Natia Skhvitaridze

Background The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. Methods In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-ofpocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Cooperation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. Findings In 2019, at the onset of the COVID-19 pandemic, US$9•2 trillion (95% uncertainty interval [UI] 9•1-9•3) was spent on health worldwide. We found great disparities in the amount of resources devoted to health, with high-income countries spending $7•3 trillion (95% UI 7•2-7•4) in 2019; 293•7 times the $24•8 billion (95% UI 24•3-25•3) spent by low-income countries in 2019. That same year, $43•1 billion in development assistance was provided to maintain or improve health. The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, $1•8 billion in DAH contributions was provided towards pandemic preparedness in LMICs, and $37•8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12•2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the healthrelated COVID-19 response is 252•2% of the recommended target. Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11-21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP. Interpretation There was an unprecedented scale-up in DAH in 2020 and 2021. We have a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness. However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained.

Importance Georgia experienced an increase in maternal mortality (MM) during the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic, which warrants further investigation.Objective This study aimed to assess associations between SARS-CoV-2 infection during pregnancy and MM, post-delivery intensive care unit (ICU) admission, and caesarean section (CS) delivery.Methods We performed a national birth registry-based cohort study including pregnant women who delivered between February 28, 2020 and August 31, 2022. Data was linked with Coronavirus disease (COVID-19) testing, vital, and immunization registries. Pregnant women were classified into three groups: confirmed SARS-CoV-2 infection from conception through 31 days before delivery, confirmed infection in the 30 days before or at delivery, and women negative for SARS-CoV-2 infection or without any test results (reference group). Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) and 95...

Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches1, while maintaining proven preve...

INTRODUCTION Reduction of the maternal mortality ratio (MMR) to 12 per 100,000 live births by 2030 is a priority target in Georgia. This study aims to assess and classify MM in Georgia by direct and indirect causes of death from 2014 to 2017, using data from the national surveillance system and in accordance with internationally approved criteria. MATERIAL AND METHODS In this secondary study, MM data was retrieved from the Maternal and Children's Health Coordinating Committee and validated with data from the Vital Registry System and the Georgian Birth Registry. The study sample comprised 61 eligible MM cases. Relevant information was transferred to case-report forms to review and classify MM cases by direct and indirect causes of maternal death. RESULTS The MMR during the study period was 26.7 per 100,000 live births. The proportion of direct causes of maternal death exceeded that of indirect causes, at 62% and 38%, respectively. The leading direct cause of maternal death was h...

Health care is the most difficult and dynamic industry where the expenditure has grown almost four times during the past 20 years. Constantly, there are demands for expenditure cuts, for effectiveness, for quality improvement and evaluation of economic risks. All the precise and sophisticated strategic decisions taken by hospitals are to guarantee maximum profits from scarce resources and good service from an organization in unstable environmental conditions. From the different development alternatives, hospitals might prefer a horizontal and vertical integration. The integration of stationary hospitals into a network is convenient from a financial and economic point of view. Benefits are also expected in other areas, such as economies of scale, the improvement of human resources organization as well as the management and service offering. Consequently, expenses will be reduced and incomes will grow. However, there are some important questions about integration to be discussed in th...