MAY 15, 2012  Ministry of Health Website

On May 15, USAID HS-STAR project, in collaboration with the Ministry of Health, organized a round-table discussion on the “Public Private Partnership (PPP) promotion in Armenian healthcare” with the participation of MOH and private sector representatives. Banking, telecommunications, mining companies’ and retail trade networks’ directors, marketing, PR and CSR specialists participated in the discussion. PPP is widely practiced in the developed countries of the world, and MOH gives high priority to the introduction of the PPP practice into the Armenian reality.

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MAY 10, 2012

The Ministry of Health of Armenia, in the framework of its “clinical standardization initiative”, highly appreciates the role of Republican Scientific Medical Library’s (RSML) newly established evidence-based medicine (EBM) center in assuring the EBM based quality of clinical standards. The recently formed center provides technical and methodological support to MOH clinical standard  development working groups to obtain EBM based information. USAID HS-STAR project also tangibly contributes to this initiative. Particularly, in response to RSML request, HS-STAR provided the center with computers and EBM related 22 books in Russian. Earlier, the project had assured RSML’s subscription to Cochraine online library. Thanks to this action, numerous users of the library are able to access and use the wide opportunities of this worldwide scientific medical network.

It is also envisaged to conduct trainings, workshops and seminars at the EBM center. RSML director Anna Shirinyan clarifies: “The goal of the center is not only to provide relevant materials- books, journals, catalogues, but also to organize specific courses, which will introduce their participant to EBM principles.” On May 8, the donation ceremony of computer equipment to RSML took place. After the event, a working group, formed to develop public education materials and protocols on “cardiovascular diseases and diabetes risk assessment and management” for healthcare specialists, held its regular meeting at the center. HS-STAR project will continue to provide comprehensive support to the Republican Scientific Medical Library and its EBM center.

MAY 10, 2012  Ministry of Health Website

An evidence based medicine center has been established recently at MOH Republican Scientific Medical Library, which is to assure the EBM based quality of clinical guidelines. In response to RSML request, HS-STAR project provided the center with computer sets and EDM 22 books in Russian: Earlier, the project had assured RSML’s subscription to Cochraine online library.

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MAY 10, 2012

USAID HS-STAR project in collaboration with Yerevan State Medical University started a series of 5-day trainings on “Prevention of non-communicable diseases and management of cardiovascular diseases” in May, 2012. It is planned to have ten training courses at 10 Yerevan primary healthcare facilities. Overall, 150 providers: family doctors, cardiologists and general practitioners will participate in the trainings. The courses aim to improve NCD prevention, early detection processes at PHC facilities, and foster the management of NCD processes based on contemporary evidence based medicine principles. YSMU professors will lead the seminars. All trainers have taken adult learning methodology courses organized by HS-STAR project.

The trainings will have interactive nature employing situation analyses tests, discussions and group works along with providing theoretical knowledge. Medical chart reviews on focused topics will be carried out before and after each training course to assess the physicians’ performance before the training courses and assess post training knowledge and their practical application. The first 5-day training course took place at Yerevan N8 Polyclinics and ended on May 8. Fifteen providers of this facility participated in these courses. The trainees were quite delighted with the content of the courses and methods of their conducting. “It was very comprehensive 5-day training, – clarifies Marina Lalayan, N8 Polyclinics general practitioner,- particularly, the exchange of ideas and group discussions were quite useful. We’ll apply this knowledge, received from the best specialists of this arena, into our routine practice.” Stay tuned for more news about the trainings implemented with support from the project.

MAY 2, 2012

USAID HS-STAR project started a series of trainings on a number of actual Issues in maternal and reproductive health from April, 2012. The first training course on the basics of preconception care basics took place in “Saint Grigor Lusavorich” medical center on April 26. The aim of these trainings is improvement of knowledge and technical competencies of physicians enabling them to offer safer and high quality maternal and reproductive health care services.  Around 250 providers from selected primary health care (PHC) facilities and maternity hospitals in Yerevan will participate in these trainings. The focuses of the above courses are preconception health care, basics of counseling in reproductive Health/Family Planning and basics of care during childbirth and early postpartum period. Selected faculty members from Yerevan State Medical University (YSMU) will be acting as trainers for the above training courses.

