Anotation of State Programs of Social Sphere of Georgia

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1 Anotation of State Programs of Social Sphere of Georgia I. Health Programs Achieving the balance between social responsibilities, declared by the State and its real financial capacities has crucial significance for the economic development of the country at the current stage. On the basis of the experience of the recent years, we can say, that the existing misbalance caused discreditation of the social system and the reforms carried out in the field; Thus, one of the most important precondition is setting of priorities. Correspondingly, the basic priorities are as follows: preventive actions; programs facilitating development of cost-effective primary health model; improvement of maternity and child health; provision of vulnerable people with medical care; provision of drug replacement therapy. Besides, statistical data of morbidity and classic indicators evaluating the effectiveness of healthcare actions were used, they are: common causes of morbidity and mortality; optimal coverage of population; optimal accessibility to healthcare; quality of medical care; cost-effectiveness of actions; Healthcare programs for 2001 will be mainly directed towards filling the gap which exists between the real cost of one case and the amount of money (tariff) allotted on this purpose by state. Such approach will increase the effectiveness of programs and the quality of healthcare services on one hand, and reduce the volume of illegal income in the sector on the other. 1. Public Health Programs High medical and economic effectiveness of preventive actions makes public health the most significant priority. It aims at the establishment of strong primary healthcare network which will facilitate development of preventive medicine and attainment and maintaining of good epidemiological condition in the structure of morbidity ESTABLISHMENT OF HEALTHY LIFESTYLE 28

2 The purpose of the program is development of public attitudes, to deny those living and working styles which promote occurring and development of different diseases EPIDSURVEYLLANCE, QUARANTINE (PLAGUE, CHOLERA, HEMORRHAGIC CONTAGIOUS VIRAL FEVERS), CONTROL OF ESPECIALLY HAZARDOUS DISEASES AND PREVENTION, MANAGEMENT AND COORDINATION OF OTHER COMMUNICABLE DISEASES Establishment of systematic epidserveillance on extremely dangerous (plague, cholera, haemoragic contagious viral fevers) and equated with this category infectious and carrying out immediate actions on purpose to stop their prevalence and eradicate the consequences PLANNED PREVENTIVE IMMUNIZATION, MASS AND OCCUPATIONAL VACCINATION CAMPAIGNS This program implies planned immunization of population in correspondence with schedule (calendar) of vaccination DRUG-ABUSE PREVENTIVE MEASURES The program is determined in order to carry out preventive actions against drug abuse on a methodological-normative level PREVENTION OF IODINE AND MICRONUTRIENTS DEFICIENCY RELATED DISEASES This program provides: - revealing the cases of diseases and control and monitoring of epidemiological situation through the whole territory of Georgia; - supplying the population with iodized salt and monitoring of its consumption through indirect method and epidevaluation; - therapeutic and surgical treatment of modular goiter in children under 15 and pregnant women (surgical treatment and secondary prevention of possible malignization), group prophylactic measures (including treatment) ACTIVE DETECTION OF POPULATION MORBIDITY AND MASS PREVENTIVE SCREENINGS On purpose to determine structure of the morbidity and diseases of the population, and to control and supervise revealed cases it is necessary to carry out the following complex actions: - screening of population; - carrying out of surveys; - developing of recommendations concerning prevention; The program provides fulfillment of these tasks SAFE BLOOD, PREVENTION AND PARTIAL TREATMENT OF AIDS AND SEXUALLY TRANSMITTABLE DISEASES Carried out preventive actions are very effective in order to reduce and manage prevalence of infectious diseases. Like other countries spreading of HIV infection, B and C hepatitis and syphilis, due to its socio-economic and geopolitical condition, is a very serious problem for Georgia PRIMARY DETECTION OF ONCOLOGICAL DISEASES This program is a complex of actions, such as revealing of malignant tumors, their diagnosing and prevention on early stages of the development, appropriate treatment and rehabilitation. 29

