2Geographic Scope — RHWCO Focus Region
RHWCO covers 12 countries across four sub-regions. Inclusion in the scope does not indicate formal membership, institutional agreement or completion of mapping activities. The region accounts for approximately 170 million people and an estimated 2.5 million health workers across enormously varied health system contexts.
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Caucasus — 3 countries
Georgia · Anchor & demonstration country
→ PHIG Health & Migration Assessment Pop. 3.7M · WHO Country Office Armenia · Mapping planned Azerbaijan · Mapping planned |
Eastern Europe — 2 countries
Ukraine
Pop. 37M · war-context workforce crisis; massive internal displacement; health worker emigration documented by European Observatory · WHO Country Office Moldova |
Central Asia — 5 countries
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Türkiye — 1 country
Türkiye · Pop. 85M
WHO Country Office Largest health workforce in the RHWCO region; ~1.5M health workers; WHO European Region member; G20 health system; bridges Central Asia, Caucasus, Middle East and EU. Advanced health system transformation experience highly relevant to region. |
RHWCO Region — Key Health Workforce Indicators
| Country | Population | Physicians/10k | Nurses/10k | UHC Index | OOP Health % | Key workforce challenge |
| Georgia Anchor | 3.7M | 53.5 | 41.2 | 62 | ~54% | Urban concentration; emigration; specialist-heavy, PHC-weak |
| Armenia | 2.8M | 44.0 | 56.8 | 63 | ~57% | Post-conflict disruption; Yerevan concentration; diaspora emigration |
| Azerbaijan | 10.1M | 34.9 | 67.8 | 62 | ~75% | Rural deficit; IDP health access; primary care reform underway |
| Ukraine | 37M | 30.0 | 62.3 | 68 | ~43% | War-driven displacement; mass emigration of HWF; trauma care surge |
| Moldova | 2.6M | 30.1 | 51.3 | 67 | ~44% | Highest HWF emigration rate in Europe; EU alignment driving reform |
| Kazakhstan | 19M | 39.4 | 82.5 | 72 | ~28% | Soviet legacy; urban-rural split; active reform (CSHI scheme) |
| Kyrgyzstan | 6.8M | 19.5 | 62.1 | 60 | ~50% | Low density; emigration to Russia/Kazakhstan; PHC underdeveloped |
| Tajikistan | 10M | 17.8 | 40.9 | 54 | ~61% | Lowest physician density in region; severe rural deficit |
| Turkmenistan | 6.1M | 22.3 | 48.8 | 60 | n/a | Limited data availability; state-controlled system; reform nascent |
| Uzbekistan | 36M | 23.8 | 99.0 | 62 | ~39% | Largest Central Asian workforce; reform active; CBE adoption underway |
| Türkiye | 85M | 18.7 | 28.7 | 76 | ~16% | HTP reform success; largest regional HWF; strong education infrastructure |
Sources: WHO Global Health Observatory · UHC Service Coverage Index · WHO National Health Workforce Accounts · European Observatory HiT Reviews. Data approximate; latest available year varies by country. OOP = out-of-pocket health expenditure as share of total health expenditure. CBE = competency-based education. HTP = Health Transformation Programme.
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Regional Competency Gap Analysis — Preliminary Observations Across the RHWCO Region
Regional Competency Gap Analysis — Preliminary Observations Across the RHWCO Region
What RHWCO finds when it looks at the region
This section presents RHWCO’s preliminary analytical observations on the state of health workforce competency systems across the 12 countries in its scope. It draws on published European Observatory Health in Transition reviews, WHO Global Health Observatory workforce data, EU and World Bank health system assessments, and PHIG’s own country assessment work. This is not a completed mapping — RHWCO’s systematic country profiling programme (Programme 2) is in Phase 1 (Georgia). What follows represents documented observations structured by the RHWCO Framework Typology (Section A) — identifying, for each sub-region, which document types are present, which are absent, where the most critical gaps lie, and what RHWCO considers the primary competency development priority. All observations carry source references; where evidence is limited or uncertain, this is stated explicitly.
This section presents RHWCO’s preliminary analytical observations on the state of health workforce competency systems across the 12 countries in its scope. It draws on published European Observatory Health in Transition reviews, WHO Global Health Observatory workforce data, EU and World Bank health system assessments, and PHIG’s own country assessment work. This is not a completed mapping — RHWCO’s systematic country profiling programme (Programme 2) is in Phase 1 (Georgia). What follows represents documented observations structured by the RHWCO Framework Typology (Section A) — identifying, for each sub-region, which document types are present, which are absent, where the most critical gaps lie, and what RHWCO considers the primary competency development priority. All observations carry source references; where evidence is limited or uncertain, this is stated explicitly.
How RHWCO structures the gap analysis — three diagnostic questions
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Question 1
What exists?
Which of the 8 document types (Section A) are present in the country’s health workforce system? Are they aligned with international frameworks or developed independently? Does the formal existence of a document correlate with its actual use in education, regulation or practice?
