Building primary health care strategy around family medicine in Republic of Moldova

WHO/Andrei Bobr

The Ministry of Health of the Republic of Moldova, in collaboration with WHO/Europe, organized a policy dialogue on implementing primary health care (PHC) reform, which took place in Chisinau on 20–21 July 2017.

The event brought together more than 50 participants, including officials from the Ministry of Health, national and international experts, family doctors, medical specialists, representatives of the Association of Family Doctors and of patients’ associations, and academia. This was the first in a series of policy dialogues within the broader context of ongoing PHC sector reorganization. The current policy dialogue aimed at building a commonality of views on the overall priorities and direction for building a new PHC strategy around family medicine in the Republic of Moldova.

The event was organized in four sessions, each with introductory presentations followed by short reflections and plenary discussion, with the aim of answering the following questions:

  • Moving towards universal access to high-quality, people-centred care: what can and should we expect of primary care organized around family practice?
  • Where does the Republic of Moldova stand compared to other countries in terms of health system performance, health indicators, and the supply of family doctors and other specialists in primary care?
  • What is done well, what should be improved, what are the levers for improvement?
  • What are the next steps in building the country’s PHC strategy?

The Minister of Health, Mrs Ruxanda Glavan said that PHC is the driving force behind strengthening universal health coverage (UHC) for the population, as well as the basis for broader health system modernization initiatives envisaged by the government. Thus, it is important to further modernize PHC services, which will improve health system sustainability, strengthen UHC and ultimately enhance the health and well-being of citizens.

The WHO Representative in the Republic of Moldova, Mr Haris Hajrulahovic said: “While a strong commitment to modernize the health system is observed among all stakeholders, as well as the entire society, including high decision making levels, it is important not to lose the momentum and translate this commitment into plans and strategies for PHC system modernization based on the WHO European Health Policy Framework “Health 2020” and implement those in practice. WHO always stands ready to support that process by providing its technical expertise and facilitating sharing of evidence, experience and best practice”.

During the dialogue, the President of the Association of Family Doctors in the Republic of Moldova, Professor Ghenadie Curocichin, highlighted that services provided in PHC settings are not the sole responsibility of family doctors, but should be seen as a task for multidisciplinary teams comprised of nurses, ambulatory care specialists and family doctors, acting in a coordinated and integrated manner where the patient is in the centre and is also part of the team.

The representative of the Association of Nursing of the Republic of Moldova, Mrs Maria Munteanu, expressed her satisfaction with the fact that nurses are also considered an integral part of the PHC endeavour and emphasized that they play an important role in strengthening PHC services, particularly where distribution of family doctors is uneven.

In the last few decades, a series of reforms, such as the decentralization of PHC governance, the introduction of the list of compensated medicines, the standardization of care, and the introduction performance-based contracting, were implemented in the Republic of Moldova and improved the overall performance of PHC. The strong commitment at all levels to modernize and strengthen the health care sector through a large-scale health system transformation that considers PHC strengthening to be the cornerstone of the modernization initiative serves as a driver for designing a PHC strategy built around family medicine.

The dialogue ended with reflections from representatives of all stakeholders involved, who expressed their views on the current challenges faced by the PHC services delivery system, and made recommendations for further strengthening and modernization of the country’s PHC system. The results of the discussion will be considered in planning the next steps for action and designing the final version of the PHC strategy.

This event formed part of the activities envisaged under the Biennial Collaborative Agreement 2016–2017 between the Ministry of Health of the Republic of Moldova and WHO/Europe. The policy dialogue was funded jointly by WHO and the Swiss Agency for Development and Cooperation project “Support to strengthening governance and policy dialogue in health sector – 2nd phase”.