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Centrul pentru politici și analize în sănătate

The assessment of capacity building needs of NGOs working with key populations and healthcare providers in Moldova was conducted under the coordination of the Ministry of Health, Labor and Social Protection, in the framework of Joint UN Plan on AIDS, based on the UBRAF Funds, in the framework of the partnership between UNAIDS, UNFPA and UNFPA Implementing Partner, Center for Health Policies and Studies (PAS Center).

TB-REP is a multipartner project covering 11 countries: Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkmenistan, Ukraine and Uzbekistan (2016-2018). It aims to prevent TB and drug-resistant TB, and to improve TB treatment outcomes by increasing political commitment and accelerating adoption of people-centred models of care.

TB-REP countries are currently taking efforts in introducing people-centered model of care. In order to assess legal-normative acts regulating different aspects of TB care within each country, a Regulatory Framework Assessment (RFA) tool has been developed within TB-REP.  The RFA tool is designed to be used by national stakeholders from TB-REP countries for conducting a comprehensive analysis of their respective national legislation and regulations and identify the level of congruence with the principles of the people-centred model of TB care.

TB-REP countries are currently taking efforts in introducing people-centered model of care. One of the main components for transitioning to the people-centered model of care is to ensure adequate workforce involved in TB care delivery. To help National Programmes to ensure health workers requirements are met at service delivery level, a simple tool has been developed to get overview of baseline staffing needs. The purpose of the “Health Workforce Baseline Assessment Tool: Overview of Baseline staff establishment and requirement in National TB Programmes” (the Tool) is to identify what is available in terms of health workers at service delivery level and baseline against current requirements to deliver quality services as part of National TB programmes. The objective of the tool is to get a quick baseline overview of staffing implications based on TB epidemiological data as well other pulmonology disease patients’ numbers and visits.

In the context of  the UN HLM information package development, a guiding paper for CSOs in EECA region was developed through TB-REP civil society involvement. It is aligned with the major key asks of the TB global community developed to guide preparation processes  for UN HLM on TB and linked with the specifics of the TB reforms within the general healthcare agenda in the TB-REP EECA countries.  

The paper is aimed to be helpful for the civil society partners in the EECA countries for meetings and briefings with the National delegations for UN HLM on TB, as well as laying the background for the in-country actions and directions on post-HLM advocacy and accountability.

This document was developed within the project «Together in Tuberculosis Control», run by the Moldova National Association of Tuberculosis Patients ”SMIT” (Society of Moldova against TB), with the support of the Center for Health Policies and Studies from the sources allocated by the Global Fund to Fight HIV / AIDS, Tuberculosis and Malaria, through the EECA regional program (TB-REP).

Although the Republic of Moldova faces serious challenges related to both TB and especially drug-resistant TB burden, having one of the highest rates of MDR-TB in the WHO European Region, it has also made signifi cant strides in reducing TB incidence and improving access to diagnostics and DR-TB treatment. In recent years, it has even piloted fully ambulatory MDR-TB treatment and strengthened peer and community-based support. Th ere is still much to be done, but there are many promising collaborations and projects which show that Moldova is not only taking the problem of TB seriously, but is open to innovative, patient-centred approaches. 

National TB Program in Georgia is implemented by multiple partners including the Ministry of Labor, Health and Social Affairs (MOLHSA), the National Centre for Disease Control and Public Health (NCDCPH), the National Centre for Tuberculosis and Lung Diseases (NCTBLD), and the Ministry of Corrections and Legal Advice (MCLA). TB services are delivered by specialized outpatient and in-patient clinics. There are 69 TB service points staffed by a TB specialist and a nurse in each district of Georgia. In 2011 a vast majority of TB dispansaries in regions were integrated into public and private general hospitals. However, in Tbilisi, outpatient TB care is being provided by a network of TB dispensaries and a number of DOT spots at primary care facilities. 

Azerbaijan is one of the 30 countries identified by the WHO with the highest burden of MDR-TB. The country located in the Eastern Europe and Central Asia (EECA) region which is home to the world’s fastest growing drug-resistant TB epidemic. The key populations for TB include; prisoners, who have 20 times the national incidence at 1,270/100,000, people living with HIV, injecting-drug users, migrant workers and poor people living in rural areas.

The Strategy is part of the Global Fund to Fight AIDS, Tuberculosis and Malaria program implemented in Moldova by the Center for Health Policies and Studies (PAS Center) and was examined by the joint meeting of representatives of Chiril Draganiuc Institute of Phthisiopulmonology, National Tuberculosis Control Program and relevant community organizations, which took place on November 22, 2017.

The Strategy was developed by Prof. Dr. habil. Constantin Marin.

The Tuberculosis Regional Eastern European and Central Asian Project (TB-REP) on strengthening health systems for effective tuberculosis (TB) and drug-resistant TB prevention and care is a three- year project that began in 2016. It is funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria and implemented by the Center for Health Policies and Studies of the Republic of Moldova as the principal recipient and the WHO Regional Office for Europe as the technical lead agency, in collaboration with partners, namely TB Europe Coalition (through Alliance for Public Health Ukraine), Stop TB Partnership, and technical expertise of London School of Economics and Political Science, European Respiratory Society London School of Hygiene and Tropical Medicine.

