Minutes of Meetings: # 11

Meeting Date: August 6, 2014

Meeting Venue: RA Ministry of Health National Institute of Health

Meeting Chair:: V. Poghosyan, Deputy Minister of Health


CCM Members

  1. Vahan Poghosyan, Ministry of Health
  2. Harutyun Galstyan, Ministry of Defense
  3. Pavel Ghazaryan, Ministry of Finance
  4. Stepan Barseghyan, Ministry of Territorial Administration
  5. Tsaghik Vardanyan, Ministry of Health, Health Program and Quality Management Department
  6. Elvira Mirzoyan, Ministry of Health State Health Agency
  7. Varduhi Petrosyan, Associate Dean of the American University in Armenia School of Public Health, PhD.
  8. Greta Khachatryan, Positive People Armenian Network NGO
  9. Lusine Kocharyan, Armenian Red Cross Society
  10. Astghik Grigoryan, United States Agency for International Development (USAID)
  11. Raffi Doudaklian, Mission East
  12. Hasmik Harutyunyan, Ministry of Health Global Fund Program Coordination Team
  13. Meri Khachikyan, For Family and Health Pan-Armenian Association
  14. Elvira Meliksetyan, “Women’s Resource Center” NGO
  15. Mamikon Hovsepyan , “Public Information and Need for Knowledge” NGO

Other Participants

  1. Anahit Harutyunyan, Positive People Armenian Network NGO
  2. Armen Hayrapetyan , National Tuberculosis Control Center
  3. Fabien Neyrath, Embassy of France
  4. Lena Nanushyan, United Nations Program on HIV/AIDS in Armenia (UNAIDS)
  5. Samvel Grigoryan, National Center for AIDS Prevention
  6. Lilit Khachatryan, Ministry of Health Global Fund Program Coordination Team
  7. Maya Simonyan, Ministry of Health Global Fund Program Coordination Team
  8. Marina Tiroyan, Ministry of Health Global Fund Program Coordination Team
  9. Kristine Khachatryan, Ministry of Health Global Fund Program Coordination Team
  10. Elen Galajyan, Ministry of Health Global Fund Program Coordination Team
  11. Vardan Grigoryan, Country Coordinating Mechanism secretary

Meeting Agenda

  1. Opening and introduction/approval of Meeting agenda. Management of Conflict of Interest
  2. Presentation of new TB Concept Note
  3. Discussion and endorsement of new TB Concept Note
  4. Presentation and endorsement of the no-cost extension plan of the current TB grant by 6 months (until July 1, 2015)
  5. Presentation and endorsement of the HSS grant close-out plan
  6. Meeting wrap-up

Discussions and Resolutios

1. RA CCM ordinary meeting was opened by Deputy Minister of Health V. Poghosyan. He greeted participants and introduced the meeting agenda.

Varduhi Petrosyan suggested shortening the agenda items due to the lack of time and leave only urgent ones for discussion

Astghik Grigoryan suggested discussing only the questions concerning the new TB grant.

Vahan Poghosyan offered to approve the initial agenda and to finish the meeting one hour later, since it started with an hourly delay due to late arrival of some of the participants.

Mamikon Hovsepyan informed that he could not stay longer than 18.00 due to other arrangements. Some of the CCM members mentioned the same problem as well.

1. Vahan Poghosyan offered to approve shortened agenda presented in this meeting minutes, which was approved by all CCM members present. He also offered to return to other items in case the discussions proceed quickly and additional time is be available.

The suggestion was approved unanimously.

V. Poghosyan asked participants to fill-in Conflict of Interests declaration forms provided and pass them to CCM secretariat.

Floor was given to Hasmik Harutyunyan.

2. Hasmik Harutyunyan in her introductory speech greeted participants, informed that in the frames of the new TB Grant Program Concept Note development process and since May, 2014 there were 4 meetings and discussions organized with the TB WG members; joint workshops were carried out with international expert Andrei Mosneaga. She emphasized that the main work had been done after WHO mission, i.e. after 24th of July in order to take into account their recommnedations in the final version of new CN. Afterwards Hasmik Harutyunyan presented the work plan and budget of the new TB Grant CN.

Vahan Poghosyan suggested giving the floor to Lilit Khachatryan to present the indicators of the new TB grant program.

Varduhi Petrosyan offered to discuss the material presented and then continue, which was approved by CCM members.

Vahan Poghosyan accepted the offer and participants got a chance to ask questions and make comments.

