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Situation Assessment of Rehabilitation in Georgia

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Situation Assessment of Rehabilitation in Georgia Situation assessment of rehabilitation in Georgia February 2020 Situation assessment of rehabilitation in Georgia February 2020 Abstract This publication summarizes the current gaps, needs and opportunities for intervention in the field of rehabilitation in Georgia. The situational analysis was conducted under the leadership of Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs and with technical support from the WHO Regional Office for Europe and WHO Country Office, Georgia. It was undertaken in collaboration with different Government ministries and State agencies, development partners, United Nations agencies, nongovernmental organizations, disabled people’s organizations and rehabilitation users. It adopted a realist synthesis approach, responsive to the unique social, cultural, economic and political circumstances in the country. The content of this document serves to provide a snapshot in time – not an in-depth analysis of the entire rehabilitation sector. The assessment focuses on rehabilitation policy and governance, service provision and human resource with the aim of improving access to high-quality rehabilitation services in Georgia. Keywords REHABILITATION IN GEORGIA: SITUATIONAL ANALYSIS. 1. Rehabilitation. 2. Rehabilitation policy. 3. Rehabilitation services. 4. Rehabilitation – human resources. 5. Rehabilitation 2030. 6. Person with disabilities – rehabilitation and assistive products. 7. Universal health coverage. I. World Health Organization. Document number: WHO/EURO:2021-2393-42148-58068. © World Health Organization 2021 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial- ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition: Situation assessment of rehabilitation in Georgia: February 2020. Copenhagen: WHO Regional Office for Europe; 2021”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. (http://www.wipo.int/amc/en/mediation/rules/) Suggested citation. Situation assessment of rehabilitation in Georgia: February 2020. Copenhagen: WHO Regional Office for Europe; 2021. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third- party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Contents Acknowledgements ..................................................................................................................................................v Abbreviations .............................................................................................................................................................vi Executive summary ............................................................................................................................................... viii 1. Background and methodology ..........................................................................................................1 1.1 International, regional and national developments in rehabilitation .......................................2 1.2 Methodology .................................................................................................................................................2 1.2.1 Stage 1 (completion and consolidation of a standard questionnaire) ....................2 1.2.2 Stage 2 (in-country data collection and preliminary read-out) .................................3 1.2.3 Limitations ....................................................................................................................................3 2. Introduction to rehabilitation ............................................................................................................5 3. Health trends and rehabilitation needs in Georgia ..........................................................................7 3.1 Georgia country context ...........................................................................................................................8 3.2 Health context, trends and rehabilitation needs in Georgia ........................................................8 3.2.1 The rise of noncommunicable diseases in Georgia ........................................................8 3.2.2 Georgia’s ageing population ..................................................................................................9 3.2.3 Persons with disability in Georgia ........................................................................................9 3.2.4 Persons with difficulties in functioning ...........................................................................10 4. Overview of Georgia’s health and rehabilitation system ...............................................................11 4.1 Other stakeholders in rehabilitation ..................................................................................................14 5. Governance of rehabilitation ...........................................................................................................15 5.1 Rehabilitation governance and regulatory documents ..............................................................16 5.2 Rehabilitation leadership, planning and coordination ...............................................................17 5.3 Rehabilitation accountability, reporting and transparency .......................................................17 5.4 Governance, procurement and regulation of assistive products ............................................17 6. Rehabilitation financing ...................................................................................................................19 6.1 Mechanisms for health (and rehabilitation) financing ................................................................20 6.1.1 Autonomous Republic of Adjara ........................................................................................22 6.1.2 Payment processes for rehabilitation treatments ........................................................22 6.2 Rehabilitation expenditure ....................................................................................................................22 6.3 Assistive product expenditure .............................................................................................................23 6.4 Out-of-pocket costs of rehabilitation ................................................................................................23 7. Human resources, infrastructure and equipment for rehabilitation ............................................25 7.1 Context of the rehabilitation workforce in Georgia ......................................................................26 7.2 Rehabilitation workforce training .......................................................................................................26 7.2.1 Medical doctors ........................................................................................................................27
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