Strengthening Capacity of Civil Society for Promoting Research Evidence into Policy Development in Georgia
The idea of initiating the project was prompted by aggressive health and insurance market oriented reforms focusing on hospital sector privatization and financing of health care services through the private insurance companies. Implicit risks posing this campaign and fast pace of implementation needed to be mitigated through effective and evidence informed policies and regulations.
The project aims to achieve development of policies that are: a) evidence informed; b) tailored to Georgia’s social, economic and cultural context, and c) responsive to public interest. Curatio International Foundation intends to contribute to achieving this goal by allying two distinct networks of NGOs and strengthening their capacity in delivering evidence into policy process. The alliance gathers experts in their own operations field, been active as watchdogs for health sector reforms on one hand and focusing on mental health issues on another hand.
Curatio International Foundation embarked on a strategy of using evidence-informed advocacy as an essential ingredient in the policy development process. The Evidence to Policy is viewed through institutional lens rather than individual, therefore it focuses on interventions on institutions and on strengthening the links between institutions within and outside of the NGO networks through trainings of NGO staff and establishing Information Exchange Platforms. Training topics were informed from the assessment of capacity needs undertaken prior to project launch.
As a result of this project it is expected that:
* The capacity of NGOs involved in the network will be increased in accessing, acquiring and communicating available evidence to policy makers;
* NGOs will develop better capacity to identify policy relevant research evidence and use the means of communication to effectively influence the policymakers;
* NGO and stakeholder understanding about how they could engage with each other will improve “bonding” and “bridging” ties that link researchers, policy makers and NGOs involved in evidence informed policy making.
NGO networks involved in alliance are:
1. Network of NGOs already active as watchdogs and advocacy groups for health sector reforms:
a. Georgian Young Lawyer’s Association (GYLA)
b. Transparency International Georgia
c. Open Society Georgia Foundation (Soros Foundation national chapter)
d. Association of Young Economists of Georgia (AYEG)
e. Economic Policy Research Centre
2. Network of NGOs focusing on mental health issues:
a. Georgian Association for Mental Health (GAMH)
b. Mental Health Coalition
c. Association of People in Need of Special Care (APNSC)
d. The Georgian Association for Psychosocial Aid “Ndoba”
The project was funded by the Global Fund and implemented by the Curatio International Foundation (CIF) in partnership with Georgian Infectious diseases, AIDS and Clinical Immunology Research Center, Public Union “Bemoni,” and association “Tanadgoma.” The project took place from February, 2008 to December 2010.
The aim of the project was to reform HIV/AIDS surveillance system in the country. The project encompassed 3 basic components, each of them embracing series of activities.
In the framework of the first (1) component of the project, Improvement of the routine HIV/AIDS Surveillance system, the HIV/AIDS surveillance system was assessed, which later allowed to develop the HIV/AIDS national surveillance plan. Qualitative and quantitative research methodology, as well as literature review have been applied for exploring international approaches and requirements for the HIV surveillance system, priorities of national policy, and legal environment; assessing information flows, technical capacities and human resources of health care facilities, public health centers, and laboratories/blood stations; and analyzing skills and drawbacks of professional staff in regards to HIV/AIDS surveillance.
Exhaustive assessment and analysis of HIV/AIDS surveillance system led to the development of the National HIV/AIDS surveillance Plan. The document incorporates clear, comprehensive, and operationally viable information serves as a guideline for policy implementation and as an instrument for advocating and mobilizing adequate financial and technical resources. It increases understanding of key concepts and models of the HIV/AIDS surveillance system and suggests ways for effective labor division among various participants and responsible parties. The National HIV/AIDS Surveillance Plan provides an opportunity to better understand financial implications of strategy alternatives and choices to recognize financial requirements and effectively mobilize resources to support sustainability of the HIV/AIDS Surveillance System.
Collaboration of the National HIV/AIDS Routine Surveillance Guidelines was the step following the elaboration of National HIV/AIDS Surveillance Plan, clarifying standard operational procedures for routine surveillance related to and without voluntary consulting and testing (VCT), consultation before and after blood capture, and transportation rules for HIV testing. HIV/AIDS Routine surveillance guideline was endorsed by the Decree of the Minister of Labor, Health and Social Affairs #217/o on 23, July 2010.
