TB REP in country coordination

in Georgia
Tamar Gabunia, Vice chair, Georgia
Country Coordinating Mechanism
Founder, Georgia Family Medicine
Association
Chisinau, Moldova, July 2017
Background
• TB remains a major public health issue in Georgia
• The Georgia Family Medicine Association is a TB-
REP civil society partner
• Georgia is a recipient of the Global Fund to Fight
AIDS, Tuberculosis and Malaria (GFATM) grants to
support implementation of National TB and HIV
responses.
• The country entered the transition phase from
donor to increasingly domestic funding for TB and
HIV responses.
TB-REP activities
Expanding patient-centered care for TB
KAP in Georgia 2016-2017

• Develop TB outpatient Care Model Advocacy Strategy

Strengthening outpatient TB care model in

Georgia 2017-2018
• Develop a concept note on outpatient care model in
Georgia
• Facilitate engagement of private providers in TB
service delivery
• Strengthen capacity of Georgia Patients’ Union
 A conceptual framework that guide TB-REP Projects
implementation in Georgia by GFMA&Patients’ Union
THE RIGHT TO BE
INFORMED High Level advocacy
Access to information and Stakeholder
dialogue
Transparency

ADDRESS ALL NEEDS

COMPREHENSIVELY ACCESS TO CARE:
-Improve quality of TB education Consider new approaches to DOT
and counselling (e.g. VoT, community-based DOT)
Patient
-introduce economic incentives Ensure financial access
and enablers Improve referral mechanisms
-build social partnership

SAFETY
Active Drug Safety
Monitoring
Infection control
Health Care workers TB
surveillance
 What National partnerships are critical for meeting TB-
REP objectives

Parliamentary committee for Health and Social

Issues
Country Coordinating Mechanism for TB, HIV and Malaria,
Ministry of Health
Public TB REP Focal Point
Defender of
Georgia

Policy and Groups’ composition: High Level officials (DM),

advocacy NCDC, National TB Center, Academia, Primary Care
Advisory Providers, Municipalities, CSOs, Former Patients
Group

Private TB-Health TB-REP civil society

Systems Georgia TB Coalition:
Providers partner: GFMA&Patients’
Strengthening Unites 18 CSOs
Networks Union
Working
Group
 National Level coordination
mechanisms for TB response
Policy and Advocacy Advisory TB Health Systems Strengthening
Council Group
• Provide advice and assist the • Recommend on strategic
Government to effectively directions for improving TB
guide transition from the models of care and TB relevant
Global Fund to domestic health financing
funding for TB and HIV
Programs • Advice on practical, country
feasible mechanisms for the
implementation of TB models
at the national, regional and
local levels
Transparency and accountability to civil society achieved through active
involvement of CSOs members and former TB patients
What worked well
• Involvement of Patients’ Union allowed for
making patients voices heard at all levels of
health and social protection systems
• HSS working group created a good platform for
high level dialogue on TB
• Regular interaction through thematic and high
level advocacy meetings allowed for building
professional ties between public health workers,
primary care providers and specialized TB
services
What was achieved
• TB Outpatient Model Advocacy strategy adopted by
Georgia TB coalition at Civil Society Forum in
March 2017
• High level dialogue on addressing systemic issues
for strengthening TB care model in place (including
human resource shortage, introducing results based
financing etc.)
• National Guideline is been updated to include latest
WHO recommendations on DS and DR TB
management and how service should be organized
to improve patient- centeredness and clinical
outcomes
What were critical success factors
• Expression of political will and high level
support by the Ministry and TB-REP focal point
• Dedication of Patients’ Union’s members
• Availability of GF financing to support

▫ (a) CSOs involvement in TB control

▫ (b) Provide Policy and Advocacy specialist of TB-
HSS and Policy and Advocacy Council operations
▫ (c ) TB-REP grant program for advocacy
Challenges
• Concerns about sustainability
• The need for high level advocacy to mitigate
transition risks
• High level decision making and policy changes
require substantial technical resources and time
• Evidence base on patients expectations and
perspective of outpatient care model still weak
• TB outpatient care model implementation plan
has yet to be elaborated