Armenia’s Soviet-controlled health care system focused on city-based hospital care. As a result services were inaccessible to large portions of the population and rural providers lacked necessary skills. The government of Armenia committed to improving its people’s health by providing nationwide primary care services at the community level. Project NOVA, a five-year initiative that began in 2004, worked with Armenia’s government to increase the use of appropriate and safe reproductive health, family planning, and maternal and child health services and practices throughout Armenia, especially in rural areas. IntraHealth supported this program in five of the country's ten administrative units (marzes)—Syunik, Vayots Dzor, Aragatsotn, Armavir, and Ararat. IntraHealth’s work included:
Improving the performance of health care workers through preservice and in-service training and quality assurance activities
Contributing to the formulation of national policy and standards
Since the project’s inception, IntraHealth trained 354 nurses and midwives in safe motherhood clinical skills, distributed basic equipment and supplies to 337 rural health posts, and set up 22 clinical training sites. In addition, IntraHealth trained more than 2,000 medical personnel in key maternal and child health areas, including antenatal care, postpartum care, emergency obstetric care, newborn/infant care, infection prevention, reproductive health, family planning, STI management and quality assurance. NOVA-supported community nurses have given 3,423 health talks on family planning and maternal, reproductive, and child health, reaching 18,000 people living in rural, hard-to-reach areas.
IntraHealth established Quality Assurance Teams at five hospitals and opened five Schools of Motherhood, which prepare pregnant women for birth and newborn care. Due to the work of the Quality Assurance Teams, 93% of all vaginal births at project-supported hospitals are now conducted with active management of the third stage of labor—an intervention proven to significantly reduce postpartum hemorrhage, which is a leading cause of maternal deaths worldwide. The proportion of women suffering from postpartum hemorrhage at NOVA-supported sites declined from 5.4% in 2005 to 1.7% in 2008. In a one-year period, the number of pregnant women registering at health care facilities during the first trimester of gestation increased from 39% to 54%. At the same time, the number of women with at least four antenatal care visits during pregnancy increased by 10% at all NOVA-supported sites.
Through the project and local partners, IntraHealth developed a family planning/reproductive health training package for obstetricians, gynecologists, nurses, and midwives and an updated Key Reproductive Health Competencies Training Package for family physicians. A pilot program integrated safe motherhood clinical skills modules and IntraHealth’s Learning for Performance methodology into the preservice education of nurses and midwives in a pilot program at Gyumri State Medical College. Based on the success of the Gyumri pilot, Project NOVA recommended that the Armenian government roll out the modules and methodology throughout all state medical colleges.