Nino Mikava is a healthcare specialist, researcher and lecturer. She has 17 years’ experience in management, in insurance and healthcare sectors. Throughout her career, Nino occupied senior level position in Georgia’s biggest insurance company AldagiBCI, was a general director of Medison Holding (chain of outpatient clinics), was a deputy General Director in International Insurance company IRAO and currently is a director of Healthcare Association (Association of private hospital chains). Nino is actively pursuing her career in academia. She is an Assistant-Professor in Business and Technology University (BTU), she is an invited lecturer, expert and thesis supervisor in the University of Georgia and an invited lecturer in Ilia State University. Nino is a medical doctor, graduated at David Tvildiani Medical University. She holds Master’s degree in business administration and has PhD in Public health. Embracing the core values of professional development, innovation, integrity and personal growth, Nino is actively participating in various workshops and conferences abroad. She is MASHAV program Alumni, she has completed global health course in Tromso University, Norway etc. Recently, in the role of principal researcher, Nino worked on primary healthcare system’s needs assessment project. She has published several articles in scientific journals. Following her passion about healthcare quality and patient safety, Nino completed lean management course at Kaizen Institute Georgia.
Evaluation of Health, Social and Educational Needs of the Children Having Type 1 Diabetes: Challenges and Solutions, 2023
Objective: The overall purpose of this study is to evaluate health, educational and social needs ... more Objective: The overall purpose of this study is to evaluate health, educational and social needs of the children with type 1 diabetes (CwD) living in Georgia. The specific objective was to identify existing gaps in the state programs and/or system arrangements that prevent CwD having access to the necessary services. The study also aimed to develop the specific benchmark indicators to be evaluated at the end of the project implementation (supported by World Diabetes Foundation) in order to determine how the situation has changed. Methods: A combination of mixed-research methods has been applied. Initially, qualitative studyfocus group discussions (FGDs) and in-depth interviews were carried out. At the final stage, quantitative survey was performed with parents/caregivers of CwD. The following main topics were emerged in this study: socialeconomic issues of families of CwD, access to health services, management of diabetes at educational facilities, health literacy of parents and usage of innovative technologies in diabetes management. Results: Three FDGs were held with parents of the children with diabetes (CwD) and 9 in-depth interviews conducted with various stakeholders (pediatric endocrinologists, representatives of Ministry of Health, field experts). 170 parents/caregivers were interviewed using semi-structured questionnaires. Based on the results, number of recommendations were elaborated in addressing existing problems that CwD have in Georgia with regard to geographical accessibility to health services, management of diabetes at educational facilities, as well as, alleviation of socioeconomic problems of families of CwD, parents' diabetes (health) literacy and proper management of the disease. Conclusions: Consideration of these findings and recommendations can help to alleviate some of the everyday concerns of CwD and their parents/caregivers, enabling them to attain higher standards and better quality of life. It's crucial for all stakeholders to work together to address the needs and provide comprehensive support for CwD in Georgia.
Implications of Artificial Intelligence in Healthcare in Developing Countries: Perceptions and Challenges, 2023
The integration of Artificial Intelligence (AI) and Machine Learning (ML) technologies into the h... more The integration of Artificial Intelligence (AI) and Machine Learning (ML) technologies into the healthcare sector has catalyzed transformative changes across the globe. This comprehensive article delves into the multifaceted impact of AI and ML on healthcare quality, data management, and clinical practices. Moreover, it examines these trends within both a global context and the specific framework of the Republic of Georgia. The purpose of this study was to specify the most important implications of AI in healthcare for developing countries and to assess perspectives and challenges of implementation. At the first stage, desk research was performed. Fifty relevant scientific articles and reports were identified, by key words, with utilization of various scientific bases and analyzed. Moreover, the major findings of the desk research, regarding implications of AI in healthcare in developing countries and challenges were used for the qualitative research. More specifically, in-depth interviews (overall 10) were conducted with various stakeholders of Georgia's healthcare system and two focus-group discussions (FGD) were moderated with medical professionals and specialists. The purpose of in-depth interviews and FGDs was assessment of attitudes and perceptions of major stakeholders about AI implementation and utilization. According to the reviewed literature, perceptions and attitudes of stakeholders are very important for the successful implementation. However, this issue is not evaluated sufficiently, especially in developing countries. According to the results of the study AI can have substantial economical benefit for the developing countries, with consideration of the monetary savings, improved level of healthcare quality and increased patient safety. As the findings of the qualitative research demonstrate attitudes and perceptions of the doctors and important stakeholders represent a challenge for the successful implementation of AI. Consequently, it is strongly recommended to centralize and prioritize this issue on a system's level in the process of policy and strategy design.
