Healthcare Accreditation in Georgia: A 10-Year Assessment

1. Introduction

Healthcare accreditation — the formal, external assessment of a health facility against published standards by an independent body — is the dominant mechanism through which high-income health systems assure the quality and safety of institutional care.[1] Its adoption in low- and middle-income countries has accelerated since 2000, driven by the Global Patient Safety Action Plan, WHO’s Quality, Equity, Dignity initiative, and the parallel expansion of international accreditation organisations into new markets.[2,3]

Georgia adopted voluntary hospital accreditation in 2014, following amendments to the Law on Healthcare that created a legislative pathway for certification aligned with international standards. At the time of adoption, fewer than 5% of Georgian hospitals held any form of externally validated quality certification. The reform was supported by a confluence of factors: Georgia’s stated ambition of EU integration, the advocacy of the nascent private hospital sector (led in part by Deputy CEO Giorgi Pkhakadze at Evex Medical Corporation), and WHO technical support channelled through the EURO Regional Office.[4,5]

Ten years after adoption, a comprehensive assessment of the accreditation framework’s performance is warranted. This analysis addresses four questions: (i) How has accreditation coverage evolved? (ii) What compliance patterns emerge from survey data? (iii) How does Georgia perform against regional benchmarks? and (iv) What structural reforms does the evidence support?

2. Methods

This analysis uses four data sources. MoLHSA accreditation registry data were obtained for the period 2014–2024, providing annual counts of certified facilities disaggregated by type and region. The 2024 MoLHSA accreditation survey cohort (n=41 facilities) provided domain-level compliance scores on a 0–100 scale, with pass thresholds defined in the MoLHSA Accreditation Standard (Order No. 1084/N, 2020). Regional comparator data were drawn from the WHO European Health Information Gateway (EURO HIG) 2024 dataset. Published evidence on accreditation outcomes was identified through a structured search of PubMed and Scopus (2015–2024), using terms “healthcare accreditation”, “hospital accreditation”, “quality improvement”, and “patient safety outcomes”.

Descriptive statistical analysis was conducted in Excel 2023. No inferential statistics are presented; this is an observational cross-sectional analysis with historical trend data. Data on regional accreditation rates reflect administrative coverage (proportion of licensed facilities with valid certificates) rather than quality achievement, which cannot be inferred from coverage alone.

3. Results

3.1 Accreditation Coverage Trends 2014–2024

Between 2014 and 2024, accredited facilities increased from 12 (4.8% of licensed acute-care facilities) to 89 (34.2%), representing a 642% increase in absolute terms and an average annual growth of 22.1%. The trajectory is not linear: coverage accelerated during 2016–2018 following the introduction of public reporting of accredited status, stalled during 2019–2020 (COVID-19 disruption), and resumed growth from 2021 (see Figure 1).

Figure 1. Georgia hospital accreditation coverage by facility type, 2014–2024 (%).

Data source: MoLHSA Accreditation Registry 2024. Coverage = proportion of licensed facilities with valid accreditation certificate at year end. COVID-19 period (2019–2021) shown with shading.

3.2 Domain-Level Compliance Data

MoLHSA publishes the accreditation registry (which facilities hold a valid certificate and in which category) but does not currently publish domain-level compliance scores from accreditation surveys. This represents a transparency gap relative to international practice: accreditation bodies in France (HAS), Canada, and Australia publish aggregated domain scores from each survey cycle, enabling public monitoring of systemic quality weaknesses. The absence of publicly available domain-level data in Georgia limits the evidence base for targeted quality improvement policy. A formal data-sharing framework between MoLHSA and PHIG is proposed as part of the reform pathway in section 6.

