სოფლის ექიმის სახელმწიფო ......saxelmwifo auditis...

ეფექტიანობის აუდიტის ანგარიში

www.sao.ge

სოფლის ექიმის სახელმწიფო პროგრამის ეფექტიანობის აუდიტი

პირველად ჯანდაცვაში არსებული პრობლემების შემცირება სოფლად შესაძლებელია სამედიცინო პერსონალის ხელმისაწვდომობის, მათი პროდუქტიულობის და ჯანდაცვის სხვა რგოლებთან ინტეგრირების გაზრდით

janmrTelobis dacva yvela qveynis prior itetia. sazogadoebrivi janmrTelobisTvis pirveladi jandacvis, rogorc janmrTelo-bis dacvis sistemis mekaribWis, roli umniSvnelovanesia. pirveladi jandacvis saboloo mizani aris janmrTelobis gaumj obeseba yvelasaTvis daja nmrTelobaze gaweuli danaxarjebis Semcireba. gansaku -Trebul aqtualobas pirveladi jandacva iZens soflebSi, sadac samedicino servise-bis xelmisawvdomoba gacilebiT dabalia.CvenTvis mniSvnelovania, rom pirveladi

jandacva iyos yvelasTvis xelmisawvdomi da efeqtianad axor-cielebdes Tavis funqcias. swored am mizniT, mniSvnelovania sax-elmwifo programebis saTanado dagegmva da administrireba, rac gaaumjobesebs pirveladi jandacvis xelmisawvdomobasa da gaweuli momsaxurebis xarisxs.winamdebare auditis angariSSi ganxilulia soflis eqimis saxelm-wifo programa, soflad pirveladi jandacvis sistemis winaSe md-gari problemebi, maTi gamomwvevi mizezebi da warmodgenilia Ses -abamisi rekomendaciebi.

საქართველო კავკასიაში მეწყერის უმაღლესი რისკის ფასდება. ტყე წარმოადგენს ბუნებრივ დამცავს მეწყერების, ზვავებისა და მდინარეების ეროზიისაგან. ენერგფინანსური და ეკონომიკური კრიზისის პისაქართველოში ტყითსარგებლობამ განსაკუთრებიათწლეულების განმავლობაში მოიმატა. ტყეებისმოპოვება და მისი აღდგენის ხელშეწყობის უგულვებელყოფა დღეისათვის მნიშვნელოვან პრობლემას წარმოადგენსაქვე უნდა აღინიშნოს იქ ფაქტი, რომ ტყის მდგრადი ხელშეწყობის ვალდებულება ასახულია საქართველოსა ევროკავშირს შორის ასოცირების ხელშეკრულებაში, იღებენ ვალდებულებას მიიღონ სპეციალური ზომები, ხელი შეუწყონ ტყის საფარის დაცვას, ებრძოლონ ტყის ჭრასა და მასთან დაკავშირებულ ვაჭრობას.აღნიშნულიდან გამომდინარე სახელმწიფო

სამსახურმა შეისწავლა საქართველოში ხე-ტყის გადამუშავების კომერციულ სექტორში, ლიცენზირებისა და მონიტორინგის პროცესში არსებული პრომიზანშეწონილად მიგვაჩნია აუდიტის დროს ჩატარეული კვლევებისა და დასკვნების საფუძველზე წარმოდგენილი რეკომენდაციების გათვალისწინება, რაც საშუალებას მოგვცემს მნიშვნელოვნად გავაუმჯობესოთ დარგში არსებული სიტუაცია.

[email protected]

სახელმწიფო აუდიტის სამსახური

[email protected]© saxelmwifo auditis samsaxuri

saxelmwifo auditis samsaxuri

soflis eqimis saxelmwifo programis efeqtianobis auditi

efeqtianobis auditis angariSi

30.12.2015mimdinare nomeri: 74/00

pirvelad jandacvaSi arsebuli problemebis Semcireba soflad SesaZlebelia sa-medicino personalis xelmisawvdomobis, maTi produqtiulobis da jandacvis sxva

rgolebTan integrirebis gazrdiT

sarCevi

angariSSi gamoyenebul terminTa mniSvneloba .................................................................. 4

Semajamebeli mimoxilva ..................................................................................................... 5

1. Sesavali ............................................................................................................................ 81.1 auditis motivacia ....................................................................................................... 81.2 auditis mizani da kiTxvebi ......................................................................................... 101.3 auditis masStabi da meTodologia ............................................................................ 111.4 Sefasebis kriteriumebi ............................................................................................... 13

2. zogadi informacia .......................................................................................................... 142.1 pirveladi jandacvis arsi da ZiriTadi funqciebi .................................................. 142.2 soflis eqimis saxelmwifo programis dizaini.......................................................... 162.3 programis dafinansebis sistema da biujeti ............................................................. 172.4 programis farglebSi gansaxorcielebeli momsaxureba .......................................... 19

auditis mignebebi ................................................................................................................ 20

3. soflis eqimis momsaxurebis xelmisawvdomoba ............................................................. 203.1 samedicino personalis demografiul ganawilebaSi arsebuli naklovanebebi ...... 203.2 samedicino personalis geografiuli ganawilebis xarvezebi ................................. 243.3 infrastruqturasTan dakavSirebuli problemebi.................................................... 28

4. soflis eqimebis produqtiulobis winapirobebi ..............................................................................324.1 programis administrirebis sistemaSi arsebuli naklovanebebi ............................. 354.2 anazRaurebis sistema Sedegze orientirebuli ar aris ........................................... 414.3 eqimebis kvalifikaciasTan da informirebulobasTan dakavSirebuli

naklovanebebi ................................................................................................................ 43

5. soflis eqimis arasakmarisi CarTuloba skriningis programaSi .................................. 48

6. angariSgebasTan dakavSirebuli problemebi ................................................................. 51

7. damatebiTi informacia - specdafinansebaze myofi dawesebulebebisTvis dadgenili limitebis gansazRvraSi arsebuli naklovaneba ......................................... 53

Semajamebeli daskvna da rekomendaciebi........................................................................... 55

bibliografia ...................................................................................................................... 60

danarTebi ............................................................................................................................ 62

სახელმწიფო აუდიტის სამსახური I ეფექტიანობის აუდიტის ანგარიში4

სოფლის ექიმის ეფექტიანობის აუდიტი l 2015

angariSSi gamoyenebul terminTa mniSvneloba

saministro - saqarTvelos Sromis, janmrTelobis da socialuri dacvis saministro

saagento - saqarTvelos Sromis, janmrTelobis da socialuri dacvis saministroSi Semavali ssip - socialuri momsaxurebis saagento

AAFP - saojaxo medicinis akademia

UNFPA - gaeros mosaxleobis fondi

WHO - janmrTelobis msoflio organizacia

WONCA - ojaxis eqimebis msoflio organizacia

სახელმწიფო აუდიტის სამსახური I ეფექტიანობის აუდიტის ანგარიში სახელმწიფო აუდიტის სამსახური I ეფექტიანობის აუდიტის ანგარიში 5


Semajamebeli mimoxilva

saxelmwifo auditis samsaxurma Caatara soflad pirveladi jandacvis rgolis, so-flis eqimis programis efeqtianobis auditi.

mosaxleobis janmrTelobis dacva yvela qveynisTvis prioritetuli mimarTulebaa, Tumca gansakuTrebul gamowvevas ukavSirdeba janmrTelobis dacva ganviTarebadi qveynebisTvis, romlebic cdiloben socialur-ekonomikuri garemoebebidan gamomdin-are, gansakuTrebulad SezRuduli materialuri resursis farglebSi maqsimaluri Sedegis miRwevas. aseT SemTxvevaSi erT-erTi mniSvnelovani winapiroba pirveladi jan-dacvis myari safuZvlis arsebobaa, vinaidan dadgenilia, rom pirveladi jandacvis rgoli aris janmrTelobis dacvis mekaribWe, romelic erTgvarad akavebs mosaxleo-bis avadobas, aumjobesebs janmrTelobis maCveneblebs da qveynebs saSualebas aZlevs gadaudebel da stacionarul momsaxurebaze danaxarjebi Seamciron.

saqarTvelos soflebs pirveladi jandacvis momsaxureba soflis eqimis programis saxiT miewodebaT. programa 2009 wlidan amoqmedda. wlebis ganmavlobaSi is sadaz-Rvevo kompaniebis TanamonawileobiT xorcieldeboda, xolo 2014 wlis dasawyisSi saxelmwifom srulad gadmoibara programis administrireba da dafinanseba, rac yo-velwliurad daaxloebiT 20 milion lars Seadgens. amasTan, eqimebis momsaxurebis anazRaureba 30%-iT gaizarda wina wlebTan SedarebiT.

soflis eqimis programiT gaTvaliswinebul momsaxurebas 2000-ze meti samedicino personali axorcielebs, aqedan 2014 wlis monacemebiT xelSekrulebis safuZvelze momsaxurebas axorcielebs 1210 eqimi.

pirveladi jandacvis komponentis farglebSi soflis eqimebTan da eqTnebTan mi-marTvianoba saqarTvelos masStabiT yovelTviurad daaxloebiT 130,000 vizits Sead-gens.

pirveladi jandacvis mniSvnelobidan, aseve soflis mosaxleobis gansakuTrebuli saWiroebebis da programaze gaweuli danaxarjebis arsebiTobidan gamomdinare, sax-elmwifo auditis samsaxurma Caatara soflis eqimis programis efeqtianobis auditi, ris Sedegadac identificirebuli iqna naklovanebebi, romelic ukavSirdeba programis dizains, administrirebas, monitoringsa da miRweuli Sedegebis Sefasebas.

pirveladi jandacva soflad Tanabrad unda iyos xelmisawvdomi mosaxleobisTvis. auditis Sedegad gamovlinda, rom samedicino personalis demografiuli ganawileb-is kriteriumi dadgenili ar aris da garkveul SemTxevebSi mniSvnelovnad aRemateba gonivrul zRvars. amasTan, programis farglebSi 10,000-ze meti adamiani nawilobriv (eqTnis saSualebiT) iRebs momsaxurebas. garda amisa, saxezea geografiuli ganawileb-is xarvezebi da arsebobs samedicino personalis ukeT ganawilebis potenciali.

saxelmwifo auditis samsaxuri miiCnevs, rom grZelvadianad programis dizainSi ar-sebuli rigi naklovanebebis gamo ver iqneba miRweuli maqsimaluri Sedegebi da ver gaumjobesdeba soflad pirveladi jandacvis servisebis utilizacia da momsaxurebis produqtiuloba.



samedicino personalis produqtiuloba ukavSirdeba iseT mniSvnelovan faqtorebs, rogoricaa: mdgradi marTvis sistema, motivacia, anazRaureba, kvalifikacia.

eqimebis datvirTva, romelic eqimebis produqtiulobis erT-erTi maCvenebelia, sa-grZnoblad gansxvavdeba erTmaneTisagan. amisi mizezi SeiZleba konkretuli teritori-uli erTeulisaTvis damaxasiaTebeli reliefi, mosaxleobis gansxvavebuli raodenoba da dasaxlebis simWidrove iyos. Tumca arsebobs teritoriuli erTeulebi, sadac erT teritoriul erTeulSi dasaqmebul 2 eqims mniSvnelovnad gansxvavebuli datvirTva aqvs, rac eqimebis gansxvavebuli produqtiulobis maCvenebelia.

eqimebis gansxvavebuli produqtiuloba sxvadasxva mizezs ukavSirdeba: eqimebis 20% SeTavsebiT dasaqmebulia sxva samsaxurSi, amasTan, samedicino personalis samuSao drois reJimi ar aris daregulirebuli, xolo ssip - socialuri momsaxurebis saagen-tos ar gaaCnia samedicino personalis monitoringis meqanizmi. aRniSnuli berketebis ararseboba, samedicino personals saSualebas aZlevs sasurveli droiT da jeradobiT iaron momsaxurebis gawevis adgilas. Sesabamisad, xSirad sagrZnoblad gansxvavebulia iseTi eqimebis datvirTva, romlebic Tanabar pirobebSi (mosaxleobis raodenoba, geo-grafiuli Tavisebureba) asruleben samuSaos.

saministros ganmartebiT, iseT personalTan xelSekrulebebis gaformeba, romlebic sxva samsaxurSi arian dasaqmebuli, soflad kadris deficits ukavSirdeba, Tumca sa-medicino personalTan gaformebuli xelSekrulebis forma ver qmnis kadris moZiebis safuZvels. kerZod, eqimebisgan momsaxurebis Sesyidva xorcieldeba saxelmwifo Ses-yidvebiT dadgenili wesiT - gamartivebuli Sesyidvis saxiT, Sesabamisad ar cxaddeba vakansiebi, ar xdeba dainteresebuli mxareebis masobrivi informireba arsebul po-ziciebTan dakavSirebiT.

programis dafinansebis sistema ver qmnis samedicino personalis produqtiulobis miRwevis winapirobas, radgan fiqsirebuli anazRaureba ar emyareba eqimis motivaciis amaRlebas. arsebuli modeliT, Tu eqims bevri pacienti hyavs, mas gacilebiT meti ma-terialuri xarjis gaReba uwevs sakuTari anazRaurebidan vidre eqims, romelic pro-gramis farglebSi momsaxurebas naklebad axorcielebs sxvadasxva mizezis gamo: sxva dawesebulebaSi muSaoba, mcire samuSao dro da sxv.

eqimis produqtiulobis uzrunvelsayofad mniSvnelovani faqtoria soflis eqimis kvalifikacia. soflis eqimi axorcielebs pirveladi jandacvis momsaxurebas, Sesa-bamisad centraluri roli ojaxis eqimis kvalifikacias unda eniWebodes. soflis eqimebis nawili ar aris gadamzadebuli da sertificirebuli saojaxo medicinaSi, rac maT produqtiulobaze garkveulwilad aisaxeba.

pirveladi jandacva daavadebaTa adreuli gamovlenis umniSvnelovanesi meqanizmia. daavadebaTa adreuli diagnostikis erT-erT berkets, Tavis mxriv, skriningis pro-gramebi warmoadgens. auditis Sedegad gamovlinda, rom soflis eqimis programasa da skriningis programas Soris koordinacia sustia. soflis eqimebis skriningis pro-gramaSi CarTviT SesaZlebelia gaizardos skriningiT moculi kontigenti.

rac Seexeba programis Sefasebis sistemas, arsebuli indikatorebis mixedviT, pro-



grama ganmaxorcieleblis mier Sefasebuli ar aris, vinaidan ar arsebobs programis Sefasebis winapirobebi. kerZod, samedicino personalis mier yovelTviurad war-modgenili angariSgeba ar konsolidireba da ar xdeba misi analizi. amasTan, dadge-nili statistikuri forma arasrulyofilia da ar moicavs SefasebisTvis sxvadasxva mniSvnelovan informacias.

winamdebare angariSSi ganxilulia problemebi, maTi gamomwvevi mizezi da gacemulia Sesabamisi rekomendaciebi. saxelmwifo auditis samsaxuri miiCnevs, rom rekomendacieb-is Sesrulebis SemTxvevaSi arsebobs programis moklevadiani da grZelvadiani Sedegeb-is gaumjobesebis potenciali. programis dizainis da marTvis sistemis gaumjobesebiT, SesaZlebelia momsaxurebaze xelmisawvdomobis gazrda, samedicino personalis pro-duqtiulobis gaumjobeseba da daavadebaTa adreuli gamovlenis xelSewyoba.



1. Sesavali

1.1 auditis motivacia

saqarTvelos mTavrobis erT-erTi ZiriTadi prioritetia mosaxleobisaTvis xelmi-sawvdomi da xarisxiani janmrTelobis dacvis uzrunvelyofa. aRniSnuli xorcield-eba sxvadasxva saxis programebiT, romelTa mizanic mosaxleobisaTvis janmrTelobis gaumjobesebaze mimarTuli mTeli rigi RonisZiebebis gatarebaa.

pirveladi jandacva warmoadgens janmrTelobis dacvis sistemis efeqtianad fun-qcionirebisaTvis saWiro umniSvnelovanes komponents, romelmac unda uzrunvely-os mosaxleobisaTvis drouli da xarisxiani momsaxurebis miwodeba. is pasuxobs jan-mrTelobis problemebs da janmrTelobasTan dakavSirebul saWiroebebs sazogadoebaSi, xels uwyobs daavadebaTa prevencias da adreul gamovlenas, moicavs mkurnalobasa da sareabilitacio servisebs.1

pirveladi jandacva ar warmoadgens calkeul rgols, romelic damoukidebelia janmrTelobis dacvis sxva doneebisgan. is asrulebs e.w. „mekaribWis“ funqcias jan-mrTelobis dacvaSi da integrirebulia janmrTelobis dacvis ufro maRal safexure-bTan.

saqarTveloSi sikvdilianobis struqturaSi wamyvani adgili uWiravs sisxlis mimo-qcevis sistemis daavadebebs (40.5%), dauzustebel mizezebs (33.8%), axal warmonaqmnebs - simsivnur daavadebebs (10.6%).2

simsivnuri daavadebebiT sikvdilianobis maRali done umeteswilad ganpirobebulia adreul I da II stadiaze dabali gamovlenis maCvenebliT (25%-dan 30%-mde). daavade-baTa gamovlena dagvianebul etapze Tavis mxriv pirvelad jandacvaSi arsebul problemebs ukavSirdeba.

sayovelTao jandacvis 2014 wlis monacemebis mixedviT, qveyanaSi gadaudebel ambu-latoriul da stacionarul momsaxurebaze gaweuli danaxarjebi wliurad sayovelTao janmrTelobis dacvis farglebSi gaweuli danaxarjebis (335,602,940 lari) 70%s3, xolo gegmuri ambulatoriuli momsaxurebis komponenti 13%-s Seadgens.

1 Declaration of Alma-Ata International Conference on Primary Health Care - alma-atis pirveladi jan-dacvis konferenciis deklaracia2 daavadebaTa kontrolisa da sazogadoebrivi janmrTelobis erovnuli centri-statistikuri informacia;3 garda qimio, hormono, sxivuri Terapiisa da mSobiarobaze gaweuli danaxarjebisa.



grafiki №1.1.1: 2014 wels sayovelTao jandacvis farglebSi gaweuli xarjimomsaxurebis mixedviT

rogorc saministros angariSebidan irkveva4 gegmur ambulatoriul momsaxurebaze mimarTvianoba dabalia gadaudebel momsaxurebasTan SedarebiT.

“saswrafo samedicino daxmarebis sistemis efeqtianobis auditis angariSidan” irkveva,5 rom pirveladi jandacvis aradamakmayofilebeli mdgomareoba zrdis xarjs gadaudebel momsaxurebebze.

Sesabamisad, pirveladi jandacvis sistema gavlenas axdens ara marto qveynis jan-dacvis mdgomareobis, ZiriTadi indikatorebis da daavadebaTa drouli gamovlenis maCveneblebis gaumjobesebaze, aramed grZelvadianad xels uwyobs jandacvaze gaweu-li saxelmwifo da kerZo danaxarjebis Semcirebas.

saqarTvelos soflebSi pirvelad jandacvaze pasuxismgebelia soflis eqimis sax-elmwifo programa, romlis mTavari mizani soflis mosaxleobisaTvis pirveladi jan-dacvis momsaxurebaze geografiuli da finansuri xelmisawvdomobis gazrdaa. 2014 wlis monacemebiT, saqarTvelos mosaxleobis 46.3%6 soflad cxovrobs, Sesabamisad, mosaxleobis mniSvnelovani nawilisTvis pirveladi jandacvis momsaxurebis drouli da xarisxiani miwodeba did wilad soflis eqimis programis efeqtianad ganxorciel-ebazea damokidebuli.

