Designup

Category: Policy Work

  • Building Institutional Capacity for HPSR and Delivery Science- CIF is Europe region HUB

    General Overview

    The evidence-informed decision making in health still remains a major challenge. To strengthen institutional capacity in different countries around the globe the Alliance for Health Policy and Systems Research (AHPSR) launched the new program to strengthen the capacity of local teaching/research and policy institutions in six low- and middle- income countries in each WHO region, to embed high-quality training in HPSR, target both researchers and decision makers. The Knowledge to Policy (K2P) Center at American University of Beirut is lead mentor institution who will guide 6 mentee institutions around the world, Curatio International Foundation (CIF) acts as mentee institution for the European region.

    Purpose of the Program

    Strengthen the capacity of researchers and policymakers and their respective institutions to support evidence-informed decision-making in health.

     

    Expected outputs
    • Institutions that have the systems, processes and the right culture to support and facilitate evidence-informed decision-making in health in LMICs
    • Policymakers who recognize the role of evidence in informing different stages of the policymaking process and capacity to access, appraise and use evidence to inform decision-making in health
    • Researchers who understand the policymaking process and who have the skills and competencies to provide relevant, context-sensitive and timely HPSR and evidence to inform decision-making in health.

     

    Expected impact
    • A cadre of sustainable policymaking and research/knowledge institutions that champion the use of evidence in health policymaking, and that can serve as focal mentors to develop the capacity of other institutions within their respective countries and regions (i.e., ripple effect)
    • Strengthened evidence-informed decision-making in health in LMICs
    • Ultimately, by promoting the use of research, evidence, and data in policymaking and practice, the program will contribute to strengthening health systems, improving population health outcomes, reducing health care expenditures, and accelerating the attainment of the sustainable development goals (SDGs)
    • Establish and nurture critical links and collaborations between and researchers and policymakers

     

    Donors and Partners

    Lead partner: Knowledge to Policy (K2P) Center (American University of Beirut)
    Donor: WHO, the Alliance for Health Policy and Systems Research (AHPSR)

    Geographical Coverage

    Georgia and Europe Region (as defined by WHO).

     

    Project Timeline

    The project started in September 2018 and will run until May 2020.

  • Empowering civil society for engagement in and monitoring the decision making in health sector in Georgia

    Introduction and Overview

    The project aims to strengthen CSOs working on Health Systems to participate in the decision-making process, to assume watchdog functions, monitor enforcement of policies and advocate for better health for all. The project is funded by Open Society Foundation through proactive cooperation with Open Society Georgian Foundation.

    Organisations Involved

    Open Society Foundation (via OSGF); More than 20 local organizations, including Civil Society, Media, and Academy.

    Expected Results and Their Application

    To strengthening local CSOs to enable them to participate in the decision-making process, to assume watchdog functions, to monitor enforcement of policies and to advocate for better health for all regardless of the ability to pay.

    1. To conduct mapping exercise to a) identify NGOs/CSO organizations working in the health sector as well as organizations working on transparency, human rights and budget monitoring issues in Georgia, b) explore existing potentials of health‐related civil society organizations; d) explore their interest in participating in the proposed project;

    2. To strengthen health‐related civil society organizations to uncover and challenge nondemocratic, non‐transparent and non‐accountable policy decisions in health sector through training on a range of topics related to health policy cycle, health budget development processing Georgia and principles of budget monitoring, current landscape for overall health care system in Georgia, as well as landscape of pharmaceutical market etc.

    3. To strengthen networking, coordination, and communication among civil society organizations and community groups.

  • Conference paper about realist evaluation: Informing policy, assessing its effects and understanding how it works for improved Tuberculosis management in Georgia

    In the last week of October, 2017 Brisbane, Australia hosted International Conference for Realist Research Evaluation and Synthesis – Realist2017. Realist evaluation is complex sensitive approach and is useful for decision makers because rather responding the question “does the intervention or program work” Realist Evaluation indicates “What works for whom in what circumstances, and how?”

    Curatio International Foundation and the partner institution – Institute of Tropical Medicine, from Antwerp, Belgium presented a work undertaken in the frame of #Results4TB project. During the session professor Bruno Marchal, Ariadna Nebot and Lela Sulaberidze discussed issues around Informing policy, assessing its effects and understanding how it works – Combining realist evaluation, cost analysis and impact assessment of a policy for better TB care in Georgia.

