Hospital sector reform: Republic of Moldova and Estonia learn from each other


A study visit of health care managers from the Republic of Moldova to Estonia took place from 5 to 9 December 2011. The visit was organized by the WHO country offices in both countries, in close partnership with health sector authorities and health care providers in Estonia.

The visit supported the Republic of Moldova’s overall effort to restructure its hospital sector, and allowed the participants to learn from similar initiatives in the past.

The objectives of the visit were to:

  • exchange experience in the implementation of the hospital master plan and the optimization of the hospital network, within the framework of overall health care reform;
  • examine feasible solutions for the hospital network in the capital and at regional level, as well as its relations with the overall service delivery network (including primary health care, long-term care and ambulance services);
  • examine the governance and management structures of the hospital sector;
  • exchange experience in and identify potential solutions for the university clinic concept; and
  • examine ways of organizing specialist care at inpatient and outpatient levels. 

The Moldovan delegation was headed by the Minister of Health, Dr Andrei Usatii, and comprised 10 decision-makers from different levels, including representatives of the Ministry of Health, the National Centre of Health Management, the State University of Medicine and Pharmacy, and hospital managers. The agenda included visits to the Ministry of Social Affairs of Estonia and various health, local authority and academic institutions. During the visit, bilateral meetings were organized between the ministers of health and university heads to discuss how to strengthen the partnership between the countries.

“Estonia is well known in the region for its vigorous reform of the hospital sector and we are thankful for the offered opportunity to exchange experience in this area,” said Dr Usatii, during his meeting with Mr Hanno Pevkur, Estonian Minister of Social Affairs. He continued: “We hope this study visit will mark the beginning of a broader, long-term collaboration in the field of health care between our countries, including in areas of human resources development, health financing, health service delivery networks, governance in the public and private sector, and strengthening of public institutions such as the medicines agency. For us it is a good opportunity to learn from successful reforms and about the steps needed for harmonization with European Union regulations.” In his turn, Mr Pevkur added: “We’ve inherited similar systems and we are proud to share our experience in health system reforms over the past two decades. Optimization of the hospital network is one of the most challenging tasks, and half-hearted measures usually do not work in such cases.”

Health policy roadmap

Regionalization and optimization of hospital care are part of the health policy roadmap drafted recently by the Ministry of Health of the Republic of Moldova. During 2011, WHO/Europe has provided assistance both in the development of this strategic document and in the implementation of a series of activities to strengthen the hospital sector. These activities included a country-wide evaluation of hospital safety, the development of an action plan on resilience strengthening, the organization of a policy dialogue on hospital sector reform, an external review of public–private partnership arrangements for the hospital sector, and a policy study on improving the hospital sector.

The study visit was undertaken as part of a technical assistance programme funded by the European Commission and coordinated by WHO. The objectives of the programme include strengthening the stewardship of health sector investments, better monitoring of performance, and ensuring greater use of evidence in policy decisions.