Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694824468463.pdf (Georgia)
Health Care Highlights GEORGIA 2019 Highlights 0 1 ABBREVIATIONS AFP AIDS AMR ANC COPD CRD EDPs EIDSS GAVI GBD GEL GFTAM Global Fund to Fight AIDS, Tuberculosis and Malaria Acute Flaccid Paralysis Acquired Immune Deficiency Syndrome Anti-microbial Resistance Antenatal Care Chronic Obstructive Pulmonary Diseases Chronic Respiratory Diseases Especially Dangerous Pathogens Electronic Integrated Disease Surveillance System Global Vaccine Alliance Global Burden of Disease Study Georgian Lari GLAAS Global analysis and Assessment of Sanitation and Drinking- Water Survey Hepatitis C virus HCV HFA DB Health For All Data Base HIV HPV IGME IHME IHR IPC IPV LB M/XDR MDG MDR-TB Multi Drug Resistant TB MMEIG Maternal Mortality Estimation Interagency Group MoLHSA Ministry of Labor, Health and Social Affairs Human Immunodeficiency Virus Infection Human Papillomavirus Inter-agency Group for Child Mortality Estimation Institute for Health Metrics and Evaluation International Health Regulations Infection Prevention and Control Inactivated Polio Vaccine Live Births Multidrug and extensively drug-resistant TB Millennium Development Goals National Center for Disease Control and Public Health NCDC NEHAP National Environmental Health Action Plan NSO CR National Statistics Office of Georgia Population-based Cancer Registry PCR Polymerase chain reaction Reproductive Health Survey Skilled Birth Attendance Sustainable Development Goals Sexually Transmitted Infections Tuberculosis Universal Health Coverage Video Observed Therapy RHS SBA SDG STI TB UHC VOT WASH Water, Sanitation and Hygiene WHO WTO World Health Organization World Trade Organization 3 National Center for Disease Control and Public Health 4 National Center for Disease Control and Public Health SOME INDICATORS, REFLECTING THE DEVELOPMENT OF GEORGIA Last years the Government of Georgia has implemented systematic reforms.
Georgia has achieved significant improvements in the field of human rights, government transparency, freedom from corruption, effective governance, market efficiency and favorable business environment.

Successful and effective implementation of the structural reforms caused remarkable improvement of Georgia’s position in various international rankings.
As a result, Georgia gained remarkable achievements in international rankings and takes the leading position amongst the countries of the world and regions.

HUMAN DEVELOPMENT INDEX (HDI) The HDI is a summary measure for assessing long-term progress in three basic dimensions of human development: a long and healthy life, access to knowledge and a decent standard of living.

A long and healthy life is measured by life expectancy.
Knowledge level is measured by mean years of schooling among the adult population, which is the average number of years of schooling received in a life-time by people aged 25 years and older; and access to learning and knowledge by expected years of schooling for children of school-entry age, which is the total number of years of schooling a child of school-entry age can expect to receive if prevailing patterns of age-specific enrolment rates stay the same throughout the child's life.
Standard of living is measured by Gross National Income (GNI) per capita expressed in constant 2011 international dollars converted using purchasing power parity (PPP) conversion rates.

Between 2000 and 2018, Georgia’s HDI value increased from 0.669 to 0.786, an increase of 17.5 percent.

Between 1990 and 2018, Georgia’s life expectancy at birth increased by 3.2 years, mean years of schooling increased by 1.1 years and expected years of schooling increased by 3.0 years.
Georgia’s GNI per capita increased by about 19.8 percent between 1990 and 2018.

Human Development Index (HDI), Georgia, 2000-2018 In 2018, Georgia's HDI was 0.786, which is higher than the average of countries with high HDI rates (0.750) and also higher than the average of the European and Central Asia countries.

Georgia ranks 70th among 190 countries.


5 National Center for Disease Control and Public Health Human Development Index, 2018 GENDER DEVELOPMENT INDEX (GDI) In the 2014 HDR, Human Development Report Office (HDRO) introduced a new measure, the GDI, based on the sex-disaggregated Human Development Index, defined as a ratio of the female to the male HDI.
The GDI measures gender inequalities in achievement in three basic dimensions of human development: health (measured by female and male life expectancy at birth), education (measured by female and male expected years of schooling for children and mean years for adults aged 25 years and older) and command over economic resources (measured by female and male estimated GNI per capita).

The 2018 female HDI value for Georgia is 0.775 in contrast with 0.791 for males, resulting in a GDI value of 0.979.
GENDER INEQUALITY INDEX (GII) The 2010 HDR introduced the GII, which reflects gender-based inequalities in three dimensions – reproductive health, empowerment, and economic activity.

Reproductive health is measured by maternal mortality and adolescent birth rates; empowerment is measured by the share of parliamentary seats held by women and attainment in secondary and higher education by each gender; and economic activity is measured by the labour market participation rate for women and men.
The GII can be interpreted as the loss in human development due to inequality between female and male achievements in the three GII dimensions.

6 National Center for Disease Control and Public Health Gender Inequality Index, 2005-2018 http://hdr.undp.org/en/content/dashboard-5-socioeconomic-sustainability-0 Georgia has a GII value of 0.351, ranking it 75 in the 2018 index.
In Georgia, 16.0 percent of parliamentary seats are held by women, and 97.4 percent of adult women have reached at least a secondary level of education compared to 98.6 percent of their male counterparts.

For every 100,000 live births, 36.0 women die from pregnancy related causes; and the adolescent birth rate is 46.4 births per 1,000 women of ages 15-19.

Female participation in the labour market is 57.8 percent compared to 78.7 for men.
Gender Inequality Indicators, Georgia and Countries with High HDI, 2018 Georgia Countries with high HDI Maternal mortality rate Adolescent pregnancy rate Parliamentary seats held by women, (%) High education (%) Employment (%) Female Male Female Male 36.0 46.6 16.0 97.4 98.6 57.8 78.7 56.0 33.6 24.4 68.9 74.5 53.9 75.6 Skilled labor is a segment of the workforce that has specialized know-how, training, and experience to carry out more complex physical, or mental tasks than routine job functions.
Skilled labor is generally characterized by higher education, expertise levels attained through training and experience, and will likewise correspond with higher wages.

(https://www.investopedia.com/terms/s/skilled-labor.asp).
Georgia ranks 16th among 154 countries in terms of skilled labor 7 National Center for Disease Control and Public Health Skilled labor indicator (%), 2010-2018 http://hdr.undp.org/en/content/dashboard-5-socioeconomic-sustainability-0 One of the most important indicators of the country's development is the share of expenditures on scientific research and development, which is calculated as the share of expenditures on scientific research by research institutes, universities, various companies and government agencies (including foreign investment) of the country's gross domestic product.
Georgia ranks 83rd among 123 countries (this indicator = 0.3%).

Financing of scientific research and development (% of GDP), 2010-2017 http://hdr.undp.org/en/content/dashboard-5-socioeconomic-sustainability-0 8 National Center for Disease Control and Public Health SUSTAINABLE DEVELOPMENT GOALS In 2015, Sustainable Development Goals (SDGs) have been adopted at the UN Summit after a partial achievement of the Millennium Development Goals – MDGs, to maintain and further advance the successes.
SDGs represent a continuation of the Millennium Development Goals until 2030.

