Designup

Category: Europe & Eurasia

  • Transition Preparedness Assessment

    Sustainability of national HIV and TB programs gains importance in light of recent changes in the global health landscape when external funders are redirecting resources to poorer states while phasing out from middle-income countries.

    Objectively evaluation of the country transition readiness is a key in the transition process. With this aim in 2015, Curatio International Foundation developed a Transition Preparedness Assessment (TPA) Framework with the Global Fund financial support and piloted in four Eastern European countries Belarus, Bulgaria, Georgia, Ukraine.

    The country Case Studies present findings in a standardized way that enable country stakeholders to prioritize areas that need most attention during transition planning and implementation. In addition, the assessment findings are useful for the donors to guide the country in the transition process. These countries share important similarities that are presented in the Synthesis Report. The three countries case studies are also downloadable below.

    Synthesis report – 4 countries
    Ukraine-case study
    Georgia-case study
    Belarus – case study

  • New Study Findings About Tuberculosis

    Curatio International Foundation together with the Partnership for Research and Action for Health organized a meeting at the National Center for Disease Control and Public Health on 26th of December, where two different study findings were represented. Studies aimed to reveal Referral Delay from Primary Care facilities to specialized TB centers and Health System Factors Affecting Adherence to Tuberculosis (TB) Treatment in Georgia. The project was implemented by financial support of the TDR,  the Special Programme for Research and Training in Tropical Diseases, hosted at the World Health Organization (WHO).

    CIF prezented qualitative research findings about adherence to Drug Resistant TB treatment and led discussion around the findings – what can be done to improve treatment adherence among TB patients, looking through health system lens. The study report will be available by the end of January, 2017.

    CIF inventorised all civil society organizations (CSO) working on Tuberculosis issues in Georgia, with the financial support of Stop TB Partnership through the CFCS round 7.  In the frame of this project TB CSO informational directory has been developed which is available here.

  • 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.

  • Patronage (home visits) System Assessment With Equity Analysis In The Republic Of Uzbekistan

    Status: Closed project

    Introduction and Overview

    The overall purpose of the consultancy is to provide technical assistance to the Ministry of Health of Uzbekistan and the UNICEF Country Office in conducting an assessment of the Patronage/Home Visiting (HV) System. The main purpose of the assessment will be to identify the main strengths and weaknesses of the patronage system. This will help determine what concrete actions and changes to make in order to strengthen its quality and increase its coverage. The home visiting services aim to identify vulnerable children and families in a timely manner, and address the disparities and inequities in basic mother and child assistance/support services.

    In order to deliver the assignment, the CIF team will work jointly under the guidance of the UNICEF Country Office, and in close cooperation with the Ministry of Health and other partners. The project activities will be undertaken in 15 districts located in three select regions.

    The CIF team will consist of a Technical Team Leader – Tamar Gotsadze and a Researcher – Natia Shengelia. The team is supported by a local research company and a local research consultant for data collection.

     

    Organizations involved in the research

    UNICEF Uzbekistan, the Ministry of Health of Uzbekistan, Ministry of Finance of Uzbekistan, as well as regional social services offices, and regional primary healthcare facilities.

     

    Expected Results and Their Application

    As a result of Curatio’s consultancy services, UNICEF CO will have:

    1. The Report on Assessment of the existing Patronage System (P(HV)S), including an equity analysis in utilization and quality of these services.
    2. Recommendations for the improvement of the existing services
    3. Feasibility assessment for implementing a “blended” home visiting model
    4. Recommendations for the implementation of the “blended” home visiting model.

  • Barriers and Facilitators to Screening and Treatment of HCV among IV drug-users in the Republic of Georgia: A Formative Qualitative Study

    Status: Closed

    Introduction and Overview

    In Georgia HCV treatment has become accessible to the population through a new government initiative. This initiative entails the provision of costly HCV treatment drugs at a lower cost (60% lower than the market price) to the patients who have completed HCV diagnostic testing. The hepatitis C program has been placed high on the country’s political agenda, which demonstrates the priority of this public health problem. Since 2008, harm reduction programs operating in all major cities of Georgia provide free HCV antibody testing to PWIDs along with other preventive interventions. On average 2,000 IDUs get tested, and around 50% screen positive for exposure to HCV annually. Although preventive programs encourage HCV positive individuals to continue with further diagnostic procedures and treatment, the care and treatment outcomes for these individuals is unclear. Greater knowledge regarding the facilitators and barriers to diagnosis and care is urgently needed to ensure the country provides the most effective coverage of the population, and to help guide the implementation and refinement of the government’s new hepatitis C program.

