Armenia: the challenge of improving equity in an economic downturn

This new and updated HiT health system review on Armenia details recent policy initiatives that have sought to address excess hospital capacity and improve access to maternal and child health services.  Both have required reforms to the way services are purchased and staff is remunerated.  It has also helped to tackle with some success the problem of informal payments in the system. 

Policy-makers in Armenia have struggled to cope with the shortcomings of the Semashko-style health system they inherited at independence from the Soviet Union in 1991.  Severe economic and socio-political difficulties through the 1990s also left the health system chronically underfunded.  Since 2000, strong economic growth in Armenia was accompanied by increased budget spending on health and a resultant fall in out-of-pocket expenditure, however since 2008 the global financial crisis has led to reversals in both these indicators.

Improving both health system performance and financial equity in the health system as a whole remains the key challenge for reform in Armenia.  However, some individual programme successes that created pockets of efficiency constitute useful steps and learning points towards this goal.