The 17 goals of sustainable development are broader and more ambitious than the Millennium Development Goals, and represent the agenda that ensures that "no one should be left behind".

SDGs are aimed at the eradicating poverty, prioritizing of health, education, food security and accessibility, and cover a wide range of issues such as economics, social and environmental goals, aspiring more peaceful and engaged societies.
The third strategic goal is to achieve healthy living and well-being for people of all ages, ensuring access to safe and effective medicines and vaccines, universal access to healthcare services, which is a major priority for global health.

In 2018, countries have integrated SDGs into their programs.

Georgia shares global sustainable development initiatives and is actively involved in monitoring of the progress of the achievement of the above mentioned goals.
The third strategic goal is to achieve a healthy life and well-being by 2030 for people of all ages, to provide universal access to safe and effective medicines and vaccines for all, to provide an universal access to health care, which is a top priority for global health, to facilitate the implementation of the Framework Convention on Tobacco Control developed by the World Health Organization, etc.
1.1 Average Performance by SDG, Georgia, 20191 Value Rating Trend SDG3 – Good Health and Well-Being Maternal mortality rate (per 100,000 live births)) Neonatal mortality rate (per 1,000 live births) Mortality rate, Under-5 (per 1,000 live births) Incidence of tuberculosis (per 100,000 population) HIV prevalence (per 1,000) Age-standardized death rate due to cardiovascular disease, cancer, 9 25.0 5.9 9.8 80 0.2 24.9 National Center for Disease Control and Public Health diabetes, and chronic respiratory disease in populations age 30–70 years (per 100,000 population) Age-standardized death rate attributable to household air pollution and ambient air pollution (per 100,000 population) Traffic deaths rate (per 100,000 population Life Expectancy at birth (years) Adolescent fertility rate (births per 1,000 women ages 15-19) Births attended by skilled health personnel (%) Surviving infants who received 2 WHO-recommended vaccines (%) Universal Health Coverage Tracer Index (0-100) Subjective Wellbeing (average ladder score, 0-10) 102 15.3 72.6 46.4 99.9 93 66 4.9 Rating SDG achieved Challenges remain Significant challenges remain Trend Maintaining SDG achievement Score moderately increasing, insufficient to attain goal Score stagnating or increasing at less than 50% of required rate Major challenges remain Decreasing Information unavailable Information unavailable Source: https://dashboards.sdgindex.org/static/countries/profiles/Georgia.pdf To assess the overall progress of the SDG, a so-called SDG Global Index was developed.
This index is a consolidated indicator of all objectives.

According to this index, Georgia ranks 58th among 166 countries and is 1.4% behind the regional average.
SDG Global Index, 2019 Source: https://dashboards.sdgindex.org/static/countries/profiles/Georgia.pdf 10 National Center for Disease Control and Public Health DEMOGRAPHY AD SOCIAL-ECONOMIC INDICATORS Area, km2 Administrative units Capital Mid-year population Females Males Urban population Ethnical composition (according to the Census 2014) Main religions (according to the Census 2014) State system Independence National currency Membership in international organizations GDP per capita, US$ Human development index GDI GII 69 700 11 regions, 64 raions Tbilisi 3 720 200 51.9% 48.1% 59.0% Georgian - 86.8%, Azeri - 6.3%, Armenian - 4.5%, Other - 2.4% Orthodox Christian - 83.4%, Muslim - 10.7%, Armenian Apostolic - 2.9%, Catholic - 0.5% Parliamentary republic Since 1991 Lari UN, IMF, WHO, WB, WTO, other 4 763.5 (2019) 0.786 (2018) 0.979 (2018) 0.351(2018) 11 National Center for Disease Control and Public Health Key Demographic Indicators, Georgia Number of live births (per 1000 population) Total fertility rate Adolescent birth rate (per 1000 women aged under 20) Natural increase of population (per 1000 population) Number of deaths (and death rate per 1000 population) Stillbirth rate (per 1000 births) 2017 2018 2019 53 293 (14.3) 51 138 (13.7) 48 296 (13.0) 2.14 36.2 2.12 32.0 2.01 29.4 5 471 (1.5) 4 614 (1.2) 1 637 (0.4) 47 822 (12.8) 46 524 (12.5) 46 659 (12.5) 506 (9.4) 438 (8.5) 457 (9.4) Life expectancy at birth (years) 73.5 74.0 74.1 Marriages (per 1000 population) 23 684 (6.4) 23 202 (6.2) 23 285 (6.3) Divorces (per 1000 population) 10 222 (2.7) 10 288 (2.8) 11 205 (3.0) Migration balance per 1000 population -2 212 (-0.6) -10 783 (-2.9) -8 243 (-2.2) Source: National Office for Statistics In 2019 the annual mid-year population number was 3 720161; females constitute 51.9% of the total number and males -48.1% Population pyramid, Georgia, 2019 Source: National Office for Statistics 12 National Center for Disease Control and Public Health Birth rate In 2019, in Georgia, the trend for decreasing of the number of live births continues.
The total fertility rate equasl to 2.

Total fertility rate, Georgia Despite of the decrease of the total fertility rate, its value exceeds the value of the CIS, EU Member countries, and the countries of the European region.
Source: National Office for Statistics Total fertility rate (TFR) Source: Health for All Database, National Office for Statistics In Georgia, the trend for declining of the adolescents’ birth rate continued from 2010, and in 2019, the share of live births among women aged under-20 was 5.8%.
13 National Center for Disease Control and Public Health The Share of Births to Women Aged under-20 in the Total Number of Live Births, Georgia Source: National Office for Statistics POPULATION NATURAL INCREASE In 2019, in Georgia, the natural increase rate per 1,000 population decreased to 0.4 (in 2018 - 1.2).

Positive natural increase was observed only in 3 regions of Georgia: Ajara, Tbilisi, and Kvemo Kartli.
Natural Increase, Georgia Source: National Office for Statistics Life Expectancy at Birth Last years, a tendency for increase of the life expectancy at birth in women and men was observed in Georgia.

In 2019, life expectancy at birth for both sexes was 74.0: for women - 78.2; for men - 69.7.
14 National Center for Disease Control and Public Health Life Expectancy at Birth, Georgia Source: National Office for Statistics MORTALITY Over last few decades the World has seen a trend of mortality decreasing and life expectancy increasing.

Such change is partly related to the increase of the share of non- fatal diseases and a reduction of deaths due to traumatic injuries and to improved control of risk factors, early detection of diseases, and to improved disease management.
According to the data of the National Statistics Office of Georgia, in Georgia in 2019, 46,659 people died.

51.5% of cases were registerd in men, and 48.5% on women, 1.1% - in children aged under-15.
Mortality structure by age and sex, Georgia, 1999, 2009, 2019 Age 0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Total 2009 Both sexes Male Female Both sexes Male Female Both sexes Male Female National Center for Disease Control and Public Health The total mortality rate in the general population is relatively stabile during last 3 years.
Total Mortality rate per 100 000 population, Georgia Source: National Office for Statistics According to the World Health Organization information, the age-standardized mortality rate in Georgia exceeds the average rates in the countries in the European region and the European Union.

