Policy dialogue on health service delivery in the Republic of Moldova – from evidence to practice

WHO

Policy dialogue in Republic of Moldova, 14–15 March 2013

A policy dialogue on health service delivery, with an emphasis on primary health care (PHC) and access to services was held in the Republic of Moldova on 14-15 March 2013. The event was organized by the Ministry of Health with WHO/Europe support and brought together the main stakeholders in the field.

The policy dialogue aimed to provide Moldovan decision-makers with an overview of the current status of and developments in health care service delivery, with a particular focus on primary health care (PHC). It provided an opportunity to identify lessons learned and options for further improvement in the Republic of Moldova.

This event was part of a series of similar policy dialogues hosted by the Ministry of Health and WHO in 2011 and 2012 to debate options for further PHC strengthening, as well as to review evidence generated on primary health care and access to health services in this period.

Open discussions on recent developments and way forward

In opening remarks, Dr Andrei Usatii, Minister of Health, said “Ensuring equitable access to high-quality health services and, first of all, to primary health care has always been a high priority on the Ministry of Health’s agenda. In the coming two days we’ll have a nice opportunity to discuss openly recent developments in the sector that are often misinterpreted or misunderstood by some politicians and decision-makers, and agree in a participatory manner on the most appropriate way forward.” Minister Usatii also expressed gratitude to WHO for continuous technical support in improving health service delivery at the country level.

Ongoing health reform in the Republic of Moldova

A series of reform initiatives in the area of service provision were launched and implemented by the Ministry of Health in 2012 aimed at increasing efficiency and quality. These include:

  • continuous decentralization and increase of autonomy of PHC providers;
  • implementing pay-for-performance mechanisms;
  • development and implementation of clinical protocols;
  • scaling-up information systems at PHC and hospital level;
  • initiating short-term specialization programmes for PHC;
  • merging of big tertiary hospitals in the capital city under common management.

“The studies launched today and discussions among professionals show developments in recent years and pro-poor policies implemented during the financial crisis, but the full potential has not been achieved and access to services has not fully materialized for every citizen in need,” said Dr Jarno Habicht, WHO Representative to Moldova. “To take bold steps towards universal health coverage we need to discuss now openly the values related to health, necessary health sector reforms and broad determinants of health simultaneously.”

Programme and outcomes

The policy dialogue consisted of expert presentations, panel discussions, group work and open debates. The group of about 140 participants included representatives of the Ministry of Health, Municipal Departments of Health, National Centre of Health Management, National Health Insurance Company, international organizations, NGOs and managers of primary health care centres and hospitals from across the country.

The event resulted in a series of conclusions and recommendations developed by stakeholders in a participatory manner with input from international experts. Together they identified, among other priorities, the need for:

  • human resources planning and management for PHC;
  • more emphasis on intersectoral work and integration in community;
  • continuous development of informational systems at providers’ level;
  • revision and improvement of performance indicators;
  • increased access to compensated medicines at PHC level;
  • review of opportunities for co-payments to control unjustified demand.

The conclusions and recommendations will serve as the basis for further policy actions and investments at country level.

Collaboration with WHO

The policy dialogue on health service delivery was organized as part of the biennial collaborative agreement (BCA) 2012¬–2013 between the Ministry of Health of the Republic of Moldova and WHO/Europe.  It was also linked to the European Union/WHO Policy Dialogue Programme.