Report on privatization of psychiatric services in Georgia published

Scope

In our assessment, we wanted to scrutinize in detail the opportunities and risks of privatization, understand the key drivers and considerations of the private investor’s business case, assess the issue of sustainability and what mechanisms would ensure good governance of the privatized institutions. We were also very keen to establish the plans of managers and the owner to improve the quality of care and to ensure that the rights of the patients are respected.

Conclusions

The outcome is not wholly positive. It is unclear what the goals are for privatization and how this will contribute to the implementation of the National Concept on Mental Health and National Strategy. The privatization process seems rushed and was carried out without any consultation with stakeholders. There was no open call and no predefined qualifications or experience required of potential investors, and no uniformity in the format of the two privatizations. There is no certainty in terms of the long-term planning of services and their financial sustainability. The investor’s business case remains unclear.

Recommendations

Privatization must come with clear expected standards on the quality of care, patient safety and aspects of human rights. A State monitoring body of qualified officials must make regular inspections, both announced and unannounced and there must be regular external monitoring, e.g. through a Societal council and/or a patient’s council. None of this currently exists and must be introduced as quickly as possible. Particular attention must be paid to forensic mental health and compulsory treatment units. A monopoly on care should be avoided at all cost. In the case of forensic psychiatric care this implies that at least one other facility should be opened.

Treatment and rehabilitation are not only matters of medication. Patients should be stimulated to participate in activities and need to prepared for a return into society. Much more attention should be directed towards the professional knowledge and skills of clinical personnel.

Absolute transparency is necessary, both with regard to the framework within which privatized mental health institutions function and with regard to ownership, business plans and profits. All future privatizations should follow a process whereby potential bidders must demonstrate that they meet specific criteria to qualify for the tendering outline their business models and long term plans to develop services. Contracts must ensure that they operate a service that meets a full range of financial and clinical standards. Privatization contracts must also stipulate the obligations from the Government. All hospitals, both State owned and private, should have these performance figures monitored and treated in non-discriminatory manner.

It is important to suspend the process of privatization until all the important preconditions and an adequate legal framework are in place. This should include a detailed list of requirements and specify sanctions that will follow in the case of non-compliance. Adequate governmental and non-governmental control mechanisms are essential, including the development of societal and patient councils and a mechanism for patients to submit complaints when they feel their rights have been violated.

The English version of the report can be downloaded here

The Georgian version of the report can be downloaded here