Remaking Healthcare in Georgia

While many of the world's first ladies travel their countries to spotlight pressing issues, the first lady of the republic of Georgia, Sandra Roelofs, went abroad last month to raise awareness about her favorite cause:  transforming Georgia’s healthcare system. 

With her help, Georgia convened a high-level discussion in Washington, D.C., between international healthcare professionals and doctors from the Georgian diaspora that spotlighted important, universal lessons about moving from authoritarian histories to democratic futures, and from central economies to market ones.

Citizens of nations going through this transition to freedom consider access to healthcare an inalienable right.  Georgia’s two-day forum demonstrated the importance that improved  medical care can play in building support for a country’s democratic reform -- and will continue to play in Georgia’s evolution as a model for transformation in post-Soviet nations and elsewhere.

It’s painful to recall what Georgia was like in the early 1990s:  no electricity in winter time, corrupt traffic police shaking down motorists, no functional banks (let alone supermarkets), and a once-reliable central healthcare system that was underfunded and failing.  A general feeling of post-Soviet malaise pervaded the population.  

But uplifted by the Rose Revolution in 2003 -- led by a Western-educated modernizer, President Mikheil Saakashvili, Roelofs’ husband -- a new generation of young leaders has revitalized the country, society, and people.  In the process, inefficient, centralized state health facilities were privatized, underwritten by the growth of the private health insurance industry.   Individuals who live below the poverty line now have their healthcare paid for from public funds but provided by private insurers.   New hospitals and clinics are slowly replacing old, deteriorating facilities.

Today, while most of the former-Soviet Union continues to struggle with autocratic rule and resource dependency, Georgia has transformed itself into a functional democracy with a market-oriented economy, and the accompanying success in delivering health services to the people has helped consolidate support  behind the transition. 

Amid this achievement, much remains to be done if Georgia is to provide modern, cost-effective healthcare to its citizens.  The current medical school curriculum was designed in the 1930s and has evolved little since.  While Georgian physicians are trained superbly in the fundamentals—their physical diagnostic skills benefit from clinical examination that has been discarded in more modern medicine—they have no access to modern technology, and they cannot use the clinical data that forms the core of medicine in developed countries.  Continuing education -- a vital requirement for physicians and nurses -- does not formally exist in Georgia, so there is limited opportunity for improvement.  Because of outdated Soviet models, some essential specialties, including emergency medicine, do not exist.  Nursing is in a similarly dire state; in fact, there are more physicians than nurses in Georgia. 

This is where Mrs. Roelofs comes in.  The forum she hosted sparked a dynamic debate of ideas about how to harness the energy, resources and commitment of Georgian doctors in the Diaspora, government officials in Tbilisi and stakeholders in the United States to improve healthcare in Georgia.

There is a model for this sort of engagement.  Since 1992, Emory University -- and more recently, Partners for International Development, the non-governmental organization that implements many of Emory’s international programs -- has worked with Georgian partners to improve the healthcare sector, with assistance from the United States Agency for International Development (USAID).  Fifty physicians have received residency training at Emory; eighteen Georgians have received Master’s Degrees in Public Health; and we have organized bilateral exchanges of seventy-five medical students.   Emory faculty have collaborated extensively with Georgian colleagues in AIDS and tuberculosis programs, the introduction of emergency medicine to Georgia, and most recently a nurse training and education project that upgraded the skills of 1,000 nurses. 

What’s needed now is a clear vision of where Georgia’s healthcare system should head, and a long-range plan for how to get there.  We and many others from the Washington forum are eager to help generate such a strategic plan and look to the government of Georgia to lead the effort.

It is time once again to take the energy and courage that resurrected a downtrodden nation and focus it on reenergizing the reform of Georgia’s healthcare system.  We have no doubt that through this process, other countries moving towards greater democracy will continue to find inspiration in the example Georgia sets.

About The Authors

Dr.  Archil Undilashvili is the Director of International Programs in the Department of Medicine at Emory University and Director of Partners for International Development

Brian McCotter is a Board Member of Partners for International Development (PfID) and an international development consultant. 

Dr.  H.  Kenneth Walker is Professor of Medicine at Emory University and Executive Director of Partners for International Development (PfID)