The PHIG Country Assessment Tool: Methodology and First Results

PHIG’s Country Assessment Tool (CAT) is the first systematic comparative health system evaluation framework designed specifically for the South Caucasus and Eastern European transition region. This article describes its methodology and first results.

“Comparative health system assessment has always been done to middle-income countries by institutions from high-income countries. The CAT is the first tool designed and led by a regional institute, for regional use, with regional data.”

Pkhakadze G. CAT Methodology Overview. Tbilisi: PHIG; 2024.[1]

Introduction

The PHIG Country Assessment Tool (CAT) is a standardised health system evaluation framework covering six domains: governance and stewardship, health financing, health workforce, service delivery, health information systems, and access to essential medicines. It was developed by PHIG in 2023–2024, drawing on the WHO health system building blocks framework, the European Observatory’s HiT template methodology, and original primary data collected through structured stakeholder interviews, facility assessments, and administrative data analysis.[1,2]

The CAT’s key distinction from existing frameworks is its calibration to the specific context of post-Soviet middle-income health systems in the South Caucasus and Eastern Europe — a context systematically under-represented in global health system assessment tools designed primarily for high-income or low-income settings.

First Results: Georgia, Armenia, Azerbaijan

The CAT was applied to Georgia, Armenia, and Azerbaijan in 2024, generating the first systematic three-country comparison in the South Caucasus region. Georgia scored highest overall (64/100), with particular strengths in governance (71) and service delivery (68). Armenia scored 58/100, with strength in workforce (62). Azerbaijan scored 49/100, with the lowest scores in health financing (31) and health information systems (39).[1]

Figure 1. PHIG CAT Scores: Georgia, Armenia, Azerbaijan by Domain 2024 (0–100)

Source: PHIG Country Assessment Tool 2024 Results.[1]

Figure 2. CAT Overall Score Distribution — Georgia 2024 (Indicator-level, n=130)

Source: PHIG CAT 2024 (n=130 indicators for Georgia).[1]

Conclusion

The CAT provides, for the first time, a rigorous, comparable, and regionally-calibrated assessment of health system performance across the South Caucasus. The 2024 results confirm the headline findings of global monitoring frameworks while adding granularity on sub-domain performance and enabling triangulation of data sources. PHIG plans to repeat the CAT assessment in 2026, expand coverage to Moldova and Ukraine, and publish the results as an open-access regional health system report to inform WHO/Europe, World Bank, and donor investment strategies.

References

1. Pkhakadze G, Tsuladze L, Goguadze K. The PHIG Country Assessment Tool: Methodology and First Results. Tbilisi: PHIG; 2024.
2. WHO. Monitoring the Building Blocks of Health Systems: A Handbook of Indicators and Their Measurement Strategies. Geneva: WHO; 2010.
3. Richardson E, Berdzuli N. Republic of Armenia: Health System Review. Health Syst Transit. 2017;19(6):1–188.
4. Ibrahimov F, Ibrahimova A, Kehler J, Richardson E. Azerbaijan: Health System Review. Health Syst Transit. 2010;12(3):1–117.

Prof. Giorgi Pkhakadze, MD, MPH, PhD

Professor of Public Health, David Tvildiani Medical University | Chair, Public Health Institute of Georgia | Founder, Accréditation Sans Frontières

Published on behalf of the PHIG Analysis and Intelligence Team · Tbilisi, Georgia

PHIG

Public Health Institute of Georgia