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GLOBAL HEALTH PROJECT:GEORGIA

By: Leor Surilov

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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 leadershiphttps://fortytravels.com/blog/wp-content/uploads/2015/12/Tbilisi_Georgia_%E2%80%94_Old_Georgian_Parliament_building.jpg

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

HealthcareFinancing

53% of the population lived in urban area

Lack of accessto 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

Inadequatefinancing 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

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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 PfIDin 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

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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