Age-standartized Mortality Rate per 100000 population In Georgia, as in the most countries of the World, non-communicable diseases are the main burden of mortality.
16 National Center for Disease Control and Public Health Mortality Structure, Georgia, 2019 Causes of Death per 100 000 Population, Georgia, 2010-2019, All Age Groups Source: http://vizub.healthdata.org/gbd-foresight/h Last years, the number of unknown and incorrectly assigned causes of death is declining.
As a result of activities, carried out by the National Center for Disease Control, inter-agency cooperation and the involvement of municipal public health centers, the quality of identifying the cause of death has improved and the share of unidentified causes of death has been reduced to 13.2%.
17 National Center for Disease Control and Public Health MATERNAL AND CHILD HEALTH AND MORTALITY Main indicators of reproductive health, Georgia 2015 2016 2017 2018 2019 Coverage with at least 4 antenatal care visits 88.3% 81.2% 85.0% 81.0% 83.0% Coverage with at least 8 antenatal care visits - - 11% 22% 42% Coverage with at least 1 antenatal care visit 99.5% 99.4% 94.4% 94.3% 95.3% Timely initiated antenatal care 83.0% 85.0% 89.1% 89.0% 90.7% Number of deliveries Term deliveries share Normal deliveries Pathological deliveries (caesarean sections, forceps, vacuum delivery, all delivery process complication) Proportion of births attended by skilled health personnel 58830 55940 52660 50468 47571 82.1% 81.9% 86.8% 92.0% 91.7% 55.0% 52.7% 52.4% 55.0% 58.0% 45.0% 47.3% 47.6% 44.6% 42.0% 99.8% 99.9% 99.9% 99.9% 99.8% Abortions 32428 28720 24937 22733 21559 Including induced abortions 77% 74% 64% 62% 62% ANTENATAL CARE The UN Sustainable Development Goals (SDG) set a target for some indicators of maternal health.
SDG 3.1 Goals and Georgian Data Indicator Recommendations to reach SDG 3.1 Actual data (Georgia 2019) Coverage with at least 1 antenatal care visit Coverage with at least 4 antenatal care visits Coverage with HIV and syphylis testing Proportion of births in health facilities Proportion of births attended by skilled health personnel 91% 78% 95% 81% 87% 90.7% 83% 89% 99.9% 99.8% 18 National Center for Disease Control and Public Health Share of Pregnant Women (%) Initiating Antenatal Care During the 1st Trimester ADOLESCENT PREGNANCY AND DELIVERY According to the SDG 3.7.2, by 2030 the birth rate per 1000 women aged 10-14 and 15-19 years should be reduced by 40% (in Georgia, in 2015, this indicator was 51.0%).
In 2000, worldwide, adolescents birth rate was 56 per 1,000 women, by 2015, the rate decreased to 45 and in 2019 it reached 44 per 1,000 women.

(https://sustainabledevelopment.un.org/sdg3).

Compared to the previous year, in 2019, the adolescent pregnancy rate (the sum of births and abortion rates per 1000 women aged 15-19) has increased due to the increased birth rate to women in this age group.
Adolescent (Women Aged 15-19) Pregnancy Rate Indicators, Georgia 19 National Center for Disease Control and Public Health Adolescent Birth Rate, Former Soviet Union and Some European Conutries, 2018 Source: https://data.worldbank.org/indicator/SP.ADO.TFRT?most_recent_year_desc=true Caesarean section In Georgia, compared to other countries, the share of births by caesarean sections is high.
The rate of caesarean sections per 1000 live births is significantly higher than the same rates in the European region and the CIS.

Caesarean section ratio per 1000 live births (last available data) Source: WHO HFA Database, NCDC 20 National Center for Disease Control and Public Health Since 2016, as a result of regulations developed in the country, the decrease of caesarean sections ratio has been observed.
This trend was caused by the Perinatal Health Regionalization Project launched by the Ministry of Health in 2015, under which since 2017, selective contracting with medical institutions has been carried out.

According to the terms of the contract, specialized (level II) and subspecialized (level III) medical institutions, involved in the perinatal care, have a percentage limit for caesarean section, in case of exceeding this limit, they are a subject of the rules provided by the terms of the contract.
In 2019, the share of caesarean section of the total number of deliveries has decreased, compared to previous years, and amounts to 39.8% of the total number of deliveries (in 2018 - 41.6%).

It is also important, that in 2019, 46% of the total number of the electiveCa caesarean sections is done at the request of the mother.

The decline of share of caesarean sections is associated with a decrease of the emergent cases.
Caesarean section, Types and Indications, Georgia, 2019 Abortion It is difficult to calculate the level of abortions worldwide, as in many countries abortions are not registered and, consequently, international reports are not submitted.

This is especially true in countries, where abortion is prohibited by law.

In 58 of the 193 countries of the United Nations, abortion is legalized and prohibited by law in only 7 countries.
Georgia, according to the abortions rate per 1000 women of reproductive age, occupies an intermediate position among the countries of the former Soviet Union and exceeds the rates of developed countries.
21 National Center for Disease Control and Public Health Abortion Rate per 1000 women of reproductive age, 2019 Source: https://worldpopulationreview.com/country-rankings/abortion-rates-by-country In Georgia, the value of the total inducd abortions rate (TIAR) remained stable in 2014- 2017, the decrease in 2018-2019 is likely due to the accounting problems.
In 2018, a multiple indicator cluster survey (MICS) was conducted in Georgia, according to the MICS results, TIAR (0.9) is almost 2-folds higher than the official data (0.5).

Total Induced Abortion Rate (TIAR), Georgia In 2019, induced abortions accounted to 61.6% of all registered abortions (data from the Electronic Module for Pregnancy and Newborn Health Monitoring).
According to the MICS survey, almost 41% of married women are currently using some form of contraception, however, the total induced abortion rate (TIAR) during the last five years is 130.3 per 22 National Center for Disease Control and Public Health 1,000 women of reproductive age, and the total induced abortion rate (TIAR) during the lifetime is 909.4.

Maternal Mortality (SDG 3.1) The United Nations Sustainable Development Goals aim on improvement of maternal health and well-being by 2030.
According to the SDG3.1 the target maternal mortality rate is less than 70 per 100,000 live births.

According to international estimates, in Georgia, by 2030t, he maternal mortality rate is expected to reach 28.8 (19.0-43.0) deaths per 100,000 live births (https://maternalhealthatlas.org/).

