Georgia: a primary health care case study in the context of the COVID-19 pandemic

The case study examines primary health care (PHC) in the context of the COVID-19 pandemic in Georgia between January 2020 and July 2021. The Astana PHC components are used to consider integrated integrated primary care and essential public health functions, and essential public health functions, community engagement and multisectoral collaboration. A desk-based review was conducted, supplemented by a trend analysis of secondary data.

The Government of Georgia reacted to COVID-19 with timely and coordinated response activities that delayed the arrival of the first COVID-19 case in the country and slowed spread of the infection during the first wave of the epidemic. The government’s multisectoral actions were coordinated by the Interagency Coordination Committee (ICC) under the Prime Minister’s leadership, with the ICC serving as the main decision-making platform. An effective public health response was guided by the Ministry of Health and the National Center for Disease Control and Public Health (NCDC), and was implemented through coordinated efforts that spanned different sectors.

At the time of the country’s first confirmed case of COVID-19, the primary care system was not yet ready to serve as a first contact level for patients with suspected infection. To avoid an influx of patients at primary care facilities and mitigate the risks of infection, people were asked to use the ambulance service or self-refer to designated hospitals that had greater capacities for infection prevention and control.

Meanwhile, drawing on Georgia’s experience during the 2018–2019 flu epidemic, an online consultation service was established, based in 25 PHC facilities. Their primary tasks were patient triage, remote home-based management and follow- up. This service was gradually expanded to 60 PHC facilities, and was supported with trainings and methodological guidance, different reimbursement schemes and quality monitoring mechanisms.

The establishment of the patient pathways, with clear roles for the emergency hotline (112), online clinics, ambulance service and referral points was critical to ensure safe access to the services that were needed. During the second wave of the epidemic, the operation of online clinics under central online clinic supervision ensured the management of most COVID-19 cases and prevented the collapse of the system.

Georgia’s routine primary care services did not stop during the COVID-19 pandemic. All essential preventive and curative services were retained, although physical visits were replaced in many cases by online consultations – a pattern that was more common in urban than in rural areas. However, mobility restrictions and fears of contracting COVID-19 had a negative impact on the use of services such as immunization, cancer screening and tuberculosis diagnostics. In addition, community engagement in the COVID-19 response was weak, as it lacked the active involvement of community groups in discussions and in two-way dialogue with the government.

The pandemic also revealed long-standing structural problems with primary care such as the fragmentation of care, shortages of human resources, weak capacities in infection prevention and control, and an underdeveloped health management information system (HMIS). The pandemic revealed that strong PHC plays an essential role in mitigating risks and reducing pressures on the entire health system. By exposing the weakness the system, the pandemic has catalysed major changes for its future improvement.

Assessment of PHC in the country is essential to draw lessons and to inform the design of multisectoral preparedness plan for future public heath emergencies. Moreover, the COVID-19 response learnings can be considered in the design of the planned primary care reform.

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