Tbilisis Cvil bavSvTa saxlSi bavSvebis Caricxvisa da gadinebis

Sesaxeb angariSi

Tbilisi, saqarTvelo 2010 weli

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Contents zogadi mimoxilva ............................................................................................................... 2

bavSvebis Caricxva, gadineba da sikvdilianoba ...................................................... 3

Tbilisis Cvil bavSvTa saxlSi Caricxva .............................................................. 4

Cvil bavSvTa saxlSi Caricxuli bavSvebis janmrTeloba da diagnozebi ... 5

1. asaki Caricxvisas................................................................................................... 6

2. sqesi ........................................................................................................................... 7

3. Tbilisis Cvil bavSvTA saxlSi darCenis vadebi ..................................... 7

4. “gadineba” dawesebulebidan .............................................................................. 9

5. sikvdilianoba....................................................................................................... 12

Caricxvebisa da prevenciis amJamindeli sistema .................................................. 15

Svilad ayvanis da mindobiT aRzrdis Sesaxeb kanonis mimoxilva ................ 17

daskvnebi da rekomendaciebi ......................................................................................... 18

avtorebi: jaba naWyebia - direqtori “saqarTvelos bavSvebi” doqtori jein roulsi “saqarTvelos bavSvebi” konsultanti angariSi momzadda 2010 wlis 2 ivliss

warmodgenil angariSSi avtorebis mier gamoxatuli mosazreba SeiZleba ar gamoxatavdes organizaciis `gadavarCinoT bavSvebi - saqarTvelos ofisi, amerikis SeerTebuli Statebis saerTaSoriso ganviTarebis saagentos da amerikis SeerTebuli Statebis mTavrobis Sexedulebebs.

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zogadi mimoxilva Tbilisis Cvil bavSvTa saxli centraluri, didi zomis samzrunvelo dawesebulebaa, emssaxureba rogorc janmrTel aseve SezRuduli unarebis mqone Cvilebsa da bavSvebs dabadebidan eqvsi wlis asakamde. am dawesebulebis arseboba wlebis manZilze ganxilvis Temaa profesiul wreebSi.1 2006 wlidan dRemde bavSvTa raodenoba Cvil bavSvTa saxlSi 112-dan 139-mde meryeobs. miuxedavad imisa, rom am samzrunvelo dawesebulebaSi sagrZnoblad gaumjobesda rogorc fizikuri garemo, aseve zrunvis xarisxi da TanamSromlebis profesiuli unarCvevebi bavSvTa raodenoba da am dawesebulebis momsaxurebis buneba da tipi axdens Seuqcevad da mZime gavlenas bavSvTa adreul ganviTarebaze. am problemas gansakuTrebiT amwvavebs bavSvebis dawesebulebaSi darCenis xangrZlivoba, aRmzrdelebisa da bavSvebis araadeqvaturi Tanafardoba da sikvdilianobis maRali maCvenebeli. dawesebulebaSi bavSvebi dayofilia rva jgufad da isini calcalke oTaxebSi cxovroben. arc Tu ise didi xnis win SemoiRes dadebiTi siaxle, axla ukve dedmamiSvilebi erTmaneTs icnoben xolo zogierT oTaxSi Sereuli, rogorc SezRuduli unarebis mqone aseve janmrTeli bavSvebi erTad cxovroben. Tumca unda aRiniSnos rom jgufSi bavSvTa saSualo raodenoba Seadgens 17-s, amasTan TiToeul jgufs emsaxureba erTi ufrosi da ori umcrosi aRmzrdeli. oTaxSi, mocemuli drois monakveTSi imyofeba ori an arcerTi aRmzrdeli, rac samuSaos bunebidan gamomdinareobs. nebismieri adamiani, romelsac hyavs bavSvi martivad mixvdeba rom momvlelisa da bavSvis aseTi Tanafardoba SeuZlebels xdis bavSvisa da miT ufro Cvilis kvebas, gamocvlas, marTvas da masTan urTierTobas, Sedegad Cndeba qaosis, bavSvis ugulvelyofisa da uares SemTxvevaSi Zaladobis warmoSvebis saSiSroeba. Cvil bavSvTa saxlis maqsmimaluri tevadoba 160 beneficiaria, es raodenoba moicavs dawesebulebis teritoriaze arsebul “dedaTa da bavSvTa TavSesafars”. saSualod TavSesafari emsaxureba 10 beneficiars, Sedegad bavSvTa maqsimaluri raodenoba dawesebulebaSi 150-mde mcirdeba xolo am SemTxvevaSi TiToeul jgufSi bavSvebis raodenoba izrdeba 19-mde. garda amisa 2010 wlidan igegmeba ufrosi aRmzrdelis raodenobis ganaxevreba. Aam yvela pirobis Sesrulebisas raime adeqvaturi zrunvis uzrunvelyofa ararealuri xdeba.

1 Doqtorebi rovlzisa da parsonis mier momzadebuli angariSi profesori faRavasTvis nucubiZis Cvil bavSvTa saxlze 1999

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2009 wlidan dRemde bavSvTa raodenoba yoveli Tvis bolos2