In 2019, in Georgia, there were registered 14 cases of maternal deaths (maternal mortality rate per 100,000 live births - 28.9).
Maternal Mortality Rate per 100000 live births, Georgia In Georgia, according to the assessment of the Institute of Health Metrics and Evaluation of the University of Washington, the decrease of maternal mortality will continue.
Source: National Center for Disease Control, Geostat 23 National Center for Disease Control and Public Health Maternal mortality, Georgia (Deaths of women aged 10-54 per 100,000 live births) Source: https://www.thelancet.com/lancet/visualisations/gbd-SDGs Morbidity and Mortality of Children Aged Under-5 Respiratory and infectious diseases are the leading causes of morbidity in children under-5 years of age.
Leading Causes of Morbidity in Children Under-5, Georgia Incidence per 1000 children aged under-5 Cause of morbidity Diseases of the respiratory system Diseases of the ear and mastoid process Infectious and parasitic diseases Diseases of the eye and adnexa Diseases of the skin and subcutaneous tissue Injury, poisoning and other consequences of exposure of external causes Diseases of the digestive system Diseases of the blood and bloodforming organs Diseases of the nervous system 2018 606.0 57.8 94.3 44.2 28.3 25.7 15.9 15.0 14.5 2019 524.9 35.7 83.3 25.9 28.5 24.9 19.4 13.4 14.0 During last decades a significant reduction of under-5 mortality was registered worldwide.
In Georgia, the under-5 mortality rate has successfully reached the Millennium Development Goal and, according to official statistics and international experts’ estimates (UN Inter-Agency Child Mortality Assessment Group - IGME) and forecasts, maintains a declining trend.
24 National Center for Disease Control and Public Health Under-5 Mortality according to Different Sources, Georgia Source: National Center for Disease Control, Geostat Under-5 Mortality, Georgia Source: http://www.thelancet.com/lancet/visualisations/gbd-SDGs In Georgia, according to the latest available data from the World Health Organization, the mortality rate of children aged under-5 years, despite the declining trend, exceeds the rates of European countries, and occupies an intermediate position among the countries of the former Soviet Union.
25 National Center for Disease Control and Public Health Under-5 Mortality, 2018 Source: https://data.worldbank.org/indicator/SH.DYN.MORT According to the UN Sustainable Development Goals, Georgia has to reduce the under-5 mortality upto 6 per 1000 live births.
Sustainable Development Goals and Georgian Data Indicator Goal to reach by 2030 2019 Data SDG 3.2.1: under-5 mortality rate SDG 3.2.2: neonatal death rate 6 / 1000 LB 5 / 1000 LB 9.4 5.2 The largest share of ithe under-5 mortality falls on infant mortality.
Infant Mortality, Georgia IGME’s estimate 9.8 5.9 Source: National Center for Disease Control, Geostat 26 National Center for Disease Control and Public Health Infant Mortality, 2018 Source: https://data.worldbank.org/indicator/SP.DYN.IMRT.IN A large portion of infant and under-5 mortality falls on neonatal mortality.
Perinatal and Neonatal Mortality, Georgia Stillbirth rate per 1000 births Early neonatal death rate per 1000 live births Late neonatal death rate per 1000 live births Perinatal mortality rate per 1000 births Neonatal Mortality, 2018 https://databank.worldbank.org/reports.aspx?source=2&series=SH.DYN.NMRT 27 National Center for Disease Control and Public Health Health Care In 2019, the increase of the number of physicians continued, therefore, the density of physicians also increased.
The same time there was a substantial increase of the number of nurses and the density of nurses.
Healthcare Resources Healthcare Resouces, Georgia Number of physicians (including dentists) Physicians density per 100000 population Number of nursing personne; Nursing personnel density per 100000 population Number of hospital beds Number of hospital beds per 100000 population Encounters with physicians Home visits of physicians In-patient facilities Out-patient facilities Antenatal care centers Ambulance stations Blood transfusion facilities Rural physician-entrepreneurs The World Health Organization assigns particular importance to the availability of the adequate health human resources in the country.
Since 2006, Georgia has seen an increase of the number of doctors; Georgia's human resources density indicators are significantly higher than those of the European region, the European Union and the CIS countries.

Physicians Density per 100000 Population Source: WHO HFA Database; NCDC 28 National Center for Disease Control and Public Health According to WHO recommendations, 4 and more nurses per physician are the most effective, in terms of the quality of provided healthcare.
In the European region and EU countries, the average number of nurses per physician is 2-2.7, and an increase of this number is considered a positive trend.

In Georgia, density of nurses is almost the lowest, compared to the European region and CIS countries and maintains a declining trend.
Professionally Active Nurses Density per 100000 Population Professionally Active Physicians Density per 100000 Population Source: WHO HFA Database, NCDC Since 2007, the ratio of the number of nurses to the number of physicians has been less than 1 and recent years has a declining trend.
Source: WHO HFA Database, NCDC 29 National Center for Disease Control and Public Health Ratio of the Number of Nurses to the Number of Physicians In 2019, in Georgia, 14,928,350 visits to the primary healthcare were registered.

According to the latest available data from the World Health Organization, the average number of visits to outpatient services per capita for countries of the European region is about 6.

In Georgia, the value of this indicator during last two decades did not exceed 2.2.
After the launch of the state program of universal healthcare, the number of contacts with both outpatient and inpatient facilities has increased.

In 2019, the number of visits to outpatient services and ambulance services equaled 4 per capita.

The Number of Visits per Capita, Georgia In 2019, there were 502,756 cases of hospitalization registered, this is 8% more than the number of hospitalizations in 2018.
30 National Center for Disease Control and Public Health Hospital Beds and Indicators of Bed Use, Georgia Number of hospital beds 14069 13633 13378 12599 11348 11600 11675 12830 13840 15084 15909 17471 Number of beds per 100000 population 365.6 357.4 353.3 335.4 304.3 312.0 313.9 344.4 371.3 404.6 426.9 469.6 Bed occupancy rate 156.1 148.2 160.0 173.6 228.9 181.4 188.3 193.3 189.3 180.5 187.2 179.5 Average length of stay 3.0 6.3 6.4 7.0 7.0 5.4 5.2 5.3 5.0 5.2 4.9 4.9 Bed rotation 26.2 23.4 25.2 24.8 32.7 33.6 36.3 36.4 37.8 35.0 37.8 36.5 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 21.7% of hospitalizations were related to respiratory diseases, 18.8% to the circulatory system diseases, and 9.5% to pregnancy, childbirth, and puerperium.
Hospital case fatality rate did not change, compared to previous years, and equaled to 2.5%.
In-patient Care, Georgia, 2019 (Top 10 Classes) Total Diseases of the respiratory system Diseases of the circulatory system Pregnancy, childbirth and the puerperium Diseases of the digestive system Injury, poisoning and certain other consequences of external causes Injury, poisoning and certain other consequences of external causes Diseases of the genitourinary system Diseases of the nervous system Neoplasms Mental and behavioural disorders Number of hospital discharges 545216 118553 102515 52294 44179 Including deaths 13606 4098 4159 5 1015 37609 440 34210 26452 25474 23723 11402 308 330 288 1191 174 Case fatality rate, % 2.5 3.5 4.1 0.0 2.3 1.2 0.9 1.2 1.1 5.0 1.5 In 2019, in Georgian hospitals, there were 289,288 surgical operations performed (in 2018 - 221,849), the rate per 1000 population - 77.8 (in 2018 - 59.5).
31 National Center for Disease Control and Public Health In-patient surgeries, Georgia, 2019 Surgery according to the anatomical localization Number of surgeries Total Nervous system Brain Spinal cord Including: Peripheral nervous system Endocrine System Thyroid gland Parathyroidectomy The eye and adnexa Due to glaucoma Due to cataract Ear, nose and throat Ear Teeth, jaws, mouth and throat Tongue Main blood vessels of the heart and chest Tricuspid valve Shunting of coronary arteries Stenting Chest wall, pleura, mediastinum, diaphragm, trachea, bronchi and lungs Mammary gland Digestive system The genitourinary system, male genitals, and the retroperitoneal space Kidney transplantation Prostate Female genitals Obstetric procedures Musculoskeletal system Peripheral blood vessels and lymphatic system Skin Collection of organs and tissues for transplantation Ambulance The ambulance system provides free ambulance services to the population of the country.
In 2019, 1526434 visits were made by the ambulance, this is (as in 2018) 0.4 visits per capita.