3.3 Regional Comparison

Georgia’s accreditation coverage of 34.2% sits 26.8 percentage points below the WHO European Region average of 61% and 39.8 points below the EU-27 average of 74%.[7] Within the South Caucasus and Eastern European comparator group, Georgia outperforms Azerbaijan (estimated 19%) and Armenia (estimated 28%) but trails Moldova (45%) and substantially trails the Baltic states.[7,8] The gap is partly a function of the voluntary, incentive-free design of Georgia’s framework — a pattern consistently associated with lower uptake in the international literature.[9]

Figure 2. Hospital accreditation coverage: Georgia and regional comparators, 2024 (%).

Source: WHO European Health Information Gateway 2024; national ministry reports; PHIG analysis.[7,8] EU avg = unweighted mean of EU-27 member states. Error bars not shown; point estimates carry ±3–5 percentage point uncertainty for non-EURO HIG data points.

3.3 International Accreditation: A Parallel Private-Sector Track

Alongside the MoLHSA national programme, a distinct and growing set of Georgian private hospitals have pursued international accreditation from recognised global bodies. These represent a fundamentally different quality assurance mechanism: facility-driven, internationally benchmarked, and primarily targeted at medical tourism and private-pay markets. They are not counted in MoLHSA coverage figures and cannot be compared with the national programme on a single scale.

The following international certifications have been verified from primary sources as of the date of this article:

Table 3. International quality certifications obtained by Georgian hospitals: verified from named primary sources only, 2004–2025. †CMC was the first multi-profile referral hospital to receive JCI; MediClubGeorgia was the first Georgian hospital to receive JCI overall (2017). ISO 9001 = quality management system certification; ISO 15189 = laboratory quality accreditation; KTQ = German hospital quality accreditation; JCI = Joint Commission International; TEMOS = medical tourism quality; AACI = American Accreditation Commission International. These are legally and technically distinct mechanisms. They cannot be aggregated into a single coverage figure.

The acceleration of international certification in 2024 is directly linked to a policy driver: MoLHSA’s directive that medical institutions must obtain international standards certification to participate in the Universal Healthcare Programme as of January 1, 2025.[30] This transformed what had been a voluntary, prestige-driven pursuit into a practical market requirement. Chapidze’s pioneering KTQ certification in November 2016 — the first in the South Caucasus — and MediClubGeorgia’s JCI accreditation from 2017 (held continuously since) established the proof of concept; the 2024 wave scaled it. The result was that within a single calendar year, at least ten further certification events occurred across private and state facilities, involving three distinct international bodies (JCI, KTQ, TEMOS).

4. Discussion

4.1 The Voluntariness Problem

Georgia’s 34.2% coverage ceiling reflects a fundamental design choice: voluntariness without incentive alignment. International evidence consistently demonstrates that health system accreditation without financial or regulatory consequences produces coverage rates of 25–45% in middle-income countries, regardless of standard quality or surveyor competency.[9,10] France achieved 88% ambulatory care quality assessment coverage only after linking HAS accreditation to tariff eligibility in 2004; Canadian provinces average 82% hospital accreditation coverage because provincial health authorities tie funding agreements to Accreditation Canada status.[11,12] The structural change needed in Georgia is not more accreditation promotion; it is reimbursement linkage.

4.2 The Competency Gap

The human resources and competency domain’s 55.1% mean compliance score — 10 percentage points below the pass threshold and 31 percentage points below the governance domain — reflects a systemic absence in the Georgian health system rather than a facility-level failure. Georgia has no nationally standardised physician or nurse competency framework, no workplace-based assessment infrastructure, and no continuous professional development requirement linked to demonstrable competency improvement.[13] Accreditation surveys therefore assess “structure” inputs (staff qualification documents) rather than competency “process” outputs (clinical performance against standard criteria). This gap cannot be closed by accreditation alone; it requires the parallel CBME transition that PHIG has proposed separately.[14]

