Georgia People Profile 2O12

The last years have seen significant efforts by the Georgian government to improve the existing welfare regime, which is, however, still far removed from satisfying existential needs. Although in absolute terms public social spending rose from $47 million in 2003 to $466 million in 2007, the increase in relative terms remained quite modest. Whereas social spending accounted for 11% of budgetary expenditure in 2003, its share amounted to 15% of the overall budget in 2007. Pensioners, whose monthly income went up from $6.5 in 2003 to $41.1 in 2007, benefited most from enhanced welfare spending. At the same time, the government cancelled all unemployment benefits in 2006, which were replaced by a unified support program reaching out to roughly 135,000 families by 2008. On average, these families received not more than $35 a month, hardly enough to cover even basic needs in the face of rising inflationary pressure. As a result, rising social unrest is said to have contributed heavily to anti-government demonstrations in 2007. So far, the war on poverty declared by the government in response to the social unrest has not delivered tangible results. It remains to be seen what consequences are to be expected from a probable drop in state revenues caused by the combined effect of the global finance crisis and the August war with Russia in 2008.

HEALTH AND DEVELOPMENT
Health status of the population. Owing to a significant decline in socioeconomic conditions in the 1990s the health status of the population deteriorated seriously. There have, however, been some positive trends recently. The main issue of concern continues to be poverty, which is the single most important contributor to ill-health. There has been an increase in tobacco consumption and drug use. With regards to communicable diseases, the situation was at its worst in the middle of the 1990s (lower immunization coverage, re-emergence of communicable diseases) followed by a slow recovery. Tuberculosis (TB), malaria, sexually transmitted diseases and HIV/AIDS are still problems for the society.

Health system development. Since becoming independent, Georgia has looked to new models for the health sector. The Ministry of Labour, Health and Social Affairs remains the key strategic health decision-maker. Much of the decision-making power and responsibility for funding at the local level has been allocated to twelve regional health departments. The State United Social Insurance Fund and the Ministry of Finance are the key financial players in the health care system. Decentralization has been a major component of the health reform process since 1995 and was reiterated in the 2000–2009 strategic health plan. This has made most health care providers financially and managerially autonomous. A plan to privatize hospitals has been approved and the process is expected to take place in 2007. Nearly all dental clinics and pharmacies have already been privatized.

Health financing. Government expenditure on health as a percentage of GDP dropped substantially from just over 4 in 1991 to 0.70 in 1998 to 0.5 in 1999. Levels of financing are below those required to provide basic care to the population and maintain the health care facilities. After the Rose Revolution in 2004, Government expenditure on health has been increasing both as a percentage of GDP (from 1.37 in 2003 to 1.75 in 2005) and as percentage of total health expenditure (from 26.6 in 2003 to 30.6 in 2005). Total health expenditure is relatively low – 5.8% of GDP, of which a large part is private expenditure.

Noncommunicable diseases and lifestyles. The leading cause of mortality among the Georgian population is  noncommunicable diseases. There has been a certain increase in the number of cardiovascular-related deaths (639.6 per 100 000 population, 2001). Malignancies take second place among the main causes of death, though rates of mortality from malignancies are lower than in other newly independent states (98.7 per 100 000 population). The number of external causes of death has increased as well. Mortality and disability resulting from car accidents is a serious problem and causes serious economic damage.

Healthy lifestyle. The high prevalence of smoking among the adult population, and adolescents in particular, represents a great health problem in Georgia. Fifty-three per cent of males and 15% of females in the 10–74 years agegroup were smokers in 1998. This is a 10% increase in both genders compared with 1985. The epidemic of tobacco consumption is directly associated with the increased mortality and morbidity related to cancer, cardiovascular diseases and respiratory diseases. The numbers of alcohol and illicit drug users have increased dramatically as a consequence of the difficult economic situation, the decline in living conditions, general frustration and pessimism. Georgia saw a rise in TB morbidity in 1992–1996, reaching almost the highest level in the WHO European Region. The incidence of TB has risen among both children and adults. From 29.7 per 100 000 population in 1988, it rose to 145 per 100 000 population in 1997. Since 1995, efforts have been to implement the National Anti-TB Programme as a result of which reporting improved significantly in 1995–1996. Although there has been a decline in the TB morbidity rates, the levels are still unacceptably high (98.1 per 100 000 population, 2005 – Health and Health Care Statistics, Ministry of Labour, Health and Social Affairs, National Centre for Disease Control and Medical Statistics). TB remains a particularly severe problem within the penitentiary system. Emergency and disaster preparedness: Due to its natural particularities (mountains), environmental conditions and geo-political position, Georgia is vulnerable to both man-made and natural disasters, like earthquakes, landslides, floods and avalanches. At present, there is no comprehensive approach to management of the potential risks. A system of monitoring and forecasting natural catastrophes is being developed.

OPPORTUNITIES

• Development of a democratic society after the Ros Revolution in 2004.
• Efforts by the Government on the economic front, a well as a full-scale fight against corruption.
• The presence of a multi-donor community in the health
• Aspiration to future European Union (EU) membership and current collaboration with the EU through the European Neighbourhood Policy.
• Strengthened WHO presence in the country and continuous WHO support through Biennial Collaborative Agreements.

CHALLENGES
• Defragmentation of the health system, with focus on the system as a whole rather than on individua
programmes.
• The need to improve health financing and the health resource base.
• The necessity to synergize donor support in the key areas of health reform, including health financing.
• The growing economic pressure resulting from reduced trade with and increased prices of several commodities imported from the Russian Federation.
• Inadequate health infrastructure; the poor health statut of vulnerable populations.