DOCSLIB.ORG

Ambulatory Care Sensitive Conditions in the Republic of Moldova Page I

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Ambulatory Care Sensitive Conditions in the Republic of Moldova Page I Ambulatory care sensitive conditions in the Republic of Moldova Page i Ambulatory care sensitive conditions in the Republic of Moldova Health Services Delivery Programme Division of Health Systems and Public Health Ministerul Sănătății al Republicii Moldova Ambulatory care sensitive conditions in the Republic of Moldova January 2015 Health Services Delivery Programme Division of Health Systems and Public Health Ambulatory care sensitive conditions in the Republic of Moldova Page iv Abstract In the context of a multicountry study on ambulatory care sensitive conditions (ACSCs) in the WHO European Region, this study seeks to contribute to strengthening health services delivery by identifying possible improvements to effectively prevent, diagnose and treat ACSCs in primary health care settings, and deriving contextualized and actionable policy recommendations for health service delivery transformation. This study contains the results of desk research, data analysis, a country stakeholder meeting and follow-up interviews aimed at identifying potential opportunities that enable ACSCs to be effectively prevented, diagnosed and treated in a primary health care setting in the Republic of Moldova. Keywords AMBULATORY CARE PRIMARY HEALTHCARE HOSPITALIZATION MOLDOVA Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office website (http://www.euro.who.int/pubrequest). © World Health Organization 2015 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. Design and layout by Phoenix Design Aid A/S, CO2 and ISO 14001 (environmental management), and DS 49001 (Corporate Social Responsibility) certified and approved CO2 neutral company – www.phoenixdesignaid.com. Ambulatory care sensitive conditions in the Republic of Moldova Page v Contents Acknowledgements . vii Abbreviations . viii Executive summary . ix 1 . Introduction . 1 2 . Methods . 2 2.1 Health services desk research ................................................................2 2.2 Selection of ACSCs: stakeholder consultation ...................................................2 2.3 Preliminary hospital admission data analysis ....................................................2 2.4 Follow-up country visit: key informant interviews................................................3 2.5 Limitations of this study . 3 2.5.1 Regional variation . 3 2.5.2 Estimate potential savings ..............................................................3 3 . Building the case for focusing on ACSCs . 4 3.1 Selection of a limited number of ACSCs relevant for the Republic of Moldova .........................4 3.2 Prevalence, incidence and regional variation for hypertension and diabetes ............................5 3.2.1 Diabetes . 6 3.2.2 Hypertension ........................................................................6 3.3 Regional variation in discharge data ...........................................................6 3.3.1 Diabetes . 6 3.4 Estimated avoidable admissions for diabetes and hypertension ......................................8 3.5 ACSCs in brief ...........................................................................9 4 . A health services delivery perspective to ACSCs . 10 4.1 Governance and management of health services ................................................10 4.1.1 Health insurance and coverage of services ................................................10 4.1.2 Access and OOP payments.............................................................11 4.1.3 Availability of after-hours clinics........................................................11 4.1.4 Availability and distribution of health workforce ...........................................12 4.1.5 Development of information management and communication technology ......................12 4.1.6 Public–private partnerships in PHC delivery ..............................................12 4.2 Model of care............................................................................13 4.2.1 Integrated care management ...........................................................13 4.2.2 Discharge planning and monitoring of high-risk patients . .13 4.2.3 Dependency on specialist care ..........................................................13 4.2.4 Update and access to clinical protocols ...................................................13 4.3 Organization of providers ..................................................................14 4.3.1 Organization of PHC .................................................................14 4.3.2 Gatekeeping ........................................................................14 4.3.3 Scope of practice ....................................................................14 4.3.4 Using technology to coordinate .........................................................15 4.4 Performance improvement .................................................................15 4.4.1 Services utilization...................................................................15 4.4.2 Waiting times .......................................................................16 4.4.3 Length of stay in hospitals .............................................................16 Ambulatory care sensitive conditions in the Republic of Moldova Page vi 4.4.4 Pay for performance .................................................................16 4.4.5 Retraining FDs .....................................................................17 4.4.6 Non-adherence to medication ..........................................................17 4.5 Health services delivery for ACSCs in brief ....................................................17 4.5.1 Governance and management of health services ............................................17 4.5.2 Model of care .......................................................................18 4.5.3 Organization of providers..............................................................18 4.5.4 Performance improvement.............................................................18 5 . Policy recommendations . 19 5.1 Availability of FDs and nurses in PHC centres ..................................................19 5.2 Expansion of the scope of practice for FDs and nurses ...........................................19 5.3 Provision of pharmaceuticals and devices .....................................................20 5.4 Pay-for-performance ......................................................................21 5.5 Health promotion, health literacy and patients empowerment ......................................21 References . 23 Annex 1 . Summary of the analytical framework . 25 Annex 2 . List of participants . 27 Annex 3 . Follow-up visit questionnaire . 29 Ambulatory care sensitive conditions in the Republic of Moldova Page vii Acknowledgements This study was developed by the Health Services Delivery Programme with the management and technical oversight of Juan Tello (Programme Manager) and the coordination of Christine Beerepoot (Technical Officer, Primary Health Care) under the overall direction of Hans Kluge (Director) in the Division of Health Systems and Public Health of the WHO Regional Office for Europe. Data collection, analysis and reporting were conducted by Marijke Bos (Consultant, Health), Wija Oortwijn (Partner, Health Unit) and Matthijs Versteegh (Consultant, Health) of the research and consulting firm Ecorys in the Netherlands. Technical inputs and logistical support were provided by the Ministry of Health of the Republic of Moldova and the National Centre of Health Management, in particular, Petru Crudu. The WHO Country Office, Republic of Moldova under the leadership of WHO Representative and Head of Country Office, Jarno Habicht, and with the support of staff, most notably Angela Ciobanu, facilitated the organization of the in-country workshop and follow-up
Load more

Recommended publications
  • Report on Research Into the Process of Transition from Kindergarten to School
    Ensuring Educational Inclusion for Children with Special Educational Needs Report on Research into the Process of Transition from Kindergarten to School Chisinau, 2015 1 Contents Abbreviations and acronymns ................................ ................................ .................... 2 1. Introduction ................................ ................................ ................................ .......... 3 1.1. Background to the research ................................ ................................ ............. 3 1.2. Background to the context ................................ ................................ ............... 5 2. Findings ................................ ................................ ................................ ................ 6 2.1. Attitudes towards inclusive education ................................ .............................. 6 2.2. Teaching and learning practices ................................ ................................ ...... 7 2.3. Parents’ roles and expectations ................................ ................................ ....... 8 2.4. Communication issues ................................ ................................ ................... 11 2.5. Specialist support ................................ ................................ .......................... 11 2.6. Suggestions from respondents to make transition more inclusive ................. 12 3. Conclusions ................................ ................................ ................................ .......
