Biennial Collaborative Agreement (BCA) 2020-2021

Description of the Biennial Collaborative Agreement

This document constitutes a practical framework for collaboration. It has been drawn up in a process of successive consultations between national health authorities and the Secretariat of the WHO Regional Office for Europe.

The collaboration programme for 2020–2021 has started with the bottom-up GPW 13 outcome prioritization process undertaken by the country in cooperation with the Regional Office. This work was carried out as part of WHO’s transformation in the overall context provided by GPW 13. The objective of the bottom-up planning exercise was to determine the priority health outcomes for WHO collaboration with the country during the period 2019–2023. This document further details the collaboration programme, including the prioritized outcomes, proposed outputs, and products and services deliverables.

The outcomes are the desired changes in the Member State’s capacities that result in increased access to services and that ultimately contribute to sustainable changes in the health of populations. These changes in the health of populations are those that the Member State aims to achieve on the basis of its uptake of the WHO Secretariat’s outputs, and hence they are a joint responsibility of the Member State and the Secretariat.

Achieving the prioritized outcomes as identified in this BCA is therefore the responsibility of both the WHO Secretariat and the Government of Georgia.

Different modes of delivery are foreseen in the implementation of this BCA, ranging from country-specific (for outputs that are highly specific to the needs and circumstances of individual countries), to intercountry (addressing countries’ common needs using Region-wide approaches) and multicountry (for subregional needs).

Annex 1: GPW 13 results framework

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Health situation analysis

Georgia is an upper-middle-income country according to the World Bank classification. Over the past decade the country has achieved significant economic growth at an average annual rate of 4,5% and a decline in poverty rates from 36.9% in 2006 to 20.1% in 2018. In 2019 Georgia’s population was estimated at 3.72 million.

Health information system in Georgia needs further improvements to be able to ensure quality data overcoming challenges in civil registration and vital statistics system (death registration, certification and coding of causes of death, population and live birth data, etc.).

Noncommunicable diseases remain the major challenge of the country, with 93% of mortality in Georgia being attributable to Non-Communicable Diseases (NCDs) (led by diseases of circulatory system and cancer).  Prevalence of smoking, alcohol use and obesity are showing an upward trend. The country is losing 2,4% of its Gross Domestic Product (GDP) due to tobacco related death, disability, productivity loss and other burden. NCDs prevention and control is suboptimal, in particular within Primary Health Care (PHC).

Georgia faces many challenges also in the area of communicable diseases. In Tuberculosis (TB) control one of the main challenges remains insufficient adherence to treatment for which sustainable linkage between private clinics, Non-Governmental Organizations (NGOs) and civil society (CS) is needed. HIV epidemic is largely concentrated among men having sex with men, people who inject drugs and their sexual partners. The most critical challenge for HIV national program is low detection rate and late diagnosis. The Hepatitis C Elimination Programme is successfully implemented, under an integrated approach (tackling also HIV and TB) and reaching nation-wide coverage.

In 2018-2019 Georgia was seriously affected by the measles outbreak, being among 3 countries in the Region with the highest incidence per million of population. Georgia is also among 10 countries still endemic for measles.

Antimicrobial Resistance (AMR) is becoming an issue of increased concern. The sub-optimal AMR surveillance and little use of diagnostic support for treatment decisions remains and issue in Georgia, despite endorsing the National AMR Strategy.

Universal Health Coverage (UHC) Programme came into force on 28 February 2013, with over 90% of the resident population entitled to a tightly defined package of state-funded benefits. Despite substantial progress, public health expenditure is still low (2.9 percent of GDP) in comparison to other countries in the Region. Out-of-pocket spending as a percentage of total health expenditure remains to be very high in Georgia (54% in 2018), two thirds of which are for outpatient pharmaceuticals. In July 2017, the package of benefits was expanded for the vulnerable households, pensioners, veterans, disabled persons and  covers essential medicines.

WHO Emergency Preparedness Hub for South Caucasus has been established in WHO Country Office in 2018. Purpose of the Hub is to ensure that the three priority countries (Armenia, Azerbaijan and Georgia) in the Region receive more intensive support to strengthen health system’s capacities for health emergency response, including detection, assessment and reporting of potential public health events of international concern.