The project support 11 countries of eastern European and central Asian in addressing outdate models of TB care in order to tackle the high burden of TB and MDR-TB. The project assists countries in implementing effective and efficient TB service delivery systems with sustainable financing.

This newsletter summarizes project key activities and achievements during June-December 2017.

This study is a continuation of the study conducted in 2013 as part of PAS Center’s Health Monitor initiative. Its purpose was to provide a situation analysis of procurement of antiretroviral drugs in the context of transition from procurement through external sources to national procurements. This assessment analyses procurements during gradual takeover of medicines procurement and concludes that the government has not fully tapped into all available technical solutions to procure quality drugs at most affordable prices to ensure a higher covereage of people living with HIV with ART within the available budget. The study outlines some opportunities for interventions, in order to maximize use on national and international resources.

This operational research was conducted with the support from the Global Fund to Fight AIDS, Tuberculosis and Malaria. The research method was developed by the staff of the Center for Health Policies and Studies (PAS Center). The research included 318 people identified in the SYME-TB who met the chart audit criteria which included being informed of having multidrug-resistant tuberculosis (MDR-TB) in 2012 and having had the result of treatment prior to December 2015.

A key deliverable of the TB-REP project, the People-Centered Model of TB Care: Blueprint for EECA Countries is now available and is formally launched to representatives of 11 TB REP countries in Chisinau, Moldova today, June 30. 

Its goal is to shift care closer to people and communities.  This entails moving towards ambulatory treatment and care, strengthening services involving primary care, and better integrating care across various providers, levels and settings within health systems.

We would like to thank all TB-REP partners, the Writing Committee and the Members of the TB-REP Scientific Working Group for their contributions. This has the potential to be a game changer in improving TB response in OUR region and if implemented, will have an impact on the epidemic and improve the lives of people affected by TB.

This is the electronic calculation tool for planning inpatient care capacities based on disease resistance profile. The explanations on its use are presented in Annex 2 (page 38) of the People Centered Model of TB Care: Blueprint for EECA Countries. The bed forecasting tool sets out the instructions for following these suggested actions and example results.  It contains 18 steps, divided into two stages. A number of brief explanatory notes are also included.

The evaluation of opioid substitution treatment services in Moldova was conducted under the program "Strengthening the HIV control in Moldova, 2015 - 2017", financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and implemented by the Centre for Health Policies and Studies in collaboration with the Republican Narcological Dispensary. 

The Center for Health Policies and Studies provided data analysis and developed the report of the 2012 Access to Health Services Survey (2012 AHSS) desk review and qualitative research. 2012 AHSS was carried out as part of Moldova Multiple Indicator Cluster Survey (MICS) in 2012 by the National Centre of Public Health of the Ministry of Health, with support from the United Nations Children’s Fund (UNICEF) and in collaboration with the National Bureau of Statistics, the Scientific Research Institute of Mother and Child Health Care, the Ministry of Labour, Social Protection and Family, the Ministry of Education, the National Centre for Health Management, and the National Centre for Reproductive Health and Medical Genetics. The Center for Health Policies and Studies provided data analysis and developed the report of 2012 AHSS. Financial and technical support was provided by UNICEF, with direct contribution of the Swiss Agency for Development and Cooperation.

Qualitative Study on Primary School Children point-of-sale advertising and promotion of cigarettes focuses on determining the reaction of the children towards advertisement and promotion of tobacco products in points of sales. The main findings of the study showed that in points of sales, all the consumers, regardless of age or the fact that they are or are not smokers are exposed to the influence of the slogans and images that stimulate smoking.

 

 
 

This operational research was conducted with the support from the Global Fund. The original design was developed by the staff of the Centre for Health Policies and Studies. UNAIDS RCA ECA has provided technical assistance to finalise the study protocol, the data collection and to oversee parts of data collection.

Despite the fact that tuberculosis is quite known and spread, it is a stigmatizing disease in the Moldovan society, and is linked with moral prejudices, especially in rural areas, among elder people, population with lower education levels and persons with lower socio-economic status. Every fourth person considers that it is a shame to have tuberculosis and slightly more than a half of the respondents (56%) think that persons with tuberculosis would not disclose their TB status. The main reason is the fear of being avoided by community (both at work and in the community of friends, relatives and acquaintances). The majority of respondents believe that people change their attitudes towards persons who have tuberculosis (59%), and commonly try to avoid them (77%).

In the current negotiations for Deep and Comprehensive Free Trade Area Agreement, the European Union (EU) requires the Republic of Moldova to introduce in the national legislation data exclusivity as a new form of intellectual property protection. Data exclusivity would allow pharmaceutical companies to hold exclusive rights over their clinical test data for a defined period of time. In essence, this measure ensures the exclusive right and market monopoly of originator drugs for a maximum of 11 years and the European Union promotes this measure to return initial investments that lead to discovering an innovative pharmaceutical entity. To support its position, the European Union brings several arguments that are discussed below in this document.

The Maternal and child health equity analysis was commissioned by UNICEF Moldova to describe and assess the extent of inequalities in maternal and child indicators and other key indicators causally relating to maternal and child health in the Republic of Moldova. This situational analysis focuses on the differences in various categories and to confirm whether and if these groups, of the child and woman populations, of the country may suffer disproportionately.