CIF consultant, Ketevan Goguadze in April 1-7, 2007 traveled to Armenia. The major purpose of the visit was to provide technical support to the Armenian national working group in order to estimate the costs of the current immunization program; evaluate the financing of the current programme; project resource for the future requirements and financing levels and patterns over the cMYP time period; estimate financing gaps, prepare alternative scenarios of cMYP costing and financing components to reduce the funding gaps and identify the strategies for the improvement of financial sustainability.
Category: Project
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Protocol of the Policy Club on the Public Health Organizational Development
On February 23, 2007 the policy club has been organized within the framework of CoReform Project with the aim to discuss organizational arrangement of the Public Health at local level. It has brought together Deputy Ministers MOLHSA, representatives of Sector Policy Planning Department, Head of the Regulatory Department, Head of the Health Care Department, Director of the National Centre for Disease Control and Medical Statistics, Head of the Public Health Department, Head of the Juridical Department, State Minister Office of Reform Coordination, CoReform Project, Curatio International Foundation representatives, etc. CIF represented by Ivdity Chikovani had presented resources required for effective functioning of public health at the local level. This includes the following activities: immunization, supervision, surveillance and control, routine collection of statistical data and analysis, malaria control measures.
See Georgian version of the presentation.
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Primary Health Care Strengthening Project in Azerbaijan
Primary Health Care Strengthening Project was implemented during the period of September 2005- September 2007 by a consortium of organizations led by International Medical Corps (IMC) in cooperation with Abt Associates Inc., Curatio International Foundation, and the John Hopkins University Bloomberg School of Public Health’s Center for Communication Programs. The PHC Strengthening Project provided technical assistance to the Government of Azerbaijan (GoAZ) in a collaborative effort to strengthen the country’s primary healthcare system.
The project consisted of four components:
Creating a policy and legal framework that defines primary healthcare and the primary health delivery system;
Increasing public expenditures for the improved health allocation for primary healthcare;
Improving quality of primary healthcare services;
Promoting the idea of personal responsibility for one’s health among individuals and families.
The general objectives of the project were:Establishing current referral and utilization patterns for the most common health conditions in the population;
Estimating household health expenditures to adjust the findings of quarterly Household Budget Survey (HBS) that was implemented by the State Committee on Statistics (SCS);
Obtaining baseline and impact indicators to monitor and evaluate reforms implemented in PHC (in pilot regions) and in Health Care Financing;
Developing instruments and obtaining primary data (at least for one pilot district) for mapping health utilization and elaborating health system Master Plan in pilot districts;
Providing Government of Azerbaijan with the critical information about population’s self-reported health status and health care utilization, with the purpose of helping the government to formulate or adjust state policies.
The Project concentrated on assisting the GoAZ in the development of major changes in nationwide health policy and financing. Simultaneously, the Project tested critical interventions at the level of individual facilities and communities in selected districts that served as pilot demonstration sites. The Project activities, both on national and district levels, were closely coordinated with the World Bank Project in Health Sector (Health II). Agreement was reached on focusing the Project’s pilot efforts to demonstrate the new PHC financing and organizational models in those pilot districts that were targeted by the World Bank Project. The latter envisions the rationalization of health infrastructure and optimization of human resources in pilot districts as a necessary precondition for significant investments required for modernizing health care delivery system in these districts. Respectively, the Baseline Study envisioned under the Project served as (a) baseline for anticipated World Bank Project interventions and (b) primary data source for health care delivery system rationalization planning (master planning) exercise. -
Strengthening surveillance, IEC and procurement planning to address Avian Influenza in Georgia
The project was funded by USAID/Caucasus and implemented by Curatio International Foundation (CIF) and Program for Appropriate Technology in Health (PATH) in June 2006-April 2007. The key partners were: Ministry of Labour, Health and Social Affairs, DPH, NCDC, WHO, UNICEF, World Bank, DTRA, HHS/CDC, MoA, AgVantage. The aim of the project was to assist the Government of Georgia with well-coordinated approach on surveillance, IEC and procurement that would strengthen early warning systems, outbreak investigation, and effective response to a possible pandemic.
The objective of the project was to strengthen surveillance/early warning system, procurement planning, and procurement of commodities to address the immediate need, information, education, communication. One of the major components of the project, surveillance, included following activities: assessment of current practices, needs and system design, development of surveillance standards and protocols, development of guidelines, training of public health workers and medical professionals, provision of ongoing on-the-job technical assistance, dissemination of methods, results and lessons learned. The second component for the project, procurement, it combined the need of immediate assessment in consultation with the Government and major donors/partners and in procurement such as the World Bank and DTRA; procurement and delivery of required commodities; development of a master inventory of all commodities required to support surveillance of pandemic influenza. The third component IEC was implemented through provision of input to the development of the National Communications Strategy; development of essential talking points for spokespersons; workshops with media representatives; roundtables with national and regional officials; development of guidelines for health workers on communication with the public.
