Healthcare

INCREASED UTILIZATION OF SUSTAINABLE, HIGH-QUALITY PRIMARY HEALTHCARE SERVICES

During the Soviet era, Armenians had the longest life expectancy and one of the best developed healthcare systems of all the Soviet republics. The system was known for impressive health outcomes and provided a comprehensive range of state-subsidized medical services. However, dire post-independence economic and subsequent social conditions resulted in a health system characterized by:
 More than half of the national health budget devoted to expensive curative, hospital care;
 High out-of-pocket expenditures on health: it is estimated that private financing (much of it informal payments) represents about two-thirds of national health expenditures;
 Healthcare providers have not had continual clinical and managerial professional development for nearly a decade; and
 Many facilities are in disrepair with out-of-date equipment and insufficient supplies and there is a shortage of healthcare personnel in rural areas.

USAID ASSISTANCE IN THE HEALTH SECTOR

USAID’s support to the Government of Armenia is designed to increase utilization of sustainable, high-quality primary health care (PHC) services. The objective has a twofold approach: (1) strengthen national institutional capacity for PHC reform; and (2) reinvigorate provision of PHC services at the facility level. Currently, USAID’s annual health portfolio budget is about $7 million.

Strengthened institutional capacity: USAID is strengthening the capacity of institutions – Ministry of Health (MOH), State Medical University (SMU), nursing schools, National Institute of Health (NIH), State Health Agency (SHA), regional health departments, health provider organizations – to improve the environment for PHC reforms and to build up a cadre of well-trained family medicine providers. To build a sustainable foundation for PHC reform, USAID is working with the MOH to promote and implement physician and nurse training programs, and better management and healthcare financing practices in order to achieve greater transparency and accountability in the healthcare sector. Moving client payments for services from the informal to the formal sector will enhance transparency in the health sector and demonstrate that cost-recovery may occur in a professional, ethical manner.
Improved service delivery in priority PHC disciplines: Given continuing economic hardships and immediate healthcare needs, USAID’s assistance aims to strengthen the quality of medical services. USAID improves service delivery by: utilizing community-based approaches, emphasizing patient-focused activities, and strengthening the clinical and managerial skills of employees of the MOH, NIH, SHA, regional healthcare departments, primary healthcare facilities, and professional associations. USAID also supports mobile outreach teams to ensure PHC services are available to vulnerable groups in remote communities with limited access to healthcare services. Emphasis is also placed on sexually transmitted infection (STI) control and prevention activities, and strengthening reproductive health and maternal-child health services, especially in rural health posts.

CURRENT ACTIVITIES

Armenian Demographic and Health Survey 2005 (ADHS): A nationally representative household survey to analyze demographic information on population and health issues, determine dominant health challenges and the country’s progress in addressing them, and provide accurate data which will enable decision-makers to make evidence-based policies and appropriate financial commitments. The preliminary report was released in early 2006 and the final comprehensive report was finalized and disseminated in 2007. ADHS is implemented by Macro International Inc.

Primary Healthcare Reform Project (PHCR): PHCR supports the Government of the Republic of Armenia (GOAM) in its efforts to introduce PHC reforms. PHC reforms are part of the overall GOAM strategy for reforming the entire health sector. The major PHC reforms include: (1) strengthen PHC services for common medical conditions with a focus on preventive care and improved management of chronic diseases; (2) instituting the practice of open enrolment whereby every resident of Armenia has a right to choose his/her own health care provider; and (3) Improve quality and performance of PHC by establishing new systems of health care financing and monitoring. PHCR is currently working in Lori, Shirak, Ghegharkunik, Kotayk and Tavush. The project will be expanded until the entire country is covered. PHCR is implemented by Emerging Markets Group (EMG) and several sub-contractors.

Project NOVA (Innovations in Reproductive Health): NOVA works with the GOAM MOH to improve the quality of reproductive, maternal and child health (RH/MCH) services. To this end, NOVA increases the knowledge and improves the clinical skills of rural PHC providers, and provides basic PHC medical equipment and supplies. NOVA develops the capacity of regional health managers to manage and supervise rural facilities, accelerates the momentum of reform in the health delivery system to be more responsive to the reproductive and child health needs of the population, and increases consumer demand for high-quality RH/MCH services through community education and mobilization activities. The project is implemented by EMG and partners IntraHealth and Save the Children.

Rational Pharmaceutical Management Plus (RPM+) Project: RPM+ is a world-wide USAID/Washington designed project implemented by the U.S. firm Management Sciences for Health. The RPM+ Armenia program complements USAID’s other health sector programs in the country. The program conducted a study on prescriber adherence to current standard treatment guidelines (STGs) relevant to PHC and Family Medicine, implications for quality healthcare delivery, selected drug costs for the Basics Benefit Package (BBP), and proposed interventions to support STG implementation. RPM+ also assessed the legal, political, technical, and financial viability of alternative pharmaceutical supply strategies for the BBP. After the study RPM+ engaged stakeholders in policy options dialogue and consensus building workshop(s), and conducted a Rational Drug Use Training Course for Family Medicine Doctors.

Mobile Outreach Teams: Implemented by World Vision, the MOTs ensure access to PHC for the populations of remote communities through mobile outreach teams in Gegharkunik, Lori, Syunik and Tavush, at a total of 123 sites. Project activities include renovation of rural health facilities, the creation of revolving drug funds, and implementation of community health education activities – all in close collaboration with local healthcare managers and providers.

Armenian Eyecare Project: A Global Development Alliance project, AECP employs four main strategies for providing high-quality ophthalmology services using a mobile eyecare truck: (1) outreach, screening and treatment of vulnerable populations; (2) medical education and training program for regional ophthalmologists and family (primary care) physicians and ancillary personnel; (3) public communication and education programs; and (4) epidemiology. AECP works nation-wide according to a pre-determined schedule.

Armenian-American Wellness Center: A Global Development Alliance project, AAWC has a large clinic in Yerevan, a satellite clinic in Gavar, and provides outreach visits. AAWC PHC services include annual physical examinations, health promotion, breast and cervical cancer screening, diagnosis and referral services, gynecological services including STI management, and monthly outreach missions. AAWC provides periodical training to update clinical and managerial skills of Center staff and has also developed a quality management system for accurate reporting, cost accounting and patient record keeping.

Avian Influenza (AI) Preparedness Activities: Using USAID/W grant mechanisms, USAID/Armenia has allocated funds to support AI preparedness and response and AI public education activities conducted by the local offices of WHO and UNICEF respectively.

WHO grant on Technical Assistance of Tuberculosis services: USAID/Armenia is providing technical assistance to develop TB policy documents and a TB control training package in accordance with international recommendations focusing primarily on the provision of TB services at the primary health care level.