Small maternity hospitals. close or provide solutions to existing problems?

WomenNet.am presents some of the key insights about the closure of small regional maternity hospitals and the possibilities for resolving this scandalous topic.

The problem is that the Ministry of Health, after evaluating the maternity departments, has decided to stop financing maternity hospitals with fewer than 150 births and those that do not meet certain delivery requirements. One of them is the Maralik maternity hospital, which was so strongly received by local residents that citizens even closed the Yerevan-Gyumri highway demanding that the Ministry of Health’s intention be canceled. Moreover, protesters threaten that if a final decision is made to close the maternity ward, they will again block the Yerevan-Gyumri highway and resort to other measures. Health Minister Arsen Torosyan’s response was drastic. “If there is no surgery, if there is no intensive therapy, even if there is not even an anesthesiologist in the maternity ward, there can be no talk of working under such conditions as long as the road wants to be closed. It is a principle that is aimed at protecting the health of our citizens. ”

It should be noted that the Maralik maternity hospital has been operating since the Soviet era, receiving 100-150 births each year. It also serves 17 adjacent villages, which are 20-40 kilometers from Gyumri. By closing the maternity ward, the state is making the residents of Maralik and neighboring villages face the specific fact of traveling 20-40 kilometers each time to see a doctor, and those who do not have their own car by taxi, which means an extra expense for the already poor residents of Shirak province settlements. In addition, this also includes the risk.  Can a woman who is expecting a baby or is already giving birth go so far before reaching a doctor. And given the poor state of the intercommunity roads…

While everyone was focused on Maralik, it turned out that the problem was more global: maternity hospitals in a number of other communities would also be closed. Closed maternity hospitals also include the departments of Achajri, Arteni, Artsvaberd, Yeghvard, Tsaghkahovit, Kajaran, with a total of 9 maternity hospitals in different regions. Almost all of these addresses have been protests for several days.

The Ministry of Health explains its decision with the intention of not endangering the lives and health of women and children. In particular, Health Minister Arsen Torosyan clarified that the main purpose of closing the Maralik maternity ward is to provide safe childbirth conditions for women and safe childbirth for children. According to him, the imperative comes from women who “want to give birth in larger medical institutions, where more quality medical services are provided and there is almost no chance of infant and maternal mortality.”

“Imagine a maternity ward where there is no surgery, in case of an urgent need for a caesarean section during delivery. What will this maternity hospital do? Can you answer me? ”Says the minister, noting that childbirth should be at a medical facility so that a mother or child with an unanticipated health problem can eliminate the problem that has arisen, rather than having to be moved to a higher-level maternity hospital.

Torosyan insisted that the ministry does not close any medical facilities, but regulates the types of services provided there, and reforms in the field of maternity care are in the interests of the population only.

Asked whether it would be better  to close the gap, rather than close the maternity ward, the minister responded that this authority was given to regional administrations and that they were obliged to deal with community health facilities and that the ministry was a policy-making body. But, the minister added, it is not always appropriate, as health needs to be concentrated.

To summarize, the ministry’s stated goal of minimizing the risks to mother and child life and health is certainly understandable and acceptable. The only ways how government officials try to solve the problem are unclear. Instead of equipping dozens of existing maternities in the area with the necessary equipment, specialists, anesthesiologists, and resuscitation units, the easiest way was to close and send residents of these dozens of villages to medical centers in the region. That is to say, if there is money in the budget for the millions of bonuses, it will be possible to raise money for maternity care if there is a political will…

At a press conference held yesterday, the health minister confirmed that the issue of closure of the departments would be discussed for a few more days, not excluding that the maternity hospitals of Yeghvard and Maralik would continue to operate if they solved the existing problems and ensured minimum requirements.

It turns out that the regional administrations have their share of blame as they have not tried to solve the problems identified by the ministry at least a year ago. As a result, today they have to respond to the tough steps of the ministry.

One of the first to respond to the situation with the example of the dissolution of the Maralik maternity hospital was Sofia Hovsepyan, a member of the “My Step” faction of the National Assembly. The latter, let’s recall, before getting the deputy mandate was Shirak’s deputy governor, that is, she had a clear idea of what the Shirak residents would face after the dissolution of the maternity ward.

“The liquidation issue has been in place since 2018, but it has since been suspended. There are many objective and subjective reasons. For example, there are retired nurses in this institution, the number of which is artificially high, there are 18 nurses over seventy years old. We had already decided last year that the number should be reduced and yes, 4 out of 18 nurses could work and get not 25 or 30,000 AMD but a minimum wage, ”says Hovsepyan in an interview with Tert.am.

According to her, the Maralik maternity hospital has not received any state support for many years, has no paid services, there are only very good building conditions and there are many good opportunities to do both paid surgery, sonography and other services.

But it is not done and the building is just idle. If you furnish the hospital, people will not go to Artik or Gyumri. Citizens often have this difficulty so that they can enjoy the highest quality conditions there, “Hovsepyan said.

WomenNet.am has applied to the United Nations Population Fund (UNFPA) Armenia Office, which has been conducting regular visits to regional hospitals, including maternity hospitals, in recent years to cover issues on the ground. As a result, the fact that both the facilities and equipment of community health facilities, including staff, are mild, has been reported in the press for several times. But were there other solutions than closure? Mher Manukyan, UNFPA Communications Officer, said:

“Our approach is: Affordable and quality reproductive health services must be provided in the country. It is precisely these two components – in terms of accessibility and quality of services – that any changes in the field should be considered. The Foundation’s experience allows us to conclude that there are serious issues with the quality of reproductive health services in Armenia, especially in remote areas, but only after discussing with partners in the Ministry of Health we will have a clearer picture of their decision. We are not aware of the details at this time, but as far as we are aware, an attempt is being made to resolve the qualitative aspect of the service. But I repeat, this should be done without disrupting the issue of accessibility and affordability of the service – it should be both geographically and financially accessible to the population, ”he said.

In making decisions on the organization of medical services, including maternity care, the Ministry of Health is exclusively guided by the realization of its statutory goals and objectives, in this case maintaining maternal and child health and reducing morbidity and mortality rates,” Deputy Minister of Health Artyom Smbatyan explains Termination of Financing of Obstetric-Gynecological Services in 9 Health Centers  in the context of these goals., who co-authored the above-mentioned optimization.