Over the project period of June 2006 to April 2007, PATH and CIF closely collaborated with the Government of Georgia and other stakeholders.
Key partners included:
Ministry of Labor, Health and Social Affairs (MoLHSA)
Department of Public Health (DPH) and a network of regional and rayon Centers of (????????)
Public Health (CPH)
National Center for Disease Control and Medical Statistics (NCDC)
World Health Organization/European Region (WHO/EURO) and WHO/Georgia office
United Nations Children’s Fund (UNICEF)
World Bank (WB)
US Defense Threat Reduction Agency (DTRA)
Department of Health and Human Services/US Centers for Disease Prevention and Control (HHS/CDC)
Ministry of Agriculture (MoA)
AgVantage Project
The following activities were undertaken within the frame of the project:Training of public health personnel and health care professionals in the new surveillance procedures and measures to control AI infection in humans;
Development of AI communication guidelines (“talking points” and “message maps”), followed by training for spokespersons and media representatives;
Procurement and delivery of surveillance and laboratory supplies;
Development of an inventory and forecasting tool to strengthen laboratory preparedness and ensure coordination of laboratory supplies and personal protective equipment (PPE). -
Community Based Health Insurance
Community Based Health Insurance Project was funded by Japan Social Development Fund (JSDF) and was implemented by Curatio International Foundation (CIF) during the period of September 2003 – September 2007. The objective of the project was to test the feasibility and effectiveness of community based health insurance (CBHI) schemes implemented by the selected communities in Georgia.
More specifically, the project aimed to:
Improve access to health services and provide financial protection for poor and vulnerable groups through increased community participation;
Replicate seven pilot (CBHI) schemes implemented in Western Georgia in at least thirty six (36) other communities in Eastern and Western Georgia;
Link the micro schemes (micro-insurance) that increase the size of the risk pool and generate economics of scale with management of the insurance schemes.
This grant complemented the Development Credit Agreement (Credit Number 3702 GE) of the Primary Health Care Development Project dated November 8, 2002 between Georgia and IDA and facilitated the implementation of the Primary Health Care Development Project. -
Ukraine Mission Report
CIF consultant George Gotsadze was invited by the country office of UNAIDS Ukraine to support the reconstruction of the management component of the Tuberculosis and HIV/AIDS Control Project, financed with the loan proceeds from the World Bank. The project has been suspended by the World Bank since April 2006 due to the slow implementation of the project. Three conditions were recommended by the World Bank to the Government for the continuation of the project. The Government had met required conditions and the suspension placed on the project was effectively lifted. Restructuring the project management and developing detailed implementation plan for the period December 2006-June 2007 were two conditions out of three for the Government of Ukraine to tackle with the help of the consultant.
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Feasibility Assessment for Introduction of the Community Based Health Financing in Egypt
The project of Feasibility Assessment for Introduction of the Community Based Health Financing (CBHF) was funded by Egyptian Social Fund for Development (SFD) and implemented by Curatio International Foundation during the period of September 2005- May 2006. The objective of this mission was to provide technical assistance to the SFD in evaluation of feasibility of CBHF in the selected Egyptian communities and, if CBHF proved feasible, cooperate with the government authorities in developing an action plan for CBHF implementation.
Consultants conducted following activities:
Visited Egypt during November 5 – 22, 2005 and discussed with SFD the methodology of and the approach to the assignment, agreeing on the final methodology to be used in feasibility assessment;
Conducted meetings with the Egyptian government, technical counterparts/experts in the area of health sector financing, and the donors active in health sector reform area;
Identified main risks associated with the implementation of a CBHF scheme in Egypt;
Reviewed the documented evidence about CBHF in Egypt;
With the help of SFD staff and based on the proposed methodology, they identified the sites/communities and institutions in which to conduct visits;
Analyzed the available information relevant to the household health care needs, health service utilization patterns, health care access barriers, socio-cultural factors determining health care seeking behavior, and considered these factors in determining the feasibility of CBHF;
Prepared the feasibility study report and discussed the findings with the client;
Conducted a workshop with the stakeholders to discuss feasibility study findings as well as to propose options and to agree on those conceptual models that were found acceptable by the stakeholders for the pilot project. -
Georgia Health Information and Disease Surveillance Reform
Georgia Health Information and Disease Surveillance Reform project was funded by the U.S. Agency for International Aid/ Caucasus (USAID) and was implemented in partnership with Partners for Health Reform Plus (PHRplus) Project and Curatio International Foundation. The objective of the project was to strengthen Immunization Management Information System (MIS) and Vaccine Preventable Disease (VPD) Surveillance. The project ran from January 2002 until September 2006.
