Public Health System Reform: can it affect Human Rights - Case of Georgia Mamuka Djibuti Tbilisi State Medical University

Reform  In 1995, Georgia embarked on health care reform which entailed public health system reform too  The Soviet-style sanitary-epidemiological system was divided into two separate entities – sanitary control and epidemiological service  Ambitious decentralization of public health services – creation of district-level Centers for Public Health  Many core functions of public health were delegated to the city and district government level (e.g. surveillance and control functions, including many that pertain to surveillance data collection, analysis, and response)

Ten years later after the initiation of reforms  System-building innovations have not returned in sustainable health gain: Substantial increase in the incidence of  Vaccine preventable diseases (outbreaks)  sexually transmitted disease  drug abuse  cardiovascular diseases  cancer  injuries  prevalence of smoking  etc

Law on Health Care (communicable disease)  Central and local government is responsible for communicable disease prevention and control  State is responsible for providing free vaccination to population according to the national calendar  State is responsible for providing free antirabies vaccination to population

Immunization Coverage (nationwide)2005 DPT-3, Polio-3 78% Hepatitis B-3 64% Measles-1 85% Measles-2 62%

Vaccine preventable diseases  In 2004, the country experienced a large outbreak of measles (reported incidence 158 per 100,000 population);  In , the country’s official statistics featured  67 fatal cases for rabies  25 fatal cases for diphtheria  25 fatal cases for tetanus Is it violation of the Law? Human rights?

 What is wrong?  There is a law, but problems still exist  It seems that even good law alone is not enough  What are the other factors ???

Other Factors  Low budget allocations to public health (may undermine any reform!)  No formal link between public health centers and health care facilities (it was lost under reforms!)  Inadequate public health workforce in terms of knowledge and skills (was not addressed by the reform at all !!!)  Poor legislation

Poor legislation – an example  Organic law on self governance does not make local governments responsible for ensuring public health  As a result - ignorance of public health by the local governments, which results in serious under funding of local public health services  Now, Law on Public Health (pending) is trying to address this problem

Other problems  In similar manner, human rights are violated among  People exposed to second hand smoke  People living in polluted areas  People with mental illness who could be deinstitutionalized but are not  etc

Potential solutions  Alongside with “Health and Law”, special emphases must be placed on “Public Health and Law”, w hich can help to properly address the aforementioned problems

What needs to be done  Proper education and training of future leaders and professionals may help to advocate for addressing all factors including  Resource allocation  Workforce development  Improving infrastructure  Improving public health services  etc

Thank you !