Health Care System Armenia case

1
Health Care SystemArmenia case
2

• Hospital cases 285 000
• State funded 230 000, 120 000, 110 000
• Paid 55 000

3
Overview

• Country profile, Health profile
• Inherited System, reforms,
• Current situation
• Health financing
• Health services delivery (PHC)
• Maternal and child health
• The way forward

4
Country profile

• Area 29,743 sq km
• Population 3.2 mln (64.1 urban)
• Homogenous country about 98 of the population
  are Armenians
• Growth rate 1.4
• Capital Yerevan
• Administrative units Regions (11 Marzes)

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Health profile

• Surviving infants - 38000 (2006)
• IMR - 13.8/1000 (2006)-official vs DHS 2005
• Under 5 mortality rate - 15.5/1000 (2006)
• Life expectancy at birth 73.5 (2006)
• Per capita GDP - 1850 (2006), 3000 (2007)
• Percentage of GDP allocated to health 1.4
• Health worker density - 3.8 per 1000 population
• DTP3 coverage - 86.8 (2006)
• Districts reaching 90 DTP3 91

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Inherited System characteristics (1)

• Before 1991
• Verticaly centralized system
• Officially Free of charge services
• Planned budget, reimbursement based on reporting,
  quality indicators undermined
• Focus on in-patient care, over reporting in
  practice
• Medical education-poor clinical practice

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Inherited System characteristics (2)

• Excess capacities of facilities and human
  resources
• Deteriorated facilities and technologies
• Poor financial resources
• Disparities urban and rural sectors
• Poor health indicators earthquake, severe energy
  crisis, imposed war, poverty.

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After the Independence

• Actual reforms started in 1997
• paid services, decentralized system
• Public hospitals- 106, Private 34
• Public polyclinics, ambulatories-386, Private -
  74
• Doctors 12.177, 37.8 per 10000 population
• Other personnel 18428, 57.2 per 10000

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Current characteristics

• Economic growth and improved macroeconomic
  indicators, average growth of 13
• Financial stability- health budget annual
  increase in average by 25.
• Poverty reduction- 55- 32 last three years,
  Diaspora support
• New legislation
• Accumulated problems in medical education and
  practice- introducing new standards
• Individual and public health perspectives
• PHC reforms consistency, drug provision

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State budget for Health sector (billion drams)
2002-30mln 2008-180mln
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Source HSPA report 2007
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Low public spending on healthwith very high
out-of-pocket share
Armenia
Private hexp. as total hexp.
Source WHO Europe Health for All Database 2008
13
Fiscal contextPublic finance capacity among
lowest in the region
Armenia
Source Estimates reported by WHO
14
Government gives low priority to healthin terms
of budget allocations
Armenia
Source WHO Europe Health for All Database 2008
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Health financing

• Health Care 8.18 of the State Budget
• Primary Health Care - 35.2
• Hospital Care - 37.2
• Allocation per person 12.226AMD 36
• Other sources of revenue
• Paid services legal
• Paid services illegal

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• Armenian health system has high dependence on
  out-of-pocket payments, and performs poorly on
  key policy goals
• Human resources for health
• Refocus BBP and formalise co-payments, within
  broader set of reforms related to purchasing
  health services, infrastructure optimisation,
  strengthened primary care, service quality
  improvements, and sustained increases in public
  funding
• Ensure awareness of entitlements for patients

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Average salaries of Doctors and Nurses
Source HSPA report 2007
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Primary Health Care

• Primary Health Care Strategy 2003-2008
• Empowerment of the Preventive services, increase
  the share of public expenditures allocated to
  PHC
• Establishment and empowerment of Family medicine
• Empowerment of the recourses of the
  ambulatory-polyclinics
• Improve the qualification of GP
• The Primary Health Care services are completely
  free of charge since 2006 20 increase in
  utilization

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Infant and Child mortality rates
Source HSPA report 2007
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Child Mortality

Deaths per 1,000 live births for the 5-year
period before the survey
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Causes of infant mortality 1988-2005
Source RA NHI 2006
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Gynecological Care
More than half of women have either never visited
the gynecologist or havent been for 5 or more
years
Percent distribution of women
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Maternal and Child care

• Safe motherhood OBGYN
• Essential newborn and early childhood Neonatal
  care
• Child growth and development Pediatricians
• Integrated management of childhood illnesses
• Immunization-All components are introduced, issue
  of sustainability
• Breast Feeding- Success

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Trends in Breastfeeding
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Vaccination (DHS-2005)
14 dropout
14 dropout
Percentage of children age 12-23
months vaccinated at any time before the survey
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Lessons learned and conclusions

• Political will and intersectoral collaboration
• More understanding and emphasis on health
• Market economy is an instrument, but not an
  objective
• Delegated authority, decentralization,
  motivation and competition in health sector might
  have negative implications
• Health sector governance Health sector
  performance continuous evaluation
• The Government has to maintain the regulatory
  role in health sector by legislation, quality
  control and management, licensing, health
  information systems
• Transparency and organizational, professional,
  legal and financial accountability of health
  sector
• Informal payments reduction and legalization
• Shift from input to process and outcome, outcome
  oriented motivation mechanisms

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General conclusion

• Clear policy making faces difficulties in the
  economic transition period because political,
  economic and social life changes dynamically.
  Formulation of a public value system is a crucial
  political agenda where healthcare plays its
  unique role. Socio-economic conditions and
  political processes influence political goals and
  their achievement strategies. These factors leed
  for continuous analysis and monitoring. Although
  thera are internationally accepted policy
  principles, strategies and values, there is no
  simple solution for any country and health system
  reforms will remain under continuous observation
  and refinement.