Subject: RE: focal points for COVID-19 project
From: Tamar Gabunia </O=EXCHORGANIZATION/OU=EXCHANGE ADMINISTRATIVE GROUP (FYDIBOHF23SPDLT)/CN=RECIPIENTS/CN=E6CA04F38EC94D0CADAB9CBDF90FCDDE-TAMAR G>
To: Volkan Cetinkaya <[email-masked]>
Cc: Ketevan Goginashvili </o=ExchOrganization/ou=Exchange Administrative Group (FYDIBOHF23SPDLT)/cn=Recipients/cn=f1d7f6d1d9384748b751e919e3623665-Ketevan>; Lika Gamgebeli <[email-masked]>; Iryna Postolovska <[email-masked]>; [email-masked]; Adrien Arnoux Dozol <[email-masked]>; Ha Thi Hong Nguyen <[email-masked]>; [email-masked]; Ana Kvernadze <[email-masked]>; [email-masked]
Date: Tue, 14 Apr 2020 06:14:08 +0000

Dear Volkan

Many thanks for your e-mail. We would be more than happy to use the Bank Facilitated Procurement (BFP) along with other mechanisms we’ve been using currently.

Cost estimate (USD)

Comments

TG Comment

100 Fully equipped ICU beds for severe cases

including ventilators, mobile X-ray machines, etc.

50 ICU beds for Rukhi and 50 ICU beds for others

7,329,375

5.7% increase in ICU bed capacity

In addition to ICU beds for Rukhi it would be most important to have a computer tomography machine which is quite well used for COVID differential diagnosis

PPE, disinfecting supplies

13,830,806

30% of WHO estimate + PPE for labs. This may need to be adjusted depending on the share of supplies that will be procured by the private sector as well as development partners’ support.

Laboratories (Lugar and regional laboratories)

3,851,675

1 million tested (~27% of the population)

Information system for effective COVID 19 surveillance, data management and contract tracing

3,000,000

Considered for the project?

Hospital needs should be the first priority . Czech Technical Assistance Agency also has some resources mobilized for strengthening lab information system, we could build on EU assistance for this component.

Hospital beds for non-severe cases

Waiting on cost-estimates from consultant

For all new hospitals Rukhi and Batumi having at least two operating theaters is important for managing surgical emergencies occurring among COVID patients

Sterilization for hospitals

Waiting on cost estimates from consultant

This is very important and should also among most basic needs.

Minor construction in 4 hospitals

Any estimate budget?

We’ve done very rough estimates for refurbishment in other public hospitals. Please see the attached Excel file.

Waste management

Any needs?

Incinerators for medical waste are needed.

Total

28,011,856

Please find below answers to your questions:

Are there any additional needs for waste management? – Yes, some items are specified in the attached file in addition there is need for additional waste incinerators.

Will health workers receive top-ups/bonus payments? Will they be provided with temporary housing?- Health workers compensation scheme is currently being elaborated by SSA. I will send estimates later today.

Does SSA reimburse teleconsultation under the UHC program?- teleconsultation has been part of the regular practice even before the COVID program started. PHC providers are getting per capita payment and an additional service fee for 24 hour online consultation service.

Will the building for the Infectious Disease Hospital covered by the World Bank loan? – not necessarily, we are discussing other option for covering the new building costs.

What is the current breakdown of ICU beds vs. regular beds in other 4 hospitals (Infectious Disease Hospital Regular Beds 100 ICU 10, Central Republic Regular Beds 98 ICU 45, Oncology- None of current beds are prepared for COVID response, and Republican Hospital In Batumi 170 beds ICU 27 )-

With kind regards

პატივისცემით,

თამარ გაბუნია

მინისტრის პირველი მოადგილე

Sincerely,

Tamar Gabunia, MD, MPH

First Deputy Minister

From: Volkan Cetinkaya [mailto:[email-masked]]
Sent: 14 April, 2020 07:05
To: Tamar Gabunia <[email-masked]>
Cc: Ketevan Goginashvili <[email-masked]>; Lika Gamgebeli <[email-masked]>; Iryna Postolovska <[email-masked]>; [email-masked]; Adrien Arnoux Dozol <[email-masked]>; Ha Thi Hong Nguyen <[email-masked]>
Subject: RE: focal points for COVID-19 project

Dear Tamar,

Thanks for your answers. Just to clarify my comment on procurement—the Bank Facilitated Procurement (BFP) and other procurement methods including your standard emergency procurement mechanism and UN procurement can be used together. You don’t have to choose one over another option.

Based on the input we have collected and some assumptions,  we have prepared the estimates below. As you can imagine, it is very rough estimate that we intend to revise it based on feedback from you. We are still waiting cost-estimates from consultant for hospitals beds.