4 jandacvis sistemis efeqturobis Sefasebis 2013 wlis angariSi - saqarTvelos Sromis, jan-mrTelobis da socialuri dacvis saministro; ssip daavadebaTa kontrolis da sazogadoebrivi janmrTelobis erovnuli centri - epidemiologiuri biuleteni 2014 .5 saxelmwifo auditis samsaxuri - saswrafo samedicino daxmarebis sistemis 2011-2012 wlebis efeqtianobis auditis angariSi - saswrafo samedicino daxmarebis droul reagirebasa da momsax-urebaSi arsebuli problemebi.6 saqarTvelos statistikis erovnuli samsaxuri - http://geostat.ge/?action=page&p_id=151&lang=geo.

15%

13%

3%8%

8%2%0%4%

47%

gadaudebeli ambulatoria

gadaudebeli stacionari

gegmuri ambulatoria

gegmuri qirurgiuli momsaxureba

kardioqirurgia

mSobiaroba da sakeisro kveTa

samkurnalo saSualebebi

sxivuri Terapia

qimioTerapia da hormonoTerapia

2014 wels sayovelTao jandacvis farglebSi komponentebis mixedviT gaweuli xarji



programa 2009 wlidan mimdinareobs, programis farglebSi saxelmwifo auditis samsaxuris mier auditi ar Catarebula.

pirvelad jandacvaSi arsebuli problemebi miuTiTebs riskebze, rom sofla programis farglebSi arsebuli momsaxureba mosaxleobisTvis arasakmarisad xelmis-awvdomi da produqtiulia, ramac SesaZlebelia jandacvaze gazrdili saxelmwifo Tu kerZo danaxarjebi gamoiwvios.

saxelmwifo auditis samsaxuri miiCnevs, rom gamovlenili garemoebebis siRrmiseul-ma Seswavlam da gacemulma rekomendaciebma SesaZloa mniSvnelovnad gazardos pirve-ladi jandacvis produqtiuloba soflad, rac samomavlod Sesabamisad aisaxeba qveya-naSi janmrTelobis dacvis maCveneblebsa da jandacvaze gaweul danaxarjebze.

1.2 auditis mizani da kiTxvebi

auditis mizania Seafasos soflad pirveladi jandacvis produqtiulobis sakiTxebi: programis farglebSi gaweuli momsaxurebis xelmisawvdomoba, mosaxleobisTvis pro-duqtiuli momsaxurebis gawevis winapirobebis arseboba, janmrTelobis dacvis sis-temaSi soflis eqimis integrireba. gamovlenili garemoebebi da Sesabamisi rekomenda-ciebi aisaxeba auditis angariSSi.

zemoaRniSnuli mizniT, auditma upasuxa Semdeg kiTxvas:

ramdenad uzrunvelyofs soflis eqimis programis farglebSi miwodebuli momsaxureba pirveladi jandacvis rgolis produqtiulobas soflad?

mTavar kiTxvaze pasuxis gasacemad, auditma upasuxa Semdeg qvekiTxvebs:

» ramdenad uzrunvelyofilia pirveladi jandacvis Tanabari geografiul- demo-grafiuli xelmisawvdomoba soflad?

» ramdenad qmnis programis dizaini produqtiuli momsaxurebis gawevis winapirobas?

» ramdenad uzrunvelyofilia soflad pirveladi jandacvis sistemis koor-dinacia ufro maRali donis jandacvis sistemasTan?

» ramdenad uzrunvelyofs soflis eqimebis mier warmodgenili angariSi pir-veladi jandacvis mdgomareobis analizis SesaZleblobas da problemuri mimar-Tulebebis gamovlenas?



1.3 auditis masStabi da meTodologia

soflis eqimis saxelmwifo programis komponentis „pirveladi jandacva soflad“ auditis periodi moicavs 2014 wels. auditis miznebisTvis aseve gamoyenebulia audi-tis mimdinareobis periodic - 2015 wlis I-II kvartali.

auditma damatebiT Seiswavla programis erT-erTi komponentis, kerZod, specdaf-inansebaze myofi dawesebulebebis mier Sesabamisi ambulatoriuli da stacionaruli momsaxurebis miwodebis farglebSi gansazRvruli finansuri limitebisa da angariS-gebis sakiTxebi.

auditis obieqts warmoadgens saqarTvelos Sromis, janmrTelobis da socialuri dacvis saministro da mis sistemaSi Semavali ssip - socialuri momsaxurebis saagento.

auditis ZiriTad kiTxvaze pasuxebis mosapoveblad SemuSavda auditoruli proce-durebi, romlis meSveobiTac Seswavlil iqna soflis eqimis programis marTvis, admin-istrirebis, dafinansebis, programis farglebSi gaweuli momsaxurebis sakiTxebi, ris Sesaswavladac gamoyenebul iqna sxvadasxva meTodebi:

» saerTaSorisod miRebuli praqtikis gacnoba da analizi;» samarTlebrivi bazisa da maregulirebeli normebis analizi;» programis marTvisa da administrirebis procedurebis analizi;» monacemTa bazebis analizi;» statistikuri informaciis analizi;» finansuri dokumentaciis analizi;» dokumenturi informaciis analizi;» auditis obieqtebTan (Sesabamis pasuxismgebel pirebTan) interviuebi;» gamokiTxvebi - municipalitetebisa da eqimebis gamokiTxva kiTxvarebis meSve-

obiT:

» municipalitetebis gamokiTxva - kiTxvari miznad isaxavda mosaxleobis raode-nobis, ambulatoriebis mdgomareobis, soflis eqimis momsaxurebis xelmisawvdomo-bis da momsaxurebis miRebasTan dakavSirebuli problemebis dadgenas. kiTxvarebi gaigzavna saqarTvelos municipalitetebSi. saqarTveloSi sul 63 municipalite-tia, aqedan 4 municipalitets ar aqvs soflebi, aseve mcxeTa-mTianeTis regionis or municipalitetSi ar xorcieldeba soflis eqimis programa. Sesabamisad, kiTx-vari gaigzavna 57 municipalitetSi, aqedan, saxelmwifo auditis samsaxurma 53 (93%) municipalitetidan miiRo pasuxi.

» soflis eqimebis gamokiTxva - ssip socialuri momsaxurebis saagentos re-gionuli samxareo centrebis meSveobiT, kiTxvari Seavso sxvadasxva regionis 185 soflis eqimma. kiTxvari emsaxureboda eqimebis samuSao grafikis, samuSao saaTeb-is, miRebuli pacientebis raodenobis, momsaxurebasTan dakavSirebuli sir-Tuleebis dadgenas. kiTxvarma aseve moicva daavadebaTa adreuli gamovlenis programebSi eqimebis CarTulobisa da informirebulobis sakiTxebi.



auditis TiToeul qvekiTxvaze pasuxis gasacemad gamoyenebul iqna Semdegi meTodebi da procedurebi:

» ramdenad uzrunvelyofilia pirveladi jandacvis Tanabari geografiul- demo-grafiuli xelmisawvdomoba soflad? - kiTxvaze pasuxis gasacemad Seswavlil iqna samarTlebrivi baza, romelic aregulirebs samedicino personalis ganawilebas. ganxorcielda statistikuri informaciis analizi. amasTanave, xelmisawvdomo-bis sakiTxebTan dakavSirebiT Seswavlil iqna saerTaSoriso praqtika. ter-itoriuli erTeulebis soflebs Soris manZilis dadgena ganxorcielda ruke-bis meSveobiT. moxda municipalitetebisa da eqimebis gamokiTxva momsaxurebis xelmisawvdomobasTan, ambulatoriebis mdgomareobasTan dakavSirebiT. auditis obieqtTan Catarda interviuebi (ssip socialuri momsaxurebis saagento - 2, jan-mrTelobis dacvis departamenti -1);

» ramdenad qmnis programis dizaini produqtiuli momsaxurebis gawevis winapirobas? - kiTxvaze pasuxis gasacemad ganxorcielda samedicino personalis mier warmodgenili Sesrulebuli samuSaos (2014 weli) monacemTa bazebis analizi, eqimebis dasaqmebis sakiTxebis Seswavla - dasaqmebulTa monacemTa bazebis anali-zi. eqimebis anazRaurebasTan dakavSirebuli samarTlebrivi bazis, saerTaSoriso praqtikisa da eqimebTan gaformebuli xelSekrulebebis Seswavla da analizi. eqimebis kvalifikaciis maregulirebeli normebisa da saerTaSoriso praqtikis Seswavla. programis administrirebis proceduris analizi, eqimebis datvirTvas-Tan da momsaxurebasTan dakavSirebuli kiTxvebi gaTvaliswinebul iqna municipal-itetebisa da eqimebis gamokiTxvaSi. ssip - socialuri momsaxurebis saagentosTan Catarda 2 ZiriTadi interviu;

» ramdenad uzrunvelyofilia soflad pirveladi jandacvis sistemis koor-dinacia ufro maRali donis jandacvis sistemasTan? - kiTxvaze pasuxis gasacemad Catarda eqimebis gamokiTxva, saerTaSoriso praqtikis Seswavla, dokumentaciis analizi. Catarda interviu saministros sistemaSi Semaval ssip - daavadebaTa kon-trolisa da sazogadoebrivi janmrTelobis erovnul centrTan, romelic axor-cielebs daavadebaTa adreuli gamovlenisa da skriningis programas;

» ramdenad uzrunvelyofs warmodgenili angariSi pirveladi jandacvis mdgomare-obis analizis SesaZleblobas da problemuri mimarTulebebis gamovlenas? - kiTx-vaze pasuxis gasacemad ganxorcielda warmodgenili angariSebis, monacemTa baze-bis analizi, aseve Catarda 2 ZiriTadi interviu ssip - socialuri momsaxurebis saagentosTan da ssip - daavadebaTa kontrolisa da sazogadoebrivi janmrTelo-bis erovnul centrTan.



1.4 Sefasebis kriteriumebi

pirveladi jandacvis efeqtianobis indikatorebs gansazRvraven iseTi mniSvnelovani saerTaSoriso organizaciebi da profesiuli gaerTianebebi, rogoricaa:

» janmrTelobis msoflio organizacia (WHO);» ojaxis eqimebis msoflio organizacia (WONCA - GLOBAL FAMILY DOCTORS);» saojaxo medicinis akademia (AAFP).

aRniSnuli organizaciebis mier gansazRvrul standartebSi gaTvaliswinebulia sx-vadasxva qveynebis saukeTeso praqtika da eqspertuli mosazrebebi. standartebi da saukeTeso praqtika moicavs iseT sakiTxebs, rogoricaa pirveladi jandacvis xelmis-awvdomoba, eqimebis anazRaurebis sakiTxebi, ojaxis eqimebis kvalifikaciasTan dakav-Sirebuli mniSvnelovani sakiTxebi.

aRniSnuli kriteriumebi qvemoT mocemul TavebSi detaluradaa ganmartebuli.

sistemis SefasebisTvis aseve gamoyenebul iqna:

» saqarTvelos mTavrobis 2014 wlis 2 dekembris dadgenileba №650 da Sesabami-si cvlilebebi;

» saqarTvelos mTavrobis 2014 wlis 11 noembris №624 dadgenileba;» saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministris 2013 wlis

23 dekembris №01-264/o brZaneba;» saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministris 2009 wlis

16 ivlisis №244/n brZaneba;» programis farglebSi samedicino personalTan gaformebuli

xelSekrulebebi;» 2006 wlis pirveladi jandacvis ganviTarebis erovnuli generaluri gegma.



2. zogadi informacia

2.1 pirveladi jandacvis arsi da ZiriTadi funqciebi

alma-atis deklaraciis mixedviT, pirveladi jandacva ganisazRvreba rogorc au-cilebeli jandacva, romelic unda iyos Tanabrad xelmisawvdomi sazogadoebis yvela wevrisTvis da unda iTvaliswinebdes sazogadoebis Tanamonawileobas janmrTelobaze zrunvis sistemaSi.7

pirveladi jandacva xels uwyobs: sazogadoebis informirebulobas da ganaTlebas dominanturi janmrTelobis problemebis, prevenciuli meTodebis Sesaxeb, jansaR kve-bas, sasmel wyalTan dakavSirebuli problemebis aRmofxvras, ojaxis dagegmvis sakiTx-ebs, dedaTa da bavSvTa janmrTelobas, imunizacias ZiriTadi infeqciuri daavadebebis winaaRmdeg. is uzrunvelyofs esenciuri, pirveladi medikamentebiT mosaxleobis uz-runvelyofas Sesabamisi saWiroebis SemTxvevaSi.

pirveladi jandacva ar warmoadgens calkeul rgols, romelic damoukidebelia janmrTelobis dacvis sxva doneebisgan. is asrulebs e.w. „mekaribWis“ funqcias jan-mrTelobis dacvaSi da integrirebulia janmrTelobis dacvis ufro maRal safexure-bTan pacientis referalis (gadamisamarTebis) sistemis meSveobiT.

sqema №2.1.1: janmrTelobis dacvis sistemis piramida8

7 http://www.who.int/publications/almaata_declaration_en.pdf - alma-atis deklaracia.8 specializebuli klinikebi - damatebiTi jandacvis momsaxureba (tertiary care), romelic janmrTelobis dacvis piramidaSi mesame (yvelaze maRal) safexurs warmoadgens.

specklinikebi

meoradi jandacvaviwro specialistebi

pirveladi jandacva



pirveladi jandacvis servisebis miwodeba 4 komponents moicavs:9

sqema №2.1.2: pirveladi jandacvis servisebis miwodeba

xelmisawvdomoba - pirveladi jandacva warmoadgens karibWes jandacvis sistemaSi, Sesabamisad, sazogadoebis TiToeul wevrs unda SeeZlos servisiT sargebloba.

uwyvetoba - pirveladi jandacvis rgolSi pacientTan muSaoba uwyveti procesia. ojaxis eqims aqvs saSualeba pacientze awarmoos xangrZlivi dakvirveba.

yovlismomcveloba - saojaxo medicina zrunavs pacientis fizikur da fsiqikur keT-ildReobaze.

koordinireba - saojaxo medicina gadaamisamarTebs pacients jandacvis sistemis sxva rgolSi, saWiroebis Sesabamisad.

msoflios mraval qveyanaSi pirveladi jandacvis safuZvelze saojaxo medicinis sistema ganviTarda. ojaxis eqimi aris piri, romelsac umetesad gegmuri ambulato-riuli momsaxurebis miRebis msurveli, aseve prevenciuli vizitis msurveli piri mi-marTavs, Tumca es ar gulisxmobs imas, rom ojaxis eqimma saWiroebis SemTxvevaSi ar gaswios gadaudebeli ambulatoriuli momsaxureba.

ojaxis eqimis specialoba centralizebulia xangrZliv, zrunviT urTierTobebze pacientebTan da maT ojaxebTan.

9 http://www.euro.who.int/ data/assets/pdf_file/0004/107851/PrimaryCareEvalTool.pdf janmrTelobis msoflio organizacia - pirveladi jandacvis Sefasebis instrumentebi

servisebis xelmisawvdomoba

servisebis uwyvetoba

koordinirebuli servisiservisebis

yovlismomcveloba



2.2 soflis eqimis saxelmwifo programis dizaini

saqarTveloSi pirvelad jandacvas soflad uzrunvelyofs soflis eqimis saxelm-wifo programa, romlis ganmaxorcielebelia saqarTvelos Sromis, janmrTelobisa da socialuri dacvis saministros (SemdgomSi - saministro) saxelmwifo kontrols daqvemdebarebuli ssip - socialuri momsaxurebis saagento (SemdgomSi - saagento). centraluri roli programaSi uWiravs soflis eqims, romelic ojaxis eqims warmoad-gens soflad.

soflis eqimis saxelmwifo programa moicavs iseT komponentebs, rogorebicaa:

» pirveladi jandacvis momsaxureba soflad - aRniSnuli komponenti emsax-ureba soflad pirvelad jandacvas. komponentis farglebSi saqarTvelos TiTqmis yvela soflisTvis formdeba xelSekruleba soflis eqimsa da eqTanTan;10

» Sida qarTlis soflebis ambulatoriuli qselis xelSewyoba da ganviTareba - kom-ponentis farglebSi finansdeba Sps Sida qarTlis pirveladi jandacvis centri, romlis farglebSic uzrunvelyofilia ambulatoriebis aRWurvis, ambulato-riebis movla-Senaxvis da aucilebeli medikamentebis xarjebi;

» specdafinansebaze myofi dawesebulebebis mier Sesabamisi ambulatoriuli da stac-ionaruli momsaxurebis miwodeba - specdafinansebaze myofi dawesebuleba warmoadgens samedicino dawesebulebas konfliqtur, masTan mimdebare da maRalm-Tian regionebSi, sadac samedicino momsaxurebis miwodeba komerciulad aramomge-biania mosaxlebis mcirericxovnobidan gamomdinare. specdafinansebaze myofi dawesebuleba pirveladi jandacvis momsaxurebas ZiriTadad11 awvdis raionuli centris mosaxleobas da ara soflis mosaxleobas.

» specdafinansebaze myofi rigi samedicino dawesebulebebis Seuferxebeli funqcion-irebis xelSewyobis mizniT, damatebiTi RonisZiebebis ganxorcielebis uzrun-velyofa - 2014 wlis 9 ivliss saministrom miiRo gadawyvetileba – maRalm-Tian municipalitetebSi samedicino centrebis (yazbegi, TianeTi, bakuriani, TeTriwyaro, walka, ambrolauri, oni, cageri, mestia) Seuferxebeli funqcioni-rebis mizniT, saxelmwifos mxridan aRniSnuli centrebis gamosyidvamde, Ses-abamisi samedicino dawesebulebebis funqcionirebisaTvis aucilebeli Tanxebis damatebiT gadaxdis Taobaze, aRniSnuli dawesebulebebis moTxovnis safuZvelze, romlis mixedviTac kompaniebi zemoT miTiTebul raionul centrebSi ganicdidnen zarals.

