The American International Health Alliance (AIHA) and the United States
Agency for International Development (USAID) Announce a
Grants Competition

NIS Health Partnerships Program/Republic of Georgia

Date Issued: March 18, 1999
Closing Date and Time: April 19, 1999 12:00 Noon (EST)

The announcement below is excerpted from a solicitation by AIHA for  new
partnerships in the Republic of Georgia.  Separate announcements were
previously disseminated for new partnerships in West NIS, Central Asia, and
the Russian Federation.  Up to four partnerships in Armenia and additional
partnerships in Azerbaijan will be established through subsequent
solicitations.

For further information, please see the full-text of these solicitations,
which are available at:

        http://www.aiha.com/english/partners/newpartn/index.htm

Questions regarding this solicitation should be directed via e-mail to
[log in to unmask] or via fax at (202) 789-1277, Attention: NISSOLICIT.

I.  Summary

AIHA and USAID are pleased to announce a grants competition in support of
establishing new partnerships between US health-related institutions and
their counterparts in the New Independent States (NIS) of the former Soviet
Union, as part of the NIS Health Partnerships Program.  AIHA is soliciting
applications from qualified US health-related institutions willing to
devote substantial in-kind resources, mainly in the form of human resources
committed on a volunteer basis, to a 3 to 4-year partnership with
counterparts in the Caucasus region, in accordance with the strategic
direction of USAID.  Through this solicitation AIHA will award up to three
partnerships in the Republic of Georgia.  Two of these new partnerships
will focus on improving primary care through the development of
community-based models that show meaningful results locally and are
replicable nationally.  One partnership will address the development of a
health management education program.  Up to four partnerships in Armenia
and additional partnerships in Azerbaijan will be established through
subsequent solicitations.

IX. Partnership Descriptions

Background:  In the final years of the Soviet Union, the economies and
social structures of Armenia, Azerbaijan, and Georgia all experienced
growing difficulties.  The breakup of the former Soviet Union significantly
exacerbated these problems.  For example, gross domestic product of
Georgia, the most severely affected of the three countries, fell by
approximately 90 percent between 1991 and 1994.  In large part, the
economic disruptions reflected the often artificial economic relationships
developed by the Soviet Union. When those relationships dissolved, the
underlying inefficiencies became apparent.  The resulting macroeconomic
shock led to massive closure of plants, rampant unemployment, and the
ruinous decline in government services such as public utilities and in
social welfare programs such as health delivery.

In addition, all three countries have experienced costly civil and military
strife, most notably in the regions of Nagorny-Karabakh, South Ossetia, and
Abkhazia. Finally, natural disasters, especially in Armenia, have
aggravated the already enormous burden faced by the three nations.

As noted by the USAID Health Assessment Team that conducted assessments in
Armenia, Georgia and Azerbaijan in 1998, "the health delivery systems of
all three countries are characterized by massive excess capacity and an
absence of patients.  The Caucasus nations have too many hospitals, too
many beds, and too many hospital-based medical specialists". Virtually all
facilities are now in disrepair; lack necessary medical equipment, drugs,
and supplies; and cannot afford the energy necessary to provide heat and
light and to power the minimal medical equipment available.  Many
facilities now lack running water, effective sanitation or sterilization,
continuous electricity or telephone systems.

Overwhelmingly, physicians and related health personnel are hospital-based
specialists, too many of whom are inadequately trained. Moreover, because
of the economic collapse, the official salaries paid to virtually all
physicians and other care providers are inadequate to meet basic living
needs, leading to the creation of incentives that have affected provider
behaviors in undesirable ways.  Despite the overall surplus of physicians,
all three countries suffer from an inadequate supply of appropriately
trained primary care physicians and primary care service.

Although the incidence of some infectious diseases such as tuberculosis and
STDs has increased in the last several years, epidemiological profiles
indicate that cardiovascular diseases, cancers, and other "life-style"
diseases are the leading causes of morbidity and mortality in the three
Caucasus nations.  Nevertheless, the medical establishment devotes little
attention to disease prevention, health promotion, and lifestyle
modification programs, which, in the long run, have the greatest effect on
reducing a population's disease burden.  Mental health disorders and
injuries (including automobile accidents) appear to be seriously
underreported and are undoubtedly high.  Serious reproductive and maternal
and child health concerns remain in pockets of each of the three republics."

