The realisation of successful health assistance
in Nagorno Karabagh
Economic collapse in 1990 coupled with a 6 year long conflict with Azerbaijan
which largely destroyed infrastructure, left health services in Nagorno
Karabagh in appalling physical disrepair, and devoid of equipment, basic
supplies and essential drugs. Eight years later hospital buildings still
suffer from lack of running water, dysfunctional sewage systems, broken
window glass, flaking plaster and paint, leaking roofs and absence of
heating in winter.
The flow of new medical information previously coming through the Soviet
led system ceased in 1991. Health staff were isolated, grossly underpaid
and lacking the basic necessities to run the service.
Doctors found themselves managing hospitals with little guidance and grossly
limited budgets. The service was rapidly decentralised and with transport
and communication also badly affected each level became isolated from
the next.
Patients who were already suffering from poverty had to meet the shortfalls,
buy their own medicine and provide some additional income to the $10 per
month wages of health staff, through gratuity pay. But the service was
hardly able to meet their need and gradually patient numbers began falling
as people reverted to staying at home, coping with illness until an acute
emergency forced them to seek medical assistance.
Intervention
This near collapse of the service demands intense assistance to sustain
an adequate level of recovery and a comprehensive approach to problem
solving. Family Care's strategy in Karabagh was to work at all levels
of the service with the maternal health sector, looking at and addressing
the problems faced by women.
Family Care's approach is emergency intervention in parallel with longer
term development. Across the health sector this has been achieved through
the following activities :