Georgian Doctors Devastated By Health Reforms

For two months now, Tbilisi's Ophthalmology Centre has been a battleground between its medical staff and management.

The row flared up when it was announced that staff of pensionable age - women and men over 60 and 65 respectively - would not be eligible to compete for new jobs, when the centre shut down as part of a vast across-the-board reduction in the number of Georgia's hospitals.

When their bosses refused to back down, around 80 doctors, who had been classed as "too old" occupied part of the clinic's courtyard. The dispute then moved to the courtroom, where it is still going on.

"They treat us as if we're nobody, rubbish on the planet," said eye surgeon, Medea Simongulova, one of the leaders of the protest. "How can they send us to live on 14 lari a month?" That sum, equivalent to about seven or eight US dollars, is the value of a pension in Georgia.

However, the court case turns out, it will be too late to save the Ophthalmology Centre, which has now shut down. It is one of 56 medical institutions condemned to closure or reorganisation under the Consolidation and Optimisation Programme, launched in Georgia under the auspices of the World Bank.

Georgia's mammoth medical sector, a legacy of the Soviet era, turned into a significant burden after independence, when the country chose to adopt a western economic model.

"Grandiose multi-storey compounds were built for medical institutions staffed with hundreds of employees and two or three times more bed space was available then was actually needed," said Prof Roman Shakarashvili, head of the Institute of Neurology. "All of this generated enormously high expenditure."

"There was a time when people lay in hospital corridors because all the wards were occupied," said Gaioz Tsintsadze, one of the leading Georgian cardiologists. "However, this was caused by the fact that in the Soviet period there were a lot of patients who stayed on in hospital even when they didn't need in-hospital care. That was because of the large number of perks, such as the free medicines and meals were offered at the hospital."

In the 1990s, the bloated health system was an obvious target for budget cuts by the cash-strapped Georgian government. A World Bank-sponsored programme advocated closing down a lot of medical institutions and transferring their functions to selected strategic hospitals. Under the initiative, the number in the capital will be cut from 70 to 12 in five to seven years' time. It will mean that half the 30,000 doctors currently working throughout Georgia will lose their jobs.

"Doctors who are devoted to their profession and their patents will be thrown onto the streets!" said Academician Zurab Robakidze, of Tbilisi's Hematology and Transfusion Institute, one of the hospitals selected for closure.

It is being amalgamated with the Georgian Oncology Center and only 13 of the current staff of 380 will survive the merger. "So what will the remaining people do?" Robakidze asked rhetorically. "Set up stalls and sell groceries?"

According to Giorgy Nikolaishvili, head of the World Bank department of the Ministry of Health and Social Care, efforts will made to spare licensed and relatively young doctors in the cull.

Sacked hospital staff are being offered compensation, worth between 1,000 - 3,000 lari (500 to 1500 US dollars) for physicians and 200-300 for nurses. These sums include both the government's debts in unpaid salaries to the employees and a discharge bonus.

Many Georgian doctors are supporting the programme as a necessary measure, despite its ferocity.

"There were four cardiology centres in Tbilisi in Soviet times," said Gaioz Tsintsadze. "After the collapse of the USSR, both cardiology clinics and others mushroomed on every corner. The government cannot sustain so many clinics and it is natural that their number should be reduced. Central clinics will assume the function of those clinics, which do not always have enough patients."

The World Bank programme has so far been confined to Tbilisi, so the row over the Ophthalmology Centre will be a test case for the rest of the country.

Giorgy Lomsadze is a correspondent with Georgia Today