Breaking Barriers to Universal Health Coverage: Insights from Georgia’s Chronic Disease Medicine Program
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Background
Despite global progress towards Universal Health Coverage (UHC), achieving financial protection remains a challenge, particularly in low- and middle-income countries (LMICs). Out-of-pocket (OOP) payments for pharmaceuticals drive households into poverty and increase inequalities. In Georgia, pharmaceutical costs cause catastrophic health spending, disproportionately affecting the poorest. This study evaluates Georgia’s Chronic Disease Medicine Program (CDMP), explores its evolution and barriers, and proposes strategies to strengthen performance and financial protection.
Methods
This exploratory qualitative study combined stakeholder interviews with secondary data analysis. Participants were recruited through purposive and snowball sampling, with semi-structured interviews conducted in person and online. Thematic analysis was conducted to identify key patterns and insights.
Results
The CDMP has undergone significant evolution, including expanding benefits and beneficiary groups, adjustments to cost-sharing mechanisms leading to broader population coverage. Recent measures, such as removing limits on reimbursement, have improved participation and service uptake. However, challenges remain: inequitable access, shortcomings in medicine selection, inadequate patient-centered care, limited public awareness, and insufficient involvement of primary healthcare (PHC) providers. While procurement and distribution have improved, capacity constraints and governance issues hinder implementation.
Conclusions
The CDMP is a critical step toward achieving UHC objectives and reducing OOP burden imposed by medicine costs. Enhancing the program effectiveness requires prioritizing vulnerable groups, empowering PHC providers, and targeted awareness campaigns. Strengthened governance and increased system capacity are as well critical to overcome remaining barriers and maximize program impact. Findings offer actionable insights for other LMICs seeking to design and implement effective pharmaceutical benefit programs.