    During the session, the conference audience was informed about the new project – provider Results-Based Financing for improved TB care management in Georgia that is currently being designed to be piloted from 2018 in the country. In this project, we use Realist Evaluation approach to evaluate mechanisms of effect and impact of the intervention. At the conference research team introduced insights of using Realist Evaluation to not only elicit the Programme Theory of the policy-makers and implementers, but also of the researchers, to help

    • Policymakers to achieve a better view on the problem and the solution, and the conditions required to make it work
    • Researchers to develop a better common understanding that would lead to a better research design, and an integrated data collection and analysis strategy
    • Review of the existing evidence is supposed to contribute to better-informed policies and evaluations

    During the presentation research team emphasized the following issues: 1. Insights into the program theory elicitation process, from concept to practice; 2. Participative methods applied during the program theory elicitation.

     Please read the slightly modified presentation.

  • Results4TB: Designing and evaluating provider Results Based Financing for Tuberculosis in Georgia

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    Introduction and Overview

    Curatio International Foundation in partnership with Queen Margaret University (UK), London School of Hygiene and Tropical Medicine (UK) and Antwerp Institute of Tropical Medicine (Belgium) is implementing a study “Designing and evaluating provider results-based financing for tuberculosis care in Georgia: understanding costs, mechanisms of effect and impact”.[/vc_column_text][/vc_column][vc_column width=”1/2″][vc_column_text]

    Visit the project website

    [/vc_column_text][/vc_column][/vc_row][vc_row][vc_column width=”1/1″][vc_column_text]The 48-month duration research project will assist the Government of Georgia in developing a provider incentive payment scheme for Tuberculosis (as a pilot intervention) and will generate evidence on its effects on adherence and treatment success rates and costs.

    The research will seek to answer the following research questions:

    (1) What is the impact of provider-focused Results-Based Financing (RBF) on patients’ adherence to tuberculosis treatment and treatment outcomes of both Drug-Susceptible (DS) and Multi Drug Resistant (MDR) patients in Georgia?

    (2) Is the RBF intervention cost-effective?

    (3) How does it work, for whom and in which conditions? and

    (4) How should RBF be modified to optimize national roll-out for this and possibly other health services?

    Project has launched in March 2017 and will run till March 2021[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column width=”1/1″][ultimate_spacer height=”30″][vc_column_text]

    Organizations involved in the research

    The project is funded through the Joint Health Systems Research Initiative which is jointly funded by the Department of International Development (DFID), the Economic and Social Research Council (ESRC), the Medical Research Council (MRC) and the Wellcome Trust (WT).

    The study will be implemented by CIF (Georgia), Queen Margaret University (UK), London School of Hygiene and Tropical Medicine (UK) and Antwerp Institute of Tropical Medicine (Belgium).

     

    Expected Results and Their Application

    The beneficiaries of this research will be TB patients, nurses and physicians involved in TB care, health facility managers, policy-makers, community members and the scientific community in Georgia, in the region and globally.

    The research will narrow the knowledge gap existing around RBF interventions, such as their application in public/private settings and their cost-effectiveness, the conditions of success and the wider (negative and positive) consequences of the scheme.

    The research will also produce methodological innovation regarding the use of realist evaluation alongside cost-effectiveness analysis.

    The evidence produced through this research will be used by national policy-makers to reform the financing of primary health schemes in a way that improves efficiency, quality, and sustainability of services. Additionally, findings will be beneficial for other LMICs, particularly for those with a similar vertical organization of TB services (most of the former Socialist countries of Eastern and Central Europe and Central Asia) and for countries where private providers play an important role in the provision of TB services

     

    Would you like to be updated about the project achievements?

    The Results4tb project has its own website. Visit the page to learn more about the project.[/vc_column_text][/vc_column][/vc_row]

  • Article: Privilege and inclusivity in shaping Global Health agendas

    Health Policy and Planning published an article Privilege and inclusivity in shaping Global Health agendas.  CIF director George Gotsadze co-authors the paper together with Kabir Sheikh, Sara Bennett and Fadi el Jardali.

    The article discusses lack of inclusivity in Global Health and possible actions to promote inclusivity and diversity in the field.

