Armenia

Background information

The Gavar Town “Child Development and Rehabilitation Centre” (CDRC) is part of the regional CDRC network established to support implementation of the National Concept on Early Intervention.

The CDRC includes a programme that addresses developmental delays and disorders and mainly targets children of early age. The Centre was founded in 2007 to improve the early screening of developmental difficulties, increase access to services and prevent disability. A key component of the programme is to train local family doctors, paediatricians and nurses about developmental screenings, and CDRC staff, and to promote social mobilization.

The CDRC takes a multidisciplinary approach when it comes to employment; the staff consist of a paediatrician trained in developmental paediatrics and rehabilitation, a psychologist, a physical therapist, an ergotherapist, a speech therapist and a special educator. The CDRC addresses the comprehensive needs of children with both mental and physical delays and disorders.

Achievements and challenges

Up-to-date training modules and curricula have been designed, and a system for regular supervision and monitoring as well as continuous professional development has been established to achieve and sustain the quality of services. As a result, Centre staff work effectively in collaboration with local family doctors, paediatricians and nurses as well as tertiary-level facilities.

One of the key challenges faced by the Centre was practices of “over-medicalization” by developmental and rehabilitation services and the use of multiple unnecessary medicines (e.g. over-diagnosing symptoms and then over-prescribing medicines). These old practices were eliminated by introducing and demonstrating the effectiveness of modern non-drug therapies. Another challenge was a lack of qualified specialists in the regions.

In Armenia, some primary health care health workers do not consider child development as a priority compared to “hot” topics, such as pneumonia or vaccination (such attitudes also exist outside of Armenia). This is partially caused by general problems of the health sector, such as work overload, low staff motivation as well as a lack of basic education on developmental issues.

These challenges were solved by introducing an effective model of training, which included theoretical lessons and practical sessions in teaching hospitals, followed by on-the-job training sessions and regular supervision in targeted institutions.

Gaps and needs for ECD

Child development has many determinants and related disorders have multiple outcomes which need to be jointly managed by the key sectors of health, education and social protection. Within the frame of this programme, many efforts have been employed to tackle the issue of intersectoral collaboration and these efforts were partially effective. However, service provision is still highly sectoral and is more formal than practical.

Another issue is the late identification of cases caused by non-complementary concepts, policies, non-congruent technical guides and tools, and weak referral mechanisms; and not comprehensively assessing and addressing the needs of children. Additionally, weak practices in inclusive education for children with severe and multiple disabilities is a particularly important issue.

Specialists from multiple sectors should join their efforts at all levels – international (including UN agencies), national, regional and community – to eliminate these gaps in ECD.