3 1.9. PREVENTION OF CARDIOVASCULAR SYSTEM DISEASES This program envisages establishment and implementation of the system of epidemiological supervision and monitory, improvement of the register of such problems as blood circulation system diseases, prevalence of risk factors arterial hypertension, stroke and ischemic heart diseases for the adult population of Georgia, giving the information to people about the risk factors which promote development of these diseases, using massmedia PREVENTION OF TRAUMATISM The program aims at the development and implementation of preventive measures against traumatism and establishment of its epidsurveillance on a methodological level PREVENTION OF MALARIA This program is long-term, as Georgia due to its geographic situation and conditions is considered as a possible endemic country of malaria. The program considers elimination of malaria infection detected in recent period, implementation of epidsurveillance and monitoring systems ADDITIONAL MEDICAL CARE OF RURAL POPULATION The volume of the responsibilities, taken by the State at the beginning of Healthcare Reform, is quite wide and includes such priority directions as: the complete immunization of population, prevention of socially dangerous diseases, provision of child health and safe motherhood, inpatient and outpatient treatment of psychiatric and ptisiatric patients, arrangement of urgent care actions for population. In spite of this, the most part of population often have difficulties in paying for the medical care that nowadays is not considered by the active state programs. These are mainly the people living in regional centres and villages. Their total number countrywide is 3225 thousand persons. Specific living conditions and housing should also be considered. The mentioned situation requires special organization of medical care and attention from government and health authorities. Since 1999 this function is carried out in frames of The Program of Additional Medical Care of the Population in Rural Regions. Participation of specialists (surgeon, pediatrician, ophthalmologist, otolaringologist, neuropathologist) and also, functioning of additional 5 inpatient beds on rayon (district) level have been considered in the composition of referral team ADDITIONAL MEDICAL CARE OF HIGH-MOUNTAIN REGIONS POPULATION Population of highlands need special organization and particular attention. Their total number is 435 thousand. Considering the experience of recent years and on purpose to execute the relevant legislation, we think it is reasonable to implement State Program of Additional Medical Care of Highland Regions Population, which will provide maximum accessibility to healthcare. High increasing rate of planned amounts in this program is caused by difficult socioeconomic situation in highland regions and on purpose to provide affordability and accessibility (geographic) to primary healthcare facilities. Participation of specialists (surgeon, pediatrician, ophthalmologist, otolaringologist, neuropathologist) and, also, functioning of additional 5 inpatient beds on rayon (district) level have been considered in the composition of referral team. 30

4 2. State Programs of Mandatory Medical Insurance Development of this program implies provision of equity in health for population; implementation of which is possible only in conditions of Universal State Insurance system. At present, in the result of field reorientation institutional arrangement of the system is completed, the most part of medical service has been shifted to insurance principles PSYCHIATRIC CARE This program aims at provision the basic contingent of mentally ill people with qualitative outpatient and inpatient treatment STRUGGLE AGAINST TUBERCULOSIS The aim of this program is to reduce cases of mortality and morbidity caused by TB and spreading the infection by creation of universal system of preventive measures determined by the DOT strategy and by strict keeping of diagnostic and treatment requirements OBSTETRICS On the background of existing difficult demographic situation this program is focused on reduction of morbidity and mortality of mothers and children. Besides, Trustworthy Start or taking a special care of an individual in pre and postnatal periods is of crucial importance in forming the healthy generation. Significant increase of amounts necessary for financing the program is caused by difficult demographic situation. The mentioned amounts will be directed to the significant increase of delivery tariff that will promote the real implementation of free delivery declared by the State and strengthening of patronage in the period of pregnancy MEDICAL CARE OF CHILDREN Deterioration of socio-economic conditions had the most significant influence on the mental and physical health state of children. Morbidity and mortality rates in children are very high, especially in neonatal period. Problems connected with mental and physical health of children are morphemic in structure. The solution of these problems requires carrying out planned measures in different directions. Otherwise won t be possible to form socially active future generation ADDITIONAL MEDICAL CARE OF VULNERABLE POPULATION Certain part of country population is in hard economic situation, so they cannot afford elementary medical care. The program provides access to Basic Benefit Package for poor population and, in individual cases, reimbursement of resourceful medical care of the poorest part of the population TREATMENT OF INFECTIOUS DISEASES 31