    [Show full text]
  • Rapid Assessment of Trafficking in Children for Labour and Sexual Exploitation in Moldova
    PROject of Technical assistance against the Labour and Sexual Exploitation of Children, including Trafficking, in countries of Central and Eastern Europe PROTECT CEE www.ilo.org/childlabour International Programme on the Elimination of Child Labour (IPEC) International Labour Office 4, Route des Morillons CH 1211 Geneva 22 Switzerland Rapid Assessment of Trafficking E-mail: [email protected] Tel: (+41 22) 799 81 81 in Children for Labour and Sexual Fax: (+41 22) 799 87 71 Exploitation in Moldova ILO-IPEC PROTECT CEE ROMANIA intr. Cristian popisteanu nr. 1-3, Intrarea D, et. 5, cam. 574, Sector 1, 010024-Bucharest, ROMANIA [email protected] Tel: +40 21 313 29 65 Fax: +40 21 312 52 72 2003 ISBN 92-2-116201-X IPEC International Programme on the Elimination of Child Labour Rapid Assessment of Trafficking in Children for Labour and Sexual Exploitation in Moldova Prepared by the Institute for Public Policy, Moldova Under technical supervision of FAFO Institute for Applied International Studies, Norway for the International Programme on the Elimination of Child Labour (IPEC) of the International Labour Organization (ILO) Chisinau, 2003 Copyright © International Labour Organization 2004 Publications of the International Labour Office enjoy copyright under Protocol 2 of the Universal Copyright Convention. Nevertheless, short excerpts from them may be reproduced without authorization, on condition that the source is indicated. For rights of reproduction or translation, application should be made to the ILO Publications Bureau (Rights and Permissions),
    [Show full text]
  • Regional Business Environment Development Index 2016
    IDIS Viitorul INEKO Regional Business Environment Development Index 2016 Authors Liubomir Chiriac, PhD, Vice Director IDIS Viitorul Tatiana Lariusin, PhD, Senior Economist, IDIS Viitorul Ion Butmalai, Economist, IDIS Viitorul Peter Golias, PhD, Director, INEKO Official Development Assistance of the Slovak Republic is an intrinsic instrument of the Slovak foreign policy, which to a large extent shapes Slovakia’s relations with aid recipients and relevant international organizations. Having committed itself to the fulfillment of the Millennium Development Goals, Slovakia shares the responsibility for global development and poverty reduction endeavors in developing countries, aiming to promote their sustainable development. INEKO Institute is a non-governmental non-profit organization established in support of economic and social reforms which aim to remove barriers to the long-term positive development of the Slovak economy and society. Mission The Institute’s mission is to support a rational and efficient economic and social reform process in the Slovak Republic (SR), through research, information development and dissemination, advice to senior government, political and selfgoverning officials, and promotion of the public discourse. It also focuses on those areas of social policy on the regional as well as the European level critical to the economic transformation of the SR. It draws on the best experience available from other transition countries and members of the European Union (EU) and the OECD. Regional Business Environment Development Index 2016 Authors Liubomir Chiriac, PhD, Vice Director IDIS Viitorul Tatiana Lariusin, PhD, Senior Economist, IDIS Viitorul IDIS is an independent think tank, established in 1993 as a Ion Butmalai, Economist, IDIS Viitorul research and advocacy think tank, incorporated by Moldovan Peter Golias, PhD, Director, INEKO laws on non-for-profit and NGOs.
    [Show full text]
  • Advancing Democracy and Human Rights PROMO-LEX ASSOCIATION
    advancing democracy and human rights THE CIVIC COALITION FOR FREE AND FAIR ELECTIONS PROMO-LEX ASSOCIATION REPORT #3 Monitoring the preterm parliamentary elections of 28 November 2010 Monitoring period: 26 October 2010 – 8 November 2010 Published on 11 November 2010 Promo-LEX is grateful for the financial and technical assistance offered by the United States of America Embassy in Chisinau, the National Endowment for Democracy (NED), and the National Democratic Institute for International Affairs (NDI). The opinions expressed in this report do not necessarily reflect those of the donors. Page 1 of 28 Third monitoring report on the preterm parliamentary elections of 28 November 2010 CONTENTS: I. SUMMARY II. PROMO-LEX MONITORING EFFORT III. INTRODUCTION A. Legal framework B. Electoral competitors C. Election authorities D. Local authorities E. Electoral campaigning F. Financial analysis G. Mass media H. National and international observers I. Transnistrian region IV. CONCERNS V. RECOMMENDATIONS Page 2 of 28 I. SUMMARY This report, covering the period from October 25 through November 8, 2010, describes the electoral environment and reviews from a legal perspective the recent developments in the election campaign, and the performance of the electoral competitors and of the local and election authorities. The election campaign is becoming increasingly intense, with cases of intimidation and abuse being registered both against electoral competitors and voters. While engaged in various campaigning activities, some candidates resort to the misuse of administrative resources and offering of “electoral gifts”. Promo-LEX salutes the impartiality of the election authorities in performing their duties. The Central Election Commission registered until the end of the authorization period 40 electoral competitors and issued warnings to the contenders that violated the rules.
