Abstract
The "Child Certificate" program, launched in Armenia in 2011, made hospitalization for children less than seven years free in order to improve access to hospitalization, reduce out-of-pocket expenses and ensure Universal Health Coverage. We aimed to estimate trends in the number of outpatient and hospitalized acute respiratory infection (ARI) cases and related under-five mortality. Cross-sectional study using data from national databases before (2008-2011) and after (2012-2017) Program implementation. The diagnosis of ARI was based on the International Classification of Disease (ICD-10). The average hospitalization per 1000 children under 14 and infants increased by 85% and 75% respectively, compared with the period before the introduction of the Program, while the frequency of outpatient visits remained unchanged. The ARI-related mortality in children less than five years and in infants decreased by 11% and 19%, respectively. Financial allocations for ARI-associated hospitalizations amounted to 2.1 billion Armenian drams in 2011 and increased to 3.3 billion drams in 2016 (an increase of 57%). For pneumonia, this increase was 108% (from 0.35 to 0.72 billion). The introduction of free hospitalization for ARI led to an increase in the hospitalization rates. There was a favorable decline in under-five mortality and an exponential increase in financial allocations. The reasons for hospitalization should be investigated to ensure rational hospitalization with parallel improvement of primary care to reduce delayed presentations. It is necessary to find ways addressing the growing financial allocations for ARI-associated hospitalization.
Highlights
The “Child Certificate” program, launched in Armenia in 2011, made hospitalization for children less than seven years free in order to improve access to hospitalization, reduce out-of-pocket expenses and ensure Universal Health Coverage
For infants, there was a similar increase by 75% in average hospitalizations per 1,000 infants after introducing free hospitalization (233/1,000) compared with the prior period (133/1,000; Figure 1)
The reduction in mortality translated to roughly 11 saved lives per 100 under-five children who had previously died of acute respiratory infection (ARI) and 19 saved lives per 100 infants
Summary
The “Child Certificate” program, launched in Armenia in 2011, made hospitalization for children less than seven years free in order to improve access to hospitalization, reduce out-of-pocket expenses and ensure Universal Health Coverage. In 2015, the international community embraced the Sustainable Development Goals (SDGs), the Goal 3 of which includes universal health coverage (UHC) and reducing morbidity and mortality of children less than five years (under-five children) [1]. Incidence of ARI is about 5 episodes per child per year among [3] The reasons behind these high ARI morbidity and mortality include socio-economic factors such as poverty, undernutrition, and barriers to accessing healthcare services [4]
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