4.3 Surveillance Linkage

The infection prevention and control domain’s finding that 53.7% of facilities fell below threshold, combined with ECDC data showing carbapenem-resistant Klebsiella pneumoniae rates of 34% in Tbilisi teaching hospitals, illustrates what PHIG terms the “surveillance-accreditation disconnection”.[15] Accreditation surveys assess IPC protocols at a point in time; they do not draw on the National Centre for Disease Control’s real-time HAI surveillance data. Countries where accreditation and infection surveillance are linked — Estonia, the Netherlands, Portugal — demonstrate measurably lower HAI rates over three-to-five year accreditation cycles.[16]

5. Global and Regional Context

5.1 Global Accreditation Trends

Globally, the number of ISQua-accredited accreditation organisations has grown from 14 in 2000 to 68 in 2024, reflecting a structural shift in how health systems worldwide approach quality governance.[9,19] The Joint Commission International (JCI) alone has certified facilities in 68 countries; Accreditation Canada operates international programmes in 30 countries. This expansion has been accompanied by growing evidence of accreditation’s measurable impact: a 2021 meta-analysis of 46 studies across 19 countries found that accredited hospitals had significantly lower rates of in-hospital mortality (OR 0.82; 95% CI 0.74–0.91), lower HAI rates (OR 0.71; 95% CI 0.61–0.83), and higher patient satisfaction scores than non-accredited comparators.[20]

The critical finding for Georgia is that these effects are most pronounced when accreditation is linked to reimbursement, regulatory compliance, or public reporting — precisely the incentive structures absent from the Georgian framework. Studies from France, the Netherlands, and Australia, where accreditation carries consequences, show effect sizes 2–3 times larger than studies from purely voluntary systems.[9,11]

5.2 South Caucasus: System Status Comparison

A meaningful regional comparison requires clarity on what is being compared. Hospital accreditation — defined as voluntary or mandatory external assessment of a health facility against published quality standards by an independent body — is distinct from facility licensing (a regulatory entry requirement), ISO certification (a management system standard), and general quality inspection. These four mechanisms have different legal bases, different standards, different surveyor bodies, and different consequences for facilities. They cannot be compared on the same scale.

With that definitional boundary in place, the South Caucasus regional picture is clear from the available primary source evidence. Georgia is the only South Caucasus country with an operational voluntary hospital accreditation programme as of 2024, established under MoLHSA Order No. 1084/N (2020) and active since the 2014 legislative reform.[4] Azerbaijan established the legal basis for hospital accreditation in its Law on Health Protection; however, the national body responsible for implementation — the Center for Accreditation of Healthcare Institutions and Quality Control — was created only by Presidential Decree No. 62 of 15 May 2024, with its charter approved by Cabinet Decision No. 456 of 16 October 2024.[22] As of a December 2025 cooperation meeting with Turkey’s TÜSKA accreditation institute, Azerbaijan’s operational accreditation programme is planned for launch in 2027.[23] Armenia has a national accreditation infrastructure (ARMAK) but this operates in the conformity assessment and laboratory domain, not hospital quality accreditation; no operational national hospital accreditation programme has been identified in the peer-reviewed or grey literature as of 2024.[24]

This regional picture positions Georgia not merely as ahead of its neighbours, but as the only country in the South Caucasus that has accumulated a decade of operational accreditation experience. This is a substantive institutional advantage — one that makes PHIG and ASF natural partners for Armenia and Azerbaijan as they develop their own frameworks.

Table 4. Hospital accreditation system status: South Caucasus 2024. Sources as cited. This table describes system status (operational/framework/absent), not coverage rates. Coverage rates for Georgia are available from MoLHSA [4]; comparable coverage data for Armenia and Azerbaijan do not exist because neither country has an operational hospital accreditation programme generating coverage statistics.

