Republic of Moldova takes first steps in reform of school health services
As part of a re-organization of school health services in the Republic of Moldova, a national regulation framework and training package for school nurses were launched on 19 September 2012 at an event organized by the Ministry of Health with WHO support.
Attending the official event were representatives from the Ministry of Health, Ministry of Education, State Medical and Pharmaceutical University "Nicolae Testemitanu", National Institute on Mother and Child Health, National Medical and Pharmaceutical College, school nurses, adolescents and health care managers from across the country. Together they discussed the lessons and options for the Republic of Moldova, the developed training package for school nurses, and future steps leading to approval of the new documents at governmental level, including by the Ministries of Health and Education.
Background of the re-organization
Since 2007, WHO/Europe has provided support to the Government of the Republic of Moldova in strengthening health system functions related to school health services (SHS). The applied step-by-step approach for SHS reform developed by WHO includes a situation analysis, revision of the policy and regulatory framework, quality standards and improvement, and capacity building of healthcare personnel through revision of competencies and training programmes.
Application of the approach revealed a number of challenges pertaining to the outdated clinic-oriented paradigm of the SHS, which did not reflect the epidemiological transition, and routine use of ineffective interventions. Structural challenges identified pertained to the poor legal and normative support for quality improvement, funding, staffing and infrastructure; poorly implemented structural mechanisms to ensure adequate workforce capacity and prestige of the profession; and a fundamental lack of multi-agency work.
Since the reform started, the approach has effectively supported stakeholders in establishing a common vision and the steps needed to effect change. It has furthermore contributed to the empowerment of school nurses, application of measurable quality standards and criteria for SHS, and implementation of a competency-based training curriculum.
Progress of reform
The following were presented at the launching event:
- regulation package, including the regulation framework for SHS, school nurse job description, quality standards and monitoring indicators, description of care packages for school health services, referral mechanism "family doctor – school nurse", supervisory mechanism;
- training package for school nurses that included the training curriculum and the facilitator and participants’ manuals.
The developed documents passed the revision process at the ministerial level, but final approval is still pending. A continuing point of discussion is the sharing of responsibilities between the Ministry of Education and Ministry of Health with respect to the payment schemes of the school health services and engaged personnel. Both ministries have confirmed their readiness and willingness to continue the dialogue and to resolve this issue in the short term.
These activities took place within the framework of the biennial collaborative agreement (BCA) 2012-2013 between the Government and WHO/Europe. The launching event was organized in partnership with the United Nations Population Fund.