2024-03-23-世界银行-调查报告_摩尔多瓦服务提供指标健康调查（英）_227页_6mb

Here is the summary of the World Bank Group's 2021–2022 Service Delivery Indicators Health Survey for Moldova:

2. Methods

The survey used a stratified sampling approach to represent Moldova’s primary health care (PHC) system, grouping facilities by urban vs. rural areas and facility types (e.g., health centers, family doctor offices, consultative diagnostic centers). Data were collected from 247 PHC facilities, interviewing 470 doctors, 807 nurses, and 1,497 patients. Surveys included structured interviews with facilities and providers, clinical case simulations, and patient experience metrics. Approximately 98% of sampled facilities participated, ensuring high national and regional representation.

3. Foundations (Input Components)

The survey assessed the structures and resources enabling PHC delivery:

• Service Availability: 83% of facilities offered all required PHC services (e.g., noncommunicable disease care). However, services for mental health (70% availability) and infectious diseases (66%) were lower.
• Physical Infrastructure: Most facilities had basic amenities like functional phones (97%'), computers (82%'), and refrigerators for vaccines (85%'), but 48% had functional electricity and 69% had internet connectivity. Less than half had ramps or tactile flooring for differently-abled users.
• Staff Availability: 54% of providers were trained in primary care competencies; however, 26% of time spent by doctors and nurses was on administrative tasks, potentially detracting from clinical care.
• Emergency Preparedness: 62% conducted emergency drills and 75% had supporting protocols, but few facilities had fire safety equipment.

Processes of Care

This domain evaluated the delivery of clinical, referral, and patient experience standards:

• Clinical Competence: Providers correctly diagnosed hypertension (92%) and diabetes (92%) but only 68% correctly diagnosed depression. 83% correctly identified and referred for pneumonia, but 146 lacked protocols for integrated care.
• Referral Systems: 95% of referred patients were informed of transfers; however, 28% cited long travel or service unavailability as barriers.
• Patient Experience: 95% of patients were satisfied with care, rating environmental factors (e.g., privacy) highly. 98% recommended the facility to others, but 43% rated staff skills as "good" or "very good."

4. Person-Centered Outcomes

Key findings on patient engagement, quality of care, and financial access:

• Satisfaction: 95% of patients rated care very good or good; however, 24% incurred lost income from seeking care.
• Confidence & Uptake: 99% of patients received recommended services, and 98% planned to return.
• Financial Protection: Out-of-pocket costs were minimal (MDL 156 per consultation on average), but 20% of patients lost income due to care-seeking.

Conclusions

Moldova’s PHC system demonstrates high-functioning quality for core services (e.g., hypertension/ diabetes), strong provider retention, and high patient satisfaction. However, key gaps exist:

• Service availability for mental health and specialized care.
• Infrastructural deficits, such as uninterrupted energy and water, particularly in rural areas.
• Need for improved referral systems and human resource management to balance workloads.

Recommendations include investing in digital health tools, enhancing provider training for high-demand areas, and ensuring inclusive infrastructure for differently-abled users. Continuous monitoring via SDI surveys can track progress toward universal and equitable PHC access.

This survey provides a baseline for policymakers to implement targeted interventions, ensuring Moldova strengthens its health system aligns with universal health coverage goals.