10 gamonakliss warmoadgens saCxere, Sida qarTlis zogierTi sofeli, sadac eqimebis dakon-traqtebas uzrunvelyofs Sesabamisad, s/s “saCxeris raionuli saavadmyofo poliklinikuri gaerTianeba” da Sps „Sida qarTlis pirveladi jandacvis centri“.11 gamonakliss warmoadgens okupirebuli soflebi, aseve yazbegis da TianeTis municipalitete-bi, sadac specdafinansebis komponentis farglebSi pirveladi jandacvis momsaxurebas iRebs rogorc raionis, aseve, soflis mosaxleobac - individualurad ar aris dakontraqtebuli sof-lis eqimi/eqTani. 2015 wlis 1 ivlisidan TianeTis da yazbegis soflis eqimebis da eqTnebis dakon-traqtebas axorcielebs Sps „regionuli jandacvis centri“.



soflis eqimis programis mizania soflis mosaxleobisaTvis pirveladi jandacvis momsaxurebaze geografiuli da finansuri xelmisawvdomobis gazrda da specdafi-nansebaze myof dawesebulebebSi registrirebuli mosaxleobis samedicino momsaxure-baze xelmisawvdomobis uzrunvelyofa. mosalodnel Sedegs warmoadgens pirveladi janmrTelobis dacvis momsaxurebis utilizaciis gazrda, xolo aRniSnulis Sesafase-blad gansazRvruli indikatorebia:

» vizitebis raodenoba samizne populaciaSi;» pirveladi jandacvis, ambulatoriuli momsaxurebis utilizaciis wili.12

2.3 programis dafinansebis sistema da biujeti

qvemoT mocemuli cxrili warmoadgens programis 2014 wlis biujets komponentebis mixedviT:

cxrili №2.3.1: soflis eqimis 2014 wlis biujeti komponentebis mixedviT

komponentis dasaxeleba biujeti (lari)

pirveladi jandacvis momsaxureba soflad 16,070,700

specdafinansebaze myofi dawesebulebebis mier Sesabamisi ambulato-riuli da stacionaruli momsaxurebis miwodeba

3,548,200

Sida qarTlis soflebis ambulatoriuli qselis xelSewyoba da ganvi-Tareba

122,300

specdafinansebaze myofi rigi samedicino dawesebulebebis Seuferx-ebeli funqcionirebis xelSewyobis mizniT, damatebiTi RonisZiebebis ganxorcielebis uzrunvelyofa

878,300

programis biujetis 78% - „pirveladi jandacva soflad“ komponentis biujets war-moadgens.

2009 wels soflis ambulatoriebi Camoyalibdnen mewarme–fizikur pirebad da gau-formdaT xelSekrulebebi janmrTelobisa da socialuri dacvis programebis saagen-tosTan.13

2013 wlis seqtembridan sadazRvevo kompaniebi uzrunvelyofdnen TavianT samedici-no raionebSi soflis eqimis/eqTnis momsaxurebas da Tanadafinansebas. 2014 wlidan saagento uzrunvelyofs programiT gaTvaliswinebuli momsaxurebis srulad dafi-nansebas.

12 biujetiT gansazRvruli programebis mosalodneli Sedegebi da indikatorebi. 13 ssip socialuri momsaxurebis saagentos Seqmnamde arsebuli saagento.



2014 wlis 1 maisidan saagentos mier samedicino personals mniSvnelovnad (30%-iT) gaezarda dafinanseba da soflis erTi eqimis momsaxurebis Rirebuleba ganisazRvra TveSi 650 laris odenobiT, xolo erTi eqTnis/ferSlis momsaxurebis Rirebuleba - TveSi 455 laris odenobiT.

pirveladi jandacva soflad - es komponenti finansdeba „global biujetis“ principiT, rac gulisxmobs yovelTviurad fiqsirebuli Tanxis gadaxdas momsaxurebis mimwodebel eqimze, eqTansa da dawesebulebaze.

programis farglebSi ministris brZaneba14 gansazRvravs eqimebisa da eqTnebis ganaw-ilebas sxvadasxva teritoriul erTeulSi. teritoriuli erTeuli municipalitet-is Semadgeneli nawilia da moicavs sofels, dabas, dasaxlebas an/da maTi garkveuli raodenobis gaerTianebas.

komponentis farglebSi 2014 wlis mdgomareobiT, saqarTvelos regionebis masStabiT, ministris brZanebiT damtkicebulia samedicino personalis Semdegi raodenoba: 1267 eqimi da 1520 eqTani.

samedicino personalTan xelSekrulebis gaformeba xdeba saagentos mier. gamo-nakliss warmoadgnes Sida qarTlis municipalitetebis (gori, kaspi, xaSuri, qareli) garkveuli soflebi, sadac momsaxurebis mimwodebelia Sps Sida qarTlis pirveladi jandacvis centri da saCxere, sadac momsaxurebas uzrunvelyofs s/s saCxeris raionu-li saavadmyofo poliklinikuri gaerTianeba.

programis pirveladi jandacvis komponentis biujetis didi nawili samedicino per-sonalis anazRaurebis xarjebisagan Sedgeba,15 Tumca moicavs eqimis CanTisa da sa-medicino dokumentaciis SeZenis xarjsac (CanTis ganaxlebis xarji biujetSi gaTvaliswinebuli ar aris).

specdafinansebis komponentis farglebSi specialur dafinansebaze 2014 wlis de-kembris mdgomareobiT imyofeba 36 samedicino dawesebuleba, maT Soris: dawesebulebe-bi okupirebul soflebSi da aseve maRalmTian raionul centrebSi. aRniSnuli dawese-bulebebi finansdeba yovelTviurad, winaswar gansazRvruli limitis Sesabamisad.

14 saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministris 2013 wlis 23 dekem-bris brZaneba №01-264/o15 garda programis Sida qarTlis ambulatoriuli qselis ganviTarebis da xelSewyobis kompo-nentisa



2.4 programis farglebSi gansaxorcielebeli momsaxurebasoflis eqimi aris umaRlesi samedicino ganaTlebisa da damoukidebeli saeqimo

saqmianobis uflebis damadasturebeli saxelmwifo sertifikatis mqone piri,16 romel-sac gavlili aqvs Sesabamisi profesiuli mzadebis cikli da axorcielebs soflis mosaxleobisaTvis ambulatoriuli samedicino momsaxurebis miwodebas, saxelmwifo programis „soflis eqimis” farglebSi.

soflis eqimis programis komponenti - „pirveladi jandacva soflad“ Sedgeba Sem-degi momsaxurebebisgan:

» eqimTan/eqTanTan viziti;» imunizacia;» janmrTeli pirebisa da axali pacientebis janmrTelobis mdgomareobis Semow-

meba qveyanaSi damtkicebuli gaidlainebis Sesabamisad;» eqimis an eqTnis viziti binaze 3 wlamde bavSvebSi, qveyanaSi damtkicebuli gaid-

lainebis Sesabamisad da weliwadSi 4-jer mudmivad mwoliare pirebTan;» inkurabelur pacientebTan binaze viziti saWiroebis Sesabamisad;» qronikuli (maT Soris, hipertoniuli daavadeba, Saqriani diabeti, gulis iSemiuri

daavadeba, bronquli asTma, inkurabeluri pacientebi) da mwvave daavadebebis di-agnostika, marTva da referali, saWiroebis Sesabamisad;

» tuberkuloziT daavadebuli pacientebis uSualo meTvalyureobis qveS (DOT) mkurnalobis uzrunvelyofa eqTnis mier;

» samedicino daxmarebis uzrunvelyofa gadaudebeli mdgomareobebis dros;» ambulatoriul doneze, samedicino saWiroebidan gamomdinare, samedicino doku-

mentaciis (maT Soris, saangariSgebo da statistikuri formebi) warmoeba, cnobeb-isa da receptebis gacema (maT Soris, inkurabeluri pacientebisaTvis);

» gadaudebeli ambulatoriuli momsaxurebisaTvis aucilebeli medikamentebi-Ta da samedicino daniSnulebis sagnebiT pacientis uzrunvelyofa saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministris Sesabamisi aqtiT damt-kicebuli „eqimis CanTidan”.

pirveladi jandacvis komponentis farglebSi soflis eqimebTan da eqTnebTan mimarTvianoba saqarTvelos masStabiT yovelTviurad daaxloebiT 130,000 vizits Sead-gens.

specdafinansebaze myof dawesebulebebSi momsaxurebis moculoba ufro didia. Sesabamisad, moqalaqeebs damatebiT miewodebaT sxvadasxva servisi (gamokvleva, stac-ionaruli momsaxureba), romelic ar aris gaTvaliswinebuli soflis eqimis pirveladi jandacvis komponentis farglebSi.

yovelTviurad saagentos samxareo centrebSi xdeba Sesrulebuli samuSaos angari-Sis warmodgena rogorc soflis eqimebisa da pirveladi jandacvis komponentis sxva momsaxurebis mimwodeblebis, ise specdafinansebaze myofi dawesebulebebis mier. Sesrulebuli samuSao moicavs SemTxvevaTa reestrs da SemTxvevaTa CamonaTvals un-ikaluri kodebiT, romelic axdens sxvadasxva momsaxurebis klasificirebas.

16 saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministris 2009 wlis 16 ivlisis N244/n brZaneba - „samedicino dawesebulebaSi dasaqmebis uflebisa da Sesabamisi ganaTlebis mqone samedicino personalis nusxis damtkicebis Sesaxeb“



auditis mignebebi

3. soflis eqimis momsaxurebis xelmisawvdomoba

ojaxis eqimebis msoflio organizaciis standartebis Tanaxmad, maRali xarisxis jandacvis sistemis CamoyalibebisTvis saWiroa qveyanaSi pirveladi jandacvisa da konkretuli specialobis mqone eqimebis optimaluri raodenobis gansazRvra demo-grafiul-geografiuli principebis Sesabamisad, rac xels uwyobs pirveladi jan-dacvis xelmisawvdomobas.17

saqarTveloSi, soflis eqimis saxelmwifo programis farglebSi saeqimo da saeqT-no punqtebis raodenoba administraciul-teritoriuli erTeulebis mixedviT damt-kicebulia saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministris brZanebiT18. TiToeuli teritoriuli erTeuli warmoadgens samedicino personalis momsaxurebis areals da is Sedgeba erTi an ramdenime soflisgan/dasaxlebisgan.

3.1 samedicino personalis demografiul ganawilebaSi arsebuli naklovanebebi

soflis eqimis mimdinare programiT ar aris gansazRvruli kriteriume-bi, romelic adgens samedicino momsaxurebis mimwodebelTa ricxovnobas mosaxleobis raodenobasTan mimarTebiT. Tumca, pirveladi jandacvis ganviTarebis erovnuli gen-eraluri gegmis mixedviT, romelic msoflio bankis da evrokavSiris mxardaWeriT 2006 wels saqarTvelosTvis SemuSavda, samedicino momsaxurebis mimwodeblebis raodenoba ganisazRvreboda Semdegi demografiuli faqtorebiT: erTi ojaxis eqimisa da eqTnis-agan Semdgari gundi 1000-2000 mosaxleze.19

eqimebis mosaxleobaze ganawileba mocemulia grafikze, sadac aRniSnulia saSualod erT soflis eqimze mosaxleobis raodenoba regionebis mixedviT.

17 http://www.globalfamilydoctor.com/ - sasoflo samedicino ganaTlebis gzamkvlevi - WONCA Rural Med-ical Education Guidebook18 saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministris 2013 wlis 23 de-kembris brZaneba №01-264/o19 pirveladi jandacvis ganviTarebis erovnuli generaluri gegma - https://heconomic.files.word-press.com/2013/08/pirveladi-jandacvis-ganvitarebis-erovnuli-gegma-phc.pdf

raWa

mcxeTa-T

ianeTi



grafiki №3.1.1:20 erT soflis eqimze mosaxleobis saSualo raodenoba regionebis mixedviT

grafikze mocemuli monacemebis mixedviT, erT eqimze mosaxleobis saSualo raodenoba msgavsia yvela regionisTvis da miaxloebulia 2006 wlis pirveladi jan-dacvis gegmiT gaTvaliswinebul kriteriumTan. gamonakliss warmoadgens raWa, sadac erT eqimze saSualod 661 mosaxle modis, Tumca es bunebrivicaa, regionis maRalm-Tiani reliefis gaTvaliswinebiT.

miuxedavad regionul doneze arsebuli Tanabari maCveneblisa, mniSvnelovani gansx-vavebaa teritoriuli erTeulebis (soflis, soflebis gaerTianebis) doneze eqimisa da mosaxleobis Tanafardobis monacemSi. qvemoT mocemul cxrilSi naCvenebia informa-cia erT eqimze mosaxleobis raodenobis Sesaxeb teritoriulim erTeulebis mixedviT.

20 saqarTvelos statistikis erovnuli samsaxuris mier Catarebuli 2014 wlis (2002 wlis Semdeg pirveli aRwera) sayovelTao aRweris Sedegad gamoqveynebuli monacemebi moicavs mosaxleobis raodenobas municipalitetebis WrilSi, soflebis doneze monacemebi gamoqveyndeba 2016 wlis aprilSi, Sesabamisad soflis mosaxleobis raodenobis analizisas saxelmwifo auditis samsax-urma gamoiyena 2002 wlis aRweris Sedegebi. aseve, winamdebare angariSSi raWis regioni moicavs raWa- leCxumsa da qvemo svaneTs, xolo samegrelos regioni - samegrelo zemo svaneTs.

661

2000

1800

1600

1400

1200

1000

800

600

400

200

0

1210

14391533 1534

1667 1666 17121824 1839

erT soflis eqimze mosaxleobis saSualo raodenoba regionis mixedviT

raWa

mcxeTa-T

ianeTi

გგგგგg

uria

Sida qarTl

i

kaxeTi

samegrelo

qvemo qarTl

i

imereTi

samcxe-javaxeT

i

aWara



grafiki №3.1.2: mosaxleobis raodenoba erT eqimze teritoriuli erTeulebismixedviT21

0

50

100

150

200

250mosaxleobis saSualo raodenoba erT eqimze

0-500

501-1000

1501-2000

1001-1500

2001-2500

2501-3000

3001-6300

garkveul teritoriul erTeulebSi, mosaxleobis simciris SemTxvevaSi, maRalmTian, meCxerad dasaxlebul regionebSi, sadac ramdenime soflis gaerTianeba da misTvis samedicino punqtis mikuTvneba ver xerxdeba geografiuli Taviseburebis gamo, xelmisawvdomobis mizniT, dasaSvebia erT eqimze mcire raodenobis mosaxlis mikuTvneba. Tumca, problemas warmoadgens is teritoriuli erTeulebi, sadac erT eqimze 2500-ze meti mosaxle modis, rac TavisTavad aRemateba pirveladi jandacvis arsebul zogad kriteriums (1000-2000 mosaxle). aRniSnuli gulisxmobs imas, rom zo-gierT teritoriul erTeulSi momsaxureba sxva teritoriul erTeulebTan SedarebiT nakleb xelmisawvdomia. aseTi teritoriuli erTeulebis raodenoba 57-s, xolo maTi mosaxleobis raodenoba mTliani soflis mosaxleobis 12.1%-s Seadgens.

magaliTad, imereTis regionSi mdebare teritoriul erTeulSi - qvacixeSi, erT eqimze 2953, xolo kaxeTis regionSi, sagarejos municipalitetSi mdebare terito-riul erTeul TularSi, erT eqimze 4832 mcxovrebi modis. 22

erT eqimze mosaxleobis gansxvaveba sxvadasxva mizeziT SeiZleba iyos gamowveuli. erT-erT mTavar mizezs mosaxleobis dasaxlebis simWidrove warmoadgens, Tumca, qve-moT mocemuli cxrilidan Cans, rom zogjer mosaxleobis raodenoba erT eqimze arse-biTad gansxvavebulia msgavsi simWidrovis municipalitetebSic.

21 soflis mosaxleobis analizisas ver moxerxda 4% mde soflebis mosaxleobis raodenobeb-is dadgena Sesabamisad cxrilSi SesaZlebelia mciredi cdomilebis arseboba.

132

3819

195202

121

60



grafiki №3.1.3: mosaxleobis23 raodenoba erT eqimze msgavsi simWidrovis24 munic-ipalitetebSi

mosaxleobis raodenoba erT eqimze msgavsi simWidrovis municipalitetebSi

0

500

1000

1500

2000

2500

dmanisiTeTriwyaroonilentexi

806

495

1122

2461

mosa

xleo

bis

rao

den

ob

a er

T e

qimz

e

samedicino personalis araTanabar ganawilebaze miuTiTebs cxrilSi mocemuli len-texisa da onis, aseve TeTriwyarosa da dmanisis magaliTebi. aRniSnul municipal-itetebSi simWidrove msgavsia, Tumca mosaxleobis raodenoba erT eqimze gansx-vavebulia: lentexisa da onis SemTxvevaSi 806-sa da 495-s, xolo TeTriwyarosa da dmanisis SemTxvevaSi - 1122-sa da 2461 kacs Seadgens.

garda imisa, rom demografiuli TvalsazrisiT samedicino personalis ganawileba garkveul SemTxvevebSi araTanabaria, arsebobs teritoriuli erTeulebi, sadac mosax-leobis uzrunvelyofa pirveladi jandacvis momsaxurebiT nawilobriv xdeba. minis-tris brZanebis25 mixedviT, 10,000-ze met kacs momsaxureba arasrulad miewodeba, rac gulisxmobs imas, rom am teritoriul erTeulebSi xelmisawvdomia mxolod eqT-nis momsaxureba. Tavis mxriv, eqTnis saqmianoba misi kvalifikaciidan gamomdinare, sakmarisi ar aris da is ver gauTanabrdeba eqimis saqmianobas pirveladi jandacvis momsaxurebis gansaxorcieleblad.

23 simWidrovis gamosaTvlelad gamoyenebulia municipalitetis mTliani mosaxleoba da farTo-bi, xolo soflis mosaxleobis raodenobis analizisas gamoyenebulia 2002 wlis aRweris monace-mebi. saministros mier programis dizainis SemuSavebisas aseve gamoyenebulia 2002 wlis aRweris monacemebi.24 lentexi - 3,3, oni - 3,6; dmanisi - 15,8, TeTriwyaro - 17,9. (kaci/km№)25 saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministris 2013 wlis 23 dekembris 01-264/o brZaneba.



qvemoT mocemul cxrilSi naCvenebia is teritoriuli erTeulebi, sadac mxolod eqTnis momsaxurebaa xelmisawvdomi.

cxrili №3.1.1: teritoriuli erTeulebi soflis eqimis gareSe

regionimunicipal-

itetiteritoriuli

erTeulimosaxleobis

raodenobaeqimi eqTani

sul 11017

kaxeTi axmeta Saxvetila 260 0 1

samegrelo mestia kala 172 0 1

samegrelo mestia fari 364 0 1

samcxe-javaxeTi aspinZa awyvita 577 0 1

samcxe-javaxeTi aspinZa saro 612 0 1

samcxe-javaxeTi aspinZa vargavi 215 0 1

samcxe-javaxeTi aspinZa Tmogvi 633 0 1

samcxe-javaxeTi adigeni fxero 514 0 1

samcxe-javaxeTi axalqalaqi gogaSeni 460 0 1

samcxe-javaxeTi axalqalaqi karwaxi 992 0 1

samcxe-javaxeTi axalqalaqi koWio 3269 0 2

samcxe-javaxeTi axalqalaqi sulda 2134 0 2

samcxe-javaxeTi axalcixe andriawminda 355 0 1

samcxe-javaxeTi borjomi balanTa 460 0 2

saministros ganmartebiT, samedicino personalis araoptimaluri ganawilebis mizezi mdgomareobs imaSi, rom soflad sakmarisi raodenobisa da sruli samuSao dat-virTviT momuSave personalis moZieba SeuZlebelia. (kadrebis deficitTan dakavSire-buli sakiTxebi ganxilulia Semdeg qveTavebSi - 3.2.1 da 4.1.1)

3.2 samedicino personalis geografiuli ganawilebis xarvezebi

miuxedavad imisa, rom umetes teritoriul erTeulSi samedicino personalis mosax-leobis raodenobaze (demografiuli) ganawileba optimaluria, zogierT aseT ter-itoriul erTeulSi arsebobs geografiuli xelmisawvdomobis gaumjobesebis poten-ciali.

demografiuli ganawilebisgan gansxvavebiT, ucnobia is, Tu ramdenad xSiri da sis-temuria geografiuli ganawilebis xarvezebi, vinaidan aRniSnuli ukavSirdeba eqimebis momsaxurebis arealisa da teritoriuli erTeulebis soflebs Soris arsebuli man-Zilebis detalur Seswavlas.

geografiul xelmisawvdomobasTan dakavSirebuli xarvezebi eqimis momsaxurebis ar-ealis araoptimalur formirebas ukavSirdeba.



qvemoT mocemul rukebze naCvenebia geografiul ganawilebaSi arsebuli 2 tipis na-klovaneba:

magaliTi 1:

ruka №3.2.1: uaxloesi manZilis gauTvaliswinebloba teritoriul erTeulebSi:

სოფლის ექიმის ეფექტიანობის აუდიტი | 2015

სახელმწიფო აუდიტის სამსახური | ეფექტიანობის აუდიტის ანგარიში 25

მაგალითი 1:

რუკა №3.2.1: უახლოესი მანძილის გაუთვალისწინებლობა ტერიტორიულ ერთეულებში:

მოსახლეობა ექიმი ექთანი

1 სულ სვირი/პამაჯი/საძელი 3425 2 3 მათ შორის: სვირი 551 ტატანისი 159 ბოგა 229 დიდი პამაჯი 591 პატარა პამაჯი 658 ყულალისი 167 ორალი 324 ხაკი 139 საძელი 607

რუკაზე მოცემულია ტერიტორიული ერთეული სვირი/პამაჯი/საძელი, რომელსაც 2 ექიმი ემსახურება. 1 ექიმი დადის პამაჯის სოფლებში, ხოლო მეორე ექიმი დადის საძელისა და სვირის სოფლებში, რომლებიც დიდი მანძილით არის დაშორებული ერთმანეთისგან. თავის მხრივ, სვირის ერთეულში, სადაც არის ამბულატორია, ექიმი მუდმივად არ იმყოფება.

