Category Archive for "Policy Work"
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.
CIF Pharmaceutical Price and Availability Study (Fifth Wave Results)
The Curatio International Foundation has released the results of the fifth wave of the Pharmaceutical Price and Availability (PPA) study in Georgia. The study set out to generate further evidence regarding pharmaceutical prices and availability in the country through the continuous monitoring of the prices of medicine. One of the chief aims of the study is to inform and strengthen health policy and contribute to evidence-based discussions around current trends and processes in pharmaceutical market in Georgia.
The study analyzes the current, as well as the previous four waves of the PPA studies that have been conducted by CIF since 2009. The main findings of the research responds to two important questions:
- What is the trend of physical and financial availability for Generic (LPG) and Originator rand (OB) drugs in Georgia, and how is the treatment cost linked to the availability?
- How is Georgia’s pharmaceutical sector being developed after the introduction of the new prescription policy?
The answers to these questions are available in the main findings of the study:
Main Findings
AVAILABILITY
- Currently, OB availability is almost two-times higher compared to LPG
- The observed trend in decreased LPG availability can be attributed to several factors:
- Insufficient knowledge and/or trust in the quality of LPGs among consumers and providers
- Low demand for LPGs among the population caused by physician reluctance to prescribe generic medicines
- The revenue-maximizing strategy of pharmaceutical suppliers
TRENDS IN PRICING STRATEGIES
- It is likely that increased competition caused by legal changes in the country’s drug laws in late 2009 determined the downward trend in the OB prices observed during 2009-2012 waves, albeit OB prices rebounded and significantly increased in 2016
- OBs are largely imported from western countries. Therefore, it is possible that the price increase documented in 2016 can be partially attributed to the significant devaluation of the country’s national currency against the USD and Euro that began in late 2014, and continued throughout 2015. Consequently, OB prices increased in both pharmacy networks and in independent pharmacies
- In 2015, MoLHSA initiated a new prescription policy with the aim of reducing the level of irrational drug use in the Country. The importance and/or need for prescription system introduction is unquestionable, like in many other countries; however, the insufficiency and/or lack of the necessary instruments for the effective operation of the system most likely allowed pharmaceutical companies to use this initiative to further increase their profits. This assumption is supported by the fact that while in 2012 markups were largely comparable for prescription and non-prescription drugs, in 2016, we observed significant changes in behavior. Namely, markups for prescription OBs are now 89% higher compared to non-prescription OBs, and markups on prescription LPGs are currently 210% higher compared to non-prescription LPGs
- Surprisingly, locally-manufactured LPGs are sold at a higher price compared to their imported equivalents, most likely affording greater profit potential to local manufacturers. Along with the marketing strategies used by the largest retail networks (also linked to local manufacturing), the promotion of locally-produced drugs over imported drugs helps local producers effectively use their market power in a poorly-regulated marketplace
EMERGING POLICY RECOMMENDATIONS
A single policy intervention in a complex pharmaceutical market like Georgia’s will most likely fail to meet its objective i.e. a reduction in costs to the public, and improved access to pharmaceuticals. Therefore, the government needs to immediately implement a multi-pronged policy to better address the issue.
This policy should include the following:
- The introduction of reference pricing on the market – the government can achieve this by learning from other countries’ (high/low/middle-income) experiences and best practices. Through observing others’ experiences, the most appropriate reference pricing methodology can be utilized to further facilitate the regulation of drug prices in the country.
- Encourage the use of generic prescription drugs and enforce the generic substitution in the prescription of medicines.
- Introduce strict rules and controls for drug promotion, marketing, education, and sponsorship gifts to doctors.
- Enhance pharmaceutical market monitoring to adequately adjust for weaknesses in the policy or its implementation.
The full report is available here.
About the Study
The study was conducted using World Health Organization (WHO) standard methodology. The survey looked at the prices and mark-ups of 52 medicines (brand-name medicines and their generic equivalents) in six regions of Georgia.
CIF has been conducting the PPA study since 2009. The results of the study’s previous waves were released in 2010, 2011, 2012 and 2014.