bavSvebis Caricxva, gadineba da sikvdilianoba 2009-2010 wlebis bavSvebis Caricxvisa da gadinebis (igulisxmeba dawesebulebida gasvla da gardacvaleba) dinamika Seswavlil iqna am angariSis miznebisTvis. informaciis moZieba Cvil bavSvTa saxlis administraciis meSveobiT, yovelTviuri Canawerebze dayrdnobiT moxda. monacemTa baza maikrosofT eqselis formatSi Seiqmda da Seicavs Semdeg monacemebs: saxeli, sqesi, dabadebis TariRi, Caricxvis TariRi, Caricxvis wyaro, diagnozi Caricxvis momentSi, gayvanis TariRi da gayvanis saxe. mogvianebiT aseve moxda arasaTanado monacemebis gadamowmeba da Sesworeba Cvil bavSvTa saxlis Canawerebze da TanamSromlebTan gasaubrebaze dayrdnobiT. bavSvTa raodenoba dawesebulebaSi meryeobs Tumca mainc maRali rCeba, zrda SeimCneva 2010 wlis manZilzec, radgan Semodineba aRemateba gadinebas. qvemoT moyvanili grafiki naTlad asaxavs, rom 2009-2010 wlebis (2010 wlis maisis CaTvliT) Semodineba aRemateba gadinebas, gayvanasa da sikvdilianobas jamurad. mTavar mizezad gvesaxeba arasakmarisi dacvis Sekavebis meqanizmi. 2010 wlis ianvridan gaZnelebulma gadinebis procesma (mizezebi axsnilia Semdgom) gamoiwvia bavSvTa raodenobis 139-mde zrda 2010 wlis ivnisisTvis.

2 2010 wlis ivnisis dasawyisSi raodenobam miaRwia 139

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(Savi feri – sikvdilianoba, mwvane- gadineba, narinjiseri-Caricxva)

Tbilisis Cvil bavSvTa saxlSi Caricxva

(grafikSi cisferi aRniSnavs Tbiliss, wiTeli regionebs)

2009-2010 wlebis ganmavlobaSi Caricxuli bavSvebis Sesaxeb monacemebis analizma aCvena, rom bavSvTa umravlesoba saqarTvelos sxvadasxva regionebidan aris. geografiuli ganawileba Cvil bavSvTa saxlSi arsebuli monacemebis SeswavliT iqna gamovlenili. zogierT SemTxvevaSi mSoblis/dedis mier miTiTebuli misamarTi gansxvavdeboda mudmivi sacxovrebeli adgilis misamarTisgan. amis erTerTi da mTavari mizezi aris is rom, martoxela dedebi sazogadoebis wnexis Tavidan asarideblad, bavSvis gasaCenad modian TbilisSi. am SemTxvevebSi Cvilis Caricxvas, Cvil bavSvTa saxlSi axorcielebs Tbilisis meurveobisa da mzrunvelobis organo. 2009-2010 wlebSi Caricxuli bavSvebis umravlesoba ganaxorciela meurveobisa da mzrunvelobis teritoriulma organoebma, maTive socialuri muSakis daskvnis safuZvelze, mxolod bavSvTa 8 % iqna napovni quCaSi da Caricxuli am dawesebulebaSi. (grafikSi cisfrad moniSnulia napovni bavSvebi, wiTladi ki

soc. muSakis momarTviT Caricxuli). es

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faqti adasturebs rom TiTqmis yvela mitovebuli bavSvi xvdeba arsebuli bavSvTa dacvis sistemaSi. gamomdinare iqidan, rom bavSvebis umravlesobas toveben maTi sicocxlis pirvelive TveSi upriani iqneboda maTi mindobiT aRzrdaSi ganTavseva, raTa moxdes institucionalizaciis negatiuri zegavlenis3 Tavidan acileba. msgavsi dacvis meqanizmis administrereba SesaZlebelia arsebuli bavSTa keTildReobis sistemaSi. arasaTanado prevenciis problema gamowveulia imiT, rom prevenciuli momsaxureba an ar arsebobs an arasakmarisia.

Cvil bavSvTa saxlSi Caricxuli bavSvebis janmrTeloba da diagnozebi am kvlevaSi Seswavlilia 265 bavSvis SemTxveva, romlebic Cairicxnen an gavidnen dawesebulebidan 2009 wlis da 2010 swlis pirveli naxevris ganmavlobaSi. bavSvebis umravlesoba (153) Cairicxa dawesebulebaSi rogorc janmrTeli, 21 bavSvi aRiarebuli iqna rogorc janmrTeli, magram sinamdvileSi hqonda raime formis SezRuduloba an janmrTeolibis problema, xolo 91 bavSvi Cairicxa rogorc Sezguduli unaris mqone. bavSvebis janmrTelobis mdgomareobis pirveladi Canawerebi miuTiTebda imaze, rom bavSvTa umravlesoba janmrTelia. uzustobebi gamovlinda, rodesac am kvlevis mimdinareobisas gadamowmda samedicino Canawerebi da diagnozebi bavSvebis janmrTelobis arsebul mdgomareobasTan. bavSvebis janmrTelobis mdgomareoba gadamowmda Caricxvis dros dadgenili diagnoziT, romelic gadamowmda samedicino CanawerebTan da Sedarda uSualod bavSvebTan momuSave “saqarTvelos bavSvebis” da Cvil bavSvTa saxlis TanamSromlebTan gasaubrebiT. ocdaerTi (21) bavSvi gamovlinda, romelic Cairicxa rogorc janmrTeli, Tumca maT garkveuli janmrTelobis problema an/da SezRuduloba aqvT. ori SesaZlo mizezi romliTac SeiZleba aixsans amgvari araswori “klasifikacia” aris:

saavadmyofodan swrafad gamowera, anu naadrevi iyo saTanado diagnozis dasma

araswori diagnozis dasma samSobiaros mier, ucnobi mizeziT Canawerebis Seswavlisas aseve gamovlinda rom bavSvebis 8% klasiicirebul iqna rogorc janmrTeli, xolo mogvianebiT identificirebuli rogorc SezRuduli unaris mqone. winamdebare kvlevis miznebisaTvis bavSvebi dajgufda sam jgufad:

3 bavSvebi mavne instituciebs gareT, “ederacia gadavarCinoT bavSvebi” didi britaneTi 2009

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1. janmrTeli – janmrTeli bavSvebi romlebic namdvidal

janmrTelebi iyvnen Caricxvisas, grafikSi mwvane frad aRniSnuli 2. mogvianebiT identipicirebuli rogorc SezRuduli unaris mqone –

Cairicxen rogorc janmrTeli aRniSnulia wiTlad 3. SezRuduli unaris mqone – Caricxen swori diagnoziT, AaRniSnulia

iasamnis frad. am jgufSi Sedis 22 bavSvi mZime da Rrma SezRudulobiT da janmrTelobis mdgomareobiT.

informaciis damuSavebisas gamoyenebuli iyo informacia asaki Caricxvisas, sqesis, dawesebulebaSi Seyovnebis vadebis, gadinebisa da ganTavsebis da bolos sikvdilianobis Sesaxeb. Sesabamisad TiToeuli es punqti calcalke iqneba ganxiluli Semdgom.