    Organizations involved in the research

    The Curatio International Foundation (leading), Public Union Bemoni (partner) and New York University College of Nursing have considerable experience in the field of public health research, qualitative research methods, HCV research and studies with PWIDs.

    Expected Results and Their Application

    The implementation of this research will generate evidence that will in turn inform the future design of the Hepatitis C program. Specifically, the research findings will help to identify the barriers and facilitating factors to providing adequate HCV care and treatment. Additionally, it will assist in guiding the design of strategies to remove these barriers and enhance enabling factors, thus increase the effective coverage of the program.

    Sustainability Implementation Plan

    In Georgia there is no evidence regarding the factors that influence PWIDs decision to take the HCV test and to seek treatment following a positive test. Moreover, since the introduction of the government’s Hepatitis C program, there is a changing context (a decrease in the financial barriers), the influence of which, is interesting to investigate. Therefore, the findings of this research will be unique

    Read the report >>

     

  • CIF Pharmaceutical Price and Availability Study in Georgia

    Status: Closed project

    Introduction and Overview

    The goal of this project is to generate evidence and information on pharmaceutical prices and their availability at pharmacies; the enforcement of regulations regarding prescriptions; as well as pharmaceutical industry practices, in order to inform and strengthen health policy.

    Organizations involved in the research

    Curatio International Foundation conducts the fifth wave of the survay that is supported by the World Bank.

    Expected results and their application

    The objective of this study is to continue the series of Pharma surveys. The fifth round employs the same international methodology for measuring medicine prices that was used in the previous rounds, and attempts to collect information on medicine prices and the physical availability of a pre-selected list of medicines (brand and lowest price generics, with and without prescription requirements).

    The data allows international comparisons as well, using an external standard for the evaluation of local prices recommended by Management Sciences for Health (MSH) ‘International Drug Price Indicator Guide’. In addition, the survey also helps to determine and present an affordability trend among population.

    Furthermore, customs data on import prices for survey medicines (except of local production) is obtained from the Ministry of Labour, Health and Social Affairs (MoLHSA). This allows for the calculation of retail mark-up percentages for survey medicines for both brands and generics.

     

  • Evaluation of UNICEF’s Contribution in Central and Eastern European Five Countries

    Curatio International Foundation conducted an evaluation of UNICEF’s contribution to the reduction of under 5 mortality in five countries: Kazakhstan, Kyrgyzstan, Moldova, Serbia, and Uzbekistan. The evaluation covered 12 years from 2000 – 2012 and was performed in 2014-2015.

    UNICEF’s Regional Office for the CEE/CIS commissioned this Multi-Country Evaluation, as one of a series of such exercises, to a) document progress in reducing under-5 and infant mortality and morbidity and to generate lessons on how this was accomplished; b) inform programs aimed at scaling-up evidence-based and equity-focused interventions; and c) enable better partnering with national governments to advance the child health and rights agenda.

    The evaluation was based on a Theory of Change to reduce and close the equity gap in under-5 and infant mortality and morbidity in the CEE/CIS and applied both UNICEF MoRES framework and the WHO essential health system functions approach.

    Evaluation findings are assembled across the following key areas: Impact on the health status of children; Equity; Relevance; System-level changes; UNICEF’s contribution; Sustainability

    The study found a reduction in infant and under-5 mortality and morbidity over the evaluation period, although equity gaps exist in different geographical, gender and socio-economic groups. The evaluation concluded that UNICEF-supported programmers addressed the most important causes of infant and under-5 morbidity and mortality and were mostly successful in identifying and applying the right interventions to address the health system bottlenecks.

    Key Recommendations

    The evaluation recommended to sharpen equity-focus of programming, consider not sufficiently addressed underlying causes of child mortality and morbidity and addressing persisting bottlenecks at health system and community levels.

    To learn more, download full evaluation report.

     

  • 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.

     

  • Assessment of GAVI Alliance HSS support to Tajikistan

    In August 2014, Curatio International Foundation conducted an assessment of GAVI Alliance HSS support to Tajikstan to provide solid evidence of to what extent the support achieved its objectives and contributed to strengthen the health system of the country.

    The assessment aimed to identify successes, key challenges and lessons learned that may help GAVI Alliance to improve the design and implementation of future HSS support to Tajikistan and other countries. The assessment covered the period of GAVI’s HSS grant to Tajikistan from 2008-2014.

    The full report of the assessment is now available on GAVI’s website. Please visit the page for more information.

    You can also download the full report here.

  • Infographic: HIV/AIDS in Georgia

    Though preventive programs are focused on the high risk population, we face slightly but growing tendency of HIV/AIDs among general population.