საძელი და პამაჯი ახლომდებარე სოფლებია, შესაბამისად, შესაძლებელია პამაჯის და საძელის სოფლების ერთი ექიმისთვის მიკუთვნება, ხოლო მეორე ექიმი შესაძლებელია მუდმივად ემსახურებოდეს სვირის სოფლებს.

mosaxleoba eqimi eqTani

sul sviri/pamaji/saZeli 3425 2 3

maT Soris:

sviri 551

tatanisi 159

boga 229

didi pamaji 591

patara pamaji 658

yulalisi 167

orali 324

xaki 139

saZeli 607

rukaze mocemulia teritoriuli erTeuli sviri/pamaji/saZeli, romelsac 2 eqi-mi emsaxureba. 1 eqimi dadis pamajis soflebSi, xolo meore eqimi dadis saZelisa da sviris soflebSi, romlebic didi manZiliT aris daSorebuli erTmaneTisgan. Tavis mxriv, sviris erTeulSi, sadac aris ambulatoria, eqimi mudmivad ar imyofeba.

saZeli da pamaji axlomdebare soflebia, Sesabamisad, SesaZlebelia pamajis da saZe-lis soflebis erTi eqimisTvis mikuTvneba, xolo meore eqimi SesaZlebelia mudmivad emsaxurebodes sviris soflebs.



magaliTi 2:

ruka №3.2.2: eqimi/eqTnis araoptimaluri ganawileba teritoriul erTeulSi



მაგალითი 2:

რუკა №3.2.2: ექიმი/ექთნის არაოპტიმალური განაწილება ტერიტორიულ ერთეულში

მოსახლეობა ექიმი ექთანი

1 სულ: სარო 612 0 1

მათ შორის:

ნიჯგორი 375

სარო 237

2 სულ: ხიზაბავრა 850 1 1

მათ შორის:

ხიზაბავრა 850 1 1

ნიჯგორი და სარო ერთ ტერიტორიულ ერთეულში შემავალი სოფლებია, რომლის მოსახლეობა პირველადი ჯანდაცვის მომსახურებას იღებს მხოლოდ ექთნის მეშვეობით. ტერიტორიული ერთეული - ხიზაბავრა არის საროდან 2 კმ-ის დაშორებით, რომელსაც მომსახურებას უწევს როგორც ექიმი, ასევე ექთანი.

მუნიციპალიტეტის გამოკითხვის შედეგად გამოვლინდა, რომ ხიზაბავრას ექიმი, მომსახურებას უწევს საროს ტერიტორიულ ერთეულში შემავალ სოფლებს მხოლოდ კეთილი ნებით (აღნიშნული სოფლები არ წარმოადგენს მისი მომსახურების არეალს).

იქიდან გამომდინარე, რომ ტერიტორიულ ერთეულებს შორის ახლო მანძილია და საროს ტერიტორიულ ერთეულს არ ჰყავს სოფლის ექიმი, ორი ტერიტორიული ერთეულის ერთ პუნქტად გაერთიანება 3-ვე სოფლის მაცხოვრებელთათვის ქმნის სოფლის ექიმის მომსახურების სრულყოფილად მიღების საშუალებას.

mosaxleoba eqimi eqTani

1 sul: saro 612 0 1

maT Soris

nijgori 375

saro 237

2 sul: xizabavra 850 1 1

maT Soris:

xizabavra 850 1 1

nijgori da saro erT teritoriul erTeulSi Semavali soflebia, romlis

mosaxleoba pirveladi jandacvis momsaxurebas iRebs mxolod eqTnis meSveobiT. teri-toriuli erTeuli - xizabavra aris sarodan 2 km-is daSorebiT, romelsac momsaxure-bas uwevs rogorc eqimi, aseve eqTani.

municipalitetis gamokiTxvis Sedegad gamovlinda, rom xizabavras eqimi, momsax-urebas uwevs saros teritoriul erTeulSi Semaval soflebs mxolod keTili nebiT (aRniSnuli soflebi ar warmoadgens misi momsaxurebis areals).

iqidan gamomdinare, rom teritoriul erTeulebs Soris axlo manZilia da saros teritoriul erTeuls ar hyavs soflis eqimi, ori teritoriuli erTeulis erT pun-qtad gaerTianeba 3-ve soflis macxovrebelTaTvis qmnis soflis eqimis momsaxurebis srulyofilad miRebis saSualebas.



zemoaRniSnuli tipis geografiuli xarvezebi SesaZlebelia mraval sxva teritoriul erTeulebSic arsebobdes, rac mniSvnelovnad aisaxeba konkretul sof-lebSi momsaxurebis xelmisawvdomobaze.

3.2.1 maRalmTiani soflebi

pirveladi jandacva maRalmTian soflebSi xSirad qveynebisTvis gamowvevas warmoad-gens. aRniSnulis mizezi cxadia: soflebi geografiulad rTul pirobebSia moqceuli, mcirericxovani mosaxleoba ki did manZilze an meCxerad dasaxlebulia.

municipalitetebis gamokiTxviT dasturdeba, rom momsaxurebis xelmisawvdomobasTan dakavSirebuli problemebi yvelaze mkafiod maRalmTian soflebSia gamokveTili.

maRalmTiani soflebi, saqarTvelos soflebis saerTo raodenobis 40 %-s Seadgens. miuxedavad imisa, rom maRalmTian teritoriebze 1 eqimze mosaxleobis mcire raode-noba modis (raWis municipalitetebSi 1 eqimze mosaxleoba 495-dan 806-mde meryeobs, xolo mestiaSi erT eqimze 825 mosaxle modis), soflis eqimis momsaxureba aseT sof-lebSi mainc nakleb xelmisawvdomia 2 mizeziT:

» soflis eqimebi programis farglebSi momsaxurebas yoveldRiurad ar as-ruleben, vinaidan Tavis regionSi sxva jandacvis dawesebulebaSic arian dasaqme-bulebi (ix. Tavi 4.1, cxrili 4.1.1);

» soflebi didi manZiliTaa erTmaneTisgan daSorebuli da amavdroulad, arsebobs transportis problema.

pirveli mizezis sapasuxod, saministros damtkicebuli aqvs diplomisSemdgomi sa-medicino ganaTlebis programa26. aRniSnuli programa miznad isaxavs maRalmTian da sazRvrispira municipalitetebSi mcxovrebi mosaxleobisaTvis samedicino servisebis miwodebis uwyvetobisa da geografiuli xelmisawvdomobis gaumjobesebas. programa iTvaliswinebs am municipalitetebisaTvis deficitur da prioritetul saeqimo spe-cialobebSi adamianuri resursebis momzadebas. programis farglebSi gaTvaliswinebu-lia 5 adgili saojaxo medicinis mimarTulebiT. unda aRiniSnos, rom 2014 wels pro-gramis biujetis aTviseba ar momxdara, xolo 2015 wels (8 Tvis mdgomareobiT) biujetis mxolod 1%-ia aTvisebuli. aRniSnuli gulisxmobs imas, rom am dromde kadris deficitis problema ar aris aRmofxvrili.

rac Seexeba transportirebis problemas: soflis eqimebs, iseve rogorc soflis eqTnebs, uwevT maT teritoriul erTeulSi Semaval soflebSi vizitebi iseTi momsax-urebis gawevis mizniT, rogoricaa: binaze vizitebi 3 wlamde asakis bavSvebTan, agreTve inkurabelur da mudmivad mwoliare pacientebTan. amas emateba isic, rom Tavad sof-lis eqims, soflebSi gasvliTi vizitebisas sakuTari anazRaurebidan uwevs transpor-tirebis xarjis gaweva.

26 saqarTvelos mTavrobis 2014 wlis №624 dadgenileba



Tavis mxriv, adgilobriv mosaxleobas uwevs eqimTan vizitebi sxvadasxva soflidan. transportis ar arsebobis gamo, xSir SemTxvevaSi mosaxleobas uwevs samedicino pun-qtamde fexiT misvla, rac did dabrkolebas warmoadgens soflis mosaxleobisaTvis, gansakuTrebiT zamTarSi.

soflis eqimis programis xelmisawvdomobis gaumjobesebaSi didi roli SeiZle-ba iTamaSos adgilobrivma TviTmarTvelobam, romlis interesSic aris adgilobrivi mosaxleobisTvis servisebis drouli miwodeba.

am mizniT, saministrom 2014 wels Caatara Sexvedrebi municipalitetebTan, raTa maT sakuTar Tavze aeRoT da SeemsubuqebinaT soflis eqimebisTvis gaweuli danaxarjebi.

municipalitetebis gamokiTxviT gamovlinda, rom 53 municipalitetidan mxolod 10 municipaliteti uzrunvelyofs eqimebis transportirebis problemis mogvarebas. 43 municipaliteti, maT Soris, raWis, mestiis maRalmTiani municipalitetebi eqimebis transportirebis xarjs ar faraven. (ix. danarTi N1) Sesabamisad, am mxriv programis xelmisawvdomoba SezRudulia.

aris SemTxvevebi, rodesac adgilobrivi mTavroba maRalmTiani soflebisTvis da-moukideblad uzrunvelyofs ojaxis eqimis mobilobis gaZlierebas. magaliTad, aWaris avtonomiuri respublikis mTavrobasa da gaeros mosaxleobis fonds Soris (UNFPA) mimdinare sapartnioro proeqtis farglebSi, pirveladi jandacvis rgolis gaZlierebisa da ojaxis eqimebis servisis gaumjobesebis mizniT, aWaris maRalmTiani soflebisTvis Sesyiduli iqna 21 avtomobili.

3.3 infrastruqturasTan dakavSirebuli problemebi

2014 wels saministros iniciativiT, saxelmwifo biujetis dafinansebiT, sxvadasxva municipalitetSi aSenda 82 ambulatoria, romelic saSualebas aZlevs regionebSi mcx-ovreb mosaxleobas miiRos samedicino momsaxureba, Tumca kvlav mniSvnelovani problemebis winaSe dgas sxvadasxva teritoriul erTeulebSi arsebuli ambulato-riuli infrastruqtura.

xSir SemTxvevaSi, eqimebs momsaxurebis gaweva uwevT municipalitetebis, gamgeobebis, skolebisa da sabavSvo baRebis SenobebSi.

grafikze mocemulia Senobis tipebi sadac soflis eqimis programis farglebSi xde-ba samedicino momsaxurebis gaweva.



grafiki №3.3.1 eqimis momsaxurebis gawevis adgili soflis eqimis programis farglebSi27

51%

31%

8%

3%2%

2%3%

eqimis momsaxurebis gawevis adgili

ambulatoriis gareSe

kerZo saxli/kerZo Senoba

axali tipiuri Senoba/konteineri

skola/sabavSvo baRis Senoba

sxva saxis Senoba

municipalitetis administraciuli Senoba

ambulatoria/saavadmyofo/samed.centri

rogorc grafikidan Cans, Senobebis didi nawili ar warmoadgens ambulatorias, eqimis momsaxurebis miRebis punqtebis 47% ganTavsebulia skolebSi, administraciul da sxva tipis SenobebSi.

municipalitetebis gamokiTxviT gamovlinda, rom momsaxurebis gawevis adgilebSi arsebuli pirobebi ar qmnis Sesabamisi momsaxurebis gawevis winapirobas.

Senobebis did nawils ar miewodeba eleqtroenergia, ar aqvs samedicino inventari, zamTrSi - gaTbobis saSualebebi. aRniSnuli punqtebi ZiriTadad saremontoa da ver uzrunvelyofs imunizaciisaTvis saWiro samedicino masalis saWiro garemoSi gan-Tavsebas.

27 axali tipiuri Senoba/konteineri warmoadgens axlad aSenebul ambulatoriebs.



grafiki №3.3.2 teritoriul erTeulebSi arsebuli ambulatoriebis mdgomareoba

3%

26%

36%

35%

soflis eqimis momsaxurebis gawevis adgilis mdgomareoba

garemontebuli

gasaremontebeli

nawilobriv garemontebuli

ar aris informacia

eqimis momsaxurebis punqtebis 39 %-Si (ambulatoriuli tipis Senobebis 28%-Si)ikveTeba wylis miwodebasTan dakavSirebuli problemebi: ar aris xelsabani, ar

aris gamdinare wyali, dazianebulia wyalgayvanilobis sistema. Sesabamisad, aRniSnul dawesebulebebSi sanitarul-higienuri normebis dacva SeuZlebelia.

daskvna

imisTvis, rom soflad pirveladi jandacva axorcielebdes Tavis funqcias, pir-vel rigSi, is Tanabrad xelmisawvdomi unda iyos soflis mosaxleobisTvis. xelmis-awvdomobas gansazRvravs samedicino personalis optimaluri raodenoba demografi-uli da geografiuli faqtorebis gaTvaliswinebiT.

arsebuli mdgomareobiT, demografiuli kriteriumi dadgenili ar aris. pirvela-di jandacvis ganviTarebis erovnuli generaluri gegmis Sesabamisad, demografiu-lad samedicino personalis ganawileba zRvars aRemateba 57 teritoriul erTeulSi, sadac eqimebs 2500-ze meti mosaxlis momsaxureba uwevT. amasTanave, programis far-glebSi 10,000-ze meti adamiani nawilobriv (eqTnis saxiT) iRebs pirveladi jandacvis momsaxurebas. garda demografiuli ganawilebisa, xarvezebia samedicino personalis geografiuli ganawilebis kuTxiTac - uaxloesi ambulatoriis principis dacviT, teritoriul erTeulebSi arsebobs samedicino personalis ukeT gadanawilebis po-tenciali.

pirveladi jandacvis xelmisawvdomobisTvis mniSvnelovani dabrkolebebia maRalm-Tian soflebSi, sadac problema 2 mimarTulebiT ikveTeba:

» samedicino personalis nakleboba - soflis eqimebi metwilad programis garda sxva jandacvis dawesebulebaSic arian dasaqmebuli.



» soflebs Soris distancia da transportirebis problema - adgilobrivi mTavroba naklebadaa CarTuli eqimebis mobilobis, Sesabamisad, servisis xelmisawvdomobis gaumjobesebaSi.

aRniSnuli problemebis mogvarebis SemTxvevaSi arsebobs programis xelmisawvdomo-bis gaumjobesebis mniSvnelovani potenciali.

rekomendaciebi

saministros da saagentos:

» samedicino personalis optimalurad ganawilebis mizniT, SemuSavdes da dadgindesdemografiul-geografiuli kriteriumebi teritoriuli erTeuleb-isTvis (maT Soris, maRalmTiani da meCxerad dasaxlebuli teritoriuli er-TeulebisTvis) saqarTvelos statistikis erovnuli samsaxuris mier Catare-buli mosaxleobis aRweris 2015 wlis monacemebze dayrdnobiT, soflebs Soris arsebuli distanciebisa da aseve geografiuli pirobebis gaTvaliswinebiT;

» mniSvnelovania damyardes aqtiuri komunikacia adgilobriv TviTmarT-velobasTan im mizniT, rom maRalmTian da transportis problemis mqone so-flebSi mogvardes eqimis momsaxurebis arealSi transportirebis sakiTxebi. amasTanave, Sesabamisi ambulatoriuli infrastruqturis arsebobamde, moxdes im eqimebis droebiT adgilsamyofelTan da Sesabamisi samuSao pirobebis Seqm-nasTan dakavSirebuli sakiTxebis xelSewyoba, romelTac ar aqvT samuSao adgi-li (oTaxi) an arsebuli ambulatoriis pirobebSi SeuZlebelia maTi saqmianoba.

saministros:

» saministrom xeli Seuwyos maRalmTiani soflebisTvis sakmarisi da Sesabami-si kadris moZiebas diplomisSemdgomi samedicino ganaTlebis programis an/da sxva meqanizmebiT.



4. soflis eqimebis produqtiulobis winapirobebi28

programis farglebSi, soflis mosaxleobisTvis pirveladi jandacvis momsaxurebis miwodebas soflis eqimebi da eqTnebi axorcieleben. Sesabamisad, maT produqtiul muSaobazea damokidebuli soflis mosaxleobisTvis pirveladi jandacvis momsax-urebis drouli da xarisxiani miwodeba. eqimebis produqtiulobis erT-erT ZiriTad maCvenebels miRebuli pacientebis29 raodenoba - eqimis datvirTva warmoadgens, konk-retuli periodis ganmavlobaSi.

eqimebis gansxvavebuli datvirTva pirdapir ar gulisxmobs eqimebis gansxvavebul produqtiulobas, radgan datvirTvis maCvenebelze bevri sxva faqtori axdens gav-lenas, kerZod: mosaxleobis raodenoba da dasaxlebis simWidrove, teritoriuli er-TeulisaTvis damaxasiaTebeli reliefi, mosaxleobis informirebulobis done pirve-ladi jandacvis sakiTxebze, samedicino personalis araTanabari ganawileba, samuSao pirobebi.

saqarTveloSi soflis erT eqimTan vizitebis raodenoba TveSi saSualod 70-s Sead-gens, Tumca eqimebis datvirTva gansxvavdeba rogorc regionul, aseve municipalur da teritoriuli erTeulebis doneze. qvemoT mocemuli cxrili aCvenebs saqarTvelos regionebSi saSualod 1 eqimTan pacientebis vizitebis raodenobas TveSi.

grafiki №4.1: saSualod soflis 1 eqimTan pacientebis vizitebis raodenoba TveSi re-gionebis mixedviT

0

20

40

60

80

100

120

raWa

mcxeTa-T

ianeTi

guria

kaxeTi

samegrelo

qvemo qarTl

i

imereTi

samcxe-javaxeT

i

aWara

soflis eqimebis saSualodatvirTva regionebSi

soflis eqimebis saSualodatvirTva saqarTveloSi

1 eqimis mier miRebuli pacientebis raodenoba

28 mocemuli qveTavi exeba mxolod soflis eqimebis datvirTvas da masSi ar aris ganxiluli eqT-nebis datvirTva. eqimebis datvirTvis analizi gakeTebulia mxolod saagentos mier pirdapir da-kontraqtebuli eqimebisaTvis da masSi ar Sedis Sida qarTlis municipalitetebis, aseve Sps „Sida qarTlis pirveladi jandacvis centrisa“ da s/s “saCxeris raionuli saavadmyofo poliklinikuri gaerTianebis“ soflis eqimebis datvirTva maTi gansxvavebuli administrirebis sistemis gamo.29 eqimebis datvirTvis analizi efuZneba mxolod eqimTan pacientebis vizitebis raodenobas da ara unikaluri pacientis raodenobas.