1. asaki Caricxvisas

Carcixvisas bavSvTa asakis analizma gamoavlina, rom bavSvebis umravlesoba anu 80%, TavianTi cxovrebis pirvelive wels xvdeba dawesebulebaSi. ufro metic bavSvebis 53% miatoves da Caricxes bavSvTa saxlSi sicocxlis pirvelive TveSi. rac imis maCvenebelia rom mSobeli gadawyvetilebas bavSvis gaCenisas iRebs. SezRuduli unarebis mqone bavSvebis SemTxvevaSi mitoveba, rogorc wesi da umravles SemTxvevaSi ufro mogvianebiT xdeba, rac SeiZleba iyos dakavSirebuli imasTan, rom mSoblebma ar ician rogor izrunon TavianT SezRuduli unaris mqone Svilze an kidev eSiniaT bavSvis diskriminaciis. es ori jgufi gansxvavebul prevenciul midgomas saWiroebs. aucilebelia sakonsultacio momsaxureba gaewios dedebs mSobiarobamde an samSobiaro saxlSi. aseve saWiroa daxmareba gaewios im dedebs romlebsac SeeZinaT SezRuduli unarebis mqone bavSvi, raTa Tavidan aviridoT mitoveba da gavzardoT mSoblis unarCvevebi aRzrdis sakiTxebSi.

(grafiki 1-erT wlamde asakis bavSvebi Caricxva grafiki 2- erTidan eqvs wlamde Caricxva)

bavSvebis mitovebis precedenti mcirdeba maT zrdasTan erTad, Tumca ori wlis asakis Semdeg mitovebis SemTxvevebis aRiniSneba. rogorc wesi msgavsi SemTxveva ganpirobebulia siRaribiT an/da mSoblis uunarobiT izrunos bavSvze. saintereso is aris, rom yvela es socialuri problema saWiroebs prevencias da saxelmwifo da arasamTavrobo seqtoris momsaxurebis efeqturi CareviT

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institucionalizaciis Tavidan aridebis da alternatiulil gamosavlebis moZiebis saSualebas Seqmnis. Sesajameblad, ufrosi asakis bavSvebis mitoveba ufro iSviaTia, janmrTeli bavSvebis raodenoba orjer metia vidre SezRuduli unarebis mqone bavSvebisa da rogorc wesi 1 an ori Tvis bavSvis mitoveba ufro xSiria.

2. sqesi

ufro xSiria biWebis mitoveba (54%) vidre gogonebisa (46%). janmrTeli bavSvebis jguSi Tanafardoba Tanabaria, xolo SezRuduli unarebis mqone bavSvebis SemTxvebvaSi biWebis raodenoba ufro maRalia, rac SeiZleba iyos ganpirobebuli im rwmeniT, rom gogonebis aRzrda ufro martivia da SemdgomSi isini damxmare Zalas warmoadgenen saxlSi, rogorc diasaxlisebi.

(biWebi- lurji, gogonebi-wiTeli)

3. Tbilisis Cvil bavSvTA saxlSi darCenis vadebi

Cvil bavSvTa saxlSi bavSvis Seyovnebis vadebi Semdegnairad SeiZleba daiyos:

o 3 Tvemde o 3-dan 12 Tvemde o 13-dan 23 Tvemde o 24-dan da zemoT

qvemoT moyvanili monacemebi asaxavs bavSvebis dayovnebis vadebs yvela im bavSvisaTvis romelic Cairicxa da gavidan dawesebulebidan, amasTan es grafiki ar asaxavs im bavSvebs romlebic amJamadac cxovroben Cvil bavSvTa saxlSi. janmrTeli bavSvebis umravleosaba (68%) tovebs bavSvTa saxls Caricxvidan 12 Tvis ganmavlobaSi. maTi umravlesoba ubrundeba biologiur ojaxs, ganTavsdeba mindobiT aRzrdaSi, Svilad ayvana,

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meurveobaSi, xolo mcire raodenoba gadadis sxva samzrunvelo dawesebulebaSi. amasTan SezRuduli unarebis mqone an janmrTelobis mZime mdgomareobiT bavSvebi saSualod ufro did dros dahyofen Cvil bavSvTa saxlSi TiTqmis 41% ki or welze mets atarebs am dawesebulebaSi. (mwvane-jamrTeli, wiTeli - mcdari, klasificirebuli rogorc SezRuduli unaris mqone, iisferi-SezRuduli unaris mqone)