    [Show full text]
  • Republic of Moldova
    EVALUATION REPORT REPUBLIC OF MOLDOVA G R E T A Group of Experts on Action against Third evaluation round Trafficking in Human Beings Access to justice and effective remedies for victims of trafficking in human beings GRETA(2020)11 Publication: 3 December 2020 Secretariat of the Council of Europe Convention on Action against Trafficking in Human Beings (GRETA and Committee of the Parties) Council of Europe F-67075 Strasbourg Cedex France [email protected] www.coe.int/en/web/anti-human-trafficking 2 GRETA(2020)11 _______________________________________________________________________________________________________ Contents Executive summary ................................................................................................................ 3 Preamble ................................................................................................................................ 5 I. Introduction ................................................................................................................... 6 II. Overview of the current situation and trends in the area of trafficking in human beings in the Republic of Moldova ..................................................................................................... 8 III. Developments in the legislative, institutional and policy framework for action against human trafficking ................................................................................................................... 9 IV. Access to justice and effective remedies for victims of human trafficking
    [Show full text]
  • Children in the Republic of Moldova
    CHILDREN IN THE REPUBLIC OF MOLDOVA SITUATION ANALYSIS 2016 This report was produced with the support of UNICEF Moldova. Authors: Dennis Arends, Mariana Ianachevici, Ala Nemerenco, Arina Turcan Quality assurance: Camelia Gheorghe Acknowledgements The Situation Analysis was developed by a team of consultants: Mariana Ianachevici, Ala Nemerenco and Arina Turcan under the leadership of Dennis Arends. Quality assurance review was completed by Camelia Gheorghe. The research was supported by UNICEF Moldova. We are thankful to UNICEF programme team colleagues who provided expertise and contributed extensively to the review of the document. UNICEF is immensely grateful for the support and extensive reviews provided by government counterparts: the State Chancellery of the Republic of Moldova, the National Bureau of Statistics, the Ministry of Education, the Ministry of Health, the Ministry of Labour, Social Protection and Family , the Ministry of Justice and other relevant ministries, state institutions and government agencies, including the Ombudsperson for Child Rights. Stakeholders consulted during the field research included national-level policymakers, local public authorities, professionals, representatives from non-governmental organizations, as well as adolescents and youth. UNICEF is very grateful for their invaluable contributions to the research as well. Extracts from this publication may be freely reproduced with due acknowledgment using the following reference: UNICEF, ‘Children in the Republic of Moldova: A Situation Analysis’, 2016.
    [Show full text]
  • Republic of Moldova [Energy Profile]
    UNITED NATIONS ECONOMIC COMMISSION FOR EUROPE Energy Efficiency 21 Programme Republic of Moldova [Energy Profile] Project Number: ECE/GC/2008/033 Project Title: Financing Energy Efficiency Investments for Climate Change Mitigation Submitted to: United Nations Economic Commission for Europe Submitted by: National Participating Institution / Climate Change Office under the Ministry of Environment November, 2009 Financing Energy Efficiency Investments for Climate Change Mitigation Table of Contents 1. GEOGRAPHICAL LOCATION ........................................................................................... 4 2. RELIEF.................................................................................................................................... 5 3. CLIMATE................................................................................................................................ 5 4. NATURAL RESOURCES...................................................................................................... 7 4.1. LAND RESOURCES................................................................................................................. 7 4.2. WATER RESOURCES.............................................................................................................. 8 4.2.1. RIVERS................................................................................................................................. 8 4.2.2. LAKES .................................................................................................................................