The project was designed and implemented in coordination with principal stakeholders from the Interagency Coordinating Committee (ICC) of Georgia. ICC members were invited from the Department of Public Health, Ministry of Labour, Health, and Social Affairs (MoLHSA), the National Centre for Disease Control and Medical Statistics (NCDC), and international organizations, such as USAID and UN Agencies (UNICEF, WHO). The project aimed to provide assistance to the Government of Georgia to improve the Immunization Information System and the Surveillance of Vaccine Preventable Diseases to provide public health managers, providers of health services, and other stakeholders with appropriate information for making correct strategic, tactical, and operative decisions to keep the VPD epidemiological situation under control. The project also aimed to reduce the morbidity and mortality burden of these diseases on the population and to determine how to use the available vaccines and other programme resources more efficiently.
Immunization MIS:
The improved MIS model is based on an accurate census of the child population, performed by every health facility in its catchments area on an annual basis. The model enables the Health workers to more accurately determine target population, project vaccine needs, compute immunization coverage, and evaluate performance of individual facilities. The reformed MIS model also includes a number of innovations that allow better immunization program management and more rational use of resources at all levels. Countrywide implementation of the reformed MIS was supported by the Decree of the MoLHSA.
The reform package included:
Immunization MIS guidelines for health care providers and public health workers
Job aids for public health and facility workers
Software application “GEOVAC” for the district, regional and National levels. The application improves the process of data unification, enables to determine poorly performing administrative units, and identifies underlying reasons causing the deficiencies. -
Healthy Women in Georgia
Healthy Women in Georgia (HWG) project was funded by U.S. Agency for International Aid (USAID) and implemented by JSI Research & Training Institute Inc. in collaboration with Curatio International Foundation, Save the Children, Orthos. The duration of the project was September 2003 – July 2006.
The objective of the project was to improve women’s health in Georgia. The HWG Program targeted selected facilities in the Imereti region at regional and district levels, and ten ambulatories at the primary health care level. The program developed “Women- Friendly” health care information, counseling and services in facilities and communities. District and ambulatory health providers, pharmacists, and “sakrebulo” (village council) leadership were engaged in the program.
“Parents’ Schools” for patients and clients were established in three district-level health care facilities, to provide information and counseling in formal courses. The HWG Program established a peer education system for adolescents in schools and community gathering places, and reached out to women in communities who did not attend health facilities.
Georgia has one of the highest abortion rates in the world. The HWG Program strengthened access to and availability and quality of modern methods of contraception for family planning, as safe and effective alternatives to abortion.
The objectives of the project:
Establish sustainable, accessible, and high quality “Women-Friendly” services in “combined” facilities (which respectively include a Maternity Hospital, Women’s Consultation Center, and Reproductive Health Cabinet) at regional and district levels in Kutaisi, Zestaphoni and Chiatura;.
Strengthen provision of women’s health information, counseling, and services, including antenatal care, contraception, and family planning at primary health care level in ten “ambulatories”, located in the coverage areas of the two facilities in Zestaphoni and Chiatura, develop referral procedures from primary to secondary level facilities, and encourage health providers to reach out to the village-based;.
Target women, men, and adolescents (patients/clients, service “drop-outs,” and those who have never attended health facilities) living in the coverage areas of the regional, district, and primary care facilities, increase their knowledge, and affect their practices and behaviors to improve healthy life styles and women’s health status;.
Increase availability and use of modern contraceptives as an alternative to present high rates of abortion, and to prevent sexually-transmitted infections (STIs) and contribute to the health of mothers and infants;
Update and improve women’s health care knowledge and skills among health care providers, with reference to WHO standards and international research-based medical and program evidence. -
Effectiveness of Supportive Supervision in Improving the Performance of National Immunization Program in Georgia
The project was funded by Cida/IDRC (Canadian International Development Centre; The International Development Research Centre) and implemented by Curatio International Foundation in collaboration with Toronto University. The duration of the project was July 2004 – March 2006.
The study objective was to document the effects of “supportive supervision” on the performance of the immunization program at the district level in Georgia.
The intervention package included: development of supervisory guidelines, district-level training, continuous supervision and support, monitoring and evaluation, and funding for Centers of Public Health to carry out the package of interventions (travel and communication costs). Supportive supervision, which was the focal point of the package of interventions, was based on introducing updated job descriptions with documented lines of supervision; improving communication lines and skills; introducing guidelines and tools for supervision, performance review and monitoring, and evidence-based action planning, all of which help health workers to improve immunization service delivery.
The effectiveness of the intervention package was assessed with a pre/post-experimental research design. The package of interventions was uniformly implemented in 15 districts selected randomly out of the nation’s 67 districts. Another 15 districts were selected to serve as controls. Measurements were assessed at the baseline and end of the one-year intervention. Quantitative, qualitative and postal surveys were used to collect the information and derive conclusions. Study revealed that significant improvements in the performance of immunization program occurred after implementation of the intervention. In contrast to control districts, intervention districts experienced a significant increase in DPT-3 coverage, decrease in contraindications rate, decrease in refusals rate, and decrease in vaccine wastage between baseline and follow-up stages. The intervention did not appear to have independently contributed to the relative change in service delivery outcome indicators.