Human Rights in Patient Care: A Practitioner Guide - Georgia

Health systems can too often be places of punishment, coercion, and violations of basic rights—rather than places of treatment and care. In many cases, existing laws and tools that provide remedies are not adequately used to protect rights.This Practitioner Guide series presents practical how-to manuals for lawyers interested in taking cases around human rights in patient care. The manuals examine patient and provider rights and responsibilities, as well as procedures for protection through both the formal court system and alternative mechanisms in 10 countries.Each Practitioner Guide is country-specific, supplementing coverage of the international and regional framework with national standards and procedures in the following:ArmeniaGeorgiaKazakhstanKyrgyzstanMacedoniaMoldova (forthcoming)RomaniaRussia (forthcoming)SerbiaUkraineThis series is the first to systematically examine the application of constitutional, civil, and criminal laws; categorize them by right; and provide examples and practical tips. As such, the guides are useful for medical professionals, public health mangers, Ministries of Health and Justice personnel, patient advocacy groups, and patients themselves.Advancing Human Rights in Patient Care: The Law in Seven Transitional Countries is a compendium that supplements the practitioner guides. It provides the first comparative overview of legal norms, practice cannons, and procedures for addressing rights in health care in Armenia, Georgia, Kazakhstan, Kyrgyzstan, Macedonia, Russia, and Ukraine.A Legal Fellow in Human Rights in each country is undertaking the updating of each guide and building the field of human rights in patient care through trainings and the development of materials, networks, and jurisprudence. Fellows are recent law graduates based at a local organization with expertise and an interest in expanding work in law, human rights, and patient care. To learn more about the fellowships, please visit health-rights.or

Stroke incidence and 30-day case-fatality in a suburb of Tbilisi: results of the first prospective population-based study in Georgia

