The Primary Health Care Reform (PHCR) Project

After establishing its independence from the Soviet Union in 1991, Armenia’s economy and the health status of its people declined as it struggled with self-sufficiency. The Soviet model of healthcare—in which specialists provided a large proportion of patient care and general practitioners had a limited scope of work—proved ineffective, as it fragmented people’s health concerns and failed to approach the individual as a whole.[1] Recognizing the limitations of this system, including its inefficient use of resources and poor quality of care, the Armenian government positioned health reform as one of its top priorities, and in the late 1990s, moved to retrain doctors and nurses and shift the health system to center around family medicine.

Initially, the World Bank supported a project to retrain nearly 1,500 Armenian specialists and physicians as family doctors by 2013. Unfortunately, by 2005, only 200 physicians had been retrained. Many of these newly-trained physicians reported feeling unprepared as family medicine doctors, and many clinical instructors felt unqualified to train their students.[2] In response to these concerns, USAID launched the Primary Health Care Reform Project in 2005. The project aimed, in part, to:

  • Ensure that the topics and content of family medicine training curricula were consistent and well-suited to the trainees’ needs
  • Standardize and update the teaching methodologies and curricula for family medicine training, and develop continuing education courses based on these standards.

As a part of the Primary Health Care Reform Project, IntraHealth International employed its Learning for Performance methodology to prepare five clinical training packages for trainers and trainees, and oversaw the training of clinical trainers—including more than 500 physicians, nurses, medical faculty, and clinical preceptors. Subsequently, eight Armenian medical training institutions adopted the methodology and curricula.

In addition to curricula development and the training of trainers, IntraHealth also focused on working with Armenian nurses in rural health posts. Because of the remote locations of many of these posts, it is difficult for the nurses to participate in training courses that are generally offered in the Armenian capital city, Yerevan. Yet these nurses are often expected to take on more responsibilities than regular family nurses, including in-home care, clinical pharmacology, and emergency care. To help meet the needs of these nurses and the communities they serve, the Project:

  • Developed a nurses’ training manual, which was approved and endorsed by the Ministries of Health and Education, and distributed to regional nursing schools, trainers, and trainees
  • Organized trainings in each of Armenia’s ten districts, making them more accessible to the nurses at rural health posts
  • Trained clinical preceptors and regional trainers how to better teach these nurses the knowledge, skills, and competencies they need.

Between 2006—2010, the Project trained more than 500 nurses across Armenia’s ten districts as both family nurses and community nurses. The nurse training curricula became the official curricula for training primary healthcare nurses nationwide.

[1] Primary Health Care Strategy of the Population of the Republic of Armenia, 2003–2008, Amendment 1 to GOA Decree N 1533-Ü, November 13, 2003

[2] Danielyan, A. 2005. Report on Family Medicine Training Evaluation.