13 6 26 7 27 13 10 9 10 25 14 1
13 6 15 13 1 7 14 1
ICU 1 X
2001 9
1-1 B 2 1-2 IMR B 2 1-3 MMR B 2 1-4 064 B 3 1-5 064 B 3 1-6 5 1-7 8 2 11 3-1 39 3-2 40 3-3 41 3-4 44 4-1 2000 D 56 4-2 2000 D 57 1-1 A 1 1-2 1999 B 3 1-3 1999 B 3 1-4 E 5 1-5 G 7 1-6 7 1-7 2000 C 9 2-1 D 11 2-2 E, F 12 2-3 3 F 13 2-4 D 13 2-5 D 14 2-6 D 15 2-7 3 D 17 2-8 2000 D 18 3-1 D 33 3-2 D 33 3-3 34 3-4 36 3-5 44 3-6 44 3-7 45 3-8 46 3-9 48 3-10 48 3-11 49 3-12 50 3-13 50 4-1 52 4-2 54 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
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
1991 CIS GDP 5 GDP 19962000 2001 6 3 3 12 10 JICA 13 6 25 7 27 13 10 9 10 25 i
3 ICU ii
iii 2 10.5 4.95 3% 13%
380 PHC PHC 2 3 2 3 PHC 3 PHC PHC PHC 1. 2. 3. 4. 5. 6. 7. 8. 8 iv
SMU NIH 3 v
---------------------------------------- 1 ---------------------------------------- 1 ---------------------------------------- 1 ---------------------------------------- 6 ---------------------------------------- 9 ---------------------------------------- 9 -------------------------------------- 10 -------------------------------------- 10 -------------------------------------- 11 -------------------------------------- 11 -------------------------------------- 11 -------------------------------------- 12 -------------------------------------- 13 -------------------------------------- 15 -------------------------------------- 17 -------------------------------------- 19 -------------------------------------- 19 -------------------------------------- 19 -------------------------------------- 20 -------------------------------------- 20 -------------------------------------- 21 -------------------------------------- 21 -------------------------------------- 23 -------------------------------------- 39
-------------------------------------- 42 -------------------------------------- 42 -------------------------------------- 42 -------------------------------------- 42 -------------------------------------- 43 -------------------------------------- 43 -------------------------------------- 43 -------------------------------------- 44 -------------------------------------- 45 -------------------------------------- 46 -------------------------------------- 47 -------------------------------------- 47 -------------------------------------- 47 -------------------------------------- 51 -------------------------------------- 52 -------------------------------------- 52 -------------------------------------- 58 -------------------------------------- 59 -------------------------------------- 60 ----------------------------------------- i ---------------------------------------- ii ---------------------------------------- v ---------------------------------------vii M/D ----------------------------------------ix -----------------------------------------x -------------------------------------- xiii
29,800km 2 13 1) CIS 380 9 11 19 CIS 1988 100 1994 197599 1-1 1.2% 1970 3.0 1990 1.4 missing men 94 100 marz 11 10 3 120-1 -
1990 GDP 1988 1-1 20 1990 199899 NIS 1980 EU 20 1-2 1988 1990 1998 USAID 15.7 20% 15 20 NIS 1990 10 PHC - 2 -
1-2,1-3 WHO/Europe 1 64 3% 6.6% 1-2 1999 WHO/Eur WHO/Eur ope ope 1-3 1999 WHO/Eur ope 1990 1-4 20 1993 1995 20 EU 1-5 1993 1996 DOTS - 3 -
PHC 2 village dispensary PHC 2 3 CIS - 4 -
PHC 40 3040% 20% 1-4 1997 1998 1999 2000 25,560 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 -
1996 2001 3 3 Program of Development and Reform of the Health Care System of the Republic of Armenia, 1996-2000 PHC The Strategy of Health Care System Development in Armenia, 2000~2003 2001 6 Health System Optimization Program 30% 20% 6000-6 -
PHC2 3 1-5 1-6 1 PHC - 7 -
200500 1999 2000 PHC PHC PHC 40 1-7 3 400~500 2 150200 3 2 5 11 5 40 5-8 -
CIS 5 GDP 5 GDP 1-6 2000 1996-2000 1999-9 -