The Role and Importance of Digital Health under the Spotlight during COVID-19 Pandemic: Barriers, Challenges and Enablers for Broader Adoption, 2021
The role and importance of digital health has been rapidly increasing in many countries of the wo... more The role and importance of digital health has been rapidly increasing in many countries of the world, in the last decade. Furthermore, its uptake dramatically accelerated during Covid-19 pandemic and is under the spotlight. In particular, telemedicine has become an only alternative for the management and prevention of non-communicable diseases and their complications, during lockdowns and social distancing. For the effective utilization of telemedicine services electronic medical records carry great importance. Electronic medical records have significant potential to improve quality of patient care and patient safety, facilitate workflow and provide benefits to specialists and healthcare organizations. While benefits and importance of telemedicine and electronic medical records has been widely recognized, adoption is still lagging behind in many countries, especially in developing countries. The purpose of the presented research was to identify barriers and challenges for digital health adoption in healthcare sector, as well as, on the system level. To best achieve the research objectives, qualitative research method was applied. At the first stage, a detailed Literature review was conducted and was focused on barriers and challenges, as well as, enablers for broader adoption of telemedicine and EMRs. A total of 150 articles were identified and among them, 80 were determined to be relevant. At the second stage of the research unstructured, in-depth interviews were conducted with the stakeholders. In total, 29 interviews were conducted, recorded, transcribed and analyzed using N-Vivo software. Analysis of the results revealed that major barriers for telemedicine and electronic medical record adoption on the system level are-lack of clear vision and strategy with regard to digital health, lack of reimbursement of telemedicine practices, inadequate legislative framework, lack of coordination and consistency, lack of stakeholder engagement and cooperation. Moreover, on the provider level major barriers are-resistance to change, low awareness, lack of trust in healthcare professionals and technological illiteracy. Cultural barriers and skepticism among doctors and specialists contribute to the hindered adoption of digital health, as well. On the basis of results of the research recommendations were elaborated for decision makers. Consideration of these recommendations will facilitate irreversible process of digital transformation and technological disruption of healthcare in the Georgia.
The Role of Digital Technologies for Effective Self-management in Patients with Diabetes during COVID-19 Pandemic, 2021
The purpose of this study is to evaluate the need and describe the potential role of globally uti... more The purpose of this study is to evaluate the need and describe the potential role of globally utilized digital technologies in the effective treatment of diabetes in the country of Georgia. The overall objective was to identify means to respond to challenges in developing countries with regard to a dearth of easily accessible knowledge about the disease, its complications, and the need for self-care and to overcome problems of limited geographical and financial accessibility to medical services aggravated during the Covid-19 pandemic. A combination of mixed-research methods has been applied. Initially, a narrative literature review was performed. At the second stage, qualitative study-in-depth interviews with stakeholders were conducted. At the third stage, quantitative research was performed. More specifically, an online survey of adult patients-having diabetes, as well as, an online survey of parents whose children have diabetes, was conducted. Based upon the results, one of the possible solutions in addressing existing problems in Georgia and other developing countries with regard to patient education and self-management is to leverage digital technologies. The overall implication of the electronic platform is to increase awareness and education in patients and parents of children with diabetes, as well as, to improve communication between doctors and patients alike. Consequently, this can help to alleviate some of the everyday concerns of patients, and to increase their motivation, thus enabling them to carry on a higher standard and quality of life.