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Question 2
What is absent?
Which document types are missing entirely — most commonly Type 7 (assessment systems) and Type 4 (educational frameworks aligned to competency standards)? Where does the chain break between framework adoption and practice change?
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Question 3
What exists on paper only?
This is often the most analytically important finding: documents (curricula, professional standards, CPD requirements) that exist formally but have no implementation infrastructure — no faculty trained to deliver them, no assessment tools to verify them, no enforcement mechanism to require them.
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RHWCO Typology Presence Matrix — Preliminary Assessment
Ratings: ● Present & functional · ◐ Partial or formal only · ○ Absent or marginal · ? Insufficient evidence · Based on published HiT reviews, WHO GHO data and PHIG assessment work. These are preliminary analytical observations, not official country evaluations.
| Country | T1 Norm. Standard |
T2 Competency Framework |
T3 Professional Standard |
T4 Educational Framework |
T5 National Qualification |
T6 Curriculum |
T7 Assessment System |
T8 Implementation Guidance |
Primary gap | Key source |
| Caucasus | ||||||||||
| Georgia Anchor | ● | ◐ | ◐ | ◐ | ● | ● | ○ | ◐ | T7: No validated competency assessment. Attestation-based CPD. OSCE absent at licensure. | HiT Georgia · PHIG 2026 |
| Armenia | ● | ◐ | ◐ | ○ | ● | ● | ○ | ○ | T4+T7: No competency-referenced educational framework. No practice assessment. Post-Karabakh workforce restructuring without competency framework. | HiT Armenia · PHIG 2026 |
| Azerbaijan | ● | ◐ | ◐ | ○ | ● | ● | ○ | ◐ | T4+T7: MHI Phase 2 reform creates leverage for CBE introduction. No validated assessment. OHS competencies for oil/construction sector workers absent. | HiT Azerbaijan · PHIG 2026 |
| Eastern Europe | ||||||||||
| Ukraine | ● | ◐ | ◐ | ◐ | ● | ● | ◐ | ◐ | Context: war-driven system disruption. Pre-war: most advanced CBE reform in region. Current priority: trauma and emergency competencies; mental health workforce; continuity of education under displacement. EU accession alignment accelerating. | HiT Ukraine |
| Moldova | ● | ◐ | ◐ | ◐ | ● | ● | ○ | ◐ | T7 + retention: highest health worker emigration rate in Europe. EU candidate status creating alignment pressure. Family medicine reform partially CBE-aligned. Assessment for specialist re-certification remains attestation-based. | HiT Moldova |
| Central Asia | ||||||||||
| Kazakhstan | ● | ◐ | ◐ | ◐ | ● | ● | ◐ | ◐ | Most advanced in Central Asia. CSHI reform creating CBE drivers. Nazarbayev University medical school piloting competency-based model. National qualification framework exists but misaligned with WHO frameworks. T7 partial — OSCE introduced at some institutions. | HiT Kazakhstan |
| Kyrgyzstan | ● | ◐ | ○ | ○ | ● | ◐ | ○ | ○ | T3+T4+T7: Professional regulatory system weak. Primary care relies heavily on feldshers without standardised competency framework. Health emigration to Russia and Kazakhstan depletes trained cadres. FETP programme provides competency-based model for epidemiology workforce. | HiT Kyrgyzstan |
| Tajikistan | ● | ○ | ○ | ○ | ● | ◐ | ○ | ○ | Deepest gap in region: lowest physician density (17.8/10k), no documented competency framework adoption, Soviet curriculum largely unchanged, no validated assessment. World Bank reform programme provides entry point. RHWCO mapping priority for Phase 4. | HiT Tajikistan |
| Turkmenistan | ? | ? | ? | ? | ● | ? | ? | ? | Insufficient published evidence. State-controlled health system with limited external review access. RHWCO treats Turkmenistan as a monitoring scope country; active profiling requires access not yet available. | HiT Turkmenistan |
| Uzbekistan | ● | ◐ | ◐ | ◐ | ● | ● | ◐ | ◐ | Largest Central Asian workforce (36M population). Active reform agenda with World Bank engagement. Tashkent Medical Academy piloting CBE. Primary health care competency reform in progress. T7 partial — OSCE introduced but not standardised. | HiT Uzbekistan |
| Türkiye | ||||||||||
| Türkiye | ● | ◐ | ● | ● | ● | ● | ◐ | ● | Most developed system in RHWCO scope. Health Transformation Programme delivered major structural reform. UEMS-aligned postgraduate specialist training. Primary gap: T7 at generalist level — family medicine competency assessment not standardised. Strong RHWCO knowledge-sharing potential. | HiT Türkiye |
Sub-regional synthesis — four distinct competency development landscapes
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Caucasus
Intermediate regulatory environment, active reform, emigration pressure
All three countries have functioning qualification systems and basic regulatory frameworks, but none has implemented validated competency assessment (Type 7). Georgia is furthest in reform trajectory, supported by EU association and active accreditation development. Armenia faces the additional challenge of post-conflict workforce restructuring without a competency framework to guide it. Azerbaijan’s MHI Phase 2 reform creates an exceptional window for introducing competency-referenced contracting and workforce standards. The sub-region’s shared challenge is converting framework references in policy documents into curriculum delivery and assessment reality. RHWCO anchor country: Georgia.