32 National Center for Disease Control and Public Health Blood banks In 2019, the total number of blood donations in all licensed blood banks (22 blood banks) was 82048, of this number 27,022 (32.9%) donations were free.
Immunization From the point of view of the Government of Georgia, immunization is a leading priority of public health, which is clearly confirmed by the significant increase in funding of the program: in 2012 4 million GEL were allocated to the immunization program, in 2018 - 22400 million GEL, in 2019 - 22800 million GEL.
According to the national calendar, vaccinations against the following 13 infectious diseases are conducted in the country: tuberculosis, hepatitis B, diphtheria, pertussis, tetanus, polio, measles, mumps, rubella, Hib (Haemophilus influenzae), Rota virus, pneumococcal infection, and human papiloviral infection.
Immunization Calendar, Georgia Vaccine BCG Hepatitis B Hib+DPaT+HepB+IPV bOPV DPT DT Td MMR Rota PCV HPV Number of doses 1 1 3 2 3 2 2 3 2 Age at vaccination Newborn 0-5 days Newborn 0-12 hours 2, 3, 4 months 18 months, 5 years 18 months 5 years 14 years 12 months, 5 years 2, 3 months 2, 4, 12 months 10-11-12 years cohort Last years 5 new vaccines have been added to the immunization calendar: in 2013 - Rota virus vaccine, in 2014 - PCV10 (with GAVI support), in 2015 - IPV (Penta vaccine replaced by Hexavalent vaccine), in 2016 - Bivalent polio vaccine (bOPV).
In 2017, HPV vaccination was launched in 4 regions of Georgia (Tbilisi, Kutaisi, Adjara, Abkhazia), with the aim of including 9-years-old girls in the demo program.

Since September 2019, human papillomavirus vaccination (APV) has been introduced throughout Georgia for girls aged 10, 11 and 12 years.

All vaccines, included in the national calendar of vaccinations, are free of charge for the population.
To ensure high quality and safe immunization, the Government purchases only pre-qualified by the World Health Organization vaccines.

33 National Center for Disease Control and Public Health Coverage with Immunization (%), Georgia, 2019 The country maintains high coverage rates for most antigens, however, the annual target coverage rate of 95% for some vaccines has not been reached yet.

Since 2002, Georgia has been certified as a wild polio virus-free country.
Infectious diseases In 2019, in Georgia, a decrease of incidence of infectious and parasitic diseases is registered in the entire population,and in children.

COVID-19 Coronavirus 2, called COVID-19, which originated from Wuhan, Hubei Province of China, in December 2019, is the third zoonotic coronavirus outbreak of the 21st century, when the infection was transmitted from person to person and caused a health problem.

In Georgia, testing, using PCR, to detect COVID-19 started on January 30, 2020.
From January 30 to August 13, the number of tests, conducted in the country, was 288,814, of which 283,789 were primary tests.

According to the target groups, the most part of the PCR tests (28%) were conducted among the beneficiaries of fever (covid) clinics and quarantine areas.

The share of tests among healthcare providers (excluding ambulance staff) was 26%.

In Georgia, the first confirmed case was registered on February 26.
According to July 11 data, COVID-19 was confirmed in 980 people, of which 499 (50.9%) were males and 481 (49%) - females.

The positivity result rate is 0.7% (for May 11 - 2%, June 11 - 1.2%).

The eldest patient was 90 years of age and the youngest was 9 months.

34 National Center for Disease Control and Public Health By July 11, the cumulative incidence rate of COVID-19 was 19.0 per 100,000 population (95% CI 17.7-20.5).
The highest numbers of new cases of COVID-19 per 100,000 population are in Kvemo Kartli and Tbilisi, and the lowest - in Samegrelo-Zemo-Svaneti and Imereti.

Cumulative incidence of COVID-19 per 100 000 population by the place of exposition (n=708) 272 cases (27.7%) out of 980 cases were imported.

Of these, the largest share imported from Russia - 46.6% (127 cases), Turkey - 8.4% (23 cases), Azerbaijan - 8% (22 cases) and Armenia - 7.7% (21 cases).
Among other epidemiological characteristics of COVID-19 in Georgia, it should be noted that the period of doubling of cases from the first case till July 11 the average length is 16 days, and the effective reproduction index Rt was 0.93 (95% CI 0.46-1.65).

The index is also shown in a report produced by the Washington Institute for Health Metrics and Evaluation, according to which the reproduction index is also in the range of 0.8-0.91.
In Georgia by July 11, 2020, 129 cases of COVID-19 infection were registered in healthcare providers, this is 13.2% of the total number of registered cases (980 confirmed cases).

This number includes 111 (86.1%) cases of health staff and 18 (13.9%) cases of technical staff.

The number of infected health personnel participating in the provision of health services in Georgia was defined as 110, this is 11.2% of the total number of Covid cases in the country.
More than a half of such cases are registered in nurses.

The first patient with COVID-19 was hospitalized on February 26, 2020, the first recovered patient was discharged from the clinic on March 16.

By July 11, the total number of recovered patients was 851 (87%).

The number of patients discharged was almost equally distributed by sex: 49.4% males and 50.6% females.

The average length of stay spent by discharged patients was 21 days.
Among COVID-19 infected people, there are 15 cases fatal cases (case fatality rate - 1.5%).

1 http://www.healthdata.org/ 35 National Center for Disease Control and Public Health Measles in Georgia is a subject of mandatory registration and epidemiological Measles surveillance.

In 2004 and 2013, there was a significant increase of measles cases in the country.

The peak of 2013 was caused by a failure of the mass immunization campaign in 2008.
This contributed to the accumulation of the non-immune layer of the population, which led to an epidemic increase of measles.

The burden of morbidity was mainly observed in the population under-1 year of age and 15-30 years of age.
Since 2013, additional campaigns measures have been implemented to manage the epidemic: to provide the measles vaccination course to children under-14 years of age and to provide additional vaccinations to the population aged 15-30, health workers and other specific groups of the population.

In 2013-2015, approximately 150,000 citizens received additional doses of the measles-mumps-rubella vaccine.

As a result, the number of measles cases in the country has dropped significantly.
In early 2019, as in the most European countries, a measles outbreak started, and was successfully managed, additional immunizations of 170,000 people were conducted, especially at the age group of 20-40 years.

In 2019, 3,918 cases of measles were reported.


