Georgia health care system beginning with a background and discussing the health concerns and international affiliations.

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GLOBAL HEALTH PROJECT:
GEORGIA
By: Leor Surilov
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content/uploads/2015/11/shutterstock_280828427.jpg
Table of Content
▪ Country Background Overview
▪ Epidemiology
▪ Health Care System
▪ Dental Health
▪ Primary Health Care Settings
▪ Main Barriers Present in Health Care System
▪ Medical Schools in Georgia
▪ International Medical Affiliations
▪ Public Health
▪ Main Health Concerns
▪ USAID'S BEDAQUILINE DONATION PROGRAM IN PARTNERSHIP WITH JOHNSON AND JOHNSON
▪ Dangers of Tuberculosis
▪ Personal Reflection

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Country Overview: History
▪ Historically believed to have ancient past going back to
Noah’s son Thargamos, which settled in the Caucasus mountains
▪ Protohuman remains about 1.7 million years old have been found, and many Palaeolithic artefacts
▪ Oldest record of Georgia is by Xenophon, who retreated from Persia at the end of the 5th century
BC
▪ 337AD Georgia became the world’s second Christian state
▪ Georgia has been the focus of many empire conflicts because of its location between Europe and
Asia
▪ Country was annexed by Russia in the 19th Century
▪ Georgia gained independence in 1991 after collapse of the Soviet Union.
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Country Overview: Politics
▪ Government: Semi-Presidential-parliamentary
representative democracy, with the President acting as the
Head of State and the Prime Minister as the Head of
Government
▪ Judicial Branch: highest court is the Supreme Court and a
Constitutional Court
▪ President: Giorgi Margvelashvili
▪ Administrative Divisions: 2 autonomous republics, 9 regions, and a capital
territory
▪ Suffered after independence due to years of corruption, and poor leadership
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Georgian Parliament Building

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Country Overview: Economy
▪ GDP: $36.8 Billion (est. 2016)
▪ Currency: Lari (GEL), which was introduced
in 1995
▪ Top exports of Georgia: Cars, Refined
Petroleum, Ferroalloys, Copper Ore, and Wine
▪ Export Destinations: Azerbaijan, United States, Russia, Bulgaria, and Armenia
▪ Georgia struggled since independence from the Soviet Union, restructuring a
previous state-owned system
▪ Turnaround in the economy in 1995 with privatization of previous state-owned
companies
http://atlas.media.mit.edu/en/profile/country/geo/
Country Overview: Population, Cities,
Languages, Religions, and Culture
▪ Population: 4.95 million
▪ 83.8% are ethnically Georgian
▪ 5.7% Armenian
▪ 6.5% Azeri
▪ 1.5% Russian
▪ 2.5% other groups
▪ Major Towns: Tbilisi (population 1.4 mil), Kutaisi (200,000)
▪ Languages: Georgian and Russian widely spoken
▪ Georgian Alphabet was devised in the 4th or 5th century
▪ Religions: 70% Georgian Orthodox; with minor Muslims, and Jewish presence
▪ Culture: Although, many are poor, Georgians are friendly and have a rich culture of theatre,
ballet, film, literature, and music
▪ Georgian music is highly distinctive tradition of polyphonic singing
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Epidemiology
Georgia EU Average
Population Growth Rate -0.33% (2012) 3.5% (2015)
Life expectancy, male
(years)
71 (2014) 78.1 (2014)
Life expectancy, females
(years)
78 (2014) 83.6 (2014)
Life expectancy, total
(years
74.7 (2014) 80.9 (2014)
Infant mortality rate, (per
1000 live births)
15.7 (2010) 18.8 (2014)
Fertility rate, total (births
per women)
1.5 (2012) 1.58% (2015)
Birth rate (per 1,000 live
births)
14 (2014) 10 (2014)
According to the
World Health
Organization
(WHO) and The
World Bank
Health Care System
▪ Collapse of the Soviet Union the real per capita public expenditures on health care declined
from US $13.00 (in 1990) to under US $1.00 (in 1994)
▪ Reform and Privatisation of Georgia’s corrupt health care service started in 1995
▪ Health care reform is led by the Ministry of Labour, Health and Social Affairs of Georgia
(MoLHSA), which manages the public health services; while the governmental role in
regulating healthcare and financial transactions has decreased
▪ Georgia has a social insurance system covering some benefits and social assistance system
that provides benefits to the poor and disabled
▪ Health care system relies mainly on out-of-pocket payments

