Pediatric palliative care in Armenia

Abstract

This chapter discusses pediatric palliative care in Armenia that is set against a post-Soviet republic in transition. Inheriting the health system of the Soviet Era, Armenia has a centralized hierarchic system where decisions are made centrally by the Ministry of Health. It has a well-developed structure that predominately focuses on hospital care and includes specialists from various domains. Following independence and a socio-economic crisis, radical reform in healthcare was undertaken and is still ongoing. In the Soviet system, healthcare was free and therefore accessible to all of the population, but people did not have a choice of doctor or medical institution. This changed in the years after independence when various fees and a private healthcare system were introduced. Privatization is well underway in Armenia, but it is also expensive and therefore only accessible to those who are able to pay out-of-pocket. Services such as palliative care are available to those who can pay; however, these services are not yet recognised as part of the national healthcare system. It is a relatively new concept to Armenia. In 2003, the Armenian Pain Control and Palliative Care Association (APC&PCA) was established. Its 146 members are mainly leading specialists from the National Center of Oncology. Since its inception, it has been pioneering palliative care and the provision of essential palliative care medicine. More recently, a small group of dedicated people formed an informal working group to guide efforts of palliative care development in Armenia. This Palliative Care Working Group (PCWG) has now been approved by the Ministry of Health and tasked with writing and creating a National Strategy Policy for Palliative Care Development. Palliative Care training is taking place but it does not include pediatric palliative care. Essential medications for palliative care are difficult to obtain-making pain control almost impossible to achieve, especially outside the hospital setting and in rural areas. There is a lack of any oral opioids, and morphine is available in ampoule form only; problems are encountered because of limitations in prescribing practice. Although palliative care has commenced in Armenia, it will take considerable time, resources, and effort to scale up the provision of care throughout Armenia for both adults and children. The provision of palliative care services will be a challenge because health care resources are limited.