Prime Minister Nikol Pashinyan visited the Ministry of Health to participate in the discussion of the activity report 2023 of the Ministry.

Minister of Health Anahit Avanesyan and deputy ministers made reports.

First, the works carried out in the healthcare sector were presented. In the current year, the implementation of programs of systemic importance in the healthcare sector continued. One of the key reforms, the bill on the introduction of the comprehensive health insurance system, was developed. Expert groups were formed, price research was conducted, based on which the package of basic services and cost calculations were drawn up. The ultimate goal of the reform is to improve access to basic medical services, increase the level of financial protection, and reduce mortality and morbidity. After being amended, the bill was submitted to the government.

Prime Minister Pashinyan inquired about the changes made in the state order system. "Previously, we had the practice that the ministry distributed money, essentially, with a discretionary decision. Now, has that practice gone, that is, are the funds distributed according to the logic of the offerta and are they going after the patient? Is it completely like that now?" asked Nikol Pashinyan.

In response, Anahit Avanesyan gave a positive answer and added that now the money goes after the patient.

Responding, the Prime Minister noted: "We say, first, there should be no minister's order regarding the limits and, secondly, there should be health medical centers that do not have a state order. In other words, the practice of linking the state order to a particular medical center disappears.

In this regard, I have instructed the Minister to ensure the mobility of waiting lists. A person is a beneficiary, his status of beneficiary has been recorded, he sees that his service can be provided at the X Medical Center within 15 days, and he agrees. The next step is seeing if there is a health facility that can provide that same service within a week. A person should have the freedom to move from one list to another and automatically opt out of the other list. In other words, we follow the person, not the healthcare institution, so that mobility is more effective. I think this will become an additional incentive for health centers to improve the quality of service provision."

Aimed at developing the human resources of the healthcare sector, a licensing system for doctors was introduced. An ethics commission composed of independent experts was established to investigate violations of the ethics rules by health workers in medical centers.

A "Register of Healthcare Professionals" was created, the purpose of which is to have a complete database of healthcare professionals operating in Armenia. A medical rapid response team has been created, which will provide medical assistance and service both in our country and outside the borders of Armenia during an international humanitarian mission.

During 9 months of 2023, 826 persons applied to the free medical care program for those with viral Hepatitis C, of which 649 received treatment, the rest are undergoing treatment. It is planned to include 1440 patients in the program in 2024.

Measures to improve reproductive, maternal and child health were implemented in the current year. Prenatal screening for all pregnant women of the region has been introduced and is being carried out on a pilot basis in Gyumri Medical Center, which will improve the situation of prenatal diagnosis. The future "Fetal Medicine Center" was established in "St. Grigor Lusavorich" Medical Center, and construction works for an in vitro fertilization center started. The newborn screening program for adrenogenital syndrome has been developed, which will be introduced in in Yerevan from the beginning of 2024, then will include all the regions. Screening will identify infants with congenital adrenal hyperplasia, resulting in a reduction in neonatal mortality due to early detection of severe forms before adrenal crisis develops.

In 2023 the maternal mortality rate has halved, as well as the stillbirth rate, which is the target of the "Health-related birth rate improvement program", which fluctuated stably within 16-19 ppt (600-850 cases) until 2020, but today it does not exceed 11.2.

As of November 30, 2023, the number of births increased compared to the same period last year (32,926 - increased by 336). Overcoming infertility is one of the most important goals of the country, and at the same time, it is one of the programs that has an extremely high demand among the population. Considering all this, due to the sharp increase in funding allocated to the program since January 2023, the groups of beneficiaries have expanded unprecedentedly. Since the start of the program until November 30, 368 children were born, of which 54 were in the families of fallen servicemen. The listed measures are aimed at one goal: to reach the targets set by the sector strategies.

Referring to the topic of reproductive health, Nikol Pashinyan noted. "Regarding our age policy, are we sure that we are conducting the right policy? Because there are many cases, I receive letters and applications, especially in the families of the fallen servicemen, the problems related to age restrictions sound more acute. Are we convinced that our policies are accurate here?"

Minister Anahit Avanesyan noted that the relevant legislative initiative has already been sent to the National Assembly. "We are changing two thresholds: we are raising the age of 53 to 55 for IVF and 35 to 38 for surrogate mother," the minister noted.

