Category Archive for "2011"

EPIC Studies – Governments Finance, On Average, More Than 50 Percent Of Immunization Expenses, 2010–11

Journal Health Affairs publishes a new Article EPIC Studies: Governments Finance, On Average, More Than 50 Percent Of Immunization Expenses, 2010–11 coauthored by CIF team member Keti Goguadze.

Abstract: Governments in resource-poor settings have traditionally relied on external donor support for immunization. Under the Global Vaccine Action Plan, adopted in 2014, countries have committed to mobilizing additional domestic resources for immunization. Data gaps make it difficult to map how well countries have done in spending government resources on immunization to demonstrate greater ownership of programs. This article presents findings of an innovative approach for financial mapping of routine immunization applied in Benin, Ghana, Honduras, Moldova, Uganda, and Zambia. This approach uses modified System of Health Accounts coding to evaluate data collected from national and subnational levels and from donor agencies. We found that government sources accounted for 27–95 percent of routine immunization financing in 2011, with countries that have higher gross national product per capita better able to finance requirements. Most financing is channeled through government agencies and used at the primary care level. Sustainable immunization programs will depend upon whether governments have the fiscal space to allocate additional resources. Ongoing robust analysis of routine immunization should be instituted within the context of total health expenditure tracking.

The online version of the Article is available here.

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An investigation on community-level influences on mental health amongst internally displaced persons in Georgia, 2011-2012

The project was implemented by CIF in collaboration with London School of Hygiene and Tropical Medicine (LSHTM) (Dr. Bayard Roberts, Professor Martin McKee, Professor Vikram Patel and Dr. Nino Makhashvili). The project was funded by Wellcome Trust (United Kingdom).

Aim of this research study is to deepen understanding of the extent to which community-based influences may help promote mental health (including alcohol use) amongst IDPs and returnees in Georgia. The study would provide rigorous evidence on the burden of depression, psychological distress, harmful alcohol use, and also coping strategies amongst IDPs and returnees in Georgia. This information could be used to help inform appropriate responses from governmental and nongovernmental agencies. This would be one of the first studies globally to specifically explore the way in which community factors may help promote the mental health of IDP and returnees.

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Assessing the Health Insurance for the Poor in Georgia

During the last two decades Government of Georgia initiated series of reforms introducing major changes in health financing policy and restructuring the health system to reverse the negative trends observed in equity, affordability and quality of essential health service for significant part of the country population and particularly for the poor.

Addressing problems in equity and financial protection against health care costs through re attainment of universal coverage for essential health care services for the entire population was one of the longstanding and explicitly stated national health policy goals.

Affordability of health care services is one of the most critical issues for Georgia’s health sector. The matter is among top five most important national issues for a large part of the Georgian population. Medical Insurance for the Poor (MIP), a public program initiated in 2007, provides private insurance coverage to one fifth of the Georgian population and is aimed to protect its beneficiaries from financial hardship and impoverishment that may be caused by health care expenditures.

The study implemented by the Curatio International Foundation with the support from the Alliance for Health Policy and Systems Research/World Health Organization assesses the impact of Medical Health Insurance (MIP) for the Poor on equity in access to essential health care services and financial protection against health care costs for the poor and general population.

The first phase of the study was published in May 2011. The document briefly describes identified accomplishments and shortcomings of the public private partnership in realization of medical insurance for the poor and discusses emerging policy options and policy recommendations on the future of MIP.

The second part of the study aimed to assess the overall impact of medical insurance for the poor. The resulting document also reviews steps undertaken by the government in the design and implementation of the insurance program: the way the benefit package was designed, institutional and purchasing arrangements. It also describes the role of high level actors in MIP formulation and implementation, their influence, nature of interest and perceived position on possible future MIP expansion.

