The present report “Price, availability and affordability of medicines in Georgia” attempted to obtain reliable data on these aspects and documents tendencies of change over the course of 6 month in 2010. The survey looked at availability and price of Innovative Brands and their equivalent low price generics, analyzed collected data by type of medicine, regional differences as well as by type of pharmacy. The survey also looks at medicine mark-ups and compares with mark-ups in European countries, measures affordability of standard treatments as percent of average subsistence monthly allowance and provides comparison of the standard treatments by innovative brands and equivalent low price generics. Though the study has not covered all therapeutic categories, these do not detract from the importance of the above results as basis for action and as baseline for future studies. Authors: Tamar Gotsadze, Natia Rukhadze, Tinatin Turdzeladze; 2010. The full version of the report in available in Georgian.
Category: Health Systems Research
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Opportunities for Change-Presentation
The presentation describes the importance of the pharmaceutical sector, factors conditioned development of the draft Bill on Changes and Amendments to the Georgian Law on Drugs and Pharmaceutical Activities, which has been passed by the Parliament of Georgia 10th of August, 2009 and became effective from October 15, 2009. The presentation also describes key concepts, recommendations rendered to the Ministry of Labor, Health and Social Affairs in 2007, including the information on which recommendations accepted and which of them ignored by the Ministry; The presentation also provides recommendations for further improvement of the legislation. Author of the presentation: Vakhtang Megrelishvili. Full version is available in English and in Georgian.
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Exploring providers' and patients' perspectives on barriers to quality of care for chronic heart failure (CHF) in Uzbekistan and Georgia
Exploring providers’ and patients’ perspectives on barriers to quality of care for chronic heart failure (CHF) in Uzbekistan and Georgia
In the framework of the project the qualitative study will be undertaken aiming at exploring barriers to quality of care for heart failure in two FSU states: Uzbekistan and Georgia. The project is funded by the Alliance for Health Policy and Systems Research (AHPSR).
Lead investigators are: Dr. Judith Green, London School of Hygiene and Tropical Medicine, Dr. Mohir Ahmedov, Tashkent Medical Academy, School of Public Health, Dr. George Gotsadze, Curatio International Foundation (CIF).The study is a part of a project that explores transferability of qualitative principles (those for group and individual interviews) to low income former Soviet countries by conducting qualitative studies in Uzbekistan and Georgia. The aim of the larger project is to develop understanding of how qualitative methodologies can be developed for use in low/middle income countries, and how they can be developed for use in comparative health systems research. The proposed study therefore includes two countries in a comparative case study design. Each case study will use qualitative methods (individual interviews and group discussions) to explore a topic in quality of care that is of interest to both health care systems. The interviews will be used to explore physician and patient perspectives on barriers for quality care in the treatment of chronic heart failure in primary care settings.
The choice of topic for this project is based on a number of factors. First, the share of non-communicable conditions in the burden of diseases in developing countries is continuously increasing. According to WHO data, in 2001, non-communicable conditions accounted for 46% of the disease burden, the number that is expected to grow to 56% by 2020. [2]
Secondly, a significant shift in health policy making centering on quality care has taken place in the West over the last two decades. A noticeable translation of the policy shift in the developing country settings followed suit. The increasing interest in quality of care in developing countries is timely, as improved quality of care benefits patients by reducing medical errors and unnecessary care, increasing utilization of effective medications and procedures, as well as leading to significant system-wise improved efficiencies.
