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Report No 81 USAID вڲêî²ÜÆ êàòÆ²È²Î²Ü ´²ðºöàÊàôØܺðÆ Ìð²¶Æð ARMENIA SOCIAL TRANSITION PROGRAM 14 êáõݹÏÛ³, ºñ¨ e -3175/69 g REPORT NO 81 NEEDS ASSESSMENT: PRIMARY HEALTH PROBLEMS AND HEALTH EDUCATION NEEDS OF VULNERABLE POPU- LATIONS IN ARMENIA Prepared for Armenia Social Transition Program Prepared by The Center for Health Services Research and Development, American University of Armenia July 29, 2002 PLANNING AND DEVELOPMENT COLLABORATIVE INTERNATIONAL Development Solutions for the 21st Century NEEDS ASSESSMENT: PRIMARY HEALTH PROBLEMS AND HEALTH EDUCATION NEEDS OF VULNERABLE POPULATIONS 2 PREFACE Under USAID Contract No. 111-C-00-00-00114-00, the Armenia Social Transition Program is providing assistance to the Government of Armenia to support the development of health promotion and education ma- terials that can be used by primary care providers as a tool to improve the health status of vulnerable groups in Armenia. The development of these materials has been designed by the ASTP as a three-step process: Step 1: The conduct of a needs assessment to identify vulnerable groups in Armenia and their health problems/needs; Step 2: The design and modification of health education/health promotion materials; and, Step 3: The development of a curriculum for training health providers in the use of the health materi- als and the conduct a Training of Trainers course for Armenian Master Trainers in the use of the cur- riculum. This report represents Step 1 of this process. In this report, vulnerable population groups in Armenia are identified along with their major health problems and needs. The report concludes by presenting a list of rec- ommended health topics that can be addressed through health education, followed by an exploration of chan- nels for the delivery of these health education topics to vulnerable groups. This report has been prepared by the Center for Health Services Research and Development at the American University of Armenia. NEEDS ASSESSMENT: PRIMARY HEALTH PROBLEMS AND HEALTH EDUCATION NEEDS OF VULNERABLE POPULATIONS 3 TABLE OF CONTENTS PREFACE ........................................................................................................................................................ 2 TABLE OF CONTENTS................................................................................................................................ 3 LIST OF ACRONYMS................................................................................................................................... 5 EXECUTIVE SUMMARY............................................................................................................................. 6 1. INTRODUCTION/BACKGROUND......................................................................................................... 9 1.1. ARMENIA SOCIAL TRANSITION PROGRAM (ASTP) ......................................................................... 9 1.2. ASTP PILOT SITES ........................................................................................................................... 9 1.3. RESEARCH OBJECTIVES .................................................................................................................... 9 2. IDENTIFICATION OF VULNERABLE POPULATIONS IN ARMENIA........................................ 10 2.1. CHSR METHODOLOGY FOR IDENTIFICATION OF VULNERABLE GROUPS...................................... 10 2.2. REVIEW OF EXTANT AND PRIMARY DATA (BY METHODOLOGY)................................................... 11 2.2.1. The Paros System .................................................................................................................. 11 2.2.2. Family Poverty Benefit System.............................................................................................. 12 2.2.3. ASTP Poverty Assessment ..................................................................................................... 12 2.2.4. Assessment of Vulnerable Populations in the Region. .......................................................... 14 2.2.5. Vulnerable Groups Identified by Government ...................................................................... 15 2.2.6. Vulnerable Groups Identified by NGO’s, Bi/Multi-Lateral Organizations........................... 16 2.3. SYNTHESIS AND RECOMMENDATIONS ........................................................................................... 17 3. HEALTH NEEDS OF VULNERABLE POPULATION GROUPS ..................................................... 20 3.1. CHILDREN UNDER 5........................................................................................................................ 20 3.1.1. General Health Problems...................................................................................................... 