Medical chart reviews on focused topics  will be carried out before and after each  training course to assess the physicians’  actual performance before and after each training course and assure   post training endorsement  of relevant skills into routine practices.  Moreover, during trainings the pre and post training knowledge tests will evaluate the trainees’ received knowledge. Particularly, the knowledge testing during the first training on Preconception Care principles showed quite high results. “According to the pretest results the participants’ knowledge scored аt 63%. The posttest results recorded dramatic increase in participants’ knowledge: up to 99%,” gladly clarified HS-STAR’s MCH/RH advisor Gohar Panajyan. The MCH/RH trainings in Yerevan will last until late July-early August, each week taking place in a different medical center. Stay tuned for more news about the trainings implemented with support from the project.

APRIL 25, 2012

In 2012, the Family Medicine Independent Practicioners (FMIP) institution will function in Armenia. Currently, the introduction of five family medicine practices in underway, from which two are collective and three individual practices. USAID HS-STAR project directly supports all formation processes of three independent practitioners. Moreover, HS-STAR project is also to provide all five entities with continuous methodological, advisory and educational backing both at their establishment phase and during their full-scale activities.

In this context, on April 21 the first seminar took place marking the launch of the training courses on management, financial management, financial accounting, expenditures accounting and other relevant and important themes for five FMIIPs doctors. The seminar-courses will be held once or twice a month and will last until October. An expert in each arena will lead the corresponding seminar.  Seven family doctors will participate in these trainings. HS-STAR also envisages conducting trainings for these FMIIPs’ accountants and nurses in the future. “Newly established family doctors lack the experience, necessary knowledge and skills of running an independent business entity, and our trainings aim to make them FMIP skilled managers- administrators and organizers,” clarifies HS-STAR advisor Garnik Harutyunyan.

The project has already provided the trainees with necessary educational packages- medical and administrative methodological guidelines and books. During the first training course broader and introductory topics were discussed, namely the health system structure, current legislation, licensing and state order application procedures. The topics for the next seminars were identified and assessed after discussions with participants. These themes will address the practical issues and challenges, which the FMIPs will face at particular stages of their activities. Stay tuned to our project news to get further updates on the next steps and achievements of FMIP introduction process.

APRIL 11, 2012

On April 10, at “Saint Grigor Lusavorich” medical center Yerevan State Medical University Emergency and Disaster Medicine department initiated a workshop-discussion on “Pre-hospital emergency care models in world developed countries” with the participation of Armenia’s leading specialists in this arena. The workshop was a continuation of a series of discussions organized by USAID HS-STAR project on emergency care situation improvement in Armenia, and aimed at informing the participants about the emergency care systems in world-developed countries and their experience, and at pondering over possible application of some elements into our system.   “Saint Grigor Lusavorich” medical center director, YSMU department head, professor Ara Minasyan conducted the meeting.

Mr. Minasyan introduced the participants to the United States emergency care system, its peculiarities and progress. Afterwards, the pre-hospital emergency care systems and their reforms in the European countries were presented.  Lively discussions followed the presentations, where the participants discussed the situation of emergency care in Armenia, implemented reforms, further improvement ways and strategies. Participants also emphasized the need of forming a professional association. The association will reveal the current problems in Emergency system and will consistently address those issues.

APRIL 09, 2012

Behavior Change Communication (BCC) is a systematic approach that draws on social science, adult learning theory, and marketing to encourage adoption of sustained behaviors that can be used to prevent or mitigate disease. Anti-tobacco posters that aim to discourage women from smoking are an example of BCC. To improve BCC efforts in Armenia, the USAID HS-STAR project organized two-day training on BCC for Ministry of Health (MOH) public education officials on March 31-April 1, 2012 in Tsakhkadzor, Armenia. Representatives from the MOH Public Relations and Public Health Education departments, the State Hygienic Anti-Epidemiological Inspectorate (SHAI) regional centers, and SHAI regional center public health departments participated in the course. The aim of this introductory training course was to provide participants with sufficient knowledge about BCC approaches and tools to manage the implementation of public education strategies and activities.

