ArticleBMJ global health2025
Private provision of health services in Georgia: a qualitative exploration of governance behaviours.
Article in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionThe private sector occupies a dominant position in Georgia's health system, with most hospitals, primary care clinics, diagnostic facilities, pharmacies and insurance companies under for-profit ownership. Robust governance arrangements are required to align the profit-orientation of providers with health policy objectives.
methodsThis paper examines governance arrangements in Georgia's 'mixed' health system. It draws on document analysis, key informant interviews and a validation workshop. Analysis is guided by the WHO's 'governance behaviours' framework, focusing on strategy, regulation, purchasing and information generation as well as mechanisms for policy dialogue, actor alignment and trust building.
resultsGeorgia has established a complex array of governance mechanisms for its dominant private health sector, but these remain weakly enforced. Strategic plans lack detailed implementation and budgetary integration; regulation and purchasing structures are fragmented; data systems and oversight capacity are limited; and consultation mechanisms underdeveloped-together constraining accountability, efficiency and progress towards universal health coverage. CONCLUDING DISCUSSION: Georgia's experience highlights a persistent gap between governance intent and implementation capacity. In highly marketised systems, sustained political commitment and investment in state capacity for enforcement, data use and stakeholder dialogue are essential to align private incentives with policy goals-and advance universal health coverage.
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