A SITUATION ASSESSMENT OF REHABILITATION (STARS) IN GEORGIA

J. Gosling¹, S. Eitel², M. Jokhidze³, G. Kurtsikashvili⁴, J. Shad¹, S. Mishra¹, N. Jinjolava⁵

Background: Following the 2017 World Health Organization (WHO) launch of ‘Rehabilitation2030’ and subsequent ‘Call for Action’, Georgia requested technical assistance from WHO to support the Ministry of Internally Displaced Persons from the Occupied Territories, Labor, Health and Social Affairs (MoLHSA) in assessing the rehabilitation situation and developing a rehabilitation national strategic plan within the health system. WHO describes rehabilitation as a set of interventions designed to optimize functioning and reduce disability. The 2014 Georgia Census shows 35% of the population have difficulty functioning.

Purpose: To assess the rehabilitation situation in Georgia via STARS to review rehabilitation provision, strengths, gaps and to create a foundation to formulate a national rehabilitation strategic plan.

Methods: STARS is structured around the building blocks for health system strengthening including leadership and governance, financing, health workforce, service delivery, medicines and technology and health information systems. Data collection for the STARS in Georgia ran from 10-28 February 2020. The assessment comprised over 40 semi-structured interviews, focus group discussions and five site visits with more than 100 stakeholders contributing.

Results: Georgia’s Universal Health Coverage (UHC) benefits 95% of the population, but does not include rehabilitation. Funding for rehabilitation is available from the MoLHSA’s central budget for children and some assistive products. Rehabilitation for adults is not centrally funded. A list of priority assistive products (APL) has not been developed. As at February 2020, there is no national plan for rehabilitation and limited accountability mechanisms between rehabilitation service providers and MoLHSA. Rehabilitation doctors are regulated, but the rest of the workforce is unregulated, lacks standards and has no continuing education requirement. Outcome based care is not the norm and there are many gaps in rehabilitation service provision across the health care continuum. Georgia ratified the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) in 2013. In 2017, Georgia developed the draft Law on the Rights of Persons with Disabilities, however this is not yet approved. The rehabilitation sector in Georgia is evolving but deep linkages with disability, stemming from past technology, treatments and terminology remain.  

Conclusion(s): The Government of Georgia, through MoLHSA, is committed to further developing and strengthening rehabilitation in the country.There are many promising initiatives in the sector, but also many gaps that could benefit from attention and support. Rehabilitation and disability are deeply connected and require disentanglement to emphasize and highlight that rehabilitation is part of the health care continuum for all.

Implications: Agreement on the content and implementation of a national strategy on rehabilitation that involves and includes all relevant ministries, departments and stakeholders is vital for continued and cohesive evolution of rehabilitation in Georgia.
The development of competencies, regulations and licensing requirements is required for rehabilitation staff to ensure quality and safe practice. 

Funding, acknowledgements: WHO work in Georgia is ongoing and financially supported by USAID.

Keywords: Georgia, Rehabilitation, Assisted products

Topic: Disability & rehabilitation

Did this work require ethics approval? No

Institution: WHO

Committee: N/A

Reason: The abstract is based on the yet to be published document "Situational assessment of rehabilitation (STARS) in Georgia" from WHO-MoLHSA