RESUMO
The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. Since independence, the health system in Armenia has undergone numerous changes that have effectively transformed a centrally run state system into a fragmented one that is largely financed from out-of-pocket payments. The population, especially those in need, meet with limited access to health services, and those services which are available are often of questionable quality, as health care standards and quality assessment systems are absent. Drugs on the essential drugs list are generally not affordable to those in need. Many health facilities, especially in rural areas, lack modern medical technology and what is available is not distributed efficiently. The commitment to free health care thus remains more declarative than factual, as informal payments are still expected in many cases. Despite significant investments in primary care, a disproportionate share of resources has been invested in secondary and tertiary care. Nevertheless, Armenia is increasingly engaged in reforming the system from one that emphasizes the treatment of diseases and response to epidemics towards a system that emphasizes prevention, family care and community participation. The shift towards a primary care orientation is noticeable, with gradually increased roles for health workers to influence the determinants of health.