Measles, Incidence Rate per 100 000 Population, Georgia 36 National Center for Disease Control and Public Health Measles Incidence per 100 000 Population, Last Available Data Source: HFA data base Rabies In Georgia, in 1997-2006, 96 cases of rabies were registered, and during next ten years - 42.

The largest number of rabies in humans (21 cases) was registered in 1996.

Zero incidence rate of rabies in humans first was reached in 2015.
In 2016-2017, this level was maintained.

In 2019, 61,893 cases of contact with animals, suspected of being infected with rabies, were reported (in 2018 - 59,420).

Of these contucts, in 53,558 cases vaccination against rabies was conducted under the State program.

The number of vaccinated included 18.5% of the combined (vaccine + immunoglobulin) prophylactic vaccinations.

In Georgia, in 2019, 1 case of rabies was registered.

Annually approximately 35,000 - 49,000 people are vaccinated against rabies.
Rabies Cases, Georgia 37 National Center for Disease Control and Public Health Crimean-Congo Hemorrhagic Fever In 2014, an outbreak of Crimean-Congo hemorrhagic fever occurred in the eastern part of Georgia.

There were 24 cases of Crimean-Congo hemorrhagic fever (incidence per 100,000 population - 0.6).

Four people died (case fatality rate - 16.7).

In 2018, the first time since 2014, the incidence of Crimean-Congo hemorrhagic fever has increased (incidence per 100 000 population - 0.3).
In 2019, 8 cases of Crimean-Congo hemorrhagic fever were registered.

Crimean-Congo Hemorrhagic Fever, Incidence per 100000 Population, Georgia Rotavirus infections In 2013, antiretroviral vaccination was introduced in the country.

In 2019, coverage with antiretroviral vaccination was 81%.

Infection surveillance is carried out through sentinel surveillance.

Since 2013, there has been a reduction of the share of rotaviral diarrhea wit (decrease equals 84%).
Share (%) of Rotaviral Diarrhea of the Total Checked Patients, Georgia, Sentinel Surveillance Data 38 National Center for Disease Control and Public Health In 2019, in the frame of the State program, fecal samples of 216 children were tested for rota-, noro-, and adenoviruses.

Rotaviral etiology was found in 7 cases (3.2%), in 2 and 2 cases of noro- and adenoviral infection (0.9%) was found.
Hepatitis C Georgia is among the countries with a high prevalence of hepatitis C. In April 2015, Georgia launched an unprecedented program aimed on the eliminating of hepatitis C in the country.

In 2015, within the framework of the Hepatitis C Elimination Program, with a support of the CDC / Atlanta, for the first time in the country, a population-based "Survey of Seroprevalence of Hepatitis B and C in Georgia" was conducted.
To achieve the ultimate goals of eliminating of hepatitis C, a long-term strategy (2016- 2020) was developed and approved in 2016.

The strategy includes actions in various areas, such as awareness raising, surveillance, prevention, screening, diagnostics and treatment.
On February 11-13, 2019, in Tbilisi, the World Health Organization held the first regional consultation on viral hepatitis in the European Region "Achievements on the Road to Elimination" to reviewing the progress and challenges of countries in combating the viral hepatitis.

In 2019, at the International Liver Congress, Georgia was awarded the status of the first "model country to fight hepatitis."

Hepatitis C, Elimination Program, Treatment Cascade, 28.04.2015 – 30.06.
2020 The main objectives of the hepatitis C elimination strategy:  Testing of 2.85 million adult citizens of Georgia for hepatitis C;  Revealing of 135 thousand people (90% of the diseased population) with chronic hepatitis C; 39 National Center for Disease Control and Public Health  Treatment of 128 thousand (95% of identified) people with chronic hepatitis C infection;  Cure of 122 thousand (95% of treated) carriers of chronic hepatitis C infection.
2020 situation analysis of data registered in the unified electronic system for hepatitis C screening: By February 2020, about 4 million screening tests have been registered in the electronic hepatitis C screening module.

The number of tested population approached 2.3 million, with positive rate of 6.8%.
Almost 70% of the adult population (up to 2 million adults) were screened on Hepatitis C.  A total of 3,791,001 screenings were registered (including people with personal number - 3,705,683), of which 178,685 (4.7%) screening tests were positive (including with personal number 158,522 - 4.3%);  According to the data registered in the electronic screening database, the number of unique beneficiaries is 2223883 (including 2130030 identified by personal number), of which 152496 persons are positive 6.9% (including with unique ID number 133913 - 6.29% );  The unique screening for hepatitis C in the adult population: screened 1,893,910 unique adults (66.3% of the target population).
Among them, 150,322 people with antibodies were identified (70% of the target population).

The detection rate is 7.9%.

Achieving these results was significantly caused by active testing of the population for hepatitis C, the testing is provided to all hospitalized patients, all pregnant women, blood donors, conscripts, and high-risk groups.

In 2019, 8671 new cases of hepatitis C virus were registered (incidence rate - 233.1), including 749 cases in children (incidence - 99.0).
Anti-HCV Prevalence Rate (%), 2016 Source: https://www.hpsc.ie/a-z/hepatitis/hepatitisc/worldwideprevalenceestimates/ 40 National Center for Disease Control and Public Health HIV / AIDS Georgia is a country with a low prevalence of HIV / AIDS.

In 2019, 668 new cases of HIV infection were registered in Georgia (incidence rate per 100,000 population - 18.0).
Last years, in the frame of various state programs (including Maternal and Child Health, Safe Blood, and HIV AIDS) targeted populations, such as pregnant women, donors, high- risk behavior population, and other risk groups were tested for HIV, these programs included “Voluntary screening of accused / convicts in the penitentiary system for HIV / AIDS”.

In 2019, 441119 tests were conducted under the state programs.
Under the Global Fund program, representatives of high-risk behavioral groups (NMS, CSM women, MSM) were provided with HIV preventive packages, including voluntary HIV counseling and testing.

HIV Incidence per 100 000 Population In 2019, 39.7% of new HIV cases were diagnosed at the AIDS stage (in 2018 - 40.6%).
HIV Infection Distribution by Ways of Transmission, Georgia, 2019 Source: HFA DB, NCDC 41 National Center for Disease Control and Public Health Compared to other countries in the region, Georgia has a high performance rate of the second and third 90 UN targets - rates of involvement of HIV-infected people in the antiretroviral treatment and achievement of viral suppression.
State and Global Fund provide finding of the universal access of the AIDS patients (including the population of Abkhazia) to antiretroviral drugs.

Georgia's antiretroviral treatment program is recognized as one of the best in the region of Eastern Europe and Central Asia.

The program has a high coverage, is sustainable, and provides a high quality of services.
Georgia was among the first countries in the region to introduce a "treatment for all" strategy to start treatment for people living with HIV / AIDS, regardless of the number of CD4 cells, this significantly improves the treatment outcomes and helps stop the spread of HIV / AIDS in the country.

In 2019, in line with the Global Fund AIDS-funded program of phased transfers, like in 2015-2019, using the state financing, the first-line ARV medicines were successfully purchased.
In addition, in 2019, 50% of second-line ARV medicines were purchased.

In 2019, the Global Fund signed new grant agreements for AIDS and Tuberculosis.

