13.12.2007 - Source: Médecins Sans Frontières

Annual activity report of Médecins Sans Frontières (covering mid-2006 to mid-2007) ("International Activity Report 2006/7") [ID 22038]

Document(s): Open document

11.10.2007 - Source: Internal Displacement Monitoring Centre (formerly Global IDP Project)

IDPs mention numerous barriers to receiving health care; it is easier to benefit from the services of the IDP polyclinics than hospitals used by the general public ("New IDP strategy awaits implementation; a profile of the internal displacement situation") [ID 21476]

"“Though many IDP children and their families have medical policies, and certainly use them when possible, they nevertheless mentioned numerous barriers to receiving health care. Even with these policies, IDPs mention having to wait months to get assistance for their children. Many medications and procedures still carry costs which either prohibit access to treatments by the poorest IDPs or result in families incurring serious debt to heal themselves and their children. Additionally, IDPs mentioned that it is easier to benefit from the services of the IDP polyclinics than hospitals used by the general public as they have often been refused care at these medical institutions. This is perhaps due to health care providers and IDPs themselves having had poor information as to the patient’s rights guaranteed by their health policies […]. Doctors also may have refused to provide treatment in fear that they would not be reimbursed later by the government. Unable to claim social help, families often go into debt to take care of medical expenses. This debt may take years to pay off and may put stress on their social networks and relations.[…]"

Document(s): Report

31.05.2007 - Source: Institute for War and Peace Reporting

Reform of health system denies benefits to thousands of disabled and veterans, leaving them in poverty, say campaigners ("Disabled Stripped of Benefits") [ID 20229]

Document(s): Open document

23.05.2006 - Source: EurasiaNet

Demand for narcotic treatment programs rapidly rising in Georgia; in 2004, 2,016 new cases of drug abuse reported in the country, only 1,275 cases noted in Azerbaijan and 538 in Armenia ("Georgia Grapples With Brewing Drug Addiction Crisis") [ID 15865]

According to local experts, no treatment of addicts is funded by state; NGOs are trying to cover gaps in governmental programs, however patients are deterred by high cost of such treatment, since health insurance does not cover it

"The latest data provided by the South Caucasus Anti-Drug program (SCAD), reveals that in 2004, 2,016 new cases of drug abuse were reported in Georgia, while 1,275 cases were noted in Azerbaijan and 538 in Armenia. [...] Some local experts are critical of the Georgian government response to the brewing addiction crisis. "I’m ashamed to describe the current state policy toward treatment in Georgia. The Minister of Health has reduced funding from the budget five times in the last three years; from 250,000 [Georgian lari, or about $140,000] to 150,000 lari last year to 50,000 [$28,000] this year," says Jana Javakhishvili, a project manager for SCAD, which is funded by the European Union. "No treatment is funded by the state, although every patient has the right to be treated," Javakhishvili added. Georgia’s 2003 law on "Drugs, Psychotropic Substances, Precursors and Narcological Aid" classifies drug addiction as a disease, granting addicts the same rights as people with mental disorders. It defines the need for compulsory treatment, but Javakhishvili says that no entity exists to provide the services mandated by the law. "The state has neither money nor means, and depends on the handful of NGOs to fill in the gap." [...] There are currently four drug detox centers in Tbilisi and one in Batumi, yet none of them possess the resources to function properly. Non-governmental organizations are trying to cover the gaps in governmental programs. [...] Many Georgians remain reluctant to seek treatment, in part out of concern that their identities will not be kept confidential.  [...] Another deterrent to participation in detox programs is the fact that no health insurance plans cover such treatments. Thus, patients must bear the program’s full costs."

Document(s): Open document

31.12.2005 - Source: ReliefWeb

People with mental disabilities suffer from poverty, lack of access to healthcare and extremely limited access to education; accurate information on number of such persons, their living conditions and needs is missing ("Georgia: Humanitarian and development update Dec 2005 (UN Country Team in Georgia)") [#42042], [ID 6054]

"On 15 December, the Georgian Association for Mental Health (GAMH) organized a presentation of the study “The Situation of People with Mental Health Problems and People with Intellectual Disabilities.” Representatives from the Government, international and local NGOs and other interested individuals/organisations attended the event.
Obviously, in Georgia civil war in early 90s, armed conflicts and dire socio-economic conditions have had the immense impact on the whole population and especially, of those with disabilities, turning them into the poorest and most vulnerable group in Georgia. The situation is aggravated by public ignorance of the problem, stigma and discrimination.
[…]
As per the main findings of the report, the situation of people with mental disabilities in Georgia is characterised by poverty, lack of access to adequate healthcare and other support services, virtually no alternatives to institutionalisation, and extremely limited or no access to education and poverty.
Following the Government change in 2003, new hopes and some new positive developments emerged such as involving a range of stakeholders, including NGOs in the development of new state policy. Existing problems include absence of accurate information about the number of persons with disabilities, on their living conditions and their needs.
Currently Government is spending on health care about 2% of the GDP, and this is one of the lowest in the Eastern European regions. Only 2.75 of this amount is allocated to mental health annually. The total benefit package for people with disabilities is much less than minimum subsistence level. Only 2% of people with disabilities lived above the poverty line in 2003, with most people with disabilities still living in extreme poverty.
There is urgent need to improve the quality, the quantity and the range of professionals who work in mental health field in Georgia, as the number of qualified psychiatric nurses and psychotherapists is very limited. There is no statistical data on the employment rates of people with mental disabilities and only small number of employment initiatives were established by NGOs that operate as pilot projects. There is a very little opportunity for children with disabilities to receive education, to be outdoors and to live in the community.
One of the most important problems is inappropriate institutionalisation of people with mental disabilities. In the vast majority of cases, institutionalisation is the only solution because alternatives to it simply do not exist. Conditions in all long-stay institutions are appalling, buildings are poorly heated and without basic technical and material resources. It is noteworthy that the psychiatric institutions receive GEL 6.70 per patient/per day to cover all treatment and operating costs."

Document(s): Open document

12.2005 - Source: World Health Organization

Country profile for HIV/AIDS (situation analysis, antiretroviral therapy coverage) ("Summary Country Profile for HIV/AIDS Treatment Scale-Up") [ID 15725]

