Renewing the Primary Healthcare System in Georgia

Primary health care (PHC) deserves top priority focus in policy planning and in medical practice.

A comprehensive PHC system is prevalent throughout the EU, comprising a wide range of health education, promotion, prevention, curative and rehabilitative, and terminal activities. Comprehensive PHC is not just for richer EU member states, it is also affordable and deliverable in countries like Georgia, at least in the long term perspective.

Given the right incentives, in the Georgian health system there is a real opportunity to expand provision of medical services in a PHC setting, which is a prerequisite of an improved healthcare system and the better health of citizens..

The remaining gaps in access to high quality PHC in Georgia are in part a reflection of the fact that monetary support for primary care has been lagging behind rhetoric. The situation in which primary care has been constrained by a lack of resources has, however, aggravated the lack of trust that Georgian citizen are willing to bestow on it, particularly when hospitals, secondary and tertiary care facilities are in better physical condition, better equipped and better staffed. The rural population suffers disproportionately from this situation, and physicians, feldshers and nurses often act as de facto generalist staff, even when they are not fully trained to do so. Primary care facilities in Georgia are not yet in a position to take on the bulk of health services, as would be necessary for the full implementation of the family medicine model.

There are a number of steps that would need to be taken to achieve this goal. In addition to the appropriate allocation of financing for human resources and equipment, as well as investments in the training of staff, these include revised payment allocation mechanisms, improved quality of care through the development and implementation of clinical practice guidelines and the enforcement of quality assurance mechanisms, more clearly delineated levels of care, and improved gatekeeping and referral mechanisms.

Policy-makers need to be made aware of the concept of primary care and what it has to offer. This will require investment for advocacy and marketing activities to communicate the benefits of primary care to health professionals, policy-makers and the public. The role of primary care should not be defined in isolation but in relation to the constituents of the PHC system. Primary and secondary care, generalist and specialist, all have important roles in the development of new Georgian healthcare system.

There are varied definitions and options for the scope and role of general practice, PHC and specialists in Georgia. For instance, theoretically a primary care team can vary from a community nurse, a feldsher or rural general practitioner to a multidisciplinary team of up to 30, comprising specialist nurses, managers, support staff, family medicine and other primary care specialists (like in the most developed EU countries).

The developmental process has to build on existing structures, private ownership and more than one organizational form can coexist in parallel. The rural medical point as an organizational framework can tackle the diversity of existing activities and offer different levels and scales of services depending on the size and quality of human and infrastructural resources, on the basis of a well established quality control and development system. In the long term, a gradually developing GP system, the new role of the general practitioner, better equipped and better remunerated on performance basis, may give an indication of the breadth of the primary care services provided, and the degree of uniformity in the services.

Organizational structures in Georgia are changing, potentially giving way to integrated institutions comprising primary and secondary care. In the Georgian healthcare system, services traditionally provided by hospital and secondary care specialists could now be increasingly the responsibility of the primary care team.

A new approach is necessary: one in which primary care is seen in a positive light, with a proven contribution to health gain beyond control or cost-containment functions. The approach should be based on a comprehensive and integrated model developed in the frame of the new healthcare policy in Georgia. The new approach should combine a principle of equity, new universalism with affordability, economic realism with the objective of providing coverage for all and not coverage for everything.

The renewed PHC will provide integrated primary health care to patients in a single point; will to a greater degree focus on diagnostic and treatment of chronic diseases and conditions; will provide accessible, appropriate and affordable health care to their patients; and increase the interest of the population in their own health and prevention of illness, including through promoting a healthy lifestyle, which could help improve diagnostic and treatment of chronic diseases. PHC will use effective and efficient information technologies and should provide a good working environment to attract and encourage a high quality workforce.