janmrTeli bavSvebis umravlesoba Cvil bavSvTa saxlSi dahyofs 3 Tves. am faqts gavlena aqvs moklevadiani mindobiT aRzrdis prevenciuli momsaxurebis ganviTarebaze. magaliTisaTvis im bavSvebisaTvis romlebic am kvlevis Catarebis dros cxovrobdnen Cvil bavSvTa saxlSi msgavsi momsaxurebi miwodeba 3 Tvis manZilze, kanoniT daSvebuli erTi Tvis sanacvlod 33 bavSvs miscemda saSualebas aeridebinaT Tavi institucionalizaciisaTvis (2009 inavridan 2010 wlis maisis manZilze). amJamad arsebuli momsaxurebis farglebSi SesaZlebelia am prevenciuli meqanizmis CarTva Tu kanonmdeblobaSi saTanado cvlileba Sevida da momsaxurebis dafinanseba garantirebuli iqna. SezRuduli unarebis mqone bavSvebi savaraudod ufro did dros dahqofens samzrunvelo dawesebulebaSi. warsuli wlebis manZilze am bavSvebisaTvis ar ganxorcielebula iseTi momsaxureba romelic am bavSvebi instituciidan gayvanis saSualebas mogvcemda, am bavSvebs bevrad ufro kompleqsuri da individualurad awyobili momsaxureba sWirdeba vidre es dRes xerxdeba Cvil bavSvTa saxlis farglebSi. Tumsca aRsaniSnavia rom TanamSromlebis damokidebulebaSi didi Zvra moxda mas mere rac “saqarTvelos bavSvebma” aqtiuri muSaoba Caatara am bavSvTa saxlis bazaze. xsenebuli bavSvebis Cvil bavSvTa saxlSi movla patronobisa da ganviTarebis gaumjobesebis mizniT aucilebelia aRmzrdelebisa da bavSvebis Tanafardobis adeqvaturoba, rac SeiZleba bavSvTa raodenobis SemcirebiT iyos miRweuli, aseve TanamSromlebi saWiroeben unarCvevebis gaumjobesebas. yuradReba unda gamaxvildes bavSvebisa da TanamSromlebis momzadebaze bavSvebis gadinebis mizniT da aseve daxmareba gaewios potenciur ojaxebs raTa maT SeZlon msgavs

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bavSvebze zrunva da maTi usafrTxoebisa da keTildReobis uzrunvelyofa.

4. “gadineba” dawesebulebidan

2009-2010 wlis Suamde 70 janmrTeli bavSvi gavida Cvil bavSvTa saxlidan xolo 4 gardaicvala. Aam raodenobidan 23 bavSvi dabrunda biologiur ojaxSi (reintegrirebul iqna)4, 6 Svilad ayvanze, 18 ganTavsda meurveobaSi, 19 ganTavsda mindobiT aRzrdaSi da 4 gadavida sxva instituciaSi. is bavSvebi romlebic mogvianebiT identificirebuli iyvnen rogorc SezRuduli undarebis mqone 1 Svilad aiyvane, kidev erTi gadavida sxva dawesebulebaSi, xolo 4 gardaicvala, esec imave periodSi. SezRuduli unarebis mqone bavSvebidan ocdaoTxma (24) datova Cvil bavSvTa saxli (3 reintegracia, 7 meurveoba, 10 mindobiT aRzrda da 4 gadavida sxva dawesebulebaSi). SemaSfoTeblad maRalia sikvdilianoba am jgufSi, 30 bavSvi gardaicvala imave periodSi. (Savi- sikvdilianoba, lurji-Svilad ayvana, cisferi- meurveoba, mwvane- reintegracia, iiseri- mindobiT aRzrda, wiTeli- sxva institucia)

gavaanalizeT ra Cvil bavSvTa saxlidan gasuli bavSvebis ganTavsebis mimdinareoba, gamoCnda rom ojaxur garemoSi ZiriTadad Tavsdebian janmrTeli bavSvebi. SezRuduli SezaZleblobis mqone bavSvis ayvana TiTqmis arasodes xdeba adgilobrivad, aseve iSviaTia maTi ganTavseba ojaxTan miaxloebul garemoSi. samwuxarod SezRuduli SesaZleblobis mqone bavSvebze moTxovna saqarTveloSi ar aris, amasTan janmrTeli bavSvis ayvanisaTvis ixwvis bevri, rac did momlodineTa sias qmnis. amavdroulad SezRuduli unarebis mqone bavSvebs aqvT SesaZlebloba, rom isini iSvilon sazRvargareT, Tumca es xangrZlivi procesia, romelic Sedegad aferxebs am bavSvebisaTvis adreuli ganviTarebis an/da saTanado fizikuri da emcoiuri daxmarebis gawevis SesaZleblobas.

