WONCA President's visit to Armenia

Family medicine residents and Associate Professor Marina Ohanian

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WONCA works through our member organisations, to support nations around the world as they strengthen their systems of family medicine to better meet the health care needs of their populations.

This month I was invited to visit Yerevan in the Republic of Armenia.

The Republic of Armenia is a mountainous country in the South Caucasus region of Eurasia. Located at the crossroads of Western Asia and Eastern Europe, it is bordered by Turkey to the west, Georgia to the north, the de facto independent Nagorno-Karabakh Republic and Azerbaijan to the east, and Iran and the Azerbaijani exclave of Nakhchivan to the south. On 23 August 1990, Armenia declared independence, becoming the first non-Baltic republic to secede from the Soviet Union. When, in 1991, the Soviet Union was dissolved, Armenia's independence was officially recognized. The population of Armenia is 3,262,200 people.  

In Yerevan, I met with the Minister of Health, Dr Derenik Dumanyan, and had the opportunity to learn about the progress that is being made in the developments to strengthen primary care through family medicine in Armenia.

Photo: Republic Square, Yerevan

Armenia introduced training in family medicine in 1992, and this has since been strengthened through the introduction of a two-year postgraduate residency in family medicine for recent medical graduates, and a one-year training course for experienced primary care doctors.

Armenia has adopted a “train-the-trainer” approach with the first cohorts of graduates actively engaged in training the subsequent groups of residents, and now has a growing workforce of 1500 family medicine doctors working in rural and urban clinics. A similar program has resulted in a workforce of 2000 family medicine nurses.

It was great to learn about the support that other WONCA member organisations have provided over the years to our colleagues in Armenia as they develop their family medicine training programs.

The Government of Armenia has also shown strong commitment by supporting the training of family doctors and nurses, and building a network of new family medicine clinics, especially in rural villages, and renovating existing clinics.

The Government also has a commitment to preventative care and has introduced screening programs with incentives to increase the detection and management of cardiovascular disease and diabetes and for screening for cervical cancer. The Government has also committed to reducing the size of each family doctor's list to allow more comprehensive care to be provided to each doctor’s patient population, and the aim of providing one family doctor for every 1800 people.

Photo: Professor Samvel Hovhannisyan and members of Armenian Association of Family Physicians

I met with the President of the Armenian Association of Family Physicians, Professor Samvel Hovhannisyan, and family doctors from rural villages and cities in Armenia to learn about the progress that has been made to strengthen family medicine and the formal training programs for family medicine residents and the development of national clinical guidelines. I also met with current family medicine residents to learn about their training experiences.  The Armenian Association of Family Physicians is a member of WONCA Europe.  It has a website at www.armafp.info.am/index.html

I visited family doctor, Dr Armine Tadevosyan, and her primary care team at their family medicine clinic in the rural village of Agarak. Dr Tadevosyan is a specialist in family medicine, and leads a team of four family medicine nurses and a midwife, and also supervises the work of two community nurses based in more remote villages, and a driver who is responsible for the clinic ambulance. Together Dr Tadevosyan and her team provide comprehensive primary care to 3,500 people in their rural region.

Photo: Dr Armine Tadevoysan and her team

I had been invited to visit Armenia by the Armenian Psychiatric Association and Armenian Medical Association which was hosting a World Psychiatric Association conference on “Mental Health and Mental Illness, focusing on Eurasia.” I was invited to speak about Mental Health and Primary Care and the work of WONCA. A copy of my speech will soon be available on the WONCA website at http://www.globalfamilydoctor.com/AboutWonca/PresidentsBlog.aspx

WONCA has been working for several years with the World Health Organization (WHO) on strengthening the integration of mental health into primary care, led by the indefatigable members of our WONCA Working Party on Mental Health (www.globalfamilydoctor.com/groups/WorkingParties/MentalHealth3.aspx). I shared with our psychiatry colleagues the key components of this work and our recommendations for improving the prevention and management of mental health problems through family medicine.

In Armenia, I signed the “Yerevan Declaration” along with the leaders of the World Psychiatric Association and three other global mental health professional associations. This declaration commits our organisations to working together to promote continuing improvement of the mental health of all people in the world through ensuring that affordable mental health services are available to all people, tackling stigma and discrimination associated with mental illness, strengthening the focus on mental health in the training of medical students and continuing professional development of experienced doctors, enhancing advocacy work with governments and civil societies, and promoting the development of additional mental health services, especially through primary care. Watch out for it on the WONCA website.

This was my first visit to the Republic of Armenia and I didn’t really know what to expect. What I found was dedicated family doctors and nurses, a sophisticated family medicine training program, and some really positive health care reforms.