View full documents:

Policy Brief-Medical Insurance for the Poor: impact on access and affordability of health services in Georgia

Policy Brief- Health Insurance for the Poor in Georgia, Content, Process and Actors

Full Study Report- Health Insurance for Poor: Georgia’s Path to Universal Coverage

 

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Fourth Wave Results of Pharmaceutical Study Published

Curatio International Foundation has completed a study exploring ‘Price, Affordability and Availability of Medicines in Georgia’. The study was divided into three stages and carried out in 2009-2001.

The key aim of the study is to improve affordability and availability of medicines for the population.

Based on a three-year observation of pharmacies and different medicines in Georgia, Curatio International Foundation studied the practice in the pharmaceutical sector and came up with recommendations based on research findings. The recommendations will be presented to the broad audience of the health sector – the Health Care Committee of Parliament, the Ministry of Health, the insurance sector and other interested parties.

The study was conducted using the methodology of the World Health Organization (WHO). The survey looked at prices and mark-ups of 52 medicines (brand-name medicines and their cheap generic equivalents) over the period of three years in licensed pharmacies nationwide.

Findings and recommendations of three stages were unveiled in December 2011.

Read more on study methodology, findings and recommendations- Presentation (available in English) and Brief (available in Georgian).

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Price, availability and affordability of medicines in Georgia-2009-2011

The present report unveils the findings of the study “Price, availability and affordability of medicines in Georgia” implemented over the course of three years- 2009-2011 in the capital Tbilisi and regional cities. The study was supported by the World Bank and the Open Society Institute.

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.

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 three years. Over the course of three years the study covered almost all licensed pharmacies and 52 types of medications in the capital Tbilisi and regional cities.

The power point presentation document and brief study report can be viewed here (yet avaialble only in Georgian).

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Findings of the pharmaceutical market study in 2009-2011 years

The key aim of the study is to improve affordability and availability of medicines for the population.

Based on a three-year observation of pharmacies and different medicines in Georgia, Curatio International Foundation studied the practice in the pharmaceutical sector and came up with recommendations based on research findings. The recommendations will be presented to the broad audience of the health sector – the Health Care Committee of Parliament, the Ministry of Health, the insurance sector and other interested parties.

Giorgi Gotsadze, the Curatio International Foundation Director: “Through the study we provide strong evidence to decision and policy makers on the current condition of the pharmaceutical market. We hope that this study will foster debates between the interested parties”.

The study was conducted using the methodology of the World Health Organization (WHO). The survey looked at prices and mark-ups of 52 medicines (brand-name medicines and their cheap generic equivalents) over the period of three years in licensed pharmacies nationwide.

The survey measures the quality of access to medicines in both pharmacy chains and independent pharmacies. In 2011, Pharmadepo and Parmacenter added to the pharmacy chains involved in the survey (PSP, Aversi, GPC) in 2009-2010.
The survey looks at the access to medicines by years as well. It analysis the impact of amendments made in 2009 to the Law on Drugs on the access to medicines and medicine prices in Georgia. The survey analysis how the changes influence the patients’ treatment costs in patients with different diagnosis.

The survey has found that:

• The market has witnesses a tougher rivalry since 2009, which has likely led to the reduction of markups of brand-name products. Markups decreased most in 2001;
• The year 2011 witnessed an increase in access to both brand-name products and their cheap generic equivalents;
• Despite improved affordability the market is experiencing a lack of generic products;
• Access to medicines varies by regions. Access, especially the access to generic medicines, in some regions is still low;
• The level of access is highest in the Pharmadepo/Pharmacenter pharmacy chain and lowest in independent pharmacies, which is likely to be the result of unequal competition among pharmacies;
• Even though there is a decreasing trend in medicine markups, the markups in Georgia are higher than in European states, which means that Georgian importers add more funds to medicine prices than European ones (which should respectively lead to higher profits). Consequently, the share of pharmaceutical costs in the national healthcare spending in Georgia is much higher compared to European states.
Impact on Standard Treatment Costs:
• There has been a decreasing trend in the standard treatment price for the past three years;
• In 2011 standard treatment costs decreased more in case of treatment by brand-name medicines compared to treatment by generic products, however the treatment by generic medicines requires less spending because of low retail price of such medicines.
The survey of prices and availability of medicines was divided into three phases and conducted in Georgia in 2009-2011. The first and third stags were financed by the World Bank, while the second one – by the Open Society Institute.CIF presents the results of the study exploring “Price, availability and affordability of medicines in Georgia”.

