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.