08.2007 - Source: Country of Return Information Project

Limited access to basic and specialized health care services ("Country Sheet; Armenia") [ID 21424]

"Paid medical services, as a concept, were officially introduced in Armenia from 1997 to 2005. They were applied to medical care and services provided outside the framework of healthcare programs financed from the state budget. In 2006 the Government implemented very important changes in the healthcare system providing free ambulatory-polyclinics healthcare guaranteed by State.138
The existing “state order” provision of free-of-charge health care thus remains more declarative than factual. The population, especially those in need and/or with the least means, meet with limited access to basic and specialized health care services. Nevertheless, Armenia is increasingly engaged in reforming the system from one that emphasizes the treatment of disease and response to epidemics towards a system that emphasizes prevention, family care and community participation. The shift towards a primary care orientation is noticeable, with gradually increased roles for health care workers to influence the determinants of health.
The Basic Benefits Package (BBP) currently covers a range of services including inpatient care (e.g. emergency care, intensive care, obstetric and gynaecological services, health services for certain vulnerable groups, dialysis, health care for selected conditions including Tuberculosis and Sexually transmitted infections); ambulatory-outpatient care (e.g. primary care, dispensary care, pre-/postnatal care, examination and treatment of individuals at (pre-)conscription age); sanitary and epidemiological services and other health services and programmes (e.g. certain expensive diagnostic tests). 139
All patients falling into a socially vulnerable group140 are eligible to receive a comprehensive package of free outpatient and inpatient services. All other residents in Armenia must pay out of pocket, in full, at the point of use, for all care and pharmaceuticals that are not listed in the BBP. In 2004, the Government introduced co-payments for those populations not considered socially vulnerable, in the form of a one-off flat-rate fee for specifically defined medical care and services that are included in the BBP. However, this is restricted to Yerevan hospitals only and there are several exceptions for both; certain conditions (i.e. diseases and diagnoses that require hospital care and services as adopted by order of the Ministry of Health) and certain population groups, namely pensioners, vulnerable and special population groups as well as patients referred by the Ministry of Health, by the Ministry of Labour and Social Affairs or by the Marz governors.
According to surveys done in all Marzes, lack of access to health care was considered as one of the most difficult problems of vulnerable groups: such problems as “demands for additional informal payments” in general, “shortage of health care facilities”, “poor technical provisions”, “quality of services”, “short period of time during which the health care provider attached to the community is actually available” in rural areas”."

Document(s): Open document

08.03.2006 - Source: US Department of State

Health care for children until the age of 8 is free, but of poor quality; officials often demand payment ("Country Report on Human Rights Practices 2005") [#46111],  [ID 17232]

"Free basic health care was available to boys and girls through age eight, but often was of poor quality, and officials often demanded overt or concealed payment for service."

Document(s): Open document

28.02.2005 - Source: US Department of State

Free health care for children hrough age of 8; emergency care of poor quality, practice of demanding payment for medical service continued ("Country Report on Human Rights Practices 2004") [#29491],  [ID 3461]

"Free health care was available for all children through age 8 for treatment of some diseases and for emergency care, but care often was of poor quality, and the practice of demanding overt or concealed payment of fees for medical service continued. Boys and girls had equal access to health care"

Document(s): Open document

10.2004 - Source: Médecins Sans Frontières

People with mental health problems are being strongly rejected by their own community and lack access to medical care ("People with mental health problems lack access to medical care") [ID 22121]

Document(s): Open document

06.09.2003 - Source: Institute for War and Peace Reporting

Almost 50 per cent of pharmaceuticals sold in the country are counterfeit, expired or smuggled, thus putting the population's health at risk ("Armenia: The Drugs Don't Work") [#15841],  [ID 3465]

Document(s): Open document

28.11.2002 - Source: Austrian Centre for Country of Origin and Asylum Research and Documentation

Many people cannot afford to buy medicine ("8th European Country of Origin Information Seminar Vienna, 28 - 29 June 2002: Final Report - Armenia - co-funded by the EU Odysseus Programme") [#9877],  [ID 3468]

