Georgian Medical Journal (GMJ)
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Palliative Care as a Health System Indicator in Georgia: Unmet Need, Access Barriers, and Policy Implications
No full textBackground:Palliative care is increasingly recognised as a fundamental component of universal health coverage (UHC) and people-centred health systems. The World Health Organization estimates that approximately 56.8 million people worldwide require palliative care each year, including individuals in the final stages of life and patients living with chronic or progressive illness who require symptom management and supportive care [1,2]. However, only about 14% of those who need palliative care globally receive it, with the greatest unmet need concentrated in low- and middle-income countries [1,2]. The Lancet Commission on Palliative Care and Pain Relief estimated that more than 61 million people experience serious health-related suffering annually, driven largely by cancer, cardiovascular diseases, chronic respiratory diseases, neurological disorders, and advanced organ failure [3]. Demographic ageing and the rising prevalence of non-communicable diseases are expected to substantially increase the global demand for palliative care in the coming decades [4].
Methods:This article presents a policy-oriented narrative review and conceptual analysis based on international literature, national policy documents, and health system statistics. The analysis synthesised evidence from three complementary domains: global research on palliative care needs and serious health-related suffering; Georgia-specific literature and policy frameworks addressing the development of palliative care services and opioid access; and national health system statistics describing healthcare infrastructure, workforce capacity, and service utilisation. Evidence from these sources was integrated to examine how structural characteristics of the Georgian health system influence access to palliative care services and pain management within the broader context of health system performance [5–8].
Results:Global evidence demonstrates a persistent mismatch between palliative care need and service availability. Research indicates that more than 80% of the global population lives in countries with inadequate access to opioid analgesics, while a small number of high-income countries account for the majority of global morphine consumption for medical purposes [9]. In Georgia, available evidence suggests that palliative care services remain limited in geographic coverage and insufficiently integrated within mainstream healthcare delivery. Major constraints include concentration of services in urban centres, limited development of community- and home-based palliative care models, gaps in workforce training, and administrative and regulatory barriers affecting opioid prescribing and dispensing practices. These challenges indicate that palliative care access in Georgia is constrained not only by service availability but also by broader structural factors within the healthcare system [10–13].
Conclusions:Palliative care in Georgia should be interpreted not only as a specialised clinical service but also as a health system performance indicator reflecting equity of access, continuity of care, and availability of essential medicines. Persistent gaps in service coverage, opioid accessibility, workforce capacity, and community-based care reveal broader structural weaknesses within the healthcare system. Strengthening palliative care in Georgia will require expansion of community-based services, balanced opioid policy implementation, improved professional training, and systematic monitoring of service coverage and equity indicators. The Georgian case illustrates how palliative care can function as a tracer condition for evaluating health system responsiveness and equity in countries undergoing demographic and epidemiological transition.
Keywords:palliative care; health systems; universal health coverage; serious health-related suffering; opioid access; health equity; Georgi
COVID-19 Webinar Series Session 8: What Next for Agenda 2030? — The COVID-19 Crisis, Inequality, and the Future of the SDGs (GCSP, 2020): Reference Summary (Video)
No full textThis reference summary presents key information from the following video: https://youtu.be/nq-80Wl_3iI. The source is a webinar session published by the Geneva Centre for Security Policy (GCSP) as part of its “Global Crisis, Global Risk and Global Consequences” series. The session examines the impact of the COVID-19 pandemic on global development and the Sustainable Development Goals (SDGs), focusing on how the crisis has intensified existing social and economic inequalities. The discussion highlights the disruption of health systems, supply chains and economic stability, with long-term consequences for vulnerable populations. The webinar brings together leading experts in global health, nutrition, education and policy to analyze how the pandemic threatens progress toward Agenda 2030 and to propose strategies for recovery. It emphasizes the importance of accountability, equity and coordinated international action to ensure that no one is left behind and to support the transition toward more resilient and inclusive systems
Where Is the Accountability to Adolescents? (The Lancet, 2017): Reference Summary (Article)
