The Founding Decision

In 2014, a technical working group inside the newly established Public Health Institute of Georgia (PHIG, founded 2011) made a decision that would shape the next decade of healthcare accreditation in the country: rather than build a Georgian accreditation body from scratch, PHIG would spend its early years convincing the country that accreditation belonged there at all.

The decision looked, on paper, almost self-effacing. PHIG's founders — public health specialists who had spent years inside Georgia's hospital system — reasoned that the country's healthcare sector didn't need another local certificate nobody outside Georgia would recognize. It needed the real thing: the standards already trusted by patients, insurers, and regulators internationally. PHIG's technical group partnered with Evex Medical Corporation, then Georgia's largest private healthcare provider, and organized the country's first missions by Joint Commission International experts — demonstrating, hospital by hospital, what internationally credentialed accreditation could actually look like on Georgian ground. PHIG never intended to become an accreditor itself. Its founders' ambition was smaller, and in the end more consequential: prove the case, and open the door.

That door didn't open by itself. Over the years that followed, PHIG carried the argument for accreditation directly into government — several rounds of meetings with staff of Georgia's Ministry of Health, across successive ministries, as leadership in Tbilisi changed and the case had to be made again each time. This wasn't advocacy in the abstract. It was the patient, repeated work of explaining, to whoever held the health portfolio that year, why a country's hospitals benefit from being held to a standard nobody in that country wrote.

From Demonstration to Policy

By 2018, that advocacy had produced something concrete: the first draft of an accreditation standard adapted specifically to Georgian healthcare. Two years later, in 2020, it produced something larger — the formal establishment of Accréditation Sans Frontières as an international legal entity in Paris, founded alongside its own standing technical authority, the ASF International Standards Council.

Between 2020 and 2022, PHIG, ASF, and David Tvildiani Medical University united as the Accreditation Georgia Initiative — the first Georgian effort to bring academia, professional bodies, and international accreditation expertise into a single, coordinated push. The initiative's first real test came in 2021: more than fifty Georgian healthcare facilities volunteered to enter a pilot accreditation process against the newly adapted standard. Four were accredited — the first facility accreditations the country had ever recorded.

What happened next moved the work from demonstration into policy. In 2022, sustained engagement with the Ministry of Health — the product of those years of repeated meetings — produced a ministerial decision establishing, as government policy, that Georgian hospitals should hold independent international accreditation. That policy became law on 26 January 2023, through Order №4/ნ: from 1 January 2025, recognition under Georgia's Universal Healthcare State Program would require it. The same month, PHIG formalized a partnership with Accreditation Canada, becoming its representative office in Georgia. Within the year, twenty-three Georgian hospitals had entered the accreditation process; nine had already achieved it. A decade after a handful of public health specialists decided Georgia needed real accreditation rather than a local imitation of it, the country had a functioning national accreditation system.

Three Headquarters, One Standard

ASF now works from three headquarters, and each does something different. Paris is the organization's legal seat and the base of its French and European technical expertise. Geneva is its window onto global health governance — sustained proximity to WHO and the wider Geneva health community, keeping ASF's standards current with how international practice actually moves. Tbilisi is where the whole undertaking began, and remains where it is most concretely tested: a standard that only worked on paper in Paris or Geneva would have been discovered, quickly, in Georgian hospitals.

That structure isn't cosmetic. It reflects a deliberate design choice: a standard genuinely informed by global evidence, refined through European technical rigor, and proven against the specific, often resource-constrained conditions of the country where it was first built.

Four Pillars, One Council

ASF's standards work is organized the way the wider accreditation field itself is structured — into four distinct pillars, each requiring its own discipline. The first is accreditation of organizations: individual healthcare facilities assessed against ASF's published standards, the work reflected directly in ASF's seven current standards documents. The second is accreditation of the standards themselves — the ongoing responsibility of keeping the standards evidence-based, current, and genuinely fit for the settings they govern, carried out by ASF's own International Standards Council. The third is accreditation of the surveyors who conduct ASF's own assessments — ensuring the people carrying out an assessment are themselves genuinely trained and competent, not merely credentialed, governed by the ASF Surveyor Training Standard. The fourth is accreditation of training — ensuring the people expected to meet a standard have genuine access to the education that lets them do so, delivered through GMJ Academy.

The Council's own methodology draws directly on the World Health Organization's guideline development process, including WHO's use of the GRADE framework for weighing the certainty of evidence — adapted specifically to the practical, operational work of accreditation standards rather than clinical guidance [2]. ASF has been a member of the International Society for Quality in Health Care (ISQua) since 2023 [3], and the Council's revision cycle — a formal review of every standard every three years — sits comfortably alongside the cycles used by the field's more established international bodies.

