The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Uzbek health system has undergone significant changes since the country became independent in 1991. While Uzbekistan has made progress in the restructuring of different layers of health services with an increased emphasis on primary care, the coordination of different levels of care remains a major challenge. The establishment of a state-guaranteed benefits package was an important element of health reforms. However, a number of essential services were left outside the state-guaranteed benefits package for the majority of the population, including secondary and tertiary services and outpatient pharmaceuticals. This has created many challenges, such as increasing the pressure on emergency services, which are comparatively well equipped and formally free of charge. Overall, access to secondary and tertiary care seems to have deteriorated in recent years and out-of-pocket payments (both formal and informal) present a major barrier to accessing health services and pharmaceuticals, in particular for low-income groups. In addition, there are significant differences in terms of per capita health expenditure across regions and many rural physician points face staffing shortages. Quality improvement is another major challenge for the Uzbek health system and initial quality improvement initiatives are now being undertaken.