"Despite low prevalence, Georgia is considered to be at high risk for an expanding HIV/AIDS epidemic due to widespread injecting drug use and intensive population movement between neighbouring high-prevalence countries, such as Ukraine and the Russian Federation. Georgia is experiencing a nascent epidemic, mostly concentrated among injecting drug users (63% of the cumulative total), although heterosexual transmission is reported to be increasing. The worst affected areas are Tbilisi, the capital, and Black Sea coastal regions of Georgia. Before 1997 very few HIV cases were detected. By 1998, the number of new HIV cases had doubled. By the end of 2004, Georgia had reported a cumulative total of 638 HIV cases. A total of 163 new HIV cases were registered in 2004. Most people living with HIV/AIDS were aged 25–40 years at the time of diagnosis, and 82% were male. Georgia’s socioeconomic conditions put it at risk of developing an epidemic similar to that of the Russian Federation and Ukraine.   Policy on HIV testing and treatment   The Law on HIV/AIDS Prevention and Control was adopted in 1995 and amended in 2000. According to new requirements, HIV counselling and testing is voluntary for all population groups, except blood donors. The law ensures equal access to free diagnostic and treatment services, including antiretroviral therapy for everyone living with HIV/AIDS. National HIV/AIDS treatment guidelines, including first- and second-line regimens, have been developed with the assistance of WHO. Substitution therapy is legal in Georgia.   Georgia was one of the first former Soviet republics to develop a national HIV/AIDS programme in 1994 followed by a strategic action plan for 2003–2007. A National AIDS Registry was begun in 1988, and the Georgian National AIDS Program was established in 1993. The Law on HIV/AIDS Prevention and Control was adopted in 1995 and revised in 2000. The overall capacity of the health sector to provide antiretroviral therapy is adequate to meet the current needs of the country. Since December 2004, Georgia has ensured universal access to antiretroviral therapy for all registered people. Since 2005, Georgia has also ensured universal access to HIV counselling and testing for all pregnant women, including antiretroviral prophylactic treatment free of charge for pregnant women living with HIV/AIDS and their newborns. By the end of 2004, only the National AIDS Center had full capacity to provide antiretroviral therapy. To improve access to antiretroviral therapy, the National AIDS Center is working on decentralizing HIV/AIDS treatment services. Along with the National AIDS Center, treatment will be provided at the regional AIDS treatment centres to be established by the end of 2005 in Batumi, Autonomous Republic of Ajara and Zugdidi, Samegrelo. Both regions are among the geographical areas most affected by HIV. [...]  The need for antiretroviral therapy is monitored through quarterly testing of all registered people living with HIV/AIDS on CD4 and viral load according to the national protocols. The Global Fund supports the provision of antiretroviral therapy. HIV genotypic resistance testing for assessing treatment effectiveness is implemented at the National AIDS Center. Substitution therapy programmes have begun to be implemented at the Institute on Drug Addiction since December 2005. The initial number of injecting drug users to be enrolled in the programmes is 60."

Document(s): Open document

11.2005 - Source: ReliefWeb

Healthcare system is under-funded and ineffective and proved unable to eliminate communicable diseases; excessive health costs prevent half of the poor in Georgia from seeking medical care; there is growing concern about high maternal and child mortality, HIV/AIDS, tuberculosis and malaria ("Humanitarian Situation and Transition to Development 2006 (Humanitarian Affairs Team, Office of the UN Resident Coordinatior in Georgia)") [#41665], [ID 6055]

"Georgia’s large network of public health providers suffered a major setback during the 1990s. Though subsequently the country managed to stem the decline in healthcare funding, it is still at very low levels of spending (c. 4% of the 2005 budget). The excessive network of healthcare providers has largely been retained, resulting in under-funded and often ineffective facilities. The lack of resources for basic interventions and prophylaxes has resulted in a repeated failure to eliminate communicable diseases, as well as an even greater burden of non-communicable diseases. [...] Official statistics show the low utilization of healthcare services, with persistent differentials across rural and urban areas. Despite the presence of illness, as many as half of the poor in Georgia do not seek medical care because of prohibitively expensive health costs. [...]
Dramatic growth in morbidity and mortality of the critical 1990s has generally been arrested, but there continue to be concerns about the delivery and the quality of critical medical services. Very slow progress is observed in achieving reductions in child and maternal mortality, which are among the main indicators in the MDG, and one of the focuses of the USAID Cooperation in Health System Transformation programme. Maternal morbidity is very high, while the situation could be drastically improved through relatively simple measures such as regular medical oversight. The same is true regarding the morbidity among young children, where simple approaches such as improving the food security of mothers and enhancing breast-feeding, are needed. [...] Accessibility of specialised medical assistance for young children is also much needed.
There is a rapidly growing threat to the health of the country’s population from HIV/AIDS, even if by international standards the incidence is not yet very high. The threat is related to the increase in injecting drugs (which is the primary cause for HIV transmission in Georgia); commercial sex work; a concurrent increase in the incidence of sexually transmitted infections (STIs); Georgia’s proximity to neighbouring countries with HIV/AIDS epidemics and high migration rates to these countries; the limited capacity of the Government to implement effective preventive responses; and low levels of awareness of HIV and STI. At the same time, through the implementation of the national anti-AIDS strategy (2003-2007), and with the assistance of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), UN agencies, USAID, and other donors, a number of active preventive measures are supplementing the treatment of all HIV-infected patients with anti-viral medicines, and will do so until 2009, when responsibility will be taken over by the Government. [...]
Another serious threat is the spread of tuberculosis. Georgia has one of the highest tuberculosis rates in Europe and, alarmingly, it seems to be growing. TB is fuelled by ineffective approaches to diagnosis and treatment. TB prevalence is high among prisoners, who serve as an epidemiological source for the spread of disease. Major challenges remain in providing TB patients in Georgia easy access to TB diagnostic and effective treatment, as well as the GFATM and other international programmes that support the Government in dealing with these challenges. In 2004, WHO launched the South Caucasus programme for control of TB with headquarters in Tbilisi; since 1998, ICRC has supported a TB programme in the penitentiary system. […]
There also is concern related to the possible spread of malaria, though currently there is a decline in incidence rates. Emerging threats such as mutating flu varieties (i.e. avian flu) pose a special danger and require special preparedness and significant material resources due to their potential scale.
In general, institutional capacity in disaster-related medicine is underdeveloped, and in the case of a large-scale emergency, it will be very difficult to provide medical assistance to victims numbering even in hundreds, not to mention higher numbers."

Document(s): Open document

10.2005 - Source: UK Home Office

According to latest WHO health indicator of May 2005, 100% of population have access to primary healthcare ("Operation Guidance Note: Georgia") [#39388], [ID 6056]

"4.4.2 In 2000 the Georgian government adopted a State programme for a national health policy. The same year saw the adoption of a Strategic plan for health care development in Georgia. According to the latest World Health Organisation (WHO) health indicators for Georgia of May 2005, 100% of the population have access to primary healthcare. Between 90 and 100% of children have received all major inoculations. Per 10,000 people in 2003 there was a total of 48.4 doctors and 41.9 hospital beds. Measles and tuberculosis are the main causes of death by disease."

