Armenians struggle for health care and medicines.

News Armenians struggle for health care and medicines Private financing constitutes about half of total health expenditures in Armenia and most of that comes directly out of the consumer's pocket. In the current economic downturn, fewer and fewer people can afford it. Monika Mkhitaryan and Onnik Krikorian report. Naira Thovmasian, 34, has kidney failure and goes for dialysis three times a week. She lives with her mother and her son, pictured here. In the Communist era, Armenia enjoyed one of the best health-care systems of all the Soviet republics, delivering comprehensive care on a centralized basis. Since then the system has fragmented along partially free-market lines and is today failing the majority of the people it is supposed to serve. Skewed towards expensive hospital interventions that swallow up more than 50% of the national health budget, the Armenian health system falters at the local community level and is often totally absent from rural areas. The Armenian government is trying to redress the problem, notably by introducing primary health care reforms with an emphasis on preventive care and the management of chronic diseases. But as Dr Ara Babloyan, Armenia's minister of health between 1991 and 1997, puts it, " Despite efforts in the area of primary health care, the health system requires new improvements " , he said, adding that the scope and definition of primary health care should be revised and enlarged. One of the most pressing concerns is the cost of treatment and medicine for working Armenians who don't benefit from the minimal social programmes that are in place. To address this, the ministry of health has implemented several programmes since independence in 1991 including a Basic Benefits Package (BBP) established in 1999. The package provides specific health-care services, including medicines, at no charge to vulnerable segments of the population , including children, the elderly and disabled, impoverished people and injured military personnel. Since 2006, primary health care services have been free of charge under the BBP. But, of course, being eligible is not the same as being covered. And concern about the BBP being stretched a little thin is expressed in the highest places: " Each year the number of people included on the 'vulnerable' list is increased by the Armenian authorities and as a consequence, the money attributed to each individual decreases, " explains Babloyan. In concrete terms this means that people like Naira Thovmasian, a 34-year-old …