Governance of the private health sector in Georgia: a situation analysis using WHO’s Progression Pathway for Governance of Mixed Health Systems

Since 2013, Georgia has aimed to achieve universal health coverage by progressively expanding publicly funded benefits. However, with 85% of hospital beds and most primary care clinics, outpatient facilities and pharmacies under private ownership, strong governance is essential to align profit-driven incentives with policy goals. This study examines governance in Georgia, analysing sectoral strategies, regulations, purchasing mechanisms, and public–private dialogue. It is based on a literature review, document analysis, interviews with state authorities, private sector representatives and local experts, and a validation workshop. Although a strategic framework for the health system exists, it lacks sufficient detail to inform private sector investment and resource allocation. Regulatory and purchasing gaps contribute to imbalances in provider distribution and risks to care affordability, quality and appropriateness. Weak institutional mechanisms for inclusive policy dialogue have hindered effective collaboration between stakeholders and failed to address conflicts of interest. To enhance governance, strategic planning must be supported by detailed implementation plans with full budgetary integration. Strengthening the capacity of the state purchaser is crucial to creating the right incentives and holding providers accountable. Transparent and inclusive policy processes are also needed to enhance the design of reforms, facilitate implementation and protect the public interest.