Document(s): Open document

21.06.2005 - Source: Schweizerische Flüchtlingshilfe

Costs of medical treatment in Georgia ("Behandlungsmöglichkeiten von Hepatitis C und der Umgang mit Drogensüchtigen, Auskunft der SFH-Länderanalyse") [#33208], [ID 6057]

"Medizinische Behandlungen in Georgien sind häufig nur durch kostendeckende Bezahlung möglich. Damit sind sie für viele GeorgierInnen kaum verfügbar. Komplexe Behandlungsprogramme sind wegen mangelnder finanzieller Ressourcen des Staates oft nicht gesichert. Das georgische Rote Kreuz geht davon aus, dass die Behandlung chronischer Krankheiten nicht gewährleistet ist.2 Unabhängig von bestehenden gesetzlichen Regelungen über eine Pflichtversicherung und theoretisch freiem Zugang zu medizinischer Behandlung bei einigen definierten Krankheiten, zahlt die georgische Bevölkerung nahezu alle Behandlungskosten selbst. Nebst den eigentlichen Behandlungskosten (Untersuchungen, Medikamente etc.) müssen PatientInnen auch für unterbezahlte Ärzte und Pflegepersonal wie auch das eigentliche Krankenbett aufkommen. 2003 beliefen sich die Kosten für ein Krankenhausbett durchschnittlich auf 27 Franken pro Tag. Ärzte mussten täglich mit zehn Franken, Krankenschwestern mit 3.50 Franken bezahlt werden.3 Für den Grossteil der Bevölkerung verunmöglichen die hohen Summen dieser "Schwarzgeldzahlungen" eine der Krankheit angemessene medizinische Versorgung. Aufgrund der schlechten sozioökonomischen Lage würden viele PatientInnen erst dann medizinische Hilfe in Anspruch nehmen, wenn sie ernsthaft erkrankt sind, da oft auch eine einfache medizinische Grundversorgung nicht in Anspruch genommen werden kann.4
Im Falle eines Unfalls kann zwar davon ausgegangen werden, dass die ärztliche Erstversorgung gewährleistet ist, eine allfällige Weiterbehandlung im Krankenhaus ist allerdings nur dann sichergestellt, wenn durch Familienangehörige oder Bekannte die zusätzlichen Kosten übernommen werden.5
Das gesamte Gesundheitssystem hat einen hohen Grad an Informalität und bestehende Gesetze, Programme und Krankenversicherungen bleiben weitgehend theoretischer Natur. Zwar existiert eine staatliche Krankenversicherungsanstalt, welche für die Krankenpflichtversicherung zuständig ist. In der Realität ist aber nur ein kleiner Teil der Bevölkerung durch staatliche Krankenversicherung abgedeckt. Der Grossteil der GeorgierInnen hat eine geringe Chance davon zu profitieren. Für 50 Prozent ist die Inanspruchnahme der Krankenvorsorgeleistungen äusserst eingeschränkt, für 30 Prozent sind sie unerreichbar. Insgesamt gehen 40 Prozent der Krankenvorsorgeausgaben an nur 2,5 Prozent der georgischen Bevölkerung.6"

Document(s): Open document

21.06.2005 - Source: Schweizerische Flüchtlingshilfe

Medical treatment for Hepatitis C patients ("Behandlungsmöglichkeiten von Hepatitis C und der Umgang mit Drogensüchtigen, Auskunft der SFH-Länderanalyse") [#33208], [ID 6058]

"Chronische Krankheiten aus dem Bereich der inneren Medizin können wenn überhaupt nur in den grösseren Städten behandelt werden. PatientInnen mit einer chronischen viralen Hepatitis können im Georgian Infectious Diseases, Aids & Clinical Immunology Research Center in Tbilisi behandelt werden, welches eine Behandlung mit längerfristiger Überwachungskapazität gewährleisten kann.7
Der Zugang zu Behandlung von Hepatitis-Erkrankungen ist aber aufgrund der (auch für landesübliche Verhältnisse) hohen Kosten für die therapeutischen Massnahmen und Medikamente erschwert. Eine medizinische (molekularbiologische) Untersuchung der Leber kostete 2002 rund 1000 US Dollar.8 Gemäss einem Telefongespräch mit der verantwortlichen Ärztin im Georgian Infectious Diseases, Aids & Clinical Immunology Research Center kostet die vom Departement für Innere Medizin, Gastroenterologie und Hepatologie des Universitätsspitals Zürich für Ihren Mandanten vorgeschlagene halbjährige Therapie mit pegyliertem Interferon und Ribavarin 9000 US Dollar. Eine halbjährige Therapie mit "normalem" Interferon kostet 6000 US Dollar.9
Die Kosten für Behandlung und Medikamente werden dabei weder vom Staat noch von der Krankenversicherung übernommen und müssen vom Patienten selbst bezahlt werden. Wegen der hohen Kosten ist eine Behandlung für die meisten Patienten nicht erschwinglich.10"

Document(s): Open document

21.06.2005 - Source: Schweizerische Flüchtlingshilfe

Acquaintance of with addicts ("Behandlungsmöglichkeiten von Hepatitis C und der Umgang mit Drogensüchtigen, Auskunft der SFH-Länderanalyse") [#33208], [ID 6059]

"Eine Meldung des Human Rights Information and Documentation Center (HRIDC) beschreibt, dass Drogenabhängigkeit in Georgien noch immer als Schande betrachtet wird.11

Konsumenten werden in der Gesellschaft stigmatisiert und verstecken daher ihre Sucht vor der Öffentlichkeit. Drogenkonsum und -handel findet in Georgien denn auch nicht auf offener Strasse, sondern im privaten statt. Gemäss georgischem Recht ist bereits der Erwerb und der Besitz von kleinen Mengen von Drogen strafbar. Nach Artikel 45 des georgischen Verwaltungsstrafgesetzbuches können dafür entweder eine Geldstrafe (bis zu hundert Mindestlöhnen), oder dreissig Tage soziale Arbeit oder eine bis zu fünfzehn Tage dauernde Haftstrafe verhängt werden.12 Der Konsum von Drogen wird gemäss Artikel 273 des georgischen Strafgesetzbuches allerdings erst als Straftat angesehen, wenn eine Person bereits in der Vergangenheit wegen Drogenkonsums mit einer Verwaltungsstrafe belegt und zum Zeitpunkt des erneuten Drogenkonsums nicht mehr als ein Jahr vergangen ist.13 In solchen Fällen muss mit bis zu 180 Tagen sozialer Arbeit oder bis zu einem Jahr Freiheitsentzug gerechnet werden.14

Nach Angaben des Programms zum Schutz vor Drogenmissbrauch und Drogenhandel im Südkaukasus (SCAD) gibt es derzeit eine grosse Kluft zwischen der Nachfrage nach Behandlungsmöglichkeiten von Drogenabhängigen sowie den effektiven Möglichkeiten dazu. Aufgrund von mangelnden staatlichen Ressourcen fehlt eine angemessene Zahl von Behandlungszentren sowie eine Vielfalt an Therapiemöglichkeiten. 15 In Georgien existieren zwei Spitäler (in Tbilisi), die sich um den stationären Entzug von Drogensüchtigen kümmern. Das Angebot beschränkt sich auf ungefähr 300 Plätze pro Jahr, wobei die Aufenthaltsdauer zwischen einer Woche und einem Monat variiert. Ein Entzug kostet dabei 500-700 US Dollar und muss von den Nutzern selbst bezahlt werden. Eine solche Behandlung kann sich daher nur eine kleine Anzahl an Patienten leisten.16 Im Jahr 2003 wurden insgesamt 306 drogenabhängige Patienten stationär behandelt. Neben den Entzugsprogrammen in den beiden Spitälern gibt es nur wenige (Drogen-)Rehabilitierungsstrukturen. Es existieren zehn Regionalzentren und 21 Beratungsstellen in verschiedenen Landesteilen, die ambulante Versorgungsmöglichkeiten und medizinische Untersuchungen anbieten.17

Stationäre Drogen-Rehabilitierung existiert in Georgien nicht; das Angebot beschränkt sich hauptsächlich auf psychotherapeutische Behandlung. Es ist geplant, dass im kommenden Herbst ein Methadonabgabeprogramm starten soll, das vom Global Fund for Fight against Malaria, Tuberculoses and AIDS finanziert wird. Das Programm wird 60 Plätze zur Verfügung stellen.18"

Document(s): Open document

21.06.2005 - Source: Schweizerische Flüchtlingshilfe

Options for medical treatmend of Hepatits C patients ("Behandlungsmöglichkeiten von Hepatitis C und der Umgang mit Drogensüchtigen, Auskunft der SFH-Länderanalyse") [#33208], [ID 6060]

"Zur spezifischen Situation von Hepatitis C-Kranken im georgischen Strafvollzug sind uns keine Informationen bekannt. Da aber der Zugang zu Therapie und Behandlungsmöglichkeiten auch ausserhalb des Strafvollzugs sehr schwer ist, kann davon ausgegangen werden, dass sich die Behandlungsmöglichkeiten in den georgischen Gefängnissen kaum besser darstellen.

