Georgia, Armenia and Azerbaijan share disease epidemiology, migration patterns, and health workforce challenges. Yet no formal health cooperation framework exists among the three. PHIG examines what a South Caucasus Health Corridor would look like — and what it would take to build one.
“The South Caucasus is not three separate health problems. It is one shared epidemiological space divided by politics. The region will solve its health challenges together or not at all.”
Pkhakadze G. South Caucasus Regional Health Forum Address. Tbilisi: PHIG; 2024.[1]
Introduction
The South Caucasus — Georgia, Armenia, and Azerbaijan — shares a common geography, overlapping disease burdens, and deeply intertwined migration and labour patterns, yet lacks any functioning regional health cooperation framework. The political obstacles are real: Armenia and Azerbaijan remain in a post-conflict relationship following the 2020 and 2023 military operations over Nagorno-Karabakh, and Georgia’s path toward EU integration creates asymmetric external alignments.[2] Despite this, PHIG’s analysis of shared health system challenges makes the case that selective technical cooperation in health is both feasible and urgently needed.
Shared Epidemiological Profile
The three countries share a remarkably similar NCD burden: cardiovascular disease accounts for 56–62% of all deaths across the three countries, substantially above the EU-27 average of 36%.[3] Tuberculosis incidence remains elevated in all three, at 41 (Georgia), 34 (Armenia), and 22 (Azerbaijan) per 100,000 — all above the EU average of 9.[4] Antimicrobial resistance (AMR) patterns show strong regional similarity, with carbapenem-resistant Klebsiella pneumoniae rates of 32–38% across all three countries.[5]
| Indicator | Georgia | Armenia | Azerbaijan | EU-27 Avg |
|---|---|---|---|---|
| CVD mortality rate (per 100,000) | 412 | 389 | 401 | 172 |
| TB incidence (per 100,000) | 41 | 34 | 22 | 9 |
| Cancer age-std. mortality (per 100,000) | 148 | 141 | 136 | 163 |
| Maternal mortality (per 100,000 live births) | 16 | 19 | 22 | 4 |
| Life expectancy at birth (years) | 73.8 | 74.9 | 74.2 | 80.4 |
| Health expenditure (% GDP) | 7.1% | 9.4% | 3.8% | 9.6% |
| Out-of-pocket health spending (%) | 42% | 51% | 64% | 16% |
Sources: WHO European Health Information Gateway 2024; ECDC 2024; World Bank Health Data 2024.[3,4,5]
The Cooperation Gap
No formal trilateral health cooperation agreement exists among Georgia, Armenia, and Azerbaijan. The WHO Regional Office for Europe’s European Health Policy Framework (Health 2020 and successor Health for All) nominally includes all three, but WHO’s convening role has not translated into a functional regional health data or response architecture.[6]
Bilateral agreements are limited and rarely operationalised. Georgia and Armenia signed a memorandum of understanding on health cooperation in 2019, with provisions for data sharing and joint training programmes — but PHIG’s inquiry found that no structured activity has taken place under this MOU since its signature.[1]
Figure 1. Cardiovascular Disease Mortality Rate: South Caucasus vs. EU Countries 2024 (per 100,000)
Sources: WHO European Health Information Gateway 2024; ECDC 2024.[3]
| Cooperation Area | Feasibility | Shared Benefit | Lead Institution Proposed | Timeline |
|---|---|---|---|---|
| AMR Surveillance Network | High — technical only | Shared resistance data; coordinated response | NCDC Georgia + regional | 2025–2026 |
| TB Contact Tracing Across Borders | High | Prevent re-importation; close treatment gaps | WHO/Europe facilitated | 2025–2026 |
| Health Worker Mutual Recognition | Medium — political | Mobility; efficiency; skills deployment | MoLHSA × 3 countries | 2026–2028 |
| Joint NCD Screening Campaigns | High | Scale efficiencies; shared data | PHIG coordinated | 2025 |
| Regional Blood Supply Cooperation | Medium | Emergency resilience; rare groups | National blood centres | 2026–2027 |
| Pharmaceutical Price Negotiation | Medium | Cost reduction; supply security | WHO/Europe facilitated | 2027–2028 |
Sources: PHIG Regional Health Corridor Analysis 2024; WHO/Europe; stakeholder consultations.[1,6]
Figure 2. TB Incidence Trend: South Caucasus 2014–2024 (per 100,000)
Sources: ECDC 2024; WHO European Health Information Gateway 2024.[4]
Conclusion
The South Caucasus Health Corridor is not a utopian project — it is an incremental technical programme that can begin with AMR surveillance and TB contact tracing without requiring political normalisation between Armenia and Azerbaijan. PHIG has proposed to WHO/Europe a facilitated multi-stakeholder process to establish the Corridor’s first operational pillar by 2026. The evidence base for shared action is clear; the political will is the variable.
References
- Pkhakadze G. South Caucasus Regional Health Forum: Opening Address and Policy Paper. Tbilisi: PHIG; 2024.
- International Crisis Group. Nagorno-Karabakh: After the 2023 Military Operation — Implications for Regional Stability. Brussels: ICG; 2024.
- WHO Regional Office for Europe. European Health Information Gateway: Cause of Death Statistics 2024. Copenhagen: WHO/Europe; 2024.
- European Centre for Disease Prevention and Control. Tuberculosis Surveillance and Monitoring in Europe 2024. Stockholm: ECDC; 2024.
- ECDC. Antimicrobial Resistance in the EU/EEA and Candidate Countries 2024. Stockholm: ECDC; 2024.
- WHO Regional Office for Europe. Health 2030: Towards a Healthier and More Equitable Europe — the Regional Health Policy Framework. Copenhagen: WHO/Europe; 2022.
Public Health Institute of Georgia
