Primary health care development in the Republic of Armenia and perspectives for enhancement

Abstract

Primary health care (PHC) is an essential component of an effective and efficient health care system. It is the basis of an effective health care system because it can address the large majority of the health problems present in the population, and achieve the main objectives of health care: high quality care, including desired health outcomes; patient satisfaction; and efficient use of resources. Since 1995, the Republic of Armenia (RA) has introduced health care reforms focused on PHC. The reforms are necessitated by several factors: excessive centralization of management, sole reliance upon state funding, the limited framework of health care objectives and medical services, the exaggerated number of health care providers and medical facilities, and their inequitable allocation. These factors resulted in health care and medical science falling behind that of developed countries. To increase the quality and effectiveness of PHC, the concept of “family medicine” (FM) was introduced in Armenia, and training and retraining programs for family physicians and nurses were launched. So far, training sessions have been mainly theoretical: time and opportunities for practice have been limited. In addition, introduction of family medicine has not received adequate support from the health financing system. Trained family physicians, who should be rendering a broader circle of services compared to traditional PHC providers, do not have the necessary incentives to do so. State financing is insufficient and the capacity of family physicians to render fee for services is limited. Improving provider payment mechanisms and support of FM could be better were it not for the scarcity of state financial resources. The goal of this research is to show the dynamics of PHC development in Armenia from 1997-2002, analyze the main problems still present in the PHC system, and describe current and potential intervention strategies. Based on the above analysis it is recommended iito introduce social workers into the interdisciplinary teams of PHC providers; create community nursing organizations for provision of home care of patients; introduce a compulsory referral system by family doctors to secondary level; add to the curriculum clinical instructions to reflect the practical needs of family medicine; improve the provider payment mechanisms in the area of primary care. These long-term initiatives will ultimately improve both access and the quality of health care services.