BACKGROUND AND PURPOSE: Although stroke is one of the main public health problems worldwide, no study of stroke incidence has been performed in Georgia, and therefore, a population-based registry was established to determine the incidence and case-fatality rates of first-ever stroke. METHODS: We identified all first-ever strokes between November 2000 and July 2003 in a defined population of 51,246 residents in the Sanzona suburb of Tbilisi, the capital of Georgia, using overlapping sources of information and standard diagnostic criteria. RESULTS: A total of 233 first-ever strokes occurred during the study period. The crude annual incidence rate was 165 (95% CI, 145 to 188) per 100,000 residents. The corresponding rate adjusted to the standard "world" population was 103 (95% CI, 89 to 117). In terms of stroke subtype, the crude annual incidence rate per 100,000 inhabitants was 89 (95% CI, 74 to 106) for ischemic stroke, 44 (95% CI, 34 to 57) for intracerebral hemorrhage, 16 (95% CI, 10 to 25) for subarachnoidal hemorrhage, and 16 (95% CI, 10 to 25) for unspecified stroke, and the corresponding case-fatality rates at 1 month were 19.2%, 48.4%, 47.8%, and 69.6%. CONCLUSIONS: The overall stroke incidence rate in an urban population of Georgia is comparable to those reported in developed countries. As for the stroke subtypes, there is an excess of hemorrhagic strokes compared with other registries. Geographical and lifestyle variations may explain these findings, whereas inadequacy of the stroke care system in Georgia might contribute to the high case-fatality. [Authors]]]> Cerebrovascular Accident oai:serval.unil.ch:BIB_31770 2022-05-07T01:14:25Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_31770 La résurrection du Christ dans les apocryphes. Gounelle, R info:eu-repo/semantics/bookPart incollection 2004 Les premiers temps de l'Église. De saint Paul à saint Augustin (Folio Histoire 124), pp. 117-121 Baslez, M-F (ed.) oai:serval.unil.ch:BIB_31771 2022-05-07T01:14:25Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_31771 Le Christ des apocryphes. Gounelle, R info:eu-repo/semantics/bookPart incollection 2004 Les premiers temps de l'Église. De saint Paul à saint Augustin (Folio Histoire 124), pp. 242-245 Baslez, M-F (ed.) oai:serval.unil.ch:BIB_31771256CC87 2022-05-07T01:14:25Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_31771256CC87 Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. info:doi:10.1016/S2213-8587(14)70102-0 info:eu-repo/semantics/altIdentifier/doi/10.1016/S2213-8587(14)70102-0 info:eu-repo/semantics/altIdentifier/pmid/24842598 Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration Danaei, G. Lu, Y. Singh, G.M. Carnahan, E. Stevens, G.A. Cowan, M.J. Farzadfar, F. Lin, J.K. Finucane, M.M. Rao, M. Khang, Y.H. Riley, L.M. Mozaffarian, D. Lim, S.S. Ezzati, M. Aamodt, G. Abdeen, Z. Abdella, N.A. Rahim, H.F. Addo, J. Aekplakorn, W. Afifi, M.M. Agabiti-Rosei, E. Salinas, C.A. Agyemang, C. Ali, M.K. Ali, M.M. Al-Nsour, M. Al-Nuaim, A.R. Ambady, R. Di Angelantonio, E. Aro, P. Azizi, F. Babu, B.V. Bahalim, A.N. Barbagallo, C.M. Barbieri, M.A. Barceló, A. Barreto, S.M. Barros, H. Bautista, L.E. Benetos, A. Bjerregaard, P. Björkelund, C. Bo, S. Bobak, M. Bonora, E. Botana, M.A. Bovet, P. Breckenkamp, J. Breteler, M.M. Broda, G. Brown, I.J. Bursztyn, M. de León, A.C. Campos, H. Cappuccio, F.P. Capuano, V. Casiglia, E. Castellano, M. Castetbon, K. Cea, L. Chang, C.J. Chaouki, N. Chatterji, S. Chen, C.J. Chen, Z. Choi, J.S. Chua, L. Cífková, R. Cobiac, L.J. Cooper, R.S. Corsi, A.M. Costanza, M.C. Craig, C.L. Dankner, R.S. Dastgiri, S. Delgado, E. Dinc, G. Doi, Y. Dong, G.H. Dorsi, E. Dragano, N. Drewnowski, A. Eggertsen, R. Elliott, P. Engeland, A. Erem, C. Esteghamati, A. Fall, C.H. Fan, J.G. Ferreccio, C. Fezeu, L. Firmo, J.O. Florez, H.J. Fornés, N.S. Fowkes, F.G. Franceschini, G. Frisk, F. Fuchs, F.D. Fuller, E.L. Getz, L. Giampaoli, S. Gómez, L.F. Gomez-Zumaquero, J.M. Graff-Iversen, S. Grant, J.F. Carvajal, R.G. Gulliford, M.C. Gupta, R. Gupta, P.C. Gureje, O. Gutierrez, H.R. Hansen, T.W. Hata, J. He, J. Heim, N. Heinrich, J. Hemmingsson, T. Hennis, A. Herman, W.H. Herrera, V.M. Ho, S. Holdsworth, M. Frisman, G.H. Hopman, W.M. Hussain, A. Husseini, A. Ibrahim, M.M. Ikeda, N. Jacobsen, B.K. Jaddou, H.Y. Jafar, T.H. Janghorbani, M. Jasienska, G. Joffres, M.R. Jonas, J.B. Kadiki, O.A. Kalter-Leibovici, O. Kamadjeu, R.M. Kaptoge, S. Karalis, I. Kastarinen, M.J. Katz, J. Keinan-Boker, L. Kelly, P. Khalilzadeh, O. Kiechl, S. Kim, K.W. Kiyohara, Y. Kobayashi, J. Krause, M.P. Kubínová, R. Kurjata, P. Kusuma, Y.S. Lam, T.H. Langhammer, A. Lawes, C.M. Le, C. Lee, J. Lévy-Marchal, C. Lewington, S. Li, Y. Li, Y. Lim, T.O. Lin, X. Lin, C.C. Lin, H.H. Lind, L. Lissner, L. Liu, X. Lopez-Jaramillo, P. Lorbeer, R. Ma, G. Ma, S. Macià, F. MacLean, D.R. Maggi, S. Magliano, D.J. Makdisse, M. Mancia, G. Mannami, T. Marques-Vidal, P. Mbanya, J.C. McFarlane-Anderson, N. Miccoli, R. Miettola, J. Minh, H.V. Miquel, J.F. Miranda, J.J. Mohamed, M.K. Mohan, V. Mohanna, S. Mokdad, A. Mollentze, W.F. Morales, D.D. Morgan, K. Muiesan, L.M. Muntoni, S. Nabipour, I. Nakagami, T. Nangia, V. Nemesure, B. Neovius, M. Nerhus, K.A. Nervi, F. Neuhauser, H. Nguyen, M. Ninomiya, T. Noale, M. Oh, S.W. Ohkubo, T. Olivieri, O. Önal, A.E. Onat, A. Oróstegui, M. Ouedraogo, H. Pan, W.H. Panagiotakos, D.B. Panza, F. Park, Y. Passos, V.M. Pednekar, M.S. Pelizzari, P.M. Peres, M.A. Pérez, C. Pérez-Fernández, R. Pichardo, R. Phua, H.P. Pistelli, F. Plans, P. Polakowska, M. Poulter, N. Prabhakaran, D. Qiao, Q. Rafiei, M. Raitakari, O.T. Ramos, L.R. Rampal, S. Rampal, L. Rasmussen, F. Reddy, K.K. Redon, J. Revilla, L. Reyes-García, V. Roaeid, R.B. Robinson, C.A. Rodriguez-Artalejo, F. Rojas-Martinez, R. Ronkainen, K. Rosero-Bixby, L. Roth, G.A. Sachdev, H.S. Sánchez, J.R. Sanisoglu, S.Y. Sans, S. Sarraf-Zadegan, N. Scazufca, M. Schaan, B.D. Schapochnik, N. Schelleman, H. Schneider, I.J. Schooling, C.M. Schwarz, B. Sekuri, C. Sereday, M.S. Serra-Majem, L. Shaw, J. Shera, A.S. Shi, Z. Shiri, R. Shu, X.O. Silva, D.A. Silva, E. Simons, L.A. Smith, M. Söderberg, S. Soebardi, S. Solfrizzi, V. Sonestedt, E. Soysal, A. Stattin, P. Stein, A.D. Stergiou, G.S. Stessman, J. Sudo, A. Suka, M. Sundh, V. Sundquist, K. Sundström, J. Swai, A.B. Tai, E.S. Tambs, K. Tesfaye, F. Thomas, G.N. Thorogood, M. Tilvis, R.S. Tobias, M. Torheim, L.E. Trenkwalder, P. Tuomilehto, J.O. Tur, J.A. Tzourio, C. Uhernik, A.I. Ukoli, F.A. Unwin, N. Hoorn, S.V. Vanderpump, M.P. Varo, J.J. Veierød, M.B. Velásquez-Meléndez, G. Verschuren, M. Viet, L. Villalpando, S. Vioque, J. Vollenweider, P. Volpato, S. Wang, N. Wang, Y.X. Ward, M. Waspadji, S. Welin, L.X. Whitlock, G. Wilhelmsen, L. Willeit, J. Woodward, M. Wormser, D. Xavier, A.J. Xu, F. Xu, L. Yamamoto, A. Yang, G. Yang, X. Yeh, L.C. Yoon, J.S. You, Q. Yu, Z. Zhang, J. Zhang, L. Zheng, W. Zhou, M. Ward, M. info:eu-repo/semantics/article article 2014-08</