4 moicavs naTesaur mindobiT aRzrdas

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jamSi 9 bavSvi, aqedan 4 janmrTeli, xolo 5 SezRuduli unaris mqone gadayvanil iqna sxva saaRmzrdelo dawesebulebaSi, konkretulad ki senakSi, kojorSi, da wyneTis bavSvTa saxlSi sadac fizikuri pirobebi da zrunvis xarisxi Camouvardeba Cvil bavSvTa saxlSi arsebul pirobebs. bavSvebis fsiqologiuri stresi mwvavdeba imiTac rom am dawesebulebebSi higiena ar aris daculi iseTive maRal doneze, izrdeba Zaladobisa da ugulvelhyofis SesaZlebloba. gansakuTrebiT saxifaToa da SeiZleba gamoiwvios bavSvis ganviTarebis CamorCena ukve SezRuduli unarebis mqone bavSvebSi, romlebsac ufro uWirT garemos cvlileba da romelTa saWiroebebis marTva garTulebulia. samwuxarod am bavSvebis usafrTxo ojaxur garemoSi ganTavseba rTulia Sesabamisad erTaderTi saTanado gamosavali maTi deinstitucionalizaviis mizniT, mcire saojaxo tipis saxlebia. damatebiT zemoT ukve Tqmulisa arsebobs kidev erTi faqtori romelic xels uSlis SezRuduli SesaZleblobebis mqone bavSvebis deinstitucionalizacias, konkretulad ki bavSvis statusis dadgena. Cvil bavSvTa saxlSi macxovrebeli bavSvebis janmrTeloba dazRveuli, maT SeuZliaT isargeblon mxolod im momsaxurebiT romelic uzrunveloyofilia sadazRveo paketSi. amasTan poliklinikis mier gamokvlevis Catareba da statusis dadgena ar aris uzrunvelyofili dazRvevis mier5 (am kvlevis Catarebisas es faqti marTebuli iyo). “saqarTvelos bavSvebis” specialistebs, romlebis Cvil bavSvTa saxlSi uzrunvelyofen ojaxis damxmare momsaxurebas qondaT ramodenime SemTxveva, sadac am statusis uqonlobam ganapiroba, rom zogierTi bavSvi ver CaerTo im, saxelmwifos mier dafinansebul momsaxurebaSi romelic uzrunvelyofda maT ganviTarebasa da reabilitacias. am statusis mqone bavSvebi, romlebic cxovroben ojaxebSi Rebuloben saxelmwifo pensias. amgavri bavSvebis reintegraciis process xels Seuwyobda maTi janmrTelobisa da reabilitaciis xarjebis dafinanseba. Semdegi grafiki asaxavs Cvil bavSvTa saxlidan bavSvebis gadinebas ufro xangrZlivi periodis ganmavlobaSi, kerZod ki 2007 dan 2010 wlis Suamde. grafiki naTlad asaxavs gadinebis formebSi cvlilebebs am periodis ganmavlobaSi, magaliTisTvis mindobiT aRzrdaSi gasvla dominirebda rogorc 2007 da kidev ufro 2008 wels, es suraTi Seicvala 2009 wels, romlis ganmavlobaSic 21 bavSvi ganTavsda mindobiT aRzrdaSi xolo 2010 wlis maisisTvis mxolod 1 bavSvi gadavida mindobiT aRmzrdel ojaxSi. unda aRiniSnos rom swored am periodSi anu 2009 wels bavSvTa keTildReobis sistema saqarTvelos ganaTlebisa da mecnierebis saministrodan, Sromis, janmrTelobisa da socialuri dacvis saministros uflebamosilebaSi gadavida. 2009 wlamde mindobiT aRzrda waxalisebuli iyo ori meTodiT: erTis mxriv mindobiT aRmzrdel ojaxs bavSvis ayvanis upiratesi ufleba hqonda, xolo meores mxriv SezRuduli unarebis mqone bavSvis mindobiT aRzrdaSi ayvanis SemTxvevaSi ojaxis mier miRebuli anazRaureba aRemateboda janmrTeli bavSvis ayvanis dros gacemul anazRaurebas. 2009 wlidan mindobiT aRmzrdelebi, romelTa

5 Cvil bavSvTa saxlis administracia acxadebs, rom amJamad mimdinareobs damzRvevis Secvla, romelmac SeiZleba dafaros statusis dadgenis xarji

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motivic iyo bavSvis ayvana aRar iRebden am upiratesobas, sanacvlod socialuri momsaxurebis saagentom aqtiurad daiwyo muSaoba gaSvilebaze da meurveobaze. umetes SemTxvevaSi es ori jgufi erTi da imave dainteresebul xalxs warmoadgenda erTi gansxvavebiT am SemTxvevaSi saxelmwifo ar aanazRaurebda maT “momsaxurebas”.

(2007-2010 ganTavsebis tipebi; mwvane- reintegracia, iisferi- mindobiT aRzrda, lurji-

Svilad ayvana, cisferi- meurveoba, wiTeli- sxva institucia) meurveobaSi ganTavseba mkafiod gaizarda 2009 wels, rac ganapiroba amave wels sikvdilianobis mkafio zrdam. socialuri momsaxurebis saagentom swrafi da efeqturi reagireba moaxdina momxdarze da SeaCera Sedineba da gaaqtiura gadineba meurveobaSi bavSvebis ganTavsebis gziT. samwuxarod es procesi mogvianebiT SeCerda, 2010 wlis martidan ZalaSi Sevida axali kanoni romlis mixedviTac, meurveobis da mzrunvelobis organo bavSvs ganaTavsebs mindobiT aRzrdaSi an meurveobaSi mxolod mas mere rac biologiurma ojaxma ganacxada Tanxmoba an maTi mSoblis ufleba SeizRuda an CamoerTva, es procesi xangrZlivdeba radgan saWiroebs sasamarTlo dadgenilebas. Sedegad Semcirda gadinebis maCvenebeli, momdevno grafiki aCvenebs rom 2010 wlis pirvel naxevarSi gadineba Cvil bavSvTa saxlidan SezRudulia.

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(Tveebis mixedviT monacemebi – meurveoba, sikvdilianoba, Caricxva; cisferi-meurveoba,

Savi – sikvdilianoba, narinjisferi- Caricxva)

