Health Sector Assessment, Part One
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American University of Armenia Center for Health Services Research and Development HUMANITARIAN ASSISTANCE PROJECT, NAGORNO KARABAGH HEALTH SECTOR ASSESSMENT, PART ONE: HEALTH FACILITIES Prepared for the United States Agency for International Development FAR/AUA Contract # 111-1-00-02-00064-00, Task Order 2 Yerevan, Armenia, December 2003 Authors and Contributors Michael E. Thompson, MS, DrPH Alina Dorian, PhD Anahit Demirchyan, MD, MPH Gohar Hovhannisyan, MD, MPH Charles Dunlap, PhD Zaruhi Mkrtchyan, MPH Melanya Ohanyan, Arthur Karapetyan Assessors Ira Khachatryan, MD Manushak Sargsyan, MD Nina Hovhannisyan, MD Lilia Babayan, MD Center for Health Services Research and Development, December, 2003 i Table of contents List of Acronyms.......................................................................................................................iii Executive Summary.................................................................................................................. iv 1. Background.......................................................................................................................... 1 1.1 Project Description.......................................................................................................... 1 1.2 Health Services Structure in NK..................................................................................... 1 1.3 Prior Interventions Related to the Project....................................................................... 3 1.4 Selection of facilities to be covered by the assessment .................................................. 4 2. Assessment Methodology ................................................................................................ 4 2.1 Village ambulatory services assessment methodology................................................... 5 2.2 Village district hospitals assessment methodology......................................................... 7 2.3 Central regional and republican hospitals assessment methodology.............................. 8 2.4 San-epi stations assessment methodology .................................................................... 11 2.5 The Ambulance Center assessment methodology ........................................................ 12 3. Data Analysis and Findings ............................................................................................ 12 3.1 FAPs and Village Ambulatories ................................................................................... 13 3.2 Village District Hospitals.............................................................................................. 31 3.3 Central Regional Hospitals and Republican Dispensaries............................................ 36 3.4 San-epi Stations ............................................................................................................ 57 3.5 Ambulance Station........................................................................................................ 61 4. Summary of Needs ............................................................................................................. 62 4.1 FAPs and Village Ambulatories ................................................................................... 62 4.2 Village District Hospitals.............................................................................................. 72 4.3 Central Regional Hospitals and Republican Dispensaries............................................ 73 4.4 San-epi Stations ............................................................................................................ 81 4.5 Ambulance Station........................................................................................................ 83 5. Summary of Priorities/Recommendations................................................................. 84 6. References.......................................................................................................................... 87 7. Appendices…………………………………………………………………………………….. 88 Center for Health Services Research and Development, December, 2003 ii List of Acronyms ADM Adult Disease Management AMIC Armenian Medical International Committee ARC American Red Cross AUA American University of Armenia ASTP Armenia Social Transition Program ARCS Armenian Red Cross Society CHSR Center for Health Services Research and Development CRH Central Regional Hospital CRS Catholic Relief Services ECG Electrocardiogram EDL Essential Drug List FAP Village Health Post (Feldsher/Obstetrical Post) FAR Fund for Armenian Relief ICRC International Committee of Red Cross IMCI Integrated Management of Childhood Illnesses MSF Medicines sans Frontiers MOH Ministry of Health NK Nagorno Karabagh NGO Non-Governmental Organization PHC Primary Health Care RA Republic of Armenia SES Sanitary Epidemiological Station SHCMA School of Health Care Management and Administration STD Sexually Transmitted Diseases SVA Village Ambulatory SUB Village District Hospital USAID United States Agency for International Development WHO World Health Organization Center for Health Services Research and Development, December, 2003 iii Executive Summary A thorough assessment of selected health care facilities in Nagorno Karabagh (NK) was carried out by the Center for Health Services Research and Development (CHSR) in the scope of a USAID-funded humanitarian assistance project collaboratively conducted by the Fund for Armenian Relief (FAR) and the American University of Armenia (AUA). The assessment included a detailed physical assessment and inventory of equipment, supplies, pharmaceuticals, and personnel of each facility and was aimed to develop a strategy to renovate/reconstruct and equip/supply the health facilities of NK according to prioritization of their needs. Out of 200 health facilities functioning in NK, 148 were covered by the assessment including 115 village health posts (FAP), 15 village ambulatories (SVA), 4 village district hospitals (SUB), 4 central regional hospitals (CRH), 2 republican dispensaries (Oncological and Skin/STD), 7 san-epi stations, and the Stepanakert Ambulance Station. Five facility-specific instruments and four different lists of essential drugs were developed to assess the target facilities combined in the following types: (1) Village primary health care facilities (FAPs and Village Ambulatories); (2) Village hospitals; (3) Central Regional and Republican Hospitals; (4) San-epi Stations; and (5) Ambulance Station. Standard listings of equipment and supplies for each facility group were included in the assessment tools to identify the existing needs and workload of each was measured to prioritize facilities in terms of those needs. The assessment revealed that, of 130 PHC facilities, 62 needed varying degrees of physical renovation. These facilities were grouped into three priority categories by the extent of renovation needed. Almost all village PHC facilities need piped water and/or swage system to ensure minimal hygiene standards are maintained and excretions properly disposed of. The majority of facilities need furniture and equipment, and all facilities need periodic supply of drugs/disposables. Standard listings of furniture, equipment, and essential drugs/disposables for PHC level were developed and the cost for providing each facility in need with those items was estimated. The needs of the San-Epi and secondary/tertiary level facilities were also identified in terms of renovation/equipment/supplies and recommendations were made. Given the largely rural distribution of the population outside of Stepanakert, the overall strategy is to provide maximal health to the population by improving the primary care system through · First, improving primary care services available at the village/ambulatory level; · Second, improving the capacity of San-Epi to o Promote health through vaccination and monitoring of food and water supplies o Protect health through disease surveillance and control programs by providing updated/expanded laboratory facilities in combination with Central Regional Hospitals, etc; and · Third, improving secondary and tertiary facilities ability to treat patients referred from primary facilities, especially for conditions related to IMCI/ADM illnesses, with emphasis on diagnostic and inpatient services. · In parallel with point three, local solutions will be sought to improve the ability of patients to be transported from villages to regional facilities and from regional facilities to national facilities through a sustainable transportation and/or ambulance system, possibly with support from this project. Center for Health Services Research and Development, December, 2003 iv 1. Background 1.1 Project Description USAID contracted the Fund for Armenian Relief and the American University of Armenia to carry out a humanitarian assistance project in Nagorno Karabagh. In the scope of the project, rehabilitation and construction activities will be conducted in schools, local health clinics, water systems, and shelter in NK. The Center for Health Services Research and Development (CHSR) of the American University of Armenia is implementing the health component of the program, which includes revitalization of the health care system and infrastructure of NK to meet humanitarian demands. For this purpose, CHSR conducted a thorough assessment of the health care facilities, which included a detailed physical assessment and inventory of equipment, supplies, pharmaceuticals, and personnel, as well as utilization/service