Vouchers for Childbirth | A Field Study

CRRC fellow Simon Gabrichidze and his research partner Tamar Trapaidze evaluated the implementation of a newly launched State Assistance Program (SAP) by the Ministry of Labor, Health and Social Affairs aimed at providing better health services for people living under the poverty line in the Samegrelo and Adjara regions.

The fellow conducted focus groups with stakeholders and structured interviews with 320 mothers living in the abovementioned regions who gave birth in Zugdidi and Batumi between June and September of 2007. Gabrichidze compared three female target groups, those who:

1. Were in the database of people living under poverty line;
2. Were not in the database but applied for a "voucher" that covers delivery expenses;
3. Did not apply for any assistance from the state and paid all the expenses related to child delivery themselves.

According to the findings, the general population is aware of the health benefits envisages by SAP, however, the level of awareness is rather low: only 57% of patients in Batumi and 60% in Zugdidi knew that a voucher for free medical service fully covers all the expenses related to child delivery; the rest of the respondents thought that the voucher only partially covers costs.

The main reasons for mothers not using the State Assistance were the regulations of the program. The study showed that trust in health care professionals was the lowest in this last group, those that paid all for themselves. So that people (curiously even those in need of the social assistance program) preferred to pay money for child birth, rather than visit doctors and health care service provides unknown to them. The respondents from the first group were most satisfied with medical service, while the ones from the second and third groups were more dissatisfied with out of pocket payment and financial affordability of the program.

According to doctors and social agents, very often comparatively rich pregnant women request voucher from the State; as the fellow recommends, the government should introduce more strict criteria for identifying beneficiaries of this group (or completely abolish it) and direct funds to the people that really need such assistance.

Here is the PowerPoint (although, note, this was for a verbal presentation, not specifically for the web). 

Vouchers for Obstretic Care in Georgia

View SlideShare presentation or Upload your own. (tags: georgia vouchers)

The full report is also available on the CRRC-Georgia website.

Book Review | The Post-Soviet Wars: Rebellion, Ethnic Conflict and Nationhood in the Caucasus | Christoph Zürcher

The earliest books that came out about the Caucasus after the collapse of the Soviet Union were firsthand accounts of events. Now, a second spate of books, which attempt to apply analytical frameworks to the turbulent events that occurred have the breakup of the Soviet Union are beginning to appear. Christoph Zürcher’s The Post-Soviet Wars: Rebellion, Ethnic Conflict and Nationhood in the Caucasus, published with New York University Press, falls into this category. The book examines where wars occurred in the Caucasus (Georgia, Nagorno-Karabakh and Chechnya) and where they didn’t (Dagestan and Ajara) and places those cases studies within the context of the international quantitative literature that attempts to explain why internal wars occur.

Those who are knowledgeable about the Caucasus will find much information they have already come across. However, for those interested in international conflict who possess little regional understanding, the tersely written detail provides a good overview.

To whet your appetite for some of the details about why wars started in the Caucasus, Zürcher argues that, in Georgia, anti-Soviet rhetoric allowed for no maintenance of Soviet institutions, increasing the likelihood of conflict, since state institutions utterly collapsed as a result. Furthermore, the fallback on nationalist rhetoric, which was seen as the only way of creating a cohesive political force, then alienated both Abkhaz and Ossetians. Zürcher, perhaps controversially, also claims that Armenian politics looked very similar to Baltic politics (and different from Georgian and Chechen) in that the same type of state weakness did not exist. However, Zürcher makes the claim, which has been echoed in much of the democratization commentary about Armenia, that instead of the Baltic states’ orientation towards Europe, Armenia’s politicians unified around war in Nagorno-Karabakh, creating an anti-reform minded regime.

From a more technical standpoint, the book is a rare breed within the political science literature, as it is specifically concerned about testing existing theories about internal wars by examining a series of cases studies. In doing so the volume seeks to refine those theories. While this type of book is out of vogue because the academic nomenklatura does not perceive the endeavor as groundbreaking, it serves an important role in refining theories, something Zürcher does throughout the book.

So what does Zürcher find in relationship to the international quantitative literature? Several variables that are generally cited as determinants of internal war do not appear to hold true in the Caucasus: low economic development and mountainous terrain do not help in explaining the conflagrations in the Caucasus. Despite the Caucasus being mountainous, most conflict occurred in urban environs or in the plains. In the conflicts where mountains played a role, the guerillas (which conflict theory supposes are aided by mountains) had the mountains against them. In fact, Zürcher seeks to refine the theory about the relationship between mountains and war and suggests several plausible alternative hypotheses, part of the intellectual merit of the book. One interesting hypothesis is that mountains are a proxy for the cheap recruitment of male soldiers, since mountainous areas often have high unemployment rates and hence a male population ready to mobilize.