117109

97

71 67

45 43 42

18



rogorc grafikidan Cans, eqimis datvirTvis yvelaze dabali maCvenebeli raWis so-flebSi, yvelaze maRali ki - guriis soflebSia. raWis soflis eqimebis dabali dat-virTva eqimebis dabal produqtiulobas pirdapir ar ukavSirdeba, radgan raWis mosax-leobis raodenoba sxva regionebisgan gansxvavebiT mcirea30, da amavdroulad misi reliefi mTagoriania.

auditis Sedegad gamovlinda SemTxvevebi, rodesac msgavsi simWidrovis da msgavsi mosaxleobis raodenobis municipalitetebSi eqimebis datvirTva gansxvavebulia, rac qvemoT mocemul cxrilSia asaxuli:

cxrili №4.1: soflis eqimebis gansxvavebuli datvirTva msgavsi simWidrovis munici-palitetebSi31

municipal-iteti

simWi-drove32

farTobi kv.km

mosaxle-oba 2015

sul

soflis mosaxle-

oba33

eqimebis saSualo datvirT-

va

eqimis raodeno-

ba

1 eqimis saSualo

dat-virTva

axalcixe 39 1,010 39,000 28,640 938 17 55

axalqalaqi 36 1,235 44,900 33,751 234 14 17

borjomi 21 1,189 25,100 17,569 1,337 16 84

ninowminda 18 1,354 24,500 16,452 506 15 34

cxrilidan gamomdinareobs, rom magaliTad axalcixisa da axalqalaqis municipal-itetis soflis eqimebis datvirTva mniSvnelovnad, xolo eqimebis raodenoba, munici-palitetebis simWidrove da mosaxleobis raodenoba umniSvnelod gansxvavebulia.

gansxvavebulia aseve erT teritoriul erTeulSi dasaqmebuli ori eqimis datvirT-va. grafiki №4.2 aCvenebs oTx sxvadasxva regionSi Semaval teritoriul erTeulebSi dasaqmebuli eqimebis gansxvavebul datvirTvas. teritoriuli nerTeulebi SerCeulia ise, rom masSi dasaqmebul soflis 2 eqims soflebi gayofili ar aqvT, Sesabamisad, isini momsaxurebas awvdian mosaxleobis erTsa da imave raodenobas, erTsa da imave geografiul pirobebSi.

30 saqarTvelos statistikis erovnuli samsaxuris monacemebiT 2015 wlisTvis raWis mosaxleo-bis raodenoba 31.8 aTas adamians Seadgens.31 Sesabamisi municipalitetebis soflis eqimebTan pacientebis vizitebis jamuri raodenoba saSualod 1 TveSi.32 simWidrove daTvlilia municipalitetebis 2015 wlis mosaxleobis raodenobis SefardebiT municipalitetis farTobTan. am maCveneblebSi soflebis maCveneblebis garda aseve Sedis munic-ipalitetis centrSi mcxovrebi mosaxleobis raodenoba da centris farTobic. soflis mosax-leoba Sesadari municipalitetebisaTvis mTliani municipalitetis mosaxleobis raodenobis Sesabamisad icvleba.33 monacemebi aRebulia municipalitetebis kiTxvarebze gacemuli pasuxebidan. axalqalaqis SemTxvevaSi ar iqna mowodebuli informacia ramdenime teritoriuli erTeulis mosaxleobis Sesaxeb.



grafiki 4.2 erT teritoriulerTeulSi dasaqmebuli soflis eqimebis gansxvavebuli datvirTva34

0

50

100

150

200

250

jandaraZegvidabalaiTuri

222

129

190

77

116

5680

37

eqimi X saS. datvirTva saqarTveloSieqimi Y

rogorc grafikidan Cans, eqimebis datvirTva sagrZnoblad gansxvavdeba erTi ter-itoriuli erTeulis SigniTac, rac pirdapir SeiZleba ukavSirdebodes eqimebis gansx-vavebul produqtiulobas. am SemTxvevaSi ki gansxvavebuli produqtiuloba mcire mosaxleobiT, geografiuli TaviseburebebiT Tu sxva faqtorebiT ver aixsneba.

gansxvavebuli produqtiulobis mizezi aris soflis eqimis programis dizainSi ar-sebuli naklovanebebi, kerZod:

» programis administrirebis sistemaSi arsebuli problemebi - xelSekrulebebis menejmenti da soflis eqimebis monitoringis meqanizmis ararseboba;

» anazRaurebis sistemaSi arsebuli naklovanebebi;» eqimebis gansxvavebuli kvalifikacia.

qvemoT mocemuli qveTavebi detalurad ganixilavs eqimebis gansxvavebuli produqti-ulobis zemoT CamoTvlil mizezebs:

34 erT eqimTan pacientebis vizitebis raodenoba saSualod 1 TveSi.

mandaeTi/gezruli



4.1 programis administrirebis sistemaSi arsebuli naklovanebebi

4.1.1 xelSekrulebebis menejmenti

rogorc zemoT aRiniSna, soflis eqimis programis pirveli komponentis fargleb-Si saagento pirdapir akontraqtebs eqimebs an momsaxurebis mimwodebelTan aform-ebs xelSekrulebas35. orive SemTxvevaSi, soflis eqimebis anazRaureba erTi da igivea (daricxuli anazRaureba: 650 lari - eqimebisTvis da 455 lari - eqTnebisTvis), Tumca pirvel SemTxvevaSi gadaxdili Tanxebi ar warmoadgens samedicino personalis xel-fass, saagento mewarme-fizikuri pirebisgan gamartivebuli wesiT yidulobs momsax-urebas, Sesabamisad, urTierToba saagentosa da soflis pirveladi jandacvis gunds Soris warmoadgens ara damsaqmeblisa da dasaqmebulis urTierTobas, aramed Semkve-Tisa da momsaxurebis mimwodeblis urTierTobas, xolo Sida qarTlis pirveladi jan-dacvis centris mier dakontraqtebuli eqimebis SemTxvevaSi gaformebulia SromiTi xelSekruleba.

Sesabamisad, saagentos mier pirdapir dakontraqtebis SemTxvevaSi xelSekrulebis pirobebi ar Seicavs SromiTi xelSekrulebis iseT debulebebs, rogoricaa, samuSao dro, saaTebi, dasaqmeba sxva samsaxurSi, Svebuleba (Sesabamisad, gamoyofili ar aris saSvebulebo Tanxebi) da sxv.

Sida qarTlis pirveladi jandacvis centris mier samedicino personalTan gaforme-buli xelSekrulebebiT dgindeba Tanamdebobrivi movaleobisTvis aucilebeli pirobe-bi, damsaqmeblisa da dasaqmebulis valdebulebebi, Tumca am SemTxvevaSic, samuSao dro xelSekrulebiT gawerili ar aris.

xelSekrulebaSi gauwereli samuSao saaTebi eqimebs aZlevs saSualebas, sasurvel dReebsa da saaTebSi iaron samsaxurSi. es ki TavisTavad gavlenas axdens eqimebis dat-virTvaze da amavdroulad, problemas uqmnis soflis mosaxleobis pirvelad jan-dacvaze xelmisawvdomobas, rac programis mTavar mizans warmoadgens.

municipalitetebis gamokiTxvis Sedegad irkveva, rom arsebobs iseTi teritoriuli erTeulebi, sadac eqimi kviraSi mxolod 1 an 2 dRis ganmavlobaSi awvdis mosaxleobas programiT gaTvaliswinebul momsaxurebas (ix. cxrili N4.1.1).

es problema ufro metad ikveTeba raWis municipalitetebSi, rac aisaxeba raWis eqimebis datvirTvaze (ix. grafiki N4.1 ).

qvemoT mocemuli cxrili aCvenebs msgavsi problemis mqone teritoriuli erTeuleb-is raodenobas da am teritoriul erTeulebSi eqimebis mier kviris ganmavlobaSi namuSevari dReebis odenobas.

35 Sida qarTlis pirveladi jandacvis centri da saCxeris poliklinikuri gaerTianeba.



cxrili №4.1.1: municipalitetebi, romelTa SemadgenlobaSi Semaval teritoriulerTeulebSi36 eqimebi wlis ganmavlobaSi kviraSi 1-2 dRe muSaoben

municipaliteti

municipalitetSi Semavali

teritoriuli erTeulebis raodenoba

teritoriuli erTeulebis

raodenoba, sadac eqimebi arasruli

datvirTviT muSaoben

kviris ganmavlobaSi namuSevari

dReebis raodenoba teritoriul erTeulebSi

ambrolauri 15 11 1 dRe an naklebi

oni 9 4 1-2 dRe

cageri 16 9 1-2 dRe

dmanisi 10 6 1-2 dRe

adigeni 13 6 1-2 dRe

qareli 14 13 2 dRe

soflis eqimis programis farglebSi eqimebis mier arasruli samuSao datvirTva ZiriTadad gamowveulia imiT, rom soflis eqimebi SeTavsebiT arian dasaqmebuli jan-dacvis sxva dawesebulebebSi: saswrafo samedicino daxmareba, municipalitetSi arse-buli kerZo ambulatoriebi da sxv.

axalcixis, dmanisis da xonis municipalitetebma gamokiTxvis Sedegad daadastures, rom eqimebi yoveldRiurad ar muSaoben soflis eqimebad sxva dawesebulebebSi muSa-obis gamo, xolo xSirad soflis eqimebis ararsebobiT gamowveul droul samedicino momsaxurebis miwodebasTan dakavSirebul problemebs, saswrafo samedicino daxmare-bis brigadebi agvareben.

rogorc cnobilia, saswrafo samedicino daxmarebis samsaxurSi dasaqmebul eqimebs 24 saaTiani morigeoba aqvT yovel me-4 dRes (zogierT municipalitetSi eqimebs uwevT yovel me-2 an me-3 dRes morigeoba) Sesabamisad bunebrivicaa, rom eqimebi, romlebic saswrafoSi muSaoben, gacilebiT cota dros uTmoben soflis eqimad muSaobas.

saswrafo samedicino daxmarebis sistemis 2011-2012 wlebis efeqtianobis auditis angariSSi aRniSnuli iyo, rom saswrafo daxmarebis dabal prioritetul gamoZaxebaTa raodenoba saSualod 26%-s Seadgens, rac pirdapir ukavSirdeba pirvelad jandacvaSi arsebul xarvezebs.

auditis Sedegad gamovlinda, rom 121037 soflis eqimidan, 221 eqimi (soflis eqimebis 18%) muSaobs saswrafo samedicino daxmarebis samsaxurSi. garda amisa, 54 eqi-mi muSaobs specdafinansebaze myof dawesebulebebSi, romelic, Tavis mxriv, raionul centrebSi mdebareobs. qvemoT mocemuli sqema saqarTvelos masStabiT uCvenebs saswr-afos, soflis eqimebisa da specdafinansebis eqimebis kveTas:

36teritoriuli erTeulebis raodenoba warmodgenilia dajgufebuli saxiT saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministris 01-264/o brZanebis mixedviT 37eqimebis raodenoba aRebulia saagentos mier mowodebuli eqimebi/eqTnebis reestridan 2015 wlis 1 ianvris mdgomareobiT da ar moicavs Sps „Sida qarTlis pirveladi jandacvis centrisa“ da s/s “saCxeris raionuli saavadmyofo poliklinikuri gaerTianebis” mier dakontraqtebuli eqimebis raodenobas.



sqema №4.1.1: saswrafos, soflis eqimebisa da specdafinansebis dawesebulebaSi dasaqme-buli eqimebis kveTa38

muSaoben mxolod soflis eqimad

967 (80%)

22

muSaoben specSi da

soflis eqimad

muSaoben samive

adgilas32 muSaoben

saswrafoSi da specSi

45

muSaoben saswrafoSi

soflis eqimad

189

muSaoben mxolod specdafinansebisdawesebulebaSi

703 (88%)

muSaoben mxolod saswrafoSi

515 (66%)

soflis eqimebis raodenoba

(1210)

saswrafoSi dasaqmebuli eqimebis raodenoba

(781)

specdafinansebis dawesebulebaSidasaqmebuli samedicino

personali (802)

38 saswrafoSi dasaqmebuli eqimebis raodenoba aRebulia ssip saswrafo samedicino daxmarebis adamianuri resursebis marTvis departamentis monacemebidan 2015 wlis aprilis mdgomareobiT, xolo specdafinansebis dawesebulebaSi dasaqmebuli eqimebis raodenoba aRebulia ssip socia-luri momsaxurebis saagentos werilze sapasuxod specdafinansebis dawesebulebebis monaceme-bze dayrdnobiT 2014 wlis dekembris mdgomareobiT. specdafinansebis dawesebulebaSi dasaqme-buli personalis monacemi Seicavs mxolod 30 dawesebulebas 36-dan, aseve 39 dasaqmebulis Tanamdebobrivi monacemebi ucnobia.„muSaoben mxolod soflis eqimad“ - igulisxmeba rom eqimebi ar muSaoben specdafinansebis dawesebulebasa da saswrafoSi. 80%-dan eqimebis nawili SesaZloa muSaobdes jandacvis sxva dawesebulebaSi, Tumca informacia amis Sesaxeb auditis jgufisTvis xelmisawvdomi ar aris.



rogorc grafikidan Cans, soflis eqimebis 20% SeTavsebiT muSaobs specdafinanse-bis dawesebulebaSi an/da saswrafoSi. es ki imas gulisxmobs, rom garkveul terito-riul erTeulebSi, problemebia pirveladi jandacvis momsaxurebis komponentis xel-misawvdomobasTan dakavSirebiT. soflis mosaxleobas, romelsac janmrTelobasTan dakavSirebuli problema gauCndeba, aqvs ori alternativa: mivides soflis eqimTan, romelic pasuxismgebelia ambulatoriuli momsaxurebis miwodebaze an gamoiZaxos sas-wrafo, romelic pasuximgebelia gadaudebeli momsaxurebis miwodebaze.

4439 municipalitetidan 25 municipalitetSi saswrafoSi dausaqmebeli eqimebi saSualod ufro met pacients iReben saswrafoSi dasaqmebul eqimebTan SedarebiT da es gansxvaveba 2%-dan 144%-mde meryeobs, xolo 19 municipalitetSi suraTi piriqiT icvleba da saswrafoSi dasaqmebul eqimebs ufro meti pacientis vizitebi aqvT. Tumca sxvaoba maTi pacientebis vizitebisa da saswrafoSi dausaqmebeli eqimebis pacientebis vizitebis raodenobas Soris 2%-dan 51%-mde meryeobs (municipalur doneze gamovle-nili garemoebebi detalurad ixileT N2 danarTSi).

saqarTvelos masStabiT, soflis eqimi, romelic saswrafoSi araa dasaqmebuli, saSualod TveSi 35%-iT40 met pacients iRebs, saswrafoSi dasaqmebul eqimTan Sedare-biT.

im municipalitetebis nawilSi, sadac eqimebi nakleb dros uTmoben soflis eqimad muSaobas SeTavsebiT saswrafoSi an specdafinansebis dawesebulebaSi muSaobis gamo, saswrafos gamoZaxebebis wili SedarebiT maRalia sxva municipalitetebTan SedarebiT (ix. cxrili N4.1.2). amis mizezi isaa, rom pacients, romelsac ar esaWiroeba gadaude-beli daxmareba da sWirdeba soflis eqimis momsaxureba, saswrafos gamoZaxeba mouwevs, radgan misi teritoriuli erTeulis eqimi im dRes soflis eqimad ar muSaobs saswra-foSi morigeobis gamo. es ki Tavis mxriv ganapirobebs 2 programis kveTas da Sesabamis-ad iwvevs araekonomiur xarjvas, vinaidan saswrafo daxmarebis gamoZaxeba (manqanis, sawvavis, brigadis xarjidan gamomdinare) gacilebiT Zviri momsaxurebaa.41

39 soflis eqimis programis pirveli komponentiT mosargeble 57 municipalitetidan analizi ar gakeTda Sida qarTlis municipalitetebis (4 municipaliteti) da saCxeris municipalitet-ze gansxvavebuli administrirebis sistemis gamo. 7 municipalitetSi arc erTi soflis eqimi ar muSaobda saswrafoSi, Sesabamisad ver Sedardeba saswrafoSi dasaqmebuli da dausaqmebeli eqime-bis datvirTva.40 saqarTvelos masStabiT, saswrafoSi momuSave eqimebis datvirTva saSualod 54-s Seadgens, xolo eqimebis datvirTva, romlebic saswrafoSi ar muSaoben - 73-s.41 saswrafo samedicino daxmarebis sistemis efeqtianobis auditis Sedegad gamovlinda, rom sas-wrafo daxmarebaSi dabal prioritetuli - pirveladi jandacvis rgols mikuTvnebuli gamoZaxe-bebis wili maRalia, rac zrdis saswrafo samedicino daxmarebis xarjebs.



qvemoT mocemuli cxrili uCvenebs jamuri pirveladi jandacvis momsaxurebidan42

saswrafos gamoZaxebaTa wils da soflis eqimTan da eqTanTan pacientebis vizitebis raodenobis wils:43

cxrili 4.1.2: saswrafosa da soflis eqimis pacientebis wili jamur pirveladi jan-dacvis pacientebSi

municipaliteti

saswrafos gamoZaxebaTa

raodenoba saSualod 1 TveSi

soflis eqimebTan da eqTnebTan pacientebis

vizitebis raodenoba

saSualod 1 TveSi

jamuri mimarTvianoba

2-ve saxelmwifo programis farglebSi

saswrafos gamoZaxebaTa

wili

walka 269 507 776 35%

ambrolauri 409 805 1214 34%

oni 150 306 456 33%

martvili 420 874 1294 32%

TeTriwyaro 419 1025 1444 29%

dmanisi 327 831 1158 28%

aRsaniSnavia, rom zogierT municipalitetSi44 saswrafos gamoZaxebaTa wili pir-velad jandacvaSi 6%-dan 8%-mde meryeobs. es dadebiTi movlenaa, radgan gazrdilia soflis eqimis roli pirvelad jandacvaSi da Semcirebulia saswrafos gamoZaxebaTa raodenoba.