Bio-Behavioral Surveillance Survey among Men who have Sex with Men in two major cities of Georgia, 2015
Bio-Behavioral Surveillance Survey among Men who have Sex with Men in two major cities of Georgia, 2015
Curatio International Foundation continues implementation of Bio-Behavioral Surveillance Surveys (BBS) among Key Affected Populations (KAP’s) with the aim to measure HIV prevalence among KAP’s, monitor risk behaviors among these groups and generate evidence for advocacy and policy-making.
The current study describes the most recent wave of BBS surveys among Men who have Sex with Men (MSM) in Georgia (Bio-BBS surveys among MSM have been implemented since 2007). Study also was looking at HCV and STI (Syphilis) prevalence among MSM. CIF implemented this study together with partner organisations – Center for Information and Counseling on Reproductive Health – Tanadgoma and the Infectious Diseases, AIDS and Clinical Immunology Research Center.
The study used a cross-sectional design and respondent‐driven sampling methodology (RDS). A sample of 415 MSM18 years and older were recruited in the survey in two major cities of Georgia: Tbilisi and Batumi.
The study was financially supported by the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM).
Major findings:
Socio-demographic characteristics
- The median age was 28 years in Tbilisi and 29 – in Batumi, majority had secondary level education, had never been married, big proportion of MSM had permanent work, and majority’s monthly income was less than 500 GEL.
- The study did not reveal high proportion of heavy alcohol use or injecting drug use, indicating that there is no overlap with key populations such as MSM and PWID.
Sexual behavior
- MSM had different types of both male and female sex partners (regular, occasional and commercial). The median number of male partners (anal/oral partners) in the last 12 months 6 in Tbilisi and 5 – in Batumi. Tbilisi number is higher than that of 2010.
- Out of MSM that reported anal partner during the last year, 63.2% in Tbilisi and 78.8% – in Batumi used a condom during their last anal sexual contact. Condom use at last AI in Tbilisi in 2015 slightly higher compared to 2010 (61.7%).
- Overall more than 50% of MSM reported having female sex partner (regular, occasional or paid) during the last 12 months- 55.4% in Tbilisi and 53% in Batumi. More than two thirds (71.2% in Tbilisi and 65.9% in Batumi) said they used a condom at last sexual intercourse with their female partner.Since 2010 there is increase in condom use at last sex with female partners in Tbilisi. As for Batumi, this rate is also high.
Condoms and lubricants
- There was a slight increase in the proportion of MSM who reported receipt of condoms from preventive programs during the last 12 months in Tbilisi from 40.3% in 2010 to 43.5% in 2015.
- Awareness about condoms stays high.
- Awareness about the lubricants as well as their reported use during the last AI has improved vastly in Tbilisi and is also high in Batumi. These are higher indicators compared to the previous surveys, which can be explained by provision of free lubricants by preventive programs, started since 2014.
HIV knowledge and HIV testing practice
- Knowledge and testing on HIV showed significant improvement in Tbilisi since 2010 – from 19.9% in 2010 to 30.4% in 2015 (p (2-tailed), 0.001). In Batumi this indicator was measured the first time and reached 35.2%.
- During the recent five years there is statistically significant improvement in MSM awareness where to get HIV test in case of necessity (p < 0.001), as well as in the proportion of MSM who were tested during the last 12 months and received results (p< 0.001). This can be explained by sustainable use of HIV rapid (finger prick) testing in the outreach under preventive programs, which makes HIV testing easily accessible to the target group.
- Researchers also measured increase in testing uptake from 2012 to 2015, and it was also statistically significant (p (2tailed) – 0.07).
Violence
- Survey participants reported that they have experienced violence because of sexual orientation or homosexual behaviour in the last 12 months (32% in Tbilisi and 4.7% in Batumi). In Tbilisi violence rate has increased significantly compared to 2012.
Program coverage / media
- Coverage by preventive intervention measured by awareness of where to get a HIV test and receipt of a condom during the last 12 months increased from 20.9% in 2010 to 43.5% in 2015 in Tbilisi. In Batumi coverage is quite high – about 40%.
