Dear Nino,

Thank you for sharing the report, which provides helpful recommendations for successful transition to the domestic financing . Please, see some comments we would like to communicate for  your consideration and follow up:

·         It is unclear what evidence lead to conclusion that “private clinics actively dissuade TB patients from attending their clinics, thus avoiding their responsibility to provide services and care to TB patients”.  The provider payment is case-based, thus if the TB care site is functioning, there is no reason to avoid care provision.

·         Information regarding the need to replace West Georgia Center of TB and Lung Diseases that has not yet been planned is outdated. The Center was privatized, but not fully, with investment obligation and is under renovation.

·         According to the report “the government pays for 70% of TB services and the remaining 30% is privately funded (out-of-pocket expenses)” . At the same time the survey done in 2015 (and cited in NSP) points at 5% of out-of-pocket payments and decreasing trend.

·         MoLHSA is recommended to deliver a case study highlighting the negative impact of the Law of Georgia on Public Procurement. The majority of civil society representatives find uncomfortable to meet strict requirements of the Law, but still currently number of NGOs and CSOs are subcontracted by NCDC, and there has been no case, where regulations created real barrier for their engagement.

·         Externally produced TSP – TSP was drafted by CIF consultants contracted under the GF Program, however,  the development process went through PAAC, chaired by the Deputy Minister; TSP was endorsed by the CCM

·         According to report NCTBLD is providing storage and countrywide distribution of TB drugs without reimbursement, however, the staff involved in the process is payed through GFATM project. Besides, the report points at lack of clarity about staff responsible or budget available for managing and distributing stock for microscopy and culture assays. In reality the mechanism is clearly defined, documented and well-coordinated.  

We look forward for your feedback.

Thanks and regards,

Irma