies into Turkmenistan. The focus now is on health, but developments in Turkmenistan could also permit additional training and technical assistance in support of the economic and political transition in Turkmenistan.
Host Country and Other Donors: Other donor activity in Turkmenistan is limited, but USAID programs are coordinated with those organizations . For example, USAID-funded advisors participated in planning for a World Bank health sector loan. Coordination also takes place with WHO and UNICEF.
Beneficiaries: Immediate beneficiaries include professional medical staff involved in partnership hospitals and in the family planning field as well as their clients. As relationships strengthen and expand, the wider Turkmen public should benefit as new approaches to health care management and service delivery are tested and introduced.
Principal Contractors, Grantees, or Agencies: Private U.S. firms provide technical assistance and training to Turkmen counterparts under the health earmark. The medical partnership is a cooperative effort involving the American International Health Alliance and the Cleveland Clinic in Cleveland, Ohio.
Major Results Indicators*:
Number/kind of management systems and practices strengthened
Percent of medical staff providing services and counseling based on modern family planning approaches and technologies
*These are illustrative indicators. ENI Missions are in the midst of the complex process of developing measurable country-specific indicators and targets, which will be completed by June 1996.
PROGRAM: UZBEKISTAN
TITLE: Citizens' Participation, 110-S002.1
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1997: $1,700,000 Freedom Support Act
INITIAL OBLIGATION: FY 1993; ESTIMATED COMPLETION DATE: FY 1999
Purpose: Increased citizens' participation in political and economic decision-making.
Background: Government control in Uzbekistan remains very much centered in the office of the president. Meaningful opposition is not tolerated, the press is closely controlled, and completely free and fair elections have yet to be held. President Karimov was confirmed in office through 2000 following a referendum. A new parliament was elected in a process that allowed voters to choose among officially sanctioned candidates. Despite these developments, the government appears to welcome the emergence of a non-governmental sector as well as input from foreign legal experts in developing and analyzing potential new laws and legislation.
USAID Role and Achievements to Date: Several USAID-funded small grants programs are available to directly fund the NGO sector in Uzbekistan. Through December 1995, 62 such grants had been provided, covering areas including human rights, environmental issues, women's rights, agricultural development, civic education, rule of law and market transition. This support has also invigorated the formation of NGOs and prompted them to seek ways to improve the legal environment in which they operate. The presence of an American Bar Association (ABA) advisor in Tashkent has also proven to be very effective. The advisor works closely with local lawyers, gives them updates on developments elsewhere, and has been requested by the government to comment on and in some cases help shape future laws and legislation. Finally, modest election assistance in 1994 provided some measure of voter education and ensured that foreign observers were informed about specific laws and procedures so that they could provide a more accurate and useful assessment of electoral deficiencies; similar assistance is planned in anticipation of future elections.
Description: USAID's current program focuses on introducing rudimentary concepts of civil society and democratization to Uzbekistan. Technical advisors, training, and grants to local organizations are all used in this effort to disseminate information and energize local counterparts about the role and potential of non-governmental players in contributing to the economic, political and social development of the country. The Counterpart Consortium focuses on NGO training and provides small support grants to local NGOs. The Eurasia Foundation, whose regional office is located in Tashkent, has also been very active. Although not all their grants are targeted at NGOs, many do involve information and education activities which help inform the public and provide opportunities to engage in broader policy issues. One grant is specifically aimed at assisting NGOs in dealing with legal issues and meeting registration requirements and in drafting NGO legislation. A USAID grantee has begun working with local broadcasters to improve the professionalism and viability of independent media outlets.
Host Country and Other Donors: The United States is the major foreign donor in the area of democratization in Uzbekistan. Other donors have sponsored parliamentary exchanges and the Adenauer Foundation from Germany is especially active. NGO activity has also received support from several donors, including the United Nations agencies. USAID coordinates with these groups in carrying out its own activities.
Beneficiaries: Immediate beneficiaries include individuals directly associated with the Uzbekistan NGO sector and legal profession. Many more should benefit through the public interest advocacy and social services provided as the NGO sector grows and expands. More broadly, all citizens stand to benefit from strengthened civil society and the introduction of more democratic norms and practices.
Principal Contractors, Grantees, or Agencies: USAID activity in democratization in Uzbekistan is largely carried out through the work of various American PVOs. Those involved include ABA/CEELI, Internews and the International Foundation for Election Systems (IFES). American groups such as Goodwill Industries, Aid to Artisans, and the Citizens Network for Foreign Affairs all participate in local NGO development as part of the Counterpart Consortium.
