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9 2001 9
10 1-1 B IMR B MMR B B B D D A B B E G C D E, F F D D D D D D D A B C D E F Armenia 2001, Statistical Booklet, National Statistical Bureau of Republic of Armenia Highlights on Health in the Repuclic of Armenia, 2001, WHO/EURO Country Assistance Strategy for the Republic of Armenia, 2001, World Bank
11 A/P Authorization to Pay B/A Banking Arrangement BS CIDA Canadian International Development Agency CIS Commonwealth of Independent States DIN ü DOTS Directly Observed Treatment, Short-course EU European Union GDP Gross Domestic Product ICU Intensive Care Unit IMR Infant Mortality Rate JIS MMR Maternal Mortality Rate MOH Ministry of Health NGO Non Governmental Organization NIH National Institute of Health NIS New Independent States PHC Primary Health Care SHA State Health Agency SMU State Medical University UNICEF United Nations Children s Fund USAID United States Agency for International Development WB World Bank WHO World Health Organization
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13 1991 CIS GDP 5 GDP JICA i
14 3 ICU ii
15 iii % 13%
16 380 PHC PHC PHC 3 PHC PHC PHC iv
17 SMU NIH 3 v
18
19 i ii v vii M/D ix x xiii
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21 29,800km ) CIS CIS % missing men marz
22 1990 GDP NIS 1980 EU USAID % NIS PHC - 2 -
23 1-2,1-3 WHO/Europe % 6.6% WHO/Eur WHO/Eur ope ope WHO/Eur ope EU DOTS - 3 -
24 PHC 2 village dispensary PHC 2 3 CIS - 4 -
25 PHC % 20% ,560 25,725 23,574 20,748 12,720 (8,476) 12,650 (8,448) 12,332 (8,161) 11,923 (7,892) 26,060 25,281 24,313 22,164 (10,925) (10,505) (9,966) (9,140) - 5 -
26 Program of Development and Reform of the Health Care System of the Republic of Armenia, PHC The Strategy of Health Care System Development in Armenia, 2000~ Health System Optimization Program 30% 20%
27 PHC PHC - 7 -
28 PHC PHC PHC ~
29 CIS 5 GDP 5 GDP
30 ICU PHC Health Financing and Primary Health Care Development Project 1,000 PHC State Medical University, SMU National Institute of Health, NIH PHC BBPBasic Benefit Program PHC USAIDPHC UNICEF NGO CIDA
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37 3 20 ICU 100KVA NGO
38 ICU
39 %41%60%
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44 A B
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60 - 38 -
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68 , , CIS
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73 3% 13% 3 3 E/N
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81 140 PHC 2 3 PHC 3 DOTS PHC PHC
82 PHC PHC SMU NIH
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89 Rouben Karapetian, Director, Director Asia-Pacific & Afrika Department Michael Vardanian, Head, Pasific and Africa Division Haik Darbinyan, Deputy Minister Levon Eolyan, Deputy Minister Hovhannes Margaryants, Adviser to the Minister Levon Yepiskoposyan, Director, Department of Health Policy Haik Grigoryan, Director, Department of International Relations Karine Saribekyan, Director, Department of Maternity and Child Health Ara Ter-Grigorian, Director, State Health Agency, SHA Hamret Mirzoyan, Director, Dept. of Health Care, Yerevan Municipality Manouk Vardanyan, Chairman Richard Walkling, Chief Executive Officer Karen Israelyan, Executive Director Nikolay Dallakian, Director, Children's Clinical Emergency Hospital Ara Asoian, Director, Infectious Diseases Clinicak Hospital "Nork" Sergey Stepanian, Director, Republican Clinical TB Dispensary DOTS Marina Saferian, Expert, DOTS program v
90 Grigor Grigorian, Director, Medical Center Samvel Hovhannisyan, Head, Department of Family Medicine, NIH Mikayel Nareimanyan, Head, Department of Family Medicine, SMU Hrair Tsolak Aslaniann, WHO Liaison Officer in Armenia Szannna Hayrapetyan, Operation Officer PIU Sergey Khachatryan, Director, Health Project Implementation Unit Tatul Hakobyan, Health Expert Aharon Praff, Health Delegate vi
