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Delvento G, Curteanu A, Rotaru C, Van Poel E, Willems S, Prytherch H, Curocichin G. The impact of the COVID-19 pandemic on primary health care practices and patient management in the Republic of Moldova - results from the PRICOV-19 survey. BMC PRIMARY CARE 2023; 24:221. [PMID: 37880576 PMCID: PMC10598887 DOI: 10.1186/s12875-023-02116-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 07/20/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND The COVID-19 pandemic has had an enormous impact on health systems in Europe and has generated unprecedented challenges for tertiary care. Less is known about the effects on the activities of local family doctors (FDs), who have shifted tasks and adapted their practice to accommodate the new services brought by the pandemic. The PRICOV-19 study was a multi-country survey aiming to understand the challenges posed by the pandemic in primary health care (PHC) practices around Europe. Within the framework of this study, we assessed the impact of the pandemic on PHC facilities in urban, rural, and mixed urban/rural areas in the Republic of Moldova. METHODS We present the results from the PRICOV-19 questionnaire designed at Ghent University (Belgium) and distributed between January and March 2021 to PHC facilities from the 35 districts of the Republic of Moldova. This analysis presents descriptive data on limitations to service delivery, staff role changes, implementation and acceptance of COVID-19 guidelines, and incidents reported on staff and patient safety during the pandemic. RESULTS Results highlighted the differences between facilities located in urban, rural, and mixed areas in several dimensions of PHC. Nearly half of the surveyed facilities experienced limitations in the building or infrastructure when delivering services during the pandemic. 95% of respondents reported an increase in time spent giving information to patients by phone, and 88% reported an increase in responsibilities. Few practices reported errors in clinical assessments, though a slightly higher number of incidents were reported in urban areas. Half of the respondents reported difficulties delivering routine care to patients with chronic conditions and a delay in treatment-seeking. CONCLUSIONS During the pandemic, the workload of PHC staff saw a significant increase, and practices met important structural and organizational limitations. Consequently, these limitations may have also affected care delivery for vulnerable patients with chronic conditions. Adjustments and bottlenecks need to be addressed, considering the different needs of PHC facilities in urban, rural, and mixed areas.
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Affiliation(s)
- Giulia Delvento
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.
- University of Basel, P.O. Box, CH-4003, Basel, Switzerland.
| | - Ala Curteanu
- Healthy Life project: Reducing the Burden of Non-Communicable Diseases in Moldova, Chișinău, Moldova
- Swiss Agency for Development and Cooperation (SDC), Chișinău, Moldova
- Mother and Child Institute, Chișinău, Republic of Moldova
| | - Cristina Rotaru
- Healthy Life project: Reducing the Burden of Non-Communicable Diseases in Moldova, Chișinău, Moldova
- Swiss Agency for Development and Cooperation (SDC), Chișinău, Moldova
- Nicolae Testemitanu Medical University, Chișinău, Republic of Moldova
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Helen Prytherch
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland
- University of Basel, P.O. Box, CH-4003, Basel, Switzerland
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Matovu F, Gatome-Munyua A, Sebaggala R. Has Strategic Purchasing Led to Improvements in Health Systems? A Narrative Review of Literature on Strategic Purchasing. Health Syst Reform 2022; 8:2151698. [PMID: 36562734 DOI: 10.1080/23288604.2022.2151698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Strategic purchasing is noted in the literature as an approach that can improve the efficiency of health spending, increase equity in access to health care services, improve the quality of health care delivery, and advance progress toward universal health coverage. However, the evidence on how strategic purchasing can achieve these improvements is sparse. This narrative review sought to address this evidence gap and provide decision makers with lessons and policy recommendations. The authors conducted a systematic review based on two research questions: 1) What is the evidence on how purchasing functions affect purchasers' leverage to improve: resource allocation, incentives, and accountability; intermediate results (allocative and technical efficiency); and health system outcomes (improvements in equity, access, quality, and financial protection)? and 2) What conditions are needed for a country to make progress on strategic purchasing and achieve health system outcomes? We used database searches to identify published literature relevant to these research questions, and we coded the themes that emerged, in line with the purchasing functions-benefits specification, contracting arrangements, provider payment, and performance monitoring-and the outcomes of interest. The extent to which strategic purchasing affects the outcomes of interest in different settings is partly influenced by how the purchasing functions are designed and implemented, the enabling environment (both economic and political), and the level of development of the country's health system and infrastructure. For strategic purchasing to provide more value, sufficient public funding and pooling to reduce fragmentation of schemes is important.
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Affiliation(s)
- Fred Matovu
- Department of Policy and Development Economics, Makerere University School of Economics, Kampala, Uganda
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Sécula F, Erismann S, Cerniciuc C, Chater A, Shabab L, Glen F, Curteanu A, Serbulenco A, Silitrari N, Demiscan D, Prytherch H. Evidence-based policy making for health promotion to reduce the burden of non-communicable diseases in Moldova. BMC Proc 2020; 14:1. [PMID: 32165921 PMCID: PMC7059653 DOI: 10.1186/s12919-020-0183-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The Republic of Moldova faces several concurrent health challenges most notably an increase in chronic non-communicable diseases, spiralling health care costs and widening health inequalities. To accelerate progress in their resolution there is a need for new and innovative health promotion and behaviour change communication interventions. The Ministry of Health, Labour and Social Protection in collaboration with the newly created National Agency for Public Health held a conference on the occasion of the Moldovan National Day of Health Promotion on 14th March 2018 in which national and invited international experts exchanged their views on (1) best practice examples of behaviour change interventions, health promotion activities and lessons learned from the UK and elsewhere; and (2) possible ways forward for Moldova to implement cost-effective and evidence-based intersectoral health promotion programmes. The experts provided recommendations on implementing behaviour change interventions to reduce and prevent obesity; on the creation of a favourable tobacco control environment to reduce smoking prevalence; and on how physical activity programme design can benefit from health psychology research. All these strategies could foster health promotion activities and ultimately contribute to improving the health outcomes of the Moldovan population.