No full textThis reference summary presents key information from the following article: https://doi.org/10.1016/S0140-6736(17)32482-0. The source is a commentary titled “Where is the accountability to adolescents?”, authored by Barroso C and Gautam KC, on behalf of the United Nations Secretary-General’s Independent Accountability Panel for Every Woman, Every Child, Every Adolescent (IAP: Nicholas Kojo Alipui, Dame Carol Kidu, Brenda Killen, Elizabeth Mason, Giorgi Pkhakadze, Jovana Ríos Cisnero, Gita Sen, Alicia Ely Yamin, Kul Chandra Gautam, and Joy Phumaphi), and published in The Lancet in 2017. The article highlights gaps in accountability frameworks related specifically to adolescent health, emphasizing that adolescents are often overlooked in policy, data systems, and implementation strategies. It underscores the need for targeted monitoring, inclusive governance, and stronger accountability mechanisms to ensure that adolescent health and rights are adequately addressed within the Sustainable Development Goals (SDGs). The discussion reinforces the importance of recognizing adolescents as a distinct population group and ensuring their inclusion in health system planning and evaluation
Patient-centred Care in Liver Transplantation in Georgia:Implications for Professionalism, Communication, and Accredited Transplant Services
No full textLiver transplantation represents one of the most complex and ethically demanding domains of contemporary healthcare, characterised by prolonged care pathways, organ scarcity, and heightened vulnerability of both recipients and living donors. In Georgia, the expansion of liver transplant services over the past decade has demonstrated increasing clinical capacity while simultaneously exposing systemic challenges related to access, communication, continuity, and ethical governance. This commentary examines patient-centred care in liver transplantation as an organisational and educational responsibility rather than an individual professional attribute. Drawing on international transplant evidence, Georgian clinical experience, and accreditation standards governing access, intake, informed consent, living donation, and ethics oversight, the article argues that patient-centred transplant care can only be sustained through integrated systems of professionalism, communication, and institutional accountability
Public Health Policy as Educational: Beyond Short Term Behaviour Change in Non-Communicable Disease Prevention
No full textPublic health policies to prevent non-communicable diseases (NCDs) are typically assessed through their short-term behavioural effects, yet their longer-term normative and educational influences are also key to consider. This commentary argues that public health policy should also be understood as a mechanism that shapes social norms, preferences, and autonomy over time. Recognising this guiding role is essential for a fuller evaluation of policy legitimacy and impact in contemporary NCD prevention
ჯანდაცვის ეფექტურობის გაუმჯობესება IT სერვის მენეჯმენტის მეშვეობით
No full textOperational inefficiencies in healthcare systems remain a major and under-addressed determinant of system performance, cost, and patient outcomes. Global evidence suggests that up to 20–40% of health expenditure is lost due to inefficiencies, including poor procurement practices, fragmented workflows, and weak coordination mechanisms [6,23]. In parallel, stockouts of essential medicines affect 30–50% of healthcare facilities in many low- and middle-income countries, highlighting systemic failures in operational processes that directly compromise service delivery [9,13].
Despite extensive focus on financing, workforce capacity, and access to services, current health system frameworks provide limited guidance on how internal operational workflows should be structured, governed, and monitored. This creates a critical policy gap between system-level objectives and their execution in routine healthcare operations.
This study presents a policy analysis and conceptual framework, examining the applicability of IT Service Management (ITSM), grounded in the ITIL framework, as an operational governance approach for healthcare systems. Drawing on cross-sectoral evidence from service management, health systems research, and procurement literature, the analysis maps ITSM practices to healthcare workflows and develops a service-oriented model for managing operational processes.
The findings suggest that ITSM can function as a governance translation layer, aligning clinical demand, administrative workflows, and digital systems into a structured service architecture. By introducing standardized request mechanisms, incident-based management of disruptions, and measurable service-level performance, ITSM enables healthcare organizations to improve coordination, transparency, and accountability. Evidence from service environments indicates that such approaches can reduce operational delays by 20–30%, with potential implications for improving reliability of care delivery [3,29].
This analysis positions ITSM as a policy-relevant governance framework for strengthening healthcare system performance. Its adoption offers a scalable pathway to improving efficiency, service reliability, and system resilience, particularly in resource-constrained settings. However, the framework remains conceptual and requires empirical validation through implementation and evaluation in real-world healthcare environments.
Keywords: Health systems governance; IT Service Management; Healthcare operations; Procurement systems; Service delivery; Operational efficiency; Health system resilienceჯანდაცვის დაწესებულებები სულ უფრო ხშირად აწყდებიან ოპერაციულ გამოწვევებს, როგორიცაა შესყიდვების დაგვიანება, ფრაგმენტული სამუშაო პროცესები და სერვისების მიწოდების პროცესების ნაკლები გამჭვირვალობა. გამოწვევები პირდაპირ გავლენას ახდენს პაციენტების უსაფრთხოებაზე, მომსახურების უწყვეტობაზე და დაწესებულების მდგრადობაზე.
ეს სტატია განიხილავს, როგორ შეიძლება IT სერვის მენეჯმენტის (ITSM) პრაქტიკების, რომელიც დაფუძნებულია ITIL ჩარჩოზე, ადაპტირება ტრადიციულ IT გარემოს გარეთ, რათა გაუმჯობესდეს ოპერაციული ეფექტურობა ჯანდაცვის დაწესებულებებში. განსაკუთრებული ყურადღება გამახვილებულია შესყიდვებთან და მიწოდებასთან დაკავშირებულ პროცესებზე, მათ შორის მედიკამენტებისა და სამედიცინო აღჭურვილობის დროულ მიწოდებაზე.