    “Northern voices dominate Global Health discussions. Of recent Lancet Commissions, excluding representatives from international organizations, 70% of commissioners on the Women and Health commission came from the global North, and likewise, 71% of the Health and Climate Change commission, 72% of the Global Surgery commission and 73% of the Global Health commission (Lancet 2016). Only two out of the 16-member Board of Directors of the Consortium of Universities of Global Health come from the global South (CUGH 2016). No current or past president and only one current member of the World Health Summit’s scientific committee is from the global South (WHS 2016). Only one of the 17 advisory board members of the journal Global Health Governance is based in a low/middle income country (LMIC) institution (GHG 2016).

    Only 15% of the world’s population lives in high-income countries. Yet Global Health conferences continue to be dominated by invited Northern speakers and important committees on Global Health composed mainly of Northerners. The words of a few from the global North wield a disproportionate power that carries …”

    The full text is downloadable here.

  • CIF Pharmaceutical Price and Availability Study (Fifth Wave Results)

    The Curatio International Foundation has released the results of the fifth wave of the Pharmaceutical Price and Availability (PPA) study in Georgia. The study set out to generate further evidence regarding pharmaceutical prices and availability in the country through the continuous monitoring of the prices of medicine. One of the chief aims of the study is to inform and strengthen health policy and contribute to evidence-based discussions around current trends and processes in pharmaceutical market in Georgia.

    The study analyzes the current, as well as the previous four waves of the PPA studies that have been conducted by CIF since 2009. The main findings of the research responds to two important questions:

    1. What is the trend of physical and financial availability for Generic (LPG) and Originator rand (OB) drugs in Georgia, and how is the treatment cost linked to the availability?
    2. How is Georgia’s pharmaceutical sector being developed after the introduction of the new prescription policy?

    The answers to these questions are available in the main findings of the study:

    Main Findings

    AVAILABILITY

    • Currently, OB availability is almost two-times higher compared to LPG
    • The observed trend in decreased LPG availability can be attributed to several factors:
      • Insufficient knowledge and/or trust in the quality of LPGs among consumers and providers
      • Low demand for LPGs among the population caused by physician reluctance to prescribe generic medicines
      • The revenue-maximizing strategy of pharmaceutical suppliers
    TRENDS IN PRICING STRATEGIES
    •  It is likely that increased competition caused by legal changes in the country’s drug laws in late 2009 determined the downward trend in the OB prices observed during 2009-2012 waves, albeit OB prices rebounded and significantly increased in 2016
    • OBs are largely imported from western countries. Therefore, it is possible that the price increase documented in 2016 can be partially attributed to the significant devaluation of the country’s national currency against the USD and Euro that began in late 2014, and continued throughout 2015. Consequently, OB prices increased in both pharmacy networks and in independent pharmacies
    • In 2015, MoLHSA initiated a new prescription policy with the aim of reducing the level of irrational drug use in the Country. The importance and/or need for prescription system introduction is unquestionable, like in many other countries; however, the insufficiency and/or lack of the necessary instruments for the effective operation of the system most likely allowed pharmaceutical companies to use this initiative to further increase their profits. This assumption is supported by the fact that while in 2012 markups were largely comparable for prescription and non-prescription drugs, in 2016, we observed significant changes in behavior. Namely, markups for prescription OBs are now 89% higher compared to non-prescription OBs, and markups on prescription LPGs are currently 210% higher compared to non-prescription LPGs
    • Surprisingly, locally-manufactured LPGs are sold at a higher price compared to their imported equivalents, most likely affording greater profit potential to local manufacturers. Along with the marketing strategies used by the largest retail networks (also linked to local manufacturing), the promotion of locally-produced drugs over imported drugs helps local producers effectively use their market power in a poorly-regulated marketplace
    EMERGING POLICY RECOMMENDATIONS

    A single policy intervention in a complex pharmaceutical market like Georgia’s will most likely fail to meet its objective i.e. a reduction in costs to the public, and improved access to pharmaceuticals. Therefore, the government needs to immediately implement a multi-pronged policy to better address the issue.