Die Behandlung der Gefangenen in den chronisch überfüllten georgischen Gefängnissen gibt immer wieder Anlass zu kritischen Äusserungen in den bekannten Menschenrechtsberichten. 19 Dabei wird die im Justizapparat überall vorhandene Gewalttätigkeit und Korruption noch immer als eine unvermeidliche Folge der schlechten wirtschaftlichen Situation und der tiefen Löhne angesehen. Die Gefangenen werden mit Medikamenten und Nahrung nur mangelhaft versorgt. Teilweise herrschen unmenschliche, lebensbedrohende Verhältnisse, sodass immer wieder Berichte über krankheitsbedingte Todesfälle in den Gefängnissen bekannt werden.20"

Document(s): Open document

15.05.2005 - Source: UK Home Office

Provisions of health care law ("Georgia bulletin 5/2005") [#37885], [ID 6061]

"The following are among the principal provisions of the health care Law of Georgia:

The aim of the Law is to protect citizens' rights in health care and to ensure the inviolability of their dignity and privacy.
Citizens' rights and welfare have priority over medical and research interests. Discrimination on the basis of, inter alia, race, sex, economic status, disease, or sexual orientation is prohibited.
A patient may freely apply to another physician or health care institution for a second opinion and has the right to choose and change the health care provider.
Equal access to medical services is ensured through State Medical Programmes. In the case of scarce human, technical, financial, and other resources, patients are to be selected for medical services on medical criteria alone."

Document(s): Open document

15.05.2005 - Source: UK Home Office

Basic Health Facts ("Georgia bulletin 5/2005") [#37885], [ID 6062]

"Life expectancy at birth m/f (years): 67.0/75.0
Healthy life expectancy at birth m/f (years, 2002): 62.2/66.6
Child mortality m/f (per 1000): 50/39
Adult mortality m/f (per 1000): 195/76
Hospital Beds: 3.8/1000 population
Access to safe water: 76% population"

Document(s): Open document

28.02.2005 - Source: US Department of State

Discrimination against persons with disabilities in employment, education, access to health care, or in the provision of other state services was a problem in 2004 ("Country Report on Human Rights Practices 2004") [#29503], [ID 6063]

"Discrimination against persons with disabilities in employment, education, access to health care, or in the provision of other state services was a problem. There is no law or official provision mandating access to buildings for persons with disabilities and very few, if any, public facilities or buildings were accessible. The law mandates that the Government ensure appropriate conditions for persons with disabilities to freely use the social infrastructure and to ensure proper protection and support and provide special discounts and favorable social policies for persons with disabilities, particularly veterans; however, in practice, a lack of funding precluded much assistance. Most persons with disabilities were supported by family members or by international humanitarian donations. Societal discrimination against persons with disabilities existed."

Document(s): Open document

10.12.2004 - Source: EurasiaNet

Report on mental health care in Georgia ("Mental Health Care in Georgia -- Forgotten by the Revolution?") [#28361], [ID 6064]

Document(s): Open document

27.10.2004 - Source: Human Rights Center

State assistance for mental hospitals does not meet minimum requirements of psychiatric patients; mentally disabled people forced to live in intolerable and humiliating conditions ("Georgian Government against Human Beings") [#26750], [ID 6065]

Document(s): Open document

14.05.2004 - Source: UN Committee on the Elimination of Discrimination Against Women

457 HIV infected patients were registered in Georgia in 2003; WHO and local experts think that official figures do not reflect real numbers; HIV-infected women are granted free diagnostic services and symptomatic treatment; Georgian society has negative approach towards the HIV-infected ("Consideration of reports submitted by States Parties under article 18 of the Convention on the Elimination of All Forms of Discrimination against Women; Combined second and third periodic reports of States parties; Georgia [CEDAW/C/GEO/2-3]") [#48220], [ID 6066]

"77. Measures to prevent and combat HIV/AIDS are implemented within the framework of the Law on Prevention of HIV/AIDS adopted on March 21, 1995. In compliance with the Decree of the President of Georgia issued in October. [...]
80. According to the Ministry of Labor, Health and Social Affairs, in 2003, 457 HIV infected patients are officially registered in Georgia, out of which 70 are women. In 2002, 95 new cases of HIV were exposed. It should be noted that, in opinion of the WHO and local experts, officials figures do not reflect adequately real situation with respect to HIV/AIDS and total number of persons suffering from HIV/AIDS amounts to 2 000. Data available within the last 6 months demonstrate that the quantity of HIV/AIDS cases in Georgia is in increase. For instance, in 1999 – 35, in 2000 – 79, in 2001 – 93, and in 2002 - 95 new cases of this disease were registered. The main risk-factor in this regard has been intravenous drug addiction (70% of registered cases). No children suffering from AIDS are registered in Georgia. It is advisable to add in this context that, in compliance with Article 131 of the Criminal Code, intentional infecting/attempted infecting with HIV/AIDS is a crime that is punished with deprivation of liberty 5 to 10 years (depending on absence/existence of aggravating circumstances). [...]
122. [...] There have only been rare cases of transmitting HIV from the mother to the child, but it should be taken into account that up to date HIV-testing of pregnant women is voluntary and a restricted number of women has undergone it. Within the framework of the respective State program, HIV-infected women are granted free diagnostic services and symptomatic treatment. It should be stressed that there is no HIV-related discrimination in Georgia; at the same time, the Ministry of Labor, Health and Social Affairs notes that negative approaches towards AIDS are strong enough in Georgian society and normally HIV-infected women have been trying to keep their diagnosis confidential, in order to avoid possible societal pressure linked to their health condition."