Influence of household demographic and socio-economic factors on household expenditure on tobacco in six New Independent States

<p>Abstract</p> <p>Background</p> <p>To identify demographic and socio-economic factors that are associated with household expenditure on tobacco in Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Russian Federation, and Tajikistan.</p> <p>Methods</p> <p>Secondary analysis of the data available through the World Bank Living Standards Monitoring Survey conducted in aforementioned countries in 1995–2000. The role of different variables (e.g. mean age of household members, household area of residence, household size, share of adult males, share of members with high education) in determining household expenditure on tobacco (defined as tobacco expenditure share out of total monthly HH consumption) was assessed by using multiple regression analysis.</p> <p>Results</p> <p>Significant differences were found between mean expenditure on tobacco between rich and poor – in absolute terms the rich spend significantly more compared with the poor. Poor households devote significantly higher shares of their monthly HH consumption for tobacco products. Shares of adult males were significantly associated with the share of household consumption devoted for tobacco. There was a significant negative association between shares of persons with tertiary education within the HH and shares of monthly household consumption devoted for tobacco products. The correlation between household expenditures on tobacco and alcohol was found to be positive, rather weak, but statistically significant.</p> <p>Conclusion</p> <p>Given the high levels of poverty and high rates of smoking in the New Independent States, these findings have important policy implications. They indicate that the impact and opportunity costs of smoking on household finances are more significant for the poor than for the rich. Any reductions in smoking prevalence within poor households could have a positive economic impact.</p