The global growth in the flow of patients and health professionals, as well as, capital funding a... more The global growth in the flow of patients and health professionals, as well as, capital funding and medical technology has given rise to broadly defined, rapidly growing, multi billion industry of medical tourism. In the last decade, medical tourism industry captured particular interest of the whole world. Experts of the field forecast great perspectives in medical tourism for Georgia. Georgia's healthcare sector is indeed competitive in number of medical services. The objective of conducted research was to identify barriers hindering medical tourism development and existing challenges in Georgia and to elaborate recommendations, accordingly. For this purpose, narrative review was performed utilizing various scientific article bases. In line with the research goals, 37 semi-structured, deep interviews were conducted with stakeholders of medical tourism industry in Georgia. Results were processed and analyzed using NVIVO software. According to the results of the research, to develop medical tourism direction, in Georgia, it is necessary to position and promote country as a medical tourism destination, globally. It is important to strengthen role of the government and increase its engagement in this direction. Another recommendation concerns quality of medical care and need for
The global growth in the flow of patients and health professionals as well as capital funding and... more The global growth in the flow of patients and health professionals as well as capital funding and medical technology has given rise to the multi billion industry of medical tourism, on the global market. Experts often call it medical tourism Gold Rush, comparing the recent explosive growth and pace of medical tourism participants' emergence on the international market with California gold rush. Nations' Governments around the World express interest in cultivating sectors of medical tourism, as a source of lucrative income and an opportunity for economic growth, health system improvement. Experts of the field find big potential and forecast great perspectives in Health and Medical tourism for Georgia. However, the topic is not studied. For this purpose, firstly, scoping review of literature is conducted to overview the best practices in developing and less developed countries, to identify needs and topics to focus for the research, in Georgia. Studies mainly focus on the drivers of medical tourism, with aim to identify which push and pull factors are mostly influencing customers' decision to travel for the treatment and a choice of the destination country. It shows that, geographical proximity, shorter travel time and ease of barriers in reaching the destination, also familiarity and cultural similarity are significant determinants of the destination country. Moreover, the industry appears to be developing regional hubs that strategically cater services to potential customers in proximity and another well established trend is the reversed flow of medical tourists from developed to developing countries. Governments of all the countries being top destination and successful in medical tourism, have played key role by putting this direction on the top of their agenda, adopted strong measures and enacted policy of promoting medical tourism. Strategic elements for this goal have been: incentives, such as reducing tariffs on imports of equipment for hospitals, incentivizing international accreditation of hospitals through tax free approach, providing incentives or subsidies to attract private sector investment, encouraging cooperation in the public sector between various ministries, developing general tourism infrastructure etc. All-in-all, government's active involvement and appropriate policy are crucial to utilize resources, to develop inbound medical tourism in Georgia and to be established as a destination country in this highly profitable industry. Furthermore, for this purpose, needs assessment research should be conducted to fill gaps in knowledge and increase certainty about what needs to be done to develop medical tourism in Georgia.
The global growth in the flow of patients and health professionals, as well as, capital funding a... more The global growth in the flow of patients and health professionals, as well as, capital funding and medical technology has given rise to broadly defined, rapidly growing, multi billion industry of medical tourism. In the last decade, medical tourism industry captured particular interest of the whole world. Experts of the field forecast great perspectives in medical tourism for Georgia. Georgia's healthcare sector is indeed competitive in number of medical services. The objective of conducted research was to identify barriers hindering medical tourism development and existing challenges in Georgia and to elaborate recommendations, accordingly. For this purpose, narrative review was performed utilizing various scientific article bases. In line with the research goals, 37 semi-structured, deep interviews were conducted with stakeholders of medical tourism industry in Georgia. Results were processed and analyzed using NVIVO software. According to the results of the research, to deve...
