The idea of healthcare quality improvement (QI) and disseminating evidence-based practice has been attractive for local health policy makers in Uzbekistan since the early 2000s. One aspect in need of discussion is the degree to which the country's healthcare system is open for the proposed QI activities. Funding of health care resulted in building and equipping rural primary care practices, training medical and administrative personnel for these practices, and vesting some regulatory functions at primary care level and enhancing their autonomy from the central regional hospitals. However, these inputs did not provide the sustainability of practices required to meet the needs for improvement in local quality of care. Although standards are effective tools for external and internal quality control, their development in Uzbekistan is rather sporadic and has not been regulated. An important quality of care issue is the need for evidence-based medicine fundamentals to be taught in graduate and postgraduate curricula. However, efforts to implement this through the training of medical school teachers and students have weak support from faculty heads, despite being declared to be among the institute's priorities. International policy regarding Uzbekistan currently ranges from local short-term health projects to large-scale medium-term efforts. The latter are very ambitious, but are the most resource- and time-consuming. In contrast to the view that developing world health systems are becoming more flexible to local QI projects, the post-Soviet health systems, including that in Uzbekistan, seem to resist such interventions.