Health system barriers to strengthening vaccine-preventable disease surveillance and response in the context of decentralization: evidence from Georgia

BACKGROUND: A critical challenge in the health sector in developing countries is to ensure the quality and effectiveness of surveillance and public health response in an environment of decentralization. In Georgia, a country where there has been extensive decentralization of public health responsibilities over the last decade, an intervention was recently piloted to strengthen district-level local vaccine-preventable disease surveillance and response activities through improved capacity to analyze and use routinely collected data. The purpose of the study is 1) to assess the effectiveness of the intervention on motivation and perceived capacity to analyze and use information at the district-level, and 2) to assess the role that individual- and system-level factors play in influencing the effectiveness of the intervention. METHODS: A pre-post quasi-experimental research design is used for the quantitative evaluation. Data come from a baseline and two follow-up surveys of district-level health staff in 12 intervention and 3 control Center of Public Health (CPH) offices. These data were supplemented by record reviews in CPH offices as well as focus group discussions among CPH and health facility staff. RESULTS: The results of the study suggest that a number of expected improvements in perceived data availability and analysis occurred following the implementation of the intervention package, and that these improvements in analysis could be attributable to the intervention package. However, the study results also suggest that there exist several health systems barriers that constrained the effectiveness of the intervention in influencing the availability of data, analysis and response. CONCLUSION: To strengthen surveillance and response systems in Georgia, as well as in other countries, donor, governments, and other stakeholders should consider how health systems factors influence investments to improve the availability of data, analysis, and response. Linking the intervention to broader health sector reforms in management processes and organizational culture will be critical to ensure that efforts designed to promote evidence-based decision-making are successful, especially as they are scaled up to the national level

The role of supportive supervision on immunization program outcome - a randomized field trial from Georgia

<p>Abstract</p> <p>Background</p> <p>One of the most common barriers to improving immunization coverage rates is human resources and its management. In the Republic of Georgia, a country where widespread health care reforms have taken place over the last decade, an intervention was recently implemented to strengthen performance of immunization programs. A range of measures were taken to ensure that immunization managers carry out their activities effectively through direct, personal contact on a regular basis to guide, support and assist designated health care facility staff to become more competent in their immunization work. The aim of this study was to document the effects of "supportive" supervision on the performance of the immunization program at the district(s) level in Georgia.</p> <p>Methods</p> <p>A pre-post experimental research design is used for the quantitative evaluation. Data come from baseline and follow-up surveys of health care providers and immunization managers in 15 intervention and 15 control districts. These data were supplemented by focus group discussions amongst Centre of Public Health and health facility staff.</p> <p>Results</p> <p>The results of the study suggest that the intervention package resulted in a number of expected improvements. Among immunization managers, the intervention independently contributed to improved knowledge of supportive supervision, and helped remove self-perceived barriers to supportive supervision such as availability of resources to supervisors, lack of a clear format for providing supportive supervision, and lack of recognition among providers of the importance of supportive supervision. The intervention independently contributed to relative improvements in district-level service delivery outcomes such as vaccine wastage factors and the DPT-3 immunization coverage rate. The clear positive improvement in all service delivery outcomes across both the intervention and control districts can be attributed to an overall improvement in the Georgian population's access to health care.</p> <p>Conclusion</p> <p>Provider-based interventions such as supportive supervision can have independent positive effects on immunization program indicators. Thus, it is recommended to implement supportive supervision within the framework of national immunization programs in Georgia and other countries in transition with similar institutional arrangements for health services organization.</p> <p>Abstract in Russian</p> <p>See the full article online for a translation of this abstract in Russian.</p