These agreements cover funding until 2022.

Global Fund assistance will continue during 2022- 2025.

Tuberculosis Last years, in Georgia, according to the World Health Organization, there is a decline of TB prevalence, although the rate is significantly higher compared to the European region and EU countries.
There is significant progress in the fighting against tuberculosis in Georgia.

During last few years, the prevalence of tuberculosis has decreased by about 9%.

According to a sustainable epidemiological surveillance system, this trend is a true decline of the disease incidence.

It should be noted that in 2019 the Ajara region joined the "Zero Tuberculosis Initiative".

An updated TB management guideline has been developed and implemented.
In 2019, 2448 cases of all forms of tuberculosis were registered (the registered prevalence of all forms of tuberculosis was 65.8 per 100000 population), including 1896 new cases (incidence per 100,000 population - 53.1).

78.6% of new cases were pulmonary tuberculosis.

In 2019, 319 patients were diagnosed with resistant tuberculosis (MDR).
42 National Center for Disease Control and Public Health Tuberculosis, Incidence per 100 000 Population, Georgia Since 2017, exposed to the index patients, which are diagnosed with pulmonary tuberculosis, have been added to the contact group.

2.0% of new cases and relapses of tuberculosis are reported in the penitentiary system.
Tuberculoses, Incidence per 100 000 Population, Georgia Source: http://www.thelancet.com/lancet/visualisations/gbd-SDGs Georgia, with assistance of the Global Fund, has managed to introduce effective anti-TB treatment for both sensitive and MDR patients.

The country has ensured the universal access to both first and second line medicines.

Under the State program new anti- tuberculosis drugs are available, a drug safety monitoring system has been introduced.
Last years the management of multidrug-resistant TB included the use of new drugs.

43 National Center for Disease Control and Public Health A video surveillance (VOT) pilot program has been launched in Tbilisi to improve patient geographical access.

Today 280 patients receive drugs through VOT.


Since 2019, the National Center for Disease Control and Public Health has started remote meetings (ECHO-TB) with TB managers of Adjara Public Health Centers, with the main goal to consult on TB management issues and provide them with lecture topics on various TB surveillance issues.
The methodical recommendation for the Survey of TB Index Patients was updated, approved by order of the Minister of Internally Displaced Persons from the Occupied Territories, Labor, Health and Social Affairs.

This recommendation is intended to improve the survey of contacts.

The country introduced modern diagnostic methods recommended by WHO: liquid culture, GeneXpert MTB / RIF systems for rapid diagnosis of TB and MDR-TB.
Georgia works in relationships with international partners and local organizations to ensure the effectiveness and sustainability of the TB program.

The country is a partner of such multicenter studies as: FIND, EXPAND TB, STREAM, STAND, END-TB, Nix-TB.

Malaria Since 2002 malaria incidence rate has been declining sharply and reached zero in 2013- 2014.

In 2019, 8 cases of malaria were registered in Georgia (one was a foreigner, 7 - citizens of Georgia).
In 2019, the Ministries of Environment and Agriculture and Labor, Health and Social Affairs jointly carried out vector control of 9261030 m2 of outdoor and indoor areas.

Malaria, Incidence per 100 000 Population, Georgia 44 National Center for Disease Control and Public Health Non-communicable Diseases The main part of the disease burden in Georgia falls on non-communicable diseases, which have a major impact on the most productive years of life.
Non-communicable diseases affect not only health but also the sustainable development of the country.
Effective prevention and control of non-communicable diseases requires access to accurate and reliable information, monitoring and identification of health indicators, monitoring and evaluation of to effectively control non- communicable diseases, Georgia has introduced the WHO STEPS methodology; STEPS surveys were conducted in 2010 and 2016 with the technical and financial assistance of WHO Europe and the Head offices.

interventions.
interventions.

In order Since 2017, the state program for provision of medicines for treatment of chronic diseases has been launched.

The program covers: chronic cardiovascular diseases, chronic lung diseases, diabetes type II, thyroid diseases, epilepsy, Parkinson's disease.

Diseases of the circulatory system The share of diseases of the circulatory system is 15.3% of the number of all diseases registered in the country, and 7.4% of the number of new cases.
In this group of diseases hypertensive, ischemic heart diseases and cerebrovascular diseases have got high morbidity and mortality.

In 2000-2018, in Georgia, there was an increase of the prevalence of the circulatory system diseases, although, in 2019, there is a decrease of the prevalence of the circulatory system diseases.

The incidence rate also reduced in adults and in children as well (general incidence - 3770.5, incidence in children - 92.1).
Diseases of the Circulatory Syste, Hospital Admission Rate per 100 000 Population, Georgia Source: NCDC; WHO HFA Database 45 National Center for Disease Control and Public Health Hypertensive disease In 2019, in the structure of registered by the end of the year cases of cardiovascular diseases, hypertension share is 62.5% (in 2018 - 64.8%), in the structure of new cases - 46.6% (in 2018 - 48.5%).
According to the results of the STEPS2016 - a risk factors of non-communicable diseases survey, hypertension was registered in 37.7% of the population.

According to STEPS2010 survey, this share was 33.4%.
Structure of the Circulatory System Diseases (%), Georgia, 2019 Ischemic Heart Diseases In 2019, ischemic heart diseases accounted for 15.6% of new cases of the circulatory system diseases (in 2018 - 16.3%), including angina pectoris - 5.3% (in 2018 - 4.9%); acute myocardial infarction - 1.5% (in 2018 - 2.2%), other acute ischemic diseases - 1.9%.

In the country, since introduction of the universal health care program, access to cardio- surgical intervention has significantly increased.
In 2019, 15,131 cardiac surgeries were performed: 1,669 shunt insertion (in 2018 - 2,131), 686 rhythmological surgeries (implantation of cardiac stimulators; in 2018 - 232), 628 ablations (in 2018 - 516) and 157 valve prostheses (in 2018 - 133).

Diabetes Mellitus In Georgia, last years, there is a growth of the number of diabetes cases, which is mainly caused by the growth of diabetes type 2.
In 2019, on the background of a decrease of the incidence of diabetes type 1 and type 2, there is a 3.75-fold increase, compared to 2018, of the incidence of type 2 diabetes in children under-15.

According to the results of the STEPS2016 - a risk factors of non-communicable diseases survey, an raised fasting glucose level (6.1 - 7.0 mmol / L) was found in 2% of the population aged 18-69, and a high fasting glucose level (> 7 mmol / L) in 4.5%.
of the population 46 National Center for Disease Control and Public Health Diabetes Mellitus, Prevalence Rate per 100 000 Population, Georgia Chronic lung diseases The group of chronic diseases of the respiratory system (asthma, allergic diseases of the respiratory system, chronic obstructive pulmonary diseases, occupational diseases of the lungs, pulmonary hypertension) is a major part of the diseases of the respiratory system.
In 2019, chronic obstructive pulmonary diseases (COPD) constituted 73.0% of the lower respiratory chronic diseases (in 2018 - 75.9%).

Malignant Neoplasms In Georgia, on January 1, 2015, a Cancer Population Register was launched in order to improve the surveillance of oncological diseases.

In 2019, according to the register data.

