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Health Care System Armenia case

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Health Care System Armenia case – PowerPoint PPT presentation

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Title: 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)

5
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

6
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

7
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.

8
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

9
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

10
State budget for Health sector (billion drams)
2002-30mln 2008-180mln
11
Source HSPA report 2007
12
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
15
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

16
  • 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

17
Average salaries of Doctors and Nurses
Source HSPA report 2007
18
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

19
Infant and Child mortality rates
Source HSPA report 2007
20
Child Mortality

Deaths per 1,000 live births for the 5-year
period before the survey
21
Causes of infant mortality 1988-2005
Source RA NHI 2006
22
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
23
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

24
Trends in Breastfeeding
25
Vaccination (DHS-2005)
14 dropout
14 dropout
Percentage of children age 12-23
months vaccinated at any time before the survey
26
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

27
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.
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