Document(s): State report
Concluding observations of 25 August 2006 [CEDAW/C/GEO/CO/3]

14.05.2004 - Source: UN Committee on the Elimination of Discrimination Against Women

Constitution grants everybody right to health insurance; according to law, no patient may be discriminated on grounds of his race, skin colour, language, sex, religion, origin or sexual orientation; however, population`s inability to pay affects negatively access to treatment under State programmes ("Consideration of reports submitted by States Parties under article 18 of the Convention on the Elimination of All Forms of Discrimination against Women; Combined second and third periodic reports of States parties; Georgia [CEDAW/C/GEO/2-3]") [#48220], [ID 6067]

"117. The Constitution states that everyone has the right to health insurance as a means of securing accessible medical care. The law specifies that in certain circumstances medical care is provided free of charge (Article 37, Paragraph 1). [...]
118. The right to public health and medical care is regulated by the Law on Healthcare and the Law on Medical Insurance. The Law on Healthcare states that one of the central tenets of Government health policy is a pledge to provide universal and equal access to medical care in the form of appropriate medical programmes. No patient may be discriminated against on the grounds of race, skin colour, language, sex, religion, national, ethnic or social origin, or sexual orientation (Article 6). All Georgian citizens have the right to obtain accessible, full and objective information about the state of their health, except when such information would cause the patient significant harm (Articles 7 and 41).
119. Under the terms of the Law on Medical Insurance, State medical insurance is compulsory for all Georgian nationals and stateless persons resident in Georgia. The system is designed to cover all medical expenses incurred under State medical programmes (Article 2). [...]
120. [...] To date, the reforms have yielded a qualitatively new organizational and administrative model for the health-care system, and appropriate institutions have been established at both the central and local levels. More than 1,500 medical institutions have become financially autonomous, and preventive medical and pharmaceutical institutions have been licensed. [...] The main problem regarding the exercise of the right to medical care is the population’s inability to pay, which has negatively affected accessibility to treatment not provided under State programmes."

Document(s): State report
Concluding observations of 25 August 2006 [CEDAW/C/GEO/CO/3]

22.07.2003 - Source: Austrian Centre for Country of Origin and Asylum Research and Documentation

Access to health care ("Reisebericht Georgien 18. - 25. Mai 2003") [#14436], [ID 6068]

"Nach Angaben der MitarbeiterInnen des Georgischen Roten Kreuzes wäre die medizinische
Versorgung völlig unzureichend. Seitdem für alle medizinischen Leistungen gezahlt werden
müsste, stünden die Krankenhäuser leer. Neben den eigentlichen Behandlungskosten, den
Kosten für die Durchführung bestimmter Untersuchungen und/oder für Medikamente,
müssten PatientenInnen darüber hinaus für die Ärzte, das Pflegepersonal und
Krankenhausbett aufkommen. Die Kosten für ein Bett betrügen pro Tag allein 40 Lari,
weitere 5 Lari wären an die betreuende Schwester zu zahlen. Es sei in diesem
Zusammenhang allerdings anzumerken, dass ein Arzt pro Monat etwa 22-24 Lari bekäme –
ein Gehalt, das weniger als der georgische Durchschnittslohn betrage. Ein Patient mit
Hepatitis A hätte nach Erkenntnis eines Mitarbeiters der Helsinki Citizens Assembly an den
behandelnden Arzt täglich 15 Lari und zusätzlich noch einmal 1-2 US Dollar für die
Krankenschwester zahlen müssen. Die inoffiziellen Zahlungen an das medizinische Personal
würden in Georgien auch als „humanitäre Hilfe für Ärzte“ bezeichnet.
Seit einiger Zeit würde ein großer Teil der georgischen Krankenhäuser privatisiert werden.
An Privatspitälern angestellte Ärzte verdienten um ein Vielfaches mehr. Dem Wissenstand
unserer GesprächspartnerInnen des Georgischen Roten Kreuzes nach belaufe sich solch ein
Monatsgehalt auf circa 100 US Dollar.
Im Falle eines Unfalls könne man zwar davon ausgehen, dass die ärztliche Erstversorgung
gewährleistet werde, eine Weiterbehandlung im Krankenhaus allerdings nur dann
sichergestellt sei, wenn durch Familienangehörige oder Bekannte gezahlt werden würde.59
Auch die Helsinki Citizens Assembly gehe davon aus, dass Erste-Hilfe bei akuten Notfällen
auch ohne Bezahlung geleistet würde, das mit der weiteren Versorgung beauftragte
Krankenhaus allerdings versuchen würde, einen zahlungsunfähigen Patienten so schnell wie
möglich wieder loszuwerden. So hätte man beispielsweise von dem Fall eines Kindes in
Südgeorgien gehört, das durch die Explosion einer Bombe schwer verletzt wurde. Während
die Notfalloperation gratis durchgeführt worden sei, hätte die Familie des Kindes ihr
gesamtes Hab und Gut verkaufen müssen, um eine weitere Behandlung zu gewährleisten.
Die Behandlung chronischer Krankheiten könne laut dem Georgischen Roten Kreuz
grundsätzlich nicht gewährleistet werden."

Document(s): Open document

22.07.2003 - Source: Austrian Centre for Country of Origin and Asylum Research and Documentation

Treatment of psychiatric diseases ("Reisebericht Georgien 18. - 25. Mai 2003") [#14436], [ID 6069]

"Was die psychiatrischen und/oder psychotherapeutischen Behandlungsmöglichkeiten angehe,
so gebe es in den staatlichen Psychiatrien kaum Betten und die Warteschlangen wären
extrem lang. Eine funktionierende Infrastruktur gebe es nach Kenntnis der Helsinki Citizens
Assembly ohnehin nur in Tbilisi. Psychiatrische Ambulanzen, die auch außerhalb von Tbilisi,
existierten würden weitaus besser funktionieren.
Es gebe zwar einige kleinere NGOs und Selbsthilfegruppen, die eine psychotherapeutische
Behandlung anböten, diese hätten allerdings kaum Ressourcen und könnten nur sehr
eingeschränkt arbeiten.
Psychologische Behandlung und Betreuung sei wie auch die medizinische Versorgung
kostenpflichtig. Die MitarbeiterInnen des Georgischen Roten Kreuzes konnten allerdings
keine genauen Angaben zu den möglichen Kosten psychologischer Behandlung machen.
Binnenflüchtlingen hätte man in der Vergangenheit psychotherapeutische Beratung innerhalb
des Georgischen Roten Kreuzes angeboten, aufgrund fehlender finanzieller Mittel habe man
dieses Programm allerdings aufgeben müssen."

Document(s): Open document

21.07.2003 - Source: UN Security Council

Abkhazia: Report focused on political process, human rights and humanitarian situation ("Report of the Secretary-General on the situation in Abkhazia, Georgia S/2003/751") [#14606], [ID 6070]

Document(s): Open document

23.06.2003 - Source: Prima News

A group of handicapped Georgians launched on June 20 a hunger strike in front of the parliamentary headquarters in Tbilisi. They demand better social conditions and government’s assistance in finding employment ("Georgian invalids go on hunger strike") [#15865], [ID 6071]

Document(s): Open document

31.03.2003 - Source: US Department of State

Many facilities for persons with disabilities remained closed due to lack of funding ("Country Reports on Human Rights Practices - 2002") [#11848], [ID 6072]

"There is no legislated or otherwise mandated provision requiring access for persons with disabilities; however, the law mandates that the State ensure appropriate conditions for persons with disabilities to use freely the social infrastructure and to ensure proper protection and support. The law includes a provision of special discounts and favorable social policies for persons with disabilities, particularly veterans; however, many facilities for persons with disabilities remained closed due to lack of funding. Most persons with disabilities were supported by family members or by international humanitarian donations. Societal discrimination against persons with disabilities exists."

