Banking on Health: Supporting “Accidental Healthcare Entrepreneurs” in Georgia
A health sector in the midst of dramatic change Primary health care in rural Georgia is delivered via small rural ambulatory facilities, typically staffed by one to three doctor and nurse teams. These teams provide basic primary health care and family planning services under a contract with the government. Soon, the Government of Georgia will hand over ownership of these small facilities and practices to the doctors who currently work in them, creating, practically overnight, more than 900 “accidental entrepreneurs.” The Abt Associates-led USAID Banking on Health project is developing an entrepreneurship and business management training course to help increase the chances for these practices to survive and to continue to offer essential services in a post-privatization reality.
This privatization will be the final step in a series of dramatic health sector reforms which will result in a health system that is firmly routed in the private sector. In recent years, family planning had been introduced into primary health care delivery through a series of reforms, USAID-sponsored training of providers, and product donations for distribution in rural areas. Most of the hospitals in the country have been privatized within the last year. The remaining public facilities function using a mixture of government funds and informal out-of-pocket payments. Officially, rural ambulatory facilities are operating using payments provided by the government, plus payments from health insurance companies participating in the government program for health coverage for the vulnerable.
Moving forward after conflict
An April 2008 Banking on Health assessment found that the health sector was in need of capacity building at almost every level – and that one of the most pressing needs was to provide technical support for these rural physicians who are essential providers of public health and family planning services. The August 2008 conflict with Russia created thousands of internally displaced persons and a general sense of political uncertainty. Only a month after this conflict ended, the Government of Georgia echoed Banking on Health’s recommendation with a request to USAID for business management training support for physicians in rural ambulatory facilities whose practices will soon be privatized.
“Starting, Managing, and Growing a Private Medical Practice”
In early 2009 Banking on Health is slated to train local training firms to deliver a five-day course on “Starting, Managing, and Growing a Private Medical Practice.” This course will be piloted with the coordination of the USAID CoReform Project and the World Bank to over 100 doctors. The training is designed to give these physicians the confidence, skills and knowledge that they will need to begin operating as entrepreneurs. In addition to factors such as the knowledge of how to incorporate and the ability to use a balance sheet, it will be important for these physicians’ success that they have the ability to envision themselves as business owners, and to have an appreciation for the risks and opportunities that this new role entails.
