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.
To be successful, health reform has to defined and supported as a social imperative and development priority, with the government’s full support. It’s not just the responsibility of a ministry of health. Indeed, to be fully realized, health reform should embody and express the social values of the country and its aspirations for economic and social development.
With that articulated vision guiding policy making, strategic planing, resource mobilization and funding, communication and engagement with the public, and the management of program implementation, it’s critical to have the capacity to stay the course, and develop and adopt heterodox approaches by engaging different stakeholders (as in the case of Georgia, private health insurance companies, foreign and local investors to modernize health services delivery infrastructure, regional and local authorities, physician associations, and civil society), as well as coordinated support from international and donor agencies.
Effective leadership also depends on the ability to be flexible in adjusting processes, investments and activities with new knowledge and experiences, without deviating from the broad vision. Flexibility is crucial but it must be backed up by evidence.
All of us working in international development should be mindful that more than simple technocratic solutions, effective and sustainable health reforms require specific leadership attributes. If we’re going to be effective in supporting health reform efforts, we need to see the big social and political picture and avoid getting lost in discussions and proposals that are not fully articulated or embedded in the social fabric of countries.