Heart failure (HF) is a major contributor to morbidity and health care costs, with an estimated population prevalence of 3-4%. Two threats to quality of care are the poor utilization of evidence based treatment protocols and inadequate patient adherence. To explore physician and patient perspectives on the barriers to quality of care for heart failure, researchers will first interview physicians from a purposively selected sample of urban and rural clinics to identify factors that impede compliance at the physician and patient level in Uzbekistan and Georgia. Prescription of ACE-inhibitors and beta-blockers will be used as markers of quality of care. The physicians (N = 10-15 in each country) will be interviewed to identify their current treatment approaches to patients with HF, their knowledge of existing guidelines, and their perspectives on what factors limit the use of ACE-inhibitors and beta-blockers in their practice. To explore patient level factors, CIF will invite 5-6 HF patients from each clinic (N= 4 groups in each country) to a group discussion to identify their perspectives on managing HF, treatment regimes, accessing health care for HF and their views on medications prescribed. All interviews and discussions will be audio recorded, transcribed and qualitatively analysed. The outputs from the project will be peer reviewed publications on barriers to quality of care for HF in the two countries and information for policy makers on potential areas for improvement. This study is part of a larger study on the transferability of qualitative methodology, and additional outputs will be: learning about the development of qualitative methods suitable for comparative health systems research and the development of web based materials to help training for health systems researchers. -
Tracking global HIV/AIDs initiatives and their impact on health systems: effects on the roles of civil society organisations in Ukraine, Kyrgyzstan and Georgia
The aim of the study is to explore the effects of Global Fund HIV programmes on the roles of civil society organisations (CSOs) in Georgia, Kyrgyzstan and Ukraine. The study represents a follow-up to the Global HIV/AIDS Initiatives Network (GHIN) studies that examined the effects of Global HIV/AIDS initiatives on country health systems. Specifically the study will assess the effects of Global Fund programmes on the focus, aims and roles of CSOs; seek to understand how Global Fund HIV programmes have influenced the relationships between CSOs and government; and build an understanding of the effects of Global Fund HIV programmes on relationships between CSOs. The study will primarily be based on semi-structured interviews with country stakeholders and CSOs. Duration: January-July 2010.
Country studies are supported by the Open Society Institute. Network Funders are DFID, Irish Aid and Danida.
In Georgia the study with be implemented by Ketevan Chkhatarashvili and Natia Rukhadze from Curatio International Foundation.
The country researchers will provide inputs into the development of the Research Protocol (methodology) at other appropriate stages in the study including: design of interview tools, sampling strategy, identification of appropriate secondary data sources and relevant literature plus conducting the fieldwork.
As a result of the study articles in peer reviewed publications will be posted.
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Tajikistan Child Health Care Services and Data Quality Assignment
Aim of the project was to identify deficiencies in children birth and death registration system and identify quality of child health care rendered by family medicine practitioners at primary health care level; The project was funded by the World Bank. Duration: May 2010 – May 2011.
Project encompassed the following two components:
Part I: Qualitative research to identify attitude, practice and barriers to effective collection of data related to child births and deaths registration. The data were collected in selected regions from health officials and staff responsible for health data reporting at the different administrative levels (health facilities, local government, rayons, oblasts and central levels) and different groups in the community (women and men) to identify the factors that prevent them from registering child birth and death cases. Analytical report provided specific policy and operational recommendations for the government and donor community.
Part II: Primary Health Care (PHC) facilities survey in selected regions using the IMCI Health Facility Survey methodology. The survey covered 70 PHC centers stratified by centers with and without personnel trained in Family Medicine. The study report along with main findings provided specific policy and operational recommendations to improve child health care services at the primary care level;
The findings of both surveys were disseminated at the workshop in Dushanbe in May 2011. -
Georgia Immunization MIS and Disease Surveillance Reforms: Achievements, Lessons Learned and Future Directions
From 2001 to 2006, the government of Georgia and the Partners for Health Reformplus (PHRplus) project collaborated to strengthen two components of the Georgia Health Information System (HIS): the immunization management information system (MIS) and infectious disease surveillance system (IDS). The work was funded by USAID/Caucasus and coordinated by a multidisciplinary expert group of stakeholders. Participating expert group members came from the Ministry of Labor, Health and Social Affairs, the Department of Public Health, the National Center for Disease Control and Medical Statistics, local Centers of Public Health (CPH), and several international donors (USAID, UNICEF, and the World Health Organization). Implementation was the responsibility of the Georgian nongovernmental organization Curatio International Foundation, subcontracted by PHRplus. View the document.
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Statement for the Media-The Study on Injected Drug Users Completed
Only 1/4 of Intravenous Drug Users are getting tested for HIV, putting their wife’s and girlfriends and the rest of the Georgian population at risk for a widening epidemic
Curatio International Foundation, a Georgian think tank, says “motivating IDUS to get tested is the key to prevention.”
According to a recent study by Curatio International Foundation and Public Union Bemoni, the Injecting Drug Users (IDUs) can put their regular sex partners at risk of HIV infection by having unprotected sex with them.
The study, which was conducted in 2009 in five different locations in Georgia (Tbilisi, Batumi, Zugdidi, Telavi and Gori) found that only 25% of intravenous drug users have been ever tested for HIV through their lifetime -even though the testing is free and available in their communities.
The IDUs especially in Tbilisi are well educated and half are married. The majority of them started drug injection in their late teens. The most frequently injected drug by Tbilisi IDUs is subutex, while Batumi IDUs favor heroin.