"Although the citizens of Armenia have a right to basic health care, many cannot afford
to buy medicine. In theory, there is medical insurance, but in practice the cost of medical
treatment in a hospital can be quite high. More specifically, as no salaries are paid to
hospital staff people who want to get treatment in hospitals usually have to pay a share
of those salaries and also have to pay for the medicine. It is not easy to give an estimate
of the costs, because these vary with the length of stay in the hospital as well as the
kind of illness and required treatment, including surgery, a person may need. Yet, it is
important to emphasize that indeed about 70 % of the population do not have access to
health care, due to the high costs involved. Given the above-mentioned average salary
of USD 20 – 60, the expenses for a very simple surgical treatment during a one-week
stay in hospital of about 100 USD, would amount to two to five times a monthly salary.
Additionally, some drugs or medicines are so expensive that people have to work for
half a year in order to afford them.
There have been cases in German jurisprudence where Armenian asylum seekers with
chronic illnesses were deemed non-returnable because of the high costs of medical
treatment in Armenia. The reasoning is that if you cannot get necessary medical
treatment it can constitute ill-treatment or cruel treatment. For instance, an individual
who was in need of dialysis could not return to Armenia since three weekly hospital visits
to receive this kind of treatment would simply be unaffordable.
Moreover, in many cases the hospitals do not have the necessary technical equipment or
the medical staff is not qualified to work with sometimes expensive or sophisticated
medical equipment that has been provided as a gift from the international community or
from the Diaspora. In fact, technical equipment sent from abroad is mainly provided by
the Diaspora.
AI:
In contrast to the majority of the Armenia population, expats have access to medical
care comparable to Europe at higher costs. Likewise, Armenians who have enough
money can get fairly decent medical care. For instance, recently one of the local UN staff
had a multiple bypass surgery in Armenia, which was a complete success. So the skills
are there, and if you have the resources, you can have access to the best medical care
available in the country. On the other hand, if you do not have the resources, even
though you theoretically have free access to basic health care, you will not be able to
afford medical treatment. This is exacerbated by the fact that often the required
medicine is not available, the quality of the service is low and sometimes corruption also
comes into play. [...] It can also be observed that in rural areas even physical access to health care facilities is
very bad because the state system collapsed. There is an increase in the delivery of
babies at home in rural areas. They cannot even go to the nearest posts, so they deliver
babies at home, with all the health risks involved. A phenomenon that UNHCR is
concerned about is that sometimes babies are not registered and therefore face the risk
of being stateless in the future.
Not surprisingly, given the miserable overall state of the Armenian health care system,
the rights of the physically and mentally disabled or the chronically sick are either not
developed or not getting enough attention."

Document(s): Arm-cois2002-rep.pdf

28.11.2002 - Source: Austrian Centre for Country of Origin and Asylum Research and Documentation

IDPs and refugee families in Armenia have equal access to health care ("8th European Country of Origin Information Seminar Vienna, 28 - 29 June 2002: Final Report - Armenia - co-funded by the EU Odysseus Programme") [#9877],  [ID 3469]

"Concerning health care, in principle, IDPs and refugee families in Armenia have equal
access to health facilities. This basically means that for them it is as bad as for everyone,
i.e. they have to pay for medicines and treatment and often bribe medical staff. In other
words, in theory they have access, but in reality they may not receive the treatment
that they would need. There are also some free-of-charge health care programs run by
NGOs that cater to the refugee population, especially in rural areas, and include even
visits to isolated villages."

Document(s): Arm-cois2002-rep.pdf

10.2002 - Source: Sakharov Armenian Human Rights Centre

People in remote villages of mountain regions will not be able to apply for timely medical assistance ("Analytical Report (period covered: 1 September 2001 to 30 September 2002)") [#9949],  [ID 3474]

"The RA Government has not developed any clear policy of reforms in the field of health care and medical service of population.
The RA Ministers of Health have been permanently changed for
the past years, and for the term of office each Minister’s mind had
been occupied by the mere idea of being employed after inevitable
resignation.
The reforms of health care system aimed to raise its efficiency,
which have been drafted by the RA Government, appear to be faulty
as the people in remote villages of mountain regions will not be able
to apply for timely medical assistance.
Besides, these reforms stipulate to dismiss 25,000 – 35,000 medical
workers.
Moreover, as a result of mass migration from Armenia the standard
of professional competency of medical personnel has considerably degraded.
Besides, the RA regions are not supplied with necessary pharmaceutical
products and medications."

