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Jean-Elie Malkin: Health is a human right

Jean-Elie Malkin: Health is a Human Right

Georgian Government Signs Cooperation Agreement to Better Georgia’s Health Care System.

In a move that recognized the Government’s desire to make much-needed improvements to the country’s healthcare system, on April 6 the Ministry of Labor, Health and Social Affairs of Georgia signed a cooperation agreement with consulting organization Global Alliance for Health and Social Compact (GAHSC), a team of international experts who are now set to catalyze partnership and collaboration with national counterparts towards health improvement in the country in.

Following on from the heritage of the former Soviet Union system, Georgia has succeeded in transforming its health care system through a step-by-step process involving privatization, the delegation of care services to health insurance companies, and then, in 2012, the establishment of universal health coverage. But there are still many improvements that could and should be made. The GAHSC will be offering guidance, monitoring and evaluation services to the government in order to reduce costs, and improve management and accessibility of better care to the population.

We met Dr. Jean-Elie Malkin, President of Global Alliance for Health and Social Compact for an exclusive interview to discuss the expected impact of the cooperation agreement.

Q: Dr. Malkin, could you tell us more about how the cooperation agreement will work; what the main focal points are, and how soon our citizens will be able to feel the changes? 

A: The agreement signed on 6th of April aims to provide services, guidance and recommendations regarding the main components of the health care system in Georgia. That doesn’t mean that Georgia’s health care system isn’t working or that it’s working particularly badly. Of course, if we compare health care systems in different countries from Western Europe to Eastern Europe or within Eastern Europe, we come up against the heritage of the former Soviet Union system. Since then a lot of changes have been made, especially in Georgia, which means that during recent years the people of Georgia have been getting better access to services.

But there are always improvements which should be made, such as in better management of the whole system in Georgia; through re-engineering of the integrated service delivery model; in the balance between the hospital sector , patient clinics and primary healthcare. That means also improving the quality of care, because if the people ask for better access to care, that means better access to better quality of care. This is the kind of advance the GAHSC will be aiming for by co-operating with the Georgian Government.

The universal healthcare coverage programme has seen huge progress, though there’s still a lot to be done in order to reduce the costs. Reducing the cost means two things: first of all reducing the overall cost for the government and for the project, and secondly reducing the cost for the individual. The cost of drugs is still very high in Georgia. We need to address all these issues.

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Q: Since the majority of Georgia’s population is socially vulnerable, how accessible to individuals do you see the future model being? Do you see them being able to take full advantage of it?

A: Of course, improving any health care system means offering access for the majority of the population, including what we call the most vulnerable people. And once again, the universal health coverage has been a step forward on this issue. Now there are a variety of further issues that need addressing in order to improve this access. For example, we should find a way to improve the services provided by primary healthcare facilities. This means that people should have access to basic packages of care in their own neighborhoods, which would not only be prime quality care, but also without personal cost to those people.

At present in Georgia there are many hospitals meant to reduce out-of-pocket expenses, but it is often the case that the target social group avoids such facilities as they are either distrustful of them or because the facilities are not sufficiently equipped, or for the simple fact that there are people who prefer going directly to hospital. In such cases a certain re-engineering is called for, which we will recommend to perform step-by-step through joint activities of government institutions and various stakeholders. This should become a common goal for all stakeholders.

Q: The Georgian Government names health care a top priority. Could you talk about the challenges facing the healthcare system and the cooperation between the GAHSC and the Ministry of Health? 

A: Georgia, like all countries in the region, has a lot of issues to be addressed in order to move forward: economic challenges, social challenges, industrial challenges, but health is definitely something committed to by the higher authorities. The reason is simple: Georgia’s political leaders now understand that if they don’t give quality care to the majority of the population, those citizens will be prevented from contributing to and participating in the economic growth of the country. Health is a human right.

A better health care system will serve to satisfy the general population as one of the highest priorities in any household is health. The Georgian government understands this, and that’s why the challenge now is to move forward in the main directions of quality and cost reduction. The GAHSC will support the government in finding how to successfully re-design the system; that’s to say, not transforming everything, nor using a copy/paste system, but adapting innovative tools and making them usable in Georgian specificities. One of the challenges is to do this by building, transforming, improving, and strengthening the system with one objective in mind: to be closer to European Union standards.

Q: The Georgian Government works in close cooperation with various national and social programs, including the health care system, and with different foundations and international partners both from the European Union and from the United States. Georgia is committed to EU standards. With that in mind, do you think that European standards can be successfully implemented in Georgia?

A: I would say they could be implemented everywhere. I’m not saying that European Union standards are the best in the world, but they definitely include a basic quality of care and products. Of course, standards mean procedures, guidelines, protocols, rules, and I don’t see any reason why we can’t provide such in Georgia.

A practitioner, a family doctor or a specialist not having the same kind of tools in his hands as a colleague in Western Europe or the European Union [wouldn’t be unable to follow standards]; I don’t see any reason why adapting all the procurement regulations for pharmaceuticals in Georgia according to EU rules wouldn’t work. It’s a question of commitment; of willingness. And it is a question of establishing how we will be able to support the Georgian government in transforming and implementing those necessary procedural rules and laws.

