Designup

Category: Project

  • 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.

  • Health System Resource Centre

    The Health System Resource Centre (HSRC) provides access to technical assistance, knowledge, and information in support of pro-poor health policies, financing, and services, for the Department for International Development of UK and its international and national partners. The duration of the project was 2002 – 2005.

    HSRC services are delivered by an international consortium of seven partner organizations, bringing together a wealth of research and operational expertise in national and international health policy issues and system development:

    Aga Khan Health Services, Community Department (CHD), Kenya;
    Centre de Recherchers et d’Etudes pour le Developpement de la Sante (CREDES), France;
    Curatio International Foundation (CIF); Georgia;
    The Harvard School of Public Health’s International Health Systems Group (IHSG), USA;
    The Institute of Development Studies, (IDS), UK;
    The Institute for Health Sector Development (IHSD), UK;
    The Institute of Policy Studies (IPS), Sri Lanka.
    The HSRC works with national, regional, and international initiatives in support of health system capacity to deliver affordable health services to the indigent people in the developing countries.

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  • Community Investment Program– East

    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.

  • Community Investment Program – West

    The Community Investment Program – West was funded by BP/CARE Int. and implemented in partnership with CARE Int., ICCN, TAG, Constanta, and Curatio International Foundation (CIF) in the period of 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. CIF conducted trainings for community members on First Aid and psycho-social care of the elderly. In addition to conducting trainings, CIF also designed and implemented the Psycho-social network for the elderly and community based health financing schemes. CIF developed and implemented the education, communication, and information campaign for communities on prevention measures of Chronic diseases, as well as STD/HIV/AIDS and alcohol and drug addiction. The informational materials have been printed and were distributed in the communities.

  • HIV/AIDS Mapping Study in the Central Asia Region

    Imperial College Consultants (Central Asia HIV/AIDS mapping study April-June 2004), together with the Curatio International Foundation, have designed and managed implementation of the Central Asia (Tajikistan, Uzbekistan, Kyrgyzstan, Turkmenistan, Kazakhstan) HIV/AIDS mapping study, which looked at the spread and the overlap of four epidemics (HIV, STI, TB and Drug Use). The study detected critical regional drivers for the epidemic spread that require regional response. The findings were used to advocate Central Asian governments for the regional HIV/AIDS control project.

  • Community Based Health Financing Project

    Community Based Health Financing (CBHF) project was implemented by Curatio International Foundation (CIF) through the Sub-Grant Agreement No: RFA-GC6-001-DT under the West Georgia Community Mobilization Initiative Project, which was administered by the Care International in Caucasus and was funded by the United States Agency for International Development (USAID). CIF started project implementation in August 2003 and completed it by August 2004, in accordance with the proposed implementation schedule.

    The main goal of the CBHF project was to decrease the financial access barriers for the poor members of the targeted communities by establishing Community managed and operated health care schemes, that mobilize community’s financial resources (designated for the health care) on a pre-paid basis.

    CIF identified the following objectives:

    Establish 12-18 sustainable CBHF schemes in selected geographic areas, involving communities and local healthcare providers;
    Utilize CBHF schemes to target the most needy within the communities;
    Develop and strengthen local capacity to manage CBHF schemes;
    Ensure future sustainability of CBHF schemes
    The following Project Activities took place during the implementation phase:

    Initial assessment of the situation in 6 regions of Western Georgia;
    Selection of communities that indicated interest in establishing CBHF schemes
    Through the participatory approach, designed CBHF schemes that were custom tailored to each selected community;
    Introduced the designed schemes to Community Based organization through Workshops;
    Identified the training needs of the Community groups and Health Providers;
    Developed training materials for the Communities and Health Providers based on the identified needs;
    Trained Fund Managers, and Health Providers;
    The CBHF Schemes were initiated in 8 targeted communities.

  • Management Information System Development

    The project Safe Motherhood Initiative was funded by U.S. Agency for International Development (USAID) and implemented by Management Science for Health (MSH) in partnership with Curatio International Foundation, Program for Appropriate Technology (PATH), and Emory University. The duration of the project was September 2000 – January 2003.

    The Project consisted of four components: Management and Information system development; community mobilization and provider-client interactions; enhancement of maternal and perinatal clinical performance; STD/Anemia prevalence study.

