Category Archive for "Health Systems Strengthening"

Article: Privilege and inclusivity in shaping Global Health agendas

Health Policy and Planning published an article Privilege and inclusivity in shaping Global Health agendas.  CIF director George Gotsadze co-authors the paper together with Kabir Sheikh, Sara Bennett and Fadi el Jardali.

The article discusses lack of inclusivity in Global Health and possible actions to promote inclusivity and diversity in the field.

“Northern voices dominate Global Health discussions. Of recent Lancet Commissions, excluding representatives from international organizations, 70% of commissioners on the Women and Health commission came from the global North, and likewise, 71% of the Health and Climate Change commission, 72% of the Global Surgery commission and 73% of the Global Health commission (Lancet 2016). Only two out of the 16-member Board of Directors of the Consortium of Universities of Global Health come from the global South (CUGH 2016). No current or past president and only one current member of the World Health Summit’s scientific committee is from the global South (WHS 2016). Only one of the 17 advisory board members of the journal Global Health Governance is based in a low/middle income country (LMIC) institution (GHG 2016).

Only 15% of the world’s population lives in high-income countries. Yet Global Health conferences continue to be dominated by invited Northern speakers and important committees on Global Health composed mainly of Northerners. The words of a few from the global North wield a disproportionate power that carries …”

The full text is downloadable here.

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Washington DC hosts workshop Immunization Costing: what have we learned, can we do better?

On May 17-18 EPIC Immunization Costing hosts workshop Immunization Costing: what have we learned, can we do better? in Washington DC.  CIF executive director George Gotsadze and Business Develop
ment unit director Ketevan Goguadze are invited to attend the event.

George Gotsadze will be one of the panelist in the panel discussion: Sustainable institutional linkage and improving immunization program implementation, taking place on May 18 in frame of the workshop.Capture

About the event: EPIC supports a community of practice comprised of researchers and practitioners concerned with measuring immunization program cost and financial flow – and utilizing such information to improve program operations and mobilize resources.

A 300 members’ community from more than 50 organizations are involved in immunization programs across the globe, exchanging information and enabling new approaches, collect and use cost information to improve vaccine delivery.

The workshop is sponsored by Bill and Melinda Gates Foundation and organized by Harvard School of Public Health.

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BioBehavior Surveillance Survey results were represented to the members of Parliament of Georgia

Curatio International Foundation together with BEMONI PUBLIC UNION (BPU) represented BioBehavior Surveillance Survey results to the Members of Parliament of Georgia.


The study was conducted in seven major cities of Georgia (Tbilisi, Gori, Telavi, Zugdidi, Batumi, Kutaisi and Rustavi) with a sample of 2037 injecting drug users 18 years and older. The current study describes the most recent wave of Bio-BBS surveys among PWIDs in Georgia (Bio-BBS surveys among PWIDs have been undertaken since 2002).  The study was funded by the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM).

Study Findings

Socio-demographic characteristics

  • The median age of initiating non-injection drug consumption and injection drug use has not changed since 2012 and equals 15-16 years and 18-20 years, respectively.

Drug Scene and other contextual factors

  • Non-injecting drugs consumption did not demonstrate major changes since 2012. CNS depressants and hallucinogens were reported as the most popular drugs for consumption with a slight decrease observed since 2012. About a quarter of young PWID who reported non-injection drug use mentioned use of new psychoactive drugs.
  • Injected drug scene has significantly changed during last years. Heroin is the most misused substance among drug users in Georgia followed by buprenorphine. Alternatively, lower proportion of PWID reported use of homemade opioid-type drugs like Desomorphine and Amphetamine type stimulants (so cold “Vint” and “Jeff”) compared to 2012. Thirty-five percent of the survey participants are active opioid-dependent.
  • Injection in other countries has dramatically grown across all survey locations and this trend is notable since 2009. HIV risk behaviors increase while abroad, as exhibited by the four-fold increase in rates of sharing injection equipment in other countries compared to Georgia.

HIV knowledge and HIV testing practice

  • Knowledge of HIV/AIDS among PWID remains relatively good. The majority is aware of primary transmission risks associated with injection and sexual behavior.
  • There is significant increase in proportion of PWID who were tested during last 12 months and know their results. Increase is observed across all cities. In general one in four injecting drug user has been recently tested on HIV.

Sexual behavior

  • High risk sexual behavior remains one of the major problems among PWIDs.
  • Although, more drug injectors have safe sexual contacts with occasional partners than in previous years, but in Kutaisi, Batumi and Rustavi, however, protective behavior remains at alarmingly low levels and needs special attention.

Access to and coverage of treatment and harm reduction interventions

  • The majority of PWIDs have never accessed drug treatment facilities. Only 6% underwent or was still under any kind of treatment.
  • Coverage of preventive programs (minimal coverage) defined as knowing where to get an HIV test and receiving at least one of the following program commodities: sterile injecting equipment, condom, brochure/leaflet/booklet on HIV/AIDS, and qualified information on HIV has increased from 24% to 32.4% since 2012.
  • While awareness about syringe exchange programs has improved in Telavi, Batumi, and Zugdidi, in general, knowledge about the program remains low and needs to be improved. Substitution therapy programs are much more well-known among PWID.

