HEALTHCARE POLICY AND MANAGEMENT REFORM

PROBLEM

Excerpt from a report by a Public Health official:

The health services are in disarray. Most of the doctors working in the public sector have not been paid for many months, although they are reluctant to discuss it. The hospitals are crumbling and unheated, ill equipped and without modern technology. They rely heavily on what little foreign aid escapes the corrupt system of distribution. There is an oversupply of doctors and hospital beds as a result of Soviet health policies, which are now completely inappropriate. Tblisi has over 150 medical schools, some of which are little more than postal addresses.

Letter from a young Georgian physician who did his internal medicine residency in Atlanta and returned to Georgia:

I would like to tell you about me and my future plans, hoping to hear from you in near
future. Right now I am staying in Georgia and probably will spend couple more months here. I live in city of xxxx and situation there almost desperate. There is no electricity, no running water in the city with population of 150.000. Hospitals are in deep necessity, no medications, no facilities, and in addition, because of huge unemployment people aren't capable to pay for medications, doctors clearly are miserable.

I am seeing patients in the city but there is not much I can do for them. As you know, educational level of most Georgian doctors is so low, they even don't know how to manage hypertension or diabetes, and there is huge work to be done everywhere, but nobody seems to be interested in progress and improvement of medical care.

People struggling to feed their families and this is first priority and there is no money for real medicine. Situation is so bad, it would be difficult even to imagine 15 years ago. Most of men drink and smoke because of depression and many of them commit suicide. Every Georgian's dream is to escape, trying find jobs in Russia, Europe or in the USA, but most of them cannot get visas to reach the USA.

I love my country and I want to stay in Georgia more than anything, but unfortunately but there is no place here for hard working people. If I stay here, I will either go crazy or get mad. If I get visa, I will go to the USA for research position, that was my dream for long time. If not--to Europe or Arabia.

I don't want finish this letter in pessimistic mood, I think man can create his own fate with God's help and I always stay optimistic.

ACCOMPLISHMENTS

-Health Management Reform began with a needs assessment, followed by a series of training seminars in Borjomi for 55 health care managers, conducted by AIHA and the APHA.

-Atlanta-Tbilisi cosponsored five National Health Policy Workshops in Georgia focusing on health care reform, health care policy and human resources.

-President Eduard Shevardnadze issued Decree 400 on December 23, 1994, establishing the State Health Care Fund, ensuring licensure of medical facilities, creating registration and quality control of medications and supplies, and certifying and licensing health care providers.

-As a result of the National Health Policy Workshops, the World Bank initiated its investigation of designing their Georgia Health Project as part of the overall loan to Georgia in 1996.

-Atlanta-Tbilisi supplied an onsite representative, Ms. Sherry Carlin, during the second year of the partnership. Ms. Carlin worked closely with the Ministry of Health and nongovernmental organizations in assessing the state of the health system and in planning for change.

-Emory School of Public Health participated extensively in planning for the transition, working with the Ministry of Health

PUBLICATIONS

Skarbinski, Jacek, Walker, H. Kenneth, Kobaladze, Archil, Kirtava, Zviad, Baker, Laurence C. and Raffin, Thomas A.: Ten Years of Transition: The Severe Burden of Out-of-Pocket Payments for Healthcare in Tbilisi, The Republic of Georgia; submitted.

MORE INFORMATION

Archil Kobaladze <askobal@nilc.org.ge>

Deborah McFarland <dmcfarl@sph.emory.edu>

Jim Setzer <setzer@fox.sph.emory.edu>

Sherry Carlin <scarlin@usaid.gov>

Jacek Skarbinski <skarb@leland.Stanford.EDU>

LINKS:

Rollins School of Public Health, Emory University
[http://www.sph.emory.edu/hpdih.html]

American International Health Alliance [http://www.aiha.com/]

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