By the Order No.1984-A of the Minister of Health of the Republic of Armenia dated July 22, 2019 a national Board was established to coordinate the improvement and efficiency management of cancer care in Armenia.
The Order also approves the structure and operations of the national Board. Among 18 members of the Board, HENARAN charitable foundation, as a cancer patient advocacy organization in Armenia, is the only non-governmental organization to represent the voice and interests of cancer patients.
Since its inception in July 2019 the Board worked to draft the working document for the “Strategy for combatting malignant neoplasms 2019-2023” and its justification.

Effective analgesia is accessible if appropriate analgesics of the appropriate size and quantity are prescribed. Despite many problems, especially in the provinces and rural areas, together we can improve the accessibility of palliative care in Armenia when patients are empowered and protect their rights.

Unfortunately, most problems occur due to prescription or provision of strong painkillers of the inappropriate type, size, or quantity. Doctors avoid prescribing opioids for pain relief. Patients or their relatives most often mention that doctors do not prescribe morphine or other strong painkillers, saying, "There will be a heart attack", "Do you want us to be sued?", “We are not allowed to do that, it is the last resort” and other similar expressions. We urge doctors to strictly follow the established order and clinical guidelines for provision of narcotics and psychotropic substances that are approved by the orders of the RA Ministry of Health, to be guided exclusively by legal acts and not yield to stereotypes.



The framework of legal acts and clinical expertise for provision of palliative care in Armenia includes:

In compliance with the RA Government Decree No.642-Ndated May 30, 2019 , the drugs within the palliative care framework are provided with full or partial compensation to beneficiaries included in the list of social or special groups of the population.

Palliative care is provided at institutions with a license for provision of out-patient or in-patient palliative care. Palliative care is provided to patients under two schemes: within the framework of the free state-funded healthcare and as a paid service or funded by other sources.



Palliative care is provided by a multidisciplinary team, which includes a doctor, nurse, psychologist, social worker, volunteers, and other specialists, if necessary. Patients, their families and the community can also be involved in the activities of this team.

Palliative care is provided to anyone who has a life-threatening disease or a life- limiting illness with essential restrictions, and the objective is to improve the patients’ quality of life. Palliative care aims to alleviate a patient’s pain and mitigate the disease-related physical, psychosocial, spiritual, and other problems through early detection and assessment thereof and arrangement of necessary interventions.

In compliance with the RA Minister of Health Order No.17-N dated August 15, 2018 palliative care is provided in the cases of incurable diseases or conditions to patients who are divided into the following main groups: malignant neoplasms, chronic diseases of incurable stages, severe, irreversible post-traumatic consequences, HIV/AIDS, multidrug-resistant tuberculosis, congenital and genetic diseases typical of childhood, patients with severe developmental disorders, etc. Prescription of narcotics and psychotropic drugs within the context of palliative care is carried out with the objective of management of the pain syndrome, as well as in the case of severe short breathing in accordance with clinical guidelines. These drugs can also be prescribed in case of appropriate medical recommendations. The list of institutions providing palliative care can be found here under the heading "Palliative care and service".

Palliative care can be provided in various methods:
Outpatient palliative care is provided at the primary healthcare centers (PHC) of the Republic of Armenia (polyclinic) by a multidisciplinary team of palliative care clinics (around-the-clock medical surveillance in non-treatable cases, including home visits).

Mobile palliative care is provided by a respective multidisciplinary mobile team to a patient who is unable to move on his/her own, or whose transfer is complicated or at the patient’s request.

Hospital (in-patient) palliative care is provided by a multidisciplinary team in a hospital setting at a palliative care unit or a unit with specifically assigned beds or service.

At a hospice the palliative care is provided by a multidisciplinary team to patients in the final stages of their disease who require continuous provision of in-patient care.

Palliative care is an uninterrupted service provided 24/7. At polyclinics, palliative care services are provided during the work hours of the institution, including home visits.

The principles of palliative care are:
The activity of the multidisciplinary team specialists providing palliative care has the following principles:

There are no effective analgesics other than narcotic (opioid) analgesics for treatment of moderate to severe chronic pain. Therefore, strong narcotic (opioid) analgesics are the necessary element within the framework of treatment of pain. Unfortunately, the lack of knowledge about opioid use and the associated fear often hinder the effective treatment of pain both in children and adults. The effectiveness of strong opioids for the treatment of pain has been proven: the indirect data and considerations derived from treatment of chronic, non-cancerous pain in adults justify the inclusion of morphine into the WHO list of essential drugs to be used for treatment of moderate to severe pain in adults and children.