The Government endorsed “nationalized Sustainable Development Goals (SDGs)” that include all 17 SDGs. United Nations have signed with the Government the United Nations Partnership for Sustainable Development 2016 – 2020 with 5 focus areas: 1. Democratic governance; 2. Jobs, livelihood and social protection; 3. Education; 4. Health; 5. Human security and community resilience. A Mainstreaming, Acceleration and Policy Support (MAPS) mission and meeting took place in April 2019. The health-related SDGs desk review resulted in draft Health and Sustainable Development report.

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GPW 13 prioritized outcomes and links to Health 2020 and the 2030 Agenda in Georgia

Many of the health reforms initiatives in Georgia focused on strategic objectives of Health 2020, aiming at health for all, reducing health inequities and improving leadership and participatory governance for health. In 2013 the Government started the State health programme “Health for All”, which introduced UHC Programme. Recent initiatives for UHC include development of the National strategic purchasing mechanisms and starting of selective contracting, reorganization of the Social Services Agency; development of the DRG payment system for hospital services and initiation of a large-scale PHC reform, with focus on strengthening PHC services in rural area. Improving access to and quality of medicines is also a top priority, with a new Law on medicines under development and GMP practices under implementation.

Georgia has assumed responsibility to gradually harmonize Georgian legislation with the EU acquis as well as align its policies with the UN conventions and SDGs. The Association Agreement with the EU foresees modernization of the health sphere and step-by-step adjustment to respective European standards as regards to health and well-being. The SDGs have become an integral part of the Government of Georgia institutional and legal reforms.

In Georgia there are some good examples of whole-of government and whole-of-society approach, despite outside the health sector there is limited understanding of the socioeconomic rationale for improving health and for investment through integrated approaches in health promotion, disease prevention and well-being. The best examples could be found in the areas of tobacco control, environment and health, emergency preparedness and response, HIV/TB and Hepatitis C control.

As a response to the key health challenges and in line with Health 2020 and 2030 Agenda in Georgia, as well as with the GPW13,  the following high priority areas have been agreed for collaboration in 2020-2021:

  • Improved access to quality essential health services,
  • Reduced number of people suffering financial hardships,
  • Country health emergency preparedness strengthened,
  • Health emergencies rapidly detected and responded to,
  • Determinants of health addressed leaving no one behind.

In addition, collaboration will be extended in the following areas:

  • Improved availability of essential medicines, vaccines, diagnostics and devices for primary health care,
  • Reduced risk factors through multi sectoral approaches.

Limited technical assistance will also be provided in several other areas, as listed in Annex 2.

From WHO’s side, the collaboration will be coordinated by the WHO Country Office in Georgia. The necessary expertise will be mobilized through all three levels of WHO, including the technical units in WHO Regional Office for Europe and WHO Headquarters. The local Georgian expertise will be continuously developed and used whenever possible.

Annex 2

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Linkage of the BCA with national and international strategic frameworks for Georgia

This BCA for Georgia supports the realization of Georgia’s national health policies and plans:

  • The Georgian Healthcare System State Concept 2014-2020 “Universal Health care and Quality Management for Protection of Patient Rights”,
  • The Universal Healthcare Programme,
  • The NCDs’ Prevention and Control Strategy and the Action Plan 2017-2020,
  • The National Environment and Health Action Plan of Georgia 2018-2022,
  • Strategic Plan for the Elimination of Hepatitis C Virus in Georgia, 2016-2020,
  • Georgian Maternal and new-born health strategy 2017-2030,
  • The National AMR Strategy 2017-2030,
  • Georgia HIV/AIDS National Strategic Plan, 2019-2022,
  • The National Strategy for Tuberculosis Control in Georgia, 2019-2022, and others.

This BCA derives from the Georgia’s United Nations’ Partnership for Sustainable Development (Framework Document) 2016-2020.

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Programmatic priorities for collaboration

The collaboration programme for 2020–2021, as detailed in Annex 2, is grounded in the above analysis and was mutually agreed on and selected in response to public health concerns and ongoing efforts to improve the health status of the population of Georgia. It seeks to facilitate strategic collaboration and enable WHO to make a unique contribution.

Annex 2

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