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Dental Health
 The entire population has partial healthcare
 The insurance system covers only urgent medical services such as relief of pain an
treatment of oral cancer
 Non-urgent oral health treatment is paid for by patients and not funded by the state
 No state oral health education programs in the country
 In 2006, Colgate-Palmolive launched an oral health educational program “Bright Smile
Bright Future” with the voluntary support from the Department of Dentistry and Maxilla-
Facial Surgery of the Tbilisi State University
 Dental Workforce: Number of dentists registered in 2012 was 8423
 Dental Education: Dentists study in one of the 11 Dental Schools, (four are state funded
and seven are private)
 Only 20-25% of Georgians visited a dentist in 2012
Primary Health Settings
 Georgia had well-funded health care system during its time as
a Soviet republic, and many travelled to Georgia because of there
“cure” health spas
 Decreased funding after independence led to deterioration
of the infrastructure
 In 2010, Georgia had 13.76 health posts per 100,000 population and 2.21 specialized
hospitals per 100,000 (according to WHO)
 Primary health care is free for people living below the poverty line
 High number of doctors per capita in Georgia, compared to other European countries ; 462
doctors per 100,000 people compared to 327 in European countries
 98% of births in Georgia were attended by skilled personnel (According to WHO in 2005)
Iashvili Children’s Central Hospital in Tibilisi, Georgia
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Main Barriers Present in Health Care
System
Access to
services
Access to
Medicine
Human
Resources
Training and Re-
training
Healthcare
Financing
 53% of the
population lived
in urban area
 Lack of access
to services in
rural
populations
 Availability and
cost of
medicine a
major concern
 Medicines are
available mainly
in the capital,
Tbilisi, and not
always found in
rural
communities
 Inequalities in
medical staff
outside of the
Tbilisi (where
there is three
times as many
doctors
compared other
regions)
 Lack of nursing
staff
 Few specialists
available
 Medical staff
received
training during
the Soviet
Union and a
skill gap has
developed
 Lack of re-
training
programs of
medical
professionals in
the country
 Inadequate
financing to
healthcare
system
Medical Schools in Georgia
 Tbilisi State Medical School (State Medical School)
 Founded in 1918
 Almost 5000 undergraduate and 203 post-graduate
students
 Produced more than 40,000 doctors
 Largest Medical University in Georgia, Caucasus,
and Eastern Europe
 David Tvildiani Medical University (Private)
 Founded in 1993 as AIETI Medical School
 Medical school aimed for students to pass the USMLE Steps
 Tuition Fee: ~$7000 USD for 1st year and ~$5000 for subsequent yrs
 6 year program (2.5 yrs basic medical sciences, 2.5 yrs clinical science and pre-diploma
specialization or clinical clerkship for 1 yr)
 Geomedi Medical University (Private)
 Founded in 1998
 6 year program
Tbilisi State Medical School
https://www.sites.google.com/site/medicineinggeorgia/_/rsrc/1353939867864/tbilisi-state-medical-university/Tbilisi%20State%20Medical%20University%202.jpg

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International Medical Affiliations
 University at Albany School of Public Health under a NIH Fogarty International funded program
assisted in public health training lead the International School of Public Health in Tbilisi, Georgia
 The Centers for Disease Control and Prevention (CDC) has a program called Global Disease
Detection (GDD) programs since 2009.
 Partners for International Development (PfID)- for the past four years Emory and PfID have held a
mini-residency program in emergency medicine for doctors and nurse, which was established by PfID
in 2009
 Atlanta-Tbilisi Healthcare Partnership (ATHP) has brought together educational educational and
governmental institutions in Atlanta, Georgia and in the country of Georgia for the purpose of sharing
information and expertise to improve health care in Georgia
 Forged the western-style pediatric emergency facility, Iashvili Pediatric Hospital in Tbilisi opened
in 2005
 Tbilisi State Medical University
 Many affiliations with prominent schools worldwide
 Canada: University of Quebec in Chicoutimi
 USA: Emory University, School of Public Health (Albany), The University of Scranton
 Israel: Ben Gurion University of the Negev, and Ariel University
Public Health
 2010 immunization rates for 1 yr old’s were
 91% for diphtheria, and pertussis (DPT3)
 94% for measles
 67% for Hib (Hib3)
 In 2010, estimated 65% of persons with advanced human immunodeficiency (HIV)
infection were receiving antiretroviral therapy
 In 2010, 95% of the population of Georgia had access to improved sanitation facilities
and 98% had access to improved sources of drinking water
 According to the World Higher Education Database (WHED), eight universities in
Georgia offer programs in epidemiology or public health

