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Healthcare Challenges and Opportunities in Armenia: Contributing to Evidence-Based Policy Making

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Zoom-based webinar by Dr. Haley Tupper and Nathan Chu.

This webinar is organized by the Promise Armenian Institute at UCLA and co-sponsored by the ARPA Institute (Analysis Research & Planning for Armenia), the Armenian International Medical Fund (AIM Fund) and the Armenian American Nurses Association

Thursday, May 25, 2023
10:00 AM - 12:00 PM (Pacific Time)

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Supporting Universal Health Coverage: Vertical and Horizontal Approaches to Health System Development in Armenia
By Dr. Haley Tupper 

This work focused on health system development in Armenia. Broadly, the purpose was two-fold: 1) To support the Armenian Ministry of Health’s work, particularly policy development, in developing universal health coverage (UHC) and 2) To research cancer care in Armenia from a multi-faceted approach. The Ministry of Health aims to provide UHC for its population by 2027 to improve health outcomes and protect its population from catastrophic medical costs, but UHC is an enormous undertaking that requires significant health system development. Building on prior public health knowledge and ongoing research into international best practices over this past year, I have contributed technical expertise to the Republic of Armenia and advised on key issues, including primary healthcare reform, drug procurement, pricing and reimbursement policies, and provider licensing and registration. This work has been further enriched by collaboration with international partners, including the WHO, World Bank and UNDP. 93% of Armenia’s mortality is due to non-communicable diseases and cancer is the second leading cause of death. Over the last year, we have focused on lung, breast, and cervical cancer research in Armenia, specifically examining screening attitudes that would influence screening behaviors (lung, breast, cervical cancer) and understanding the true cost of breast cancer treatment for patients in Armenia with the ultimate goal of informing healthcare coverage for these conditions. Armenia is at an exciting crossroads for its health system with universal health coverage and some of the most important ongoing work is internal capacity building in the government. Work over the next few years will be pivotal in the long-term success of this ambitious project.


Perceptions of Lung Cancer Screening Among Male Smokers in Armenia
By Nathan Chu

Greater than 50% of the male population in Armenia smokes, leading to a strikingly high incidence of, and mortality from lung cancer. Recently, lung cancer screening with a CT scan has been shown to reduce mortality in other countries. Little is known about the knowledge, attitudes and perceptions (KAP) towards lung cancer screening in Armenia. Our study recruited male smokers, and utilized the Expanded Health Belief Model to assess KAP amongst this high-risk group. Nearly three-quarter of respondents felt they were at risk for lung cancer, but over half also reported their risk as the same or lower than non-smokers. Respondents overwhelmingly agreed that a scan could help detect cancer earlier (85.7%), but 30% fewer agreed this would improve their cancer mortality. Absence of symptoms and cost of scan and treatment were important barriers. We conclude that while the potential for screening to reduce lung cancer-related deaths in Armenia is high, there are a number of central health beliefs that may limit its uptake and effectiveness. These include concerns about cost and perceived risk. Improved health education and appropriate recommendations for screening may be useful in overcoming these beliefs.


Haley Tupper, M.D., is a UCLA General Surgery resident currently on research (7/2022-7/2024). She is from Seattle, WA, but spent a decade on the east coast, earning her BA at Penn, MPH at Boston University, and MD at Mount Sinai. In addition to obtaining her MPH in Global Health, she has also conducted research in the Cambodian hospital system on kidney injury and is a member of the Delta Omega Public Health Honor Society. She is passionate about access to care and served as the chief clinic manager in medical school at the East Harlem Health Outreach Partnership serving undocumented New Yorkers. Her particular interest is in health systems and, as a PAI Postdoctoral Scholar, she is working with Dr. Shant Shekherdimian on strengthening the Armenian health system. Within the Ministry of Health, she is working on a variety of projects including primary care reform, provider licensing, universal health coverage, project management, and developing a strategy for monitoring and evaluation of a pilot primary care clinic in the Lori region.

Nathan Chu is a senior at the University of California, Los Angeles where he is majoring in Human Biology and Society with a minor in Global Health. He is currently working with Dr. Shant Shekherdimian on a PAI-funded study examining the knowledge, attitudes, and perceptions of male Armenian smokers towards lung cancer screening.