The IDUs are quite knowledgeable on HIV transmission routes, however they still commit behaviors that pose risk to their sexual or needle partners.
About half of married IDUs have occasional sex partners and every second of them did not use condoms with such partners. This is particularly unconscionable because in most of cases IDUs do not use condoms with their wives, girlfriends.
Highest HIV rates and risky behavior were found among Batumi IDUs compared to other cities.
“Low uptake of testing services indicates that a large proportion of IDUs is unaware of their HIV status, which leads to high risk behaviors,” says Ketevan Goguadze, project manager, “Motivating IDUs to get tested is the most effective way to prevent spread this infection.”
The study was undertaken in 2009 under the Global Fund supported project implemented by Curatio International Foundation, a local think tank working on the health care issues, and its partner organizations.
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Assessment of HIV/AIDS Surveillance System Pilot is Already Available
Curatio International Foundation has provided Assessment of HIV/AIDS surveillance system pilot. The operations research of HIV/AIDS surveillance pilot in Georgia was conducted in the framework of the project “Establishment of evidence-base for national HIV/AIDS program by strengthening the HIV/AIDS surveillance system in the country” funded by the Global Fund, as a preparatory stage for revision of HIV/AIDS surveillance national guidelines. The operations research aims to assess the performance of a new design of HIV/AIDS routine and sentinel surveillance system, developed in the frames of the project in pilot regions of Tbilisi and Adjara; to reveal the factors hindering effective performance of the system, standard operational procedures and limitations of registration, notification, and reporting forms and to develop recommendations for their revision for countrywide implementation of the new design of the system.Full version of the report is available in English and Georgian languages.
Get full report (English version)
Get full report (Georgian version) -
Findings of Behavior Surveillance Surveys (BSS) Endorsed
Curatio International Foundation in collaboration with Infectious Diseases, AIDS and Clinical Immunology Research Center and Public Union Bemoni and association Tanadgoma has carried out Behavior Surveillance Surveys with biomarker component among Injecting Drug Users (IDUs), Commercial Sex Workers (CSWs), and Prisoners. As a result of endeavor 1100 IDUs from capital Tbilisi plus 4 regional cities, 210 prisoners, and 280 CSWs have been interviewed.
The project is funded by the Global Fund and implemented by the Curatio International Foundation in partnership with Georgian Infectious diseases, AIDS and Clinical Immunology Research Center, Public Union “Bemoni” and Association “Tanadgoma”.
Follow the link to view the full versions of the documents.
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The Art of Crafting Policy Briefs
High quality research evidence is one of the critical preconditions for employing the evidence by policy makers into policy making. However, high quality research evidence itself is not sufficient; it must be communicated in ways that make it compelling.
On February 5-6 alliance of Georgian NGOs attended the training in designing policy briefs. The course took place in the framework of the Strengthening Capacity of Civil Society for Promoting Research Evidence into Policy Development in Georgia and was led by Ketevan Chkhatarashvili, the President of Curatio International Foundation.
The course on policy briefs is designed to enhance participant’s skills in writing policy brief in a way that will enable them to adapt/summarize a more reader-friendly research and to disseminate research findings. Research evidence is one important consideration in the decision-making process. However, one common complaint from policy makers is that they have little time to read full research reports. Therefore, well structured, concise and easy to read policy brief is an important tool for researchers to effectively communicate research findings to policy makers.
The course gave the clear insight of why is the policy brief important, who can be the target audience of the policy brief and how the messages should be conveyed in order to influence the reader and trigger the interest of the policy maker to choose a particular policy alternative or course of action in a current policy debate.
Participants discussed some common and well known policy briefs and practiced in criticizing as well as finding positive sides. At the final session participants were requested to choose the policy topic and draft a policy brief in accordance with the knowledge obtained.
“This course was very timely. The topic is very relevant and lecurer led it exactly to the point. I found training extremely interactive and full of energy. It will really help organizations to acquire the knowledge and technique of writing policy briefs and thus raise the quality and effectiveness of their communication with policy makers”, noted Tamar Karosanidze, Director of Transparency International.
“There is a rich experience, knowledge and information accumulated over many years on public policy issues, although we find it hard to put together all these components and use them effectively. Training provided by CIF was timely and precisely responded to this need”- Nikoloz Loladze, Director of United Georgia Professional Network said.
Alliance for Health Policy and Systems Research (HPSR) and Open Society Georgia Foundation (OSGF) support this effort.