For now, we only included Rukhi hospital ICU needs, We may reconsider equipping Rukhi hospital fully (after we receive consultant Paolo’s estimates), as equipping the hospital only partially may do more harm especially since high-risk COVID-19 patients may require additional services.

Cost estimate (USD)

Comments

100 Fully equipped ICU beds for severe cases

including ventilators, mobile X-ray machines, etc.

50 ICU beds for Rukhi and 50 ICU beds for others

7,329,375

5.7% increase in ICU bed capacity

PPE, disinfecting supplies

13,830,806

30% of WHO estimate + PPE for labs. This may need to be adjusted depending on the share of supplies that will be procured by the private sector as well as development partners’ support.

Laboratories (Lugar and regional laboratories)

3,851,675

1 million tested (~27% of the population)

Information system for effective COVID 19 surveillance, data management and contract tracing

3,000,000

Considered for the project?

Hospital beds for non-severe cases

Waiting on cost-estimates from consultant

Sterilization for hospitals

Waiting on cost estimates from consultant

Minor construction in 4 hospitals

Any estimate budget?

Waste management

Any needs?

Total

28,011,856

Georgia already has a high ratio of ventilators per population (47 ventilators that manage respiratory distress conditions per 100,000) even compared to high income countries.  Since this is an emergency project, the investments have to be aligned with the COVID-19 response. Certain equipment, such as dialysis equipment for example, may not be eligible for funding under the project.

We have a few follow-up questions:

Are there any additional needs for waste management?

Will health workers receive top-ups/bonus payments? Will they be provided with temporary housing?

Does SSA reimburse teleconsultation under the UHC program?

Will the building for the Infectious Disease Hospital covered by the World Bank loan?

What is the current breakdown of ICU beds vs. regular beds in other 4 hospitals (Infectious Disease Hospital, Central Republic, Oncology, and Republican Hospital In Batumi)

For your information, following up a meeting among MOF, WB, and Asian Infrastructure and Investment Bank (AIIB) managements, we met with the AIIB colleagues last week. AIIB plans to co-finance the COVID-19 project by providing additional US $100m. However, MoF hasn’t informed us yet how they would like to allocate the additional US $100m between health and social projection. For a project to be eligible for certain waivers and expediated processing under COVID-19 multi-phase approach, the share of health needs to be 33% minimum.

Our colleague Maddalena, social protection co-team leader, has decided to request a meeting with MoF and MOH to discuss AIIB financing, and a few other things. We can discuss the list of equipment/activities above in the same meeting. Alternatively,  we can organize another separate meeting tomorrow to go over the list of equipment/activities above with our technical team copied here.

Best,

Volkan

From: Tamar Gabunia <[email-masked]>
Sent: Monday, April 13, 2020 1:32 AM
To: Volkan Cetinkaya <[email-masked]>
Cc: Ketevan Goginashvili <[email-masked]>; Lika Gamgebeli <[email-masked]>; Maddalena Honorati <[email-masked]>; Iryna Postolovska <[email-masked]>; Adrien Arnoux Dozol <[email-masked]>; [email-masked]
Subject: RE: focal points for COVID-19 project

[External]

Dear Volkan

Many thanks for your e-mail and follow up. Please find my responses below:

Would the Ministry consider using Bank Facilitated Procurement (BFP) among other alternative procurement options? Our procurement specialist Tanvir informed us about this opportunity, if the Ministry is interested in, we can share the BFP request.  For some critical equipment such as ventilators, we heard that waiting period is quite long.- Ministry is currently using a standard emergency procurement mechanism. I will discuss with our procurement team if they would be interested in switching to BFP.

Is the government already contracting with private facilities to deliver COVID-19 services or are there plans to do so? During the first call, if we recall correctly, you told us that an assessment of ICU/ventilator capacity at private facilities showed that there was sufficient supply of ventilators in Georgia to meet even the high-infection scenarios. If there is indeed sufficient availability of ventilators and ICUs, perhaps it may not be necessary to purchase additional ventilators for the public sector. The situation may differ by region – for example, if there are fewer private facilities with ICU/ventilator capacity near Abkhazia, there is a strong justification for investing to equip Rukhi hospital. It would be great if we could have more information on this. Is the private sector willing to provide such services?- As you know 85% of inpatient capacity in Georgia is private. The number of ventilators in private sector facilities is around 1700. 60% of this capacity is utilized at a time for other health conditions. Private providers have been engaged in COVID treatment however critical cases are being transferred to selected public facilities in Tbilisi. Rukhi hospital is currently being prepared for operations and we hope this will happen within the next couple of days with most basic services. The bed shortage is most severe in Samegrelo region with only 15 infection disease beds in Zugdidi and a 100 beds referral hospital (Private) which continues general health service delivery (except COVID). We consider full equipment of Rukhi clinical very important and people with COVID may experience other health emergencies and the hospital should be fully equipped to address those needs. As for ICU equipment it is indeed very urgent.