The "Republican Emergency Service" pilot program of Shirak region has been launched since the 4th quarter of 2023 to address crises and disasters. A unified call reception, analysis and transfer management center was established in Gyumri. From the second half of 2024, it is planned to cover the entire territory of the country.

Within the measures aimed at early detection and prevention of diseases, the main emphasis was placed on the most common and high mortality diseases. As a result of implemented diagnostic, therapeutic and preventive measures, the number of deaths due to diseases of the cardiovascular system decreased by 14.1% in 2022, and in January-September 2023, in comparison with the same period of the previous year, the death rate was reduced by about 13.5%. As a result of early detection of malignant neoplasms and complex treatment, it was possible to increase the number of cases detected for the first time and, at the same time, reduce mortality, particularly in 2022 the number of cases detected for the first time increased by 10.5%, and the death rate decreased by 3.4%. In the period of January-September 2023, compared to the same period of the previous year, the number of cases detected for the first time increased by 3%, and the death rate decreased by 0.5%.

It was emphasized that a decrease in mortality was recorded from almost all diseases. In this series, the decrease in mortality from diabetes should also be highlighted. If in 2015 there were around 77,000 people with diabetes registered in the republic, the death rate in absolute numbers during that period was 1,276, then in the case of around 115,000 patients registered in 2022, the death rate in absolute numbers is 371. Such a decrease in mortality among patients with diabetes is due to the full drug supply program. Within the framework of the cerebral palsy treatment program, 720 services were provided to the population during the reporting period. Availability of services is increasing year by year.

The reconstruction works of the "National Center for Mental Health Care" started in August, 2021. Partial repair works of "Avan" Mental Health Center" and "Sevan Mental Health Center" will start in 2024. According to the government's decision, psychotropic drugs are provided free of charge to people with mental health problems, with full reimbursement of their cost.

Referring to the topic of mental health, Prime Minister Pashinyan noted: "Traditionally, if we look at it, the facilities that provide mental health services are usually at the back, it's not considered a place where you should invest, provide proper and dignified conditions and so on. The capital program of the Nubarashen Center for Mental Health that we are implementing is itself a serious practical signal of the government's attitude. But here the problems are much deeper and an interdepartmental approach is needed, starting from the educational level, so that we can address the problem and make some kind of change."

Anahit Avanesyan noted that not only the Nubarashen project is being implemented, but also renovations are being carried out at the "Avan" mental health center, the works will be completed within two years. "This year we allocated 130 million AMD to completely renovate two departments and we have already opened another department. In other words, the Avan center will also be completely transformed. This year, we allocated another 30 million AMD for the Sevan mental health center, it will be completely renovated. In other words, we will update all the centers in terms of infrastructure in three years," the minister emphasized.

It was reported that within the framework of the modernization of medical institutions, construction works were carried out in 25 medical centers, of which 2 have already been completed and 2 are in the final stage. In 2024, the construction works of 22 rural outpatient clinics, 3 regional medical centers and 10 polyclinics, Jermuk health center, 1 regional center for disease control and prevention, 3 regional branches of the Forensic Medical Research Center and the Meghri morgue, "Armavir" department of the Penitentiary Medicine Center, 2 mental health centers will be launched. The construction works of the new maternity hospital being built by Vartan Sirmakesh in Gyumri will be completed.

Free screening programs for high blood pressure, diabetes, and cervical cancer are implemented in the Primary Health Care (PHC) system. The breast cancer prevention and early detection screening program launched in 2021 continues, covering Lori, Tavush, Syunik, Shirak regions. 26,238 examinations were performed, 1,584 women were referred for additional free examinations, and 261 were diagnosed with breast cancer. The goal of the program is to stabilize and reduce premature mortality from breast cancer by at least 1.5% per year.

By the pilot program implemented in 2023, the electronic registries of prescriptions, vaccinations, blood bank, cornea, cadaver donors, cardiovascular, hepatitis and chronic obstructive pulmonary diseases were fully digitized. In 2023, about 68.5 million AMD was allocated from the state budget to 12 border health organizations for the purpose of acquiring stocks of medicines.