Along with endorsing guidelines, the trainings on routine HIV/AIDS surveillance requirements, registration/notification/reporting procedures were delivered to health care specialists throughout the country.
Based on the National HIV/AIDS Surveillance Plan the electronic data base for HIV/AIDS surveillance system was developed. Electronic surveillance system collects case-based data on every tested individual by epidemiological groups. The data allows and software automatically calculates all routine surveillance indicators and produces different types of analytical reports.
The second (2) component of the project foresaw elaboration of the sentinel HIV/AIDS Surveillance guidelines including registration, notification, reporting forms and standard operation procedures. Collection of data through sentinel surveillance would make it possible to provide evidence-grounded HIV/AIDS statistics and strengthen HIV/AIDS surveillance in Georgia.
The third (3) component focused on carrying out behavior surveillance survey with biomarker component among the IDUs, CSWs, Prisoners and MSM and development of standard guidelines for BSS, including standard methodology, standard tools/questioners for data collection, and standard framework for data analysis.
Newly designed HIV/AIDS surveillance system gathers information from different sources: routine surveillance, sentinel surveillance and BSS.
Follow the links to view:
Bio-Behavioral Surveillance Surveys
National HIV/AIDS Surveillance Plan (Eng.version)
National HIV/AIDS Surveillance Plan (Geo.version)
HIV/AIDS Surveillance Assessment Report (Eng.version)
HIV/AIDS Surveillance Assessment Report (Geo.version)
Georgia is among the countries with low HIV/AIDS prevalence but with a high potential for the development of a widespread epidemic. However, over the past several years while transmission through injecting drug use is still the prevailing route for HIV spread, the role of heterosexual transmission is increasing. According to the national HIV surveillance system, infections acquired through homosexual contact account for a small proportion of all HIV cases.
Curatio International Foundation and Association Tanadgoma release a study report on Bio-behavioral surveillance survey (BSS) among men who have sex with men (MSM) in Tbilisi, Georgia.
This study evaluated prevalence of HIV and other STIs (Hepatitis B and C, Syphilis, Chlamydia, Herpes type-2 virus) and sexual risk behaviors among MSM in Tbilisi. Overall 278 respondents aged ≥18 years and having homosexual contact during last year were recruited using Respondent Driven Sampling (RDS) technique. The study findings has changed the country HIV epidemiological picture, moving from a low level to a concentrated epidemic among MSM in Tbilisi. The study provides recommendations for advocacy and policy level.
The study was implemented in 2010 within the GFATM funded HIV/AIDS surveillance system strengthening project.
Read the full version of the report to learn more on study methodology and findings.
In December 2010 CIF wrapped up the second stage of the study exploring “Price, availability and affordability of medicines in Georgia”.
The study aimed at increasing awareness of civil society and improved access to medicines for the population through strengthening respective evidence. Field works during the first stage of the study were conducted in December 2009, while the second phase in July 2010. During the second phase the research covered four Georgian regions involving 146 pharmacies.
The present report “Price, availability and affordability of medicines in Georgia” attempted to obtain reliable data on these aspects and documents tendencies of change over the course of 6 months in 2010. The survey looked at availability and price of Innovative Brands and their equivalent low price generics, analyzed collected data by type of medicine, regional differences as well as by type of pharmacy. The survey also looks at medicine mark-ups and compares with mark-ups in European countries, measures affordability of standard treatments as percent of average subsistence monthly allowance and provides comparison of the standard treatments by innovative brands and equivalent low price generics. Though the study has not covered all therapeutic categories, these do not detract from the importance of the above results as basis for action and as baseline for future studies.
The present report “Price, availability and affordability of medicines in Georgia” attempted to obtain reliable data on these aspects and documents tendencies of change over the course of 6 month in 2010. The survey looked at availability and price of Innovative Brands and their equivalent low price generics, analyzed collected data by type of medicine, regional differences as well as by type of pharmacy. The survey also looks at medicine mark-ups and compares with mark-ups in European countries, measures affordability of standard treatments as percent of average subsistence monthly allowance and provides comparison of the standard treatments by innovative brands and equivalent low price generics. Though the study has not covered all therapeutic categories, these do not detract from the importance of the above results as basis for action and as baseline for future studies. Authors: Tamar Gotsadze, Natia Rukhadze, Tinatin Turdzeladze; 2010. The full version of the report in available in Georgian.