    This policy should include the following:

    1. The introduction of reference pricing on the market – the government can achieve this by learning from other countries’ (high/low/middle-income) experiences and best practices. Through observing others’ experiences, the most appropriate reference pricing methodology can be utilized to further facilitate the regulation of drug prices in the country.
    2. Encourage the use of generic prescription drugs and enforce the generic substitution in the prescription of medicines.
    3. Introduce strict rules and controls for drug promotion, marketing, education, and sponsorship gifts to doctors.
    4. Enhance pharmaceutical market monitoring to adequately adjust for weaknesses in the policy or its implementation.

    The full report is available here.

     About the Study

    The study was conducted using World Health Organization (WHO) standard methodology. The survey looked at the prices and mark-ups of 52 medicines (brand-name medicines and their generic equivalents) in six regions of Georgia.

    CIF has been conducting the PPA study since 2009. The results of the study’s previous waves were released in 2010, 2011, 2012 and 2014.

     

  • Bio-Behavioral Surveillance Survey among Men who have Sex with Men in two major cities of Georgia, 2015

    Bio-Behavioral Surveillance Survey among Men who have Sex with Men in two major cities of Georgia, 2015

    Curatio International Foundation continues implementation of Bio-Behavioral Surveillance Surveys (BBS) among Key Affected Populations (KAP’s) with the aim to measure HIV prevalence among KAP’s, monitor risk behaviors among these groups and generate evidence for advocacy and policy-making.

    The current study describes the most recent wave of BBS surveys among Men who have Sex with Men (MSM) in Georgia (Bio-BBS surveys among MSM have been implemented since 2007).  Study also was looking at HCV and STI (Syphilis) prevalence among MSM. CIF implemented this study together with partner organisations – Center for Information and Counseling on Reproductive Health – Tanadgoma and the Infectious Diseases, AIDS and Clinical Immunology Research Center.

    The study used a cross-sectional design and respondent‐driven sampling methodology (RDS). A sample of 415 MSM18 years and older were recruited in the survey in two major cities of Georgia: Tbilisi and Batumi.

    The study was financially supported by the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM).

    Major findings:

    Socio-demographic characteristics

    • The median age was 28 years in Tbilisi and 29 – in Batumi, majority had secondary level education, had never been married, big proportion of MSM had permanent work, and majority’s monthly income was less than 500 GEL.
    • The study did not reveal high proportion of heavy alcohol use or injecting drug use, indicating that there is no overlap with key populations such as MSM and PWID.

    Sexual behavior

    • MSM had different types of both male and female sex partners (regular, occasional and commercial).  The median number of male partners (anal/oral partners) in the last 12 months 6 in Tbilisi and 5 – in Batumi. Tbilisi number is higher than that of 2010.
    • Out of MSM that reported anal partner during the last year, 63.2% in Tbilisi and 78.8% – in Batumi used a condom during their last anal sexual contact. Condom use at last AI in Tbilisi in 2015 slightly higher compared to 2010 (61.7%).
    • Overall more than 50% of MSM reported having female sex partner  (regular, occasional or paid) during the last 12 months- 55.4% in Tbilisi and 53% in Batumi. More than two thirds (71.2% in Tbilisi and 65.9% in Batumi) said they used a condom at last sexual intercourse with their female partner.Since 2010 there is increase in condom use at last sex with female partners in Tbilisi. As for Batumi, this rate is also high.

    Condoms and lubricants

    • There was a slight increase in the proportion of MSM who reported receipt of condoms from preventive programs during the last 12 months in Tbilisi from 40.3% in 2010 to 43.5% in 2015.
    • Awareness about condoms stays high.
    • Awareness about the lubricants as well as their reported use during the last AI has improved vastly in Tbilisi and is also high in Batumi. These are higher indicators compared to the previous surveys, which can be explained by provision of free lubricants by preventive programs, started since 2014.

    HIV knowledge and HIV testing practice

    • Knowledge and testing on HIV showed significant improvement in Tbilisi since 2010 – from 19.9% in 2010 to 30.4% in 2015 (p (2-tailed), 0.001). In Batumi this indicator was measured the first time and reached 35.2%.
    • During the recent five years there is statistically significant improvement in MSM awareness where to get HIV test in case of necessity (p < 0.001), as well as in the proportion of MSM who were tested during the last 12 months and received results (p< 0.001). This can be explained by sustainable use of HIV rapid (finger prick) testing in the outreach under preventive programs, which makes HIV testing easily accessible to the target group.
    • Researchers also measured increase in testing uptake from 2012 to 2015, and it was also statistically significant (p (2tailed) – 0.07).