Human resources for health challenges of public health system reform in Georgia

<p>Abstract</p> <p>Background</p> <p>Human resources (HR) are one of the most important components determining performance of public health system. The aim of this study was to assess adequacy of HR of local public health agencies to meet the needs emerging from health care reforms in Georgia.</p> <p>Methods</p> <p>We used the Human Resources for Health Action Framework, which includes six components: HR management, policy, finance, education, partnerships and leadership. The study employed: (a) quantitative methods: from September to November 2004, 30 randomly selected district Centers of Public Health (CPH) were surveyed through face-to-face interviews with the CPH director and one public health worker randomly selected from all professional staff; and (b) qualitative methods: in November 2004, Focus Group Discussions (FGD) were held among 3 groups: a) 12 district public health professionals, b) 11 directors of district public health centers, and c) 10 policy makers at central level.</p> <p>Results</p> <p>There was an unequal distribution of public health workers across selected institutions, with lack of professionals in remote rural district centers and overstaffing in urban centers. Survey respondents disagreed or were uncertain that public health workers possess adequate skills and knowledge necessary for delivery of public health programs. FGDs shed additional light on the survey findings that there is no clear vision and plans on HR development. Limited budget, poor planning, and ignorance from the local government were mentioned as main reasons for inadequate staffing. FGD participants were concerned with lack of good training institutions and training programs, lack of adequate legislation for HR issues, and lack of necessary resources for HR development from the government.</p> <p>Conclusion</p> <p>After ten years of public health system reforms in Georgia, the public health workforce still has major problems such as irrational distribution and inadequate knowledge and skills. There is an urgent need for re-training and training programs and development of conducive policy environment with sufficient resources to address these problems and assure adequate functionality of public health programs.</p

Human resource management in the Georgian National Immunization Program: a baseline assessment

Background: Georgia's health care system underwent dramatic reform after gaining independence in 1991. The decentralization of the health care system was one of the core elements of health care reform but reports suggest that human resource management issues were overlooked. The Georgian national immunization program was affected by these reforms and is not functioning at optimum levels. This paper describes the state of human resource management practices within the Georgian national immunization program in late 2004. Methods: Thirty districts were selected for the study. Within these districts, 392 providers and thirty immunization managers participated in the study. Survey questionnaires were administered through face-to-face interviews to immunization managers and a mail survey was administered to immunization providers. Qualitative data collection involved four focus groups. Analysis of variance (ANOVA) and Chi-square tests were used to test for differences between groups for continuous and categorical variables. Content analysis identified main themes within the focus groups. Results: Weak administrative links exist between the Centres of Public Health (CPH) and Primary Health Care (PHC) health facilities. There is a lack of clear management guidelines and only 49.6% of all health providers had written job descriptions. A common concern among all respondents was the extremely inadequate salary. Managers cited lack of authority and poor knowledge and skills in human resource management. Lack of resources and infrastructure were identified as major barriers to improving immunization. Conclusion: Our study found that the National Immunization Program in Georgia was characterized by weak organizational structure and processes and a lack of knowledge and skills in management and supervision, especially at peripheral levels. The development of the skills and processes of a well-managed workforce may help improve immunization rates, facilitate successful implementation of remaining health care reforms and is an overall, wise investment. However, reforms at strategic policy levels and across sectors will be necessary to address the systemic financial and health system constraints impeding the performance of the immunization program and the health care system as a whole

The 2022 symposium on dementia and brain aging in low‐ and middle‐income countries: Highlights on research, diagnosis, care, and impact

Two of every three persons living with dementia reside in low‐ and middle‐income countries (LMICs). The projected increase in global dementia rates is expected to affect LMICs disproportionately. However, the majority of global dementia care costs occur in high‐income countries (HICs), with dementia research predominantly focusing on HICs. This imbalance necessitates LMIC‐focused research to ensure that characterization of dementia accurately reflects the involvement and specificities of diverse populations. Development of effective preventive, diagnostic, and therapeutic approaches for dementia in LMICs requires targeted, personalized, and harmonized efforts. Our article represents timely discussions at the 2022 Symposium on Dementia and Brain Aging in LMICs that identified the foremost opportunities to advance dementia research, differential diagnosis, use of neuropsychometric tools, awareness, and treatment options. We highlight key topics discussed at the meeting and provide future recommendations to foster a more equitable landscape for dementia prevention, diagnosis, care, policy, and management in LMICs. Highlights: Two‐thirds of persons with dementia live in LMICs, yet research and costs are skewed toward HICs. LMICs expect dementia prevalence to more than double, accompanied by socioeconomic disparities. The 2022 Symposium on Dementia in LMICs addressed advances in research, diagnosis, prevention, and policy. The Nairobi Declaration urges global action to enhance dementia outcomes in LMICs