Tumca cxrilSi moyvanilia is municipalitetebi, romlebSic saswrafo gamoZaxebebis wili SedarebiT maRalia saSualo maCvenebelTan (13%) SedarebiT da 6 municipalitet-idan 3 (ambrolauri, oni da dmanisi) swored is municipalitetia, sadac soflis eqime-bi kviraSi 1-2 dRe muSaoben (ix. cxrili N4.1.1). Sesabamisad, gadaudebeli daxmareb-is wili aseT municipalitetebSi ufro maRalia, rac winaaRmdegobaSi modis soflis eqimis programiT gansazRvrul iseT indikatorTan, rogoricaa pirveladi jandacvis/ambulatoriuli momsaxurebis utilizaciis wilis zrda.

zemoaRniSnulidan gamomdinare, zogierT SemTxvevaSi soflis eqimis SeTavsebiT muSaoba sxva samsaxurSi iwvevs soflis eqimis rolis Semcirebas.

saministros ganmartebiT, SeTavsebiT sxva samsaxurSi dasaqmebuli kadrebis soflis eqimis poziciaze ayvana xdeba kadrebis deficitis gamo.

brZanebiT arsebuli ganawilebis Sesabamisad, yovelwliurad programis farglebSi gamartivebuli Sesyidvis saSualebiT xelSekruleba formdeba erTsa da imave samedi-

42 soflis eqimTan da eqTanTan pacientebis vizitebis raodenobas damatebuli municipalitet-Si saswrafos gamoZaxebaTa raodenoba43 mocemuli analizi gakeTebulia 2014 wlis 3 Tvis (ivlisi, agvisto, seqtemberi) monaceme-bze dayrdnobiT44 yvareli, walenjixa, dedofliswyaro, Terjola, lagodexi, gurjaani, mestia



cino personalTan. gamartivebuli Sesyidvis wesi ki ar qmnis konkurentul garemosa da Sesabamisi kadris moZiebis saSualebas, vinaidan aRniSnuli meqanizmi warmoadgens mimwodebelsa da SemkveTs Soris saxelmwifo Sesyidvebis Sesaxeb saqarTvelos kanoniT dadgenil urTierTobas.

saministroSi moqmedi pirveladi jandacvis sakoordinacio sabWos mier45 gansaz-Rrulia soflis eqimis kandidaturis SerCevis kriteriumebi, romlis Tanaxmadac upiratesoba eniWeba im kadrs, romelic ar aris dasaqmebuli saswrafo daxmarebis samsaxurSi an stacionarSi. SerCevis kriteriumebis gamoyeneba formalurad ar xde-ba, vinaidan ar arsebobs kandidaturis SerCevis formaluri procesi: ar cxaddeba vakansia an/da sxva alternatiuli saSualebiT ar iqmneba konkurentuli garemo, rac uzrunvelyofs iseTi kadris SerCevas, romelic upiratesad ganaxorcielebs soflis eqimis funqcias. zemoaRniSnulidan gamomdinare, Sesabamisi procedurebis danergvis SemTxvevaSi arsebobs potenciali, rom nawilobriv mainc aRmoifxvras kadris defi-citi.

4.1.2 monitoringis ararseboba

monitoringis meqanizmi warmoadgens administraciul zedamxedvelobas da uzrun-velyofs samedicino personalis profesiuli movaleobebisa da valdebulebebis jer-ovan da xarisxian Sesrulebas.

auditis Sedegad gamovlinda, rom programis farglebSi ar arsebobs samedicino personalis monitoringis meqanizmi, romelic, Tavis mxriv unda moicavdes samedicino personalis samuSao procesis, samsaxurSi yofnis sakiTxis, aseve gaweuli momsaxurebis xarisxis Semowmebas.

programis farglebSi saagentos mier eqimebis monitoringi realurad ar ganxor-cielebula.

monitoringis naklovanebaze municipalitetebic miuTiTeben. magaliTad, abaSis mu-nicipaliteti gamokiTxvaSi aRniSnavs, rom sasurvelia soflis eqimis adgilobriv doneze hyavdeT koordinatori, romelic Caatarebs monitorings.

monitoringis meqanizmis ararseboba miuTiTebs imas, rom programis ganmaxorciel-ebelma saagentom realurad ar icis sruldeba Tu ara programiT gaTvaliswinebuli momsaxureba, dadian Tu ara eqimebi samuSao adgilze da ra xarisxiT asruleben dakis-rebul movaleobas.

45 saministros sistemaSi arsebuli warmomadgenlobiTi organo, romelic gadawyvetilebebs iRebs pirveladi jandacvis sakiTxebze.



4.2 anazRaurebis sistema Sedegze orientirebuli ar aris

evropuli qveynebis mniSvnelovani nawili46 pirveladi jandacvis gundis dafi-nansebisas upiratesobas aniWebs motivaciaze mibmul dafinansebas, rac gulisxmobs eqimis stimulirebas miiRos bevri pacienti, adreul stadiaze gamoavlinos daavade-bebi. magaliTad, litva, romelic sabWoTa jandacvis sistemidan pirveladi jandacvis Tanamedrove modelze gadavida, upiratesobas aniWebs samedicino personalis indika-torebze mibmul anazRaurebis sistemas47, rac gulisxmobs ara mxolod miRebuli pacientebis raodenobriv maCvenebels, aramed Sesrulebuli samuSaos xarisxs: magali-Tad, adreul stadiaze gamovlenil simsivnur daavadebas da sxv.

saqarTveloSi pirveladi jandacvis komponenti soflad finansdeba global biu-jetis principiT, rac gulisxmobs imas, rom komponentis dafinanseba damokidebuli ar aris eqimis mier gaweuli momsaxurebis raodenobaze da ar axdens eqimis motivire-bas. amasTanave, arsebobs mniSvnelovani faqtori, rac uaryofiTad moqmedebs eqimebis stimulze miiRon meti pacienti - es aris im xarjebis didi moculoba, romlis gawevac maT soflis eqimad muSaobis periodSi uwevT.

aRsaniSnavia, rom eqimebi komunaluri da transportirebis xarjis garda, saWiro medikamentebsa da samedicino nivTebs sakuTari xarjiT yiduloben. saagentom 2014 wels erTjeradad uzrunvelyo eqimebi aucilebeli medikamentebiT da samedicino daniSnulebis sagnebiT,48 mas Semdeg eqimis CanTa gadaecema yovel axal eqims, xolo eqimebs sakuTari anazRaurebidan yovelTviurad uwevT samedicino CanTis ganaxleba samedicino produqciis xarjvis gaTvaliswinebiT.

eqimebis gamokiTxvis Sedegad vlindeba, rom komunaluri, transportisa da medika-mentebis xarji saSualod TveSi 143 lars Seadgens, xolo am Tanxas zamTris TveSi emateba saSualod 80 lari, Sesabamisad, zamTris TveebSi gadasaxadebis gadaxdis Sem-dgom da xarjis gawevis Semdgom, samedicino personalis anazRaureba 300 lars ar aRemateba.

eqimebi, romlebic bevr pacients emsaxurebian, mets xarjaven rogorc medikamenteb-is CanTis ganaxlebaSi, aseve transportirebaSi, xolo eqimebi, romlebic nakleb dros uTmoben soflis eqimad muSaobas, nakleb xarjs gaweven.

46 litva, latvia, estoneTi, didi britaneTi da sxv.47 http://www.euprimarycare.org/column/primary-care-lithuania48 ,,soflis eqimis“ saxelmwifo programis farglebSi, Sesabamisi administraciul-teritori-uli erTeulebis mixedviT, saeqimo da saeqTno punqtebis raodenobisa da ,,eqimis CanTis“ gansaz-Rvris Sesaxeb“ saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministris 2013 wlis 23 dekembris 01-264/o brZaneba.



cxrili №4.2.1: gasvliTi vizitebisa da aucilebeli medikamentebis gaxarjvis SemTxvevaTa raodenoba im eqimebis mier, romlebic gansxvavebuli raodenobis (100-300 da 301-500) pacientebs iReben:49

gaweuli momsaxurebis dasaxeleba

miwodebuli momsaxurebis raodenoba

100-300 pacientis miRebis SemTxvevaSi

miwodebuli momsaxurebis raodenoba

301-500 pacientis miRebis SemTxvevaSi

inkurabelur pacientebTan binaze vizitebis raodenoba

36 53

weliwadSi 4-jer mudmivad mwoliarepirebTan vizitebis

raodenoba21 62

aucilebeli medikamentebis gamoyenebis raodenoba

50 92

cxrilidan gamomdinareobs, rom gasvliTi vizitebisa da aucilebeli medikament-

ebiT pacientis uzrunvelyofa mniSvnelovnad gansxvavdeba im eqimebTan, romlebic gansxvavebuli raodenobis (100-300 da 301-500) pacientebs iReben. Sesabamisad, eqimis mier sakuTari jibidan gaweuli danaxarjebi miRebuli pacientebis raodenobis propor-ciulad izrdeba.

garda imisa, rom eqimebis dRevandeli anazRaureba ar aris stimulebze orientire-buli, saqarTvelos kanoniT „maRalmTiani regionebis ganviTarebis Sesaxeb“50 gan-isazRvra maRalmTian regionebSi samedicino personalisTvis motivaciis Seqmna, rac iTvaliswinebs saxelmwifos wilobrivi monawileobiT dafuZnebul da mis marTvaSi ar-sebul samedicino dawesebulebaSi dasaqmebuli samedicino personalisaTvis (romlis Sroma saqarTvelos saxelmwifo biujetidan anazRaurdeba), saqarTvelos mTavrobis dadgenilebiT gansazRvruli wesiT yovelTviuri danamatis micemas. am SemTxvevaSi so-flis eqimebisTvis aRniSnuli anazRaureba ar iqneba gaTvaliswinebuli, vinaidan maTi statusi individualuri mewarmea da saxelmwifos mier maTi anazRaureba xorcieldeba saxelmwifo Sesyidvebis wesiT.

arsebuli mdgomareobiT, maRalmTian regionebSi soflis eqimebi sxva dawesebule-bebSic muSaoben, Sesabamisad dRes moqmed eqimebs danamati ganesazRvrebaT, Tumca im SemTxvevaSi, Tu eqimi mxolod soflis eqimis programis farglebSi ganaxorcielebs momsaxurebas, is danamats ver miiRebs.

saxelmwifo auditis samsaxuri miiCnevs, rom aRniSnuli modeli xels ar Seuwyobs pirveladi jandacvis samedicino personalis stimulirebas.

49 guriis regioni - 2014 wlis 3 Tvis monacemi.50 2015 wlis 16 ivlisis saqarTvelos kanoni „maRalmTiani regionebis ganviTarebis Sesaxeb“.



4.3 eqimebis kvalifikaciasTan da informirebulobasTan dakavSirebuli naklovanebebi

saerTaSorisod miRebuli standartiT, soflis eqimi, romelic axorcielebs pirve-lad jandacvis momsaxurebas, kvalifikaciiT warmoadgens ojaxis eqims. ojaxis eqimis kvalifikacia damoukidebelia sxva samedicino specialobebisgan.

programis Tanaxmad, saqarTveloSi soflis eqimi SesaZlebelia iyos piri, romelsac miRebuli aqvs umaRlesi samedicino ganaTleba da flobs damoukidebeli saqmianobis uflebas. amasTanave, ar aris savaldebulo soflis eqimi iyos ojaxis eqimis kvalifikaciis mqone, am mizniT gansazRvrulia Sesabamisi momijnave specialoba.51

WONCA miiCnevs52, rom grZelvadianad maRali kvalifikaciis ojaxis eqimis mier miwodebuli servisi ufro xarjT-efeqtiania, vidre e.w. viwro specialistis mier mi-wodebuli servisi. saojaxo medicinaSi gadaumzadebeli kadri pirveladi jandacvidan ufro met referals (gadamisamarTebas) gaakeTebs sxva specialistebTan, vidre ojaxis eqimi, romlis specializaciac yvela daavadebis Tu organoTa sistemis zogad codnas ukavSirdeba.

saministros ganmartebiT, imis mizezi, rom soflad ojaxis eqimis kvalifikacia pirveladi jandacvis sistemaSi dasaqmebisTvis savaldebulo ar aris, kadrebis nakle-bobas ukavSirdeba.

auditis Sedegad gamovlinda, rom soflis eqimebis mxolod 60% - s aqvs ojaxis eqimis sertifikati. danarCeni eqimebi viwro specialobis eqimebi arian.

soflis eqimebis gansxvavebul kvalifikaciasTan mWidrodaa dakavSirebuli sof-lis eqimis produqtiuloba, rac eqimebis datvirTvis analizSic Cans. saqarTvelos masStabiT, saSualod, soflis eqimebs, romelTac ojaxis eqimis specialoba aqvT 51%53-iT meti pacientis vizitebis raodenoba aqvT, sxva samedicino specialobis eqimebTan SedarebiT.

51 sertificirebuli eqimi-specialisti, garda Semdegi saeqimo specialobebisa: fsiqiatria, fsiqoTerapia, bavSvTa fsiqoTerapia, narkologia, seqsologia, laboratoriuli medicina, pa-Tologiuri anatomia-klinikuri paTologia, sasamarTlo medicina, radiologia (Sesabamisi mo-mijnave specialobebiT), samedicino reabilitacia da sportis medicina, klinikuri farmakolo-gia, fizikuri medicina-kurortologia, samedicino genetika, homeopaTia - saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministris 2009 wlis 16 ivlisis 244/n brZaneba.52 Policy on Rural Practice and Rural Health - WONCA53 soflis eqimebs, romlebTac ojaxis eqimis specialoba aqvT saSualod 83 pacientis viziti aqvT TveSi. xolo soflis eqimebs, romelTac sxva samedicino specialoba aqvT, saSualod TveSi 55 pa-cientis viziti aqvT.



analizSi CarTuli 52 municipalitetidan 29-Si ojaxis eqimis specialobis mqone soflis eqimebis datvirTva gacilebiT didia sxva samedicino specialobis eqimis dat-virTvasTan SedarebiT da 7%-dan 151%-mde meryeobs, xolo 11 municipalitetSi54 su-raTi piriqiT icvleba - datvirTva maRalia sxva samedicino specialobebis mqone so-flis eqimebSi, Tumca es gansxvaveba 2%-dan 36%-mde meryeobs.

cxrili 4.3.1: ojaxis eqimis specialobis soflis eqimebis datvirTvis Sedareba sxva samedicino specialobis soflis eqimebis datvirTvasTan55

municipaliteti

ojaxis eqimis specialobis

soflis eqimebis

raodenoba

ojaxis eqimis specialobis

soflis eqimebis

datvirTva

sxva samedicino

specialobis soflis eqimebis

raodenoba

sxva samedicino

specialobis soflis eqimebis

datvirTva

sxvaoba eqimebis

datvirTvaSi (%)56

vani 12 85 5 44 95%

walenjixa 12 61 8 36 69%

borjomi 5 111 10 68 63%

senaki 11 53 5 35 51%

xobi 11 58 6 44 32%

Cxorowyu 11 39 4 30 31%

cxrilSi magaliTisTvis moyvanilia iseTi municipalitetebi, sadac ojaxis eqimebis specialobis mqone soflis eqimebis datvirTva SedarebiT metia sxva samedicino spe-cialobis mqone soflis eqimebis datvirTvasTan SedarebiT. aRniSnuli ki miuTiTebs ojaxis eqimis specialobis mqone eqimebis SedarebiT maRal produqtiulobaze.

ukanaskneli 5 wlis ganmavlobaSi saxelmwifos ojaxis eqimebis gadamzadeba ar Cau-tarebia. auditis farglebSi gamokiTxuli 185 eqimidan 62% profesiuli ganviTarebis problemas usvams xazs da treningebis saWiroebaze miuTiTebs.

54 darCenili 12 municipalitetidan 10-Si ar muSaoben ojaxis eqimis specialobis eqimebi, xolo 2 maTganSi mxolod ojaxis eqimis specialobis eqimebi muSaoben.55 mocemuli cxrili ganixilavs mxolod iseTi municipalitetebis eqimebis datvirTvis Sedare-bas, sadac ojaxis eqimis specialobis mqone soflis eqimebis raodenoba da sxva samedicino spe-cialobis mqone eqimebis raodenoba mcirediT gansxvavdeba erTmaneTisagan (2-dan 7-mde). mocemul diapazonSi moxvda 12 municipaliteti, romelTaganac 3-Si - sxva specialobis eqimebis datvirTva ufro maRalia ojaxis eqimis specialobis mqone eqimis datvirTvasTan SedarebiT, Tumca maTi pa-cientebis vizitebis raodenoba sagrZnoblad meti araa da 2%, 8% da 26%-s Seadgens.56 mocemuli procentuli cvlileba asaxavs Tu ramdeni %-iT met pacients iReben ojaxis eqimis specialobis soflis eqimebi sxva samedicino specialobis mqone soflis eqimebTan SedarebiT.



soflis eqimebis informirebulobis sakiTxebi

evropis bevr qveyanaSi pirveladi jandacvis modeli gunduri muSaobis praqtikas em-yareba (gundi Sedgeba ramdenime eqimisgan, eqTnisgan). gunduri praqtikis upiratesoba mdgomareobs imaSi, rom specialistebs saSualeba eZlevaT erTmaneTs gauziaron pro-fesiuli gamocdileba, moxdes problemuri SemTxvevebis ganxilva, xolo pacientma miiRos xarisxiani momsaxureba.

saqarTveloSi soflad pirveladi jandacvis modeli emyareba individualur praq-tikas, rac gulisxmobs 1 soflis eqimis damoukidebel saqmianobas konkretul teri-toriul erTeulSi. Sesabamisad, eqims ar aqvs saSualeba aqtiuri komunikacia hqondes kolegebTan, moxdes maT Soris gamocdilebis gaziareba, problemuri SemTxvevebis ganxilva da sxv. Tavis mxriv, aRniSnuli SesaZlebelia gaweuli momsaxurebis xarisxSi aisaxos.

soflis eqimebis gamokiTxviT dgindeba, rom eqimebis 23% naklebad informirebulia jandacvis sistemaSi mimdinare siaxleebisa da sxva jandacvis programebis Sesaxeb, xolo danarCeni 77% miuTiTebs, rom informirebulia, Tumca damoukideblad cdilo-ben moiZion informacia jandacvis mimdinare sakiTxebisa da samedicino siaxleebis Sesaxeb (im pirobebSi, rodesac maT umetesobas internetTan wvdoma ar aqvs) da organ-izebulad programis ganmaxorcieleblebis mier maTi informireba ar xdeba.

eqimis kvalificiurobis uzrunvelsayofad mniSvnelovani nawilia eqimis informire-buloba jandacvis sxvadasxva sakiTxebze. soflis eqimi warmoadgens pirvel rgols, visganac pacientma unda miiRos informacia janmrTelobis sakiTxebze, jandacvis sxva programebze, Sesabamis kvlevebsa da tarifebze.

daskvna:

„soflis eqimis“ programis warmateba da miznebis miRweva did wilad eqimebis pro-duqtiul muSaobazea damokidebuli. eqimebis datvirTva, romelic eqimebis pro-duqtiulobis erT-erTi maCvenebelia, sagrZnoblad gansxvavdeba erTmaneTisagan. amisi mizezi SeiZleba konkretuli teritoriuli erTeulisaTvis damaxasiaTebeli reliefi, mosaxleobis gansxvavebuli raodenoba da simWidrove iyos. Tumca arse-bobs teritoriuli erTeulebi, sadac erT teritoriul erTeulSi dasaqmebul 2 eqims mniSvnelovnad gansxvavebuli datvirTva aqvs, rac eqimebis gansxvavebuli pro-duqtiulobis maCvenebelia.

programis dizaini ver qmnis eqimebisaTvis Tanabari produqtiuli momsaxurebis gawevis winapirobas da eqimebis keTilsindisierebis imedze tovebs programis efeq-tianad ganxorcielebis SesaZleblobas. kerZod, eqimebis sxva samsaxurSi SeTavsebiT muSaoba da programis monitoringis meqanizmis ararseboba, eqimebs aZlevs saSuale-bas sasurvel droiTa da jeradobiT iaron momsaxurebis gawevis adgilas, Sesabamisad, xSirad gansxvavebulia iseTi eqimebis datvirTva, romlebic Tanabar pirobebSi (mosax-leobis raodenoba, geografiuli Tavisebureba) muSaoben.



programis dafinansebis sistema ver qmnis samedicino personalis produqtiulobis miRwevis winapirobas, radgan is ar emyareba eqimis motivaciis amaRlebas. programis farglebSi eqimebis anazRaureba ar ganisazRvreba arc miRebuli pacientebis raode-nobiT da arc eqimis mier kargad Sesrulebuli samuSaos Sesabamisad. Tu eqims bev-ri pacienti hyavs, mas gacilebiT meti materialuri xarjis gaReba uwevs, vidre eqims, romelic programis farglebSi momsaxurebas arajerovnad axorcielebs.

pacientebis raodenoba ar qmnis eqimis produqtiulobis erTaderT safuZvels. stimulebze mibmuli anazRaurebis sistema ar gulisxmobs mxolod pacientebis vizitebis raodenobis mixedviT eqimis motivaciis amaRlebas. eqimis datvirTva Ses-aZlebelia ar iyos maRali iseTi obieqturi mizezidan gamomdinare, rogoricaa, ter-itoriuli erTeulis mosaxleobis mcirericxovnoba. am SemTxvevaSi anazRaurebis meqanizmi da motivacia gansxvavebuli wesiT unda ganisazRvrebodes. pirveladi jan-dacvis eqims marTebs mniSvnelovani samuSaos gaweva im mizniT, rom moxdes daavade-baTa adreuli gamovlena da prevencia, amaRldes pacientis informirebuloba jan-mrTelobasTan dakavSirebul sakiTxebze. am miznis misaRwevad ki centraluri roli aqvs ojaxis eqimis kvalifikacias. soflis eqimebis mniSvnelovani nawili ar aris ser-tificirebuli ojaxis eqimi. soflad pirveladi jandacvis eqimebis produqtiuloba garda kvalifikaciis sakiTxisa, damokidebulia aseve samedicino personalis inform-irebulobaze jandacvis mimdinare sakiTxebTan da sxva programebTan dakavSirebiT.



rekomendaciebi:

saministrom da saagentom:

soflad pirveladi jandacvis produqtiuli funqcionirebis winapirobebis Seqm-nis mizniT, saministrom saagentosTan erTad uzrunvelyos programis dizainSi img-vari cvlilebebis ganxorcieleba, rac xels Seuwyobs programuli momsaxurebis gaum-jobesebas.