If the private sector will be involved in the COVID-19 response, will the government procure personal protective equipment (PPE) and other supplies/consumables and distribute them to private facilities or will private facilities do this on their own?- As there is a shortage of PPE on a global and local market, for the time being the ministry decided to procure PPEs centrally and distribute them to clinics which are identified as Fever or COVID clinics, other providers would also need to enhance IC measures and procure adequate amount of PPEs. Ministry will only be providing PPEs within the COVID program for selected private and public health facilities. If is decision is changed and providers are able to procure PPEs by themselves, PPE cost will be included into the service tariff to be covered by the government.

Could you also please provide the total number of existing (fully equipped) ICU beds in the public and private sectors?- Attached you can find the list of health facilities „ხელოვნური სუნთქვის აპარატები“ with the number of ICU beds with ventilators. There is also the list of facilities which are or will be involved in COVID response. Sorry these are in Georgian language. I assume local office can help with translation.

With best regards

Tamar

From: Volkan Cetinkaya [mailto:[email-masked]]
Sent: 13 April, 2020 03:10
To: Tamar Gabunia <[email-masked]>
Cc: Ketevan Goginashvili <[email-masked]>; Lika Gamgebeli <[email-masked]>; Maddalena Honorati <[email-masked]>; Iryna Postolovska <[email-masked]>; Adrien Arnoux Dozol <[email-masked]>; [email-masked]
Subject: RE: focal points for COVID-19 project

Dear Tamar,

I hope this email find you well!  Have you had a chance to discuss implementation arrangement and investment priorities during your meeting on Friday?

Could you please help us by answering a few questions regarding Georgia’s approach to working with the private sector for COVID-19?

Would the Ministry consider using Bank Facilitated Procurement (BFP) among other alternative procurement options? Our procurement specialist Tanvir informed us about this opportunity, if the Ministry is interested in, we can share the BFP request.  For some critical equipment such as ventilators, we heard that waiting period is quite long.

Is the government already contracting with private facilities to deliver COVID-19 services or are there plans to do so? During the first call, if we recall correctly, you told us that an assessment of ICU/ventilator capacity at private facilities showed that there was sufficient supply of ventilators in Georgia to meet even the high-infection scenarios. If there is indeed sufficient availability of ventilators and ICUs, perhaps it may not be necessary to purchase additional ventilators for the public sector. The situation may differ by region – for example, if there are fewer private facilities with ICU/ventilator capacity near Abkhazia, there is a strong justification for investing to equip Rukhi hospital. It would be great if we could have more information on this. Is the private sector willing to provide such services?

If the private sector will be involved in the COVID-19 response, will the government procure personal protective equipment (PPE) and other supplies/consumables and distribute them to private facilities or will private facilities do this on their own?

Could you also please provide the total number of existing (fully equipped) ICU beds in the public and private sectors?

Best,

Volkan

From: Tamar Gabunia <[email-masked]>
Sent: Friday, April 10, 2020 1:47 AM
To: Volkan Cetinkaya <[email-masked]>; [email-masked]
Cc: Ketevan Goginashvili <[email-masked]>; Lika Gamgebeli <[email-masked]>
Subject: RE: focal points for COVID-19 project

[External]

Dear Volkan

I hope all is well with you. May I kindly ask to keep me in the CC list on correspondence to focal points. This will make the communication faster.

Just to let you know, I will be meeting with the Vice Prime Minister and MoF representatives this morning to discuss the implementation arrangements and investment priorities. Will get back to you with this later today.

პატივისცემით,

თამარ გაბუნია

მინისტრის პირველი მოადგილე

Sincerely,

Tamar Gabunia, MD, MPH

First Deputy Minister

From: Volkan Cetinkaya [mailto:[email-masked]]
Sent: 10 April, 2020 04:26
To: Ketevan Goginashvili
Cc: Adrien Arnoux Dozol; Alicia C. Marguerie; Darejan Kapanadze; Djamshid Iriskulov; Fabiola Altimari; Gabriel Francis; Iryna Postolovska; Jelena Lukic; Maddalena Honorati; David Jijelava; [email-masked]; Nino Ramishvili; Parviz Ahmadov; Prachi Shrikant Tadsare; Roberto Claudio Sormani; Sophia V. Georgieva; Tamar Tsenteradze; Tanvir Hossain
Subject: focal points for COVID-19 project

Dear Keti,

I hope this email finds you well!

Could you please us identify colleagues in the ministry who can help us with specific assessments needed for preparation our project.

Specifically, focal points for :

Procurement

Financial management

Stakeholder engagement plan

Environmental and social safeguards

DM Tamar Gabunia shared the attached note with us. Do you have more information about the new building procurement plan for the Infectious Disease Hospital? Is it already identified? If so, where is it? Is it a public or private building?

Best,

Volkan