5 The aim of this program is to reduce spreading of communicable diseases, morbidity, risk of getting ill and mortality in population; readiness for adequate measures in case of outbreaks TREATMENT OF ONCOLOGICAL DISEASES One of the most important problems of practical healthcare is the appropriate treatment of tumor, precondition of which is early detection of precancer diseases and malignant tumors. According to the above mentioned and considering the need of huge amount of resources resourcefulness for treatment of oncologic diseases, the aim of this program is to improve the prospective results of oncologic diseases by timely diagnosis and adequate treatment HAEMODIALYSIS The aim of this program is lengthening of the life of people with chronic failure of kidney in terminated stage and improvement of their life quality. Due to high moral rate and cost-effectiveness (expensiveness) of the field, the state took responsibility to satisfy such patients in frames of the program TREATMENT OF ISCHEMIC HEART DISEASES Heart ischemic diseases are on the first place in the mortality structure of Georgia. The aim of this program is reduction of lethal outcomes and disability caused by heart ischemic diseases HUMAN ORGANS AND TISSUES TRANSPLANTATION 50% of patients on hemodialisis can be subject of kidney transplantation. Beside the high economic effect, the mentioned surgical intervention is characterized by high indicator of social rehabilitation. The aim of this program is organizational and financial provision of kidney transplantation in patients with chronic kidney failure in terminal stage PROVISION OF SPECIFIC PATIENTS WITH DRUGS The aim of this program is timely and continuous provision of people suffering from chronic diseases, such as: diabetes mellitus, diabetes insipidous, hemophilia and those with kidney transplantation, with specific essential medications. The high costs of this program are conditioned by the most important decision to provide insulin depended patients with synthetic insulin on the basis of 5 year agreement with a provider ADDITIONAL MEDICAL CARE OF POPULATION AT TSKINVALI REGION The aim of this program is provision of region population with medical care in correspondence with of principles reorientation taken place in healthcare system ADDITIONAL MEDICAL CARE OF IDPS SETTLED IN SAMEGRELO-ZEMO SVANETI REGION The aim of this program is provision of IDPs living in Samegrelo, Zemo-Svaneti region with medical care considered in obligatory municipal minimum. 32

6 3. Other Health Programs 3.1. DISASTER AND MEDICAL RESERVES This program provides realization of one of the most important functions of the state: to carry out adequate medical care for victims of disasters and emergency situations in the short terms REHABILITATION OF HEALTH FACILITIES On purpose to improve the quality of service this program provides renewing and development of material-technical base in strategically important facilities of social sphere providers, their provision with high quality equipment, implementation of modern technologies and retraining of qualified staff STATE SUPERVISION AND NORMING The aim of this program is elaboration and implementation of sanitary-hygienic and epidemiologic normative documents in correspondence with international standards, requirements and activity principles and, also, perfection of State Sanitary Surveillance System SUPPORT OF MEDICAL SCIENCE AND EDUCATION The aim of this program is development of effective, evidence-based institutes of social security and their provision with qualified staff MANAGEMENT AND REFORMS SUPPORT This program provides monitoring of processes necessary for effective implementation of reforms in social sphere, summarizing up the results, installation of new mechanisms of management, implementation of normative documents, essential to carry out reforms, on a regional level MONITORING OF STATE PROGRAMS The aim of this program is to improve effectiveness, and purposefulness of State Social Programs and, also, customers satisfaction through implementation of monitoring system of state programs and consumers service PROVISION OF STATISTIC AND HEALTH INFORMATION SYSTEM The aim of this program is creation of universal informational system of labour, health and social security of Georgia to provide the right strategy, tactics and making of timely decisions through coordinated processing of separate components MEDICAL EXAMINATION OF DRAFTEES The role of this program is essential as it s necessary attribute of an independent state to have morally and physically healthy, capable to act, strong and professional national army. 33

7 II. Social Protection Programs In the code of Labour Laws of Georgia about the Amendments the following point was added to the section 3, article 80 of the Law June 9, 1999, of Georgia: It is stated to add 50% of the total amount to the people living in the mountain regions. According to the requirements of this Law, by the assessment of the experts of the Fund, there was calculated the number of pensioners getting under requirement of the mentioned Law. Additional 181,4 thousand Lari will be necessary for mail service. 1. PENSIONS OF PENSIONERS 2. BENEFITS FOR TEMPORARY DISABILITY 3. SOCIAL SUPPORT OF VULNERABLE (FAMILIES) 4. SUPPORT FOR FAMILIES OF PERSONS DIED ON APRIL 9, FUND FOR SINGLE USE AID OF VULNERABLE CITIZENS III. State Programs for Support of Disabled One of the most important components of the community is existence of institutions for developing the most vulnerable part of public - disable people - as full-valued members of the society. Correspondingly, state programs of disabled people, covering their provision with medical care and social rehabilitation, make up the most important part of social responsibilities of the State. The first version of the presented plan includes the both components of disabled people rehabilitation, but in the second version it is represented by its minimal volume. 1. PROGRAM FOR FUNCTIONING AND IMPROVEMENT OF SYSTEM FOR CERTIFICATION- REGISTRATION OF DISABLED This program should provide arrangement of the determination of disabled people, their differentiation according to quality, volume and duration of disability in frames of relevant criteria and rules. 2. PROGRAM FOR MEDICAL AND SOCIAL REHABILITATION OF DISABLED 2.1. This program envisages creation of medical and psycho-social rehabilitation centres (on the first stage in Tbilisi, Kutaisi and Batumi) for the disabled people and family members of those persons died and lost in the war for territorial integrity, freedom and independence of Georgia. Physicians, methodists, psychotherapeutists, lawyers and social workers will be simultaneously involved in the process in order to increase rehabilitation potential to maximum. 34

