Republic of Moldova shares experience in implementing people-centred model of TB care

Victor Garstea

An outreach team of the NGO Act for Involvement provides services to homeless people in Chisinau

Representatives from the ministries of health, national tuberculosis (TB) programmes, and health insurance funds from Azerbaijan, Kazakhstan and Tajikistan visited their counterparts in the Republic of Moldova to exchange experiences and ideas on the organization of health systems and the financial reforms associated with improving TB services, with the aim of making TB prevention and care more people-centred.

The tour, organized by WHO in cooperation with the Moldovan Ministry of Health, Labour and Social protection and the Centre for Health Policies and Studies (PAS Centre) on 23–24 May 2018, included field visits to hospitals, family doctors and an outreach team who provide services to homeless people in Chisinau. This presented the opportunity for participants to meet with people who deal with the disease every day.

The Ministry also gave a presentation on the experience of the country in integrating TB services into primary care, and provided an overview of funding mechanisms, including financial incentives to achieve better outcomes in the detection and treatment of TB, the creation and development of support services for patients and their families, and the involvement of nongovernmental organizations (NGOs) in providing services to patients in vulnerable and hard-to-reach populations. Discussions focused on identifying practical measures, applicable in countries of the region, to provide better results in the prevention and treatment of TB.

People-centred model of TB care

One of the objectives of this initiative was to share the experience of the Republic of Moldova in implementing policy measures to establish a people-centred model of TB prevention and care.

People-centred care is focused on and organized around the health needs and expectations of people and communities rather than on patients or diseases. It shifts towards outpatients and places the initial diagnosis of presumptive TB cases with the family doctor. All presumptive patients are then referred to a TB specialist to confirm the diagnoses. After TB is confirmed, the patient is referred to either a specialized TB hospital or a specialist TB outpatient unit to prescribe, plan and start treatment.

A showcase for the people-centred model

The Republic of Moldova is one of the first countries in the Tuberculosis Regional Eastern European and Central Asian Project (TB-REP) to have developed and adopted a roadmap on implementing a people-centred model of TB care. In line with the blueprint and since 2007, the country has successfully implemented a series of policies and measures targeted at TB prevention and care. As a results, TB cases have dropped from 114 per 100 0000 in 2011, to only 83.3 cases in 2017. The number of TB beds has been reduced from 1705 in 2007 to 650 in 2017.

One of the latest developments in the country is the scale-up of TB community centres (42 centres in 2017) as an integrated part of outpatient clinics. This provides the opportunity to expand the TB team and to make supportive services (e.g. psychological and social support) more accessible for TB patients. Typically, the teams at community health centres have at least 5 members: a psychologist, a social worker, a nurse and 2 part-time supportive staff (an accountant and a coordinator) all coordinated by a doctor.

TB-REP

TB-REP actively supports a comprehensive multicomponent approach and addresses a series of important programmatic gaps related to health system strengthening for TB prevention and care. Weak regional and intercountry collaboration in health system strengthening and TB has been identified as one of the key gaps. TB-REP promotes such cooperation through intercountry thematic study tours and exchange visits.

Countries included in TB-REP are working on the implementation of a people-centred model of TB care and strengthening health systems for improved TB prevention and care. The similarities in health systems and TB burden, as well as the shared history, of the 11 targeted countries translates into a common understanding of each other’s issues and serves as a favourable basis for action-based learning.