Georgia’s experience during COVID-19 will inform its future primary health care approaches

Dr Irina Karosanidze, a primary health care (PHC) doctor in Georgia is on the frontlines of a dramatic transformation in PHC delivery that will hopefully have a lasting and positive impact on the lives of everyone, everywhere in the country.

”It is a question of people being able to access health services and receive health care advice when and where they need it. With the rapid acceleration of digital health services due to the pandemic, that can even be at home,” said Irina who is working closely with the Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs to adapt PHC services to meet the demands of a global pandemic.

Thanks to leaders like Irina, new protocols were rapidly developed and revised, and PHC providers across the country were trained in managing mild COVID-19 infections remotely.

Why is PHC important in Georgia?

Before COVID-19 struck, the Ministry was already committed to increasing the efficiency of health service delivery in Georgia and advancing universal health coverage (UHC) through strengthening the PHC system and integrating priority services. The population’s health needs were becoming increasingly complex due to the growing burden of noncommunicable diseases (NCDs) such as diabetes, cancer, heart and lung diseases.

In November 2019, a WHO mission conducted through the UHC Partnership reviewed the Ministry’s PHC reform plans. It recommended revising the scope of services to include more preventive, people-centred services, expanding the scope of practice of nurses, and redefining the role of specialists in the PHC setting. The review found that lack of performance monitoring and misaligned payment incentives undermined the system’s overall potential. In addition, high out-of-pocket payments for medicines disproportionately affected the poorest people in the population leading to increased poverty and sometimes catastrophic spending on health.

In early 2020, the Ministry asked WHO to provide technical support to revise the PHC benefits package and payment model. This would help increase access to evidence-based prevention and treatment services and support the integration of health programmes to strengthen the PHC system. Then, COVID-19 struck.

While Georgia initially experienced low rates of COVID-19 infection, cases rose dramatically throughout the last quarter of 2020. In early 2021 the country is facing a severe epidemic, with PHC called upon to serve a core role.

“Georgia has launched a strong response to COVID-19 but the pandemic has highlighted the need to accelerate progress to ensure that no one is left behind. Strong robust health systems, primary health care and accessible public health services are the best way we can deliver universal health coverage across the country. These strategies will build resilience against future health emergencies and help get essential services to people in need,” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe during a visit to Georgia in December 2020.

Capacity building to influence policy and practice

WHO, through the UHC Partnership, has supported the capacity building of organizations and individuals in the country to play a key role in shaping the strategic direction and implementation of PHC reforms and UHC.

Georgia is among the 115 countries to which the UHC Partnership helps deliver WHO support and technical expertise in advancing UHC. The Partnership is funded by the European Union (EU), the Grand Duchy of Luxembourg, Irish Aid, the Government of Japan, the French Ministry for Europe and Foreign Affairs, the United Kingdom – Foreign, Commonwealth & Development Office and Belgium.

“Access to quality health care is a concern the world over, and the European Union is proud to be working closely with WHO to develop this in 115 countries globally, including in Georgia. During the pandemic, our joint efforts here have focused on training and the roll-out of updated COVID-19 procedures, together with substantial material support, as part of the EU’s wider support to the country during these challenging times,” said Carl Hartzell, EU Ambassador to Georgia.

Strengthening PHC with a long-term vision for UHC

COVID-19 has disrupted health systems, devastated communities and economies and continues to push countries to invest in health for all. Georgia is taking advantage of the opportunity to expand the benefit package of PHC services, strengthen capacities of the PHC teams, improve coordination of care and optimal use of diagnostic and specialized services. For Georgia, these are crucial steps in tackling the pandemic and ultimately advancing UHC.

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