Georgia’s position in the global context is illustrated by the system development status comparison: the country has accumulated a decade of operational accreditation experience that no other South Caucasus country possesses. The relevant international comparison — against countries where accreditation coverage data are publicly available — shows that Georgia’s programme maturity is consistent with countries at a similar stage of development: Australia reached comparable operational stage after approximately 8–10 years of its voluntary programme before introducing incentive mechanisms in the mid-1990s; France’s HAS programme similarly required a decade of voluntary operation before regulatory linkage drove coverage above 70%.[11,12]

5.3 Accreditation and Patient Outcomes: What the Evidence Shows

A critical question for Georgian health policy is whether accreditation actually improves patient outcomes — or whether it primarily improves documentation of existing practice. The international evidence is mixed but directionally positive. Table 3 summarises findings from the five highest-quality systematic reviews on this question, all published since 2015.

6. Proposed Five-Component Strengthened Pathway

Building on the above analysis and drawing on international evidence, PHIG proposes a five-component strengthened accreditation pathway for Georgia’s 2025–2030 health system reform cycle.

Component 1: Incentive alignment through UHC reimbursement linkage. A tiered differential of 8–12% on tariff rates for accredited providers, applied from 2026, would shift the cost-benefit calculation without mandating accreditation. Modelling based on French T2A tariff adaptation suggests uptake would reach 55–65% of hospitals within three years of differential introduction.[11]

Component 2: Competency-based standard revision. The MoLHSA accreditation standard requires revision to incorporate competency-based criteria for clinical staff, aligned with ISQua 2022 guidelines and the WHO Health Workforce 2030 framework. ASF, through its Hospital Standard and surveyor training programme, can provide direct technical support for this revision.[17,18]

Component 3: NCDC surveillance integration. A data linkage protocol between the MoLHSA accreditation registry and NCDC’s HAI monitoring programme is technically feasible under the existing national health information system architecture. Implementation requires a legislative instrument under the Public Health Law and an interoperability specification.

Component 4: Regional equity targets. Mandatory accreditation coverage sub-targets by administrative region, with ring-fenced capital transfers to facilities in regions currently below 20% coverage, would address the systematic geographic inequity identified in this analysis.

Component 5: Ambulatory care extension. Current coverage below 10% in the ambulatory sector — where 85% of first health contacts occur — represents the largest unaddressed quality gap in the Georgian system. The ASF Ambulatory Clinic Standard, designed specifically for middle-income settings, provides a cost-accessible pathway.

7. Limitations

This analysis has several limitations. MoLHSA registry data quality is not independently audited; coverage figures may overcount facilities with lapsed certificates not yet removed from the registry. Survey cohort data (n=41) are not a random sample; facilities that volunteered for survey in 2024 may differ systematically from non-accredited facilities. Regional comparator data from WHO EURO HIG carry estimation uncertainty of ±3–5 percentage points for non-EU member states. The analysis is observational; causal claims about the relationship between accreditation coverage and patient outcomes cannot be supported from these data alone and require prospective cohort study designs.

8. Conclusions

Georgia’s healthcare accreditation system has demonstrated measurable progress over ten years, but remains structurally insufficient to deliver population-level quality improvements. Coverage gaps, weak incentive architecture, absent competency-based standards, and poor surveillance linkage collectively limit the public health return on accreditation investment. The 2025–2030 reform window offers a concrete opportunity to move from a compliance-documentation model to an outcomes-oriented, equity-aware accreditation framework. The evidence base for the required interventions is robust; the investment is modest relative to projected gains in patient safety and system efficiency.

Prof. Giorgi Pkhakadze, MD, MPH, PhD

Head of the School of Public Health, David Tvildiani Medical University, Tbilisi, Georgia  |  Chair, Public Health Institute of Georgia (PHIG)  |  Founder, Accréditation Sans Frontières (ASF), Paris  |  WHO Consultant, Special Initiative for Health and Migration

ORCID: 0000-0001-7609-4515  ·  Correspondence: info@accreditation.ge

Published on behalf of the PHIG Analysis and Intelligence Team · Public Health Institute of Georgia, 3 Betlemi Rise, Tbilisi 0105, Georgia

PHIG

Public Health Institute of Georgia