Governance, Human Resources and Health Georgia Case National Immunization Program

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Governance, Human Resources and HealthGeorgia
Case National Immunization Program

• Akaki Zoidze, Natia Rukhadze
• Curatio International Foundation (CIF),
  University of Toronto, Canada IDRC/GHRI
• Saly Portudel, 2005

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(No Transcript)
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Country at Glance
Area - 69,400 km2 Population - 4.6
million Nominal GDP per Capita - 1100 USD Per
Capita Spending on Health Public Spending 9
USD Private Spending 45 USD
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CIF At Glance

• Founded in 1994
• Mandate
• Support the reforms in health, education and
  social sector in Georgia and beyond its
  boundaries
• Total of 35 implemented research and development
  projects
• Continuous interaction with governmental and
  nongovernmental stakeholders to promote the real
  life implementation of innovative approaches and
  problem solutions identified through research.

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Georgia Health Information and Disease
Surveillance reform activities

• Objectives 1. Strengthening immunization MIS
• 2. Strengthening VPD
  surveillance
• 3. Improving management
  capacity
• Key partners MoLHSA (DPH, CPH) NCDC, CMSI, WHO,
  UNICEF

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National Immunization Program (NIP)

• Restored Immunization Chain in 1996
• Coverage varies from 52 to 90
• Health Providers are employed by local
  governments but paid and supervised for NIP
  services through central Public Health Department
  (DHP)
• Low salaries, low motivation, rural/urban
  inequity, logistical problems, improper reporting.

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Strategic Approach

• Generation of Demand for research among
  Policymakers from the initial stage
• End product functioning national system, not a
  demo model
• Designed in accordance with countrys resources
  (sustainable, inexpensive)
• Built upon the strengths of existing systems
• Developed on the basis of priorities and needs
  as determined by key stakeholders and system
  users (expert groups)
• Tools/methods developed, pre-tested and
  fine-tuned in a pilot region before scaling up to
  national level
• Efforts concentrated on improved management
  rather then on additional cost allocations

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IDRC/GHRI Project

• Assessment of Effectiveness of Supportive
  Supervision (SS) for Services of National
  Immunization Program in Georgia
• Prospective Case Control Design
• Duration of Intervention 1 Year (started 09.04)
• 15 Intervention and 15 Control Rayons (districts)
  
• Guidelines for SS developed (adapted to local
  conditions) and training of trainers conducted
  (local PHD workers)
• Baseline Survey of up to 600 frontline providers
  (400 is completed)
• Continuous Monitoring and Evaluation

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IDRC/GHRI Project

• Baseline Survey of Providers and PHC Centers
  (Preliminary Results)
• 124 Nurses and 286 Doctors
• 24 of providers perceive a lack of effective
  management and supervision from upper level
• 26 consider that there is no clear format for
  managing/supervising facilities and providers
• 50 of providers do not have job descriptions
• 64 do feel that for immunization work they are
  in need of supervision
• 80 are willing to receive the supervision

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IDRC/GHRI Project

• Baseline Survey of Providers and PHC Centers
  (Preliminary Results)
• Significantly higher proportion of providers in
  RURAL areas are dissatisfied with organization of
  work, declare that there is no clear format for
  managing/supervising facilities and providers,
  and confirm that they are in need of supervision

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Expected results upon completion of the Project

• Improved Human Resources Management in NIP at
  district and subsequently national level
• Improved equity in HRM (rural/urban)
• Improved coverage and case notification,
  decreased drop-out and complication levels

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Key Lessons for Ensuring Research Uptake

• Research objectives communicated/agreed with
  relevant policy makers at earliest possible stage
• Continious supply of information on
  research/project implementation is
• Research findings and/or results of the pilot
  presented in right format and to relevant
  audience
• Policymakers may not be aware of the scope of the
  problem and deeply impressed with findings
• Likelehood of successful upateke increases if
  major changes in funding levels are NOT requested