Georgia Primary Health Care Development Project, 2000-2003

The project was funded by UK Department for International Development (DFID) and implemented by Institute for Health Sector Development (IHSD) in partnership with London School of Hygiene and Tropical Medicine (LSHTM), Curatio International Foundation (CIF), National Health Management Center (NHMC), and the World Health Organization (WHO). The project began in March 2000 and was completed in 2003.

This project was designed to strengthen the ability of the public health system in Georgia to respond to widespread poverty in the country through development of primary health care based on family medicine and community health model. The project formed the basis for introduction of an accessible, effective, and sustainable primary care system for Georgia, a priority for the Government of Georgia (GoG). The project also intended to develop financing systems and models of community participation to improve access to the primary care services and essential drugs for the population and, in particular, for the poor. The Project supported the GoG initiatives in the sector.

This DFID project was designed as precursor to the World Bank’s forthcoming Health Project in primary care. It had been designed in close collaboration with the Georgian Ministry of Labor, Health, and Social Affairs (MoLHSA) and World Bank representatives. The project’s purpose was to help the GoG to develop and implement a sustainable new model of primary health care through family medicine to improve the quality, access, and participation for persons at all levels of income. This would contribute to the project goal, which was to improve the health status of the low-income population of Georgia.

The Project provided technical assistance and knowledge to the GoG, the MoLHSA and Tbilisi Municipality Health Department on how to implement the new models, train human resources, and undertake economic and social assessments and evaluations to incorporate these experiences to the national health system development process. Key beneficiaries were the people of Georgia who used, or were expected to use, the primary care services, but are currently unable to access them due to the existing financial barriers.

DFID began to support primary health care development in Georgia in 1997. The two-year project (which ended in August 1999) worked with the National Health Management Center (NHMC) in Tbilisi to develop the capacity of the country to train Family Medicine Specialists (FM). The end of project review in July 1999 concluded that the project was successful. Key achievements of the project included:

Establishment of the capacity of NHMC to train FM physicians;
Establishment of FM as a legally recognized specialty;
Development of training materials and curriculum for training FM physicians;
Establishment of a licensing and accreditation system for FM training and for FM physicians.
The Project helped to develop PHC through FM by implementing a new model of financing and provision in the four FM demonstration sites, evaluating the experience and the financial sustainability to enable a national roll out of the model through the World Bank second health project.

The Project worked closely with the World Bank to ensure a comprehensive and a holistic approach to exploring options for financing health system. Other inputs included further training, development, and strengthening of PHC team through establishment of the national FM training center in Tbilisi and regional centers in Imereti and Kartli. These regions were selected following discussions with the GoG and assessment of poverty levels in particular regions. Additionally, factors such as the presence of related DFID projects (such as good governance projects) and complementary donor activities (MSF, USAID) were taken into account.

The project drew on lessons of best practice from DFID primary care projects in Georgia, Albania, Kazakhstan, Uzbekistan, and Russia.

The implementation was managed by a UK-based agency Institute for Health Sector Development (IHSD). In addition, there was an in-country implementation committee to steer the Project. This consisted of high-level representatives from the MoLHSA, Ministry of Finance, NHMC, TMHD, Georgian Association of FM, and Georgian Association of Nursing.

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