Major Results Indicators*:
Number/percent of citizens who believe they can influence political and economic decision making
NGO legislation implemented
Number/types of NGOs
Purpose: To assist in the economic, political and social transition in Turkmenistan.
Background: In Turkmenistan, "special initiatives" refers mainly to a medical partnership and family planning. Both are part of Congressionally-mandated funding earmarks which are being used to promote broader programming and strategic concerns in Turkmenistan. There is substantial interest in the Turkmen health community in collaborating with U.S. experts, although the emphasis so far has been more on "high tech" curative practices than on basic health care approaches that would make most sense in Turkmenistan. Although the emphasis now is on health earmarks, limited training and technical assistance related to the political and economic transition is possible if funding and the situation in Turkmenistan permits.
USAID Role and Achievements to Date: The medical partnership between the Cleveland Clinic and the Niyazov Medical Consultative Center in Ashgabat was established in 1993 and is now entering its "graduation" phase. Through June 1995, some 35 short-term exchange trips had been conducted involving individuals from both institutions. Turkmen health staff from thirty other medical institutions have received management training at a number of regional seminars and workshops. Improvements that result from the partnership are designed to provide a good precedent for other hospitals to follow. For example, an examination of cost factors led to the establishment of a cost accounting department that in turn led to a marked reduction in the average length of patient stays. This review also led to the introduction of a number of fee-for-service activities which now account for 10 percent of the Niyazov hospital budget. New infection control procedures resulted in lowered morbidity and mortality rates. Turkmenistan is also participating in a USAID-funded regional family planning program that resulted in the first international meeting to address reproductive health issues in Turkmenistan. The country also participated in the USAID-funded reproductive health program, resulting in two fully equipped service delivery/clinical sites in Asghabat staffed with qualified trainers and service providers.
Description: The medical partnership involves training and people-to-people exchanges between medical staffs in Cleveland and Ashgabat. Often, the partnership becomes a vehicle for raising additional private American funds and for providing badly needed medical supplies and equipment to Turkmenistan. Family planning programs combine advisory services and training that introduces new approaches and technologies into Turkmenistan. The focus now is on health, but developments in Turkmenistan could also permit additional training and technical assistance in support of the economic and political transition in Turkmenistan.
Host Country and Other Donors: Other donor activity in Turkmenistan is limited, but USAID programs are coordinated with those organizations . For example, USAID-funded advisors participated in planning for a World Bank health sector loan. Coordination also takes place with WHO and UNICEF.
Beneficiaries: Immediate beneficiaries include professional medical staff involved in partnership hospitals and in the family planning field as well as their clients. As relationships strengthen and expand, the wider Turkmen public should benefit as new approaches to health care management and service delivery are tested and introduced.
Principal Contractors, Grantees, or Agencies: Private U.S. firms provide technical assistance and training to Turkmen counterparts under the health earmark. The medical partnership is a cooperative effort involving the American International Health Alliance and the Cleveland Clinic in Cleveland, Ohio.
Major Results Indicators*:
Number/kind of management systems and practices strengthened
Percent of medical staff providing services and counseling based on modern family planning approaches and technologies
*These are illustrative indicators. ENI Missions are in the midst of the complex process of developing measurable country-specific indicators and targets, which will be completed by June 1996.
PROGRAM: UZBEKISTAN
TITLE: Social Benefits, 110-S003.2
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1997: $1,200,000 Freedom Support Act
INITIAL OBLIGATION: FY 1993; ESTIMATED COMPLETION DATE: FY 1999
Purpose: Improved sustainability of social benefits and services.
Background: The transition to a market economy places severe strains on the social sectors, which were previously funded and managed entirely by the government. Without subsidies from Moscow, old patterns of social service planning and delivery have disintegrated. Old age pensioners and large families headed by single mothers have been especially hard hit. What is needed is a combination of fee-based services (for those able to afford it) to ensure sustainability, and targeted assistance to the most vulnerable populations. Little progress has been made in these areas so far, though the government has expressed an interest in better targeting of social services and more cost-
effective approaches to health care.