Gael O’Sullivan, the Senior Technical Advisor for BCC from Abt Associates’ headquarters, led the training with support from HS-STAR’s Civil Society Engagement team. During the two-day course, Mrs. O’Sullivan introduced the participants to BCC theories, provided an overview of the main principles of BCC, and explained the key steps for proper design and implementation of a BCC strategy. Mrs. O’Sullivan presented the information through a combination of lecture, case studies, group discussion, and role play. Thanks to the interactive nature of the training, the participants had many opportunities to ask questions and propose recommendations for applying BCC approaches and activities to the Armenian context.

Many of the participants found the training to be very relevant for their work. Armine Andryan, MOH SHAI Shirak regional center public education department head, explained how she and her colleagues would change their approach to public education as a result of the training: “Before, we used to implement all our activities without any coherent methodology. We didn’t identify our audience, our goal, or our action plan, and we didn’t evaluate our results. Now that we are acquainted with the methodology, we know how to start the process, how to plan it, how to study the characteristics of our audiences, and how to influence them through correctly designed messages.” Similarly, Karine Gevorgyan, MOH SHAI Aragatsotn regional center epidemiologist, commented on how the training would affect her work: “Deployment of the presented methods will enable us to conduct more systematized campaigns and, most importantly, to evaluate their results.”

The HS-STAR project urged the trained specialists to apply the knowledge they obtained at the training by developing public education projects for their marzes and involving local NGOs, which can play an important role both in finding financial resources for projects and in implementing planned campaigns. The participants stressed that these kinds of trainings should be continuous. The HS-STAR project will continue to provide comprehensive methodological support to MOH entities involved in public education methodology, resource allocation, project and campaign implementation, and strategy development.

APRIL 06, 2012

On April 4, 2012, USAID HS-STAR project representatives awarded certificates to 26 medical and administrative staff from Yerevan “Ambulance” CJSC who completed an emergency care IT training. This event marked the completion of the first stage of the trainings for the emergency care staff, which aimed to improve their existing computer skills, provide them with the computer skills needed to operate the new dispatcher automated system, and prepare them for the upcoming system. Overall, 30 administrative employees and 78 dispatchers from Yerevan “Ambulance” CJSC participated in these training courses conducted by “CHS Verisel Service,” an organization hired by HS-STAR. According to trainings coordinator Heriknaz Archunts, “During this first stage of the trainings, the trainees learned general computer skills, particularly fast touch typing skills, which are essential for emergency staff.” The second stage of trainings, which will start immediately after the development of the emergency care software packages, will teach the dispatchers how to use the software.

During the awards ceremony, the director of “Ambulance” CJSC Taguhi Stepanyan stressed the importance of the automatized system installation throughout her organization: “All modern approaches used by the emergency care service are based on automatic information exchange and improved communication systems. Currently, the Yerevan emergency service is equipped with a GPS system, computers and relevant software. Moreover, we plan to install automated systems in all services and functions of our company departments. That is why we pay tremendous attention to enhancing the computer skills of our dispatchers. They will be able to handle each call much faster: quickly registering the call, seeing the current location of our ambulances on the monitor, and immediately sending out the nearest ambulance.”

The trainees were pleased with the course results and eager to apply their knowledge at work. “For decades, the dispatchers in emergency care service have worked with pen and paper. Now, we are able to use modern techniques, such as taking the calls through computers, and perform our work much faster. Through this training we realized that registering a call, which takes at least 2-3 minutes to do manually, can now be done in a matter of seconds, thereby saving vital minutes,” gladly noted Hripsime Amirkhanyan, “Ambulance” CJSC N5 substation dispatcher. Gayane Darbinyan, N5 substation dispatcher, commented on the quality of the training: “Overall, the courses were provided quite professionally, and were very useful for our professional development and enhancement of our computer skills.”

