Equity in Healthcare: Reforming Armenia’s Primary Care for Resilience and Better Health

The World Bank’s 2024 Armenia Primary Healthcare Assessment highlights systemic gaps in financing, infrastructure, and workforce distribution, limiting the PHC system’s ability to address non-communicable diseases. Strategic reforms in governance, investment, and care delivery are essential to enhance health outcomes and equity across Armenia.

The World Bank’s 2024 Armenia Primary Healthcare Assessment Report, developed in collaboration with Armenia’s Ministry of Health, and the National Institute of Health, and supported by Gavi, the Vaccine Alliance, evaluates the country’s primary healthcare (PHC) system. This comprehensive analysis aims to address the growing burden of non-communicable diseases (NCDs) and advance universal health coverage (UHC). Armenia faces significant challenges with NCDs, including cardiovascular diseases, diabetes, chronic respiratory diseases, and cancer, which account for high premature mortality rates and economic losses equivalent to 6.5% of its GDP. Although Armenia boasts a higher life expectancy than its regional neighbors, the persistent impact of NCDs highlights systemic gaps in healthcare delivery, public health financing, and equitable access to essential services.

Gaps in Access, Utilization, and Diagnostic Accuracy

Despite the potential of PHC to address up to 90% of a person’s healthcare needs, its utilization in Armenia remains low. Only a third of the population visits PHC facilities annually, with many bypassing these services for hospital care due to concerns about quality, availability, and costs. Diagnostic accuracy, a cornerstone of effective primary care, averages around 80% but varies widely based on location and specialty. Pediatricians, for example, perform less reliably compared to internists and family doctors. Rural areas face disproportionate challenges, including fewer qualified providers, inadequate infrastructure, and limited diagnostic tools. The lack of adherence to clinical standards and the unavailability of internationally recommended guidelines exacerbate these shortcomings. Yet, despite these systemic issues, patient satisfaction with provider communication and respectfulness is notably high, reflecting a foundation upon which improvements can be built.

Infrastructure and Workforce Disparities

Infrastructure inadequacies significantly hinder the capacity of PHC facilities to deliver quality care, particularly in rural regions. While basic equipment is generally available, enhanced diagnostic tools such as X-rays and ultrasounds are scarce. Access to essential diagnostic supplies and emergency transportation is similarly limited, with rural areas often the worst affected. Communication tools like internet access and phones are unevenly distributed, further impeding service delivery. Workforce disparities compound these challenges; rural regions have fewer physicians and an overreliance on nurses, despite efforts to address these shortages through subsidized medical training. Vacancies in rural areas remain unfilled, underscoring the need for stronger incentives to attract and retain healthcare professionals in underserved communities.

Governance and Financial Barriers to Progress

Armenia’s healthcare governance structures lack a clear strategic vision and systematic coordination. While the government has integrated PHC into broader health policies, the absence of a standalone, costed PHC strategy undermines efforts to strengthen the system. Decision-making is often not data-driven, and there is limited stakeholder engagement, including input from local communities and patients. The referral system is fragmented, with inconsistent use of the ArMed electronic health management system, leading to incomplete medical information transfers and care disruptions. Financial barriers also play a significant role in limiting access to PHC. Out-of-pocket payments are high, and public financing is insufficient to cover essential medicines and diagnostics. Performance-based incentives for providers fail to reward improvements in service quality, and low reimbursement rates contribute to informal payments, further exacerbating inequities.

Recommendations for Transformative Reforms

To address these challenges, the report outlines strategic recommendations for improving access, quality, and governance in Armenia’s PHC system. Increasing public investment in healthcare is essential, particularly to expand coverage for outpatient medicines and diagnostics targeting NCDs. Addressing urban-rural disparities through targeted incentives for healthcare professionals, improved infrastructure, and comprehensive training programs is critical. Establishing multidisciplinary care teams can enhance diagnostic accuracy and service delivery. Governance reforms, including the development of a standalone, evidence-based PHC strategy and systematic quality assurance mechanisms, are vital. Integrating digital health solutions, such as a robust and interoperable electronic healthcare system, would facilitate better care coordination and efficiency. Drawing on international best practices, including Thailand’s rural healthcare initiatives and Brazil’s multidisciplinary team models, the report underscores the importance of strategic investments to achieve meaningful improvements.

A Path Forward for Armenia’s Healthcare System

The findings emphasize the urgent need to reorient Armenia’s healthcare system toward a more inclusive, equitable, and efficient PHC model. By addressing infrastructure gaps, enhancing workforce distribution, and prioritizing data-driven governance, Armenia can significantly improve health outcomes for its population. With sustained political commitment, increased public financing, and targeted reforms, the country has an opportunity to transform its healthcare landscape to better address NCDs, reduce disparities, and strengthen resilience against future health challenges. The report provides a detailed roadmap for policymakers, offering actionable insights and international examples to guide Armenia toward a stronger and more sustainable healthcare system.