    [Show full text]
  • Questions About Orhei National Park
    Questions about Orhei National Park 1 The booklet was developed under the Awareness Raising and Information Program on biodiversity conservation for Orhei region as part of the UNDP project “Strengthening the institutional capacity and representativeness of the Protected Area System in Moldova”, funded by the Global Environment Facility. The purpose of the booklet is to answer the most common 15 questions about Orhei National Park. The views expressed in this publication do not necessarily reflect the official views of the United Nations Develop- ment Programme in Moldova and other international organizations involved in the project. Author: AO “ProRuralInvest” Photo: Alecu Renita, www.sxc.hu Design and layout: Mancas Mihail 15 Questions about Orhei National Park Copyright © 2010-2011 UNDP Moldova 2 CONTENTS 1. What are the protected areas? 2. What are National Parks? 3. What are the zones of National Parks? 4. Where is Orhei National Park located? 5. What are the main values of Orhei National Park? 6. What are the benefits of Orhei National Park to the community? 7. May other products found in the areas located within Orhei National Park (mushrooms, medicinal herbs) be cultivated and harvested? 8. May the wood from the forest located in Orhei National Park be used? 9. May livestock growing activities be carried out within Orhei National Park? 10. What regime is applied to tourism units operating within Orhei National Park? 11. What hunting regime is applied in Orhei National Park? 12. What are my rights as an owner or user of land located within Orhei National Park? 13. May the activities carried out before the inclusion of land in Orhei National Park be continued, even if these are profit- oriented? 14.
    [Show full text]
  • The Projects Are Implemented in Cooperation with the Ecocatalyst Foundation NARRATIVE REPORT Reporting Organisation: National En
    The projects are implemented in cooperation with the EcoCatalyst Foundation NARRATIVE REPORT Reporting Organisation: National Environmental Center Country: Republic of Moldova Reporting period: 2015 1 1. Background This project has the following major activities which were carried out in 2015: CNM – leader in IWRM in Moldova Developing a youth network “Love your river!” Festival of Bic river Collaboration with the Ministry of Internal Affairs to counteract cases of environmental pollution Various activities were organised in 2015 to strengthen the youth network “Love your river!”. In autumn 2015 it is envisaged to organise the first Forum of the Youth Network “Love your river!” in order to agree and plan the activities for 2016. The third edition of the Festival of Bic river “Love your river!” will be organised in 2016 due to the fact, that there were organised local elections in summer 2015 and the chairs of the District Councils were changed, now CNM will establish relations with the newly appointed Chairs of the District Councils and other newly elected representatives of public authorities to further implement the Bic river Rehabilitation Initiative and plan the organisation of the 3rd edition of the Bic Festival. Letters to ask for the support will be again sent to private companies and to the Mayoralty of Chisinau municipality who will be the host of the event. It is envisaged to involve more seriously those companies which will be included in the SCR program of CNM. CNM will continue to promote the creation and support the operation of the River Basin Councils. At the moment CNM is Technical Secretariat of the Bic Basin Council which is meeting 3-4 times a year to discuss solutions for the improvement of the environmental state of the river, and it has also helped the local authorities to create Ichel Basin Council (spring 2015), Tigheci Basin Council (autumn 2014, the second meeting was organised in winter 2015) and Larga Basin Council (autumn 2014, the second meeting was organised in winter 2015).
    [Show full text]
  • Lea Raport Periodic Al Republicii Moldova
