საქართველოში ჯანდაცვის თანამედროვე სისტემის ფორმირების სათავეებთან
cnobilma sazogado, saxelmwifo da politikurma moRvawem, medicinis doqtorma avTandil jorbenaZem qveyanas saukeTeso saaxalwlo saCuqari uZRvna – gamosca SesaniSnavi monografia – `rogor iqmneboda janmrTelobis dacvis axali sistema~. rogorc am mniSvnelovani namuSevris saTauridanve Cans, avtori, romelsac didi wvlili miuZRvis postsabWoTa saqarTvelos jandacvis sistemis CamoyalibebaSi Cveni qveynis jandacvis ministrobis dros, Tavad mogviTxrobs, rogor moimoqmeda es, anu am sistemis gardamqmneli reformebis Sesaxeb. cnobilia jaba xubuas gamonaTqvami mis Sesaxeb: `avTandil jorbenaZem ferflidan aRadgina saqarTvelos jandacvis sistema~. dRes am saintereso naSromis Sesaxeb Cvens SekiTxvebs aRiarebuli qirurgi, profesori akaki beriZe upasuxebs, romelic avTandil jorbenaZis ministrobis periodSi aWaris jandacvis ministri gaxldaT da uSualod monawileobda reformebis procesSi.
– axlaxan gamovida saqarTvelos jandacvis yofili ministris wigni jandacvis sistemaSi gatarebuli reformebis Sesaxeb. rogor Sefasebas miscemdiT, visTvis iqneba saWiro es wigni?
– wigni saintereso da sasargeblo iqneba, pirvel rigSi, jandacvis sferoSi dasaqmebuli mravalaTasiani personalis, agreTve xelisuflebis da qveynis mTeli mosaxleobisTvis, vinaidan samedicino samsaxuri adamians mTeli sicocxle esaWiroeba. Cemi xangrZlivi saeqimo moRvaweoba safuZvels maZlevs, xatovnad vTqva: `adamianis sicocxle filmia, romlis pirvel da bolo kadrsac eqimi iRebs~. naSromi originalurad aris Sedgenili, faqtobrivad, dokumenturi masalebis krebulia – qveynis janmrTelobis dacvis ministris moxsenebebi, ministris mier gaweuli muSaobis angariSebi, romlebic sxvadasxva instanciaSi hqonda wardgenili, prezidentis mier gamocemuli brZanebulebebi da gankargulebebi, parlamentis mier miRebuli kanonebi, ministrTa kabinetis dadgenilebebi, sxvadasxva normatiuli aqti. dokumentacia wignSi kompaqturad aris warmodgenili, qronologiuri TanmimdevrobiT, advili misakvlevia da did samsaxurs gauwevs jandacvis menejmentis sferos muSakebs.
– ukeT rom gaviazroT, mainc ra saxis cvlilebebi iyo aucilebeli sabWoTa kavSiris daSlis Semdeg postsabWoTa qveynis jandacvis sistemaSi, modiT, mokled SevexoT, ra mdgomareoba iyo qveyanaSi ssrk-is daSlis Semdeg?
– ssrk-is daSlis Semdeg samoqalaqo omis, teritoriuli mTlianobisaTvis warmoebuli uTanasworo brZolebis da sxva mravali faqtoris gavleniT gaCanagebul saqarTveloSi yvelaze metad mainc jandacvis sistema dazaralda. infeqciur daavadebaTa prevenciis centraluri sistemis rRvevis Sedegad moiSala profilaqtikuri acrebis awyobili samsaxuri, mosaxleobaSi mkveTrad daqveiTda infeqciis sawinaaRmdego imuniteti, amas daemata ukiduresi siRaribe, saarsebo saSualebaTa mosapoveblad mosaxleobis masobrivi migracia sxva qveynebSi. am mxriv gansakuTrebiT rTuli viTareba Seiqmna aWaraSi sarfis karis gaxsnis Semdeg. sabaJos gamSvebi punqti ver audioda migrantTa mozRvavebuli masis momsaxurebas, Seiqmna uzarmazari rigebi, gaCnda migrantTa masobrivi TavSeyris adgilebi, Seiqmna infeqciis gavrcelebis xelSemwyobi porobebi, qveynas ki ar gaaCnda asacreli masala, sadezinfeqcio saSualebebi, medikamentebi. difteriis epidemiam erT weliwadSi 600-ze meti adamianis sicocxle Seiwira, gaxSirda botulizmis, salmonelas, gripis epidafeTqebebi. Tavi Segvaxsena malariam. am Znelbedobis Jams gangebam qveyanas mxsnelad mouvlina lideris gamorCeuli TvisebebiT dajildoebuli, energiiT aRsavse axalgazrda, magram janmrTelobis dacvis sistemis marTvis gamocdilebis mqone pirovneba avTandil jorbenaZe, romelic janmrTelobis dacvis ministrad 1993 wlis oqtomberSi dainiSna. diax, saWiro dros saWiro adgilze aRmoCnda, SeuZlebeli SeZlo, umokles droSi aRadgina da axal simaRleze aiyvana saqarTvelos jandacvis sistema.
