Transforming Health Systems in Eastern Europe and Eurasia
With the collapse of the former Soviet Union
in 1991, the health systems in most countries of Eastern Europe and Eurasia deteriorated
rapidly. Systems were under-funded, over- specialized, poorly managed, and inefficient.
The systems lacked essential medical equipment and life-saving medications and commodities.
Patients were not empowered and care was not patient-friendly or evidence-based. Health
care required high out-of pocket payments for care of dubious quality. As a result,
health services were under-utilized and patients often avoided care unless there was a medical
emergency. Beginning in the early 1990s, USAID helped
strengthen health systems in seventeen countries of Eastern Europe and the former Soviet Union.
The programs improved patient access, equity and outcomes. They did this through strengthening
key areas of health systems including: health financing, the health workforce, medical products
and technologies, health system management, health promotion, and improved quality of
services. While USAID’s activities differed from country to country, the heart of its
approach has always been to support a one-stop integrated primary health care model
in which the local primary care provider either treats the patient or refers the patient to
more specialized care, following international best-practices.
USAID assistance programs in Albania, Armenia, Azerbaijan, and Georgia exemplify these approaches.
Albania Narrator: Before USAID’s Improving Primary Health Care project, the majority
of Albanians stayed away from health services. With support from USAID and other organizations,
the Albanian government took charge of the nationís health, improving the health workforce
and quality of health services, as well as modernizing health financing.
USAID cooperated with medical and nursing schools to help Albania develop and implement
a basic package of primary care services that were adopted nationwide. Family medicine manuals
were updated to be consistent with international standards. All doctors and nurses in six of
the twelve regions of Albania were trained and certified as family physicians and USAID
worked with the Ministry of Health and the World Bank to ensure training in the remaining
six regions. In addition, USAID helped create a Health Information System which now serves
as the national system for reimbursement for health services and drugs. The program helped
increase utilization of primary health care services and reduce informal under the table
payments. Today at least 80% of Albanians now use primary health care and the increased
utilization has contributed to a dramatic reduction in infant mortality rates.
Armenia Narrator: In Armenia, rural health care clinics were ill quipped to meet basic
health needs. Many health posts were staffed by a nurse and lacked such essentials as running
water, heating, and blood-pressure cuffs. Health care practices were outdated, with
little emphasis on primary health care or disease prevention. As a result, many Armenians
neglected their health needs. With help from USAID and its partners, two
thirds of all rural health posts in Armenia were upgraded with running water, electricity,
heating and basic equipment. In addition, USAID helped institutionalize a practice where
every Armenian has the right to choose her own primary care provider. USAID also helped
the government establish new systems of health care financing and monitoring; strengthen
the quality of care; and introduce a new model for family medicine.
Under Armenia’s improved health care system: more than 90% of Armenians now choose their
own physicians; 99% of mothers now consult a doctor at least once during their pregnancy;
child immunization coverage has risen to 92%; induced abortions have decreased by 35%.
Azerbaijan Narrator: In Azerbaijan, USAID’s work in health systems strengthening has focused
on the health workforce and improving service delivery. USAID also assisted Azerbaijan to
increase public expenditures for health and focus more resources on primary health care.
Since 2008, USAID has helped Azerbaijan’s Ministry of Health institutionalize evidence-based
medicine, developing and approving 50 clinical guidelines covering such important areas as
prevention, diagnosis, and treatment of tuberculosis, diabetes, and newborn health. Today, with
those updated guidelines and USAID’s training on effective neonatal respiratory care, nutrition
and infection control, premature and sick newborn babies are more likely to receive
the appropriate care they need. Overall, these interventions are helping achieve
measurable improvements in Azerbaijan’s health profile. According to WHO’s World Health
Statistics 2011, Azerbaijanís neonatal mortality rate declined by 40% since 2000,
infant mortality declined by 48%, and mortality of children under the age of five declined
by 52%. Georgia Narrator: In Georgia, the government
launched a sweeping health reform in 2006 that expanded the role of private health insurance
and privatized hospitals and health care facilities. Central to its reform, Georgia radically expanded
the role of private health insurance beyond those who could pay for it on their own. It
now encompasses about 2.5 million Georgians. One group of assisted hospitals documented
a 25% decline in overall cost of care and a 42% decline in the cost of routine deliveries
alone. People know when the services
they receive are not worth the time and money they spend. By helping to upgrade the skills
of providers and the capacity of clinics and hospitals, by helping to address health financing
and communications, USAID has helped restore confidence in our health systems. Once again
people are utilizing health care and that’s a legacy that should make us all proud.