The USAID HS-STAR project supports the Ministry of Health (MOH) in the process of modernizing the emergency care service in Armenia through the provision of equipment, technical assistance, and capacity building. In 2012, HS-STAR will work closely with the MOH to introduce a new automated dispatcher system and create emergency dispatcher centers first in Yerevan and then in the marzes. The centers will be equipped with special dispatcher computer software and modern technologies corresponding to high international standards. At the end of the whole process, the Armenian emergency service will function according to the standards of Western counterparts. Stay tuned for more news about the project’s upcoming support to the modernization process of the Armenian emergency care system.

APRIL 5, 2012

Abt Associates Inc. International Newsletter January-March, 2012 issue has highlighted the process of HS-STAR support to modified MIDAS system installation all over Armenia. Thanks to the initiative of the Ministry of Health (MoH) State Health Agency (SHA) and support from the USAID HS-STAR project, the updated version of the MIDAS-3 automated information system was recently installed in all Primary Health Care (PHC) facilities of Armenia. The overall purpose of the MIDAS system is to improve the efficiency of healthcare service organization, management, quality improvement and financing in Armenian health institutions through better health information.

You may read the article in the 4th page of the newsletter attached below:

Q4 FY12 newsletter_English

April 03, 2012

On March 30 2012, HS-STAR project organized a workshop on Pediatric hospital referrals and pediatric hospital services quality, considering the importance of these issues after the introduction of the Child care certificate program back in January 2011. A representative group composed of MOH experts and leaders of Mother/child health care services, facility managers, pediatricians working at the PHC and hospital level form Yerevan and Armenia’s regions and project technical team participated in the meeting.

Five keynote speakers representing MOH’s MCH Department, National IMCI program, American University of Armenia’s Center for Health Services Research and Development (CHSRD), National program on the Integrated management of childhood illnesses (IMCI), Armenian Association of pediatricians as well as World Vision Armenia delivered presentations. The presentation highlighted an array of topics related to the pace of reform processes in the mother/child health protection arena, the situation of the pediatric hospital services delivery in Armenia, the results of child hospital care certificate program assessment, the existing challenges and opportunities in pediatric hospital referrals and the quality of pediatric hospital services delivery. Particularly, the results of the Child care certificate program evaluation revealed trends in accessibility, affordability, organization of pediatric hospital care services from both-provider and caregivers’ perspectives with a special focus on pediatric hospital referrals and its key determinants. Presentation of current trends in child morbidity in Armenia and analysis of promises for pediatric hospital care improvement were helpful in visualizing the preconditions of successful reform implementation.

The presentations were followed by active discussions by the workshop participants on the existing situation regarding child hospital referrals, on possible strategies for the reduction of unjustified hospital referrals and for the improvement of the quality of pediatric hospital services delivery, which will later serve as a basis for future steps prioritization. At the end of the workshop, it was decided that, based on the information presented during the workshop and the key discussion topics, the workshop participants will provide HS-STAR team with concrete recommendations and next steps for reducing unnecessary pediatric referrals and improving the quality of pediatric hospital services delivery. It is anticipated that the final set of recommendations will be sent to the Ministry of Health for further decision making purposes.

MARCH 23, 2012

On March 22, one of the quest speakers of “Yerkir Media” TV “Hello country!” morning live TV program was USAID HS-STAR project Quality Improvement Team Leader, family doctor Karine Abelyan. The TV program addresses various health topics on Thursdays, and this program’s goal was to talk about smoking hazards and provide helpful advices to those who have decided to quit smoking.

Karine Abelyan accurately presented how to organize correctly the process of quitting smoking, and overcome the psychological difficulties of that process. . Dr. Abelyan emphasized the detrimental impact of secondary smoke and exhorted smokers not to put the health and lives of their loved-ones, family members and co-workers into danger. Get the speakers’ other interesting observations by watching the whole interview (in Armenian).

