Georgia

Note on publication: This page presents a structured summary of the PHIG v6.0 assessment. The full peer-reviewed country assessment — including complete methodology, indicator-level justifications, evidence tables, and regional comparisons — is published in: Pkhakadze G. Georgia: Country Health and Migration Assessment 2026. Georgian Med J. 2026;4(4). DOI: 10.66636/gmj.2026.geo.2026. Individual country PDF reports are available at publichealth.ge/health-migration/country-assessment-tool/

Finding 1 — The Emigration-Workforce Trap: Georgia’s defining structural paradox

Georgia has more physicians per 100,000 population (561) than the WHO European Region average (387) — a figure that appears reassuring. It conceals the most severe nursing crisis in the region. With only 588 nurses per 100,000 population, Georgia’s nurse:physician ratio of 1.05:1 is the lowest recorded in the entire WHO European Region, where the accepted functional norm is 2.5:1 to 3:1. This structural inversion — high physician numbers, critically low nursing — is the direct legacy of two forces: the Soviet Semashko system, which trained physicians in bulk while systematically undervaluing nursing as a profession; and post-Soviet emigration, in which nurses have emigrated at higher rates than physicians because their qualifications transfer more easily to European labour markets and the pay differential is larger. The 2023 net emigration figure of −71,584 — the highest on record — accelerates this dynamic. 38.9% of practising physicians are now aged 55 or older, meaning the retirement wave of the next decade will not be replaced at current training and retention rates. A health system cannot deliver universal primary care, chronic disease management, or maternal and child health on a physician-dominant model. The Georgia Ministry of Health has not published a nursing workforce retention strategy. No health worker return migration incentive scheme exists. The PHIG MHSS Workforce score of 1.4/4 reflects both the structural imbalance and the complete absence of any institutional response to it.

Finding 2 — Zero migration-disaggregated health data: a self-reinforcing policy blindspot

The PHIG assessment identifies the complete absence of migration-disaggregated health data as the most consequential single finding — not because it is worse than the other gaps, but because it makes every other gap unmeasurable, untargetable, and unaccountable. Georgia cannot quantify how emigration depletes its nursing workforce by specialty and region. It cannot measure the health outcome differential between its 288,000 IDPs and the general population. It cannot demonstrate whether the UHCP reform reduced catastrophic health spending equally for mobile and sedentary populations. It cannot calculate the cost of excluding undocumented migrants from primary care. Policy without data is advocacy; evidence-based health policy requires surveillance. The WHO Refugee and Migrant Health Toolkit Module 4, Tool 14 provides the complete operational framework for establishing migration-disaggregated health information systems. It has not been initiated in Georgia — or in Armenia or Azerbaijan. The Georgia national electronic health record system, currently in development (2024–2026), represents the last structural window to embed migration status as a core variable before the architecture is locked for a decade. EU accession creates the most powerful external accountability mechanism available: the European Health Data Space framework requires health data interoperability and equity disaggregation standards that will apply to Georgia as a candidate country. This is the most time-sensitive recommendation in this assessment.

Finding 3 — The UHCP reform achievement is real but incomplete: the pharmaceutical OOP gap

Georgia’s reduction of out-of-pocket health expenditure from 82% (2011) to ~30% (2022) (2021) is one of the most significant health financing reforms in the WHO European Region in the post-2010 period — comparable in trajectory to Thailand’s 2001 UHC reform and Rwanda’s 2006 community-based insurance expansion. It deserves recognition as a genuine reform achievement. However, the ~30% (2022) OOP figure is systematically misleading in one important respect: it measures aggregate OOP as a share of total health expenditure. It does not measure the burden on any specific disease category or population group. For outpatient NCD medicines — the primary recurring cost for patients with hypertension, type 2 diabetes, or chronic obstructive pulmonary disease — the out-of-pocket exposure is not ~30% (2022). It is 100%, because outpatient medicines for non-vertical conditions are excluded from the UHCP benefit package. Hypertension is the leading attributable risk factor for cardiovascular mortality in Georgia, accounting for 24.7% of all deaths. Cardiovascular disease kills 22,108 Georgians per year — 47% of all deaths. Georgia’s COVID-19 excess mortality of 434 per 100,000 in 2021 — three times the WHO European Region average of 144 per 100,000 — is the quantified consequence of this NCD burden amplified by pharmaceutical inaccessibility. A UHCP that formally covers 93.7% of the population while excluding the medicines needed to manage the dominant causes of death is a UHCP that has not yet addressed its most consequential gap. WHO-PEN (Package of Essential NCD Interventions) provides the priority medicine list. The Georgia Ministry of Finance and Ministry of Health have the capacity and the EU accession fiscal incentive to act. The reform is technically straightforward; the constraint is political prioritisation.

Finding 4 — EU accession as the strongest policy lever in this assessment

Georgia’s EU candidate status (granted 2023) is the most structurally significant institutional development for migration health governance in a generation. Previous international commitments — the 1951 Refugee Convention, ICESCR Article 12, GCM Objective 15, WHO GAP 2019–2030 — were ratified or endorsed without producing domestic operationalisation. The EU accession process introduces, for the first time, an external accountability body (the European Commission) that assesses annual progress against specific chapter deliverables. The EU Health Security Regulation requires health equity strategies encompassing mobile populations. The European Health Data Space requires data interoperability and disaggregation standards that directly address the HIS critical gap. EU4Health and Cohesion Fund financing create pathways for migrant health infrastructure investment that no prior funding mechanism has matched. This assessment recommends that the Georgian Ministry of Health proactively frame all six priority recommendations below as EU accession deliverables — not as migration health policy per se, but as prerequisites for Chapter 28 (Consumer and Health Protection) compliance — because this framing creates binding timelines, external monitoring, and political accountability that domestic health policy advocacy alone cannot generate.

Finding 5 — The positive finding: a structurally low hostile environment that must be actively protected

Not all PHIG findings are critical gaps. Georgia’s hostile environment score — the degree to which the health system design functions as an enforcement mechanism against undocumented migrants — is LOW. Georgia does not require healthcare providers to report undocumented migrants to immigration authorities. Emergency care is accessible without identity documents. Health records are not shared with immigration enforcement agencies. This is a genuine structural positive finding that distinguishes Georgia from several Western European systems. It should not be taken for granted. EU accession processes can inadvertently raise administrative barriers: requirements for registration, digital identity, or proof of status that are routine for citizens can systematically exclude undocumented populations. PHIG recommends that Georgia explicitly protect this provision in the EU accession health chapter negotiations — not as an exception or derogation, but as a positive health system design choice consistent with ICESCR Article 12, WHO GAP Objective 3, and EU CJEU jurisprudence on emergency healthcare access.