Jean-elie Malkin: Health is a human right

Q: How do you think the medical community of Georgia will support the government initiative? What improvements in quality can they expect? 

A: First of all, we will engage in the process by working with all the stakeholders. The first are the Ministry of Health and its affiliated bodies. Furthermore, we will build working groups to address different components of the health care system. These groups will involve health care authorities and also medical professional associations. If one doesn’t collaborate to gather the input of those who will be in charge of providing the services, he will fail.

We keep hope that the community of health care professionals in Georgia will benefit from this initiative. Working in more effective environments should definitely catalyze the health care professionals to be more committed. And we also hope that by re-thinnking the system, some of professionals who have been perhaps somewhat de-motivated will soon regain their motivation due to new access to enhanced and more effective tools. And hopefully the improvement of the whole system will also have a positive impact on the income of the health professionals

We have a high-level experts specifically dedicated to reshaping the association of health care professionals; to giving them more involved in decision-making related to health care delivery and public health promotion; to getting them more involved in the accreditation of health care professionals, specialists, and doctors.

Q: Have you already set milestones for the project; objectives you aim to have fulfilled by a specific time? 

A: We signed the co-operation agreement following a lengthy discussion on the scope of the planned services and on the expected extent of our work with the government. At present, the GAHSC is in the process of putting together working groups which will work with their counterparts in the Ministry [of Health], and we are now working on the agenda for the project. We’ll be able to give a picture of what should be achieved, with a timetable, very soon. But it’s a step-by-step process and when I say soon, I mean within the next few weeks or months once we have built the agenda. I would hope to see the first achievements completed at the end of the year or early next year.

It’s not realistic to expect a total transformation, and giving promises that everything will change in three months is nonsense and definitely not possible. But we definitely aim to do our best in order to move, and move as fast as possible, in the right direction.

Q: Dr Malkin, have you become acquainted with health care projects carried out in Georgia during the last three years? Would you say some were more important than others? 

A: We have been reviewing a lot of documents; staying in touch with stakeholders, we are taking into account everything that can give us accurate information to enable us to work in a better way with the Georgian government. There was a recent report from USAID on the perception of the universal health coverage, for example. This is very important information for us. In 2009 there was also a big review led by WHO (World Health Organization) on Georgia’s transition.

We are aware of all such initiatives. We are in touch with WHO in Georgia and we will also be in touch with all the stakeholders, of course, paying attention to their input. We want to take into account what has been done before, but our focus, like that of the government, is the move forward from the reforms made to the old system after the Rose Revolution, and from the establishment of universal health coverage.

What has been done by the international stakeholders, those assessment-evaluations, are very important for us to build on, but we would like to do more by using concrete and innovative tools – not innovative systems, but innovative tools – to improve the system. And we will not implement; we will evaluate. We will support the government in order to assess, to evaluate, and to monitor what needs to be done throughout the process.

Jean-elie Malkin: Health is a human right

Q: Finally, Dr. Malkin, could you tell us about the experts of the GAHSC, and perhaps about yourself, especially about your experience in the design and development of social health care systems? 

A: As for myself, I come from the field of Infectious Disease Control and Public Health, which I worked in for many years in France before joining the UN as Senior Advisor to the Executive Director of UNAIDS, which fights AIDS worldwide, and later becoming the Regional Director for all the Eastern Europe and Central Asia.

Before joining UNAIDS I used to work in health care systems, specifically with the French Minister of Cooperation with African Countries, during which time I was fully involved in building health insurance systems in Gabon and the Congo Brazzaville in Central Africa. I continued working on this issue when I joined the UN, and especially as Senior Advisor to the Executive Director, because one of my tasks was to visualize the mid-term and long-term perspectives for including the cost of fighting AIDS within national health care financing systems in various countries, especially in the countries in this region. While there are a lot of international donors, like the Global Fund and the World Bank, we have to see but how we can sustain this costly progress by covering the costs through the health care financing systems themselves.

I plan to use my experience from my own country, France, and from the all the European countries, as well as from different part of the world to help Georgia to move forward. Regarding the expert team of the GAHSC, I can say that this team is an amazing one composed by some of the most experienced experts in the field of health care and public health.

They will work in a very close collaboration with their national counterparts including ministries and non-government stakeholders and we are planning to finalize the setup of their teams soon. We intend these teams to monitor the progress, share high-level expertise and validate the outputs.

Georgia has already explored the opportunities for health sector investment through Public-Private Partnership (PPP), but we want to leverage the use PPP to make the services more accessible, affordable, effective and efficient. We will also attract experts working on health care financing and health economics to strengthen relationships between care providers and clients through innovative management of hospitals and other medical facilities. We are now analyzing how to implement such management tools in Georgia, and that’s for this we recruited number of expert who specialize in this area and have experience of working in both Western European and transition countries.

There are very high-level experts in our team who work for European pharmaceutics, and who used to work with authorities in Brussels, as well with a European drug agency in London, and who will supervise, monitor and work very closely with those in charge at the Ministry [of Health]. They will help to reshape and redefine the Georgian regulations to make this specific component of pharmaceutics closer to European standards.