 HIV and HICV prevalence

  • The combined dataset analysis of all seven cities shows that HIV prevalence is 2.2% (95% CI 1.53-2.99) with no change since 2012 when HIV prevalence was 3.0 (95% CI 2.20-4.04). An estimate for PWID living with HIV varies from the lowest 0.9% (95%CI, 0%-4.3%) in Rustavi to the highest 4.8% in Zugdidi (95%CI, 0.2%-11%). Batumi and Zugdidi remain the cities with highest HIV prevalence rates.
  • The study revealed alarmingly high HCV prevalence (66.2% – in all seven cities).

Presentation is avalable in Georgian. 

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Response to the “Final evaluation of GAVI support to Bosnia and Herzegovina”

Gavi, the Vaccine Alliance published response to the “Final evaluation of Gavi support to Bosnia and Herzegovina” conducted by Curatio International Foundation.

Gavi assess the final evaluation and the given recommendations as an important document for the transition country program development.

Sarajevo (Bosnia): A city walk; Photo Thomas Alboth

Sarajevo (Bosnia): A city walk; Photo Thomas Alboth

“We view these evaluations as particularly important to help inform how we can better help countries transition away from Gavi support in the future and to provide lessons learned and recommendations that could inform Gavi’s Graduation Policy going forward.” – Read the full document.

The evaluation assessed both financial and programmatic sustainability through an in-depth analysis of BiH’s experiences and immunization program performance before, during and after the conclusion of Gavi’s period of support for the country. The evaluation also identified factors contributing to the sustainability of these programs and their achievements and gives five key recommendations to Gavi.

To read the final evaluation report, please follow the link.

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CIF Publishes the Short Movie on 20 Years of Healthcare, 2014

Curatio International Foundation celebrates its 20 years anniversary and prepares short movie describing the history of health care reforms in Georgia after collapse of Soviet Union. The story is retailed directly by the people involved in the process and organizations that encouraged the progress: Amiran Gamkrelidze -Minister of Labour, Health and Social Affairsin 2001-2003, Akaki Zoidze- Deputy State Minister in 2001-2003 years, Giorgi Gotsadze – CIF director, Alexander Kvitashvili – Minister of Labour, Health and Social Affairs in 2008-2010, Stephen Heikin- USAID/Caucasus Mission Director, Dandan Chen- World Bank Human Development Program Leader for the South Caucasus
We appreciate their participation in the movie.

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Development of a Strategic Plan to Strengthen Health Information System in Georgia

Development of a Strategic Plan to Strengthen Health Information System in Georgia project was financed by the Health Metrics Network (HMN). The project started in April 2007 and was completed in March 2008.

The aim of the project was to formulate a sound health information system and development of the strategic plan aligned with HMN standards. The project focused on assisting the Government of Georgia (GoG) in identifying and convening country stakeholders from health, statistics, and development agencies; assessing the current health information system using the HMN Toolkit; and composing a comprehensive, prioritized, and budgeted Health Information System Strategic Plan.

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Impact of global HIV/AIDS initiatives on health systems in Ukraine, Kyrgyzstan and Georgia

During January-July 2010 Curatio International Foundation in collaboration with London School of Hygiene and Tropical Medicine and other partners started exploring the effects of Global Fund HIV programmes on the roles of civil society organisations (CSOs) in Georgia, Kyrgyzstan and Ukraine. The study attempt to assess CSO advocacy efforts to reform HIV/AIDS and drug related Policies in three former Soviet Union countries.

In-depth semi-structured interviews were conducted in Georgia, Kyrgyzstan and Ukraine by national researchers with representatives from a sample of 49 civil society organizations (CSOs) and 22 national key informants.

On July 4th findings of the study were published in Health Policy and Planning, titled as Has Global Fund support for civil society advocacy in the Former Soviet Union established meaningful engagement or ‘a lot of jabber about nothing’?

As the results of the study prompt the Global Fund support resulted in the professionalization of CSOs, which increased confidence from government and increased CSO influence on policies relating to HIV/AIDS and illicit drugs. Interviewees also reported that the amount of funding for advocacy from the Global Fund was insufficient, indirect and often interrupted. CSOs were often in competition for Global Fund support, which caused resentment and limited collective action, further weakening capacity for effective advocacy.

The study was funded by the Open Society Foundations.

Read the full version of the paper online.

Download the paper.

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Health Insurance for Poor: Georgia’s Path to Universal Coverage

The study 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 document briefly describes identified accomplishments and shortcomings of the public private partnership in realization of MIP and discusses emerging policy options and policy recommendations on the future of MIP.

The study was financially and technically supported by the Alliance for Health Policy and Systems Research/World Health Organization and carried out by Curatio International Foundation.

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

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

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


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Poster Presentation at Copenhagen 2012 Conference on HIV

Curatio International Foundation presented two posters at Copenhagen 2012 Conference- HIV in Europe.

One of the posters presented results of Bio-Behavioural surveys among Injecting Drug Users in five cities of Georgia in 2008-2009 and specifically explored Low testing uptake and their determinants among this high risk group in Georgia. Authors: Ivdity Chikovani, Ketevan Goguadze, Natia Rukhadze, George Gotsadze

The poster was presented in the session – Lessons learned in the implementation of HIV testing strategies for IDUs.

Another poster addressed issues around late diagnoses for HIV care. The National HIV/AIDS database for 2000-2010 was analysed and characteristics of high risk groups for late diagnosis in Georgia were identified. Authors: Ketevan Goguadze, Ivdity Chikovani, Natia Rukhadze, George Gotsadze

The posters can be seen at the HIV in Europe web site:

Low testing uptake and their determinants among IDUs in Georgia

High risk groups for late HIV diagnosis in Georgia

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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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