The global growth in the flow of patients and health professionals as well as capital funding and... more The global growth in the flow of patients and health professionals as well as capital funding and medical technology has given rise to the multi billion industry of medical tourism, on the global market. Experts often call it medical tourism Gold Rush, comparing the recent explosive growth and pace of medical tourism participants’ emergence on the international market with California gold rush. Nations’ Governments around the World express interest in cultivating sectors of medical tourism, as a source of lucrative income and an opportunity for economic growth, health system improvement. Experts of the field find big potential and forecast great perspectives in Health and Medical tourism for Georgia. However, the topic is not studied. For this purpose, firstly, scoping review of literature is conducted to overview the best practices in developing and less developed countries, to identify needs and topics to focus for the research, in Georgia. Studies mainly focus on the drivers of m...
Evaluation of Health, Social and Educational Needs of the Children Having Type 1 Diabetes: Challenges and Solutions, 2023
Objective: The overall purpose of this study is to evaluate health, educational and social needs ... more Objective: The overall purpose of this study is to evaluate health, educational and social needs of the children with type 1 diabetes (CwD) living in Georgia. The specific objective was to identify existing gaps in the state programs and/or system arrangements that prevent CwD having access to the necessary services. The study also aimed to develop the specific benchmark indicators to be evaluated at the end of the project implementation (supported by World Diabetes Foundation) in order to determine how the situation has changed. Methods: A combination of mixed-research methods has been applied. Initially, qualitative studyfocus group discussions (FGDs) and in-depth interviews were carried out. At the final stage, quantitative survey was performed with parents/caregivers of CwD. The following main topics were emerged in this study: socialeconomic issues of families of CwD, access to health services, management of diabetes at educational facilities, health literacy of parents and usage of innovative technologies in diabetes management. Results: Three FDGs were held with parents of the children with diabetes (CwD) and 9 in-depth interviews conducted with various stakeholders (pediatric endocrinologists, representatives of Ministry of Health, field experts). 170 parents/caregivers were interviewed using semi-structured questionnaires. Based on the results, number of recommendations were elaborated in addressing existing problems that CwD have in Georgia with regard to geographical accessibility to health services, management of diabetes at educational facilities, as well as, alleviation of socioeconomic problems of families of CwD, parents' diabetes (health) literacy and proper management of the disease. Conclusions: Consideration of these findings and recommendations can help to alleviate some of the everyday concerns of CwD and their parents/caregivers, enabling them to attain higher standards and better quality of life. It's crucial for all stakeholders to work together to address the needs and provide comprehensive support for CwD in Georgia.
Implications of Artificial Intelligence in Healthcare in Developing Countries: Perceptions and Challenges, 2023
The integration of Artificial Intelligence (AI) and Machine Learning (ML) technologies into the h... more The integration of Artificial Intelligence (AI) and Machine Learning (ML) technologies into the healthcare sector has catalyzed transformative changes across the globe. This comprehensive article delves into the multifaceted impact of AI and ML on healthcare quality, data management, and clinical practices. Moreover, it examines these trends within both a global context and the specific framework of the Republic of Georgia. The purpose of this study was to specify the most important implications of AI in healthcare for developing countries and to assess perspectives and challenges of implementation. At the first stage, desk research was performed. Fifty relevant scientific articles and reports were identified, by key words, with utilization of various scientific bases and analyzed. Moreover, the major findings of the desk research, regarding implications of AI in healthcare in developing countries and challenges were used for the qualitative research. More specifically, in-depth interviews (overall 10) were conducted with various stakeholders of Georgia's healthcare system and two focus-group discussions (FGD) were moderated with medical professionals and specialists. The purpose of in-depth interviews and FGDs was assessment of attitudes and perceptions of major stakeholders about AI implementation and utilization. According to the reviewed literature, perceptions and attitudes of stakeholders are very important for the successful implementation. However, this issue is not evaluated sufficiently, especially in developing countries. According to the results of the study AI can have substantial economical benefit for the developing countries, with consideration of the monetary savings, improved level of healthcare quality and increased patient safety. As the findings of the qualitative research demonstrate attitudes and perceptions of the doctors and important stakeholders represent a challenge for the successful implementation of AI. Consequently, it is strongly recommended to centralize and prioritize this issue on a system's level in the process of policy and strategy design.
