Armenia is a small land-locked country in the South Caucasus with a population of 3mln people. All these people didn’t have adequate access to cancer care. Around 80% of all healthcare expenses were paid out-of-pocket.
To provide a comprehensive picture of what is currently available in terms of cancer care, it is easier to say what is NOT available: no cancer registry, hence no clinical trials, no clinical research; no universal health coverage; no streamlined system for cancer patients’ follow-up; no rehabilitation program for cancer patients/survivors; no standardised psycho-social support to patients at the clinics or elsewhere; no hospice, etc.
What was introduced recently after the Velvet Revolution in 2018, when the heavily corrupt regime was thrown over and the national healthcare system started to wake up from its lethargic sleep:
- state-funded surgical care at specific clinics for cancer-confirmed diagnoses
- state-funded radiation therapy for cancer-confirmed diagnoses at the only RT clinic in Armenia
- introduction of mandatory “tumor board” practice enforced by the Health Minister’s order
- introduction of the National Cancer Control Board enforced by the Health Minister’s order, note: together with 17 medics, HENARAN foundation members the Board as the only non-medical specialist to represent the voice and interests of cancer patients
Provision of palliative care isn’t consistent across the country. A quite advanced legislative framework is available and in force, but the majority of physicians, especially in rural areas, strongly oppose and don’t prescribe drugs or prescriptions. Provisioning is processed by a scarce network of licensed pharmacies. Often caregivers (sometimes with patients) have to make a 100km round trip to get their drugs.
Cancer advocacy, as well as patient education and empowerment were something unheard of in Armenia. Effective 2017 the situation started to improve slowly with HENARAN foundation’s publication of patient materials and other activities, including raising the public awareness on cancer prevention, early detection, and in-country treatment options. In October 2019, an advocacy seminar engaged about 30 participants who established the Armenian Cancer Patient Advocates Alliance (ACPAA) and authored a Declaration with a call for specific actions.
Screening is limited to cervical cancer only (national organised screening, PAP test based, started in 2015). Screenings are poorly run, engagement is low, there are no complete patient pathways for detected cancer cases.
In November 2019, HENARAN foundation signed a state-funded contract on development of guidelines and protocols for the pilot breast screening project in 3 provinces of Armenia. The project was to launch on October 5, 2020.
It is now postponed for an unclear period of time due to the war launched on September 27, 2020. The war came undeclared on Sunday early morning and was planned to be a blitzkrieg to cause many deaths and casualties and occupy the historically and legally owned lands of Armenians, where 370 Christian churches date back to the 4th-13th centuries. The war is launched in the midst of the pandemic.
Hripsime Martyrosyam and Jan Gerrit Schuurman
Patient Advocate Inspire2Live