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GegarkunikProvidence

Gegarkunik, Armenia / Providence, Rhode Island

1999-2004


Focus: Disease Prevention, Nursing, Obstetrics and Gynecology, Pediatrics, Substance Abuse and Dependence, Cancer, Mental Health, Primary Care



The Partners

US Partner: Care New England includes three major private, non-profit hospitals: Women & Infants Hospital of Rhode Island, Kent Hospital, and Butler Hospital. Lifespan Health Systems, a major health system in New England, consists of five hospitals, a large visiting nurse association and extensive primary care facilities across Rhode Island and Southeastern Massachusetts. The National Perinatal Information Center is the entity that coordinates all administrative aspects of the partnership.

NIS Partner: The Gegarkunik Regional Health Care Management Department is responsible for managing and coordinating health care delivery for the region's population. The department implements federal and municipal health care programs initiated by the Ministry of Health and the regional administration, and conducts data collection and analysis. The Sevan Polyclinic includes women's health services and the following specialty clinics: TB, oncology, STD, psychiatry, endocrinology, ophthalmology, and neurology.


Partnership Objectives

The overall goal was to improve the quality of health services in the region by strengthening continuing education and training for healthcare professionals and greater emphasis on disease prevention and health promotion in the population. Specific objectives were to:

Clinical Organization and Capacity Building

  • Expand continuing education programs for physicians and nurses.
  • Update medical practices through increasing access to current medical literature, practice guidelines, and protocols.
  • Improve and upgrade facilities and equipment.

Community Outreach

  • Expand community outreach and awareness based on identified needs of the population.

 

Disease Prevention/Patient Education

  • Expand disease detection and prevention services.
  • Establish relationship with Erebouni Hospital in Yerevan for staff education and patient referral.

 


Key Events

   2000

  • Survey of 800 households conducted with the American University of Armenia.
  • Regional management workshop on problem-solving, strategic thinking, and leadership styles, Tsakhkadzor.

  2001

  • Training in cytology screening and colposcopy techniques at the Sona Women's Center, Erebouni Hospital, Yerevan, March.
  • Renovation of clinic and training space, establishment of resource library for community and staff education, and audio-visual equipment provided by donations from the Armenian Church in Providence.
  • TOT workshop series on group dynamics and adult-learning methodologies, primary health care, clinical skills, CPG development, nursing, dentistry, and disease management.
  • Donated primary care equipment and supplies delivered by Carelift International.

   2002

  • Second TOT workshop on role-modeling and patient education techniques especially for school-age populations, Providence.
  • Visit of US Ambassador to Armenia, USAID Mission Director, and others to Sevan Polyclinic, April.
  • First annual health fair at Sevan Polyclinic, September.



Achievements

  Clinical Organization and Capacity Building

  • Patient care improved as a result of advanced training of providers, educational programs for clinicians and patients, and evidence-based CPGs for diabetes, bronchial asthma, hypertension, emergency care, and breast exam. Following the implementation of the hypertension guideline, the clinic reported a 20% decrease in patients with uncontrolled high blood pressure.
  • Physicians and nurses at Sevan Polyclinic had clinical training on diabetes and clinical standards; diagnostic criteria; management of hypertension; clinical breast exam; evidence-based medicine; family planning; cervical cancer screening; and emergency medicine. An intensive TOT course was conducted for clinic personnel so they can serve as a resource for disseminating practices throughout the Gegarkunik region.
  • The Sevan adult and pediatric clinics were integrated within the framework of the Ministry of Health's optimization plan. This combined facility will reduce costs by centralizing administrative and structural functions for family primary care.
  • Donations from the Providence Armenian community were used to renovate the Gagarin Clinic, install a heating system in the Sevan Adult Polyclinic, and give salary gifts for the adult and pediatric clinics.
  • A departmental cost accounting system at the polyclinic will enable management to review departmental financial performance and improve the clinic's finances.
  • A patient satisfaction survey revealed that 93% of respondents thought services in the polyclinic had improved since the partnership was initiated and 83% thought services were better than at other government health facilities.

  Community Outreach

  • Each month, about 19 community education and outreach programs are held, reaching over 700 people.
  • Healthy lifestyle programs have covered oral hygiene courses for 800 children and anti-smoking classes for 1,100 students. The children were encouraged to become involved in the programs and demonstrate their understanding by creating artwork that was featured at the Sevan Polyclinic.
  • A community health fair attracted more than 1,100 people for glucose testing; height, weight and blood pressure screening; and dental exams. Clinical breast exams were provided in conjunction with the Yerevan mammography center.
  • As part of the fair, a mental health and alcohol use survey was conducted to identify new programs and services. Of the 420 surveyed, 221 reported signs of severe depression and an additional 36 showed signs of depression. Alcohol abuse was reported as a serious problem for 168, and 66 reported some abuse. In response, educational materials were created and workshops on controlling depression and prevention of alcohol abuse were conducted for 177 and 345 people, respectively.
  • A survey of 750 households was used to establish baseline data for program planning and evaluation and to identify specific problem areas and interventions.
  • A follow-up survey in early 2004 suggested moderate but significant improvement since the baseline survey in almost all areas, including perceived health status; health knowledge; satisfaction with own health and life; accessibility of healthcare services; and use of early diagnosis/prevention services by the target population. Low affordability of health services; poor practice and knowledge of preventive care and reproductive health; high prevalence of perceived poor health and depression; and high exposure to cigarette smoke continued to be reported.
  • Educational HIV/AIDS activities were conducted in conjunction with World AIDS Day, e.g., educational poster display at the clinic and courses on AIDS at secondary schools.

  Disease Prevention/Patient Education

  • A cytology laboratory was established at the Sevan Polyclinic to facilitate early detection and prevention. In coordination with the Erebouni Medical Center in Yerevan, a gynecologist and lab assistant were trained to administer the test and read the results.
  • A total of 13 physicians and 16 nurses were trained in breast screening, glucose measurements, peak flow measurements, and the use of the ophthalmoscope and otoscope. Medical diagnostic equipment was upgraded and supplies were provided for on-site screening, including ultrasound machine strips and glucose tests.
  • Patient education tools for office visits were developed, such as a pictorial flip chart that shows disease conditions and how the body and its systems function. This visual aid helps patients understand the effect of lifestyle choices on disease conditions and overall health.


Participating Institutions




Updated on May 15, 2005