The Role and Importance of Digital Health under the Spotlight during COVID-19 Pandemic: Barriers, Challenges and Enablers for Broader Adoption, 2021
The role and importance of digital health has been rapidly increasing in many countries of the wo... more The role and importance of digital health has been rapidly increasing in many countries of the world, in the last decade. Furthermore, its uptake dramatically accelerated during Covid-19 pandemic and is under the spotlight. In particular, telemedicine has become an only alternative for the management and prevention of non-communicable diseases and their complications, during lockdowns and social distancing. For the effective utilization of telemedicine services electronic medical records carry great importance. Electronic medical records have significant potential to improve quality of patient care and patient safety, facilitate workflow and provide benefits to specialists and healthcare organizations. While benefits and importance of telemedicine and electronic medical records has been widely recognized, adoption is still lagging behind in many countries, especially in developing countries. The purpose of the presented research was to identify barriers and challenges for digital health adoption in healthcare sector, as well as, on the system level. To best achieve the research objectives, qualitative research method was applied. At the first stage, a detailed Literature review was conducted and was focused on barriers and challenges, as well as, enablers for broader adoption of telemedicine and EMRs. A total of 150 articles were identified and among them, 80 were determined to be relevant. At the second stage of the research unstructured, in-depth interviews were conducted with the stakeholders. In total, 29 interviews were conducted, recorded, transcribed and analyzed using N-Vivo software. Analysis of the results revealed that major barriers for telemedicine and electronic medical record adoption on the system level are-lack of clear vision and strategy with regard to digital health, lack of reimbursement of telemedicine practices, inadequate legislative framework, lack of coordination and consistency, lack of stakeholder engagement and cooperation. Moreover, on the provider level major barriers are-resistance to change, low awareness, lack of trust in healthcare professionals and technological illiteracy. Cultural barriers and skepticism among doctors and specialists contribute to the hindered adoption of digital health, as well. On the basis of results of the research recommendations were elaborated for decision makers. Consideration of these recommendations will facilitate irreversible process of digital transformation and technological disruption of healthcare in the Georgia.
The Role of Digital Technologies for Effective Self-management in Patients with Diabetes during COVID-19 Pandemic, 2021
The purpose of this study is to evaluate the need and describe the potential role of globally uti... more The purpose of this study is to evaluate the need and describe the potential role of globally utilized digital technologies in the effective treatment of diabetes in the country of Georgia. The overall objective was to identify means to respond to challenges in developing countries with regard to a dearth of easily accessible knowledge about the disease, its complications, and the need for self-care and to overcome problems of limited geographical and financial accessibility to medical services aggravated during the Covid-19 pandemic. A combination of mixed-research methods has been applied. Initially, a narrative literature review was performed. At the second stage, qualitative study-in-depth interviews with stakeholders were conducted. At the third stage, quantitative research was performed. More specifically, an online survey of adult patients-having diabetes, as well as, an online survey of parents whose children have diabetes, was conducted. Based upon the results, one of the possible solutions in addressing existing problems in Georgia and other developing countries with regard to patient education and self-management is to leverage digital technologies. The overall implication of the electronic platform is to increase awareness and education in patients and parents of children with diabetes, as well as, to improve communication between doctors and patients alike. Consequently, this can help to alleviate some of the everyday concerns of patients, and to increase their motivation, thus enabling them to carry on a higher standard and quality of life.
