Neurology in Georgia: Facts for reflection on the development of neurological services

Abstract

This report is a description of the existing neurological service in Georgia, a former Soviet Union country, comparable in area and population to Switzerland. Problems related to medical education, organisation of neurological care, management of the major neurological diseases and some economical issues are analysed and potential solutions outlined. The current medical education system in Georgia is much more developed than those in the former Soviet Union. The MD degree is obtained on graduating from University Medical School and the length of study is 5 years. The education in state medical universities is free of charge for the majority of students who pass the entrance examinations. The next step after graduating is a residency, which lasts 4 years for therapeutic disciplines, including neurology; to obtain it the graduate has to sit Residency Entering Examinations. After the residency, passing the State Medical Certification Examinations is obligatory to achieve the right to carry out medical practice in medical institutions. At present, there are 689 board-certified neurologists in Georgia, i.e. one neurologist per 7837 head of population. With the exception of a few neurological departments, the organisation of the neurological care throughout the country does not meet the demands of the present time. In Tbilisi, capital of Georgia, there are 7 general hospitals with neurological inpatient departments and one specialised neurological hospital, the Sarajishvili Institute of Neurology and Neurosurgery. There are 15 neurological beds per 100 000 inhabitants in Tbilisi with a rather low mean occupancy of 20-30%. The only university and teaching hospitals are in the capital. In the districts there are 5-7 neurological beds in the general regional hospitals, while, only in some large regional centres, there are neurological departments serving the populations of particular regions. There are considerable shortcomings in proper management of neurological diseases in the country, especially in the districts. The main problem is a lack of evidence-based diagnostic and management interventions caused by the lack of diagnostic and therapeutic guidelines on a nationwide level and deficit in knowledge among health care workers. A part from this, an important drawback is the lack of modern neuroimaging technique in the hospitals and the scarcity of modern medicaments in the pharmaceutical market. Therefore, at present, diagnostic and therapeutic options for patients suffering from major neurological diseases are limited. Important problems are also an insufficient reimbursement of medical care outlays and low salary for health care professionals. In summary, despite substantial progress in recent years in medical education, serious problems still exist, namely, an excess of neurologists relative to available positions and shortcomings in the diagnosis and treatment of neurological diseases and in reimbursing health care expenditure.