10,339 new cases of cancer were registered, the incidence rate per 100,000 population - 277.9 (in 2018 - 10417 new cases, incidence rate - 279.5).
Malignant Neoplasms, Incidence Rate per 100000 Population, Georgia 47 National Center for Disease Control and Public Health In 2019, about 56% of all cancer sites were registered in women and about 44% in men.

About 68% of all new cases of cancers are registered in the most active age group (30 to 70 years), 28% of cases - in the population aged 70+ years, 0.8% of cases - in children (0 - 15 years), 0.5% - in adolescents (15-19 years).
In 2015 – 2019, according to the Cancer Registry, 41.7% of new cancers of all sites were registered at I and II stages.

A share of cancers, registered at stages III and IV, is still high.
Malignant Neoplasms by Stages of the Disease (%), Georgia Top 5 Sites of Malignant Neoplasms in Women, New Cases, Georgia, 2019 Site Breast cancer Thyroid gland Colorectal Corpus uteri Cervix uteri Number of new cases Share of total number of all new cases, registered in women (%) 1629 855 335 327 322 28.3 14.8 5.8 5.7 5.6 Top 5 Sites of Malignant Neoplasms in Men, New Cases, Georgia, 2019 Site Trachea, bronchus, lung Prostate Bladder Colorectal Larynx Number of new cases 623 548 405 376 215 Share of total number of all new cases, registered in men (%) 13.6 12.0 8.8 8.2 4.7 48 National Center for Disease Control and Public Health Malignant neoplasms, Methods of Treatment, Georgia2, 2019 Method of treatment Surgery Chemotherapy / hormontherapy Radiotheraphy Symptomatic treatment Iodine therapy Palliative treatment Immune therapy Number of patients 7316 5520 2736 625 529 336 63 % of the number of new cases 70.8 53.4 26.5 6.0 5.1 3.2 0.6 In Georgia, the five-year survival rate of all cancers is low, compared to international rates.
In 2015-2019, the five-year survival rate for all sites of cancers was 50.1%.

In 2019, in Georgia 7873 persons died from cancer, in most of cases the cause of death was trachea, bronchus and lung cancer (15%) and breast cancer (10%).

Environment and health In Georgia, like in many other countries, the burden of diseases caused by harmful environmental impacts is quite high (17%).
In order to reduce and prevent the burden of environmental-related diseases, and to reduce the population's exposure to environmental risks, a National Environment and Health Action Plan has been developed in accordance with requirements of the Association Agreement between Georgia and the EU.

The "National Action Plan for Environment and Health in Georgia in 2018-2022 NEHAP-2" was approved by resolution N680 of the Government of Georgia from December 29, 2018.
Georgia has begun implementation of its commitments under the National Environment and Health Action Plan using EU-supported twinning mechanism.

Newly developed National Environment and Health Action Plan set five strategic goals: 1.

Ensuring public health through access to safe and sustainable water supply and improved sanitation.

Ensuring access to safe water and sanitation for every child by 2021.
Improving access to healthy and safe environment and daily living conditions of children to increase their physical activity by 2021.

2.

3.

Assessment of outdoor and ambient air pollution impact on human health, and measures taken to reduce the harmful effects.

4.

Prevention of disease caused by exposure of chemicals.

5.

Integrating of health issues into climate change adaptation and mitigation policies.
In 2019, various activities of the EU Institutional Cooperation Mechanism - Twinning project "Institutional Strengthening of the Environmental Health System in Georgia" were carried out.

2 Cancer Population Registry and the Social Services Agency compiled data 49 National Center for Disease Control and Public Health Recommendations for institutional arrangements in the field of environmental health were presented in the twinning project.
Also, within the framework of the project, working versions of the following technical regulations were prepared:  on bathing water regulations;  on water quality for human consumption.

In accordance with the National Action Plan for Environment and Health (NEHAP-2) a plan of work and ongoing activities for 2018-2019 has been prepared.

The composition and regulations of the Coordinating Council of the National Environment and Health Action Plan was approved.
In January 2019, an air quality portal was launched, in cooperation with the Ministry of Environment Protection and Agriculture of Georgia.

The Portal posts public information on air quality monitoring results and health recommendations for each polluter in the accordance to international methodology.
The materials for the International Lead Prevention Week were prepared, a package of information for the lead bio monitoring protocol on the impact of lead exposure on humans, the sources of exposure and their prevention.

A national working group and answers to the standard questionnaire “Global Analysis and Assessment of Sanitation and Drinking Water - GLAAS in evaluation process (GLAAS 2018/2019) were organized.
In Georgia, MICS survey was conducted with support of the National Statistics Office of Georgia, the United Nations Children's Fund, WHO and the NCDC in order to protect the population from harmful exposure and prevent environmental diseases.

The results of the MICS lead study have highlighted the urgency of the issue and the need for a proactive approach.
Lead was declared as a priority among the environment health issues and, due to the complexity of the problem, it is planned to develop a long-term multi-sectoral state program aimed at minimizing lead exposure and, in the best case, at the eliminating lead poisoning.
In 2018, as part of the Global MICS program, a multi-indicator cluster survey (MICS) was conducted in a close cooperation of the National Statistics Office, the United Nations Children's Fund (UNICEF), and the National Center for Disease Control and Public Health (NCDC).

The MICS program – Multiple Indicator Cluster Survey, was developed by the UNICEF in 1990 to collect a wide range of internationally comparable indicators.
MICS surveys measure key indicators that enable countries in providing policy-makers with the information they need to meet programs, national development plans, and sustainable development goals (SDSs).

The study looked at the increased lead level in the blood and the quality of household drinking water.

Lead is a toxic metal that causes damage of the brain and other systems of the human body.
A high levels of lead in the blood can cause growth retardation in children, behavioral difficulties, learning difficulties, and, in pregnant women, premature birth, miscarriage, and stillbirth.

The minimum, health-safe concentration of lead for the humans is not established.

However, public health activities should be planned when the venous blood lead content equals to or greater than 5 μg / dL (micrograms per deciliter).
50 National Center for Disease Control and Public Health Elevated Lead Level in the Blood by Regions, MICS-2018 Source Multiple Indicator Cluster Survey (MICS SURVEY) The household drinking water must be safe from epidemic and radiation points of view, chemically safe and have good organoleptic properties.

The quality of household drinking water is determined by a detection of a health-threatening bacterium (E.coli) in drinking water.
Share of Households (%) with E.coli in Drinking Water, MICS-2018 Source Multiple Indicator Cluster Survey (MICS SURVEY) 51 National Center for Disease Control and Public Health Mortality Rate Attributed to Unsafe Water, Sanitation and Hygiene Services (per 100000 population) Source: http://hdr.undp.org/en/indicators/174606 52 National Center for Disease Control and Public Health The published materials may be freely used and no permission for reproduction in part or in whole is needed.
The NCDC welcomes mentioning as a source.

In any question applications, should be made to the National Centre for Disease Control and Public Health named after L.Sakvarelidze at 99, Kakheti Highway, Tbilisi, Georgia E-mail: pr.ncdc@ncdc.ge Web-site: ncdc.ge FREE EDITION 53