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Main Health Concerns
 Travelling to Georgia it’s important to be up to date with vaccinations against tetanus,
diphtheria, and polio
 WHO evaluated (in 2002) that the disease burden of non-contagious disease was 89%,
contagious disease was 5%, and disease burden of trauma was 6%
 Poverty is one of the biggest risk factor for health concerns in Georgia
 Communicable diseases such as tuberculosis (TB) are increasing in Georgia
 Increasing prevalence of hepatitis B, hepatitis C, and sexually transmitted infections (STIs)
Other Health Hazards:
 Malaria: Malaria in Georgia is the benign form (Plasmodium vivax) and occur in rural
villages
 Rabies: Exists in Georgia, especially in rural areas
 Smoking: passive smoking is a concern because of the high incidence of smoking
individuals in the country (2005 smoking was banned in public places, but this does not
include restaurants and bars)
USAID'S BEDAQUILINE DONATION PROGRAM IN
PARTNERSHIP WITH JOHNSON AND JOHNSON
http://www.gettyimages.ca/pictures/tamuna-and-her-companions-at-the-tbilisi-tb-children-news-photo-113965862#tamuna-and-her-companions-at-the-tbilisi-tb-children-hospital-in-in-
picture-id113965862
https://www.usaid.gov/sites/default/files/documents/1864/TB-bdq-infographic.pdf

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Dangers of Tuberculosis (TB)
 TB is an infectious disease that results from the bacterium
Mycobacterium tuberculosis
 Tuberculosis mainly affects the lungs
 Tuberculosis is spread through the air when people who
have the active TB in their lungs cough, sneeze, speak (people
with the latent form of TB don’t spread the disease)
 TB kills 2 million people/yr worldwide
 It is estimated that 1/3 of the world’s population is thought to have tuberculosis
 Tuberculosis is curable and preventable disease
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Personal Reflections

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References
 Boslaugh, S.E., (2013). Health Care Systems Around the World: A Comparative Guide. Thousand Oaks, CA: Sage Publications
 Burford, T. (2015). Georgia (5th Eds.) Guilford, CT: Globe Pequot Press.
 Center For Global Health. (2016). Retrieved from http://www.albany.edu/globalhealth/
 Costigliola, V. (2012). Healthcare Overview: New Perspectives, Advances in Predictive, Preventative and Personalized Medicine. New
York, NY: Springer.
 Georgia. (2016). Retrieved from http://atlas.media.mit.edu/en/profile/country/geo/
 Goldman, D. (2013, Spring). Transforming medicine in another Georgia. Emory Medicine. Retrieved from
http://emorymedicinemagazine.emory.edu/issues/2013/spring/features/transforming-medicine-in-another/index.html
 History of TSMU. (2012) Retrieved from http://tsmu.edu/tsmu12/tsmu/tsmuuni/index_eng.php?p=partkl
 Holtz, C. (2012). Global Health Care: Issues and Polices (2nd Eds.). Burlington, MA: Jones & Bartlet Learning.
 Longmore, M., Wilkerson, I. B., Baldwin, A., & Wallin, E. (2014). Oxford Handbook of Clinical Medicine (9th ed.). Oxford: Oxford
University Press
 Margvelashvili, M., Mikadze, T., Margvelashvili, V. (P2013). Oral Health Care Provision Systems in the Black Sea Countries: Part 15
Georgia. Department of Dentistry and Maxilla-Facial Surgery, 12 (3), 163-165.
 Study Europe. (2014). Retrieved from http://www.studyeurope.in/georgia/study-medicine/
 Tuberculosis. (2016, March). Retrieved from http://www.who.int/mediacentre/factsheets/fs104/en/
 USAID’s Bedaquiline Donation Program in Partnership with Johnson and Johnson. (2016, April 25). Retrieved from
https://www.usaid.gov/what-we-do/global-health/tuberculosis/technical-areas/bedaquiline-donation-program