Document(s): Open document

27.02.2003 - Source: Wohlgemuth, Arno

Stellungnahme v. 27.2.2003 an VG Schleswig - 14 A 227/99 - ("Stellungnahme v. 27.2.2003 an VG Schleswig - 14 A 227/99 -") [#12938], [ID 6073]

Document(s): Open document

12.09.2002 - Source:

IWPR: A dramatic downsizing of the Georgian health system is costing thousands of Georgian doctors their jobs ("12/09/2002 - IWPR: Georgian Doctors Devastated By Health Reforms") [ID 6075]

"Georgia's mammoth medical sector, a legacy of the Soviet era, turned into a significant burden after independence, when the country chose to adopt a western economic model.

"Grandiose multi-storey compounds were built for medical institutions staffed with hundreds of employees and two or three times more bed space was available then was actually needed," said Prof Roman Shakarashvili, head of the Institute of Neurology. "All of this generated enormously high expenditure."

"There was a time when people lay in hospital corridors because all the wards were occupied," said Gaioz Tsintsadze, one of the leading Georgian cardiologists. "However, this was caused by the fact that in the Soviet period there were a lot of patients who stayed on in hospital even when they didn't need in-hospital care. That was because of the large number of perks, such as the free medicines and meals were offered at the hospital."

In the 1990s, the bloated health system was an obvious target for budget cuts by the cash-strapped Georgian government. A World Bank-sponsored programme advocated closing down a lot of medical institutions and transferring their functions to selected strategic hospitals. Under the initiative, the number in the capital will be cut from 70 to 12 in five to seven years' time. It will mean that half the 30,000 doctors currently working throughout Georgia will lose their jobs. "Doctors who are devoted to their profession and their patents will be thrown onto the streets!" said Academician Zurab Robakidze, of Tbilisi's Hematology and Transfusion Institute, one of the hospitals selected for closure.

It is being amalgamated with the Georgian Oncology Center and only 13 of the current staff of 380 will survive the merger. "So what will the remaining people do?" Robakidze asked rhetorically. "Set up stalls and sell groceries?"

According to Giorgy Nikolaishvili, head of the World Bank department of the Ministry of Health and Social Care, efforts will made to spare licensed and relatively young doctors in the cull.

Sacked hospital staff are being offered compensation, worth between 1,000 - 3,000 lari (500 to 1500 US dollars) for physicians and 200-300 for nurses. These sums include both the government's debts in unpaid salaries to the employees and a discharge bonus.

Many Georgian doctors are supporting the programme as a necessary measure, despite its ferocity.

"There were four cardiology centres in Tbilisi in Soviet times," said Gaioz Tsintsadze. "After the collapse of the USSR, both cardiology clinics and others mushroomed on every corner. The government cannot sustain so many clinics and it is natural that their number should be reduced. Central clinics will assume the function of those clinics, which do not always have enough patients.""

Document(s): 12/09/2002 - IWPR: Georgian Doctors Devastated By Health Reforms

25.07.2002 - Source: Council of Europe - European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment

Council of Europe: Patient's living conditions in psychiatric hospitals ("Report to the Georgian Government on the visit to Georgia carried out by the European Committee for the Prevention of Torture and Inhuman or Degrading treatment or Punishment (CPT) from 6 to 18 May 2001 [CPT/Inf(2002) 14]") [#11884], [ID 6076]

"152. At the outset of the visit, the hospital's Director informed the delegation that over the past
few years, the hospital had not been receiving the full budgetary allocation, based on the norm of
5.76 GEL per patient per day. He stressed that the financial resources for food, clothing and
equipment were insufficient; moreover, no major repairs had been carried out in the last ten years.
153. Most patients were accommodated two to six in a room, the rooms ranging in size from 11
to 20 m². The rooms accommodating five or six patients were rather cramped (some 3.5 m² of living
space per patient). On the positive side, all rooms benefited from good access to natural light and
had adequate ventilation. However, artificial lighting was a problem: electricity was only supplied
for 4 hours per day, and patients had to use candles in the evenings.
The rooms were fitted with beds and, occasionally, a few bedside lockers. Radio sets and
some personal possessions (stored in bags or boxes under the beds) were in view in some of the
rooms; however, the environment as a whole was austere and impersonal. Most of the rooms and their
equipment were in a state of advanced dilapidation (peeling walls, damaged ceilings, exposed
electrical wiring, broken furniture, threadbare blankets and sheets), the worst conditions being
observed in rooms Nos 9, 12, 19 and 20. In addition, with a few exceptions, the level of cleanliness in
all of the rooms left a great deal to be desired.

By contrast, a small number of rooms accommodating one or two patients had recently been
refurbished, pleasantly decorated and fitted with additional furniture. In room No 5, in particular, the
delegation saw conditions which could be described as bordering on the luxurious: a sanitary annexe
with a shower, a kitchenette with a refrigerator, additional furniture belonging to the patient
concerned, etc. Staff explained this situation by stating that the best rooms used to be the worst and
had therefore been refurbished as a matter of priority. However, the CPT is not fully convinced by this
answer; it would like to receive the comments of the Georgian authorities on this issue.
154. Most of the rooms were not equipped with sanitary annexes, and patients had to knock on the
door and wait for security staff to take them to the toilet. The delegation heard some complaints
concerning delays in granting access to the toilet, especially at night. Further, the communal toilets,
washrooms and showers, located on each floor, were rudimentary and dirty.

Patients could in principle take a shower once a week; however, hot water was frequently not
available due to power cuts. The hospital provided patients with only a limited range of personal
hygiene products (small quantities of soap, washing powder and toilet paper). As regards bedding, the
delegation was informed that it got washed every 10 days in a laundry in town. However, the bedding
in many patients' rooms appeared to be in a poor state of cleanliness.

The delegation was concerned to note that the level of personal hygiene of some patients (in
particular those whose state of health did not allow them to take care of themselves) was inadequate
and their clothes dirty. Further, the female patient complained that she had not been allowed to take
a shower and change her clothes since her arrival at the hospital some 15 days previously.
155. Several patients alleged that the food was insufficient in quantity. Regrettably, the hospital
dietician was absent at the time of the visit, with the result that the delegation could not explore in
depth the nutritional value of the food provided. Further, the fact that patients' weight was recorded
neither on admission nor at regular intervals thereafter rendered it difficult to verify the above-
mentioned allegations .

As regards the hospital’s kitchen, it was small and poorly equipped (absence of cold storage,
part of the cookers and other equipment out of order). It should be added, nevertheless, that it was
very clean."

Document(s): Report
Report Government response [CPT/Inf(2004) 1] Government response [CPT/Inf(2004) 1]

25.07.2002 - Source: Council of Europe - European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment

Council of Europe: No problems with the supply of basic psychiatric treatment at Poti hospital ("Report to the Georgian Government on the visit to Georgia carried out by the European Committee for the Prevention of Torture and Inhuman or Degrading treatment or Punishment (CPT) from 6 to 18 May 2001 [CPT/Inf(2002) 14]") [#11884], [ID 6077]

"157. Psychiatric treatment consisted almost exclusively of pharmacotherapy. At the time of the
visit, there were no problems with the supply of basic psychiatric medication.

