As an initial step, in March 2004 a contract with IPF has been signed. During the week 22-26 of March I participated in the 1st IPF Seminar in Budapest. Project proposal was discussed with the IPF team. The same time web page development has been initiated.

Literature search has been intensified in April and continued during the whole fellowship year. Electronic and hand search of the databases has been performed by using key words: International assistance, donor aid, harmonization, efficient use of international development assistance, country level coordination, sector wide approaches, budget support and alignment. George Shakarishvili has been selected and approved by IPF as an individual mentor. Professor Jonathan Watson has been selected as a group mentor for my project in May. Project proposal and activity schedule has been discussed with the individual and group mentors and relevant amendments have been made. Auto Action Learning was proposed by Prof. Watson as an approach to proceed with the project.  Collecting and studying data about present status of PHC Reforms in the country continued during the whole reporting period. An overview article Primary Health Care Reform: Coordination of International Assistance been published in Social Policy in Georgia – a quarterly, circulated in development community in Georgia. PHC Reform stakeholders were informed about project and planned activities. Alongside the whole fellowship year I participated in the number of PHC reform stakeholder (Georgian Health and Social Projects Implementation Center (GHSPIC), EC, World Bank, DFID representations, Oxford Policy Management, GVG EPOS, Ministry of Labor, Health and Social Affairs, professional societies) workshops dedicated to the PHC program planning. These opportunities were used to propagate LogFrame for planning and re-distribution of activities between implementers. I also participated in the establishment of UN inter-agency coordination working group on health and nutrition in Georgia.

In June 2004 I participated in the 6th Regional Flagship Course on Health Sector Reform and Sustainable Financing, organized by the World Bank Institute and Semmelweis University Health Services Management Training Centre in Budapest and acquired knowledge about novel trends in planning and implementation of health sector reforms.

Terms of Reference (ToR) for a consultant to develop monitoring and evaluation system for the PHC reform program, based on the LogFrame approach, have been drafted and submitted to the PHC Management Committee (PHC MC) for consideration. The document (LogFrame) should be outlining mechanisms on how to delineate tasks and responsibilities among all the stakeholders, involved in the PHC reform process. Initially ToR has been rejected by the PHC MC. But later on, after continuous stakeholder discussions and consultations, ToR has been accepted and processed. Based on these ToR GHSPIC is currently in the process of hiring expert-consultant which will perform the assignment during June-July 2005.

Research paper and outline of the policy paper was drafted and discussed with individual and group mentors during September seminar in Budapest and later on. In agreement with the mentors it was decided to conduct an evaluation of entire PHC reform progress for 1,5 years since its launching, with the emphasis on coordination arrangements deployed alongside the process by means of structured key informant interviews. List of interviewees as well as interview structure (questionnaire) has been developed in October-November and agreed with mentors.

Key informant interviews took place during the period of December 2004 – January 2005. Representatives of all the stakeholders of PHC reform in Georgia (including professional associations and reform beneficiaries) were interviewed. Analysis of the interviews revealed following major obstacles for effective implementation of the PHC reform (identified by stakeholders themselves):
•    Failed donor coordination
•    Lack of ministerial leadership of the reform process
•    Political context
•    Inexistence of the joint programme implementation plan and performance monitoring and evaluation systems

During April seminar in Budapest a public lecture Primary Health Care Reform in Georgia – Many Donors, Few Results – a Challenge of Donor Coordination has been delivered in CEU for IPF incoming and outgoing fellows and all those interested.
Final research and policy papers have been drafted and circulated to the individual and group mentors for comments and criticism. Based on the comments necessary amendments were made in the papers.

In January 2005 I was planning to attend the 6th Global Development Conference (to be held in Senegal) and present preliminary results of the project. However, my application to the conference organizing committee has been declined. Instead of the conference in agreement with individual mentor I decided to attend a Seminar on Development Project Planning, Monitoring and Evaluation, organized by CDRA in Cape Town during 9-14 May 2005.


Future Plans

Refined version of the policy paper will be published as a brochure and disseminated for discussion to all the stakeholders and international organizations active in Georgia. Shorter version of the paper is planned to be submitted as a manuscript to one of the international scientific journals in the field of health and public policy.