Publication:
Navigating the Health System : Diabetes Care in Georgia

dc.contributor.authorBalabanova, D.
dc.contributor.authorMcKee, M.
dc.contributor.authorKoroleva, N.
dc.contributor.authorChikovani, I.
dc.contributor.authorGoguadze, K.
dc.contributor.authorKobaladze, T.
dc.contributor.authorAdeyi, O.
dc.contributor.authorRobles, S.
dc.date.accessioned2012-03-30T07:31:40Z
dc.date.available2012-03-30T07:31:40Z
dc.date.issued2009
dc.description.abstractBackground Effective delivery of diabetes care requires integration across specialist teams delivering recognized interventions, a reliable pharmaceutical supply, and promoting self-management. Drawing on a framework incorporating physical, human, intellectual and social resources, the paper examines how these challenges are managed in diabetes care in Georgia. Methods The rapid appraisal study triangulated data from interviews with users, providers and key informants from various institutions in four regions of Georgia; data on clinical and social outcomes from diabetes; legislative and policy documents. Results Diabetes-related mortality in Georgia is among the worst in Europe and Central Asia, in a context of conflict, economic collapse and weak institutions. Essential inputs for diabetes care are in place (free insulin, training for primary care physicians, financed package of care), but constraints within the system hamper the delivery of accessible and affordable care. There are no evidence-based guidelines on diabetes management, formal support and quality assurance. The scope of work of primary care practitioners is limited and they rarely diagnose and manage diabetes, which instead takes place within the vertical system. Access to insulin is problematic in rural areas. Obtaining syringes, supplies and hypoglycemic drugs and self-monitoring equipment remains difficult everywhere. Prevention and effective management of complications is limited, increasing adverse outcomes. Diagnosis and treatment of diabetes complications involve hospital admission and unaffordable out-of-pocket payments. The complexity of pathways to key stages of care obstructs continuous care. There are poor linkages between primary and secondary care and ineffective patient follow-up or monitoring of outcomes. There is little effort to promote self-care, adherence to drug regimens and appropriate lifestyle, or to empower patients. Conclusions Improving diabetes outcomes will involve simplifying pathways to care and drugs, reassessing staff roles and insulin distribution systems. This would require better co-ordination of the inputs into the system and development of an integrated and patient-centred model.en
dc.identifier.citationHealth Policy Plan
dc.identifier.issn0268-1080
dc.identifier.urihttps://hdl.handle.net/10986/5177
dc.language.isoEN
dc.relation.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/igo
dc.rights.holderWorld Bank
dc.titleNavigating the Health System : Diabetes Care in Georgiaen
dc.title.alternativeHealth Policy Planen
dc.typeJournal Articleen
dc.typeArticle de journalfr
dc.typeArtículo de revistaes
dspace.entity.typePublication
okr.doctypeJournal Article
okr.externalcontentExternal Content
okr.identifier.doi10.1093/heapol/czn041
okr.identifier.externaldocumentum1876
okr.identifier.internaldocumentumWOS:000261997100005
okr.journal.nbpages46-54
okr.language.supporteden
okr.peerreviewAcademic Peer Review
okr.region.countryGeorgia
okr.volume24
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