The main purpose of this report is to assess the degree to which progress has been made by the Government of Uzbekistan in increasing the transparency, accountability, and efficiency of its primary health services, and to identify what further steps could be taken to improve the effectiveness of delivery, some of which may be applicable to other sectors as well. The report examines public spending, public financial management, and human resource management and remuneration in the primary health care sector at the local level. It draws lessons from the experience of Ferghana and Samarkand, two oblasts that have implemented reforms in primary health care, and incorporates the findings drawn from other sources, such as public expenditure data, the laws and regulations governing these systems, and the Service Quality Delivery Survey (SQDS) conducted in 2007. This report discusses the key governance issues related to improving service delivery in the primary health care area, and concludes with recommendations tailored to decision makers at the central and local government levels and those in local facilities.