The volume also reinforces the idea found in the international quantitative literature that state weakness often plays an important role – perhaps much more so than underdevelopment – as does the role of one ethnic group constituting the majority of the population. This ethnicity argument is well-highlighted with Zürcher’s case study of Dagestan, where ethnicity did not play the same role as in Georgia, Armenia or Chechnya, in part because of the fact that no ethnic group had a majority.

Overall, this reviewer found the findings sound, but would have like to see more analysis of some of the interesting proxy variables discussed above. This, however, could form the basis of a new and fruitful conflict research agenda in the Caucasus.

This book review was also printed in The Georgian Times.

Georgian Borderlands | Mathijs Pelkmans

Many social researchers working on the Caucasus bemoan the lack of good scholarly works on the region. However, one recent book, which is both excellent and readable, seems to have fallen under people's radars -- Mathijs Pelkmans' Defending the Border: Identity, Religion, and Modernity in the Republic of Georgia, which came out in 2006 with Cornell University Press.

Pelkmans' book is deeply embedded within the literature on the studies of borderlands. Using the case of Sarpi (and Ajara more generally), Pelkmans argues convincingly that the Georgian (Soviet) border was not like other borders treated in the academic literature, which were porous and where strong cross-border networks have and continue to play an important role. Conversely, the Georgian border still plays a strong role, despite the ease with which it is now crossed.

Sarpi, which is only part of the study, provides a fascinating place to study a the effects of a Soviet border. First, the village was split in half after 1921. Second, the community is the only predominantly Laz community in Georgia. Therefore, in practice, the community should have felt more oriented towards their Laz brethren on the other side of the border in Turkey, where the majority of Laz live, after the border reopened.

However, the Soviet Union did something incredible with their tactics for closed border zones. Despite the fact that those on the Sarpi side of the village still have relatives on the other side of the border and their families also used to have landplots across the border, the Georgian Laz hardly ever go across into Turkey. Furthermore, only two marriages have occurred between the two Sarpis and those only in the heady days right after the border opening.

So what happened? Pelkmans' book examines three types of bordering, the literal border, the border between Islam and Christianity and the relationship between an urban provincial capital of Batumi and its rural periphery. As a brief insight into the Islam/Chrisitian divide, Pelkmans discusses the many people within the community of Sarpi who have now converted to Christianity as part of Tbilisi's narrative of the temporary conversion of its people to Islam under the Ottoman yoke, and the book contains wonderful quotes to highlight the process by which these people chose to convert to Christianity. Furthermore, Pelkmans examines the perceptions of the Turkish Sarpi "other." Those on the Georgian side of the village feel that their brethren on the Turkish side of the border have lost their Laz identity and become turkified. Indeed, they often refer to them as Turks. Conversely, as Pelkmans notes, the Georgian Laz have lost many of their cultural traits as well.

You will have to read the book, to get insight into the other types of bordering. However, in short, Pelkmans argues that religious, spatial and cultural borders have come together to create a border that still exists in the minds of the residents of Sarpi.

A follow up study on the other side of the village would prove fascinating, but for the time being Pelkman's account is a wonderful read.

Free Economic Zones in Georgia

Economic free zones in Georgia are no longer a necessary, helpful, or even relevant option for Georgia’s economic development according to a GFSIS article written by Vladimer Papava. A free economic zone is a discreet area of a country’s economy designated by the government and bestowed with certain benefits and privileges. In general there are two different varieties: a strictly territorial one, and the regime-based variety, which is limited to functional categories such as trade, customs, and scientific and technological zones. Why use free economic zones? Theoretically, low or nonexistent customs duties and the relaxation of barriers to trade can bring in foreign revenue. They can be used as testing grounds for breeding free economy principles within regions as an incremental process, but this can also lead to the harboring of offshore funds and dirty money.

Georgia has implemented a number of free economic zones since independence but their benefits and importance may be declining in light of economic development in the region and the globalization of trade and finance transactions. By way of history, post-independence, Aslan Abashidze (the exiled former leader of Adjara) turned Adjara into a free economic zone with few restrictions on trade, and customs duties and revenues went to the Adjaran government rather than Tbilisi. His economic policies were generally viewed as successful when taken out of context from his authoritarian rule.

Since the Rose Revolution, however, on a macro-level there has been more liberalization with the taxation regime on imports, visa requirements for certain foreigners have been lifted, and the bureaucratic procedures for the establishment of businesses have been relaxed. The manufacturing of goods in a free economic zone necessitates considerable costs, and because of the aforementioned privileges granted only within the free economic zones, the transport of goods from one territory to another in-country territory necessitates the same treatment that is afforded to imports. According to Papava this can lead to a restriction in the movement of the country’s citizens and the possible necessitation of special licensing.

Papava thinks the idea of creating free economic zones within Georgia is “senseless,” and that in this state of Georgia’s development it would more appropriate to create a regime applicable to the whole country. He believes that if the government were to reestablish any free economic zones it would weaken Georgia’s relationship with international financial institutions and may lead to the possible ousting of Georgia from the WTO