Document(s): Open document

01.12.2001 - Source: German-Armenian Society

Wegfall der kostenfreien medizinischen Versorgung seit 1. Juli 1997; Regierung sieht jedoch Ausnahmen vor; auch für kostenlos vorgesehen Behandlungen müssen die Patienten jedoch zahlen ("Zur Lage in Armenien (Stand: Dezember 2001)") [#17828],  [ID 3478]

"Der Mangel an Heizmaterial und Nahrungsmitteln über Jahre hinweg hat die meisten Menschen in ihrer physischen und psychischen Konstitution stark geschwächt. Besonders anfällig für alle Arten von Krankheiten sind in dieser Situation naturgemäß Kinder und alte Menschen.

Einschneidendste Veränderung der vergangenen Jahre ist der Wegfall der kostenfreien medizinischen Versorgung zum 1. Juli 1997. Seither müssen in der Regel ärztliche Leistungen sowie Medikamente von den Patienten selbst bezahlt werden. Ausgenommen davon sind rund 500 000 Personen, die be- sonders bedürftigen oder benachteiligten Personengruppen zuzurechnen sind, wie u.a. Behinderte, allein Erziehende, Waisen, Kriegsveteranen, Kinder unter 7 Jahren sowie minderjährige Kinder aus kinderreichen Familien. Weiterhin ist die Behandlung von 14 durch Regierungsbeschluss festgeschriebenen Krankheiten, wie z.B. TBC, Leukämie, Herzinfarkt, AIDS, Malaria und Diabetes weiterhin kostenlos. Auch die imZusammenhang mit Geburtshilfe erbrachten ärztlichen und medizinischen Leistungen werden demnach zunächst weiterhin vom Staat getragen. Allerdings wurde kürzlich von der armenischen Regierung eine Eigenbeteiligung der Gebärenden in Höhe von 15 000 Dram eingeführt.

Jedoch ist es allgemein üblich, dass auch in den per Gesetz von der Selbstzahlungspflicht ausgenommenen Fällen von den behandelnden Ärzten bzw. Krankenhäusern Zahlungen der Patienten gefordert werden. Dies geschieht auch im Hinblick darauf, dass die im Staatshaushalt für den Gesundheitsbereich vorgesehenen Mittel oftmals nicht oder nur mit großer Verzögerung zur Auszahlung gelangen und die Arbeitsfähigkeit der Krankenhäuser bzw. die Löhne des medizinischen Personals daher aus diesen Quellen gedeckt werden müssen."

Document(s): Open document

01.12.2001 - Source: German-Armenian Society

Keine staatliche Krankenversicherung; technische Ausstattung der meisten Krankenhäuser veraltet ("Zur Lage in Armenien (Stand: Dezember 2001)") [#17828],  [ID 3479]

"Eine staatliche Krankenversicherung gibt es bisher nicht. Ein vorläufiges Konzept hierfür wurde zwar kürzlich nach rund zehnjährigen Vorarbeiten von der armenischen Regierung vorgelegt. Bis zu dessen Umsetzung wird es aber vermutlich noch längere Zeit dauern. Private Krankenversicherungen werden zwar seit 1993 angeboten, sind jedoch für die meisten Armenier nicht zu bezahlen. Ebenso wenig existieren derzeit verbindliche Kostensätze für die Berechnung der Leistungen von Ärzten und Krankenhäusern, die somit vorerst weitgehend eine Verhandlungssache zwischen den Leistungserbringern und den Patienten bleiben. Ein Krankenhausaufenthalt kostet den Patienten beispielsweise derzeit zwischen 3000 und 5000 Dram pro Tag.

Die technische Ausstattung der meisten Krankenhäuser ist veraltet, da seit dem Zusammenbruch der Sowjetunion keine finanziellen Mittel für Neuanschaffungen und oftmals auch für die Wartung vorhandener Geräte mehr vorhanden sind. Nach Angaben eines armenischen Ärzteverbands sind rund 90% der in Armenien vorhandenen medizintechnischen Geräte seit mehr als zehn Jahren im Gebrauch und wurden seit mindestens zehn Jahren nicht mehr repariert. Derselben Quelle zufolge sind 70% des medizinischen Geräts dadurch entweder völlig unbrauchbar geworden oder können nur mehr sehr beschränkt eingesetzt werden. Die meisten medizintechnischen Geräte gibt es demzufolge in der Hauptstadt Jerewan, gefolgt von den Regionen Lori und Schirak, die wenigsten gibt es mit jeweils 5% in den Regionen Sjunik und Tawusch sowie mit 3% in der Region Wajots Dzor."

Document(s): Open document