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Primary Care Clinic in Armenia

By Nairy Ghazourian
RMF Country Director - Armenia

July 2008


Since the germination of the idea for the RMF-Armenia Clinic project in April of 2008, we have had considerable progress. The needs assessment for the project was completed by independent consultant Dr. Alina Dorian, upon which we were able to identify the exact location and primary care services and programs RMF will implement.

The Republic of Armenia is a small, mountainous country located in southwestern Asia, between the Caucasus and Near Asia (the area between the Kur and Araks rivers). The country is bordered by Georgia and Azerbaijan on the north and east, and by Turkey and Iran on the west and south.

The country is subdivided into 11 regions (marzes) which include: Shirak, Lori, Tavush, Aragatzotn, Kotayk, Armavir, Ararat, Gegharkunik, Vaytoz Dzor, Syunik and Yerevan which is Armenia’s capital.

The present health system of Armenia has a well developed structure and network. However, the system is largely focused on tertiary care which has created great deficiencies in the primary health system. Generally, the quality of medical care is quite low. The health care reform strategy in Armenia is focusing on strengthening primary health care services, promoting health and the prevention of disease and shifting planning models from a narrow biomedical one to a more integrated, holistic, multisectoral approach.

Historically, the state budget was the primary funding source for health care. Currently, the health system is financed both from local and international sources. The main local sources are the state budget and direct out-of-pocket payments by the population. International financing sources are general humanitarian donations and project-specific support.

Based on Dr. Dorian’s assessment, demographic and health data and meetings with key health personnel, the Syunik Marz was selected as the geographic area to target. Meetings were then held with the Health Director for the Syunik Marz as well as representatives of non-governmental organizations working in the Marz. Based on those meetings and RMF’s mission and capabilities, the village of Shinuhayr with a population of 2,300 was selected as the project site.

Marz: Syunik
Village: Shinuhayr

Population: approx: 2,300
Children <5 years of age: 280
In 2007: 27 births; 19 deaths

The ambulatory in Shinuhayr is a government run health care facility. It is a large Soviet-style building which originally housed the outpatient unit as well as a maternity ward and in-patient units. At present, only a small wing of the building is utilized to provide outpatient ambulatory care. The Ambulatory serves as a referral site for many surrounding villages since it has resident physicians. Most villages in Armenia, including those surrounding Shinuhayr, only staff a nurse or a feldsher (nurse practitioner). Therefore the Shinuhayr ambulatory is a pivotal medical resource in the region.

The building is in disrepair. Over 8 years ago, only a few rooms were cosmetically renovated. The capital expense for the program will be in the initial renovation of the outpatient wing of the clinic. This renovation needs to include the flooring, doors and windows, the water and sanitation system, as well as parts of the roof. Water and sanitation are extremely important in the provision of quality health care services. The identified project engineer will need to provide further detail on the present existing system and how to improve it.

To provide a comprehensive and holistic approach, the RMF-Armenia project will focus on four components through which it will help to build local capacity and implement a sustainable program.

The four project components are:
1) Renovation of ambulatory clinic
2) Provision of basic medical supplies and pharmaceuticals
3) Training of health care staff
4) Implementation of community- wide health education outreach programs

Funding for this project is being secured by grants and personal donations. We need your support.
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Thank you for your support!



Primary Care Clinic in Armenia

By Nairy Ghazourian
May 2008


Armenia is one of the world’s oldest civilizations located in the southern Caucasus and is the smallest of the former Soviet republics.  It lies in the highlands surrounding the Biblical mountains of Ararat, upon which, as Judeo-Christian theology states, Noah’s Ark came to rest after the flood (Gen 8:4). Armenia was the first country in the world to officially embrace Christianity as its religion in 300 A.D.  Upon the collapse of the Soviet Union, Armenia declared its independence on September 23, 1991 as a free democratic country.

Armenia has an estimated population of 3,000,000 people of which 70.3% are between 15-64 years. The life expectancy at birth is 72.4 years.  The conditions that account for the biggest burden of disease are cardiovascular disease and neuropsychiatric illness.  Tobacco and high cholesterol level are the dominant risk factors for men, while the main risk factors for women are excess weight and high blood pressure (WHO).

The quality and accessibility of health services for children and mothers in Armenia, particularly in rural areas remain poor.  Immunization Coverage Survey conducted in 2006 jointly by UNICEF and Ministry of Health indicated that the rate of fully immunized children has dropped to 42%. 

It is estimated that 42.9% of the country live below the poverty line. Like other New Independent States of the former Soviet Union, Armenia's economy still suffers from the legacy of a centrally planned economy and the breakdown of former Soviet trading networks. In addition, the effects of the 1988 earthquake, which killed more than 25,000 people and made 500,000 homeless, are still being felt, though international donors and diaspora Armenian groups continue to fund reconstruction efforts in the earthquake zone.

Real Medicine Foundation is currently working toward its goal to establish a primary care clinic in Armenia which will provide free medical, preventative and public health services to the population in need. At this time we are working to identify the area with the greatest number of people living in poverty that have no or very limited access to health and medical care.