Reaching a maximum efficiency in a long-term international development program using a sectoral approach: private Healthcare in Armenia

Entering the new year 2021 with a mix of surprise and wonder, it is a good time to reflect on what has been undoubtedly a crazy 2020 for all.

For Armenia in particular, 2020 has been negative on multiple fronts: the restrictions for entrepreneurs due to increasing safety measure due to the COVID-pandemic combined with the tragic conflict in the region between Armenia and Azerbaijan-Turkey which have costs unnecessary damage to human life and the local economy. However, there have also been positive and, in my view, unique initiatives with the potential to grow into strong foundations for future economic recovery.

One in particular has laid the groundwork for an extensive efficient approach with effects on an entire sector, supported by the PUM country team and PUM experts from the Netherlands, private clinics in Armenia, and the Armenian Ministry of Health. Highlight was the organization of a so-called “Business Link” in February of last year, where all participants met in one place to discuss and elevate their businesses, and to serve as front-runners for the private healthcare sector.

First I will explain in short the general context of the healthcare sector in Armenia, the build-up through advisory missions in Armenia itself and the Business Link in which all prior made results came together.

We will continue the best we can in these challenging times without being able to provide advice face-to-face, but we can be sure that the framework is there to stay once it is possible again.

This initiative cannot only serve as a prime example of a successful multilateral cooperation, but it also shows how much you can achieve as an advisory organization as PUM before the need arises to implicate more stakeholders in the mix, guaranteeing a long-term impact. I’ll show you through this model of PUM’s Theory of Change:

General

The Armenian health care is still based on the Russian way of working. This means that the hierarchy is top-down: the word of the director is law. The general level of medical knowledge is low: simple things about hospital hygiene are implemented partly, but in such a way that the effects are minimal. The challenge for the new generation is, especially since the revolution of 2018, to have changes implemented but without always having the experience to get these necessary changes started.

In many cases there is no standard quality of medical service that we are used to, for example, in The Netherlands. We see that many Armenians are going abroad to get medical treatment (Germany for example is an frequently visited destination). In the meantime, the Germans established several well operating medical services in Armenia. These are private activities and people pay for it, health insurance hardly exists. Sometimes people must sell their house and property in order to be able to afford medical treatment.

PUM expertise – beginning of factfinding mission

In 2018 PUM Country Coordinator Jan Doeksen visited the Fund for Armenian Relief, an NGO founded by Americans. PUM offered them various services but the main question was: do you have medical specialists? There was and still is a tremendous lack of knowledge in the Armenian health care sector. The need for organizational and medical skills is considerable.

After his visit, Jan Doeksen asked his PUM-colleagues to investigate the possibilities to answer this request. Titus Vissers suggested to make an inventory of the Armenian health care sector by organizing a factfinding mission. This took place in November 2018. During his visit, Mr. Vissers made a detailed overview of the sector. The conclusion was that the Armenian health care sector needed knowledge and organizational power.

Medical missions

In February 2019 the first “medical mission” was carried out: two infection specialists, a surgeon and Mr. Vissers visited Armenia, advised and showed how the health services of several private clinics could be improved. The surgeon went for a follow up visit during the summer of 2019, as well as a stomach-colon-liver specialist and a hospital manager. During these missions PUM-experts have impressed their Armenian colleagues with several masterclasses. The visit of the PUM specialists spread around quickly and the PUM activities had an immediate positive effect on the whole sector. Most of the public hospitals are aware about the PUM activities in the country. In 2019 several missions have been made to five private institutions with the following aspects as main priorities:

 - Hospital Management

- Improving the quality of care

- Improvement of hospital hygiene

- Practical training for nurses (skill labs)

- Reduce the use of antibiotics in the context of AMR (Antimicrobial resistance).

Partnership Declaration with the Ministry of Health

Thanks to the activities in the last years in the health sector in Armenia, it has led to a Partnership Declaration with the Armenian Ministry of Health. This document stipulates that PUM supports private clinics on the before mentioned fields of expertise.

Evaluation missions

In November 2019 the findings of another strong advisory mission of our medical experts, Dr. Andreas Thurkow was evaluated with the country team and Dr. Vissers. They concluded that the impact of organizing individual missions to Armenia would become limited since it would not reach the same effects as the earlier missions. What would have more impact was to show a group of Armenian specialists and hospital managers first how the final situation could be. By inviting them to The Netherlands, they could see a solid working health system, which was the level the Armenians strived to achieve as well.

Business Link to the Netherlands

PUM would introduce the participants of six private clinics to the most important aspects of Dutch healthcare. At the end of the week, they would have to define for themselves which expertise they wanted to bring to a higher level, including quality accreditation systems, insurance and technical expertise. After rounding up the Business Link, the aim was to have various PUM experts deployed to Armenia based on “the needs” defined by the specialists themselves. There were many advantages to organize it in this way:

-         The Armenians would be aware to make fundamental changes in their organizations (private healthcare clinics, laboratories and rehab clinics), which would have a considerable impact.

-         By inviting two persons per (private) clinic: a managing director and a specialist, the business link had more impact on the decisions that had to be taken in the follow-up process than by inviting just one (especially since there is a separation between the strategic component of the CEO and the operational expertise of the specialist).

-         For five out of the six organizations, the businesslink was in fact a follow-up of the advisory missions which took place in 2019.

-         Another important advantage is that the group would stay together during more than 1 week. In Armenia they only see each other occasionally, and the willingness for cooperation would be less. This had a positive effect on the cooperation afterwards, since they were designed to be the frontrunners for the entire private health sector.

As we stand now, travel restrictions remain in place for the foreseeable future. However, the start of something lasting and durable has been made, thanks to the efforts, among others, of:

Mr. Jan Doeksen, Country Coordinator Armenia for PUM

Mr. Titus Vissers, former PUM medical expert and instigator of the initiative

Mr. Suren Khudaverdyan, local representative

Mrs. Naira Mkrtchyan, local representative

Mr. Tigran Balayan, Ambassador for Armenia in the Netherlands

The road to sustainable economic development remains long and rocky, especially now, yet as a Chinese proverb puts it: a journey of a thousand miles begins with a single step.