20 3.1.2. Health Problems of Socially Vulnerable Children................................................................ 21 3.1.3. Health Education Programs – Caretakers of Children Under Five...................................... 22 3.1.4. Assessment of Health Problems/ Needs by Key Informants .................................................. 22 3.1.5. Recommended Topics for Health Education/ Promotion...................................................... 23 3.2. PREGNANT/ LACTATING WOMEN................................................................................................... 24 3.2.1. General Health Problems...................................................................................................... 24 3.2.2. Health Problems of Socially Vulnerable Pregnant Women .................................................. 26 3.2.3. Health Education Programs – Pregnant Women.................................................................. 26 3.2.4. Assessment of Health Problems / Needs by Key Informants ................................................. 27 3.2.5. Recommended Health Topics for Health Education/ Promotion .......................................... 27 3.3. ADOLESCENTS................................................................................................................................ 28 3.3.1. General Health Problems...................................................................................................... 28 3.3.2. Health Problems of Socially Vulnerable Adolescents ........................................................... 30 3.3.3. Health Education Programs - Adolescents ........................................................................... 30 3.3.4. Assessment of Health Problems/ Need by Key Informants.................................................... 31 3.3.5. Recommended Topics for Health Education / Promotion..................................................... 31 3.4. ELDERLY ........................................................................................................................................ 32 3.4.1. General Health Problems...................................................................................................... 32 3.4.2. Health Problems of Socially Vulnerable Elderly .................................................................. 33 3.4.3. Health Education Programs - Elderly................................................................................... 34 3.4.4. Assessment of Health Problems/ Needs by Key Informants .................................................. 34 3.4.5. Recommended Topics for Health Education/ Promotion...................................................... 35 3.5. SUMMARY OF RECOMMENDED TOPICS FOR HEALTH EDUCATION/PROMOTION MATERIALS FOR VULNERABLE GROUPS ................................................................................................................................ 35 NEEDS ASSESSMENT: PRIMARY HEALTH PROBLEMS AND HEALTH EDUCATION NEEDS OF VULNERABLE POPULATIONS 4 4. DELIVERY CHANNELS FOR HEALTH EDUCATION.................................................................... 36 4.1. HEALTH EDUCATION DELIVERY CHANNELS – CARETAKERS OF CHILDREN UNDER FIVE ............ 37 4.2. HEALTH EDUCATION DELIVERY CHANNELS – PREGNANT WOMEN.............................................. 37 4.3. HEALTH EDUCATION DELIVERY CHANNELS – ADOLESCENTS ...................................................... 37 4.4. HEALTH EDUCATION DELIVERY CHANNELS – ELDERLY .............................................................. 37 4.5. HEALTH EDUCATION DELIVERY CHANNELS – SOCIALLY DISADVANTAGED GROUPS.................. 38 4.6. SUMMARY OF HEALTH EDUCATION DELIVERY CHANNELS .......................................................... 38 5. HEALTH EDUCATION/ PROMOTION MATERIALS AVAILABLE IN ARMENIA ................... 38 5.1. METHODS FOR COLLECTING AND CATALOGUING MATERIALS ..................................................... 38 5.2. BRIEF SUMMARY OF MATERIALS COLLECTED .............................................................................. 39 6. CONCLUSIONS AND RECOMMENDATIONS .................................................................................. 39 6.1. GENERAL HEALTH EDUCATION/ PROMOTION NEEDS.................................................................... 40 6.2. DELIVERY CHANNELS FOR HEALTH EDUCATION/ PROMOTION..................................................... 41 APPENDIX 1. DETAILED DESCRIPTIONS OF EACH METHODOLOGY....................................... 42 APPENDIX 2. IN-DEPTH INTERVIEW GUIDES................................................................................... 45 APPENDIX 3. QUESTIONNAIRE FOR THE COLLECTION OF INFORMATION ON EDUCATIONAL MATERIALS.................................................................................................................
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