According to information received at Poti Hospital, psychiatrists are obliged to follow
standard treatment plans established by the Ministry of Health in respect of each illness, which
determine the types and dosage of medication to be prescribed during a certain period of time. The
CPT has reservations concerning this rigid approach because it interferes with the professional
independence of doctors and limits their choice when setting up individualised treatment plans.

The CPT would welcome the comments of the Georgian authorities on these issues.
Further, in order to obtain a more clear idea of the situation, the CPT would like to receive copies of
the current standard treatment plans established by the Ministry of Health.
158. The two psychiatrists were making genuine efforts to provide the best level of care available
in the circumstances. During the first 10 days of hospitalisation, they were seeing each patient every
day, and subsequently at least once a week. In the course of those meetings, patients had the
opportunity to talk about their personal and family problems. The observations made during the
meetings were recorded patients' medical files which were well kept.
159. However, the hospital did not offer any psycho-social rehabilitative activities to patients.
This is hardly surprising given the shortage of qualified staff capable of conducting such activities (cf.
paragraph 149). With the exception of a few patients involved in simple cleaning and maintenance
tasks, patients usually only left their rooms for the purpose of going to the toilet, taking outdoor
exercise and eating their meals in the dining room; admittedly, they did also have access to a prayer
room. As regards in-room activities, they consisted of board games, reading books from the hospital's
library and, for a few patients who could afford it, listening to the radio and watching television.
160. The majority of patients could have up to 3 hours of outdoor exercise per day. However,
some patients alleged that they had occasionally been deprived of outdoor exercise by security staff.
At the end of the visit, the delegation requested the Georgian authorities to confirm within 3 months
that all patients whose medical condition so permits are offered at least one hour of outdoor exercise
every day. In their letter of 9 September 2001, the Georgian authorities informed the CPT that daily
outdoor exercise of 3 hours is now systematically offered to all patients, except to those whose
health condition does not allow it. The Committee welcomes this development.

The conditions in which outdoor exercise took place were not ideal: up to 50 patients at a
time in a yard (of some 90 m²) surrounded and topped with meshed wire, and equipped with a table
and two benches. At the same time, the delegation saw a large secure area within the hospital's
grounds, including a garden, which could be developed for the purpose of outdoor exercise."

Document(s): Report
Report Government response [CPT/Inf(2004) 1] Government response [CPT/Inf(2004) 1]

04.06.2002 - Source: Council of Europe - Parliamentary Assembly

Council of Europe: Health care for internal displaced persons ("Situation of refugees and displaced persons in Armenia, Azerbaijan and Georgia [Doc. 9480]") [#7836], [ID 6078]

"67. Access to health care provides a good example of based on illusion state assistance. It is supposed to be provided free of charge to all citizens including displaced persons, but in practice, payment is required.

68. Proportions of illness and modes of treatment are similar for the IDPs and the local population. Self-treatment and absence of treatment altogether are common response, usually for financial reasons. However, in addition to sharing many health problems common to the general population, internally displaced persons are also more susceptible to certain types of problems resulting from their displacement and the circumstances leading to it. In particular, the Save the Children Fund Survey has found that physical disability was more prevalent in internally displaced persons’ households than in the local population.

69. In some regions, health clinics specifically for the internally displaced persons have been established as part of a larger programme of parallel public services offered by the Abkhaz Government in exile, using funds channelled to it from the central government. However, these structures which impede access to the public health system, may not necessarily provide better or equal services in many cases."

Document(s): Open document

05.03.2002 - Source: Schweizerische Flüchtlingshilfe

SFH: Health care system collapsed ("Lageanalyse Februar 2002") [#8057], [ID 6079]

"Vor 1991 basierte die georgische Gesundheitsfürsorge auf dem "Grundlagengesetz über
Gesundheit in der UdSSR und in den Sowjetrepubliken" von 1964. Das Gesundheitswesen
war völlig in staatlicher Hand und wurde zu Hundert Prozent vom Staat finanziert. Die medizinische
Versorgung und Medikamente waren für die Menschen kostenlos zugänglich.
Kreisärzte wirkten als "Pförtner" und wiesen die PatientInnen im Bedarfsfall an SpezialistInnen,
Laboratorien oder Spitäler weiter. Der Zustand des Gesundheitswesens verschlechterte sich zwischen 1990 und 1995 infolge
der allgemeinen politischen, sozialen und wirtschaftlichen Lage in Georgien rapide und
unaufhaltsam. Die bestehenden Probleme wurden durch die fehlenden Finanzmittel noch
verstärkt und führten zu einem totalen Zusammenbruch des Gesundheitssystems im Lande.
In Zusammenarbeit mit der Weltbank lancierte die georgische Regierung 1995 ein Paket zur
"Reform des georgischen Gesundheitswesens". Für die Verwirklichung des Projektes übernahm
das Gesundheitsministerium mit Unterstützung verschiedener Behörden auf diversen
Stufen im Lande und von UNO-Organisationen die Federführung. Wichtigste Zielsetzung
der Reformen war die Dezentralisierung des Gesundheitssystems, die Verlagerung der Finanzierung
auf kommunale Ebene und die Privatisierung der Institutionen des Gesundheitswesens.
Zur Deckung des weiteren Bedarfes wurde 1997 die obligatorische Krankenkassenversicherung
und zusätzlich eine freiwillige Versicherung eingeführt. Für die Sicherstellung
der Ressourcen und für die Finanzierung der Gesundheitsfürsorge ist die staatliche
Krankenversicherungsgesellschaft zuständig. Zur Äufnung des staatlichen Fonds haben die
Arbeitgeber drei Prozent, die Arbeitnehmer ein Prozent des Lohnes einzuzahlen. Es ist Aufgabe
des Staates, für die Rahmenbedingungen zu sorgen (u.a. Finanzierung, Festsetzung
der Preise, Sicherstellung der staatlich garantierten medizinischen Leistungen durch staatliche
oder selbstverwaltete AnbieterInnen). Die Kostenbeteiligung der PatientInnen ist ein
wesentliches Element des Gesundheitssytems. Die Tatsache, dass 87 Prozent der Ausgaben
für Leistungen der Gesundheitsfürsorge bar bezahlt werden, zeigt, welch enormer finanziellen
Belastung die Bevölkerung in einem Krankheitsfall ausgesetzt ist. Die von der
Regierung festgelegten Preise stimmen mit den tatsächlichen Kosten der Leistungen nicht
überein. Die Beteiligung der Versicherten an den beanspruchten Leistungen beträgt auf
lokaler Ebene 50 Prozent. Wegen des Mangels an erfahrenen Fachleuten sowohl im administrativen
als auch im Bereich Krankenpflege gestaltete sich die Umsetzung der Reformen
als schwierig. Zur Verzögerung der Entwicklung trug auch das passive Verhalten der Leistungsberechtigten
bei. Die meisten von ihnen wissen nicht, auf was für Leistungen sie
Anspruch hätten oder benützen sie wegen der fehlenden Ausbildung bzw. Information über
Gesundheitspflege irrational (z.B. Antibiotikummissbrauch).
Um merkliche Fortschritte im Gesundheitswesen zu erreichen, muss dem Problem politisch
und ideologisch Priorität eingeräumt werden. Bei der Suche nach Lösungen und Verbesserungen
muss auf die spezifischen georgischen Verhältnisse in Bezug auf Bezahlung und
Inanspruchnahme der Leistungen der Gesundheitsfürsorge Rücksicht genommen und bei
der Gestaltung grösstmögliche Transparenz angestrebt werden."