➢ uzrunvelyos proaqtiuli RonisZiebebis gatareba (informirebulobis gazrda soflis eqimad dasaqmebis Sesaxeb samedicino personalis farTo speqtrisTvis), rac uzrunvelyofs konkurentuli garemos Seqmnas da saa-gentos saSualebas miscems momsaxureba Seisyidos im pirisgan, romelic up-iratesad Seasrulebs soflis eqimis funqcias;

➢ etapobrivad moxdes samedicino personalis stimulireba anazRaurebis sistemaSi cvlilebebiT, romelic, erTi mxriv, SesaZleblobas miscems Tana-bar geografiul-demografiul pirobebSi dasaqmebul eqimebs Sesrulebu-li samuSaos mixedviT miiRon programis farglebSi anazRaureba, xolo, me-ore mxriv, mniSvnelovania produqtiulobis gazrdis mizniT, etapobrivad dainergos sanqciebisa da waxalisebis (aramaterialuri an/da materialuri) sistema iseT mniSvnelovan indikatorebze da maCveneblebze dayrdnobiT, rogoricaa, magaliTad soflis eqimis mier daavadebaTa adreuli gamovlena, imunizacia, pacientebis kmayofileba da sxv;

➢ soflis pirveladi jandacvis gundis kvalifikaciis amaRlebis mizniT, sao-jaxo medicinaSi gadamzadebisa da sertificirebis procesis xelSewyoba im eqimebisTvis, romelTac ar aqvT ojaxis eqimis kvalifikacia.

saagentos:

➢ SemuSavdes samedicino personalis mier sxvadasxva soflebSi dagegmili vizitebis ganrigi/ganawileba im mizniT, rom Seiqmnas samuSaos Sesruleb-is valdebuleba da SesaZlebeli iyos samedicino personalis mier movale-obebis Sesrulebis sakiTxis monitoringi, Semowmeba da Sesabamisad, pasux-ismgeblobis sakiTxis dayeneba.

➢ programis farglebSi SemuSavdes soflis eqimis saqmianobisa da Sedegebis monitoringis meqanizmi, romelic xels Seuwyobs samuSao procesis gaum-jobesebas.



5. soflis eqimis arasakmarisi CarTuloba skriningis programaSi

pirveladi jandacvis, rogorc koordinatoris roli umniSvnelovanesia pirveladi jandacvis funqciaTa Soris. is moicavs pacientis gadamisamarTebas jandacvis zeda rgolSi, daavadebaTa adreuli gamovlenis an zusti diagnozis dadgenis mizniT.

janmrTelobis msoflio organizaciis mixedviT57 daavadebaTa prevencia 3 doneze xorcieldeba:

» mosaxleobis zogadi mdgomareobis gaumjobeseba pirveladi jandacvis doneze;» meoradi prevencia - skriningis programebi;» mesame donis prevencia - daavadebis adreul stadiaze damarcxeba.

daavadebaTa prevencia pirveladi jandacvis doneze moiazrebs pirveladi jandacvis skriningis programebTan koordinacias daavadebaTa adreuli gamovlenis mizniT.

daavadebaTa adreuli gamovlenis mizniT arsebobs daavadebaTa adreuli gamovlen-isa da skriningis saxelmwifo programa, romlis ganmaxorcielebelic saqarTvelos regionebSi aris saministros sistemaSi Semavali ssip daavadebaTa kontrolisa da sazogadoebrivi janmrTelobis erovnuli centri.

programiT gaTvaliswinebuli momsaxureba moicavs sxvadasxva daavadebis adreul diagnostikas, maT Soris, programiT gaTvaliswinebuli momsaxurebis mniSvnelovani nawilia kibos skriningi.

kibos skriningis komponenti xorcieldeba mTeli saqarTvelos masStabiT da is moi-cavs Semdeg komponentebs:

» ZuZus kibos skriningi;» saSvilosnos yelis kibos skriningi (Pap-testi da kolposkopiuri skriningi);» prostatis kibos skriningi;» koloreqtaluri kibos skriningi (FORT- testi).

auditis Sedegad gamovlinda, rom daavadebaTa adreuli gamovlenisa da skriningis programaSi pirveladi jandacvis rgoli - soflis eqimi, rogorc referalis (gada-misamarTebis) ZiriTadi ganmaxorcielebeli CarTuli ar aris. programis mixedviT mx-olod gurjaanis municipalitetis soflis eqimebi arian CarTuli saSvilosnos yelis kibos organizebuli skriningis sapiloto reJimSi.

57 EPHO – Essential Public Health Operations – www.euro.who.int/en/health-topics/Health-systems/public-health-services/policy/the-10-essential-public-health-operations/epho5-disease-prevention,-in-cluding-early-detection-of- illness2



am SemTxvevaSi gamokvlevaSi pacientis CarTvis procesi Semdegia:

sqema №5.1: soflis eqimisa da skriningis programis koordinirebuloba:

soflis eqimis mier miznobrivi populaciisTvis

konsultaciis gaweva da

gadamisamarTeba servisis

mimwodebelTan

skriningis Sedegebi igzavneba

soflis eqimTan, romelic

atyobinebs beneficiars

kvlevis Sedegs

mkurnalobis Sedegebi egzavneba

referalis ganmaxorcielebel

soflis eqims

visac kibos mkurnaloba esaWiroeba,

soflis eqimis mier

gadamisamarTebu lebi iqnebian

meoradi donis dawesebulebaSi

zemoaRniSnuli modeli kargad asaxavs pirveladijandacvis rgolis koordinaciul rols, Tumca rogorc aRiniSna aRniSnuli sistema mxolod gurjaanis municipalitet-Sia danergili. danarCeni saqarTvelos masStabiT koordinacia skriningis programasa da soflis eqims Soris ar aris danergili.

soflis eqimebis gamokiTxviT dasturdeba, rom maTi nawili (24%) flobs mxolod zogad informacias daavadebaTa adreuli gamovlenis da skriningis programis Sesaxeb, xolo kiTxvaze, Tu ramdenad xSirad gaugzavniaT pacienti skriningis programaSi gamokvlevis Casatareblad, gamokiTxul eqimTa 57% pasuxobs, rom es iSvi-aTad xdeba.

2014 wels daavadebaTa adreuli gamovlenisa da skriningis programis biujeti damt-kicebuli 2,000,000 laridan dazustda 1,513,800 larze, 2014 wlis noemberSi, rac gan-apiroba programaSi warmoqmnilma savaraudo ekonomiam. Sesabamisad, damtkicebuli bi-ujetidan auTvisebelma Tanxam 486,200 lari Seadgina.

programis mosargebleTa gazrdiT SesaZlebeli iqneboda damatebiT 28,600-mde qal-isTvis58 saSvilosnos yelis kibos skriningis Catareba (erTeulis Rirebuleba 17 lars Seadgens) da Sesabamisad, aRniSnuli daavadebis prevencia garkveul populaciaSi. pro-gramis miznebis miRweva SeiZleba mniSvnelovnad iyos damokidebuli soflis eqimebis CarTulobaze.

daskvnapirveladi jandacvis integrireba skriningis programasTan sustia, rac ukavSird-

eba imas, rom saministros mier ganxorcielebuli programebis (soflis eqimisa da skriningis) erTmaneTTan koordinacia sakmarisad ar xdeba. Tavis mxriv, daavadebaTa adreuli gamovlena xels uwyobs qveyanaSi janmrTelobis maCveneblebis gaumjobese-bas da aisaxeba mosaxleobis cxovrebis xarisxze. gvian gamovlenili daavadebebi, Tav-is mxriv, zrdis saxelmwifo da kerZo danaxarjebs, vinaidan adreul etapze gamovle-nili daavadebis mkurnaloba, rogorc wesi, ufro nakleb danaxarjebs ukavSirdeba.

58 28,600 =486,200/17



rekomendacia

saministrom saagentosTan erTad:

➢ uzrunvelyos soflis eqimis programis koordinacia daavadebaTa adreuli gamovlenisa da skriningis programasTan im mizniT, rom pirveladi jandac-va soflad metad emsaxurebodes prevenciul funqcias da gaizardos pirve-ladi jandacvis roli daavadebaTa adreul gamovlenaSi.



6. angariSgebasTan dakavSirebuli problemebi

samedicino personali yovelTviurad warudgens saagentos Sesrulebuli samuSa-os angariSs. angariSi 2 formisgan Sedgeba: SemTxvevaTa uwyisi da SemTxvevaTa reestri (statistikuri forma), romelic ar atarebs finansur datvirTvas, Tumca mas didi mniSvneloba aqvs samedicino personalis produqtiulobis, aseve maT mier Sesrulebu-li samuSaos raodenobisa da xarisxis Sesafaseblad.

rogorc zemoT aRiniSna, programis mizani pirveladi janmrTelobis dacvis momsax-urebis utilizaciis gazrdaa.

miznis misaRwevad Sedegis Sefasebis indikatorebia:

» vizitebis raodenoba samizne populaciaSi;» pirveladi jandacvis, ambulatoriuli momsaxurebis utilizaciis wili.

Sefasebis indikatorebis gasazomad angariSgebis konsolidacia da analizi ar xdeba, Sesabamisad programas ar aqvs Sefasebis meqanizmi.

samedicino personalis mier warmodgenili statistikuri forma moicavs bevr in-formacias, Tumca angariSgebis dadgenili (statistikuri) forma arasrulyofilia:

» angariSi ar moicavs pacientis sakontaqto informacias, romelic mniSvnelova-nia Semdgom imis gadasamowmeblad Tu ramdenad iyo pacienti realurad eqimTan vizitze da amavdroulad ramdenad kmayofilia is eqimis momsaxurebiT;

» angariSSi mxolod zogadi informacia aisaxeba pacientis referalis Sesaxeb, Tum-ca ar aisaxeba Tu romel specialistTan, romel diagnostikur proceduraze ganaxorciela eqimma pacientis referali;

» angariSSi ar moipoveba informacia eqimis mier pacientis skriningis programaSi gadamisamarTebis Sesaxeb.

xSirad statistikuri formebi mxolod miRebuli pacientebis raodenobas asaxavs, xolo danarCeni informacia, Tu ra iyo pacientis mimarTvis mizezi, ra Careva ganax-orciela eqimma da Semdgom sad gadaamisamarTa pacienti, carieli an arasrulad Sevse-bulia.

garda imisa, rom angariSi warmoadgens mniSvnelovan meqanizms programis Sedegebis gasazomad, is mniSvnelovania eqimis mier Sesrulebuli samuSaos xarisxis Sesafasebla-dac: eqimebis mier ganxorcielebuli referalis raodenoba da mizanSewoniloba, lab-oratoriul-instrumentuli kvlevebis raodenoba, daavadebaTa adreuli gamovlenis maCveneblebi, aseve sxva mniSvnelovani sakiTxebi, romlebic gamoavlens problemebs, tendenciebs da Semdgomi aqtivobebis sworad dagegmvisTvis mniSvnelovani wyaro gax-deba.



daskvna

angariSgeba programis Sesafaseblad umniSvnelovanesi berketia, Tumca aRniSnuli berketebis gamoyeneba ar xdeba da Sesabamisad, programis ganmaxorcieleblisTvis ucnobia ramdenad aRwevs programa dasaxul miznebs.

rekomendaciebi

saagentos:

➢ daixvewos da srulyofili gaxdes samedicino personalis mier warmosadgeni angariSis forma, romelic moicavs Semdegs: pacientis sakontaqto informa-cia, eqimis mier pacientis gadamisamarTeba sadiagnostiko procedurebze, sxva specialistebTan, eqimis mier pacientis skriningis programaSi CarTva da sxv;

➢ saagentom SeimuSavos Sesabamisi meqanizmebi, raTa ganxorcieldes samedici-no personalis mier warmodgenili angariSis konsolidireba da SemuSavdes Sesrulebuli samuSaos monitoringis da Sefasebis meqanizmebi.



7. damatebiTi informacia - specdafinansebaze myofi dawesebulebebisTvis dadgenili limitebis gansazRvraSi arsebuli naklovaneba

soflis eqimis programis erT-erTi mniSvnelovani komponentia specdafinansebaze myofi dawesebulebebis mier Sesabamisi ambulatoriuli da stacionaruli momsaxure-bis miwodeba, romlis biujetic 2014 wels 3,548,200 lars Seadgenda.

soflis eqimis programis farglebSi, soflis mosaxleobas pirveladi jandacvis momsaxurebas awvdis soflis eqimi/eqTani, xolo specdafinansebaze myofi dawesebule-ba sxvadasxva momsaxurebas awvdis raionuli centris (qalaqis, dabis) mosaxleobas da ara soflis mosaxleobas.59

specdafinansebaze myofi organizaciebisTvis, programiT gamoyofili asigneba iT-valiswinebs am organizaciebis mdgradobis SenarCunebas konfliqtur, masTan mimde-bare regionebsa da maRalmTian regionebSi, sadac samedicino momsaxurebis miwodeba komerciulad aramomgebiania, mosaxleobis mcirericxovnobidan gamomdinare.

Sesabamisad, saxelmwifo interesebidan gamomdinare, specdafinansebaze myofi dawese-bulebis Seuferxeblad funqcionirebis uzrunvelsayofad, maT bazisur dafinansebas axorcielebs saxelmwifo.

specdafinansebaze 2014 wlis dekembris mdgomareobiT imyofeba 36 dawesebuleba. dawesebulebebi yovelTviurad, winaswar gansazRvruli limitis Sesabamisad, iReben dafinansebas, limitebi TiToeuli dawesebulebisTvis gansxvavebulia (ix. danarTi N3).

auditis Sedegad gamovlinda, rom specdafinansebaze myofi dawesebulebebis lim-itebi ganisazRvra 2004 wels, mas Semdeg (2011-2013 wlebSi) limitebis ganaxleba ganx-orcielda ramdenime SemTxvevaSi, dawesebulebis moTxovnis Sesabamisad.60

2004 wels dawesebulebebisTvis gansazRvruli limitis safuZveli ver iqneba miCneu-li validurad 2015 wlisTvis.

auditis Sedegad gamovlinda, rom komponentis Sesrulebis angariSSi (romelsac dawesebulebebi yovelTviurad warudgenen saagentos) fiqsirdeba mxolod pacientis ambulatoriuli Tu stacionaruli momsaxurebis kodi. Sesabamisad, saagentosTvis ucnobia ra konkretuli momsaxureba ganaxorciela dawesebulebam. miuxedavad imisa, rom mniSvnelovania organizaciebis mdgradobis SenarCuneba konfliqtur, masTan mimdebare regionebSi da maRalmTian regionebSi, specdafinansebis dawesebulebebisT-vis dadgenil limitebs unda hqondes Sesabamisi safuZveli, rac gulisxmobs imas, rom gasacemi Tanxis safuZveli unda iyos validuri informacia, romelic asaxavs dawese-bulebis realur saWiroebebs.

59 gamonakliss warmoadgens yazbegisa da TianeTis municipalitetebi, okupirebuli soflebi, sa-dac specdafinansebis komponentis farglebSi pirveladi jandacvis momsaxurebas iRebs rogorc raionis, aseve, soflis mosaxleobac - ar aris dakontraqtebuli soflis eqimi/eqTani.60 niqozis, saberios, Satilis ambulatoriebi, aseve Sps „afxazeTidan iZulebiT gadaadgilebul pirTa zugdidis poliklinika“.



rekomendacia


➢ specdafinansebaze myofi dawesebulebebisTvis SemuSavdes da dadgindes dafinansebis ganaxlebuli limitebi Sesabamis monacemebsa da safuZvelze dayrdnobiT, im mizniT, rom gacemuli Tanxebi asaxavdes dawesebulebebis realur saWiroebebs.