WATCH THE FULL INTERVIEW (in Armenian)

MARCH 19, 2012

USAID HS-STAR project organized a workshop on “Healthcare Quality Assurance: Quality Improvement Approaches at Hospital Settings” on March 15. Healthcare quality improvement international expert, Professor Nigel McCarley was the key speaker of the meeting. The goal of the workshop was to introduce main issues in healthcare quality assurance, understand quality assurance cycle, consider a range of QA approaches/tools used internationally, in this context discuss the quality improvement approaches at hospital settings in Armenia and agree on the framework of the strategy for hospital healthcare quality improvement. Representatives from the Ministry of Health quality management, maternal and child healthcare departments, State Health Agency, State hygiene and anti-epidemiological inspectorate, Yerevan municipality and regional Health and Social Security Departments, hospitals directors participated in the workshop.

The international expert presented the fundamentals of quality and quality assurance key points. It was stressed that one should differentiate between customer and consumer. In developed countries, a patient is treated as a customer, who has his/her defined rights, selects his preferred provider and hospital, requires high quality treatment and may claim for compensation if not satisfied. In developing countries, a patient is treated more as a consumer, who just acquiescently accepts his/her treatment. “Can you imagine a patient questioning your competency in Armenia?” asked Mr. McCarley to participant physicians.

“No blaming” principle is also important in quality assurance process. “We should realize that mistakes are common in large systems, and systemic failures are their main causes. Mistakes should be used as a means to detect, address and prevent failures, not to blame specialists,” stressed Nigel McCarley. The expert clearly emphasized a need of quality assurance culture: “Quality system may operate only in a setting that has a quality assurance culture, where each specialist realizes the efficiency of the system and promotes it.” Afterwards, Nigel McCarley elaborately discussed the common terms in the quality arena, Total Quality Management system, principal approaches of quality assurance in healthcare, and the model of EFQM (European Foundation for Quality Management).

Discussions on improvement of the Armenian hospital services quality followed the presentation. Participants proposed their recommendations on precise steps, processes and measures to develop Armenian hospital care quality assurance system. Particularly, the introduction of compulsory health assurance, strengthening the quality control commissions at hospitals, development of specific quality assessment indicators and standards, improvement of hospital admission services, prevention of nosocomial infections, analysis of adverse incidents may substantially improve the hospital healthcare quality assurance/improvement process in Armenia. At the end of the workshop, the participants highly appreciated the provided information and resulted recommendations. HS-STAR project will consider these proposals in its further healthcare quality improvement activities.

MARCH 12, 2012

In March 7, USAID HS-STAR project organized a workshop on “Transition of PHC facilities to financing based on enrolled/registered population: problems, solutions” with the participation of Yerevan PHC facilities heads. Deputy Health Minister Sergey Khachatryan, Yerevan municipality Health department deputy head Olga Vardanyan and chief specialist Levon Hakobyan, heads of Yerevan PHC facilities participated in the workshop. The aim of the meeting was to present the HS-STAR analyses, discuss the roots of current problems, listen to participants’ thoughts, concerns and recommendations on addressing the situation, to clarify to PHC facilities heads how to develop a document on assessment of PHC facilities situation, identification of problems and recommendations for solutions in required format.

In his opening speech, the Deputy Health Minister stressed that տհե USAID and Ministry of Health joint efforts have resulted in a significant progress in the development of PHC sector in Armenia. Tangible investments were done, and all programs would be continuous. HS-STAR project Deputy Chief of Party Gayane Gharagebakyan presented an analysis on “Primary Health Care system enrollment based financing, PHC physicians allocation and performance and PHC workforce planning” based on Yerevan situation. The analysis implemented by HS-STAR project, aimed at studying the overall situation of Yerevan PHC facilities enrollment based financing and identifying factors impeding this financing model, also at presenting recommendations to decrease or eliminate those factors. It was also analyzed how the PHC provider workforce will be allocated if the above-mentioned system is adopted.