In compliance with the RA Minister of Health Order No.17-N dated August 15, 2018, the frequency of opioid drugs provision to patients during opioids treatment is determined by the treating physician. In the event of long absence from the patient’s place of permanent residence, the treating physician may prescribe opioids for the entire duration of the absence.

Patients or their legal representatives can be provided with narcotics and psychotropic substances at the pharmacy only in case of physical presentation of an identity document, while the pharmacist makes notes in the prescription document on the recipient’s passport details, and correspondingly in case of physical presentation of the power of attorney the legal representative’s passport details are recorded. Patients or their legal representatives may receive these drugs from the pharmacy if they present:

The power of attorney is issued in two copies and approved by the head of the out-patient facility (polyclinic). One copy of the power of attorney is affixed to the patient's out-patient card, while the other copy remains at the pharmacy. On the reverse side of any prescription for drugs containing narcotics and psychotropic substances, the pharmacist must fill in the date (dd/mm/yyyy) and the quantity of drug(s) actual received (in letters), the recipient’s passport details and signature.

In out-patient setting (polyclinic), the prescription of narcotics and psychotropic drugs is administered by the treating physician in the patient’s out-patient card recording in letters the exact quantity. Errors and overwriting are not allowed. In case of error, the correction is made by the treating physician who writes a note "the correction is done by me" and signs next to the note, and the document is then signed and sealed by the head or deputy of the medical institution.


In out-patient setting (polyclinic), the doctor shall observe narcotics receiving patients at least once every two weeks. In case when patients are confined to bed, the doctor of the out-patient institution observes the patient at the latter’s home.

In case when the patient’s relatives return the unused narcotics and psychotropic substances, it is necessary to present a copy of the patient’s death certificate stating the time (day, hour, and cause) of death.

In case of hospitalization of patients who receive narcotics and psychotropic substances in out-patient setting (polyclinic), the process of prescription of these drugs is suspended by out-patient institutions. The drugs are then provided by the hospital facility, except for drug-addicted patients who receiving treatment by narcotics.

The after-use empty drug packages (for all types and labels) are not subject to return.

Unused narcotics and psychotropic substances, when returned by the patient or his/her relatives, are handed over to the head or deputy of the out-patient institution (polyclinic). A register is kept for return and detailed record by name and quantity of unused drugs. The pages of the register must be numbered, bound, and verified by the signature and of the director of the medical institution or a private individual and stamped (if available).

The goal of “Life Without Pain” program is to improve access to palliative care and effective pain relief in Armenia. In case of chronic or cancer-related pain you can turn to your local polyclinic and receive effective painkillers. In the cases of non-adequate medical care provision and refuse of prescription of opioids for pain relief, you can send a message to our Facebook page or call the HOTLINE number at 094-422-922.

The 9th WE CAN Eastern Europe and Central Asia Advocacy Summit on Breast and Cervical Cancer was held in Yerevan, Armenia, on October 11-12, 2019.

The international Summit was attended by 30 advocates from Armenia and another 25 advocates from 12 countries of the Eastern Europe and Central Asia. The US Ambassador Lynn Tracey and the RA Deputy Minister of Health Anahit Avanesyan delivered welcome speeches emphasizing the importance of the Summit. The very intensive programme of the two-day Summit allowed the participants to further enrich their knowledge base, network and establish new connections and form partnerships.

The Summit was initiated by the Women’s Empowerment Cancer Advocacy Network (WE CAN – Women’s Empowerment Cancer Advocacy Network, www.womenscanceradvocacy.net). HENARAN charitable foundation was the national hosting organization in Armenia, while the summit took place at the Armenian-American Health Center at no cost and with great service and reception.

Within the framework of the Summit the Armenian Cancer Patient Advocates Alliance (ACPAA) was formed, and its members – cancer patient advocates - presenting themselves as civil society organizations of the Republic of Armenia, individuals, and cancer patients and survivors, declared their commitment to join efforts to prevent cancer and provide cancer patients with personalized support, ensure access to cancer treatment and care, strive for exercise and protection of healthcare and social rights.

The Armenian Cancer Patient Advocates Alliance formed within the framework of the Summit authored a DECLARATION, with a call on specific actions and measures addressed to the RA Government, the RA Ministry of Health, the RA National Assembly, Yerevan State Medical University, state and non-state stakeholder organizations. The Declaration received a great response among the civil society and state authorities, whereby shortly after its publication authorized entities took specific measures to address some problems outlined in the Declaration, which will be a continuous process.