BMJ  2004;329 (4 September), doi:10.1136/bmj.329.7465.0-a

Medicine in the south Caucasus is changing

The widespread collapse of the healthcare system and unaffordable out of pocket costs have led to poor access to health care in the south Caucasus. On page 562 von Schoen-Angerer uses the example of Armenia to show the differences in the clinical approach between the former Soviet Union and the West, and tells how harmful practices are making health care unaffordable in this region. The preference for the Soviet style, which controls public health approaches in a collapsing and corrupt healthcare system, raises ethical and efficiency questions. Access is a fundamental problem in primary care, says Hovhannisyan (p 522) in an editorial. Health promotion was not particularly developed during the Soviet era and completely collapsed after independence. As a result of pressure from the World Health Organization and non-governmental organisations, changes are now slowly happening.

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