– sakanonmdeblo bazis gareSe cvlilebebi warmoudgenelia, ra roli Seasrula jandacvis ministrma jandacvis kanonmdeblobis SeqmnaSi?
– iciT, monografia imiTicaa saintereso, rom avtori Tavadaa masSi moTxrobili masStaburi gardaqmnebis Semoqmedi. naSromSi striqonebs Soris ikiTxeba Tavad avTandil jorbenaZis adamianebTan urTierTobis niWi. dasaxuli miznis misaRwevad man erT gundad Sekra reformebis mxardamWer specialistTa razmi, romlebmac titanuri Sroma gaswies dargisaTvis sakanonmdeblo-samarTlebrivi bazis Sesaqmnelad. Tavad var mowme, rom im periodSi saqarTvelos jandacvis saministros kabinetebis umravlesobaSi Tveebis ganmavlobaSi intensiuri muSaoba Ramis saaTebSic mimdinareobda. ase iyo regionebSic. ministri diliT rom Caatarebda TaTbirs, davalebebs miscemda TanamSromlebs, Semdeg kodoris xeobaSi Cafrindeboda, adgilze gaecnoboda da daaregulirebda situacias, saRamos ki ganagrZobda TaTbirs saministroSi da dilamde CvenTan erTad muSaobda. yvelaferi es keTdeboda enTuziazmiT, yovelgvari gasamrjelos gareSe. avtori yvelas madlobas uxdis gaweuli titanuri SromisaTvis, aravin gamorCenia. sagulisxmoa, rom saqarTveloSi axali saxelmwifos mSenebloba jandacvis sistemis reformiT daiwyo, magaliTi misca sxva dargebs, reformebis lokomotivis roli Seasrula.
– konkretulad, ras gvetyviT reformebis gzaze pirveli nabijebis Sesaxeb?
– saqarTvelos jandacvis sistemaSi gatarebuli radikaluri reformebi bevrad uswrebda win sxva postsabWoTa saxelmwifoebis reformebs. samagaliTo iyo axali saxelmwifos funqcionirebisaTvis marTvis axali struqturebis Seqmna: mosaxleobis janmrTelobis mdgomareobis Semswavleli statistikuri samsaxuri; samedicino samsaxurebis xarisxis kontroli, janmrTelobis dazRveva, sanitariuli normireba da zedamxedveloba, wamlis xarisxis kontroli, fsiqotropuli da narkotikuli nivTierebebis legalur brunvaze kontroli, axali samedicino teqnologiebisa da teqnikis danergva, SeiaraRebuli Zalebis samedicino samsaxuris Camoyalibeba. axal ekonomikur sistemaSi adaptirebisTvis Seicvala jandacvis marTvis arsebuli wesebi: ganxorcielda mmarTvelobis decentralizacia, Seiqmna jandacvis marTvis regionuli da municipaluri samsaxurebi; Camoyalibda sazogadoebrivi jandacvis sistema; saojaxo medicinis principebze gadavida pirveladi jandacva; samedicino dawesebulebebi muxlobriv-biujeturi kabaluri dafinansebisgan ganTavisuflda da damoukidebel samarTal-subieqtebad Camoyalibda; moxda samedicino saqmianobis licenzireba, personalis sertificireba; damoukidebel profesiad Camoyalibda saeqTno saqme; samedicino mecnierebis dafinanseba Seicvala grantuli dafinansebis principiT; ganxorcielda saafTiaqo qselisa da