2000 10 4 3 ICU 1996 1999 1998 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 2 3 56 USAIDPHC UNICEF NGO CIDA - 10 -
3 2 3 18 3 2-1 2-1 - 11 -
2-2 79 2001 178 32 1 550 1999 7 State Health Agency, SHA 2-2 1997 1998 1999 2000 2001 118.0 160.8 191.7 252.8 241.7 12.3 17.7 18.1 20.3 17.8 3.7 5.5 4.8 14.4 14.8 13.0 140 25 1 =550 350 1999 2000 2001 6 52 34 2000 19992000 70 40%2001 3 2001 95 70 300 2-3 3 120150-12 -
2-3 3 * 3 2-4 1999 2-4 6 1 23 3 2-5 - 13 -
2-5 - 14 -
39~41 5 9 3 20 3 2 2 4 1956 3 2 2 10m 3 40 2-6 2-6 3 15,000 m 2-15 -
3 20 ICU 100KVA 10 7 2 10 45 3 3 NGO 8 2-16 -
ICU 3000 150 3 2-7 24 3000 600 2000 3000 800 10 2000 1400 900 2-7 3-17 -
3 1999 360 350 500 2001 262 278 365 50 2 2-8 3 2000 33%41%60% 2000 2001 2-8 2000-18 -
3 35 10 30 3 2 2 2 3 3 8002000m 1000 8 25 1-5 280mm - 19 -
3 24 3 3 3 3-20 -
- 21-3 ICU ICU ICU 2
A B - 22 -
20 50 20 10 12 260 450 45%2000 1 1 No. 40 4 4 41 2 2 2 2 42 2 2 62 2 2 72 1 1 74 1 1 77 2 2 88 2 2 91 1 1 100 2 1 2 1 86 1 1 1 1 1 1 1 1 1 1 1 1 70 1 1 X 15 1,500 1,000 1-23 -
1 No. 105-A 1 1 102 1 1 103-A A 3 2 104 5 4 93 1 1 26 1 1 27 1 1 84 1 1 18 1 1 33 1 1 23 1 1 1 1 2 3 16 1 ph - 24 -
No. No. 10 1 1 14 5 5 81 2 2 97 1 1 9 2 2 7 1 1 57 3 3 37 5 5 16 1 1 79-A A 3 3 8 2 2 1 36 2 2 1 78 1 1 2 39 3 3 1 1 2 2 1 56 4 4 ICU 4 3 1 1,800 3 3 1 4 1 2 3 1 1 No. No. 67 1 1 12 2 1 68 1 1 13 1 1 69-A A 1 1 4 1 1 63 3 3 54 1 1 1 1 2 4 3 23 1 1 28 3 3 66 1 1 72 3 3 22 1 1 86 3 3 106 1 1 1 104 5 5 45 2 2 103-A A 3 2 48 2 2 3 1 1 49 2 2 29 0 1 50 2 2 35 2 1 44 / 2 2 88 2 2-25 -
ICU 2 ICU 4 12 50% 6 ICU 6 2 4 2 4 2 4 2 4 ICU 1 6 2 1 ICU ICU No. No. 72 6 6 107 1 1 42 6 6 22 1 1 86 6 6 26 1 1 94 4 4 29 1 1 95 2 2 1 88 2 2 100 2 2 40 2 2 1 41 2 2 No. No. 5 3 3 86 1 1 37 2 2 103-B B 1 1 80 1 1 60 1 1 75 1 1 59 1 1 71 1 1 96 2 2 89 1 1 53 2 1 57 1 1 1-26 -
260 ICU 40 40 35 35 25 60 20 1 17,000 18,500 C 7,000 1-27 -
1,500 20 2,500 1 ICU - 28 -
ICU NGO ICU - 29 -
No. 31 1 1 90 1 1 1 1 32 1 1 30 1 1 1 1 1 1 65 1 1 1 1 103-A A 1 1 1 1 76 15 5 10 15 5 10 55 2 2 20 1 1 17 1 1 34 1 1 21 1 1 1 1 86 1 1 1 1 1 1 87 3 1 3 1 82 4 1 1 1 3 1 1 1 83 2 2 29 1 1 1 1 1 1 1 85 4 1 1 1 3 1 1 1 101 4 1 1 3 1 1 43 1 1 1 1 1 1 1 2001 9-30 -
3 No. 58 1 1 3 39 4 4 3 73 ph 1 1 1 7 2 2 1 37 1 1 79-A A 1 1 WBC, RBC, Ht, Hb, WBC 18,000 10,000 ph 1-31 -
ICU 2 3 1 2 3 100 2 1 1 No. No. 67 1 1 54 1 1 69-B B 1 1 11 1 1 63 2 2 22 2 2 2 2 2 29 2 2 28 2 2 61 2 2 72 2 2 85 2 2 45 2 1 86 2 2 51 2 1 87 1 1 52 2 1 1 49 2 1 C 1 48 2 1 1 46 2 1 37 2 2 47 2 1 43 2 2 ICU 4 7 2 No. No. 22 1 1 82 5 2 29 2 1 86 2 1 38 ICU 4 4 87 1 1 72 2 2 94 2 2 77 1 1-32 -
3-2 3-1 3-2 - 33 -
3-33-4 3-3 - 34 -
- 35 -
3-4 - 36 -
- 37 -
- 38 -
- 39-3-1
3-2 - 40 -
3-3 - 41 -
E/N 1999-42 -
111 53 6 3-5 3-6 37-43 -
3-5 3-6 3-4 - 44 -
3-7 - 45 -
3-8 3-8 10,910 1.3 1,800 3 3 150250 CIS - 46 -
4.95 4.60 0.35 4.95 3,295 0.4 4,925 0.6 2,690 0.3 10,910 1.3 13 12 1 121.78 10.5 1-47 -
2000 1 3-9 3-10 - 48 -
3-11 18.0 27.3 30.7 5 2 1 3-11 - 49 -
6,000 200 1725 125 ME 50 1 3-12 7 2 2.62.8 4 1 5 1 3-12 - 50 -
3% 13% 3 3 E/N - 51 -
3 3 380 4-1 3 3 ICU 111-52 -
3 25% 3 3-53 -
4-2 4-2 3 3 3 3-54 -
3 2000 3 ICU 12 27 40 13 10 22 19 11 20 25 33 7 3 3 4-1, 4-2 - 55 -
- 56 -
- 57-3,700 650 3,400 800 1,700
140 PHC 2 3 PHC 3 DOTS PHC 2700 2000 1 PHC - 58 -
PHC PHC SMU NIH 3 3 3-59 -
- 60 -
i
ii
iii
iv
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
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
380 2000 2005 3 11.5 17.9 2000 3700 2005 3400 2000 2005 83% 2000 650 800 2000 33% 41% xi
ODA 96 98 99 30 3 3 3 111 4.95 140 3 2002 1 12 x
100% 3 xii
3 2000~2003 The Strategy of Health Care System Development in Armenia, 2000-2003 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 99 6 28 375 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, 2001 7 xiii
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 2000 12 Analysis of Issues Related to the Implementation of Pilot Project in Lori Marz xiv