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Eastern Europe
EU alignment pressure, conflict disruption, highest emigration rates
Ukraine had the most advanced pre-war CBE reform trajectory in the RHWCO region — interrupted by systemic disruption since 2022 but with EU accession as a sustaining driver. Moldova faces the paradox of high reform ambition under severe workforce depletion: the country loses health workers faster than it can train them, making retention-through-competency-recognition a strategic imperative. For both countries, EU Directive 2013/55 alignment and the Bologna Process provide the legislative and structural levers; RHWCO’s role is mapping the competency gap between current national standards and EU minimum training requirements. Sources: HiT Ukraine · HiT Moldova.
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Central Asia
Greatest depth of gap, highest reform potential leverage, donor-dependent
Central Asia represents the deepest competency development gap in the RHWCO region — but also the highest leverage opportunity, because reform is funded (World Bank, ADB, EU) and governments have signalled reform intent. The shared challenge is that reform programmes focus on infrastructure and financing (facilities, equipment, insurance) while workforce competency development receives less systematic attention. The ETF and World Bank engagement provides entry points. Kazakhstan is the sub-regional leader with the most developed reform infrastructure; Tajikistan has the most critical baseline gap. The sub-region’s primary need is not framework adoption but the translation of existing reform energy into Type 4 (educational frameworks) and Type 7 (assessment systems). Sources: World Bank Health · ETF.
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Türkiye
Regional leader, UEMS-aligned specialists, knowledge-sharing hub potential
Türkiye’s Health Transformation Programme (2003–2013) produced the most comprehensive health system reform in the RHWCO region. UEMS-aligned specialist training, a functioning educational accreditation system, and a large health workforce create the conditions for Türkiye to serve as a knowledge hub for RHWCO regional work — sharing implementation experience on CBE reform, family medicine development and workforce planning that other RHWCO countries are beginning to undertake. Türkiye’s primary remaining gap is family medicine competency standardisation and assessment at scale. Source: HiT Türkiye · UEMS.
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Five cross-cutting findings — consistent across the RHWCO region
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1
Type 7 is the universal gap
No RHWCO country has a systematically implemented, validated competency assessment system for its health workforce at scale. This is the single most consistent finding across all 12 countries — and the most consequential. Every other reform is limited in its impact while this gap persists.
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2
Framework adoption ≠ framework use
Several RHWCO countries cite WHO or EU frameworks in policy documents without any evidence of curriculum reform, faculty development or assessment change following adoption. RHWCO records distinguish between formal adoption (Type 2 cited in policy) and operational use (Type 2 reflected in Types 4, 6 and 7).
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3
Attestation persists as the primary CPD mechanism
Knowledge-based re-attestation every 3–5 years remains the dominant continuing professional development and re-licensure mechanism across the Caucasus and Central Asia. It certifies knowledge review, not competence maintenance. RHWCO treats attestation reform as a prerequisite for meaningful CPD across the region.
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4
Public health workforce is the least mapped cadre
Every RHWCO country has a public health workforce — sanitary-epidemiological services, national public health institutes, ministry surveillance functions — but in most countries this cadre has no documented competency framework, no professional standard, and no assessment system. The WHO EPHF Framework (2024) is the first global architecture for this cadre; RHWCO Programme 3 applies it to the region.
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5
Migration creates a competency intelligence vacuum
Health worker emigration is highest precisely in the countries with the weakest competency systems — Georgia, Moldova, Kyrgyzstan, Tajikistan. The absence of Type 7 assessment means sending countries cannot document or argue the competency value of workers they are losing, and cannot use competency recognition as a retention or circular migration lever. RHWCO’s Health & Migration Observatory tracks this intersection.
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Sources: European Observatory on Health Systems and Policies — Health in Transition (HiT) country reviews for all 12 RHWCO countries · WHO Global Health Observatory — Health Workforce · World Bank Health · European Training Foundation · PHIG Country Assessment Tool 2026 · PHIG South Caucasus Regional Assessment 2026. Typology ratings are RHWCO preliminary analytical observations based on published evidence; they are not official government or WHO country evaluations. Ratings will be updated as Programme 2 country profiling proceeds.
Cite this page: Public Health Institute of Georgia, Regional Health Workforce Competency Observatory. Region. Version 5.1, 6 October 2026. https://publichealth.ge/rhwco/region/ (accessed: add date). Licence CC BY 4.0. Data from WHO NHWA/World Bank WDI are CC BY 4.0 and cited at source.