Community based health insurance schemes in rural communities of Armenia: perspectives for enhancement

Abstract

The severity of the socio-economic crisis that faced Armenia in the beginning of the nineties forced the country to make radical changes in the funding and organization of the health care system. The economic crisis hit mostly village health posts, which were poorly equipped, with low quality of health care services provided and basic drugs being unavailable for the population. The result was dramatically a decreased health status of the population and lack of access to health care services, especially in the rural areas of the country. As a result of problems (health sector financing gap, economic crisis, out of the pocket payments, low access in rural areas, etc), many preventable and avoidable diseases nowadays continue to increase and spread largely. At the Primary Health Care (PHC) level, the Armenian government set free health care for several services and vulnerable population groups, but due to inadequate financing, the quantity and quality of health care is very limited or not available. Many goals of the health care system depend on adequate financing. Today in the context of inadequate public expenditures in the health sector of Armenia, concerns over health status, equity and access to primary health care for the poor and the search for complementary financing solutions have risen. The aim of this study is to explore the main problems present in the primary health care system of rural areas of Armenia, the major financing issues and the current and potential intervention strategies. Based on the discussion of relative advantages and disadvantages, technical and political feasibility and ease of implementation, following recommendations are developed regarding the options for new financing mechanisms of primary health care in Armenia: make legislative changes to facilitate the wider introduction of Community Based Health Insurance schemes, government have to contribute to the effectiveness and sustainability of the Community Based Health Insurance schemes for rural population through technical support to strengthen management capacity of local schemes and facilitate links with formal financing and provider networks, create a new regional intersectoral consulting body “Community Based Health Insurance Regional Board”, donors and other stakeholders need to be involved in the support of this schemes, to establish a national forum for discussion of Community Based Health Insurance. These actions will improve health status of population and access in the rural areas of Armenia.