It is the first day of a five-day training program and six laboratory technicians from the Nikoloz Kipshidze Central University Clinic in Tbilisi are gathered around a new Cobas polymerase chain reaction (PCR) testing machine. A component of Georgia’s Emergency COVID-19 Response Project
, the EUR500,000 fully integrated laboratory automation system that allows PCR technology is capable of analyzing nearly 1,500 blood samples a day and is the country’s latest weapon in the battle against COVID-19.
When the novel coronavirus was first detected in Georgia on Feb. 25, 2020, the government responded immediately by shutting down schools and public venues. Three weeks later, Georgia declared a state of emergency and imposed further restrictions on movement. By April 18, Georgia had confirmed 388 cases and only four deaths—among the lowest numbers in the world.
Had the government not quickly imposed stringent measures, the health-care system would have been overwhelmed. Health-care reform has been a knotty process since Georgia became independent in 1991. A policy to privatize the antiquated system began earnestly in 2007 but left many uninsured. Today, the government is improving access through a universal health coverage program launched in 2013. However, state health spending remains low, amounting to only three percent of gross domestic product in 2017. Georgia was hardly prepared to deal with COVID-19 when it arrived.
“Before the pandemic, we had a basic stock of PPE (personal protective equipment), but it wasn’t enough. The whole country needed it,” explained Amiran Gogitidze, head of the Medical Care and Call Management Department, the state dispatcher of ambulances and emergency care throughout the country.
Georgia is a founding member of the Asian Infrastructure Investment Bank (AIIB) and has been a client since 2017. Throughout 2020, AIIB responded swiftly to the needs of its members and clients, including Georgia. In May 2020, AIIB, in partnership with the government and the International Bank for Reconstruction and Development (IBRD) launched the Georgia Emergency COVID-19 Response Project
to help the country better prevent, detect and respond to the threat posed by COVID-19.
The loan (EUR91.34 million or about USD100 million from AIIB plus EUR73.10 million or about USD80 million from IBRD) has been providing Georgia with essential medical supplies and costly equipment the state budget cannot afford, not only to fight the pandemic but also to improve access and health-care quality in general. The project’s emergency health-care assistance and social protection measures are closely interlinked and aim to protect the most vulnerable people affected by COVID-19.
According to AIIB Investment Operations Specialist Mehek Marwaha, “The project featured a unique combination of assistance for emergency health-care strengthening as well as social protection measures, which were a necessary complement to containing the outbreak of the pandemic and proved vital in preventing poor households and vulnerable individuals from falling deeper into the poverty trap.”
“Through this project, the government has been able to decrease the threshold of criteria for socially vulnerable people, providing cash benefits to our citizens,” explained Nino Kvernadze, Georgia Emergency COVID-19 Response Project manager.
AIIB and World Bank loans have provided USD66.5 million for half a million people the pandemic has left unemployed and USD17.5 million of social assistance for more than two million poor and vulnerable people, who are particularly impacted by the pandemic. They face further unemployment and poverty because of the economic downturn resulting from restrictions imposed to control the outbreak. Poor and vulnerable households received temporary income support in the form of cash transfers, while workers who lost their jobs or income because of the pandemic received unemployment assistance. These mitigating measures helped beneficiaries comply with social distancing and COVID-19 containment measures and lockdown orders.
“Over ninety percent of 2020’s social assistance and unemployment benefits were reimbursed by this project,” Kvernadze added.
Gogitidze called the project a game changer. In addition to PPE, his department is ready with emergency ventilators, oxygen generation systems and a new two-way radio system. Until now, the state’s first responders—a fleet of 300 ambulances—had been dispatched entirely by mobile phone. At the peak of the second wave in the autumn of 2020, the emergency department was receiving 3,000 calls a day. Efficient communication and transport infrastructure are requisites of tomorrow’s health-care system, and it is AIIB’s mission to continue financing Infrastructure for Tomorrow.
The project boosted Georgia’s scope of testing, crucial to preventing the spread of COVID-19. When the first cases were identified, testing was done only at the Richard Lugar Center for Public Health Research in Tbilisi, a state-of-the-art diagnostic laboratory and home of the National Center for Disease Control and Public Health (NCDC).
Through AIIB’s initial support, the NCDC was able to procure PCR and rapid test kits, laboratory reagents, molecular testing equipment and the necessary resources to increase its testing capacity, from several hundreds to 12,000 tests a day in 37 labs across the country.
“We are well-prepared for diagnosis with huge capacity in the regions,” said Dr. Maia Alkhazashvili, head of the Lugar Center. “We were able to achieve results in 24 hours,” she added with a smile.
The Lugar Center received a Cobas PCR machine, which has nearly doubled the lab’s capacity to about 2,000-2,500 COVID-19 tests a day. As the pandemic passes, the machine will be used for blood tests to diagnose other conditions, such as hepatitis and HIV.
Dr. Alkhazashivi and her team recently discovered the first United Kingdom strain in Georgia and are testing for mutations.
The project has contributed significantly to the operation of the Batumi Clinical Hospital and the newly established 220-bed Rukhi Republican Hospital. Irakli Gvazava, its director, believes the state-of-the-art full-service hospital can play an important role in the community.
Decentralizing health care, particularly during the pandemic, has been a goal of the health ministry. Tbilisi, however, where more than a third of the population of 3.7 million reside, has felt the brunt of the crisis that has so far claimed 3,751 lives.
In January 2021, the government established a new COVID-19 unit at the Kipshidze Central University Clinic, where Gvazava is also the director. “This is the flagship of COVID-19 treatment centers,” he affirmed.
The project has helped equip much of the 700-bed intensive care unit, while a wing in the 50-year-old hospital is being renovated into a modern laboratory, where the Cobas machine is installed.
“We have created a multi-profile clinic,” said Gvazava. “We will continue to use everything the project has provided even after COVID-19. This has been a big boost to our health system.”