Title: EU ENLARGEMENT AND HEALTH SYSTEMS: Experiences and practices from new EU member countries and implic
1EU ENLARGEMENT AND HEALTH SYSTEMS Experiences
and practices from new EU member countries and
implications for Georgia
or
WHAT GEORGIA SHOULD DO TO ESCAPE STAGNATION IN
HEALTH SECTOR!!!
- Levan Metreveli, MD, PhD, MPH
- Member of Parliament of Georgia
- Committee of Health and Social Welfare
2Statement of purpose
- Exploring successes and failures of the EU new
member states in reshaping their health policies
aimed at - Meeting EU health/health-related standards.
- Creating favorable conditions for building
equitable and effective health care/public health
services. We will be more thoroughly exploring
the benefits and challenges arising from the EU
membership for the national health systems.
3Statement of purpose
- Assessing current structural and operational
status of health system in Georgia. Strengths and
weaknesses present in the environment, with
particular emphasis on political and economic
feasibility of reforms. - Revealing organizational challenges present in
the health policy and politics in Georgia.
4Statement of purpose
- Addressing the existing challenges by 1.
selecting appropriate policy and strategic
approaches and 2. drawing a road map expected to
assist the Government of Georgia in developing
relatively accelerated and effective mechanisms
for fostering health sector reforms. - It is also evident that the proposed set of
recommendations would not only fit in the niche
of pre-EU-accession preparedness measures, but
feed in the government policies aimed at
improving health system functioning in general.
5From western to larger Europe
- 15 10 25
- Old members
- New members
- Candidate countries
- Potential candidates
6Health system aspects of the EU enlargement
- Adoption of EU legislation Acquis Communitaire
(Rome, Maastricht and Amsterdam treaties, other
regulations and standards) - EU laws induce direct and indirect (through
environmental protection, agriculture, migration,
human rights, etc.) influences on the health
systems of both old and new member states - The EU is primarily the economic union, therefore
health/health care issues certainly assume a
somewhat peripheral role.
7Main areas of impact
- Health policy
- Health reform
- Health/health care standards
- Human resources (workforce migration)
- Access to health care
- Biomedical RD
- Environmental health
- Right to health
8Geopolitical Context of Georgia
http//members.tripod.com/ggdavid/georgia/maps.htm
9Rose Revolution Democracy
- In the late nineties the governance deteriorated,
corruption became rampant and the institutions of
the and state have been debilitated. - In November 2003, the people of Georgia rose up
to protest massive electoral fraud and continued
economic decline, now known as the Rose
Revolution. - Subsequent presidential elections gave a broad
mandate to the new President, Mikheil
Saakashvili, who received 97 percent of the
popular vote.
10International Support Development
- The new Georgian authorities have inherited from
the previous government a marked decline in
socio-economic development. Therefore, very first
steps were made to stabilize the system and allow
maximally possible social goods to be produced.
The Government has established a national
recovery program to root out corruption and
mismanagement, restore stability, reduce poverty,
and secure sustained economic growth. The guiding
principles are creation of strong democratic
institutions, good governance, development of
human resources, protection of cultural heritage,
and preservation of Georgias territorial
integrity and national security. Moreover, the
new Government has declared its intention to
pursue closer integration with the Euro-Atlantic
Institutions.
11Health situation in Georgia
- The three main causes of infant mortality are
conditions originating in the perinatal period
(58.0), followed by infectious and parasitic
diseases (14.1) and diseases of the respiratory
system (10.8). (Gamkrelidze, Atun et al. 2002) - The immunization characteristics had shown
positive dynamics nevertheless is still far from
the perfect. (Badurashvili, McKee et al. 2001)
12Health sector challenges
- The recent economic and political developments in
the country have clearly underlined the necessity
of concerted action Government-wide and across
the sectors. - It is important to note, that Government places
an enormous importance on sustainability of
economic reforms. - Although it is the strong precedent in the law
enforcement and partly in economic block, the
Ministry of Labor, Health Care and Social Welfare
of Georgia (MOH) evidently appears to be behind
the scene.