სტატია ასევე სწავლობს ციფრული სერვის მენეჯმენტის პლატფორმების, როგორიცაა Atlassian-ის Jira, როლს ოპერაციული სამუშაო პროცესების სტრუქტურირებაში, ავტომატიზაციაში და მონიტორინგში.
წარმოდგენილია მასშტაბირებადი, სერვისზე ორიენტირებული მოდელი, რომელიც ხელს უწყობს გამჭვირვალობას, ანგარიშვალდებულებას და გადაწყვეტილებების მიღების პროცესის გაუმჯობესებას. შედეგები მიუთითებს, რომ ITSM პრაქტიკები მნიშვნელოვანი წვლილი შეაქვთ ჯანდაცვის ოპერაციული ეფექტურობისა და სერვისების უწყვეტობის გაძლიერებაში
PMNCH Accountability Breakfast — UN General Assembly Week High-Level Event (2018): Reference Summary (Video)
No full textThis reference summary presents key information from the following video: https://youtu.be/JFZrtC5Uf98. The source is a recording of the Partnership for Maternal, Newborn & Child Health (PMNCH) annual Accountability Breakfast, held on 23 September 2018 in the lead-up to the United Nations General Assembly (UNGA) High-Level Week in New York. The event brought together global leaders and policymakers to discuss accountability in advancing women’s, children’s and adolescents’ health within the Sustainable Development Goals framework. High-level speakers included Michelle Bachelet, United Nations High Commissioner for Human Rights and former President of Chile; Graça Machel, founder of the Graça Machel Trust; Gabriela Cuevas Barron, President of the Inter-Parliamentary Union; and Elhadj As Sy, President of the International Federation of Red Cross and Red Crescent Societies. The discussion emphasized the importance of leadership, human rights, and accountability mechanisms in ensuring equitable health outcomes and sustaining global commitments
PMNCH Accountability Breakfast 2024 — Accelerating Action to End Preventable Maternal, Newborn and Child Mortality (WHA77 Implementation): Reference Summary (Video)
No full textThis reference summary presents key information from the following video: https://youtu.be/H7B4tvlpl4A. The source is a high-level event organized by the Partnership for Maternal, Newborn & Child Health (PMNCH), marking its 12th annual Accountability Breakfast held in 2024. The discussion focuses on accelerating action to reduce preventable maternal, newborn and child mortality in the context of the World Health Assembly Resolution WHA77. The event emphasizes the transition from commitments to implementation, highlighting accountability as a central mechanism for achieving measurable progress at country level. Speakers underscore the ongoing global health crisis, noting that thousands of preventable child deaths occur daily, particularly in fragile and conflict-affected settings. The discussion explores the role of civil society, youth engagement, and multistakeholder collaboration in advancing health equity. It further highlights the importance of data-driven decision-making, political leadership, and sustained financing to strengthen health systems. The session concludes with a call for urgent, coordinated action, emphasizing that behind every statistic are lives that require immediate and sustained attention
IAP 2020 Report Reflections and Recommendations — Accountability for SDGs and Rights (Independent Accountability Panel, 2020): Reference Summary (Video)
No full textThis reference summary presents key information from the following presentation: https://youtu.be/ltUdmpXpf68. The source is a video produced by the United Nations Secretary-General’s Independent Accountability Panel (IAP) for Every Woman, Every Child and published on 31 December 2020. The video shares reflections and recommendations from IAP members based on the 2020 report, focusing on accountability as a key mechanism for achieving the Sustainable Development Goals (SDGs) and advancing health and rights during and after the COVID-19 pandemic. It emphasizes that accountability is a shared responsibility, requiring engagement from governments, institutions, and communities, and highlights the importance of applying the IAP accountability framework to support transparent, inclusive, and evidence-informed decision-making. The discussion reinforces the role of accountability in strengthening health systems and ensuring that no one is left behind
Dr. David Nabarro — Video Message, HLPF 2016 EWEC Side Event, New York, USA (19 July 2016, EWEC): Reference Summary (Video)
No full textThis reference summary presents key information from the following presentation: https://youtu.be/PrLLfH0ya1g. The source is a video titled “Dr. David Nabarro – Video Message – HLPF 2016 EWEC Side Event”, produced by Every Woman Every Child (EWEC) and published on 21 July 2016. The message was delivered for a high-level EWEC side event held on 19 July 2016 in New York, USA, during the United Nations High-Level Political Forum on Sustainable Development. The session focuses on strengthening accountability for action and results in advancing the Global Strategy for Women’s, Children’s and Adolescents’ Health. It highlights the importance of cross-sectoral collaboration among governments, civil society, private sector, youth, and citizen representatives to accelerate progress toward the Sustainable Development Goals (SDGs). The discussion emphasizes shared responsibility, coordinated action, and the role of accountability mechanisms in ensuring measurable and sustainable outcomes