stomatologiuri dawesebulebebis sruli gankerZoeba. praqtikul medicinaSi dainerga daavadebaTa diagnostikisa da mkurnalobis maRalteqnologiuri meTodebi: intervenciuli kardiologia, kardioqirurgia, endovideo da endovaskularuli qirurgia, onkohematologia, organoTa transplantacia. cxadia, sagazeTo werilSi axali saxelmwifos mSeneblobisTvis gatarebuli reformebis martivi CamoTvlac ki SeuZlebelia, SemovifarglebiT ramdenime momentis aRniSvniT. jandacvis sistemis reformebis moduli iqmneboda koleqtiurad, gamoyenebuli iyo qveynis Sida inteleqtualuri potenciali, uangarod gvexmarebodnen agreTve megobari qveynebis gamocdili specialistebi. am sakiTxSic gadamwyveti aRmoCnda ministris kolegebTan da zogadad, adamianebTan urTierTobis araCveulebrivi unari, gansakuTrebuli pirovnuli xibli. axali sakanonmdeblo-samarTlebrivi bazis Seqmnis rTuli SemoqmedebiTi procesis paralelurad ar Sewyvetila daavadebaTa monitoringis, diagnostikis, mkurnalobis axali meTodebis danergva. infeqciur daavadebaTa epidemiebis likvidaciaSi did daxmarebas gviwevda xelisufleba da saerTaSoriso organizaciebi. magaliTad, aWaraSi difteriis epidemiis likvidacia mokle droSi moxerxda – bavSvTa saerTaSoriso fondma usasyidlod gamogvigzavna asacreli masala, acrebi mimdinareobda `iunisefis~ mier movlinebuli specialistis, filosofiisa da medicinis doqtoris din ekenbergis konsultaciiTa da meTvalyureobiT.
– ra problemebi iyo aWaris jandacvis sistemaSi?
– aWaris xelisuflebam, avtonomiuri respublikis meTauris aslan abaSiZis gankargulebiT Seqmna difteriis epidemiis salikvidacio komisia, romlis xelmZRvanelobac TviTon iTava. Seiqmna amcreli brigadebi, romlis yvela wevrs daeniSna xuTmagi xelfasi. raionebSi am brigadebs gamoeyoT avtomanqanebi soflebSi gadaadgilebisTvis, gamoeyoT saTanado Tanxac acrisTvis saWiro masalis SesaZenad. umokles droSi moxerxda aWaris mosaxleobis samjeradi acra, Sesabamisad difteriis epidemia dasrulda. sabWoTa sistemidan memkvidreobiT miviReT samedicino dawesebulebaTa da medicinis muSakTa Warbi raodenoba, rac jandacvis sistemis gamarTulad muSaobas xels uSlida. saministrom daawesa am sakiTxis monitoringi, samedicino dawesebulebebis licenzireba da privatizacia, medicinis muSakTa sertificireba, ramac daaregulira am sferoSi Seqmnili qaosi. amrigad, jandacvis sistemis reorganizaciis pirveli etapi jandacvis sferoSi warmatebiT ganxorcielda. reformebis umravlesoba xangrZlivi droze iyo gaTvlili, Tumca qveyanaSi Seqmnili mdgomareobis Sesabamisad SesaZlebelia masSi cvlilebebis Setana. es cvlilebebi SeiZleba droebiTic iyos situaciidan gamodinare.
– rogor xorcieldeba praqtikaSi maSin miRebuli kanonebi?