    Violence

    • Survey participants reported that they have experienced violence because of sexual orientation or homosexual behaviour in the last 12 months (32% in Tbilisi and 4.7% in Batumi). In Tbilisi violence rate has increased significantly compared to 2012.

    Program coverage / media

    • Coverage by preventive intervention measured by awareness of where to get a HIV test and receipt of a condom during the last 12 months increased from 20.9% in 2010 to 43.5% in 2015 in Tbilisi. In Batumi coverage is quite high – about 40%.
    • NGOs, internet and friends seem to be the major and best way for conveying messages to MSM.

    HIV, HCV and Syphilis prevalence

    • The most alarming finding of this study is increase in HIV prevalence in Tbilisi from 6.4% in 2010 to 25.1% in 2015. During last five years we observe three-fold increase of HIV prevalence. Batumi HIV prevalence is also very high – 22.3%.
    • Syphilis was detected in 35% of the MSM in Tbilisi and 24.6% – in Batumi.As for syphilis, its prevalence is quite high but does not show difference compared to 2010 results.
    • Hepatitis C prevalence was 7% in Tbilisi but much higher in Batumi – 18.9%

    Full study report is available here.

  • BioBehavior Surveillance Survey results were represented to the members of Parliament of Georgia

    Curatio International Foundation together with BEMONI PUBLIC UNION (BPU) represented BioBehavior Surveillance Survey results to the Members of Parliament of Georgia.

     

    The study was conducted in seven major cities of Georgia (Tbilisi, Gori, Telavi, Zugdidi, Batumi, Kutaisi and Rustavi) with a sample of 2037 injecting drug users 18 years and older. The current study describes the most recent wave of Bio-BBS surveys among PWIDs in Georgia (Bio-BBS surveys among PWIDs have been undertaken since 2002).  The study was funded by the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM).

    Study Findings

    Socio-demographic characteristics

    • The median age of initiating non-injection drug consumption and injection drug use has not changed since 2012 and equals 15-16 years and 18-20 years, respectively.

    Drug Scene and other contextual factors

    • Non-injecting drugs consumption did not demonstrate major changes since 2012. CNS depressants and hallucinogens were reported as the most popular drugs for consumption with a slight decrease observed since 2012. About a quarter of young PWID who reported non-injection drug use mentioned use of new psychoactive drugs.
    • Injected drug scene has significantly changed during last years. Heroin is the most misused substance among drug users in Georgia followed by buprenorphine. Alternatively, lower proportion of PWID reported use of homemade opioid-type drugs like Desomorphine and Amphetamine type stimulants (so cold “Vint” and “Jeff”) compared to 2012. Thirty-five percent of the survey participants are active opioid-dependent.
    • Injection in other countries has dramatically grown across all survey locations and this trend is notable since 2009. HIV risk behaviors increase while abroad, as exhibited by the four-fold increase in rates of sharing injection equipment in other countries compared to Georgia.

    HIV knowledge and HIV testing practice

    • Knowledge of HIV/AIDS among PWID remains relatively good. The majority is aware of primary transmission risks associated with injection and sexual behavior.
    • There is significant increase in proportion of PWID who were tested during last 12 months and know their results. Increase is observed across all cities. In general one in four injecting drug user has been recently tested on HIV.

    Sexual behavior

    • High risk sexual behavior remains one of the major problems among PWIDs.
    • Although, more drug injectors have safe sexual contacts with occasional partners than in previous years, but in Kutaisi, Batumi and Rustavi, however, protective behavior remains at alarmingly low levels and needs special attention.

    Access to and coverage of treatment and harm reduction interventions

    • The majority of PWIDs have never accessed drug treatment facilities. Only 6% underwent or was still under any kind of treatment.
    • Coverage of preventive programs (minimal coverage) defined as knowing where to get an HIV test and receiving at least one of the following program commodities: sterile injecting equipment, condom, brochure/leaflet/booklet on HIV/AIDS, and qualified information on HIV has increased from 24% to 32.4% since 2012.
    • While awareness about syringe exchange programs has improved in Telavi, Batumi, and Zugdidi, in general, knowledge about the program remains low and needs to be improved. Substitution therapy programs are much more well-known among PWID.