Varduhi Petrosyan was interested in what considerations were based in the inclusion of Center for Disease Control (CDC) in the new program for implementation of infection control, active revelation of patients and screening of contacted persons, if that functions previously were ascribed to National TB Control Program Office.

Hasmik Harutyunyan answered that active revelation of contacted persons and new TB cases was not carried out by previous program, it is a new function but remark is proper in general, because functions of infection control has been implemented by National TB Control Program. By taking into account that Center for Disease Control has an appropriate department with 8 staff members and also the fact that it has regional branches, as well as considering the new conception of WHO in active revelation of TB patients among contacted persons, as well as the fact that Center for Disease Control always did the revelation of TB patients among family contacts, it was assumed that one function is the logical sequence of another and was decided to involve Center for Disease Control and to enhance activities carried out in that field.

Varduhi Petrosyan expressed her hope that it will be monitored if there is increase in effectiveness, proper coordination by Natinal TB Control Center will be performed in order to prevent the duplications of Natinal TB Control Center and Center for Disease Control functions.

Varduhi Petrosyan asked also about the mechanism foreseen to oversight Center for Disease Control work or to share information between Center for Disease Control and National TB Control Center in order to assure that they are working in parallel and are not becoming into independent systems.

Vahan Poghosyan answered that Center for Disease Control involvement idea was considered for a long time, taking into consideration the fact that exclusion of the Center for Disease Control that is present in Armenia and has federal (vertical) structure in marzes with 1700 staff members would be wrong at least because Center for Disease Control is engaged in whole policy of preventing infectious and non-infectious diseases under the Ministry of Health of Armenia. It is also notable that in neighboring Georgia Center for Disease Control is the PR of the TB grant. This step will be the first in order to include that large staff in activities against TB. Monitoring of the work of Center for Disease Control will be carried out by PR, i.e. Ministry of Health. Working regulations will be designed to separate the functions of Center for Disease Control and National TB Control Center, particularly control of infection will be performed by Center for Disease Control. It will be quite progressive step and was recommended by WHO representatives. Vahan Poghosyan also noticed that quite a small amount of money is envisaged for three years as it is their first engagement in program as a SR. He also mentioned that Center for Disease Control receives about 3 billion AMD from the State and by its 23 branches in different marzes can help significantly. Positive feedback for this project at last WHO mission also was mentioned.

Harutyun Galstyan noticed that program expenditures foresee gradual grow of diagnostic abilities for 2015-17, but indicators of morbidity are the same. He mentioned that TB is characterized by hidden course and asymptomatic or less symptomatic forms, which is according to the experience of armed forces is revealed at first recruitment. He also asked about enrollment of age group of 15 years old and the rest of population in fluorography investigations, especially in distant regions of Armenia.

Vahan Poghosyan answered that saying fluorography investigation one should understand only digital X-ray imaging and offered to change that term henceforth, because it is not acceptable for international partners. By means of current program there were 10 digital devices provided to different institutions. One of them was provided to Ministry of Justice. By new grant 12 more digital devices are envisaged and one mobile digital device for MOH which will be located at NTP. Mobile device will activate revelation of TB patients but the role of smear microscopy laboratories is also very important.

Hasmik Harutyunyan added that WHO mission also recommended to acquire a mobile digital X-ray device and GF offers to procure it by savings of current and extending program.

Mamikon Hovsepyan asked about amounts envisaged for goals 4 and 6 in new CN, particularly it was strange for him that for 6th goal more amount of money was intended than for the 4th one which implies more activities. He expressed his concern that the work of PR is appreciated more than the work mentioned in 4th goal.

Hasmik Harutyunyan answered that in frames of 6th goal new calculations were not made and system of current program was employed. Coming to 4th goal, it is new component in program and calculations gave the results presented. Simply it is awkward to foresee reductions in budget of previous program when developing the new one and due to this of course some contradiction is present.

Vahan Poghosyan added that remark is proper and if it was the first program than the opposite situation would be faced. But at the same time it must be considered that developing a new program and reducing the salaries of working group would not be expedient.

Varduhi Petrosyan offered simply to obtain or involve additional resources for the 4th goal without comparing it with the 6th one, because means foreseen are not enough, particularly for implementation of effective program of informing population by presented resources will be simply impossible. She also invited the attention of participants to the goal 2.3, where in her opinion very small amounts are mentioned and expressed her concern that due the lack of means there will be a deficiency of the drugs for management of side effects or alternative drugs and it may become a reason for the patient to cease the treatment and to leave it incomplete.

