The social and economic upheavals that followed the earthquake of 1988 combined with the political collapse of the Soviet Union to create a catastrophic public health situation in Armenia. According to Soviet statistics published between 1989 and 1991, the incidence of tuberculosis, viral hepatitis, and cancer were among the lowest in the Soviet republics (see table 2, Appendix). In 1990 the rates of infant mortality and maternal mortality, 17.1 and 34.6 per 1,000 population, respectively, were also among the lowest rates in the Soviet Union.
The level of medical care declined rapidly in the late 1980s and the early 1990s, however, largely because of the Azerbaijani blockade and the additional stress caused by war casualties. Even in 1990, Armenia ranked lowest among the republics in hospital beds per 1,000 population and exactly the Soviet Union average for doctors per 1,000 population. Before 1991 Armenia had acquired stocks of medical supplies and equipment, thanks largely to the Western aid projects that followed the 1988 earthquake. By 1992, however, the trade blockade had made the supply of such basic items as surgical gloves, syringes, and chlorine for water purification unreliable. In the escalating medical crisis that resulted from this vulnerability, elderly people and newborns were particularly at risk; in late 1992 and early 1993, healthy infants reportedly were dying in hospitals because of the cold and the lack of adequate equipment.
In December 1992, President Ter-Petrosian declared Armenia a disaster area and appealed to the UN Security Council to focus on the crisis in the republic. Government officials estimated that without emergency humanitarian aid some 30,000 people would die. Early in 1993, the United States launched Operation Winter Rescue to send needed assistance to Armenia. In June Project Hope sent US$3.9 million worth of medicine from the United States. From mid-1992 to mid-1993, United States medical assistance totaled US$20 million.
All hospitals in Armenia are under the jurisdiction of the Ministry of Health or the Erevan Health Department. In 1993 about 29,900 hospital beds were available. Hospitals generally had surgical, physical therapy, pediatric, obstetric/gynecological, and infectious disease wards. But according to reports, by 1993 more than half the hospitals in Armenia had ceased functioning because electricity, heat, or supplies were lacking.
Thirty-seven polyclinics serve the rural areas, which have no comprehensive health centers; such clinics are each designated to provide basic medical services to about 10,000 people. Sixty-two outpatient centers specialize in child or adult medicine in urban areas. Immunizations against certain diseases are given to most infants before they are one year old: in 1991 some 95 percent of infants were immunized against poliomyelitis, 88 percent against diphtheria, and 86 percent against pertussis.
Between 1986 and 1994, two cases of acquired immune deficiency syndrome (AIDS) were reported in Armenia: one foreigner who was subsequently deported, and one Armenian who contracted the disease in Tanzania and was treated in Armenia. Experts believe that the Azerbaijani blockade has acted to limit the incidence of AIDS. Although no AIDS clinics are operating, some research has been conducted. In 1992 Armenian scientists announced the discovery of a possible treatment compound.
Information base is from http://lcweb2.loc.gov/frd/cs/amtoc.html - dated 1994
Government Pledges To Expand Free Healthcare In 2006
By Nane Atshemian
The Armenian government unveiled on Monday plans to expand the range of medical services provided to the population free of charge by abolishing next year all fees levied for disease prevention and prophylaxis.
According to Armen Soghoyan, head of the healthcare department at the Yerevan municipality, the measure will apply to all state-run policlinics that are responsible for prophylactic treatment of most diseases. He said it was made possible by a planned 21 percent increase in government spending on healthcare in 2006.
The official could not say if the state will subsidize all drugs prescribed to patients by policlinic doctors. `Only one thing is known at the moment: policlinic service will be free of charge,' he told journalists. `Nobody knows yet whether that includes drugs or expensive check-ups.'
Public access to healthcare in Armenia has severely declined over the past 15 year due to widespread poverty and corruption among medical personnel. A nationwide household survey conducted by the National Statistics Service in 2003 found that only one in three people visit a medical facility once they have with problems with health.
The practice of informal payments thriving at virtually every health institution means that Armenians have to pay even for the few medical services that are officially free of charge. That includes prophylactic treatment of oncologic, cardiac, infectious and psychiatric ailments. Many Armenians are either unaware of that or feel that they will not receive proper treatment without `rewarding' doctors.
The informal payments typically range from 1,000 to 50,000 drams ($100). They go up sharply after hospitalization.
Soghoyan insisted that the government measure will complicate bribery at the policlinics as it will apply to all services. `When we say primary healthcare is free that means nobody can demand money from citizens at the policlinics anymore,' he said.
However, some groups of the population such as children under the age of 7 and pregnant women have long been entitled to free healthcare, but many of them have been unable to make use of that privilege. Maternity hospitals, for example, are among the most corrupt in the country.
Soghoyan also admitted that the government's modest healthcare budget for 2005, projected at 38.4 billion drams ($86 million), will still leave the quality of subsidized medical services much to be desired. The figure pales in comparison with per-capital health expenditures of the developed nations.
RFE/RL Armenia Report - 10/10/2005
Armenian Health Forum
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