8
SOCIETY
GEORGIA TODAY
OCTOBER 15 - 21, 2021
Why Improving the Primary Healthcare System in Georgia Matters municipality. “Currently, we are undergoing the module about arterial hypertension. I’m a family doctor, responsible for three districts of the village, 1600 people in total. Seasonal variability in blood pressure is a common problem for numerous patients here and new approaches and standards are very important for my work.” Project experts are also working on creating a system for improving the quality of PHC services and facility-level performance management through intensive clinical training and supportive supervision of ambulatories’ medical personnel.
BY NINA KOPALEISHVILI – PR AND COMMUNICATION OFFICER, CARITAS CZECH REPUBLIC IN GEORGIA
S
caling up primary healthcare (PHC) interventions across low and middle-income countries could save 60 million lives and increase average life expectancy by 3.7 years by 2030. Caritas Czech Republic actively works to improve the quality of primary healthcare (PHC) services in Georgia and provide it with comprehensive IT solutions.
COMPREHENSIVE IT SOLUTIONS TO PHC
PHC’S ROLE IN A STRONG HEALTH CARE It is scientifically proven that PHC is the most inclusive, equitable, cost-effective, and efficient approach to enhance people’s physical and mental health, as well as social well-being. An international study comparing the strength of primary care in 13 high-income countries found that strong primary care led to improved population health and lower health expenditure (WHO). Having qualified medical personnel and quality standards in PHC is a cornerstone in a strong healthcare system. Timely visits to family doctors that may avert citizens from paying for further expensive medical services and prevent them from potential complications in their health condition also plays a vital role in strengthening the whole system. Within the Czech Development Agencysupported project, Caritas Czech Republic works to strengthen the primary healthcare system in Georgia through the introduction of improved medical guidelines for family doctors, the devel-
opment of countrywide comprehensive IT solutions, and updating qualification standards/requirements for PHC professionals.
THE IMPORTANCE OF IMPROVED MEDICAL GUIDELINES A clinical protocol is a medical guideline – a document consisting of best practices for managing a particular medical condition, which includes a treatment plan founded on evidence-based strategies and consensus statements in the field. Caritas Czech Republic has been asked to develop clinical practice guidelines and protocols and pilot them at primary healthcare facilities (in the municipalities of the Mtskheta-Mtianeti and Samegrelo-Zemo Svaneti) based on the clinical topics selected jointly with the
Ministry of Health of Georgia. At this stage, the Ministry of Health of Georgia has approved six out of 10 developed clinical protocols. Based on those documents, Caritas Czech Republic experts have already started to train doctors and nurses in the Dusheti Municipality. "Over the next two years, we will provide rural doctors with the most up-todate and evidence-based practice from the world clinical practice. This will guarantee that a patient in a rural ambulatory receives the same quality of service as a citizen in the best clinic in the capital," says Nato Shengelia, a family doctor and Caritas Czech Republic expert. "We have been engaged in training based on the improved protocols since June 2021,” says Lamara Paghava, a family doctor in Choporti village, Dusheti
One of the core challenges to improving PHC is digitalization of medical services and health systems. Compared to manual registration, electronic medical records are characterized by much greater accuracy and a higher proportion of correct information. Besides, this practice requires less time and finances. Caritas Czech Republic is working to create a unified and standardized e-management information system. In addition, it will introduce countrywide e-queue management, telemedicine, and e–referral management systems to the Georgian healthcare system. "A unified medical record system will facilitate the collection of patient information at the PHC level and contribute to informed medical decisions,” says Marina Shikhashvili, an expert in family medicine and Caritas Czech Republic project expert. “In addition, a unified e-queue management system is a very convenient tool for receiving medical services in one space. A unified electronic information system also created
within the project will be the most important tool for those clinics which do not have internal electronic systems for data-collection.” “PHC has a “gatekeeping” function in the whole healthcare system, the main purpose of which is ensuring that a majority of patients receive basic medical services at the primary level and, consequently, the next levels of the health care are not overloaded,” says Rusudan Chkhubianishvili, Caritas Czech Republic project manager.
CCR CONTRIBUTING TO GEORGIA’S HEALTHCARE Within the Czech Development Agency supported project, Caritas Czech Republic carries out activities in close cooperation with the Ministry of Health of Georgia and the Emergency Situation Coordination and Urgent Assistance Center (ESCUAC). The project will ultimately benefit the whole of Georgia, as the results of all deliverables will be handed over to the Ministry. Currently, the project is being piloted in the selected municipalities of the Mtskheta-Mtianeti and Samegrelo-Zemo Svaneti regions. At the same time, the project continues to enhance the system of quality measurement and improvement at five pilot medical facilities in Tbilisi as part of Phase I. In total, 46 primary medical facilities will be included in the project.