13Health sector challenges
- The MOH is not armed with credible and systemic
strategic vision of development i.e. there is a
high need in comprehensive strategic paper on
health financing (white paper). - The MOH has weak technical and human capacity for
leading reforms. The health issues are not
politically and publicly sound. - Under these circumstances, ineffective and
blurrily organized health system will strongly
undermine other achievements. Any further
preservation of current situation in health
sector will ultimately lead to dramatic worsening
of access to health care and equity issues, those
to be easily transformable into wider public
dissatisfaction and loss of electoral support.
14Available policy window
15Policy objectives
- Improving intra-government cooperation and
establishing permanent communication medium - Inter-Ministerial Club on Health (IMCH)
- Strengthening human and technical capacity of the
MOH - Redesigning the mission statement of the MOH
- Ministerial Fund of Human Resources Development
(MFHRD) - External Expert Board on Health Systems (EBHS)
- Full-time expatriate consultant(s) to the
minister - New Department of Health Policy (DHP)
- Reforming MOH PR Department
- Optimizing doctor/nurse ratio
16Policy objectives
- Enhancing cooperation with old and new EU member
countries - MOH Eurointegration Office
- Drafting strategy paper on cooperation with EU
member states - Developing a white paper on health sector
financing - Creating favorable legal environment for health
reforms with the emphasis on EU legislation - Structural and institutional reforms
- Surgeon Generals Office, HIAs
- Developing effective media strategy for health
reforms.
17Conceptual framework of the proposed policy
18Unique Supportive Environment
- The Government of Georgia has an excellent
package of recent (2003-2005) successful reforms
in its portfolio. It is of paramount importance
that socially very painful reforms in law
enforcement and education has been highly
tolerated by the general public. There are two
certain benefits for the MOH the radical
reformation experience is in place and public
acceptance of the reforms is relatively high.
Therefore, the MOH should enjoy this supportive
environment (which logically may not last
indefinitely and another chance simply may not be
available). - There is a high degree of certainty in fiscal
environment as opposed to the ambiguous tax
regulations under the previous Government. The
new Tax Code (2004) provided well-defined
macroeconomic frame for health financing. - As a result of wide Western support to
democratization, the international donor
assistance literally boosted after the Rose
Revolution. Besides already approved or
functioning donor projects, there are numerous
realistic opportunities for future donor funding. - The unity and team-environment are explicit
features of the current Government, as opposed to
the previous one. In this sense the MOH may enjoy
the benefits of concerted action.
19Unique Supportive Environment
- The expectations for radical reforms in health
sector are relatively high in political
establishments (both governmental and
opposition), hence a good prerequisite of
political support. - Despite poor donor coordination, the majority of
donor-funded projects are concentrated on primary
health care (key component of any health system),
so in the short-run the MOH may secure saved
money for other purposes. - As a matter of fact, current MOH leadership
sustained for over two years (turnover was very
high in other agencies of post-revolution
Government) and may be judged as a relative
guarantee of sustainability of reforms in the
future if launched now. - There is a substantial intellectual, technical
and institutional capacity in the NGO sector,
which may be effectively utilized with at least
two beneficial outcomes overall performance in
the MOH will be improved and participatory
component of consensus on major policy decisions
will be enhanced. - The recently launched Presidential Program on
Hospital Sector Rehabilitation created favorable
conditions for conducting radical structural
reforms.
20Consequences of further delay of reforms
- Dramatic worsening of access to health care and
of equity issues, those to be easily
transformable into wider public dissatisfaction
and loss of electoral support. - N.B. The better health care was one of the
prominent pre-election promises of the current
political leadership
21Where are we now?!
- There is a big challenge related with further
possible delay of radical reforms in the Health
Sector of Georgia. The unique supportive
political and international context of the Rose
Revolution may most effectively be utilized in
the course of health reforms. The next chance of
comparable scale will be barely available in the
foreseeable future. The rationale of political
logic dictates that the immediate action must be
undertaken.
22Acknowledgments
- Dr. Deborah A. McFarland, MPH, MSc, PhD
- Dr. Richard Saltman, PhD
- Mr. Daren Djirikian, MPH
- Dr. Levan Baramidze, MD, PhD, MPH
23THANK YOU!