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An Assessment of USAID's Health Strategy in Armenia

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An Assessment of USAID's Health Strategy in Armenia An Assessment of USAID’s Health Strategy in Armenia Prepared Under a Contract with the Population Technical Assistance Project By Robert J. Taylor Capri-Mara Fillmore Tatyana N. Makarova November 5, 2002 An Assessment of USAID’s Health Strategy in Armenia Preface This paper was prepared under contract to the Population Technical Assistance Project (POPTECH) with the purpose of advising the USAID Mission in Yerevan, Armenia, on its health sector strategy. The objective of the exercise was to assess USAID’s assistance to the Armenian health sector. The report reviews the health component of USAID/Armenia’s current five-year social transition strategy (FY 1999-FY 2003) and it is anticipated that the report will be used in designing the follow-on strategy (FY 2004-FY 2008). The report is intended to provide the analytical underpinnings for the Mission’s health sector strategy planning and to offer a reference document for future activity development. It is also anticipated that the document will be useful to the Mission’s government counterparts and other development partners. The Assessment Team was headed by Robert Taylor, a specialist in health management, policy and reform, and included Capri-Mara Fillmore, a family physician and epidemiologist, and Tatyana Makarova, a specialist in health organization and finance. The team was provided able logistics and translation support by Shushanik Avagyan and Svetlana Mardanyan. The report reflects information gained by the team during a three-week visit to Armenia in late April and early May, 2002. The team had the opportunity to interview numerous individuals and to review an extensive list of documents, as detailed in the attached appendices. An Assessment of USAID’s Health Strategy in Armenia TABLE OF CONTENTS I. EXECUTIVE SUMMARY ..................................................................................................................................1 II. ARMENIA’S HEALTH SYSTEM IN TRANSITION.....................................................................................3 A. HEALTH SYSTEM FINANCING AND ORGANIZATION ............................................................................................3 1. Health spending in Armenia...........................................................................................................................3 2. Private payments for health............................................................................................................................5 3. Health System Organization...........................................................................................................................6 4. Armenia’s Health Reform Agenda..................................................................................................................8 B. HEALTH STATUS OF THE ARMENIAN PEOPLE......................................................................................................8 1. Life expectancy ...............................................................................................................................................9 2. Infant Mortality ..............................................................................................................................................9 3. Maternal Mortality .......................................................................................................................................10 4. Fertility and Infertility in Armenia ...............................................................................................................12 5. Census-Adjusted Disease Trends in Armenia...............................................................................................13 6. Infectious Diseases and the rise in TB..........................................................................................................14 7. Sexually Transmitted Infections....................................................................................................................16 8. Chronic, non-communicable, and life-style related diseases .......................................................................17 9. Nutritional status ..........................................................................................................................................19 10. Health status and access to care ................................................................................................................21 III. HEALTH AND USAID’S SOCIAL TRANSITION PROGRAM ...............................................................23 A. USAID’S HEALTH OBJECTIVES IN ARMENIA ...................................................................................................23 B. IMPROVING ACCESS TO QUALITY PRIMARY HEALTH CARE..............................................................................24 1. The need to strengthen advocacy for family medicine..................................................................................25 2. Strengthening family medicine training........................................................................................................26 3. Pilot Family Group Practices.......................................................................................................................28 4. Emphasizing PHC and altering the mix of medical practitioners ................................................................29 5. Licensing and Accreditation.........................................................................................................................31 C. HEALTH FINANCING REFORM ...........................................................................................................................32 1. Private payments and their impact on access...............................................................................................32 2. Basic Benefits Package.................................................................................................................................34 3. State Health Agency......................................................................................................................................35 4. Mandatory Health Insurance........................................................................................................................36 D. HEALTH SYSTEM RESTRUCTURING...................................................................................................................38 1. Authorities and Responsibilities after Decentralization...............................................................................38 2. Rationalizing Health Services, Facilities and Staff ......................................................................................39 3. Optimization, the next World Bank Loan .....................................................................................................40 E. POLICY AND LEGAL FRAMEWORK FOR HEALTH REFORM .................................................................................41 F. HEALTH MANAGEMENT INFORMATION SYSTEMS .............................................................................................42 1. Improving health management indicators....................................................................................................42 2. Demographic and Health Survey .................................................................................................................43 3. National Health Accounts.............................................................................................................................44 4. The capacity to analyze available data ........................................................................................................44 G. CAPACITY BUILDING ........................................................................................................................................45 H. REPRODUCTIVE HEALTH (PRIME) ..................................................................................................................46 I. MEETING IMMEDIATE HEALTH NEEDS ...............................................................................................................48 ii 1. United Methodists Committee on Relief ........................................................................................................48 2. Catholic Relief Services.................................................................................................................................49 J. AIHA PARTNERSHIPS IN HEALTH......................................................................................................................49 K. PRIVATE SECTOR AND NGO DEVELOPMENT....................................................................................................52 V. TOWARD AN EXPLICIT USAID HEALTH STRATEGY FOR ARMENIA............................................55 A. BALANCING SYSTEMIC CHANGE AND MEETING IMMEDIATE HEALTH NEEDS ..................................................55 B. DONOR COORDINATION AND USAID’S COMPARATIVE ADVANTAGE...............................................................56 1. Donor Coordination .....................................................................................................................................56 2. USAID’s Comparative Advantage................................................................................................................57 C. A PROPOSED USAID HEALTH STRATEGY AND PROGRAM ...............................................................................59
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