Document(s): Open document

05.03.2002 - Source: Schweizerische Flüchtlingshilfe

SFH: Medical situation ("Lageanalyse Februar 2002") [#8057], [ID 6080]

"Das Gesundheitssystem Georgiens ist dramatischen Veränderungen unterworfen. Es nimmt
gegenwärtig den 114. Platz von 190 Ländern auf der Rangliste des WHO ein.39 Die Hauptverantwortung
für die Minimalisierung der Gesundheitsrisiken der Öffentlichkeit trägt die
"Georgia Emergency Management Agency".
Die Empfehlungen auf der Homepage des georgischen Parlaments lässt das Ausmass der Probleme
erahnen: TouristInnen sollten ein Erste-Hilfe-Set und die gebräuchlichsten Medikamente
mitnehmen. Im Bedarfsfall ist es ratsam, die benötigten Medikamente in einer grösseren Apotheke und nicht auf der Strasse zu kaufen. Ausländischen Touristen wird geraten, Versicherungen
für eine allfällige Evakuation von Tiflis-Airport bzw. von den Bergregionen zum
Flughafen Tiflis abzuschliessen.41
Nach einem IFGM-Bericht vom September 2000 herrschte in den psychiatrischen Anstalten
blanker Hunger, es gab nicht einmal Salz, ganz zu schweigen von Wasch- und Putzmitteln.
Ärzte und Pflegepersonal erhielten monatelang ihre Löhne nicht. Aus Protest traten sie in
der psychiatrischen Anstalt auf der Asatanistrasse in Tiflis am 8. September 2000 in einen
Streik.
Die Krankheitsgeschichten der georgischen Bevölkerung weichen nicht wesentlich von
denjenigen in anderen Ländern ab. Besonders gewarnt wird vor Malaria und Diphterie. In
der Hafenstadt Poti waren im Februar dieses Jahres rund 100 Fälle von Hepatitis aufgetreten.
Diese sind auf eine schlechte Trinkwasserversorgung zurückzuführen.
Gemäss entsprechenden Untersuchungen war die Chance zu erkranken unter den Vertriebenen
mehr als doppelt so hoch als in der Normalbevölkerung."

Document(s): Open document

2002 - Source: Public Defender of Georgia

Public Defender of Georgia: Constant lack of budgetary funds is one of the major problems regarding the health care system ("Report of the Public Defender of Georgia: On the Situation of Protection of Human Rights and Freedoms in Georgia") [#10578], [ID 6081]

"Reforms in the healthcare system have been implemented in Georgia since 1995. The
reforms were necessitated by the fact that the state was not longer able to fund the healthcare
system inherited from the Soviet period. Thus, the National Healthcare Policy Program was
worked out elaborated; however, this reform was neither supported by the population, nor
welcomed by the physicians. The evaluation of the state policy in this field by the population
is rather negative.
The reform was hard blow for the poor and socially unprotected groups of the society
(including prisoners). One of the major problems is a constant lack of budgetary funds. The
number of applications to the Office of the Public Defender asking for medication and
rendering possible medical aid or assistance has considerably increased.
Today, one of the most acute problems is the existing problem of tuberculosis and
hepatitis especially among prisoners, as they continue to belong to the group of a high risk
factor."

Document(s): publicdefender-geo.pdf

12.2000 - Source: UN Development Programme

UNDP: Access to health care; information on the health care system ("Human Development Report 2000") [#10556], [ID 6074]

"The turmoil in the health care system results from of a combination of two factors. The first is the existence of an oversized and inefficient system of health care that was already crumbling in the last period of the Soviet system. The health care system developed according to the Soviet model, characterized by a centralized approach to management, finance, and distribution, which lead to gross inefficiencies. Georgia, like most of the former Soviet republics, inherited a system with a great deal of excess capacity. From 1997-1999 there was one physician for every 245 people compared to an average of one per 400
members of the population in European Union countries. The second factor behind the collapse of the health care system has been the breakneck speed with which budgetary allocations were reduced to less than minimal levels. The system never stood a chance of adjusting to the new rules of the game, with predictable results. The quality of services provided by has hospitals plunged and is now so bad that they are to blame for increasing the mortality rate of vulnerable groups such as children. The most far-reaching reforms in the health care sector are directed towards increasing the efficiency of budgetary allocations and towards the privatization of heath care services. In the last five years, 448 health care institutions have been privatized. In
addition, since 1991, the number of hospital beds has decreased from 57,300 to 24,481, or 4.5 beds per 1,000 population. Yet, even with more than a 50 percent reduction, the number of hospital beds still appears to be high. In Tbilisi alone there are about 11,000 beds in 51 hospitals serving a population of 1.38 million. In the United States, a similar population would have to make do with approximately 1,200 beds (...). Savings from the consolidation in the health care sector can be substantial. Today, Georgia has 285 hospitals, almost all of
which need to be seriously rehabilitated and re-equipped. According to the World Bank, their rehabilitation (without re-equipment) would cost as much as 100 million USD. On the other hand, patient enrollment in these institutions does not exceed 28 percent of their capacity. Further consolidation in the health care system is called for. [...]
Access to health care services is very limited for a substantial segment of the population (50 percent) and for 30 percent it is almost out of reach. In total, 40 percent of all health care spending goes on a tiny percentage of the population (2.5 percent). The system shows a high inequality in access to its medical services. We are concerned that unless accompanied by other
policies, health care privatization may, for the most part, improve only the quality of services available to the top segment of the population, because we doubt that the private sector will find the remaining segments equally attractive. Universal coverage, or at least coverage for most of the population, is likely to require government intervention."

Document(s): Open document

09.11.2000 - Source: International Helsinki Federation for Human Rights

IHF: Due to high costs access to health care for women restricted ("Women 2000: Report on Georgia") [#10550], [ID 6082]

"Up until now, most births have been professionally assisted. However, increasingly, the media has information
on cases of home births, indicating that they are becoming more common because the mother does
not have enough money to pay for professional assistance at the hospital – as a result of the very low
income in several regions of Georgia. When approached, the Department of Mother and Child Health Protection,
the Ministry of Health Care and Social Safety, refused to give any official information."

Document(s): Open document

02.2000 - Source:

International Medical Corps/Curatio International Foundation: Primary Health Care Network of Western Georgia (Guria, Imereti and Samegrelo) ("02/2000 - International Medical Corps/Curatio International Foundation: Primary Health Care Network of Western Georgia (Guria, Imereti and Samegrelo)") [ID 6083]

Document(s): 02/2000 - International Medical Corps/Curatio International Foundation: Primary Health Care Network of Western Georgia (Guria, Imereti and Samegrelo)