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115 % % 41% xi
116 ODA x
117 100% 3 xii
118 3 2000~2003 The Strategy of Health Care System Development in Armenia, Concept of Oprimization of the Health Care System of the Republic of Armenia Yerevan Health System Optimization Program, 2001, MOH/Yerevan Municipality PHC Health Financing and Primary Health Care Development Project - Mid-Term Trview Report, 2001 PHC Primary Healch Care Development Program Economic Evaluation of Tuberculosis Control in Armenia, 1998, WHO/EURO Tuberculosis Situation and Control in Armenia, June 26, 2001, WHO/EURO Highlites on Health in the Republic of Armenia, 2001, WHO/EURO Health Care Systems in Transition, Armenia, 2001, European Observatory on Health Care Systems FM Family Physician Statement, Decree N375, June 28, 1999, MOH USAID/PADCO FM Assessment of Family Medicine Training and Education in Armenia and Recommendations for Improvement, March 2001, xiii
119 2000 USAID/PADCO Ten Action Steps Towards the Formuration of a Mandatory Health Insurance Program in Armenia USAID/PADCO Assesment of Armenia's Health Care Financing Sources USAID/PADCO Analysis of Issues Related to the Implementation of Pilot Project in Lori Marz xiv
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i 1 1 1 2 3 5 5 6 7 9 10 11 13 13 14 15 15 16 17 18 20 20 20 21 22 ii CONTENTS 23 24 26 27 2 31 31 32 32 33 34 37 37 38 39 39 40 42 42 43 44 45 48 50 51 51 iii 54 57 58 60 60 62 64 64 67 69 70 iv 70 71
7 i 7 1 2 3 4 5 6 ii 7 8 9 10 11 1 12 13 14 iii.......................................... iv................................................ 21... 1 v 3 6 7 3 vi vii viii ix x xi xii xiii xiv xv 26 27
9 i 9 1 2 3 4 5 6 ii 7 8 9 10 11 12 .......................................... iii ... 1... 1........................................ 9 iv... v 3 8 9 3 vi vii viii ix x xi xii xiii xiv 34 35 22 1 2 1
i ii iii iv v vi vii viii ix x xi xii xiii xiv xv xvi 2 3 4 5 6 7 $ 8 9 10 11 12 13 14 15 16 17 $ $ $ 18 19 $ 20 21 22 23 24 25 26 27 $$ 28 29 30 31 $ $ $ 32 33 34 $ 35 $ 36 $ 37 38 39 40 $ 41 42 43 44
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PART2 iii ii iv v 1 2 3 4 5 vi vii viii ix P A R T 1 x P A R T 2 xi P A R T 3 xii xiii P A R T 1 2 1 3 4 1 5 6 1 2 1 1 2 7 8 9 1 10 1 11 12 1 13 1 2 3 14 4 1 1 2 3 15 16 1 17 1 18 1 1 2 19 20 1 21 1 22
困ったときのQ&A
ii iii iv NEC Corporation 1998 v C O N T E N T S PART 1 vi vii viii ix x xi xii PART 2 xiii PART 3 xiv P A R T 1 3 1 2 PART 3 4 2 1 1 2 4 3 PART 1 4 5 5 6 PART 1 7 8 PART 1 9 1 2 3 1 2 3 10 PART 1 1 2
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1996 2 10 1997 NGO 2006 11 NGO NGO 10 NGO 1 2011 7 ADB AsDF CIDA DDC DFID GDI GDP GIZ HDI IDA IDCJ JICA LGCDP MC/PM MDC NGO ODA SDC SWC UML UNDP UNMIN VDC Asian Development Bank Asian Development Fund
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第１章 調査の概要
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ii iii iv v 2 vi vii viii ix x xi xii xiii xiv xv xvi xvii 1 CHAPTER 1-1 1-2 1-3 2 CHAPTER 2-1 2-2 2-3 2-4 1 2 2-5 3 4 2-6 5 6 2-7 7 8 2-8 9 2-9 10 11 2-10 12 13 2-11 14 15 2-12 16 17 18 2-13 1 2 2-14
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1998 6 25 ( ) 1 10 1982 10 28 37/7 1990 12 14 45/94 (WHO) 1 1989 12 8 NGO (ECE) 3 1995 10 25 ECE 1991 2 25 1992 3 17 1998 6 4 1 2 1. 2. a b c (a) (b) d 17 3. a b (a) c (b) 4. 5. 3 1. 2. 3. 4. 5. 6. 7.
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vii ix xi xii xiii xiv xv 1 2 1 2 3 3 4 5 4 6 5 7 8 6 9 7 10 11 12 13 14 8 15 1 2 16 3 17 4 18 19 20 5 21 22 23 24 6 25 7 8 26 27 28 29 9 30 31 10 32 33 34 11 35 36 37 12 38 39 40 13 41 14 42 43 44
第3章 日本の対タンザニア援助の評価
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i ii iii iv v vi vii viii ix x xi xii xiii 2 3 4 5 6 7 8 9 10 11 12 13 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50A 50B 51A 51B 52 54 55
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困ったときのQ&A
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