• Establish a PHC center in Mtskheta that consolidates family and community oriented adult and child curative and preventive services and replicate the model center in other major cities in the region.
• Design and implement a family medicine training program for PHC physicians in Mtskheta and other major cities in the region.
• Install primary care laboratories in Mtskheta, Dusheti and Kazbegi PHC Centers.
• Design and implement a family health nurse-training program for PHC nurses in Mtskheta and other major cities in the region.
• Design and implement a nutrition program to promote and safeguard the nutritional health status of vulnerable groups within the context of the Mtskheta PHC services.
• Assess the oral health needs of school children, and develop cost-effective, preventive dental interventions.
• Design and implement a community high blood pressure control program in all 5 districts of the region.

• Four U.S. partners visited Tbilisi and Mtskheta from July 23 through August 7 for their first partnership exchange. This exchange trip provided an opportunity for the U.S. and NIS partners to meet and assess NIS partnership sites. Additionally, the partners also signed the Memorandum of Understanding establishing the formal partnership agreement during this visit.
  

• The US partners hosted the Georgian Minister of Health in Milwaukee, who was accompanied by a party of senior officials, during his visit to the United States in March. The Minister visited Washington, DC and then traveled to Milwaukee to meet with partnership representatives and learn about the goals and future plans of the partnership. The Milwaukee partners also hosted the Governor of the Mtskheta-Mtianeti Region and the Chief Executive of the Mtskheta District, accompanied by the Regional Health Administrator. In July the partners conducted a conference entitled: “Blood Pressure Control: Key to a Healthy Community” in Mtskheta. The conference focused on high blood pressure and epidemiology; links in the chain of community control and treatment; and tools on how to make blood pressure measurements more accurate and reliable. Fifty medical personnel from the region attended the conference, along with representatives from the Mtskheta-Mtianeti Regional administration and AIHA/Caucasus regional office. Following the conference a delegation visited Milwaukee to train in epidemiologic and clinical aspects of a community blood pressure control program. The visit resulted in the formulation of a conceptual framework for cardiovascular risk factor reduction and a blood pressure medical record and control data management system.
  

• The Mtskheta PHC Center, consolidated the children’s and adult’s polyclinics services, and officially opened on February 26. The opening of the newly remodeled center was well attended by regional and local officials, USAID and AIHA representatives, officials from the Ministry of Health, and Mtskheta residents. The Minister of Health, and the Mtskheta-Mtianeti governor among others provided opening remarks. Following the clinic opening, a site-dedication ceremony was held in another area of town, to launch the construction of a new clinic funded through private donations from the Meehan Family Foundation, a private philanthropist in Milwaukee. Carelift International supplied medical equipment and supplies to the partnership for use at the facility.
• A 6-week intensive family nurse training-of-trainers course was conducted at the Marquette University College of Nursing. The program was based on the WHO Primary Care curriculum and focused on the design of a nurse-training curriculum appropriate to the needs of the Mtskheta Center. The curriculum is coordinated with the family medicine training program to promote the development of family doctor/nurse teams.
• Representatives of the Milwaukee International Health Training Center conducted a workshop on “Blood Pressure Control in the Community” in Dusheti in June for eighty physicians and nurses from the Mtskheta-Mtianeti region. The workshop introduced best practices in hypertension management, including dietary approaches, and discussed problems and progress of high blood pressure detection and control in Dusheti over the past year.
• Partners held a regional nursing conference on the “Role of the PHC Nurse in Women’s Health Promotion” in Dusheti in collaboration with the Kutaisi Women’s Wellness Center. The WWC staff gave presentations on “Early Disease Detection” and “Family Planning and Contraception.” Approximately 80% of the regional attendees were nurses. Based on the findings of the oral health assessment of school children conducted in Mtskheta, a Georgian dentist and a nurse were trained in sealant application in Milwaukee and the partners instituted cost-effective preventive dental interventions for school children of Mtskheta that included sealant application and fluoride rinse days for school children at all Mtskheta schools.
  