Study presentation and small study report (available in Georgian).

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Main findings of Catastrophic Health Expenditure Analysis in Georgia

The researcher of the Curatio International Foundation Natia Rukhadze presented the findings of Catastrophic Health Expenditure Analysis in Georgia at the “Seminar on Health Financing Reforms in Georgia” held in MoLHSA on October 26, 2011.

The study was funded by the World Health Organization (WHO) and uses the data from nationally representative Integrated Household Survey (HIS) conducted by National Statistical Office (GEOSTAT) on an annual basis; Study looked at trends in household catastrophic health spending during 2006-2010 among different population groups. The purpose of the study was to look at population level impact of the Government’s health financing reforms initiated in 2006/07 and aimed at providing state subsidized health insurance to extremely poor.

See the full report of the study.

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Catastrophic Health Expenditure Analysis in Georgia

On October 26, 2011 the researcher of the Curatio International Foundation Natia Rukhadze presented the findings of Catastrophic Health Expenditure Analysis in Georgia at the “Seminar on Health Financing Reforms in Georgia” held in MoLHSA.

The study was funded by the World Health Organization (WHO) and uses the data from nationally representative Integrated Household Survey (HIS) conducted by National Statistical Office (GEOSTAT) on an annual basis; Study looked at trends in household catastrophic health spending during 2006-2010 among different population groups. The purpose of the study was to look at population level impact of the Government’s health financing reforms initiated in 2006/07 and aimed at providing state subsidized health insurance to extremely poor.

See the full report of the study.

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New web guide for using qualitative approaches to health systems research

By the end of summer 2011 Curatio International Foundation and London School of Hygiene and Tropical Medicine (LSHTM) developed the web resource which serves as a guideline for qualitative approaches in researching the health systems.

Information of the web site is based on the experience of the study “Exploring providers’ and patients’ perspectives on barriers to quality of care for chronic heart failure (CHF) “. The study, in its turn, 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. In the framework of the project CIF has conducted and analyzed findings of the qualitative research focusing on patients with heart chronic diseases and primary health care providers.

In the framework of the project CIF has conducted and analyzed findings of the qualitative research focusing on patients with heart chronic diseases and primary health care providers.

The project aims 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.

Web-based learning modules on qualitative methods of data collection for health services research in central Asia and the former Soviet Union have been developed as a part of the project. The learning outcomes for the module are designed around the specific elements of this study. The module is planned to be incorporated into teaching at the School of Public Health in Uzbekistan, LSHTM and is openly accessible on the web to interested parties.

The project is funded by the Alliance for Health Policy and Systems Research (AHPSR).

 

Follow the link to view the web site.

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CIF Study Published in BMC Magazine, The Role of Supportive Supervision on Immunization Program Outcome- a randomized filed trial from Georgia

The research article by CIF and international experts has been published in BMC International Health and Human Rights 2009. Article is a part of the supplement: The fallacy of coverage: uncovering disparities to improve immunization rates through evidence.The Canadian International Immunization Initiative Phase 2 (CIII2) Operational Research Grants.

In the republic of Georgia, a country where widespread health care reforms have taken place over the last decade, an intervention was recently implemented to strengthen performance of immunization programs. A range of measures were taken to ensure that immunization managers carry out their activities effectively through direct, personal contact on a regular basis to guide, support and assist designated health care facility staff to become more competent in their immunization work. The study addresses the issues of human resources and its management in improving immunization coverage rates and aims to document the effects of “supportive” supervision on the performance of the immunization program at the district level in Georgia.

Follow the link to learn more about methods and results of the survey.

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