The global growth in the flow of patients and health professionals, as well as, capital funding a... more The global growth in the flow of patients and health professionals, as well as, capital funding and medical technology has given rise to broadly defined, rapidly growing, multi billion industry of medical tourism. In the last decade, medical tourism industry captured particular interest of the whole world. Experts of the field forecast great perspectives in medical tourism for Georgia. Georgia's healthcare sector is indeed competitive in number of medical services. The objective of conducted research was to identify barriers hindering medical tourism development and existing challenges in Georgia and to elaborate recommendations, accordingly. For this purpose, narrative review was performed utilizing various scientific article bases. In line with the research goals, 37 semi-structured, deep interviews were conducted with stakeholders of medical tourism industry in Georgia. Results were processed and analyzed using NVIVO software. According to the results of the research, to develop medical tourism direction, in Georgia, it is necessary to position and promote country as a medical tourism destination, globally. It is important to strengthen role of the government and increase its engagement in this direction. Another recommendation concerns quality of medical care and need for
The global growth in the flow of patients and health professionals as well as capital funding and... more The global growth in the flow of patients and health professionals as well as capital funding and medical technology has given rise to the multi billion industry of medical tourism, on the global market. Experts often call it medical tourism Gold Rush, comparing the recent explosive growth and pace of medical tourism participants' emergence on the international market with California gold rush. Nations' Governments around the World express interest in cultivating sectors of medical tourism, as a source of lucrative income and an opportunity for economic growth, health system improvement. Experts of the field find big potential and forecast great perspectives in Health and Medical tourism for Georgia. However, the topic is not studied. For this purpose, firstly, scoping review of literature is conducted to overview the best practices in developing and less developed countries, to identify needs and topics to focus for the research, in Georgia. Studies mainly focus on the drivers of medical tourism, with aim to identify which push and pull factors are mostly influencing customers' decision to travel for the treatment and a choice of the destination country. It shows that, geographical proximity, shorter travel time and ease of barriers in reaching the destination, also familiarity and cultural similarity are significant determinants of the destination country. Moreover, the industry appears to be developing regional hubs that strategically cater services to potential customers in proximity and another well established trend is the reversed flow of medical tourists from developed to developing countries. Governments of all the countries being top destination and successful in medical tourism, have played key role by putting this direction on the top of their agenda, adopted strong measures and enacted policy of promoting medical tourism. Strategic elements for this goal have been: incentives, such as reducing tariffs on imports of equipment for hospitals, incentivizing international accreditation of hospitals through tax free approach, providing incentives or subsidies to attract private sector investment, encouraging cooperation in the public sector between various ministries, developing general tourism infrastructure etc. All-in-all, government's active involvement and appropriate policy are crucial to utilize resources, to develop inbound medical tourism in Georgia and to be established as a destination country in this highly profitable industry. Furthermore, for this purpose, needs assessment research should be conducted to fill gaps in knowledge and increase certainty about what needs to be done to develop medical tourism in Georgia.
The global growth in the flow of patients and health professionals, as well as, capital funding a... more The global growth in the flow of patients and health professionals, as well as, capital funding and medical technology has given rise to broadly defined, rapidly growing, multi billion industry of medical tourism. In the last decade, medical tourism industry captured particular interest of the whole world. Experts of the field forecast great perspectives in medical tourism for Georgia. Georgia's healthcare sector is indeed competitive in number of medical services. The objective of conducted research was to identify barriers hindering medical tourism development and existing challenges in Georgia and to elaborate recommendations, accordingly. For this purpose, narrative review was performed utilizing various scientific article bases. In line with the research goals, 37 semi-structured, deep interviews were conducted with stakeholders of medical tourism industry in Georgia. Results were processed and analyzed using NVIVO software. According to the results of the research, to deve...
The global growth in the flow of patients and health professionals as well as capital funding and... more The global growth in the flow of patients and health professionals as well as capital funding and medical technology has given rise to the multi billion industry of medical tourism, on the global market. Experts often call it medical tourism Gold Rush, comparing the recent explosive growth and pace of medical tourism participants’ emergence on the international market with California gold rush. Nations’ Governments around the World express interest in cultivating sectors of medical tourism, as a source of lucrative income and an opportunity for economic growth, health system improvement. Experts of the field find big potential and forecast great perspectives in Health and Medical tourism for Georgia. However, the topic is not studied. For this purpose, firstly, scoping review of literature is conducted to overview the best practices in developing and less developed countries, to identify needs and topics to focus for the research, in Georgia. Studies mainly focus on the drivers of m...
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