– am dargSi kanonebi periodul ganaxlebasac moiTxovs, magram saWiroa Tanmimdevrulobis, memkvidreobiTobis, uwyvetobis principebis dacva. samwuxarod, es moTxovnebi zogjer ar sruldeba. zemoT mogaxseneT, rom samedicino dawesebulebis da samedicino personalis siWarbe xels uSlis jandacvis sistemis funqcionirebas, magaliTad, TbilisSi, baTumsa da sxva qalaqebSi wina xelisuflebis periodSi samedicino dawesebulebebis raodenoba gaormagda, Sesabamisad gaizarda maTSi momuSave personalis raodenobac. aRniSnuli procesi xels uSlis samkurnalo RonisZiebaTa Catarebas, ganyofilebaSi pacientTa simcirea, ararentabeluria morige brigadis daniSvna, riTic pacients akldeba yuradReba, studentebi da axalgazrda eqimebi ar iReben saTanado praqtikul gamocdilebas da sxv. samwuxarod, axali samedicino dawesebulebebi dausabuTeblad, saTanado gaTvlebis gareSe amJamadac ixsneba. arsebobs gaTvlebi daavadebaTa sixSirisa da mosaxleobis raodenobis mixedviT, magaliTad, 100 000 mcxovrebze mwvave apendicitis mqone ramdeni pacienti SeiZleba iyos? igivea sxva nozologiebis mixedviT. arsebobs sxva standartebic, romelTa mixedviTac SeiZleba gamovTvaloT, ramdeni sawolia saWiro, magaliTad, ginekologiuri, qirurgiuli an urologiuri profilis pacientebisTvis, amis mixedviT dasaSvebia tenderis gamocxadeba saTanado stacionaris asagebad, sxva saWiro inventariT aRWurva da sxv. saqarTvelos parlamentma mniSvnelovani kanoni miiRo (rodis?) janmrTelobis dacvis Sesaxeb, sadac mkafiod aris Camoyalibebuli adamianis uflebebi jandacvis sferoSi, xazgasmulia, rom moqalaqes ufleba aqvs, samkurnalod airCios samedicino dawesebuleba da mkurnali eqimi, ikrZaleba samsaxuris monopolizacia, rogorc samedicino, ise farmaciis dargSi. samwuxarod, wina xelisuflebam daiwyo da axlandeli xelisuflebis drosac grZeldeba am ZiriTadi kanonis moTxovnaTa ignorireba, magaliTad, kompania `eveqsma~ qveynis mosaxleobis didi nawilis samedicino momsaxureba Caigdo xelSi. aWaraSi `eveqss~ yvela raionSi gaxsnili aqvs saavadmyofo-poliklinikebi, saswrafo samedicino daxmarebis sadgurebi, morige saswrafo manqanebs mxolod `eveqsis~ qselis samedicino dawesebulebaSi gadahyavs pacienti, avadmyofisa da misi patronis moTxovnis sawinaaRmdegod. farmacevtul kompaniebs aqvs monopolia wamlis importsa da realizaciaze, ris Sedegadac medikamentebi Zalze Zvirad iyideba.
zemoxsenebuli darRvevebis paralelurad amJamindel xelisuflebas mniSvnelovani warmatebebi aqvs samedicino programebis dafinansebaSi, gansakuTrebiT soliduri da droulia saswrafo SemTxvevebis programuli dafinanseba. mosaxleoba da samedicino personali kmayofilia agreTve socialurad daucveli mosaxleobis jandacvis municipaluri programebis dafinansebiT. STambeWdavia aWaris eqimTa sazogadoebis daarsebis 100 wlisTavisadmi miZRvnil saiubileo saRamoze wamoTqmuli sityva, romelic avtors wignSi aqvs Setanili. rogorc sazeimo RonisZiebas Seefereba, ministrma milocvasTan erTad vrclad ilaparaka aWaris eqimTa sazogadoebis rolze regionis samedicino samsaxuris Tanamedrove doneze ayvanaSi, xazi gausva aWaris medikosTa damsaxurebas jandacvis sferoSi gatarebuli reformebis SemuSavebasa da praqtikaSi danergvis kuTxiT, isaubra reformebis momdevno etapisa da samomavlo gegmebis Sesaxeb. batoni avTandilis wardginebiT, aWaris samedicino dawesebulebebSi momuSave15 eqimi dajildovda ordenebiT da medlebiT. igi gvpirdeba, rom male gamoscems wignis meore nawils, cxadia, isic iseTive saintereso iqneba, rogorc pirveli.
esaubra
marina miTaiSvili
