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Towards a New Primary Health Care in Georgia

The primary health care (PHC) is the founding pillar of a new health care system in Georgia. It desserves a top priority focus in policy planning and in medical practice.

A comprehensive PHC system prevalent in 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 longer term perspective.

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

The remaining gaps in access to high quality primary care in Georgia are in part a reflection of the fact that monetary support for primary care has been lagging behind rhetoric. The  situation in wich 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 will 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 health system. Primary and secondary care, generalist and specialist, all have important roles in the development of new Georgian health system.

There are varied definitions and options of the scope and role of general practice, primary health care 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 then one organisational form can coexist paralelly The rural medical point as organisational framework can tackle the diversity of existing activities and offer different level and scale of services depending on the size and quality of human and infrastructural resources, on the basis of a well estabsished quality control and development system. In a longer future a gradually developing GP system, the new role of the general practitioner, better equiped 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, giving potentially way to integrated institutions comprising primary and secondary care. In Georgian health 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 health policy in Georgia. The new approach should combine 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; advice to increase the interest of the population for their own health and prevention, including through promoting a healthy life style, 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 labour.

Peter Makara

Peter Makara is since 2011 professor of public health at Semmelweis University in Budapest and from 2009 to 2011 he was Head of Master School in Health Policy at University of Debrecen.