5. sikvdilianoba

Cvilebis sikvdilianoba calsaxad zrdis gadinebis maCvenebels, analizis Sedegad dadginda, rom yvelaze maRali sikvdilianobis maCvenebeli SeimCneva SezRuduli SesaZleblobis mqone bavSvebis jgufSi. Tumca aseve yuradRebasaRebia 4 janmrTeli bavSvis sikvdilis SemTxveva. qvemoT moyvanilia sikvdilis mizezebi, romelic eyrdnobma Cvil bavSvTa saxlSi arsebul Canawerebsa da sabuTebs. janmrTeli bavSvebidan 4 gardaicvala, or SemTxvevaSi sikvdilis mizezi ar aris naTeli, xolo erT SemTxvevaSi sikvdili gamoiwvia pnevmoniam xolo darCenil erT SemTxvevaSi tvinis da filtvebis hipostasis/edemam. im bavSvebidan romlebic Cairicxnen rogorc janmrTelebi da mogvianebiT identificirebul iqnen rogorc SezRuduli unarebis mqoneni, garedaicvala 4 aqedan 2 SemTxvevaSi gamomwvevi mizezi pnevmonia, erT SemTxvevaSi virusuli infeqcia xolo ukanaskneli SemTxvevis mizezi ucnobia. SezRuduli unarebis mqone bavSvebis jgufSi 30 bavSvi gardaicvala, 8 bavSvi pnevmoniiT, 4 bavSvi pnevmonia da sefsisi, sefsisi 4 bavSvi, peritoniti erT SemTxvevaSi, 1 bavSvi tvinis da filtvebis edema, 1 bavSvis SemTxvevaSi umtyuvnaGgulma da filtvebma, xerxemlis Tiaqari erT SemTxvevaSi, hidrocefalia 4 SemTxvevaSi, hipovolemiuri Soki (sisxlis moculobis nakleboba) 1 bavSvi, hipoqsia (Jangbadis nakleboba) ori bavSvis SemTxvevaSi xolo 1 bavSvis sikvdilis mizezi ucnobia. am ori ukanaskneli jgufidan zogierT bavSvs mZime unarSezRuduloba aReniSnebodaT, romelic Tandayolili daavadebebiT, nevrologiuli darRvevebiT (tvinisa da xerxemlis Tiaqari, hidrocefalia), gulisa da genetikuri darRvevebiT iyo ganpirobebuli. am jgufSi gansakuTrebiT maRali iyo sikvdilianoba 11 bavSvi daiRupa 23 dan (48%). am bavSvebidan arcerTi ar gadasula ojaxuri tipis garemoSi, ori gadavida sxva dawesebulebaSi, ris merec gardaicvala. am jgufis bavSvebi saWiroeben kompleqsur samedicino da paliatiur zrunvas maTi problemebis sirTulidan gamomdinare. Cvil bavSvTa saxli

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ver uzrunvelyos saTanado momsaxurebas am jgufis bavSvebisaTvis, isini xSirad gadahyavT saavadmyofoebSi da Semdeg abruneben Cvil bavSvTa saxlSi. bevri zemoT aRniSnuli sikvdilis gamomwvevi mizezi Zalian mtkvineuli da damTrgunvelia, sasurvelia maTi Tavidan acileba. aqedan gamomdinare rekomendirebulia gaixsnas paliatiuri zrunvis momsaxureba, romelic uzrunvelyofs am bavSvebisaTvis aucilebel kompleqsur movlas da Seamcirebs im sikvdilis SemTxvevebs romelTa gamomwvevi mizezebis Tavidan aridebac SesaZlebelia. qvemoT moyvanilia grafiki sadac naCvenebia rom 2007 dan 2009 wlis CaTvliT bavSvebis gayvana sxva zrunvis formebSi mcirdeba, xolo sikvdilianoba amavdroulad izrdeba, 2007-Si 23 SemTxveva 2009-Si 32 SemTxveva. am mdgomareobis gaTvaliswinebiT macxovrebelTA ricxvi SedarebiT stabiluri rCeboda mTeli am drois manZilze.

(2007-2010 gadinebis da sikvdilianobis dinamika; Savi-sikvdilianoba, mwvane- gadineba) mTlianobaSi 2009 wlis da 2010 wlis Suamde CaricxulTagan 37% darCa Cvil bavSvTa saxlSi, 19% gardaicvala, 4% gadavida sxva dawesebulebaSi xolo 40% raime sxva formiT moeqca deinstitucionalizaciis procesSi. aqedan gamomdinare nebismieri bavSvi, gansakuTrebiT ki SezRuduli SesaZleblobis mqone, am dawesebulebaSi darCenisa da gardacvalebis maRali riskis winaSe dgas.

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(gadineba, sikvdilianoba da macxovreblebis rotacia 2009-2010 Sua; nacrisferi – 37% rCeba, Savi- 19% sikvdilianoba, mwvane- 12% reintegracia, wiTeli-4% sva instituciebi, cisferi 12% meurveoba, lurji- 2% gaSvileba, iisferi- 14% mindobiT aRzrda)

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Caricxvebisa da prevenciis amJamindeli sistema Cvil bavSvTa saxlSi Caricxvis procesis gasagebad aseve Sefasda Caricxvis amJamindeli sistema. qvemoT moyvanilia arsebuli sistema romelic asaxavs garkveuli donis prevenciul meqanizmebsa da momsaxurebas, magram amasTan aCvenebs Semakavebeli meqanizmis ukmarisobas.

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Semakavebeli meqanizmis meqanizmi romelic Seaferxebs bavSvebis mitovebas amJamindel sistemaSi moicavs ojaxis damxmare da sakonsultacio momsaxurebas, romelic fsiqologiur daxmarebas uwevs mSoblebs, aseve arsebobs finansuri daxmarebac romelic xels uwyobs bavSvis ojaxSi ganTavsebas. damatebiT arsebos dedaTa da bavSvTa TavSesafari, romelic uzrunvelyofs droebiT sacxovrebels dedebisaTvis da maTi CvilebisTvis. momavalSi sasurveli iqneba sistemis Sevseba damatebiTi momsaxurebis saxeobiT rogoricaa satreiningo programa SezRuduli unarebis mqone bavSvebis mSoblebisaTvis, romelic daexmare mSoblebs im damatebiTi wnexisa da sirTuleebis marTvaSi, romelic dakavSirebulia SezRuduli unarebis mqone bavSvis aRzrdasTan; gadaudebeli mindobiT aRzrda kidev erTi saWiro momsaxurebaa, gansakuTrebiT ki axalSobilebisaTvis, radgan maTi ganTavseba grZelvadianad ojaxebSi ufro savaraudoa; dRis centrebi/sabavSo baRi an baga ori wlis asakamde bavSvebisaTvis. Ees ukanaskneli ar arsebobs da am momsaxurebis Seqmna gansakuTrebuli mniSvnelobisaa, radgan mSoblebs miecemaT saSualeba imuSaon da Tan aRzardon bavSvebi TavianT ojaxebSi, ufro metic am tipis momsaxureba bavSvis ganviTarebas uzrunvelyofs rac momavalSi am bavSvebis sazogadoebis srulfasovan wevrad aRzrdas uzrunvelyofs.

