Several maternity wards in different villages and cities across Armenia have stopped receiving state funding from the Ministry of Health as of this month.
The decision to stop financing these maternity wards was based on a set of criteria developed by the Ministry of Health at the end of 2018 after extensive evaluation and research was conducted by an independent group of experts on the overall state of health clinics and centers across the country.
Criteria included sanitary standards, number of beds, types of doctors, and number of births — set at 150 per year minimum.
That threshold of 150 births has become the main point of contention for those arguing against the decision to close the wards.
In Armenia, giving birth, including doctor check-ups for pregnant women, tests and the delivery of the baby are covered by the state. By ending the financing of these maternity wards, they have effectively been ordered to shut down.
Word of the new policy spread in early January when news outlets reported that the maternity ward at the Maralik Health Center in Maralik, a town in northwestern Armenia, was closing down.
Residents and doctors from the town organized a protest on 8 January blocking roads within the town.
Accusations and explanations
Since the protests, Armenia’s Minister of Health Arsen Torosyan has been on an awareness campaign to assure people that the residents of the cities and villages, who will see the closing of their nearest maternity ward will not be affected. He said that the intent of the Ministry of Health is to provide better health services for expectant mothers.
On 12 January, he went live on Facebook to address the issue. In the video he states that the maternity wards were defunded closed only because of the low number of births.
‘This is being done because these health centers lack the proper equipment and experts to carry out births and take care of newborns and their mothers post-birth’, the minister explained.
According to Torosyan, if a hospital has few patients, then their quality of services will not be up to par to those being provided in those hospitals that have many more patients throughout the year.
‘By stopping the funding for these centers, investment will be going to other health institutions and maternity hospitals that do meet our set standards, but still require more funding and support’, Torosyan said.
During a press conference held on 14 January, Torosyan clarified that there were no separate maternity hospitals being closed down, but rather maternity wards within health centers, operating since the collapse of the USSR, that would no longer receive state funding.
Torosyan had brought maps of the affected villages and cities to show that the nearest other maternity wards or hospitals were not far enough to present a threat to expectant mothers. According to him, the hospitals that were the farthest away from the affected villages were 10-30 km away, a 20-40 minute car ride on a well-paved road.
During the press conference Torosyan explained that only three maternity wards that did not reach the birth rate standards will continue to operate, taking into consideration that there were no other hospitals near those cities and nearby villages.
These include Chambarak, Berd, and Meghri.
In an interview with Armenia’s public broadcaster, Torosyan was asked what the residents of border villages should do when they do not own a car, have no access to proper public transportation, and cannot afford a taxi.
Torosyan claimed that these residents had the same issue even before these maternity wards stopped receiving state financial support.
He has two solutions for the problem of healthcare access: one is to provide more ambulances and the other is to make sure all the roads leading to and from these villages and cities are properly renovated.
He said that work is already being done on these two fronts.
When asked why the Health Ministry does not simply renovate the maternity wards and equip them with modern equipment and well-trained staff, Torosyan explained that these health centers fall under the jurisdiction of the Marzpetaran (regional administration).
The latter is responsible for equipment and staffing while the Ministry is only responsible for developing policy and providing funding for services provided.
He also explained that even if the maternity wards were under the full control of the Ministry, they would not be able maintain high-quality services due to the low number of births.
During the 14 January press conference, Torosyan stressed the fact the management of the health centers in which the maternity wards were under threat of defunding were aware that the Ministry had established minimum criteria.
He said that they were given a year to try to meet the criteria. Those maternity wards, which did not do so by the end of 2019 were told that state funding would stop.
The main aim, according to Torosyan, is to, ‘provide high-quality health services to maternity wards and hospitals instead of maintaining low-quality ones that lack the proper services and won’t be able to maintain quality due to the few number of patients.’
Despite Torosyan’s attempts to address their concerns, protests in Maralik and Yeghvard continued. In interviews with reporters, protesters have said that the conditions in their maternity wards are sufficient and wherever they are lacking, it is only due to a lack of funds.
In an interview with Yerkir, Aram Melkonyan, the mayor of the city of Vardenis, said that following the closure of the city’s maternity ward, the nearest maternity ward was too far from the city and, as a result, too expensive for local residents to reach.
He also said he did not understand the Health Ministry’s justifications for withdrawing funding.
‘The Vardenis Maternity Hospital is overloaded at any moment’, he told Yerkir. ‘You can come and see for yourself where so many people should go now. The staff is very good, experienced, knowledgeable [...] I still do not understand the justification for its liquidation.’
He called the decision ‘not only wrong but offensive’ and claimed that the authorities have ‘not taken the conditions under which our residents live,’
‘This decision will lead to a decrease in births’, he added.
In a briefing with reporters after the Government session on 16 January, Arsen Torosyan said that the Ministry was reconsidering the decision to stop funding for the Yeghvard Medical Center’s maternity ward because their number of births in 2019 was closest to their threshold.
They will be given a year’s reprieve to improve the conditions of their maternity ward. The number of births in the maternity ward will also be taken into account.
Torosyan has said the other health services will also go through a similar evaluation and standards will be set for these fields as well.