Assessing health of mothers and newborns in the Republic of Moldova
With the long term goal in mind of improving the health of mothers and newborn babies, an assessment of ante- and post-partum care and a stakeholder meeting were held in June 2013 in Chisinau. The assessment team met with professionals from obstetrics and gynaecology, neonatology and midwifery and was guided by WHO experts. Events were organized within the framework of the biennial collaborative agreement 2012-2013 between the government of the Republic of Moldova and WHO/Europe.
The goal of the assessment was to help the Ministry of Health, key partners and stakeholders to evaluate care provided at Primary Health Care level to women and newborns in a systematic and participatory way. The assessment team focused on identifying areas that require improvement, developing relevant action plans and also improving Millennium Development Goal 4 and 5 related indicators.
Evaluating strengths and challenges
The assessment was launched at a workshop on 10th June that aimed to provide an overview of the applied methodology, with a view to identifying lessons learned and options for improvement. Participants included some 30 representatives of the Ministry of Health, the State Medical and Pharmaceutical University “Nicolae Testemitanu”, National Institute of Maternal and Child Health, health care professionals and managers from across the country and representatives of WHO and other United Nations agencies.
Primary Health Care facilities from three rayons (Orhei, Falesti and Cahul) and one municipality (Chisinau) were included in the assessment. At the end of the process there was a meeting with staff and manager and the main conclusions and problems identified were communicated. The final meeting was on 21st June and assessment team members presented a summary of findings.
The team’s positive conclusions can be summarized as follows:
- there is political commitment from the government recognizing maternal and child health as a priority area;
- care and emergency services for pregnant women and for children are free of charge;
- there have been improvements in the environment, infrastructure and physical conditions of health care facilities;
- an information system is in place to collect and analyse data about perinatal mortality and morbidity;
- there is a clearly defined evidence-based national protocol for the organization and provision of antenatal care;
- the last ten years have seen substantial improvements in the quality of health care for mothers and newborn babies.
The following areas were identified as having room for improvement:
- Infection control and prevention at facility level;
- Preparedness for severe obstetric and neonatal complications;
- Promotion of exclusive breastfeeding and clarification of the definition of exclusive breastfeeding;
- Improving counselling skills among primary health care staff.
At the end of the assessment each facility that took part was given a full assessment report with detailed scores and comments regarding the assessment criteria. They also received a copy of the summary of strengths and areas for improvement.
Local health authorities were encouraged to use this in-depth, detailed information as a basis for local action plans to improve quality of care. The plans are to be presented to the Ministry of Health and will ultimately facilitate improvements in primary health care at national level. There is also a recommendation that a second assessment be carried out following the implementation of the recommendations of the first assessment to evaluate the impact and improvements to service provision.