2014年-世界发展银行全球_Moldova___Health_Transformation_Program_29页_812kb

Summary of Moldova Health Transformation Program (P144892)

Core Content

The Moldova Health Transformation Program (P144892) is a four-year initiative (2014-2018) aimed at improving the health system by reducing key risks for non-communicable diseases (NCDs), enhancing financial protection, and increasing the efficiency of health services. The program is aligned with the Government of Moldova's broader health reform agenda, which has been in place since 2004 and includes a comprehensive Health Care System Development Strategy (2008-2017) and a National Health Policy (2007-2021). The program is designed to support a subset of the Strategy's priority activities and is funded by the Government and the World Bank.

Main Objectives

• Reduce key risks for NCDs, particularly smoking and hypertension.
• Improve financial protection for the population.
• Enhance the efficiency and quality of health services.

Key Sections of the Strategy

The Strategy outlines four priority sections:

1. Improve the management/stewardship of the health system

   • Increase capacity of the Ministry of Health (MOH), MOH-affiliated institutions, and local health authorities.
   • Strengthen multi-sectoral collaboration and civil society involvement.
   • Bring national health legislations in line with EU standards.

2. Improve funding and payment mechanisms

   • Enhance financial risk protection.
   • Ensure equity and transparency in resource allocation.
   • Improve mechanisms for funding and contracting of health services.

3. Organize and provide health care services

   • Promote integration and continuity of care.
   • Develop priority sectors with high impact on population health.
   • Improve quality of care and patient satisfaction.

4. Generate and ensure necessary resources for the health system

   • Efficiently manage human resources for health.
   • Strengthen the technical and material base of health institutions.
   • Rationally manage drug provision.

Program Structure and Financing

• The program is structured around five main programs and 17 sub-programs, focusing on:

  • Policies and management in health care
  • Administration of the national mandatory health insurance fund
  • Primary care services (performance-based incentives for family medicine and outpatient drug reimbursement)
  • In-patient care (performance-based incentives for hospitals)
  • National special health programs (tobacco control activities only)

• Total estimated cost for the program over four years (2014-2017) is US$153 million, with 82.9% coming from the Government and 25% from the World Bank (IDA PforR).

• An additional US$2 million in technical assistance is required to support the program's implementation.

Strategic Relevance and Technical Soundness

C1. Strategic Relevance and Technical Soundness Regarding NCD Control

• Smoking is a major public health issue in Moldova, with 50% of men and 7% of women smoking. It is the second leading risk factor in terms of disease burden.
• Hypertension is the second leading health risk factor, contributing to high rates of stroke and heart attacks.
• The National Tobacco Control Programme (NTCP), approved in 2012, is aligned with WHO's FCTC and includes cost-effective interventions such as tax increases, warning labels, and smoking cessation services.
• The Program focuses on tobacco control and hypertension management, which are among the most cost-effective interventions for NCD prevention.
• Public support for tobacco control is high, especially among women, increasing the likelihood of program success.
• The program includes awareness campaigns, provider training, revised performance-based incentives, and reduced co-payment levels to improve hypertension management.

C2. Strategic Relevance and Technical Soundness Regarding Hospital Efficiency

• Hospital inefficiency is a major challenge in Moldova, with 73 hospitals serving a population of 3.6 million and a high number of beds compared to other countries.

• Overcapacity and duplication of services exist, especially in Chisinau, where 50% of hospitals and 56% of beds are concentrated for a population of less than 700,000.

• Monoprofile hospitals (specialized for single conditions) are not well suited for modern, multidisciplinary care and contribute to waste and inefficiency.

• The program aims to:

  • Reduce acute care beds and hospital admissions.
  • Strengthen the DRG payment mechanism to improve hospital efficiency and quality.

• The program is informed by international best practices, including:

  • Regionalization of hospitals.
  • Common management structures for public hospitals.
  • Establishment of a university hospital.
  • Use of performance-based indicators for hospital payments.

• The program includes technical assistance to guide the updating of DRGs and align them with national data, which is necessary for the effective implementation of a prospective payment system.

Key Challenges and Considerations

• Political commitment is essential for successful hospital reforms, as evidenced by the need for Parliamentary approval of the regionalization strategy.
• Provider training and patient education are necessary to improve adherence to hypertension treatment.
• Performance-based incentives in primary care are limited in scope and do not fully reflect the need for holistic quality improvement or primary prevention for NCDs.
• Equity in resource allocation is a concern, as current systems do not account for deprivation and rurality in budget distribution.

Conclusion

The Moldova Health Transformation Program is strategically relevant and technically sound, focusing on reducing NCD risks, improving financial protection, and increasing the efficiency of health services. It is aligned with international best practices and is supported by a comprehensive strategy and financial framework. The program requires strong political will, technical assistance, and continued investment to achieve its objectives and improve the overall health system performance in Moldova.