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Georgia has a population of 3.7 million. (1) Average life expectancy is 73. (2)  

Georgia gained independence with the fall of the Soviet Union in 1991, and inherited its health system model. Health care was given free at the point of care and was centrally organised in a hierarchy from district to state hospitals, all owned and all employed by the state. In 1994 the system was reformed and introduced health insurance, user fees and a focus on defining the responsibilities and cover of the public health system. The new system was deemed to have failed and was abandoned in 2004. It was replaced by a system covering only vulnerable groups, about a quarter of the population, offering them around 70% discount on care. In 2008 the system was once again reformed and a programme was initiated were private insurance companies provided compulsory insurances regulated by the state. Those unable to pay received vouchers from the state for insurance payments.  Out of pocket expenditure  still made up the majority of health spending, with a large part being informal payments. Meanwhile the infrastructure was privatised with facilities sold to insurance companies and other private investors, whilst their operation was regulated by the state. (3) In 2013 the Georgian government launched a new universal healthcare programme (UHC), and replaced the insurance companies’ plans with a state-owned and state-operated insurance system. 

COPD burden and management 

 While relatively few women are regular smokers, almost 40% of men are.  This contributes to a COPD prevalence of 3,677 per 100,000 (4). The Georgian health system relies heavily on secondary and tertiary care, even as the primary care system is undergoing rapid upscaling. This also applies to COPD care, with a lack of awareness as well as equipment for diagnosis and treatment in primary care centres. Consequently, COPD is mainly handled within secondary care, where spirometry is commonly performed. There are ongoing efforts to increase awareness among primary care workers regarding COPD and tobacco related illness, as part of the Tobacco Control State Program, although coverage is still limited. An over-reliance on secondary care also increases inequalities regarding access, due to the geographical location of hospitals. 

  1. Geostat 2016. Statistical Yearbook of Georgia 2016.
  2. NCDC 2015. Statistical Yearbook 2015.
  3. Chanturidze, T., Ugulava, T., Durán, A., Ensor, T., & Richardson, E. (2009). Georgia health system review. Health Systems in Transition, 11(8).
  4. GBD 2016. Global Burden of Disease Study 2016. Available at:

Principal Investigators: Tamaz Magladkelidze and Maka Maglakelidze


Lead Researcher: Ruska Kurua

Breathe Well study

Summary research question

What is the effectiveness of a Pulmonary Rehabilitation (PR) programme adapted to the Georgian context compared to usual care for patients with symptomatic COPD of MRC ≥2?

Study design

Cultural adaptation and feasibility RCT

Progress update

Cultural adaption of the study protocol has been undertaken and necessary revisions made.  Ethical approval for the study has been obtained and it has been registered on ISRTCN. The contract with the University of Birminham has been signed. 

Training of pulmonary rehabilitation specialists was conducted in September 2018. The information materials for the educational sessions have been prepared and the required equipment is in place.  By the end of March 2019  the first pulmonary rehab cohort had completed their 8 week session in the trial, which entails 16 visits on site, comprising of physical exercises and educational sessions.  The team have  recruited 77% of their target to the trial. 

Training of PR specialists held in September 2018 Recruitment process                      Recruitment processThe Breathe Well team in GeorgiaBreathe Well Gorgia project poster


This research was commissioned funded by the National Institute for Health Research (NIHR) NIHR Global Health Research Group on Global COPD in Primary Care global group on global COPD in primary care, University of Birmingham, (project reference: 16/137/95) using UK aid from the UK GovernmentUK Government to support global health research. The views expressed in this publication website are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health of Health and Social CareSocial Care.