Abstract
BackgroundThe Republic of Moldova is faced with a high prevalence of non-communicable diseases (NCDs) related to lifestyle and health behavioural factors. Within the frame of the decentralisation reform, the primary health care system has been tasked to play an important role in the provision of preventative and curative NCD health services. There is however limited evidence available on the actual coverage and quality of care provided. Our paper aims to provide an updated overview of the coverage and quality of service provision in rural and urban regions of Moldova.MethodsWe designed a facility-based survey to measure aspects of coverage and quality of care of NCD services across 20 districts of the Republic of Moldova. This study presents descriptive data on the structural, procedural and clinical aspects of primary healthcare delivery at health centre and family doctor office level. Adjacent private pharmacies were also assessed for the availability of essential NCD medicine.ResultsOrganised under the WHO Health Systems Framework, our findings highlight that service provision and information were generally the strongest among the six health systems building blocks, with more weaknesses found in the area of the health workforce, medical products, financing, and leadership/governance. Urban facilities generally fared better across all indicators.ConclusionsThe gaps in service provision identified by this study require broad health system improvements to ensure NCD related policies and strategies are embedded in primary health care service provision. This likely calls for stronger coordination and collaboration between the public and private sectors and the different levels of government working towards ensuring universal health coverage in Moldova.
Highlights
The Republic of Moldova is faced with a high prevalence of non-communicable diseases (NCDs) related to lifestyle and health behavioural factors
The results provide a limited overview of the state of the health systems building blocks in the Republic of Moldova, but do not cover indicators as per full World Health Organisation (WHO) handbook
Availability of essential NCD-related services, clinical protocols and health promotion materials The availability of preventative and curative primary healthcare (PHC) services was assessed based on the national list of services from the Ministry of Health
Summary
The Republic of Moldova is faced with a high prevalence of non-communicable diseases (NCDs) related to lifestyle and health behavioural factors. The Government of the Republic of Moldova has taken important steps to tackle NCDs, and their risk factors, through the adoption of numerous national strategies, policies for the prevention and control of NCDs (i.e. the National Strategy for Prevention and Control of Non-Communicable diseases 2012–2020) as well as a number of intersectoral or disease specific programmes, [2]. These efforts are embedded in broader health systems strengthening reforms underway in the last two decades that aim to reduce health inequalities and achieve Universal Health Coverage (UHC) [3]. The cost of medicines is the main reason for high Out-Of-Pocket Payments (OOPs) in Moldova (approx. 73.5%), with some essential medicines not included under the list of reimbursable drugs [3]
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