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Georgia's Health Sector Report 2013-2020: Accomplishments and Priorities

This report highlights the achievements in Georgia's health sector in 2013 and outlines the priorities for 2014-2020. It covers topics such as universal health care, healthcare infrastructure, emergency medical services, maternal and child health care, hepatitis C treatment affordability, and revised policies and strategic plans.

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Georgia's Health Sector Report 2013-2020: Accomplishments and Priorities

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  1. 2013 Health Sector Report and 2014-2020 PrioritiesMariamJashi MD, MPH, MPA Deputy Minister of Labour, Health and Social Affairs of Georgia

  2. Key Health Care Accomplishments 2013 • Universal Health Care Programme • Health and Laboratory Infrastructure • Emergency Medical Services • Primary Health Care • Maternal and Child Health Care • Hepatitis C treatment affordability • Revised Policies and Strategic Plans (Tobacco, Mental Health and PHC)

  3. 1. UNIVERSAL HEALTH CARE Declared and Better Funded Priority of the Government Unprecedented expansion of Health Sector Funding - 365 million GEL  634 million GEL - GDP 1.7%  2.7%

  4. Universal Enjoinment of Health Rights in line with EU and Global Health Vision 4,4 million Number of Beneficiaries 2.3 million 0.8 million

  5. UHC Basic Package • PHC (GP, specialists, evidence-based diagnostics - INR, Chest X-Ray, etc. • Urgent outpatient services –15,000 GEL limit - 100% • Urgent in-patient services –15,000 GEL limit - 100% • Elective Surgical Care – 15,000 GEL – 70-100% • Oncology Care – 12,000 GEL – 80-100% • Maternity Services – 500 Normal Delivery, 800 GEL C-section

  6. > 400,000 Beneficiaries of Universal Health Care May 2014 EMERGENCY HOSPITAL CARE 81,495 EMERGENCY AMBULATORY CARE 229,480 ELECTIVE SURGERY 27,030 CARDIOSURGERY 1,107 DELIVERIES 31,867 CHEMO-, IMMUNOTHERAPY AND RADIOLOGY 12,308

  7. 1st Year Review of UHC 1. Assessment from Technical Experts - World Health Organization (WHO) - World Bank - US Agency for International Development (USAID) 2. UHC Participants’ Survey - Telephone interviews with 789 beneficiaries - Focus Group Discussions

  8. Positive achievements of UHC

  9. What Needs to be Improved?

  10. Experts’ Recommendations • Harmonization of Universal Health Care and State MIPs • Further Focus on Quality Assurance of Health Services, and • Integrated Financing Systems

  11. 2. Healthcare and Laboratory Infrastructure • Inventory of Health Infrastructure - 1,553 facilities • Joint Transition Agreement on Lugar Centre signed • Construction of 82 Rural Ambulatories countrywide

  12. 3. Emergency Medical Services • EMS Assessment in 62 Municipalities • Over 10,000 late EMS response or non-response in fall 2014 • Centralization of EMS Countrywide • ~200 Ambulances to be procured in 2014 • Ongoing work on central dispatch and triage

  13. 4. Maternal and Child Health • Assessment of 95 Maternity Clinics countrywide (USAID/SUSTAIN) • Regionalization plan developed, Pilot planned in Imereti – Racha-Letchkhumi • National Protocols and Regulations • Protocols for high risk maternal and neonatal referrals (SUSTAIN, UNICEF) • C-section, Abortion • Folic Acid and Iron Supplements for Pregnant Women • Rota vaccine (2013), Pneumo (2014) – GAVI • Maternity Leave (4 to 6 months) and Remuneration (600 to 1000 GEL)

  14. 5. Primary Health Care • PHC Board • National advisory board • Regional representation • Capitation methodology for UHC • Rural PHC • 30% wage increase for physicians and nurses • Centralized procurement of medical records and essential drugs • DRAFT National PHC Concept and Operational Model

  15. 6. Hepatitis C Treatment Affordability 2013 Baseline • 6.7% prevalence, 200,000 people living with HCV (2001) • Diagnostics/treatment for HIV-HCV co-infection • 400 patients affording treatment – 5000-11000 USD 2014 Response • Penitentiary HCV Programme for 1,000 prisoners from March 1 • Leveraging Penitentiary Procurement for 10,000 civilians from July 1 Next Steps • Hepatitis C Elimination Plan • Affordable price for DAAs (Sofusbivir)

  16. Cost of 48 week regimen PI Country comparison

  17. 7. National Policies and Strategic Plans Mental Health • National Board, Ministry and Parliament • National MH Concept approved by Parliament, 2013 • Draft 2014-2017 Strategic Plan • Geneva and Lisbon Universities, London Royal College Tobacco Control • WHO Framework Convention and EU Association Agenda • High Level State Commission (PM and 10 Ministers) • Strategy and Action Plan • Drafts for 7 National Law Amendements

  18. National Health Sector Priorities2014-2020 • Evidence-based Health governance • Health Care Financing • Human resource development • Health information system (e-health, EMR) • Health service organization • Maternal, neonatal and child health (Regionalization, Accreditation) • Priority non-communicable diseases (HIV, TB, HCV, Malaria, EPI) • Priority communicable diseases • Enhanced inter-sectoral cooperation (education, penitentiary, agriculture)

  19. Key Focus Areas For bi- and multi-lateral cooperation

  20. Health Care Quality Improvement 10-Pillar Approach • Quality Planning - national QI unit • Quality Measurement – core indicators • Public Reporting • QI Campaigns • QI Capacity Building • Decision Supports – flow-sheets, protocols • Patient Engagement • Accreditation – hospital, PHC, Labs • Quality Assurance and Regulations • Accountability and Incentives 2014 Mission recommendations World Bank

  21. Health Financing • Towards universal health care - step-wise expansion of UHC package (i.e. essential drugs) 2. Financial sustainability of global PPP funded projects from 2016 - Global Fund (HIV, TB) - GAVI (new and under-used vaccines) 3. Diagnosis-Related Groups (DRGs) or equivalent

  22. Human resources for health Revamping medical education and certification system - undergraduate, postgraduate/clinical residency, continuous medical education - qualification and certification instruments/exams HRH development planning - Incentives for improved mix and geographic distribution of health professionals - Elaborate new List of Medical Specialties

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