GE-NAPR-367-ChangePHC1 Curatio International Foundation Primary health care (PHC) is a community’s first and main point of contact with the health system. Many countries are trying to improve PHC, especially as people are getting older and have more health problems which are often complex. This is particularly important for countries where long-term health problems such as heart disease or diabetes are common and where PHC is under-developed. Georgia plans to fundamentally change its PHC system to make it easier to access, especially for people in rural areas. Currently some community members find it difficult to get to see a health worker because there are too few or they are overworked, while others are referred to specialists for care that could be provide at the primary level. Also, patients often have to pay directly for services, including for medicines. To address these challenges Georgia is introducing a package of reforms to improve PHC financing, organisation and quality. We know from other countries how challenging such comprehensive change can be. We will systematically investigate in real-time how well these reforms are realised. This will give decision-makers and practitioners important information about how to adjust reform plans, ensure that the changes are accepted by the population, and that they will last. It will also generate new knowledge to help other countries that want to reform their PHC systems. We have selected three regions in Georgia that have different challenges in accessing PHC to understand: how people with diabetes, hypertension and/or chronic respiratory disease experience and use PHC and whether the PHC reform improves the quality of care they receive; how providers experience the new ways of delivering healthcare, how they change their practices and how they react to new ways of being paid for their services; how decision-makers understand the PHC reform and whether they are ready for and committed to changing the way they work; how the reform is influenced by the wider political and economic situation in Georgia; whether the reforms improve fair and affordable access to PHC services, and how this varies between different regions. To investigate these issues we will carry out surveys and speak with people living with diabetes, hypertension and/or chronic respiratory disease, healthcare providers and decision-makers. We will also analyse data on avoidable hospital stays and out-of-pocket expenditure, and examine policy documents. Using this information, we will create a model of PHC change that others can use to help them plan similarly complex reform. Throughout the study we will work with local communities to shape and interpret the research, and collaborate with key organisations (government, professional associations, civil society), to enhance policy impact. Through this project we will also strengthen the ability of people to undertake research on health policy and health systems in Georgia and in the wider eastern European region. We will train three doctoral students, strengthen the doctoral training programme at Ilya State University, and develop the skills necessary to engage with the wider public when doing research. We will also develop training materials that can be used in Georgia and beyond. We plan to use research outputs to improve the ability of researchers and policymakers in the European region to use research knowledge to inform PHC policies. Curatio International Founatiion London School of Hygiene and Tropical Medicine Ilia State University Curatio International Foundation Research Unit Maia Uchaneishvili Executive Director +995 322 251344 m.uchaneishvili@curatio.com 1083323 270762.9 LSHTM expenditure from 1 Nov 2024 till 30 Sept 2026 106331.3 ISU expenditure from 1 Nov 2024 till 30 Sept 2026 483197.81 CIF expenditure from 1 Nov 2024 till 30 Sept 2026