8 2.2. The aim of this program is provision of disabled war veterans with qualified dental care The aim of this program is improvement of motoric and cognitive functions of children with limited abilities, increase their activity indicators, prevention of disability and promotion of social adaptation and integration The aim of this program is to increase effectiveness of surgical treatment of children with hydrocephalia. For this purpose by pass grafts, necessary for operation will be purchased on the wholesale basis The aim of this program is provision of affordability to treatment of children with oncohaematologic diseases The basic principles of UNO General Assembly consider the maximum support of independence, active participation, provision with care, realization of inner potential and dignity of the elderly population In purpose to elaborate federal program of deinstitutionalization, the aim of this program is planning of the guaranteed mechanisms and measures for minimizing the rate of children s institutionalization; complete monitoring of children s residential institutions, optimization of residential institutions and analysis of deinstitutionalization possibilities of disabled people The aim of this program (at the initial stage) is to describe current psychological, psychical and economic conditions of disabled people; 2.9. To determine the aspects of living of the disabled people together with healthy contingent; To create conditions for developing a real and effective system for social protection of disabled people; This program is oriented on social integration of disabled children through full realization of their abilities. 3. PROGRAM OF SOCIAL PROVISION VULNERABLE DISABLED It is determined to provide disabled and elderly people living in residential institutions and being full dependants of the State with care, treatment and rehabilitation; to improve their psychical and physical state. In comparison with other programs a new one is focused on the expanding of activities of their social adaptation. 4. PROGRAM FOR ADDITIONAL MEDICAL AND SOCIAL ASSISTANCE OF BLIND AND PERSONS WITH POOR VISION This program aims at additional medical and social rehabilitation of blind people living in Georgia, their monitoring, improvement of their health state; carrying out medical activities to maintain their remained poor ability to see; procurement and distribution of necessary supporting means for people with poor vision (glasses, lenses, walking sticks, etc.); implementation of cultural, educational and employment program. 5. PROGRAM OF SOCIAL REHABILITATION OF DISABLED IDP-S This program aims at creation of such favourable conditions for medico-social rehabilitation of disabled IDPs that will facilitate establishment of universal problem solving system in order to improve health state of disabled IDPs; to define groups at high risk; to carry out medico-psychological, preventive and rehabilitation activities and psycho-somatic rehabilitation depending on the severity of the disorders; to reveal and use working, physical and intellectual capabilities of disabled people; to study and analyze their social condition in dynamics; to reveal and monitor disabled people needing homecare; to render 35

9 homecare to the disabled individuals belonging to the category I; to improve their health through provision with corresponding medications, to provide with dental services (treatment, surgery, dentures) in Tbilisi, Zugdidi, Kutaisi and Kodori region. 6. PROGRAM FOR HEALTH RESORT REHABILITATION OF CITIZENS IN EXTREMELY HARD CONDITIONS The goal of this program is spa-treatment and rehabilitation of the people being in extremely hard conditions. The program is determined to be implemented by NGOs. On this purpose a tender will be carried out in accordance with the Law of State procurements. IV. State Programs for Promotion of Social Protection and Employment of Unemployed This program provides implementation of the goals and objectives of state social policy in the field of labour protection and employment at the minimal level. The financing is mainly envisaged for the programs of active employment (temporary employment and employment facilitating programs). It should be taken into consideration that real financial needs for the fulfillment of the outlined objectives are much higher than planned, but it s irreal to plan mobilization of funds at comparatively higher rate in condition of existing taxation situation. 1. SUPPORT PROGRAM FOR UNEMPLOYED PERSONS This program aims at employment of economically active population and reduction of an unemployment indicator. 2. PROGRAM FOR TEMPORARY AND PERMANENT EMPLOYMENT OF UNEMPLOYED PERSONS This program aims at avoiding marginalization of economically active population and organizing of temporary or permanent (public) working places in order to make less severe the negative consequences of long term unemployment. 3. PROGRAM OF PROFESSIONAL TRAINING-RETRAINING OF UNEMPLOYED AND JOB SEEKER PERSONS This program aims at providing unemployed people of the various categories defined by existing legislation with timely allowances in accordance with the requirement of international labour organization conventions. The priorities distinguished in the programs of the social protection of unemployed people and state employment program are as follows: employment of disabled people, promotion of employment in regions with high level of poverty, employment of the young people and women. 36

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