Benchmarking Georgia's palliative care system, using WHO's new actionable indicators: alignment with the European Association for Palliative Care (EAPC) 2025 atlas.

内容摘要

Palliative care is an essential health service for patients with chronic and life-threatening conditions. Although palliative care has been formally recognized in Georgia's legislation and state programs since the mid-2000s, evidence regarding the development, accessibility, and integration of services remains limited. The WHO framework, Assessing the Development of Palliative Care Worldwide: A Set of Actionable Indicators, and its application in the EAPC Atlas of Palliative Care in the European Region 2025 provide an opportunity for a comprehensive assessment of the national palliative care system. This study evaluated the development of palliative care in Georgia using WHO actionable indicators and compared the findings with the EAPC 2025 Atlas to identify system-level gaps and priorities for improvement. This study employed a descriptive health systems assessment and policy analysis of palliative care development in Georgia. The evaluation was guided by the World Health Organization's 2021 framework, Assessing the Development of Palliative Care Worldwide: A Set of Actionable Indicators. Fourteen indicators across six domains were operationalized using national administrative data, policy documents, institutional reports, and published literature from 2021 to 2024. Quantitative and qualitative findings were triangulated and benchmarked against the European Association for Palliative Care (EAPC) Atlas of Palliative Care in the European Region 2025 to assess service availability, accessibility, geographical distribution, coverage, and system capacity. While palliative care is legally recognized and partially embedded in national health policy, implementation remains limited and uneven. Service provision is highly centralized in Tbilisi, with restricted outpatient and home-based services in regions. In 2024, only 16.7% of the estimated national palliative care need was met. Opioid consumption remains in the very low range, reflecting restrictive regulations, limited medicine availability, and insufficient prescriber training. Similarly, the EAPC 2025 Atlas shows low performance across key WHO indicators, particularly in governance, monitoring mechanisms, service integration, research, and education. Despite early legislative advances, Georgia's palliative care system remains fragmented and inadequately integrated into primary health care. Strengthening governance, financing, education, and monitoring in line with WHO and EAPC benchmarks is essential to achieve equitable, sustainable, and comprehensive palliative care coverage.