Original Research

Qualitative study of barriers and facilitators of health entrepreneurship in rural and semirural communities of Armenia


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Astghik Atanyan1
MD, MPH, Research Assistant *

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Karine Markosyan2
MPH, PhD, Senior Researcher

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Anahit Demirchyan3
MD, MPH, Senior Researcher

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Hratchia Lylozian4
MD, MPH, Research Associate

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Aida Giloyan5
MPH, Senior Researcher

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Lusine Kocharyan6

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Tsovinar Harutyunyan7
MPH, PhD, Associate Professor


1, 2, 3, 4, 5, 7 Turpanjian School of Public Health, American University of Armenia, 40 Baghramyan Avenue, Yerevan 0019, Republic of Armenia

6 The Ministry of Health of the Republic of Armenia, Republic Square, Government House 3, Yerevan 0010, Republic of Armenia

ACCEPTED: 27 October 2021

early abstract:

Introduction: Low- and middle-income countries (LMIC) often face the issue of unequal distribution of healthcare services and human resources between rural and urban areas. Globally, there are numerous factors negatively affecting the willingness of physicians to work in remote and rural areas, such as low wages, poor living conditions, poorer and sicker patients, suboptimal equipment and supplies, as well as lack of quality infrastructure and transportation.
Methods: This study explored the perceptions towards barriers and facilitators of medical entrepreneurship and the impact of medical entrepreneurship on the served communities among the owners of private medical practices in rural and semirural areas of Armenia. The researchers conducted qualitative in-depth interviews with the 13 owners of 12 private practices. The interviews were transcribed in the original language (Armenian). Only the quotes were translated into English. The direct content analysis approach was utilized for analyzing textual data.
Results: The findings of the study suggested that high investment cost, intense competition with state facilities, unfavorable laws and regulations, as well as lack of entrepreneurship and healthcare quality assurance skills were perceived as barriers to establishing/running private healthcare practices. The dissatisfaction of healthcare providers with their work conditions in state facilities, instability of the job market in Armenia, and the development of clear marketing strategies by the entrepreneurs facilitated the opening and operating private practices. All of the interviewees felt that their practices had a positive impact on the communities they served, in terms of creating new jobs and introducing up-to-date and demanded services into these communities.
Conclusions: The study recommended providing potential entrepreneurs with trainings in entrepreneurship and healthcare quality assurance and mentorship opportunities, as well as tools to support financing their enterprises.