The Community Investment Program – East was funded by BP/Mercy Corps, and implemented in partnership with Mercy Corps., Elkana, TAG, Constanta and Curatio International Foundation (CIF) in March 2003- December 2005. In the frame of this project, CIF was responsible for conducting the trainings of PHC staff available in village ambulatories (Doctors and nurses) on different health issues, including Antenatal Care, Immunization, Chronic diseases prevention, Geriatric disorders, etc.
Category: Policy Work
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Georgia Primary Health Care Development Project, 2000-2003
The project was funded by UK Department for International Development (DFID) and implemented by Institute for Health Sector Development (IHSD) in partnership with London School of Hygiene and Tropical Medicine (LSHTM), Curatio International Foundation (CIF), National Health Management Center (NHMC), and the World Health Organization (WHO). The project began in March 2000 and was completed in 2003.
This project was designed to strengthen the ability of the public health system in Georgia to respond to widespread poverty in the country through development of primary health care based on family medicine and community health model. The project formed the basis for introduction of an accessible, effective, and sustainable primary care system for Georgia, a priority for the Government of Georgia (GoG). The project also intended to develop financing systems and models of community participation to improve access to the primary care services and essential drugs for the population and, in particular, for the poor. The Project supported the GoG initiatives in the sector.
This DFID project was designed as precursor to the World Bank’s forthcoming Health Project in primary care. It had been designed in close collaboration with the Georgian Ministry of Labor, Health, and Social Affairs (MoLHSA) and World Bank representatives. The project’s purpose was to help the GoG to develop and implement a sustainable new model of primary health care through family medicine to improve the quality, access, and participation for persons at all levels of income. This would contribute to the project goal, which was to improve the health status of the low-income population of Georgia.
The Project provided technical assistance and knowledge to the GoG, the MoLHSA and Tbilisi Municipality Health Department on how to implement the new models, train human resources, and undertake economic and social assessments and evaluations to incorporate these experiences to the national health system development process. Key beneficiaries were the people of Georgia who used, or were expected to use, the primary care services, but are currently unable to access them due to the existing financial barriers.
DFID began to support primary health care development in Georgia in 1997. The two-year project (which ended in August 1999) worked with the National Health Management Center (NHMC) in Tbilisi to develop the capacity of the country to train Family Medicine Specialists (FM). The end of project review in July 1999 concluded that the project was successful. Key achievements of the project included:
Establishment of the capacity of NHMC to train FM physicians;
Establishment of FM as a legally recognized specialty;
Development of training materials and curriculum for training FM physicians;
Establishment of a licensing and accreditation system for FM training and for FM physicians.
The Project helped to develop PHC through FM by implementing a new model of financing and provision in the four FM demonstration sites, evaluating the experience and the financial sustainability to enable a national roll out of the model through the World Bank second health project.The Project worked closely with the World Bank to ensure a comprehensive and a holistic approach to exploring options for financing health system. Other inputs included further training, development, and strengthening of PHC team through establishment of the national FM training center in Tbilisi and regional centers in Imereti and Kartli. These regions were selected following discussions with the GoG and assessment of poverty levels in particular regions. Additionally, factors such as the presence of related DFID projects (such as good governance projects) and complementary donor activities (MSF, USAID) were taken into account.
The project drew on lessons of best practice from DFID primary care projects in Georgia, Albania, Kazakhstan, Uzbekistan, and Russia.
The implementation was managed by a UK-based agency Institute for Health Sector Development (IHSD). In addition, there was an in-country implementation committee to steer the Project. This consisted of high-level representatives from the MoLHSA, Ministry of Finance, NHMC, TMHD, Georgian Association of FM, and Georgian Association of Nursing.
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Health Reform and Hospital Financing in Georgia
The publication aims to analyze hospital financing and delivery of inpatient services, financial requirements of the hospitals, and their ability to meet these determinant requirements. There were different types of methods used during this work. By means of standardized questionnaire data on financial performance of 41 hospitals were collected. Patient survey, group discussions with hospital administrators, and interviews with policy-makers were also used. As a result it appeared that thirty-three hospitals were unable to recover full costs, and 29 were unable to recover full costs excluding capital consumption cost. Medium-sized hospitals recovered only 63.5% of full costs. They employed salary equalization policies, which increased the share of fixed costs, perpetuated the oversupply of medical personnel, and yielded low pays. Hospitals charged in excess of their officially accounted costs but, and due to the low collection rates, cost recovery rates were below the officially accounted costs (87.6%).In conclusion it can be said that low official reimbursement rates and patient unawareness of official hospital costs creates conducive environment for shifting major turnover of the real hospital costs to the patients, resulting in illegal patients charging.
Authors:Avtandil Jorbenadze, Akaki Zoidze, David Gzirirshvili, George Gotsadze.
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Healthcare Reform in Georgia
Since the restoration of independence, reforming Georgia`s healthcare system was vital. The report looks at reforms implemented since early 90ies. It give a brief overview of heatlh situation in the Soviet union. Authors: David Gzirishvili, George Mataradze; 1998. Read the full version.
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Assessment of the Health care System in Georgia.
Since the restoration of independence, Georgia has initiated quite a number of reforms. Some have been quite successful. The majority, though, have created an additional burden on the population. There are number of conditions that determine the success of these reforms. The most important could be the desire to change. Both the government and the population must feel the need change. The document looks at health system before and after 1991. Describes legal base and its concept, organization and financing. It also shares customers’ perspectives on healthcare services and suggests recommendations. Authors of the report: David Gzirishvili, George Mataradze.