According to the study results, if the PHC service financing is implemented only by the number of registered population (in Armenia only 89,4% of population have selected doctors and were registered), the “under-financing” of Yerevan PHC facilities will be equal to the amount calculated for not registered population. It was accentuated that the number of physicians in Yerevan is almost three times as many as the average European figures. “We have serious problem of excessive physician number, which impedes all potential reforms,” emphasized HS-STAR DCOP Gayane Gharagebakyan. Most of the Yerevan doctors are under loaded; with average patient daily visits several times as less as even in Russia. HS-STAR DCOP also proposed the project recommendations on abating the consequences of “under-financing”, the simulation model and recommendations based on this simulation model. Active discussions followed the presentations, during which Yerevan PHC facilities heads presented their concerns, problems and considerations. Deputy Health Minister, summing up the presented concerns emphasized that the Ministry gives an utmost priority to this issue: “It is unacceptable to have doctors who provide less patients than it is envisaged by the normative. We have to maintain the norms; and they won’t be reduced under any circumstances.”

At the end of the workshop, HS-STAR advisor Gayane Igitkhanyan presented and clarified the nuances to develop a document on assessment of PHC facilities situation: number of enrolled population, PHC physicians’ workload assessment, identification of problems and recommendations for solutions. Yerevan PHC facilities managers were requested to analyze their facilities’ problems based on the presented document and submit their plans with proposed activities list and timeframe to overcome those problems to Yerevan Municipality Health department by March 20.  Afterwards, HS-STAR experts together with MOH and Municipality specialists will analyze the submitted documents and develop the further strategy based on the results.

MARCH 09, 2012

“A very interesting and meaningful training.” “Training package included all that NGOs need.” “I never received all these together.” This is how the participants characterized a training course: “Health NGOs institutional capacity building”, organized from February 27 to March 06, 2012 by USAID HS-STAR project in collaboration with Counterpart International. Twenty-five representatives from Armenian 15 predominantly health NGOs participated in the trainings. The aim of the trainings was to raise the institutional capacities of Armenian health, advocacy and community non-commercial NGOs, which are involved in public policy, advocacy, and information provision- promoting their further active involvement in Armenian health initiatives.

During three days of the courses, Counterpart Int. experts Arsen Stepanyan, Tatevik Melikyan, Gayane Martirosyan and Gayane Vardanyan conducted trainings on “Advocacy” and “Types of networking collaboration.” On the following days, the experts from the same organization Ani Dallakyan and Mane Tadevosyan conducted a course on “How to conduct research analysis and surveys”, and Nuneh Pepanyan delivered training on “Social partnership: the peculiarities of its implementation mechanisms in Armenia.” Ministry of Health expert Rosa Babayan led courses on “Legal problems of RoA health system and law implementation mechanisms” and “The analysis of RoA health legislation gaps and policy monitoring.”

Through these courses, the trainers tried to develop the participants’ external relations capacities by increasing their knowledge and skills on social partnership mechanisms and networking collaboration; their service provision capacities by increasing their knowledge and skills on trainers teaching methodologies on advocacy and public communication; and their legislative initiation capacities by raising their skills on health legislation analysis/ control and law implementation mechanisms. Every participant of the training assumed an obligation to transfer the gained knowledge to the other members and stakeholders of his or her organization.

Certificate awarding ceremony followed the completion of the training courses, during which HS-STAR project Chief of Party Robert Hagan expressed a hope that civil society organizations would practically apply the acquired knowledge in their further activities. The participants thanked HS-STAR project, pointing that they would certainly realize the acquired skills in their activities, and in this sense this was a unique course. “A very meaningful and interesting training; in a short period we received serious knowledge, which will be very useful for our organization’s further plans, enabling us to undertake more targeted steps,” elaborated “Kanachastan” NGO representative Ani Hakobyan.

“The training package included all that NGOs needed- advocacy, issue management, types of collaboration etc. I have never been provided with all these. Our organization plans to form an advocacy network very soon, and during this activity we will practically realize the acquired knowledge,” noted “We are for civil equality” NGO program manager Ashot Gevorgyan. “Mission Armenia” NGO representative Ashkhen Yesayan emphasized: “As a lawyer it was very important for me to get acquainted with NGOs approach to advocacy. It was quite useful to learn that it is preferable to prevent the development of non-desirable realities from their roots, rather than deal with the legal elimination of their negative results.” The participants were also delighted with the professionalism of the trainers and their teaching skills and hoped that the course will be continuous.