სოფო მადლობა,

ჩვენსკენაც მშვიდობაა, თუ არ ჩავთვლით რომ ჯერ ისევ შეხვედრების რეჟიმში ვარ და ნაკადების მოგერიებაში ;-)

DRG და SSA ზოგადი დოკუმენტები მაქვს, გადავხედე, მაგრამ შეხვედრებისაას უფრო ნათელი ხდება ის, რაც დოკუმენტებში წერია J

მოკლედ, ბევრი საკითხი გვაქვს გასავლელი და ამ კვირაში ან იმ კვირაში შევხვდეთ, ნინოს ვეტყვი რომ შეგითანხმოს, მხოლოდ ისე რომ გადარბენაზე არ ვიყოთ

მადლობა

მოგესალმებით,

კი კარგად ვიმგზავრეთ, მიმდინარეობს შეხვედრა J თქვენსკენ რა ხდება? მშვიდობაა?

მარიანის მოწერილ მეილთან დაკავშირებით (Primary Health Care) ჩემი აზრით კარგი იქნება მარინასთან ერთად თუ გავივლით დეტალებს და შემდგომ გავაგზავნოთ საპასუხო წერილი.

რაც შეეხება (DRG, SSA) ზოგადი მიმოხილვა გადმოგიგზავნეთ მე მისიის დროს რაც გვქონდა ეხლა დავამატებ რაც განახლდა და ერთიან პაკეტს გადმოგიგზავნით. ასევე ჩავნიშნავ შეხვედრებს სამუშაო ჯგუფებთან (ჩვენი შეხვედრის შემდეგ).

სოფო გამარჯობა,

იმედია კარგად იმგზავრეთ და ქობულეთში მშვიდობაა J

შენი ჩამოსვლის შემდგომ, კარგი იქნება, თუ შევხვდებით და ერთად გავივლით მარიანის მიერ მოწერილ მეილს. ასევე, მისიების ჩამოსვლამდე იმ 2 პროქტზე, რომელზეც საუბრობს მარიანი (SSA, DRG), იქნებ ვინმემ მომაწოდოს ინფორმაცია რა გაკეთდა უკვე და ვინ რაზეა პასუხისმგებელი. მირჩევნია თუ უშუალოდ პროექტზე პასუხისმგებელ პირებს შევხვდები და მათგან მივიღებ ინფორმაციებს. მოკლედ, ჯერ ჩვენ შევხვდეთ და იმედი მაქვს უკეთ გამარკვევ სიტუაციაში.

კეთილი სურვილებით,

Dear deputy minister,

Let me thank you for the short meeting we have had on Friday, 30 March.

As agreed, attached please, find:

1.      PEN assessment, WHO, 2017 (Assessment to Knowledge, Attitude and Practice of Non- communicable disease prevention and control among health workers of primary health care settings in Tbilisi and Kakheti); the document can give you some insights into the knowledge and practice of PHC

2.      Quality of primary health care in Georgia, WHO (2018); this has been sent earlier, but I am attaching it again for your convenience

3.      Primary Healthcare System’s Development Strategy; Global Alliance for Health and Social Compact; not a WHO document and most probably you have it already; attached for your convinience

The below links can be very useful for your further thinking about strengthening PHC:

·         Strengthening people-centred health systems in the WHO European Region: framework for action on integrated health services delivery; http://www.euro.who.int/__data/assets/pdf_file/0004/315787/66wd15e_FFA_IHSD_160535.pdf; a documents discussed and endorsed by the WHO Regional Committee for Europe, September 2016 (it nicely summarizes all key areas that needs to be considered).

·         World Health Report 2008: PHC Now more than ever; http://www.who.int/whr/2008/en/; an old report that may still bring some key ideas about the PHC

·         WHO Regional Office for Europe: PHC specific web page: http://www.euro.who.int/en/health-topics/Health-systems/primary-health-care; comprehensive web page with many documents focused on integrated health care services delivery

Support envisaged by WHO:

UHC:

1.       Preparing a strategy for strategic purchasing and providing support to increase the SSA’s capacity to implement the strategy (A strategy for strategic purchasing based on international evidence and the Georgian health system context; Increased capacity of the SSA to effectively implement the strategy for strategic purchasing)

2.      Supporting DRG implementation and providing support to strengthen strategic purchasing (Preparedness for DRG payment of hospitals in 2020; Increased capacity of the SSA to engage in strategic purchasing to ensure efficiency in using public funds; Increased quality of the SSA’s claims data)

3.      Designing best practice patient pathways for selected priority clinical areas and developing tools to support their implementation (Best practice patient pathway for diabetes type 2 is developed and validated in local context; Increased MOLHSA’s and SSA’s capacity to use different policy instruments to support best practice patient pathway’s implementation)

The above includes capacity building: i.e. 2-3 top senior decision makers will be enabled to attend the Observatory Summer School on Quality of care: Improving effectiveness, safety, and responsiveness, San Servolo, Venice, 22-28 July 2018

PHC:

1.      hospitalizations of ambulatory care sensitive conditions

 Other areas that are (indirectly) linked to the provision of services:

1.      Reproductive, maternal, newborn, child and adolescent health: mid-term evaluation of the national sexual and reproductive health strategy and action plan and updating the action plan

2.      countrywide assessment of hospitals using Hospital Safety Index tool (focused on emergency preparedness)

3.      other minor interventions in the areas of TB, vaccine-preventable diseases, antimicrobial resistance, hepatitis

4.      Good manufacturing Practice and possible impact on provision of quality medicines (on mid/long-term)

Due to the limited resources within WHO and suboptimal insights into the plans of the MoLHSA, we did not plan any major activity in the area of PHC in 2018.

For that reason we thought that perhaps our support to the “Czech” project could somehow keep us in the loop, but only if you see strong links between the project and overall direction.

We have realized that with your appointment the ministry gave very clear signal that we also need to put more focus on the delivery and quality of services (across all levels of care, but with special attention to the PHC).

We see this is a challenging situation, as we are aware that the capacity of the ministry is somehow limited, having in mind huge work being done in the areas of DRG and SSA, which will keep core staff busy for quite some time.

We can see a need for an expertise in the area of service delivery, and it would be great to have one that goes beyond PHC. This work shall be well linked with the work in the area of SSA, which means that the areas of health financing and service delivery need to work together.

Having in mind the work in the area of strategic purchasing strategy, we would assume that this work will at least partly include service delivery part as well (from the purchasing perspective - PHC, essential services in the regions and consolidation of highly complex care). Maybe we should wait until June to better understand full scope of work. This could help us identify potential technical needs and entry points for the technical assistance in the second half of 2018 and in particular in 2019.

Perhaps for the second half of 2018 we should plan a policy dialogue to discuss how to link service delivery and financing.

I assume that after the meeting next week we will have better picture and will try to find some hidden resources within WHO, if applicable.

It is also important to include you personally to the work in the other two areas (SSA, DRG) as much as applicable. If nothing else it could be very useful if you attend core (high level) meetings during the missions, so you are informed first-hand about the development, which will enable you to spot the direct links between the areas, which will prevent us working in silos.

The next two missions are planned as follows:

Best regards,

Marijan Ivanusa

WHO Representative

Head of WHO Country Office Georgia

Office location: 81 Vasil Barnov Street, 0179 Tbilisi, Georgia

Mailing address: UN House, 9 Rapiel Eristavi Street, 0179 Tbilisi, Georgia

Mobile 1: +995 599 305 207

Mobile 2/EU/private: +386 40 528 639

Email: ivanusam@who.int

Skype: who-ivanusam

GPN: 74211

Web: www.euro.who.int