    ADVISORY COMMITTEE ON THE FRAMEWORK CONVENTION FOR THE PROTECTION OF NATIONAL MINORITIES ACFC/SR/V(2019)011 Fifth Report submitted by the Republic of Moldova Pursuant to Article 25, paragraph 2 of the Framework Convention for the Protection of National Minorities – received on 22 May 2019 ACFC/SR/V(2019)011 FIFTH PERIODIC REPORT OF THE REPUBLIC OF MOLDOVA ON THE IMPLEMENTATION OF THE FRAMEWORK CONVENTION FOR THE PROTECTION OF NATIONAL MINORITIES TABLE OF CONTENTS INTRODUCTION ………………………………………………………………………...3 PART I……………………………………………………………………………………4 Information on practical arrangements made by the Republic of Moldova to continue implementing the Framework Convention, to increase the involvement of civil society in the process and to pursue the dialogue with the Advisory Committee PART II…………………………………………………………………………………..7 Information on measures taken by the Republic of Moldova to address the issues for immediate action identified in the forth monitoring cycle and assessment of other core issues that are outstanding after four cycles. Situation in the Transnistrian region of the Republic of Moldova…………………………...7 Strengthening of national legal and regulatory framework…………………………………..8 Practical measures: Implementation of the Action Plan for 2017-2020 for the Strategy on the Consolidation of Interethnic Relations in the Republic of Moldova for2017-2027………………...…13 Measures taken to preserve the memory of the Holocaust victims, to study and to spread knowledge about the Holocaust…………………………………………………14 Implementation of the Action Plan to
    [Show full text]
  • (Eni/2016/372-403) the Danube, Prut and Black Sea
    European Union Water Initiative Plus for Eastern Partnership cOUNTRIES (ENI/2016/372-403) THE DANUBE, PRUT AND BLACK SEA RIVER BASIN MANAGEMENT PLAN IN REPUBLIC OF MOLDOVA for the future planning cycle (2022-2027) TECHNICAL REPORT N°6 ON ECONOMIC ANALYSIS OF WATER USE December – 2019 Technical Report N°6 Economical analysis of water use Beneficiaries IWRM department of the MARDE (legislation and supervision), Agency “Apele Moldovei” (Planning coordination and follow up of implementation) Produced by OIKUMENA Public Association Authors Petru Bacal, Iurie Bejan, Vitalie Dilan, Lucia Căpățînă, Nicolae Boboc, Boris Iurciuc, Natalia Zgîrcu Produced for: International Office for Water (France), as contracting authority responsible for RBM planning in EUWI+East member state consortium Supervision Radu Cazacu and Dumitru Proca from Apele Moldovei supported by Pierre Henry de Villeneuve (IOWater) and Victor Bujac (National EUWI+ Project Representative in Moldova) Date December 2019 Version Final Acknowledgements: Apele Romane for offering its support including the direct contribution of Irina Tutunaru from Water Administration Prut – Barlad River Basin, Romania Financed by: European Union Co-financed by: Austrian Development Agency and the Artois-Picardie Water Agency (France) for the implementing Member States Disclaimer: The EU-funded program European Union Water Initiative Plus for Eastern Partnership Countries (EUWI+ 4 EaP) is implemented by the UNECE, OECD, responsible for the implementation of Result 1 and an EU member state consortium of Austria, managed by the lead coordinator Umweltbundesamt, and of France, managed by the International Office for Water, responsible for the implementation of Result 2 and 3. This document, the “TECHNICAL REPORT N°6 ON ECONOMIC ANALYSIS OF WATER USE”, was produced by the EU member state consortium with the financial assistance of the European Union.
    [Show full text]
  • THE RESULTS of a SUCCESSFUL PROJECT European Union
    Project funded by THE RESULTS OF A SUCCESSFUL PROJECT European Union ”Joint Iniaves of Civil Society Organizaons from the both Dniester river banks for Socio Vocaonal Integraon of Disadvantaged Youth from Republic of Moldova” This project is co-funded by Caritas Vienna, Municipality of Vienna 1 and a private donor from Europe Borders are just territorial barriers and cannot stop the good relationship between people, especially among the citizens of the same country. Starting from this statement, in 2014, we set the basis for a lasting collaboration between the teams of NGOs “DEMOS” in Edineț and “SERDŢE” in Bender. The specialists from the right bank of the Nistru river shared, with gratitude, to their Transnistrian colleagues their own skills and experience of working with the vulnerable youth in order to create and develop the Socio-Professional Integration Service on the left bank too. This collaborations success, as well as the acute need for youth services, inspired us to conceive this ambitious project. We have thought that a network of CSOs providing social services could succeed better than 1-2 associations. Thus, we united in the “SVIS Moldova” network 6 teams, in which we invested skills, time, material and informational resources, so that in a short time we could have SVIS extended in the entire Transnistrian region and in 6 districts on the right bank of river. The word “confidence” has passed as a leitmotif through all project activities, meaning trust in professional potential, in people, in achieved results, and last but not least, marking the trust of authorities in the necessity and effectiveness of the Socio-Professional Integration Service provided in favour of disadvantaged young people.
    [Show full text]