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Georgia

Health information systems in developing countries: Star Wars or reality?

Patricio V. Marquez's picture

(Doctor at the GP office working with prescriptions. Kirov, Russia. Credit: Dmitry Kirillov/World Bank)

In the late 1990s, an international consultant told me that a proposed electronic health information system in the Dominican Republic was “like Star Wars and will not work in this country.”

 

Our objective was to improve service delivery by virtually connecting health providers to share medical records with one another as patients moved from health centers to hospitals. We learned that this was much more than an overnight task, requiring a sustained medium-term effort by the government to get the system fully up and running.

 

In recent years, I’ve seen similar efforts realized in the Russian Federation, Georgia, Azerbaijan and Botswana. In two Russian regions, Chuvash Republic and Voronezh Oblast, for example, electronic records are helping coordinate the flow of clinical and financial information across the health systems as facilities, departments within hospitals, and health insurance agencies have been “virtually” connected through broadband networks. The electronic records are supporting clinical decision-making, facilitating performance measurement and pay-for-performance initiatives, and ultimately the continuity of care as patients move across the health system. Inter- and intra-regional medical consultations and distance learning activities are also being supported by telemedicine networks that connect specialized hospitals with general facilities.

Are all medical procedures, drugs good for the patient?

Patricio V. Marquez's picture

Also available in: РусскийPatients waiting at health center in Angola (credit: UN/Evan Schneider).

When healthcare professionals take the Hippocratic Oath, they promise to prescribe patients regimens based on their “ability and judgment” and to “never do harm to anyone”.

Although extraordinary progress in medical knowledge during the last 50 years, coupled with the development of new technologies, drugs and procedures, has improved health conditions and quality of life, it has also created an ever-growing quandary regarding which drugs, medical procedures, tests and treatments work best.

And for policy makers, administrators and health economists, the unrestrained acquisition and use of new medical technologies and procedures (e.g., open heart surgery to replace clogged arteries, ultrasound technology scanners to aid in the detection of heart disease, and life-saving antiretroviral drugs for HIV/AIDS) is increasing health expenditures in an era of fiscal deficits.

In many countries, I’ve see how ensuring value for money in a limited-resources environment is not only difficult but requires careful selection and funding of procedures and drugs. It also comes with serious political, economic and ethical implications—and with new drugs and technologies appearing every day, this challenge isn’t going away. What should countries do?

Assessing education with computers in Georgia

Michael Trucano's picture

the buki generationOne of the fascinating benefits of working at a place like the World Bank is the exposure it offers to interesting people doing interesting things in interesting places that many other folks know little about.  Small countries like Uruguay and Portugal, for example, are beginning to attract the attention of educational reform communities from around the world due to their ambitious plans for the use of educational technologies.  Much is happening in other parts of the world as well, of course, especially in many countries of Eastern Europe and Central Asia.  The largest stand-alone World Bank education project to date that focused on educational technologies, for example, was the Russia E-Learning Support Project.  Macedonia gained renown in many corners as the first 'wireless country', with all of that Balkan country's primary and secondary schools online since the middle of the last decade -- although other countries, like Estonia and the tiny Pacific island nation of Niue, also lay claim to versions of this title. (If you are looking for more information on the Macedonian experience, you can find it here and here [pdf]). Much less well known, however, is the related experience of the small country of Georgia, located at the crossroads of Eastern Europe and Western Asia, where small laptops are being distributed to primary school students and where school leaving exams are now conducted via online computer-adaptive testing.

Out-of-pocket in the Caucasus

Owen Smith's picture

I am partway through a trip to the countries of the South Caucasus (Armenia, Azerbaijan and Georgia), where winter is settling in—snow in Tbilisi and Yerevan, and a raw wind on Baku’s seafront.