- NGOs, internet and friends seem to be the major and best way for conveying messages to MSM.
HIV, HCV and Syphilis prevalence
- The most alarming finding of this study is increase in HIV prevalence in Tbilisi from 6.4% in 2010 to 25.1% in 2015. During last five years we observe three-fold increase of HIV prevalence. Batumi HIV prevalence is also very high – 22.3%.
- Syphilis was detected in 35% of the MSM in Tbilisi and 24.6% – in Batumi.As for syphilis, its prevalence is quite high but does not show difference compared to 2010 results.
- Hepatitis C prevalence was 7% in Tbilisi but much higher in Batumi – 18.9%
Full study report is available here.
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.
Strengthening Capacity of Civil Society for Promoting Research Evidence into Policy Development in Georgia
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”
Policy Information Platform (PIP) Expert Consultation Meeting
Policy Information Platform (PIP) expert consultation was held in Istanbul on 29-30 January, 2015. At the meeting methodological issues, roadmap for the PIP implementation and evaluation approaches were discussed.
CIF director George Gotsadze and Research Unit director Ivdity Chikovani participated in the expert consultation.
PIP is a repository of peer-reviewed publications and grey literature that should generate knowledge for health policy decision-making. PIP should respond to the priority topics emerging in the policy-making process.
The project is an initiative of Alliance for Health Policy and Systems Research (AHPSR) aiming at alleviating access barriers to policy-relevant information at national level in low-middle income countries. The piloting countries are: Georgia, Argentina, Pakistan and Nigeria.
In the pilot countries PIP implementing partners are: CIF, Argentina MoH, Pakistan King Edward Medical University and Nigeria Ebonyi State University.
CIF contributes to the whole PIP initiative by developing methodological approaches for grey literature evaluation.
The PIP project will be implemented during 2015-2016.
Mental Health Care in Georgia, 2014
Policy brief: Mental Health Care in Georgia. Financial Barriers Study Findings, June 2014
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.
Rapid Assessment of Pharmaceutical Sector and Drug Supply Chain
Rapid Assessment of Pharmaceutical Sector in Uzbekistan project was funded by The World Bank and implemented by Curatio International Foundation in partnership with Credes (France). The project commenced in 2003.
The main objective of the project was to perform a rapid assessment designed to gather information on different issues like drug policy and regulation, strategic framework, product selection, forecasting methods, procurement mechanisms, quality assurance, storage, transport, and reporting. Other issues studied were the structures of public and private distribution systems, the types and values of drugs flowing through, and the availability of essential drugs.
The Rapid Assessment covered the following major tasks:
Review the relevance of several rapid assessment tools that are available (through WHO, John Snow Inc, Management for Sciences for Health, and Boston University);
Adapt the tools for Uzbekistan;
Gather data using several defined methodologies, such as in-depth interviews, focus groups, record review, flow-charting;
Compile and triangulate the data and seek clarifications where data shows conflicting results;
Compile a report providing a review of each of the supply chain functions, their strengths and weaknesses;
For a sample of drugs, collect data on the base price for drugs manufactured or imported into Uzbekistan, other additional costs such as duties, clearing charges, taxes, storage fees, and transport costs, markups, dispensing fees for drugs that pass through the public and commercial and semi-private systems;
Conduct a literature review of both published and gray materials on pharmaceuticals and Uzbekistan;
Present findings in a stakeholder workshop.
In order to obtain the most precise picture of the sector, the following activities were conducted:
Meetings with the MoH, Pharmacology Committee and CPIB to clarify the objective of the assignment and the organization of the mission;
Preparation and definition of a methodology for rapid assessment and development of approach for completion of study;
Meetings and discussions with key partners, stakeholders and policy-makers.
Assessment design was performed considering the following steps:
Define the method of interview and rapid appraisal techniques (in-depth interviews, record
review);
Identify and select the geographic sites to be visited and the major stakeholders to be met;
List the major topics to focus on;
Organize the teamwork and review the activities schedule;
Sample the drugs for the prices analysis.
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- 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