Modernizing Armenia's Healthcare
February 14, 2011
To update her medical skills, Doctor Teresa Petrosyan travels 16 kilometers to Argavand village to attend hands-on classes in family medicine. Her teacher is certified family physician Dr. Lena Gevorgyan, who is happy to share her experience. She says that in her time, she, too, was well trained by others.
Dr. Gevorgyan has been working with doctors in regional Armenia to refresh their knowledge of family medicine and teach them new techniques and new ways of interacting with patients. It's like a master's degree course where family doctors learn how to best handle a wide variety of medical challenges, most likely alone in a walk-in clinic.
"In one year, we went to so many hospitals and departments; we probably hadn't been to so many places during our whole time as medical students," says Lena Gevorgyan, Argavand family doctor. "We went to study and to implement locally what we had learned."
Now the clinic has a waiting room and separate exam rooms. It also has an otoscope and an electrocardiogram, and the clinic's nurses can perform simple blood tests on the spot.
Each newly certified family physician treats 1,500 to 2,000 patients.
Retraining physicians to emphasize family medicine is a fundamental part of the Armenian Government's strategy to improve healthcare, and the World Bank is supporting this effort through the Health System Modernization Project. A new approach that aimed to provide quality healthcare for everyone was needed in the wake of the disruption of the post-Soviet transition era. Establishing good primary healthcare was the first step.
In her comfortable and newly equipped outpatient unit, Dr. Gevorgyan now performs procedures for which she used to send patients to a regional hospital or the capital.
"We used to send patients as far as 16 km to be treated at the regional polyclinic," she says. "Say, for an electrocardiogram, which takes 3-4 minutes, they would spend their whole day waiting in front of the doors of the Hoktemberyan polyclinic."
To qualify as family doctors, physicians at outpatient units are trained at the National Institute of Health and State Medical University for one year. This training is mandatory under the directive of the Ministry of Health, and receives support from the World Bank. So far, 1,200 family doctors and more than 1,300 family nurses have been trained.
In addition to training doctors and nurses, the project which is modernizing healthcare is expanding the population's access to good primary healthcare. And it is building or modernizing dozens of outpatient clinics around the country, and providing them with modern medical equipment.
Tairov district, home to almost 3,000 people, has a new clinic built under the program. It is attracting five times more patients than when it was housed in the old building. "We used to work in very bad physical conditions," says Dr. Karine Hakobyan. "The building was in a horrible state: there were two rooms, no flooring, we were at risk of breaking our legs when we walked; the ceiling leaked. We would examine children, pregnant women, ill and healthy people—all in the same room."
Now the clinic has a waiting room and separate exam rooms. It also has an otoscope and an electrocardiogram, and the clinic's nurses can perform simple blood tests on the spot. Dr. Hakobyan says the quality of healthcare she can provide in her clinic has been raised significantly.
In Armenia, 800,000 patients have been treated in 145 improved outpatient clinics. However, 70 outpatient units around the country still need to be moved to new buildings.
As part of the second phase of the health reform, several specialized medical institutions in Armenia were merged. Inherited from a previous era was a huge number of inefficient, overstaffed and dilapidated hospitals with outdated technology and obsolete equipment. In particular, regional facilities had not seen any renovation since their construction in the 1970's. They lacked efficient management to provide high quality hospital services.
The government decided to optimize services by merging hospitals and polyclinics. As a result, there are 40% fewer empty hospital beds, and over 70,000 square meters less unused hospital and polyclinic space. Services across the country are consolidated, physical conditions upgraded, modern medical equipment provided, and modern management structures in place.
The capital is no longer the only place providing niche medical services. People do not need to travel 150 km to Yerevan for services that the regional medical centers are now providing. This means less travel, better care, and faster test results using reliable equipment. Over half of the patients living outside the capital prefer to receive care in their own regions.
"What is amazing is that people are willing to pay to undergo treatment. These are paid services; the government does not cover these costs. The hospital provides everything except for meals," says Elmira Yengibaryan, Head of Internal Medicine at Ijevan Medical Center, approvingly.
Income at the Ijevan Medical Center increased nine times after it was renovated, thanks to patients willing to pay for their services. Other newly renovated medical centers have also seen large increases in income thanks to fee for services and fewer empty beds.
Another benefit is that the small number of physicians with specialty training in the regions are now providing a wide range of healthcare services with state-of the-art equipment. And they are concentrated in centralized and renovated regional medical centers instead of being spread out across the provinces.
Residents of Armenia's southern regions are desperately waiting for similar reforms. Construction work at Goris in the south of the country is going ahead with great speed. The main building of the hospital has already been renovated. An auxiliary unit is being built next to it to house the reception, diagnostic unit, surgical department, and maternity ward. Medical equipment and furniture is being delivered.
The Goris hospital is a familiar place to Yuri Hovsepyan, a carpenter. He was operated on here in 1990. "My wife was treated here, my children were born here, and I am also going to have a grandchild soon in this hospital. We are building this for ourselves, for our children," he said.
The Goris medical center will reopen soon. Other renovated regional medical centers are expected to open next year.
"By strictly following the Government's long-term strategy on reforming the health sector for 12 years, the healthcare system in Armenia was brought back from a critical state of affairs," says Susanna Hayrapetyan, World Bank task team leader for the Health System Modernization Project."But it is still early to consider it healthy. It is necessary to improve the quality of service in the new hospitals, to eliminate the wide-spread out-of-pocket payments, and to renovate or rebuild the other outpatient clinics and hospitals in the regions. It is also necessary to completely modernize and retrain the emergency medicine system in the country. The treatment and recovery of the system will continue, based on this prescription."