Vahan Poghosyan clarified that except GF the government and other international and donor organizations (USAID, MSF) are engaged in program and by involvement of their resources it will be possible to obtain financial means both for 2.3 and 4th goals of the program. There is just a problem of coordination of the means received from different sources which will be solved in working order to avoid any gaps of deficiencies in financing.

Varduhi Petrosyan’s constructive offer was to reflect in details all above mentioned remarks in meeting protocol in order to take them into account in the future.

The floor was given to Lilit Khachatryan, who presented the indicators of the new TB grant program.

3. Astghik Grigoryan offered to reformulate the 18th indicator and to make it clearer with the purpose of avoiding further misunderstandings. She also asked about 5th indicator on whether it is needed to include the calculations of not only Drug Resistant but also drug sensitive TB patients considering the fact that patients with incomplete treatment may develop DR TB.

Lilit Khachatryan answered that these calculations are performed by National TB Control Center regularly and are independent from the new program. Regarding the DR TB she added that inclusion of those indicators in the program is related to their significance.

Varduhi Petrosyan noticed that formulation of 15th indicator can also lead to equivocal interpretations and offered to reformulate it.

Lilit Khachatryan thanked her for remark and clarified that imperfections in formulations are associated with translation from English and promised to correct them.

Vahan Poghosyan stated that the issue of new TB Concept Note endorsement will be put to the vote but some members may have Conflict of Interests. He gave floor to the CCM secretariat.

Vardan Grigoryan informed that there are 15 CCM members present and the quorum was met.

Vardan Grigoryan stated that according to the COI declaration forms submitted by CCM members there are 5 members that cannot participate in voting:

  1. Vahan Poghosyan, Ministry of Health
  2. Tsaghik Vardanyan, Ministry of Health
  3. Elvira Mirzoyan RA, MOH State Health Agency
  4. Hasmik Harutyunyan, RA MOH GF Program Coordination Team
  5. Lusine Kocharyan, Armenian Red Cross Society

Vahan Poghosyan put the issue to vote and went out from the hall with four other above mentioned members and representatives of Ministry of Health.

Voting was announced.

CCM members voted for endorsement of the new TB CN with the total budget of 9.859.005 USD. The decision was made unanimously.

Members outside got back to the hall and got informed about voting results.

4. The floor was given to Kristine Khachatryan who presented the no-cost extension plan of the current TB grant for 6 months until July 1, 2015.

Varduhi Petrosyan asked if the savings of about 1.3 million of current program will be passed on to new program.

Hasmik Harutyunyan answered that under the New Funding Model return of the savings to GF are not considered and all savings are incorporated in the budget of new TB program.

Varduhi Petrosyan asked if in case if there were no savings whether the budget of new TB program would be around 6 million instead of 7.

Hasmik Harutyunyan answered that yes.

5. The floor was given to Maya Simonyan who presented the HSS grant close-out plan.

Vahan Poghosyan by agreement of meeting participants at once put the agenda items 4 and 5 to vote.

For the reasons of Conflict of Interest representatives of the Ministry of Health and related institutions, in total 4 members again did not participate in the voting:

  1. Vahan Poghosyan, Ministry of Health
  2. Tsaghik Vardanyan, Ministry of Health
  3. Elvira Mirzoyan RA, MOH State Health Agency
  4. Hasmik Harutyunyan, RA MOH GF Program Coordination Team

CCM members voted for endorsement of the no-cost extension plan of the current TB grant by 6 months (until July 1, 2015) and of the HSS grant close-out plan. The decision was made unanimously.

Raffi Dudaklyan offered to plan the next CCM meeting not sooner than the second week of September, in order to have required level of participation of CCM members.

Vahan Poghosyan stated that work is going to be done for government representatives in CCM to attend the meetings regularly. Through mediations of appropriate ministers if necessary, representatives that are able to regularly attend the CCM meetings will be assigned.

Hasmik Harutyunyan promised to send by email the timetable of development of new HIV Concept Note for introduction and opinions.

Hasmik Harutyunyan also promised to send the new suggested structure of Armenia CCM where previous opinions are considered, for CCM members to get prepared to discussion of that issue at upcoming meeting.

6. Vahan Poghosyan thanked attendants for participation and activeness and wrapped up the meeting.

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