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Svilad ayvanis da mindobiT aRzrdis Sesaxeb kanonis mimoxilva amJamindeli kanonmdeblobis analizma aCvena garkveuli SezRudvebi Semakavebeli meqanizmebisa da deinstitucionalizaciis ganxorcielebasTan mimarTebaSi (ix. naxazi).

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pirveli rigSi unda aRiniSnod bavSvis mindobiT aRzrdaSi ganTavsebasTan dakavSirebuli sirTule.; es problema yvelaze metad exeba ukve datovebul bavSvebs romlebis imyofebian Cvil bavSvTa saxlSi rogorc “droebiT mitovebulebi”, maT iSviaTad an arasdros ar akiTxaven mSoblebi, amasTan mSobelma ar ganacxada uari bavSvze da arc Tanxmobas iZleva bavSvis mindobiT aRzrdaSi ganTavsebaze. Aamis mizezad ki gvevlineba sakanonmdeblo SezRudva, romlis mixedviTac socialuri momsaxurebis saagento ganaTavsebs bavSvs mindobiT aRzrdaSi mxolod im SemTxvevaSi, Tu mSoblis Tanxmoba miRebulia an misi mSoblis ufleba SezRudulia an CamorTmeuli. Sesabamisad am SezRudvis gamo socialuri muSakebi ver reagireben swrafad, isini valdebulni arian wamoiwyos sasamarTlo saqme romelic 5 Tvis manZilze wydeba am vadis gasvlamde ki bavSvebi rCebian ojaxuri garemos gareSe. meore mniSvnelovani sakiTxi exeba gadaudebel mindobiT aRzrdas, romelic dRevandeli kanondeblobis Tanaxmad daSvebulia 30 dRis manZilze da Sesabamisad ver gamoiyeneba rogorc Semakavebeli meqanizmi. mesame sakiTxi exeba Svilad ayvanas da kanonmdeblobiT gaTvaliswinebul procedurebs, romelic sakmaod xangrZliv dros saWiroebs Svilad asayvanis statusis gansasazRvrad. Tu bavSvi napovnia quCaSi da misi reintegracia biologiur ojaxSi SeuZlebelia, misi statusis dadgena saWiroebs umciresi sam Tves ris Semdegav bavSvi SeiZleba gaSvildes an ganTavsdes grZevladianad ojaxur garemoSi. warsulSi kanondebloba ugebda barierebs im dedebs romlebsac TavianTi Svilis gayidva surdaT, 2010 wlis martidan mSoblisa da mSvilobeli ojaxis saerTo gadawyvetilebis safuZvelze maT SeuZliaT mimarTon socialuri momsaxurebids saagentos da gaaSvilon bavSvi pirdapiri wesiT. Svilad ayvanis procesi SeiZleba 1,5 – 5 Tvemde gagrZeldes. SezRuduli unarebis mqone bavSvebi TiTqmis arasodes Svildebian saqarTveloSi, Tumca maTi gaSvileba SesaZlebelia sazRvargareT, kerZod ki gasaSvilebeli statusis miniWebidan 8 Tvis amowurvis Semdeg da im SemTxvevaSi Tu maTi gaSvileba adgilze ver moxerxda. mTlianobaSi es process sadRac 13 Tve grZeldeba, rac am bavSvebis janmrTelobsi mdgomareobidan gamomdinare Zalian didi droa, radgan mravali daavadeba Tu unaris SezRudva ukeT SeiZleba iyos marTuli sxva dasavlur qveynebSi. amasTan, Tu bavSvi miatoves da mSoblebma ganacxades uari TavianT uflebebze gasaSvilebeli statusi swrafad 1,5 TveSi dgindeba, ris Semdegac bavSvi gadadis meurveobaSi Svilad ayvanis mizniT.

daskvnebi da rekomendaciebi

I. Cvil bavSvTa saxlSi aRmzrdelebisa da bavSvis amJamindeli Tanafardoba arasakmarisia aramarto individualuri aramed saTanado zrunvis gansaxorcieleblad, amitom rekomendirebulia am Tanafardobis cvlileba erTi aRmzrdeli xuT bavSvze, gamomdinare

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bavSvebis asakidan da maTi saWiroebebidan. amJamad yvela aRmzrdeli gadis gadamzadebas individualuri zrunvis gegmis ganviTarebis sakiTxebSi, Tu Tanafardoba ar Semcirda am gegmis ganxorcieleba aramarto SeuZlebeli gaxdeba, aramed bavSvebis institucionalizaciis procesi daCqardeba.

II. arsebuli 3 aRmzrdeli romelic emsaxureba TiTo jgufs

fizikurad zrunaven bavSvebze da meTvalyureoben bavSvebis higienas, amis gamo maT ar gaaCniaT dro bavSvebis ganviTarebis stimulaciisaTvis an emociuri ganviTarebisaTvis. aqedan gamomdinare saWiroa am aRmzrdelebis drois gamonTavisufleba iseTi aqtivobebisaTvis romelic uzrunvelyofs bavSvebis socialur, emociur da saganmanaTleblo ganviTarebas, maTi individualuri saWiroebebis mixedviT.

III. Cvil bavSvTa saxlSi Caricxvebis maCvenebeli maRalia, rac

miuTiTebs imaze rom, saWiroa saswrafod dainergos yvela is prevenciuli da Semakavebeli meqanizmebi, romlebic SeaCerebs am process, xolo am ukanasknelis Sesrulebis Tanave gamocxades moratoriumi am dawesebulebaSi bavSvebis Caricxvaze. msgavsi prevenciuli momsaxureba auilebelia rogorc dedaqalaqSi iseve qveynis rainoebSic, am momsaxurebaTA ricxvs ganekuTvneba: gadaudebeli mindobiT aRzrda, dRis centri droebiT datovebis uflebiT, sakunsultacio momsaxureba da bolos ara fuladi materialuri daxmareba ojaxebisaTvis. inkluziuri baRebi SezRuduli unarebis mqone bavSvebisaTvis gaamartivebs am bavSvebis ojaxebSi dabrunebasa da ganTavsebas.