Semajamebeli daskvna da rekomendaciebi

saxelmwifo auditis samsaxuri miiCnevs, rom SesaZlebelia soflad pirveladi jan-dacvis xelmisawvdomobis da produqtiulobis gazrda. samedicino personalis optimaluri ganawilebis kriteriumebis gamoyenebiT da geografiuli ganawilebis xarvezebis gamosworebiT, SesaZlebelia pirveladi jandacva soflad gaxdes metad xelmisawvdomi momsaxureba.

programis dizainis gaumjobesebis Sedegad ki SesaZlebelia samedicino persona-lis produqtiulobis winapirobebis Seqmna. aseT winapirobas warmoadgens programis marTvis meqanizmebis, kerZod monitoringisa da Sefasebis danergva, samedicino per-sonalis samuSao reJimis marTva, im mizniT, rom teritoriul erTeulebSi yovel-dRiurad iyos xelmisawvdomi pirveladi jandacvis momsaxureba da mas hqondes gaum-jobesebuli Sedegebi.

aseve, mniSvnelovania, sakadro deficitis aRmofxvris mizniT dainteresebul mxa-reebs maqsimalurad miewodoT informacia soflis eqimis momsaxurebis mimwodeblis poziciis Sesaxeb, raTa upiratesoba mieniWos iseT samedicino personals, romelic ar iqneba dasaqmebuli sxva samsaxurSi da yoveldRiurad SeZlebs soflis eqimis momsax-urebis ganxorcielebas.

produqtiulobis gaumjobesebis kidev erT winapirobas warmoadgens samedicino personalis anazRaurebis sistema. dRes arsebuli modeliT, samedicino personalis anazRaureba fiqsirebulia da ar aris damokidebuli samuSao droze, sxva samsaxurSi SeTavsebiT muSaobaze, miRebuli pacientebis raodenobasa Tu winaswar gansazRvrul indikatorebze. evropul qveynebSi pirveladi jandacvis sistemaSi samedicino person-alis anazRaureba winaswar gansazRvrul indikatorebze da gaweul momsaxurebazea damokidebuli, vinaidan mniSvnelovania samedicino personalis motivaciis amaRleba, xelSewyoba da sargeblis samarTliani ganawileba.

produqtiulobis mniSvnelovani faqtori eqimebis kvalifikaciaa. saojaxo medicina pirveladi jandacvis sferoSi dasaqmebis kvalifikacias warmoadgens, Sesabamisad mi-uxedavad aRniSnul kvalifikaciaSi kadris naklebobisa, mniSvnelovania saministrom izrunos kadrebis gadamzadebasa da sertificirebaze.

pirveladi jandacvis umTavresi daniSnuleba daavadebaTa adreul gamovlenasa da prevenciaSi gamoixateba. Sesabamisad, mniSvnelovania iseTi berketebis gamoyeneba, ro-goricaa soflis eqimis da skriningis programebis daaxloveba da koordinacia.

soflad pirvelad jandacvaSi arsebuli problemebis gamosworeba SesaZlebelia swori dagegmvis safuZvelze. aqtivobebis dagegmvisTvis mniSvnelovania programis Sefaseba, am mizniT ki samedicino personalis warmodgenili angariSgeba unda moi-cavdes mniSvnelovan informacias, ris safuZvelzec moxdeba programis Semdgomi Se-faseba arsebuli xarvezebis, naklovanebebis gamosworebis mizniT.

soflis eqimis programis erT-erT mniSvnelovan nawils warmoadgens specdafinanse-bis komponenti. specdafinansebaze myofi organizaciebisTvis, programiT gamoyofili



asigneba iTvaliswinebs am organizaciebis mdgradobis SenarCunebas konfliqtur, mas-Tan mimdebare regionebSi da maRalmTian regionebSi. specdafinansebaze myofi dawese-bulebebis limitebi ganisazRvra 2004 wels, mas Semdeg (2011-2013 wlebSi) limiteb-is ganaxleba ganxorcielda ramdenime SemTxvevaSi. auditis samsaxuri miiCnevs, rom mniSvnelovania specdafinansebaze myofi dawesebulebebisTvis gansazRvruli limitebi asaxavdes realobas da dadgenili limitebis safuZveli iyos validuri informacia.

gamovlenili garemoebebis sapasuxod, auditis samsaxurma gasca Semdegi rekomenda-ciebi:

soflis eqimis momsaxurebis xelmisawvdomobasTan dakavSirebuli:

saministros da saagentos:

➢ samedicino personalis optimalurad ganawilebis mizniT, SemuSavdes da dadgindes demografiul-geografiuli kriteriumebi teritoriuli er-TeulebisTvis (maT Soris, maRalmTiani da meCxerad dasaxlebuli terito-riuli erTeulebisTvis) saqarTvelos statistikis erovnuli samsaxuris mier Catarebuli mosaxleobis aRweris 2015 wlis monacemebze dayrdnobiT, soflebs Soris arsebuli distanciebisa da aseve geografiuli pirobebis gaTvaliswinebiT;

➢ mniSvnelovania damyardes aqtiuri komunikacia adgilobriv TviTmarT-velobasTan im mizniT, rom maRalmTian da transportis problemis mqone soflebSi mogvardes eqimis momsaxurebis arealSi transportirebis sakiTx-ebi. amasTanave, Sesabamisi ambulatoriuli infrastruqturis arsebobam-de, moxdes im eqimebis droebiT adgilsamyofelTan da Sesabamisi samuSao pirobebis SeqmnasTan dakavSirebuli sakiTxebis xelSewyoba, romelTac ar aqvT samuSao adgili (oTaxi) an arsebuli ambulatoriis pirobebSi SeuZle-belia maTi saqmianoba.

saministros:

➢ saministrom xeli Seuwyos maRalmTiani soflebisTvis sakmarisi da Ses-abamisi kadris moZiebas diplomisSemdgomi samedicino ganaTlebis pro-gramis an/da sxva meqanizmebiT.

gaweuli momsaxurebis produqtiulobis gaumjobesebasTan dakavSirebuli:

saministrom da saagentom:

➢ uzrunvelyos proaqtiuli RonisZiebebis gatareba (informirebulobis gazrda soflis eqimad dasaqmebis Sesaxeb samedicino personalis farTo speqtrisTvis), rac uzrunvelyofs konkurentuli garemos Seqmnas da saa-gentos saSualebas miscems momsaxureba Seisyidos im pirisgan, romelic up-iratesad Seasrulebs soflis eqimis funqcias;



➢ etapobrivad moxdes samedicino personalis stimulireba anazRaurebis sistemaSi cvlilebebiT, romelic, erTi mxriv, SesaZleblobas miscems Tana-bar geografiul-demografiul pirobebSi dasaqmebul eqimebs Sesrulebu-li samuSaos mixedviT miiRon programis farglebSi anazRaureba, xolo, me-ore mxriv, mniSvnelovania produqtiulobis gazrdis mizniT, etapobrivad dainergos sanqciebisa da waxalisebis (aramaterialuri an/da materialuri) sistema iseT mniSvnelovan indikatorebze da maCveneblebze dayrdnobiT, rogoricaa, magaliTad soflis eqimis mier daavadebaTa adreuli gamovlena, imunizacia, pacientebis kmayofileba da sxv;

➢ soflis pirveladi jandacvis gundis kvalifikaciis amaRlebis mizniT, saojaxo medicinaSi gadamzadebisa da sertificirebis procesis xelSewyoba im eqimebisTvis, romelTac ar aqvT ojaxis eqimis kvalifikacia.

saagentos:

➢ SemuSavdes samedicino personalis mier sxvadasxva soflebSi dagegmili vizitebis ganrigi/ganawileba im mizniT, rom Seiqmnas samuSaos Sesruleb-is valdebuleba da SesaZlebeli iyos samedicino personalis mier movale-obebis Sesrulebis sakiTxis monitoringi, Semowmeba da Sesabamisad, pasux-ismgeblobis sakiTxis dayeneba.

➢ programis farglebSi SemuSavdes soflis eqimis saqmianobisa da Sedegebis monitoringis meqanizmi, romelic xels Seuwyobs samuSao procesis gaum-jobesebas.

soflis eqimis da skriningis programis koordinaciasTan dakavSirebuli:


➢ uzrunvelyos soflis eqimis programis koordinacia daavadebaTa adreuli gamovlenisa da skriningis programasTan im mizniT, rom pirveladi jandac-va soflad metad emsaxurebodes prevenciul funqcias da gaizardos pirve-ladi jandacvis roli daavadebaTa adreul gamovlenaSi.

angariSgebis gaumjobesebasTan dakavSirebuli:

saagentos:

➢ daixvewos da srulyofili gaxdes samedicino personalis mier war-mosadgeni angariSis forma, romelic moicavs Semdegs: pacientis sakon-taqto informacia, eqimis mier pacientis gadamisamarTeba sadiagnostiko procedurebze, sxva specialistebTan, eqimis mier pacientis skriningis programaSi CarTva da sxv;

➢ saagentom SeimuSavos Sesabamisi meqanizmebi, raTa ganxorcieldes samedici-no personalis mier warmodgenili angariSis konsolidireba da SemuSavdes Sesrulebuli samuSaos monitoringis da Sefasebis meqanizmebi.



specdafinansebasTan dakavSirebuli:


➢ specdafinansebaze myofi dawesebulebebisTvis SemuSavdes da dadgindes dafinansebis ganaxlebuli limitebi Sesabamis monacemebsa da safuZvelze dayrdnobiT, im mizniT, rom gacemuli Tanxebi asaxavdes dawesebulebebis realur saWiroebebs.



auditis obieqtebis komentarebi gacemul rekomendaciebTan dakavSirebiT

auditis angariSis damtkicebamde, angariSis proeqti gadaegzavna saministrosa da saagentos. rekomendaciebis didi nawili saministros da saagentos mier gaziarebul iqna, Tumca rekomendacia, romelic exeba eqimebis anazRaurebis sistemaSi cvlilebebs, saagentos mier ar iqna gaziarebuli.

qvemoT mocemuli teqsti asaxavs saagentos pozicias aRniSnul rekomendaciasTan dakavSirebiT:

„rekomendaciis Sesruleba, romelic exeba samedicino personalis etapobriv stim-ulirebas anazRaurebis sistemaSi cvlilebiT, ver iqneba xelSekrulebiT gaTval-iswinebuli, vinaidan aRniSnuli xelSekrulebis safuZvelze soflis eqimi/eqTani dasaqmebulad ar iTvleba da igi warmoadgens mxolod momsaxurebis mimwodebels, saxelmwifo Sesyidvis xelSekrulebis Sesabamisad. amasTan, saqarTvelos Sromis, jan-mrTelobis da socialuri dacvis saministro muSaobs pirveladi jandacvis koncefci-aze, romelic orientirebuli iqneba rogorc pacientebis, ise samedicino personalis uflebebis dasacavad da aseve, momsaxurebis xarisxis gaumjobesebisTvis mimarTuli qmediTi RonisZiebebis SemuSavebaze.“

saxelmwifo auditis samsaxuri miiCnevs, rom dRes arsebuli modelis mixedviT, Tana-bar geografiul-demografiul mdgomareobaSi momsaxure personals, romelic gansx-vavebuli produqtiulobiT asrulebs samuSaos, sxvadasxva faqtorebis gamo (sxva samsaxurSi SeTavsebiT muSaoba, aseve iseTi risk-faqtori, rogoricaa monitoring-is ar arsebobis gamo samuSao drois gacdena) ar SeiZleba hqondes erTi da igive anazRaureba, miTumetes, rodesac miRebuli pacientebis raodenobazea damokidebuli samedicino personalis mier miRebuli anazRaurebidan gasawevi Tanxis odenoba (medikamentebis xarji, transportirebis xarji). amavdroulad, saerTaSoriso praqti-ka adasturebs stimulebze orientirebuli sistemis da indikatorebze mibmuli anaz-Raurebis sistemis upiratesobas (ix. Tavi 4.2). unda aRiniSnos, rom dafinansebis aseTi sistemis Seqmnis SemTxvevaSi, sistema unda iyos mdgradi, kontrolirebadi da gamor-icxavdes susti kontrolis procedurebis gamo anazRaurebis araswor gamoTvlas.

saxelmwifo auditis samsaxuri miiCnevs, rom arsebul modelSi SesaZlebelia xelSe-krulebis individualur formatSi gaformeba, romelic iZleva Sesrulebuli samuSaos mixedviT da winaswar gansazRvruli indikatorebis mixedviT samedicino personalis anazRaurebis gansazRvris saSualebas. amasTanave, saministro muSaobs pirveladi jan-dacvis koncefciaze, romelic pirveladi jandacvis modelis Camoyalibebazea orien-tirebuli. am SemTxvevaSi ki SesaZlebeli iqneba, grZelvadianad da etapobrivad pro-gramis dizainis cvlilebebTan erTad, anazaRaurebis swor modelze iqnas morgebuli samedicino personalTan xelSekrulebis formati.



bibliografia

normatiuli masala:

saqarTvelos kanoni maRalmTiani regionebis ganviTarebis Sesaxeb, 2015;

saqarTvelos mTavrobis dadgenileba 650 2014 wlis janmrTelobis dacvis saxelm-wifo programebis damtkicebis Sesaxeb, 2014 wlis 2 dekemberi;

saqarTvelos mTavrobis dadgenileba 624 diplomisSemdgomi samedicino ganaT-lebis programis damtkicebis Sesaxeb, 2014 wlis 11 noemberi;

saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministris brZane-ba 01-264/o „soflis eqimis“ saxelmwifo programis farglebSi Sesabamisi admin-istraciul-teritoriuli erTeulebis mixedviT saeqimo da saeqTno punqtebis raodenobisa da ,,eqimis CanTis“ gansazRvris Sesaxeb, 2013 wlis 23 dekemberi;

saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministris brZaneba 244/n samedicino dawesebulebaSi dasaqmebis uflebisa da Sesabamisi ganaTlebis mqone samedicino personalis nusxis damtkicebis Sesaxeb, 2009 wlis 16 ivlisi;

2014 wlis biujetiT gansazRvruli programebis mosalodneli Sedegebi da in-dikatorebi;

alma-atis pirveladi jandacvis konferenciis deklaracia, 1978.

saxelmZRvaneloebi da publikaciebi:

saxelmwifo auditis samsaxuri - saswrafo samedicino daxmarebis sistemis 2011-2012 wlebis efeqtianobis auditis angariSi - saswrafo samedicino daxmarebis droul reagirebasa da momsaxurebaSi arsebuli problemebi, 2013.

saqarTvelos Sromis, janmrTelobis da socialuri dacvis saministro msoflio bankis da evrokavSiris daxmarebiT - pirveladi jandacvis ganviTarebis erovnuli generaluri gegma, 2006;

saqarTvelos Sromis, janmrTelobis da socialuri dacvis saministro - jan-dacvis sistemis efeqturobis Sefasebis 2013 wlis angariSi;

ssip daavadebaTa kontrolis da sazogadoebrivi janmrTelobis erovnuli centri - epidemiologiuri biuleteni 2014;

janmrTelobis msoflio organizacia - pirveladi jandacvis Sefasebis instru-mentebi, 2010;

janmrTelobis msoflio organizacia - Essential Public Health Operations, Disease



prevention, including early detection of illnesses.

ojaxis eqimebis msoflio organizacia (WONCA) - Rural Medical Education Guidebook

ojaxis eqimebis msoflio organizacia (WONCA) - Policy on Rural Practice and Rural Health

veb-gverdebi:

saqarTvelos Sromis, janmrTelobis da socialuri dacvis saministro - www.moh.gov.ge

socialuri momsaxurebis saagento - www.ssa.gov.ge

daavadebaTa kontrolisa da sazogadoebrivi janmrTelobis erovnuli centri - www.ncdc.ge

saqarTvelos statistikis erovnuli samsaxuri - www.geostat.ge

janmrTelobis msoflio organizacia - www.who.int

saojaxo medicinis akademia - www.aafp.org

ojaxis eqimebis msoflio organizacia (WONCA) - www.globalfamilydoctor.com

pirveladi jandacvis evropuli forumi - www.euprimarycare.org



danarTebi

danarTi №1: soflis eqimebisTvis transportirebis xarjebis anazRaureba municipal-itetebis mier

regioni municipalitetitransportis xarjis

anazRaureba

aWaraqeda qobuleTi Suaxevi xelvaCauri xulo

✓×✓×✓

gurialanCxuTi ozurgeTi Coxatauri

×××

imereTivani zestafoni Terjola saCxere wyaltubo WiaTura xaragauli xoni

×✓✓⁄×××××✓

kaxeTiaxmeta gurjaani dedofliswayro Telavi lagodexi sagarejo siRnaRi

×××××✓⁄××

mcxeTa - mTianeTiduSeTi mcxeTa

××

raWaambrolauri lentexi oni cageri

××××



regioni municipaliteti transportis xarjis anazRaureba

samegreloabaSa zugdidi martvili mestia senaki Cxorowyu walenjixa xobi

×✓⁄×××××××

samcxe-javaxeTiadigeni aspinZa axalqalaqi axalcixe borjomi ninowminda

×××✓⁄×××

qvemo qarTlibolnisi gardabani dmanisi TeTriwyaro marneuli walka

×✓××××

Sida qarTligori kaspi qareli xaSuri

××××



danarTi №2: saswrafoSi dasaqmebuli soflis eqimebis datvirTvis Sedareba imsoflis eqimebis datvirTvasTan, romlebic ar muSaoben saswrafoSi:

municipaliteti

saswrafoSi dasaqmebuli

soflis eqimebis

raodenoba

soflis eqimebis

datvirTva, romlebic muSaoben

saswrafoSi

saswrafoSi dausaqmebeli

soflis eqimebis

raodenoba

soflis eqimebis

datvirTva, romlebic

ar muSaoben saswrafoSi

sxvaoba eqimebis

datvirTv aSi (%)

xoni 3 29 12 70 144%

dedofliswyaro 1 40 13 88 123%

sagarejo 1 38 26 83 121%

tyibuli 2 40 10 83 108%

Coxatauri 4 0 15 118 96%

borjomi 4 49 12 95 92%

yvareli 3 86 19 129 50%

aspinZa 4 32 3 48 49%

walenjixa 7 40 13 57 42%

lanCxuTi 8 91 11 124 35%

cageri 10 23 10 31 33%

samtredia 1 45 15 58 30%

zugdidi 3 42 43 51 21%

gurjaani 2 128 37 153 19%

Telavi 7 114 25 134 18%

lagodexi 2 62 32 73 17%

qobuleTi 7 114 26 133 17%

martvili 3 21 19 24 14%

lentexi 6 11 3 13 11%

vani 3 68 14 74 10%

Suaxevi 3 58 8 64 9%

ambrolauri 11 17 11 18 7%

abaSa 4 37 12 39 5%

ozurgeTi 7 123 29 128 4%

xaragauli 9 60 10 61 2%

xelvaCauri 1 111 33 111 0%

bolnisi 4 47 24 46 -2%

qeda 2 80 10 79 -2%

marneuli 9 35 33 34 -4%

WiaTura 6 90 17 87 -4%

dmanisi 3 48 8 44 -9%

ninowminda 5 36 10 33 -10%

xobi 3 56 15 50 -10%



municipaliteti

saswrafoSi dasaqmebuli

soflis eqimebis

raodenoba

sofliseqimebis

datvirTva, romlebic muSaoben

saswrafoSi

saswrafoSi dausaqmebeli

soflis eqimebis

raodenoba

sofliseqimebis

datvirTva, romlebic

ar muSaoben saswrafoSi

sxvaoba eqimebis

datvirTv aSi (%)

walka 7 25 7 22 -11%

xulo 9 54 10 47 -13%

baRdaTi 70 14 61 -13%

mcxeTa 2 90 29 78 -13%

adigeni 7 36 7 31 -14%

gardabani 2 69 53 55 -20%

TeTriwyaro 5 43 16 34 -20%

duSeTi 4 62 17 48 -23%

oni 4 11 10 8 -23%

axalcixe 3 77 14 51 -34%

axalqalaqi 3 20 11 13 -39%

mestia 1 38 13 19 -51%



danarTi 3: specdafinansebaze myofi dawesebulebebis yovelTviuri limitebi da miRebuli pacientebis raodenoba



დანართი №3: სპეცდაფინანსებაზე მყოფი დაწესებულებების ყოველთვიური ლიმიტები და მიღებული პაციენტების რაოდენობა

saxelmwifo auditis samsaxuriq. Tbilisi. q. wamebulis gamziri N96

tel: +995 32 2438438

სოფლის ექიმის სახელმწიფო ......saxelmwifo auditis...

Documents