    In the frame of Safe Motherhood Initiative Project, a new Perinatal Surveillance system was developed by the American and Georgian experts. This system aimed to render critical data for regional (and facility) level decision-making and response planning, which the experts hoped would improve the quality of rendered services to the population. The system enabled decision makers to catch majority of the deliveries, which took place in Region (Rayon).

  • Safe Motherhood Initiative

    Safe Motherhood InitiativeSafe Motherhood Initiative
    Georgia Safe Motherhood Initiative (SMI) project was funded by U.S. Agency for International Development (USAID) and implemented by Management Sciences for Health (MSH) in partnership with Curatio International Foundation, Program for Appropriate Technology (PATH), and Emory University. The duration of the project was September 2000 – January 2003.

    The purpose of the SMI activity was to improve maternal and infant health in Georgia through strengthening of integrated maternal and perinatal health services. The project assessed the quality of perinatal services provided and began to support the transformation of the existing system of women’s care into a more integrated and effective one. This had to result in the delivery of continuous, high quality, and patient oriented services, and in increased women’s awareness of the importance of perinatal care for themselves and their child’s health. The project directed its activities toward the regional and local level. This strategy fully supported the Ministry of Labour, Health and Social Protection policy of strengthening primary health care.

    Main components of the project:

    Management and information system development;
    Community Mobilization and Provider-Client Interactions;
    Enhancement of maternal and perinatal clinical performance;
    STD/Anemia Prevalence Study
    Major Achievements:

    Enhancement of maternal and perinatal clinical performance

    SMI project supported development of the National Maternal and Perinatal Clinical Guidelines, which addressed clinical, as well as organizational issues of perinatal services. Twenty nine leading Georgian specialists in the field of Obstetrics/Gynecology, Pediatrics, and Health Care Managers worked over the course of nine months to produce this document. This team was supported by two US experts, who provided comments and valuable literature. Significant time and resources were devoted by the project to consensus building efforts that helped to inspire the thinking of national level experts and program managers to develop and agree on guidelines that call for new organization of perinatal services and that propose new approaches in clinical aspects of case management. The Guidelines were tailored to the Georgian reality, and they were evidence-based and, where applicable, comparable to International standards. The training materials were developed based on Maternal and Perinatal Clinical Guidelines. The package contains manuals both, for trainees and trainers. The training was designed to upgrade the knowledge and clinical skills of the Primary Health Care providers, including their acquisition of counseling skills in order to educate their clients on defined topics of Maternal/Infant health and care. Seventeen National experts from diverse fields (General Practitioners, Obstetricians, Pediatricians, and Counselors) worked on the development of the clinical training materials. A smaller number of experts was involved in actual provider training process in the project targeted areas. The target audience for the training was Obstetricians/Gynecologists, Pediatricians, Internists, Nurse/Midwifes. A total of hundred and ten members of the Primary Heath Care providing system benefited from this effort.

    STD/Anemia prevalence study

    Objectives of the study were:

    Estimate the prevalence rates of five specific STDs and anemia in non-high risk sexually active women;
    Provide essential data for monitoring trends and impact of STDs and anemia in order to carry out adequate policy development for the prevention and control programs;
    Strengthen technical capacity of local epidemiological, laboratory, and clinical based study investigators.
    The study was conducted by the local experts group, with technical support from CDC consultants. Laboratory tests were performed by local laboratories in Georgia. A total of thousand women were investigated.

    First time since its independence (in 1991), Georgia obtained invaluable data on prevalence rates of STDs and anemia among non-high risk population, which enabled the country to consider the results of the research for the purpose of creating clinical guidelines, formulating policy, and updating clinical practice/protocol.

    The SMI for Georgia paid significant attention to the health system components (financing, continuity of care, the workforce, community participation, and public health functions). From the beginning of the project, service deficiencies were identified and activities were planned for their resolution.

    During the project implementation stage, the management approach ensured the empowerment of national/local governments, NGOs, professional groups, and communities. Continuing dialogue between the Georgian and US experts helped to tailor technical inputs to the specific needs of Georgians, rather than proposing ready-made solutions. The latter approach assured national ownership of the program results, which could serve as a guarantee for sustainability and replication to other areas.

    The processes described above required significant staff attention and careful management of financial resources. Continuous on- the- ground presence of local project management helped ensure the attainment of the intended results.

  • 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.

  • 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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