Quality of Care

The quality of care component of the PHCR Project seeks to improve patients’ access to quality, client-focused primary health care services serving the ultimate goal of improving health status indicators at national level. The key results expected are:

    •   National primary health care/family medicine clinical “best practices” standards and protocols based on international EBM resources developed and introduced;

    •   Provider/ facility accreditation, licensing and continuous quality of care monitoring procedures established and in use.

This component of the Project links closely with primary health care reform and family medicine advancement activities and builds on the work done to date by the USAID funded Armenia Social Transition Program (ASTP). The results achieved will be measured by the Evaluation unit of the Project with facility self-assessment and patient satisfaction assessment tools and compared against baseline data collected at the start of the Project.

National PHC Clinical Standards and Protocols

The Concept Paper on Quality of Health Care Improvement and Management approved by the Government of Armenia on October 31, 2002 introduced core framework for health care quality improvement and management, however, has not been elaborated further and implemented consistently. Initiatives to introduce quality standards at the facility level undertaken by ASTP and the World Bank project proved efficient, but the set of indicators and protocols has to be refined, circulated among stakeholders, got approved at the Government level and institutionalized.

Building on the progress accomplished, the PHCR Project works with the MOH to identify gaps in the existing quality assurance regulations and introduce a set of quality standards based on approaches adopted worldwide (including World Health Organization statement on health care quality and Dr. A.Donabedian’s well-known three-dimensional quality of care model (structure, process, outcome). To improve quality of care at the facility level the Project works to:

    •   Upgrade and strengthen facility infrastructure (as part of the PHC sector reform activities)

    •   Introduce family medicine clinical protocols

    •   Establish efficient systems for clinical data collection, analysis and monitoring (including record forms and charts)

    •   Initiate facility level quality improvement and quality assurance strategies (through establishment of QI teams and providing QI training to facility managers)

Feasibility assessment for nationwide application of quality of care performance-based remuneration methods will also be conducted.

To help the Armenian FM / PHC providers stay aware of the recent developments in the field, the Project will promote their participation in the international process of updating clinical protocols and provide with access to international EBM resources through supporting Armenia’s FM involvement in the worldwide Cochrane collaboration.

Provider Accreditation, Licensing and Monitoring

Based on needs identified, the PHCR Project will help the MOH to refine, put in place and implement accreditation and licensing (or authorization to practice medicine) procedures for primary health care providers and facilities. At present facility licenses are guided by the existing Law on Licensing. However, facility licensure is not directly dependent on the compliance with quality standards, and authorization of persons to practice medicine is not regulated at all.

The Project helps the Government introduce a modern, evidence-based, accountable and transparent system that will ensure quality of medical care and will create incentives to the medical professionals to uphold minimum standards of quality. The role of the NGO sector in promoting higher professional standards, continuous quality improvement and monitoring of compliance will be emphasized throughout the process.