Nick Beresford, New UNDP Resident Representative in Georgia EXCLUSIVE INTERVIEW BY KATIE RUTH DAVIES
O
ne of the great privileges of working for the UN is you get to live and work in some wonderful places, and you get to know some amazing people. Georgia has transformed itself so fast over a few years into a democratic state, creating growth, lowering poverty and heading towards a prosperous inclusive future. Can that trajectory be maintained? The UNDP works to strengthen democratic govern-
Deepening and strengthening democratic governance, respect for human rights, equality and the rule of law are essential to ensure Georgia does not stall on its development journey
ance, protect human rights, resolve conflicts and realize sustainable development goals. In Georgia, I get the sense that there is everything to play for, and so I could not look for a more engaging and I hope rewarding place to live and work. – says Nick Beresford, the new UNDP Resident Representative in Georgia. Nick Beresford is a development professional with over 20 years of experience with the United Nations. He was appointed as UNDP Resident Representative in Georgia in September, prior to which he served in Cambodia, Bangladesh, Somalia and East Timor, as well as in the UN headquarters in New York (USA). He holds a Master of Science in Development Economics from Sussex University and degrees in audit and accountancy and English literature. GEORGIA TODAY spoke to him to find out what his impressions are of the country, and where he sees room for the kind of improvements the UNDP excels at facilitating. “Georgia is strikingly beautiful,” he tells us. “The city of Tbilisi is unique. History, culture and art are everywhere. The people are exceptionally warm and friendly. As a guest, you are really made to feel welcome. Georgian cuisine is a sensation, and they literally invented wine. As first impressions go, this one is very hard to beat!”
THIS IS A CHALLENGING TIME FOR MOST COUNTRIES. WHAT DO YOU SEE AS THE MAIN PRIORITIES FOR GEORGIA TO ACHIEVE ECONOMIC RECOVERY? The health impact of COVID cannot be separated from the economic: we need to get the “R” number, the rate of infection, under 1 and moving towards zero. The science is crystal clear: we all need to get vaccinated. And keep using masks,
washing hands and social distancing. As people become confident to return to work, shops and markets, so the real economy for working people can pick up. On the social and economic side, we have learned a lot in a short time through COVID. More than 120 countries around the world introduced new social protection schemes, including here in Georgia. Social protection builds resilience so more people are kept out of poverty and in the working economy. Expanding universal health care, another very welcome policy seen in Georgia, strengthens human capital, reduces the burden of ill health and so adds to economic growth. Just as we can’t separate the health responses from the economic response, they are complements, not alternatives, so we need to invest in people to make growth that is stronger, locked in for the long term, and shared widely, not just accruing to the wealthy.
WHAT HAVE YOU IDENTIFIED AS THE MAIN GOALS FOR THE UNDP IN GEORGIA IN THE FORESEEABLE FUTURE? I would list four priority areas. The first rounds of local elections have just ended with a higher turnout than in previous years. I’m glad UNDP and others supported programs to encourage young voters to participate and to increase women’s engagement in decision-making. Deepening and strengthening democratic governance, respect for human rights, equality and the rule of law are essential to ensure Georgia does not stall on its development journey. We have an opportunity here, as in many countries, for an economic recovery that emphasizes green growth. This is about protecting our health, our environment and planetary wellbeing, but it’s also about
jobs. Green growth investments, dollar for dollar, bring high economic multipliers and create more jobs – and ones that take us to higher skills too. As we cope with the pandemic, we can see that social protection investments in people have been essential to help people rise to their full potential and also to strengthen social solidarity. Georgia has come a long way in reducing poverty, now at 21.3%, and we need to keep that momentum to end poverty by 2030. When people escape poverty, they don’t just realize their human right to a life with dignity, they start to contribute to the wider economy, and this is something that benefits everyone. Finally, I would note that many communities, including internally displaced persons, still suffer the impacts of past conflict. We must invest in these communities to ensure no-one is left behind. Confidence building measures that bring communities together can set the basis for finding ways for lasting and peaceful resolutions.
WHAT CHALLENGES DO YOU EXPECT, AND HOW CAN/ WILL THESE BE OVERCOME? Development agencies are often good at producing technical solutions on paper, but sometimes less impressive when it comes to seeing them into action. We need a sharper focus on the political landscape: the incentives that drive our partners in government, civil society and the private sector. If we can listen more carefully to these, we can make better choices on which doors to push and which ones are perhaps shut tight. The point is to work in partnership with government, civil society, and other development partners to find a pathway ahead so we can make real systemic change. That’s how, on a good day!, we can move bright policy ideas into real development impact.
