2013 Health Sector Report and 2014 -2020 Priorities

2013 Health Sector Report and 2014 -2020 Priorities Mariam Jashi MD, MPH, MPA Deputy Minister of Labour, Health and Social Affairs of Georgia

Key Health Care Accomplishments 2013 1. 2. 3. 4. 5. 6. 7. 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)

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%

Universal Enjoinment of Health Rights in line with EU and Global Health Vision Number of Beneficiaries 4, 4 million 2. 3 million 0. 8 million

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

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

1 st 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

Satisfied or very satisfied with UHC services 431 Beneficiaries of planned Out-Patient Services 80. 3% 358 Beneficiaries of In-Patient and/or Emergency Services 96. 4%

Considers that UHC significantly improved or somewhat improved access to health care 431 Beneficiaries of planned Out-Patient Services 77. 4% 358 Beneficiaries of In-Patient and/or Emergency Services 88. 8%

Positive achievements of UHC Out-Patient 1. Financial support for the population 2. Freedom of choice among providers and physicians In-Patient/ Emergency 84% 78% 51% 31%

What Needs to be Improved? Out-Patient 1. More information on services and procedures 2. Include Pharmaceutical Benefits In-Patient/ Emergency 52% 29% 78% 60%

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

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

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

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)

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

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)

Cost of 48 week regimen PI Country comparison

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

National Health Sector Priorities 2014 -2020 1. Evidence-based Health governance 2. Health Care Financing 3. Human resource development 4. Health information system (e-health, EMR) 5. Health service organization 6. Maternal, neonatal and child health (Regionalization, Accreditation) 7. Priority non-communicable diseases (HIV, TB, HCV, Malaria, EPI) 8. Priority communicable diseases 9. Enhanced inter-sectoral cooperation (education, penitentiary, agriculture)

Key Focus Areas For bi- and multi-lateral cooperation

Health Care Quality Improvement 10 -Pillar Approach 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 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

Health Financing 1. 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

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