• The partnership conducted a conference on June 19 about “Community High Blood Pressure Control in Dusheti and Mtskheta: Progress and Problems.” Fifty physicians and nurses from the region participated. Georgian presenters provided an overview of the blood pressure control programs in Dusheti and Mtskheta. An American partner from the Tbilisi/Minneapolis partnership spoke about surveillance for cardiovascular disease and stroke risk factors as a basis for designing and implementing community interventions. Participants received a blood pressure management training video.
• The partnership started training ten doctors from the Mtskheta Primary Care Center in family medicine in order to ensure that the Mtskheta center is staffed with certified family medicine physicians. The course was conducted by the National Family Medicine Training Center, established in collaboration with the Know-How Fund-Georgia Project for the training of general practitioners.
• In September, Mtskheta PHC professionals participated in a two-week nutrition training course in Milwaukee. The course included the basics of nutrition, nutritional assessments, the definition and characteristics of nutritionally vulnerable groups and public health nutrition intervention strategies. The course strived to develop local expertise that could address the growing nutritional concerns of the people of the Mtskheta region. As part of a collaborative effort, the National Center of Disease Control initiated health promotion and health education activities to assist the partnership in promoting high blood pressure (HBP) and cardiovascular disease risk factor education/awareness in the Dusheti region, where the partnership runs an HBP control program. The first training for Dusheti district physicians and nurses took place in Dusheti in October.
  

• In May Mtskheta nurse trainers and a US partner conducted a family nurse skills training at which participants reviewed results of an earlier survey and nine educational modules including: basic nursing procedures, diabetes, cardiovascular disease risk reduction, geriatrics, pharmacology, basic concepts of primary care, principles of patient education, nutrition, and dental health. The participants also discussed the development of a nurse training program for regional nurses, worked on evidence-based practice, audit/monitoring, and evaluation issues, and learned data management, record keeping, and evaluation and testing techniques.
• The Mtskheta Family Medicine and Regional Health Training Center formally opened on October 23. Construction of the new center was initiated by a private donation from the Meehan Family Foundation and supported by the Georgian Social Investment Fund, PA Consulting, the Milwaukee International Health Training Center, and the local municipality. The Meehan Family Foundation committed an additional $50,000 for the renovation of the primary care center in Dusheti and the Ministry of Labor, Health, and Social Affairs and the local municipality of Dusheti provided matching funds for the project.
  

• State licensed and certified family medicine trainers from MFHC/RHTC started to implement a primary care training program in Tsalka in January as part of an agreement with the International Relief and Development (IRD) organization.
• Family medicine trainers from Mtskheta center conducted a 940 hour training of 19 additional doctors from Mtskheta and Dusheti to become eligible for the state certification exams in the fall.
• The partners continued implementation of hypertension prevention activities in all 5 districts of the region.
• The oral health project continues to be implemented in Mtskheta and after the opening of the new, renovated PHC center in Dusheti, partners will replicate the project in Dusheti. The renovation at the Dusheti center that was initiated by the private contribution from the Meehan Family Foundation is close to completion and the center will be officially opened in the fall of 2004.
  
  

Clinical Organization/Capacity Building

• The partners transformed an existing children’s polyclinic into the Mtskheta Family Medicine and Regional Health Training Center. The model primary care clinic was opened in 2001, and was expanded into a regional health training center in 2003. The Center was designed to be the family and community oriented primary health care model for the region. The Center served as a facility providing family medicine services and as a regional training and demonstration resource for physicians, nurses and other medical personnel.
• The partnership updated the laboratory facilities at the Mtskheta Family Medicine Center, including the introduction of new lab equipment and additional supplies. Laboratory staff also received training in the use of the new equipment and modern laboratory techniques.
• Ten Mtskheta physicians passed the state certification exam to become licensed family medicine physicians. The exam was given following the completion of a 900 hour training course at the Georgian Family Physician Training Center, in collaboration with the British Know-How Fund. Four doctors out of this group were also trained as family medicine trainers to retrain other physicians from the region in family medicine/general practice. The Mtskheta physicians are the only licensed family medicine practitioners outside of the capital city, Tbilisi.
• Six nurses completed an intensive six-week family health nurse training program at Marquette University College of Nursing based on the WHO primary health care curriculum and tailored it to the needs of Mtskheta. The Georgian nurses conducted a three-month training for 10 nurses from the Mtskheta Family Medicine Center, based on the curriculum. The Mtskheta partners implemented clinical practice guidelines (CPG) for bronchial asthma, diabetes, and cervical cancer screening.

Community Outreach

• In response to high numbers of caries and other dental problems among schoolchildren, the partners initiated a school-based fluoride rinse and dental sealant program. A dentist and nurse team, who were trained in Milwaukee, screened over 1600 mouths and applied over 300 sealants to the teeth of students in Mtskheta’s secondary schools. The team also helped the schools implement a weekly fluoride rinse program. The equipment and supplies for the oral health promotion program were obtained and shipped by Marquette University.
• The partners conducted hypertension education and screening programs in Dusheti and Mtskheta. They hosted several conferences and workshops on hypertension control for area physicians and nurses. Over 470 hypertensive patients have benefited from the program, and 70% are able to control their condition with lifestyle changes and available medications. Since the beginning of the program, there were no deaths from hypertension, and the rate of hospitalization and complications have been lowered.