A Voice at the United Nations

ASF's founder, Dr. Giorgi Pkhakadze, brought more than a Georgian public health career to this work. Since 2016, he has served as a founding member of the UN Secretary-General's Independent Accountability Panel for Every Woman, Every Child, Every Adolescent — the panel's original nine appointees, tasked with holding the global health community to its own commitments under the Sustainable Development Goals. His commentary on accountability in global health has appeared in The Lancet, BMJ Global Health, and BMC Public Health. One line from the panel's 2018 report on private-sector accountability has stayed close to ASF's own reasoning ever since:

Education as Infrastructure

ASF and its partners treated workforce capability as part of the accreditation problem from the outset, not something to address afterward. Through SheniAcademy, more than five thousand Georgian health professionals have completed certified training, and PHIG has issued competency-based continuing education certificates to over a thousand professionals in a pilot phase. That work is now consolidating into a single bilingual platform, academy.gmj.ge — a joint continuing professional development hub offering up to one hundred courses, with blended online and in-person delivery. The logic is straightforward: a standard that tells a facility what's required without also making the relevant training genuinely available is a standard that quietly assumes capacity many facilities don't yet have.

A Global Standard, Tested Locally

ASF's standards have been discussed directly with practitioners across Asia, the Middle East, and sub-Saharan Africa — not to export a Georgian or French template unchanged, but to test whether its underlying logic actually travels to healthcare systems facing very different constraints. Every ASF standard includes a Health & Migration endorsement built on WHO's own Global Competency Standards for health workers serving refugees and migrants, a commitment ASF treats as non-negotiable rather than optional, alongside a Medical Tourism endorsement addressing a distinct and growing part of global healthcare delivery.

Accreditation Without Borders

The organization's name is not a slogan. Each edition of ASF's standards is published in full and made freely available, as a deliberate act of accountability and transparency — and any organization seeking to build accreditation capacity in its own country is welcome to ASF's knowledge, expertise, and support in doing so, on a clear legal basis for local adaptation. The underlying belief, tested first in Georgia and since carried further, is that accreditation should be easy to access, transparent in what it actually requires, and ultimately self-sufficient: local organizations building and owning their own accreditation bodies, rather than remaining permanently dependent on an outside one.

The Ecosystem

That belief has produced a working ecosystem, not just a set of documents: publichealth.ge, the institutional home of PHIG itself; accreditation.ge, Accreditation Canada's representative office in Georgia; certificate.ge, the SheniEkimi Certification scheme offering smaller, non-hospital facilities an accessible first step toward full accreditation; gmj.ge, the Georgian Medical Journal; news.gmj.ge, carrying public research and policy commentary; and academy.gmj.ge, the continuing education platform built directly from the standards themselves.

This is the story behind the third edition of ASF's standards, published in 2026 — a document shaped by more than a decade of consultation across countries and continents, reviewed and revised by the ASF International Standards Council on a three-year cycle, in keeping with the principle that has guided this work since a handful of people in Tbilisi decided, in 2014, that Georgia's hospitals deserved better than a standard invented just for them.

Timeline

The chronology of how this work actually unfolded — from a technical working group's first decision in 2014 to the standard published today.

2011
The Public Health Institute of Georgia (PHIG) is established.

2014
PHIG's technical working group launches Georgia's first structured accreditation initiative, partnering with Evex Medical Corporation and organizing the country's first missions by Joint Commission International experts. Sustained advocacy with Georgia's Ministry of Health begins the same year.

2018
The first draft of a Georgian-adapted accreditation standard is completed.

2020
Accréditation Sans Frontières (ASF) is formally established as an international legal entity in Paris, alongside the ASF International Standards Council. Accreditation of training formally begins, and SheniAcademy launches.

2020–2022
PHIG, ASF, and David Tvildiani Medical University unite as the Accreditation Georgia Initiative.

2021
Georgia records its first facility accreditations: more than fifty facilities enter the pilot; the first four are accredited.

2022
A ministerial decision establishes, as government policy, that Georgian hospitals must hold independent international accreditation.

January 2023
Order №4/ნ formally implements this requirement in law. PHIG establishes an official partnership with Accreditation Canada, becoming its representative office in Georgia.

2023
ASF becomes a member of the International Society for Quality in Health Care (ISQua). Twenty-three Georgian hospitals enter the Accreditation Canada process; nine achieve accreditation. SupplementIndex (supplement.ge) launches.

2024
Foundational work begins on certificate.ge, the future SheniEkimi Certification scheme.

2025
The Georgian Medical Journal (gmj.ge) and its news platform, news.gmj.ge, launch. SheniAcademy transforms into academy.gmj.ge.

2026
certificate.ge becomes fully operational. Version 3 of ASF's standard is published.

References

1. Independent Accountability Panel for Every Woman, Every Child, Every Adolescent. Private Sector: Who Is Accountable? 2018 Report. New York: United Nations; 2018.
2. World Health Organization. WHO Handbook for Guideline Development, 2nd Edition (GRADE methodology). Geneva: WHO; 2014.
3. International Society for Quality in Health Care (ISQua). External Evaluation Association (EEA) Membership Directory. 2026.

Index

Accountability Panel (UN IAP), A Voice at the United Nations

Certificate.ge, Timeline (2024, 2026)

Council Methodology, Four Pillars, One Council

David Tvildiani Medical University, From Demonstration to Policy

Four Pillars, Four Pillars, One Council

GRADE Framework, Four Pillars, One Council

ISQua Membership, Four Pillars, One Council; Timeline (2023)

Order №4/ნ, Timeline (January 2023)

Public Health Institute of Georgia (PHIG), The Founding Decision; Timeline (2011, 2014)

Three Headquarters, Three Headquarters, One Standard