USAID Role and Achievements to Date: USAID advisors worked with a World Bank team to advance health reform and leverage World Bank funds to address them. Advisors from the Centers for Disease Control (CDC) in Atlanta have reviewed existing health surveillance systems and made recommendations to improve their effectiveness. USAID-funded advice to the Ministry of Health resulted in revised immunization schedules more consistent with world standards. This will reduce the number of vaccines requires for children less than 17, reduce current expenditures on commodities by 6.7 percent, and result in annual savings of $700,000.
Description: USAID provides training and technical advisory services to key Uzbek counterparts. Funding shortfalls preclude a large, permanent in-country presence, but short-term advisors work closely with Uzbek counterparts to organize and implement training and advisory services. An active training program is underway to introduce new approaches to family planning into Uzbekistan.
Host Country and Other Donors: Other donors involved in the health and social sectors include the World Bank and various European donors. Immunization programs are implemented in coordination with WHO and UNICEF.
Beneficiaries: Immediate beneficiaries include those directly involved in the medical institutions and pharmaceutical marketing networks which work directly with USAID advisors and participate in training programs. Clients of these facilities should benefit as service and the range of choice improves. Over the long term, Uzbek citizens will benefit as these pilot efforts are extended.
Principal Contractors, Grantees, or Agencies: Several USAID-funded groups are involved in the area of social transition, including commercial contractors and the Centers for Disease Control (CDC) in Atlanta.
Major Results Indicators*:
Number/types (percent) of social services provided on fee-for-service basis
Percent Public Social services benefits targeted
Purpose: To assist in the economic, political and social transition in Turkmenistan.
Background: In Turkmenistan, "special initiatives" refers mainly to a medical partnership and family planning. Both are part of Congressionally-mandated funding earmarks which are being used to promote broader programming and strategic concerns in Turkmenistan. There is substantial interest in the Turkmen health community in collaborating with U.S. experts, although the emphasis so far has been more on "high tech" curative practices than on basic health care approaches that would make most sense in Turkmenistan. Although the emphasis now is on health earmarks, limited training and technical assistance related to the political and economic transition is possible if funding and the situation in Turkmenistan permits.
USAID Role and Achievements to Date: The medical partnership between the Cleveland Clinic and the Niyazov Medical Consultative Center in Ashgabat was established in 1993 and is now entering its "graduation" phase. Through June 1995, some 35 short-term exchange trips had been conducted involving individuals from both institutions. Turkmen health staff from thirty other medical institutions have received management training at a number of regional seminars and workshops. Improvements that result from the partnership are designed to provide a good precedent for other hospitals to follow. For example, an examination of cost factors led to the establishment of a cost accounting department that in turn led to a marked reduction in the average length of patient stays. This review also led to the introduction of a number of fee-for-service activities which now account for 10 percent of the Niyazov hospital budget. New infection control procedures resulted in lowered morbidity and mortality rates. Turkmenistan is also participating in a USAID-funded regional family planning program that resulted in the first international meeting to address reproductive health issues in Turkmenistan. The country also participated in the USAID-funded reproductive health program, resulting in two fully equipped service delivery/clinical sites in Asghabat staffed with qualified trainers and service providers.
Description: The medical partnership involves training and people-to-people exchanges between medical staffs in Cleveland and Ashgabat. Often, the partnership becomes a vehicle for raising additional private American funds and for providing badly needed medical supplies and equipment to Turkmenistan. Family planning programs combine advisory services and training that introduces new approaches and technologies into Turkmenistan. The focus now is on health, but developments in Turkmenistan could also permit additional training and technical assistance in support of the economic and political transition in Turkmenistan.
Host Country and Other Donors: Other donor activity in Turkmenistan is limited, but USAID programs are coordinated with those organizations . For example, USAID-funded advisors participated in planning for a World Bank health sector loan. Coordination also takes place with WHO and UNICEF.
Beneficiaries: Immediate beneficiaries include professional medical staff involved in partnership hospitals and in the family planning field as well as their clients. As relationships strengthen and expand, the wider Turkmen public should benefit as new approaches to health care management and service delivery are tested and introduced.
Principal Contractors, Grantees, or Agencies: Private U.S. firms provide technical assistance and training to Turkmen counterparts under the health earmark. The medical partnership is a cooperative effort involving the American International Health Alliance and the Cleveland Clinic in Cleveland, Ohio.
Major Results Indicators*:
Number/kind of management systems and practices strengthened
Percent of medical staff providing services and counseling based on modern family planning approaches and technologies
*These are illustrative indicators. ENI Missions are in the midst of the complex process of developing measurable country-specific indicators and targets, which will be completed by June 1996.