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Affiliation(s)
- Florence Sécula
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
| | - Séverine Erismann
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
| | - Carolina Cerniciuc
- Swiss Development Cooperation’s Healthy Life Project, Chisinau, Republic of Moldova
| | - Angel Chater
- Department of Psychology and Sport Sciences, University of Hertfordshire, Hatfield, AL10 9AB UK
- School of Sport Science and Physical Activity, Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Bedford, MK41 9EA UK
- UCL School of Pharmacy, Centre for Behavioural Medicine, Research Department of Practice and Policy, University College London, BMA House, London, WC1H 9JP UK
| | - Lion Shabab
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
| | - Fiona Glen
- National Institute for Health and Care Excellence, 10 Spring Gardens, London, SW1A 2BU UK
| | - Ala Curteanu
- Swiss Development Cooperation’s Healthy Life Project, Chisinau, Republic of Moldova
| | - Aliona Serbulenco
- Ministry of Health, Labor and Social Protection of the Republic of Moldova, Subsequently Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | | | - Daniela Demiscan
- Ministry of Health, Labor and Social Protection of the Republic of Moldova, Subsequently Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | - Helen Prytherch
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland
- University of Basel, P.O. Box, CH-4003 Basel, Switzerland
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Petrea I, Shields-Zeeman L, Keet R, Nica R, Kraan K, Chihai J, Condrat V, Curocichin G. Mental health system reform in Moldova: Description of the program and reflections on its implementation between 2014 and 2019. Health Policy 2019; 124:83-88. [PMID: 31810580 DOI: 10.1016/j.healthpol.2019.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 10/21/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
In 2014, the Republic of Moldova started a systematic process of reforming its mental health system, implementing priority actions set out in the National Mental Health Programme. The reform entailed a service delivery re-design, instituting mechanisms for collaboration across health and social sectors, and revision of the policy framework. Outcomes of the first 4 years of the reform included: 1) the establishment of a network of mental health services in 4 pilot districts embedding mental health diagnosis, treatment and referral in primary and specialized mental healthcare; 2) creation of an enabling policy environment at the national and district level; and 3) strengthened community support and acceptance of mental health issues. Objectives of the first Phase were achieved and the reform is now in its second Phase (2018-2022). The implementation strategy in Phase 1 focused efforts on 4 pilot districts, whereas Phase 2 harnesses lessons learned from Phase 1 and facilitates local leaders and actors to scale-up the model to all 32 districts and municipalities in Moldova. Ownership over the reform process shifted from project-led in Phase 1 to national and local government-led in Phase 2. We reflect on the process and contents of the mental health reform, discuss lessons learned and implementation challenges encountered. We conclude with learning points for policymakers and researchers considering mental health reform in other countries.
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Affiliation(s)
- Ionela Petrea
- Trimbos Institute, Da Costakade 45, 3521 VS Utrecht, the Netherlands.
| | | | - Rene Keet
- GGZ Noord Holland Noord, Alkmaar, the Netherlands
| | - Raluca Nica
- Romanian League for Mental Health, Bucharest, Romania
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Trumbo SP, Silver D, Domenti O, Gasoyan H, Paatashvili E, Gellin BG, Gordon JL. Strengthening legal frameworks for vaccination: The experiences of Armenia, Georgia, and Moldova. Vaccine 2019; 37:4840-4847. [DOI: 10.1016/j.vaccine.2018.10.069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/24/2018] [Accepted: 10/19/2018] [Indexed: 10/27/2022]
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Blake C, Bohle LF, Rotaru C, Zarbailov N, Sava V, Sécula F, Prytherch H, Curteanu A. Quality of care for non-communicable diseases in the Republic of Moldova: a survey across primary health care facilities and pharmacies. BMC Health Serv Res 2019; 19:353. [PMID: 31164125 PMCID: PMC6547568 DOI: 10.1186/s12913-019-4180-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 05/22/2019] [Indexed: 12/02/2022] Open
Abstract
Background The 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. Methods We 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. Results Organised 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. Conclusions The 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. Electronic supplementary material The online version of this article (10.1186/s12913-019-4180-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carolyn Blake
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - Leah F Bohle
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Cristina Rotaru
- Healthy Life project: Reducing the Burden of Non-Communicable Diseases in Moldova, Chisinau, Moldova
| | - Natalia Zarbailov
- Healthy Life project: Reducing the Burden of Non-Communicable Diseases in Moldova, Chisinau, Moldova.,State University of Medicine and Pharmacy "Nicolae Testemiţanu", Chișinău, Moldova
| | - Valeriu Sava
- Swiss Agency for Development and Cooperation (SDC), Chisinau, Moldova
| | - Florence Sécula
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Helen Prytherch
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Ala Curteanu
- Healthy Life project: Reducing the Burden of Non-Communicable Diseases in Moldova, Chisinau, Moldova.,Mother and Child Institute, Chisinau, Moldova
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