     HIV and HICV prevalence

    • The combined dataset analysis of all seven cities shows that HIV prevalence is 2.2% (95% CI 1.53-2.99) with no change since 2012 when HIV prevalence was 3.0 (95% CI 2.20-4.04). An estimate for PWID living with HIV varies from the lowest 0.9% (95%CI, 0%-4.3%) in Rustavi to the highest 4.8% in Zugdidi (95%CI, 0.2%-11%). Batumi and Zugdidi remain the cities with highest HIV prevalence rates.
    • The study revealed alarmingly high HCV prevalence (66.2% – in all seven cities).

    Presentation is avalable in Georgian. 

  • Strengthening Capacity of Civil Society for Promoting Research Evidence into Policy Development in Georgia

    Strengthening Capacity of Civil Society for Promoting Research Evidence into Policy Development in Georgia
    The idea of initiating the project was prompted by aggressive health and insurance market oriented reforms focusing on hospital sector privatization and financing of health care services through the private insurance companies. Implicit risks posing this campaign and fast pace of implementation needed to be mitigated through effective and evidence informed policies and regulations.

    The project aims to achieve development of policies that are: a) evidence informed; b) tailored to Georgia’s social, economic and cultural context, and c) responsive to public interest. Curatio International Foundation intends to contribute to achieving this goal by allying two distinct networks of NGOs and strengthening their capacity in delivering evidence into policy process. The alliance gathers experts in their own operations field, been active as watchdogs for health sector reforms on one hand and focusing on mental health issues on another hand.

    Curatio International Foundation embarked on a strategy of using evidence-informed advocacy as an essential ingredient in the policy development process. The Evidence to Policy is viewed through institutional lens rather than individual, therefore it focuses on interventions on institutions and on strengthening the links between institutions within and outside of the NGO networks through trainings of NGO staff and establishing Information Exchange Platforms. Training topics were informed from the assessment of capacity needs undertaken prior to project launch.

    As a result of this project it is expected that:

    * The capacity of NGOs involved in the network will be increased in accessing, acquiring and communicating available evidence to policy makers;
    * NGOs will develop better capacity to identify policy relevant research evidence and use the means of communication to effectively influence the policymakers;
    * NGO and stakeholder understanding about how they could engage with each other will improve “bonding” and “bridging” ties that link researchers, policy makers and NGOs involved in evidence informed policy making.

    NGO networks involved in alliance are:
    1. Network of NGOs already active as watchdogs and advocacy groups for health sector reforms:
    a. Georgian Young Lawyer’s Association (GYLA)
    b. Transparency International Georgia
    c. Open Society Georgia Foundation (Soros Foundation national chapter)
    d. Association of Young Economists of Georgia (AYEG)
    e. Economic Policy Research Centre

    2. Network of NGOs focusing on mental health issues:
    a. Georgian Association for Mental Health (GAMH)
    b. Mental Health Coalition
    c. Association of People in Need of Special Care (APNSC)
    d. The Georgian Association for Psychosocial Aid “Ndoba”

  • Policy Information Platform (PIP) Expert Consultation Meeting

    Policy Information Platform (PIP) expert consultation was held in Istanbul on 29-30 January, 2015. At the meeting methodological issues, roadmap for the PIP implementation and evaluation approaches were discussed.

    CIF director George Gotsadze and Research Unit director Ivdity Chikovani participated in the expert consultation.
    PIP is a repository of peer-reviewed publications and grey literature that should generate knowledge for health policy decision-making. PIP should respond to the priority topics emerging in the policy-making process.

    The project is an initiative of Alliance for Health Policy and Systems Research (AHPSR) aiming at alleviating access barriers to policy-relevant information at national level in low-middle income countries. The piloting countries are: Georgia, Argentina, Pakistan and Nigeria.

    In the pilot countries PIP implementing partners are: CIF, Argentina MoH, Pakistan King Edward Medical University and Nigeria Ebonyi State University.

    CIF contributes to the whole PIP initiative by developing methodological approaches for grey literature evaluation.

    The PIP project will be implemented during 2015-2016.