Customer Satisfaction Research on Corporate Health Insurance aims to explore satisfaction of corporate clients of insurance companies and develops recommendations for further polishing and improvement of corporate insurance services. The research revealed that there is a high share/percent of not insured employees in corporate insurance schemes. Financial accessibility is one of the most noteworthy barriers for joining the insurance scheme. Not all citizens having the will to use insurance have a guaranteed opportunity to get corporate insurance.
The study was supported by International Health Budget Monitoring Initiative of the Open Society Institute. The research prepared by CIF experts Marine Egutia, Natia Rukhadze, Tamar Gotsadze looks at trends of insurance market, shares of insurance types and customer satisfaction. Georgian insurance market is young, though the rapid growth is apparent. Data prompted by the National Bank of Georgia proved 33 percent growth in 2009 compared with the year 2008. The Health insurance is the most popular and occupies 68.6 percent of market structure.
The share of the insurance companies has increased since 2007 following the health financing reform launched by the Government of Georgia. The private insurance companies succeeded to attract substantial amount of state finances. Insurance of state program beneficiaries by insurance companies is being implemented in the framework of state assignments. According to 2008 year data, 18 percent of Georgian population is insured by the state. Along with this, there is a slow pace of corporate insurance development which is used by employees of public, private and non-governmental sectors. Retail insurance comprises 1 percent of market. 76 percent of the population is exposed to health risks. You can read the full version of the Report, Policy Brief, or Presentation.
Exploring providers’ and patients’ perspectives on barriers to quality of care for chronic heart failure (CHF) in Uzbekistan and Georgia
In the framework of the project the qualitative study will be undertaken aiming at exploring barriers to quality of care for heart failure in two FSU states: Uzbekistan and Georgia. The project is funded by the Alliance for Health Policy and Systems Research (AHPSR).
Lead investigators are: Dr. Judith Green, London School of Hygiene and Tropical Medicine, Dr. Mohir Ahmedov, Tashkent Medical Academy, School of Public Health, Dr. George Gotsadze, Curatio International Foundation (CIF).
The study is a part of a project that explores transferability of qualitative principles (those for group and individual interviews) to low income former Soviet countries by conducting qualitative studies in Uzbekistan and Georgia. The aim of the larger project is to develop understanding of how qualitative methodologies can be developed for use in low/middle income countries, and how they can be developed for use in comparative health systems research. The proposed study therefore includes two countries in a comparative case study design. Each case study will use qualitative methods (individual interviews and group discussions) to explore a topic in quality of care that is of interest to both health care systems. The interviews will be used to explore physician and patient perspectives on barriers for quality care in the treatment of chronic heart failure in primary care settings.
The choice of topic for this project is based on a number of factors. First, the share of non-communicable conditions in the burden of diseases in developing countries is continuously increasing. According to WHO data, in 2001, non-communicable conditions accounted for 46% of the disease burden, the number that is expected to grow to 56% by 2020. 
Secondly, a significant shift in health policy making centering on quality care has taken place in the West over the last two decades. A noticeable translation of the policy shift in the developing country settings followed suit. The increasing interest in quality of care in developing countries is timely, as improved quality of care benefits patients by reducing medical errors and unnecessary care, increasing utilization of effective medications and procedures, as well as leading to significant system-wise improved efficiencies.