AIHA Partnership Strategy:  In support of USAID's strategy to improve
primary health care outside of the capital, and at the recommendation of
the Ministry of Health of Georgia, AIHA will establish two new partnerships
to implement model, community-oriented primary care service delivery
systems in the Mtskheta-Mtsianeti and Imereti regions.  The regions chosen
are intended by the Ministry of Health to serve as model demonstration
sites and will be coordinated with the World Bank investments in Georgia.
In addition, AIHA will develop a Health Management Education partnership to
support the development of programs in health services management and
health policy development and administration at a national level.

In addition to the partner travel and exchanges, equipment and shipping,
AIHA will support the orientation of both US and NIS partners, provision of
a health professionals learning resources center (LRC) and establishment of
improved communications and telemedicine components if applicable.  AIHA
will also support the partnerships' participation in workshops, training
sessions, and conferences, including the AIHA annual conference and
Caucasus and NIS-wide primary care working groups, receipt of and
participation in AIHA publications, and other AIHA support services

Each of the partnerships is described in more detail below.

Imereti Region
Type of Partnership:  Community-Based Primary Health Care
Proposed NIS partner:  Regional Health Administration
Partnership Focus:  The Imereti partnership will be a healthy community
partnership focusing on women's health issues and the establishment of the
women's wellness center in Kutaisi. Kutaisi is the capital of the Imereti
region and lies approximately a four-hour drive from Tbilisi, the nation's
capital.  The region consists of twelve districts and has an overall
population of 737,000 inhabitants.  Kutaisi has traditionally served as an
economic, industrial and cultural center of Western Georgia, although the
current economic crisis has greatly affected all sectors of society.

Initial workplan activities will be directed toward developing local
community involvement, conducting a needs assessment, and building
consensus around community issues and problems to be addressed.  The
partnership will then focus on the development of quality services to meet
these community needs and improve access to services with an emphasis on
disease prevention and health promotion.  The partnerships are also
expected to develop programs for the retraining of health professionals in
support of the primary care sites and other donor efforts that promote
primary care.  The results of the partnerships including the healthy
community's process of community development and primary care practice and
administrative guidelines will be disseminated nationally with the support
of the Ministry of Health.

As part of orientation process for the Imereti partnership AIHA anticipates
that two representatives from Kutaisi will attend the training workshop in
women's health clinical guidelines development to take place at AIHA's
Women's Wellness Center in St. Petersburg (March, 1999).  AIHA also
anticipates the partnership to be involved in ongoing meetings of the
Clinical Practice Guidelines Advisory Committee as part of AIHA's
initiative aimed at monitoring progress in the implementation of the
clinical practice guidelines in participating AIHA Women's Wellness and
Primary Care Centers.

Mtskheta-Mtianeti Region
Type of Partnership:  Community-Based Primary Health Care
Proposed NIS Partner:  Regional Health Administration
Partnership Focus: The Mtskheta-Mtsianeti partnership will focus on
enhancement of primary health care services through the development of
primary health care both in the regional center and also through the
development of referral networks in all five districts of the region.
Mtskheta, the regional capital is located approximately a 20 minutes drive
from Tbilisi, the nation's capital.  The region is comprised of five
districts and has a population of 139,000 inhabitants.  The region is
situated in a vast rural mountain range, with a low population density and
significant problems associated with travel and communications.  The
traditional economy of the region is agriculture and cattle breeding.

Initial workplan activities will be directed toward developing local
community involvement, conducting a needs assessment, and building
consensus around community issues and problems to be addressed. The
partnership will focus on the development of quality services to meet these
community needs and improve access to services with an emphasis on disease
prevention and health promotion. The partnerships are also expected to
develop programs for the retraining of health professionals in support of
the primary care sites and other donor efforts that promote primary care.
The results of the partnerships including the healthy community's process
of community development and primary care practice and administrative
guidelines will be disseminated nationally with the support of the Ministry
of Health

Tblisi, Georgia
Type of Partnership:  Health Management Education
Proposed NIS Partner:  National Health Management Center (NHMC), Ministry
of Health
Focus of Partnership:  The AIHA partnership will support the development of
the NHMC's programs in health services management and health policy
development and administration.  The NHMC partnership will be expanded in
years two and three to include the development of the
graduate/undergraduate programs in health administration.  The long-term
goal of the partnership is the creation of an ongoing training capacity in
health services management and health policy development and administration.

Applicants with demonstrated experience in working closely with the
practitioner community, providing practical, short-courses, in-service
training and/or with expertise in establishing new programs or schools are
encouraged to apply.


For further information, please see the full-text of the solicitation,
which is available at:

        http://www.aiha.com/english/partners/newpartn/solicit.htm

Questions regarding this solicitation should be directed via e-mail to
[log in to unmask] or via fax at (202) 789-1277, Attention: NISSOLICIT.