Weak Primary Health Care – The Main Barrier in Achieving Universal Health Coverage in Georgia

Abstract

Primary health care (PHC) is a cornerstone of health system. It is a whole-of-society approach to health that aims to maximize the level and distribution of health and wellbeing equitably, by focusing on people’s needs and preferences. Today it is globally acknowledged that PHC is a highly cost-effective mechanism in keeping people healthy via using preventative measures, managing chronic disease, and encouraging self-care recommendations. Moreover, universal health coverage - a key health target in the Sustainable Development Goals (SDGs) - can only be sustainably achieved with a strong emphasis on primary health care. In 2013, The Government of Georgia (GoG) initiated Universal Health Care Program (UHCP) in order to improve population coverage with health services. UHCP faces many challenges and one of the major causes of program’s low cost-efficiency is weak PHC system. According to Ministry of Health, expenditure on inpatient services almost doubled during 2012-2017 (increased from 20% (2012) to 34% (2017) as share of total health expenditure), while spending for out-patient services decreased from 20% to 17% during the same period. Furthermore, utilization of PHC services is no greater than 3.5 per person per year, which is almost 2.5 times less than the same indicator in European countries. The main objective of this study was to identify major barriers and challenges in Georgia’s PHC system. For this purpose, mixed methodology was chosen, which included desk-research and qualitative methods - in depth interviews and focus group discussions (FGDs). Semi-structured interviews were conducted with various stakeholders of PHC system. Structured part of interviews was based on “Vital Signs” of PHC Performance Initiative. Three FGDs were held with family doctors, in regions, using single-group traditional methodology. The study results indicate that major barrier hindering PHC development in Georgia, is the absence of political will. The country does not have clearly defined strategy for PHC development. Other key issues are: weak role of Ministry of Health in monitoring & regulating quality and implementing strategic purchasing function, overinvestigation and over-medicalization, high rates of referrals to specialists. Moreover, there is limited access to family doctors in rural areas, which is one of the causes for increased utilization of emergency services. To conclude, Georgia needs to strengthen primary health care system. First of all, by developing and manifesting government’s commitment towards PHC development and by establishing lead unit at the Ministry of Health responsible for successful reforms and monitoring.