It is a diverse region at the proverbial crossroads, but one common trait is a bleak health financing environment. All three countries rely on out-of-pocket (OOP) expenditures for about two-thirds of total health spending, well above their peer groups, including other countries of the former Soviet Union or middle-income countries around the world. As a result, the incidence of “impoverishing” and “catastrophic” health spending by households—both common indicators of financial protection—are among the highest in the world. Besides costing some households dearly, OOP expenditures also keep many others away from the hospital or clinic: Utilization rates are among the lowest in Europe and Central Asia.

How did the Caucasus become such OOP outliers? The proximate causes are clear enough: large formal or informal payments for health care and high prices and overconsumption of pharmaceuticals. Many of these issues, in turn, can be traced to low levels of government spending on health, around 1.8% of GDP in all three countries, roughly half the regional average. Health spending is low as a share of government budgets, as well. As a result, providers recover costs directly from patients, and can have more latitude to engage in rent-seeking in the absence of stronger pooling and purchasing mechanisms.

Reforming health systems: leadership matters

Patricio V. Marquez's picture

I was in Tbilisi last week for the launch of Georgia’s new five-year health strategy, "Affordable and Quality Health Care," the first strategy since 1999. It’s a milestone in the country’s ambitious health reform program, summarizing what has been achieved, the challenges ahead, and options to address them. And more importantly, the strategy reflects the government’s commitment to continue redesigning the health system and improving the health status of the population through the adoption of multisectoral actions.

The Georgians should be proud. Since 2006, the government has radically transformed the health system, moving rapidly from a budget-funded direct provision of medical care in public facilities to subsidizing health insurance premiums for the poor. Private health insurance cum services providers, who are increasingly operating as integrated health management organizations, are delivering services in the benefit plan. The initial results are promising: Health insurance coverage has risen steadily from about 2 percent to 40 percent of the population, and out-of-pocket health care expenditures among the poor have been decreasing, particularly after a basic drug benefit was added to the health insurance plan.

You may say that the Georgian experience is nothing new because many countries across the globe have adopted or are adopting similar arrangements—and some countries have more to show. However, this experience shows us how unwavering leadership is a key to persevering on the sometimes rocky path of health system reform.

Making a public health case for safer roads

Patricio V. Marquez's picture

Also available in: Русский

ARA0171UZB World Bank

On recent visits to Moscow and Tbilisi, and driving from Baku to the Sheki and Agdash regions in Azerbaijan, I observed challenges and progress in making roads safer. Why should this matter to public health folks? Or should this be only the concern of engineers?

If one of the goals of development is to improve health outcomes by reducing premature mortality, injuries and disability, then unsafe roads are a key public health challenge.

In Eastern Europe and Central Asia (ECA) the problem is acute. Road traffic deaths rank among the ten leading causes of death: people are 2-3 times more likely to die from road injuries than people in Western Europe. For every death, many more people have injuries that require medical care.

What is causing this problem? For sure, more people are driving because the number of cars has increased significantly due to rising incomes—the traffic jams in some ECA cities vividly reflect this change. Poor road conditions and spotty enforcement of speeding, drunk driving, and seatbelt and helmet laws are leading culprits. “Distracted driving,” due to the growing use of cell phones and texting, is also resulting in more car crashes.

The Land of Large Abandoned Objects

Chris Bennett's picture

The book ‘Stories I Stole’ was written by the English author Wendell Steavenson, who lived in the South Caucasus’ – mainly Georgia – from 1998 to 2001. This was a turbulent time, with great hardship and limited law-and-order. It makes for a fascinating read, since so much has changed in Georgia in these ten years.

Public Opinion and Authoritarian Regimes

Sina Odugbemi's picture

Is public opinion a force for good government or not? If recent events in Burma, Pakistan and Georgia show anything at all it is that public opinion is ultimately  the basis of power and legitimacy. Which is something several political philosophers have told us for over 200 years, but it is fascinating to watch these struggles unfold.

And it explains why authoritarian regimes are always keen to control public opinion by:


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