IV. udides problemas warmoadgens SezRudulobis adreuli da

marTebuli diagnostireba, sasurvelia rom Sezruduli unarebis mqone piris statusis dadgenis xarji gaTvaliswinebul iqnas sadazRveo paketSi. Aam statusis dadgena ojaxebs aZlevs finansuri daxmarebis miRebis saSualebas da bavSvebs ojaxSi darCenis SesaZleblobas aZlevs.

V. kvlevam gamoavlina, rom umetes wilad Cvilebs toveben manam sanam

maT SeusruldebaT 2 Tve, aucilebelia mizanmimarTuli momsaxurebis ganviTareba swored am bavSvebisaTvis, am momsaxureobad gvevlineba ojaxebis sakonsultacio momsaxureba da gadaudebeli mindobiT aRzrda. es saWiroeba aSkaraa da gadaudebeli, sasurvelia rom es momsaxurebebi ukve momaval wels dafinansdes.

VI. umravlesoba bavSvebisa tovebs Cvil bavSvTaA saxls 12 Tvis

ganmavlobaSi, Tumca igive ar vrceldeba SezRuduli unarebis mqone bavSvebze, romlebic dgebian arasakmarisi zrunvis, avadmyofobis da sikvdilis riskis winaSe. es bavSvebi saWiroeben ukeTes momsaxurebas ris Sedegadac maTi gadinebis Sansi dawesebulebidan izrdeba. Aucilebelia maTi uzrunvelyofa dRis centris da inkluziuri baga baRis momsaxurebiT. es ukanaskneli uzrunvelyofili iyo am bavSvebisaTvis Cvil bavSvTa saxlisa da

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“saqarTvelos bavSvebis” TanamSromlebis ZalisxmeviT gasuli wlis manZilze. amJamad momsaxureba ar miewodeba bavSvebs, radgan ar iqna uzrunvelyofili maTi transportireba sabavSo baRebSi.

VII. jer kidev xorcieldeba 7 wlis asaks miRweuli bavSvebis gadayvana

sxva instituciebSi, bavSvebis es jgufi saWiroebs saswrafo reagirebas raTa moxdes maTTvis saTanado garemos moZieba da Tavidan aviciloT is fsiqologiur-emociuri stresi da negatiuri zegavlena romelic dakavSirebulia didi zomis saaRmzrdelo dawesebulebebSi maTi gadayvaniT.

VIII. sul mcire asakis bavSvebic ki advilad Rebuloben

insitucionalizaciis mier gamowveuli emociur da socialur zians, yvela Zalisxmeba unda movixmaroT rom SevamciroT miyenebuli zarali. yvelasaTvis kargad cnobilia, rom rac ufro male moxdeba bavSvisaTvis socialuri, emociuri da ojaxuri daxmarebis gaweva miT didi Sedegi miiReba. sasurvelia rom arasamTavrobo seqtori, am dargSi gamocdilebiT, gaaqtiurdes da xeli Seuwyobs bavSvebis momzadebas ojaxur garemoSi gadasasvlelad (iqneba es ojaxi Tu mindobiT aRzrda)

IX. 2009 wlis SuaSi momxdari krizisi adasturebs, rom Semakavebeli

meqanizmis gaaqtiureba politikuri nebis sakiTxia da Sesrulebadia Tu misi grZelvadiani uzrunvelyofis neba da dafinanseba iqneba.

X. Cvil bavSvTa saxli gaxlavT yvelaze prioritetuli dawesebuleba

yvela danarCenTan SedarebiT, amis mizeizia bavSvebis rotaciis maRali maCvenebeli (180 bavSvi weliwadSi) da maTi sikvdilianobis maRali maCvenebeli, arcerTi sxva dawesebuleba ar gvaZlevs igive maCvenebels am ori mimarTulebiT. amJamindeli sistema nebiT Tu uneblied arRvevs Ggaeros bavSvTa uflebebis wesdebas radgan ver uzrunvelyofs sakmaris Semakavebel meqanizms, aRmzrdeli bavSvis saTanado Tanafardobas, saTanado jandacvas, adreuli saganmanaTleblo da socialuri dawesebulebebis xelmisawvdomobas an kidev ojaxSi an ojaxTan miaxloebul garemoSi zrunvas.

XI. Cvil bavSvTa saxlSi Caricxuli bavSvebis sikvdilianobis

maCvenebeli sagangaSoa, arsebuli jandacvis momsaxureba ver uzrunvelyofs sikvdilis im mizezebi aRmofxvras romelic aRmofxvradia magaliTad infeqciebi. mZime unarSezRudulobisa da Tu daavadebebis mqone bavSvebi ver Rebuloben saTanado paliatiur zrunvas da maTi xanmokle sicocxle iqceva mtkivneul da tanjul gzad sikvdilisaken.

XII. arsebuli kanonmdebloba xels ver uwyobs Semakavebeli meqanizmebis

daxvewas, radgan gadaudebl mindobiT aRzrdas uSvebs mxolod erTi Tvis manZilze, aseve droSi gaxangrZlivebulia procesi romlis Sedegadac bavSvebi ojaxur garemoSi gadainacvleben. sasurvelia momzaddes cvlilebebi kanonSi romelic am Seferxebebs gaauqmebs, SesaZlebelia arasamTavrobo seqtoris Zalebis

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gamoyenebac, romelic gamocdilebaze dayrdnobiT moamzadebs rekomendaciiebs cvlilebebis Sesaxeb.