Assessing Palliative Care Gaps In Georgia: A Public Health Perspective On Service Distribution

Abstract Introduction Palliative care (PC) improves the quality of life of incurable patients, particularly in developing countries where late-stage diagnoses are common. Despite this, PC services in Georgia remain severely limited and unevenly distributed. Aim To evaluate gaps in PC services and assess unmet needs across Georgia. Methods To evaluate PC services in Georgia, the study used 2023 data on available services and mortality trends. PC needs were estimated using the well-established model of the Worldwide Palliative Care Alliance, calculating the minimal need for such services (37.4% of deaths). The study also assessed the availability and distribution of PC services across Georgia. Results In 2023, a total of 42,756 deaths were recorded in Georgia. According to the WPCA model, an estimated minimum of 15,983 individuals (37.4% of deaths) required PC; yet only 2,284 patients received services, representing 14.3% of those in need. Notably, in 2023, 18 inpatient clinics providing PC were operating in Georgia, with 60% located in Tbilisi and the remaining 40% distributed across 5 of the 69 municipalities. Additionally, home-based PC services were extremely limited, with only 7 operating nationwide-4 in Tbilisi and 3 in 2 municipalities. Conclusions Despite progress, PC services in Georgia remain limited, covering only 14% of those in need. Access is highly centralized, disproportionately favoring Tbilisi. Geographic disparities, particularly in home-based services, highlight a systemic failure to provide adequate care, especially in rural areas. This severe shortage of services and the limited number of field professionals in rural areas creates a significant gap in access to essential care. Taking into account the limited budget allocated for PC programs, the interest in providing it-with fewer patients-can be very low in rural areas. Thus, a national strategy is needed to expand regional services by strengthening home-based care and integrating it into primary healthcare. Key messages • Palliative care in Georgia covers 14% of needs, with major urban-rural gaps. • To improve access and coverage, national strategy in Georgia should integrate PC into primary health care.