Heart failure (HF) is a major contributor to morbidity and health care costs, with an estimated population prevalence of 3-4%. Two threats to quality of care are the poor utilization of evidence based treatment protocols and inadequate patient adherence. To explore physician and patient perspectives on the barriers to quality of care for heart failure, researchers will first interview physicians from a purposively selected sample of urban and rural clinics to identify factors that impede compliance at the physician and patient level in Uzbekistan and Georgia. Prescription of ACE-inhibitors and beta-blockers will be used as markers of quality of care. The physicians (N = 10-15 in each country) will be interviewed to identify their current treatment approaches to patients with HF, their knowledge of existing guidelines, and their perspectives on what factors limit the use of ACE-inhibitors and beta-blockers in their practice. To explore patient level factors, CIF will invite 5-6 HF patients from each clinic (N= 4 groups in each country) to a group discussion to identify their perspectives on managing HF, treatment regimes, accessing health care for HF and their views on medications prescribed. All interviews and discussions will be audio recorded, transcribed and qualitatively analysed. The outputs from the project will be peer reviewed publications on barriers to quality of care for HF in the two countries and information for policy makers on potential areas for improvement. This study is part of a larger study on the transferability of qualitative methodology, and additional outputs will be: learning about the development of qualitative methods suitable for comparative health systems research and the development of web based materials to help training for health systems researchers.
The aim of the study is to explore the effects of Global Fund HIV programmes on the roles of civil society organisations (CSOs) in Georgia, Kyrgyzstan and Ukraine. The study represents a follow-up to the Global HIV/AIDS Initiatives Network (GHIN) studies that examined the effects of Global HIV/AIDS initiatives on country health systems. Specifically the study will assess the effects of Global Fund programmes on the focus, aims and roles of CSOs; seek to understand how Global Fund HIV programmes have influenced the relationships between CSOs and government; and build an understanding of the effects of Global Fund HIV programmes on relationships between CSOs. The study will primarily be based on semi-structured interviews with country stakeholders and CSOs. Duration: January-July 2010.
Country studies are supported by the Open Society Institute. Network Funders are DFID, Irish Aid and Danida.
In Georgia the study with be implemented by Ketevan Chkhatarashvili and Natia Rukhadze from Curatio International Foundation.
The country researchers will provide inputs into the development of the Research Protocol (methodology) at other appropriate stages in the study including: design of interview tools, sampling strategy, identification of appropriate secondary data sources and relevant literature plus conducting the fieldwork.
As a result of the study articles in peer reviewed publications will be posted.
Aim of the project was to identify deficiencies in children birth and death registration system and identify quality of child health care rendered by family medicine practitioners at primary health care level; The project was funded by the World Bank. Duration: May 2010 – May 2011.
Project encompassed the following two components:
Part I: Qualitative research to identify attitude, practice and barriers to effective collection of data related to child births and deaths registration. The data were collected in selected regions from health officials and staff responsible for health data reporting at the different administrative levels (health facilities, local government, rayons, oblasts and central levels) and different groups in the community (women and men) to identify the factors that prevent them from registering child birth and death cases. Analytical report provided specific policy and operational recommendations for the government and donor community.
Part II: Primary Health Care (PHC) facilities survey in selected regions using the IMCI Health Facility Survey methodology. The survey covered 70 PHC centers stratified by centers with and without personnel trained in Family Medicine. The study report along with main findings provided specific policy and operational recommendations to improve child health care services at the primary care level;
The findings of both surveys were disseminated at the workshop in Dushanbe in May 2011.
Global health initiatives like Global Fund to fight HIV/AIDS, TB and Malaria (GFATM), Global Alliance for Vaccines Initiative (GAVI), Roll Back Malaria and Stop TB etc. are intended to support developing countries to effectively deal with specific diseases/conditions. In practice, the vertical nature of such financing is likely to have a variety of direct and indirect effects upon health care systems, both positive and negative. The size and the components of the grant, makes Global Fund the most significant player, at least for now. But evidence shows that experience with disbursement of GFATM grants has caused considerable frustration in recipient countries. In some countries, these new financing sources are providing larger sources of funding than the entire annual public health budget. Depending on how these resources are used, they have the potential to overstretch already weakened systems, or they may serve to support to the broader health care system with potentially positive effects on other health priorities as well. In Georgia, our study looked at the possible system wide impact of Global Fund on Georgia’s health care system. Therefore, the aim of the study was to look at the actual effects of GFATM on the policy environment, public-private interaction, human resources and access to specific services by clients. The findings are based on a base-line survey implemented in 2004 with financial support received from EU and an end-line survey financially supported by Alliance for Health Policy and Systems Research (AHPSR), within the frames of research network for Global HIV/AIDS Initiative. Authors: Ketevan Chkhatarashvili; George Gotsadze, Natia Rukhadze. View the document.