Acasă

Center For Health Policies and Studies

The communities, rights, and gender (CRG) regional brief was developed as part of the multi-country program “Advancing People-Centered Quality TB Care - From the New Model of Care Towards Improving DR-TB Early Detection and Treatment Outcomes” (TB-REP 2.0), financed by The Global Fund to Fight AIDS, Tuberculosis and Malaria and implemented by the Center for Health Policies and Studies (PAS Center) as the principal recipient. 

These recommendations were developed within the framework of the Project "Support to reforms in the primary health care in Moldova", implemented by the Center for Health Policies and Studies (PAS Center), with the financial support of the Embassy of the Republic of Lithuania in the Republic of Moldova. The opinions expressed in this publication belong exclusively to the author and do not necessarily reflect the views of the Embassy of the Republic of Lithuania in the Republic of Moldova and the PAS Centre.

The “Assessment of barriers related to the legal environment, gender, stigma and human rights for key populations in the response to tuberculosis in Almaty city and Almaty Oblast" was conducted by the Association of Legal Entities "Kazakhstan Union of People Living with HIV" within the framework of multi-country program "Advancing People-Centered Quality TB Care - From the New Model of Care Towards Improving DR-TB Early Detection and Treatment Outcomes" (TB-REP 2.0), using the TB Community, Rights and Gender (CRG) tools developed by Stop TB Partnership.

The “Assessment of CRG barriers for TB high-risk groups in Georgia" was conducted by the Union “New Vector” within the framework of multi-country program "Advancing People-Centered Quality TB Care - From the New Model of Care Towards Improving DR-TB Early Detection and Treatment Outcomes" (TB-REP 2.0), using the TB Community, Rights and Gender (CRG) tools developed by Stop TB Partnership.

This report was developed within the project "Palliative Care in the Republic of Moldova, 2007-2017", implemented by the Center for Health Policies and Studies (PAS Center) with the financial support of the Soros Foundation Moldova/Public Health Department. The views and conclusions expressed in this report are those of the authors and do not necessarily reflect the official position of the Soros Foundation Moldova.

These recommendations are intended to support non-governmental organizations active in the field of tuberculosis, in ensuring the continuity of the services provided under the conditions of the COVID-10 pandemic in safe environments for their own health and for the health of those around them.

The recommendations were elaborated in partnership with PHI FPI "Chiril Draganiuc".

PAS Center team has developed a rapid risk assessment and contingency planning tool to maintain TB and HIV programs operational during COVID-19 pandemic response. It may be used not only for the purpose of Global Fund grants, but also for assessing effects on the full continuum of services and the health system functions that support service delivery. It also allows to plan possible mitigation measures, list changes in service delivery modalities, estimate additional resources and source of funding.

The "Health Barometer of the Population of the Republic of Moldova, 2019 survey was conducted for the second subsequent year to identify the citizens’ views and opinions about the health services provided within the country health system and to present the population's perceptions on two important issues: (1) self-assessment of their own health status and (2) evaluation of health services in the Republic of Moldova and access to health services both in primary and hospital care. This opinion barometer was developed within the project "Implementing Participatory Social Accountability for Better Health" conducted by the Center for Health Policies and Studies (PAS Center) with the  financial support of World Bank / Global Partnership for Social Accountability.

Address to Prime Minister Ion Chicu related the risks of undermining the Government's efforts to implement commitments assumed by the Financing Agreement between the Republic of Moldova and the International Development Association regarding the implementation of the Project "Moldovan Health Sector Modernization", as a result of an exemption from applying health warnings on tobacco products sold in duty-free shops located in the entry area of the territory of the Republic of Moldova.

The Patient Exit Survey: 2019 results presents the results of two surveys carried out within one year of each other in 55 hospitals in the Republic of Moldova. The main purpose of the survey is to measure the degree of satisfaction of the hospitalized patients in a comparable and objective way for each public hospital in the country. The survey was conducted within the project " Implementing Participatory Social Accountability for Better Health”, implemented by the Center for Health Policy and Analysis (PAS Center) in collaboration with the Ministry of Health, Labor and Social Protection, with the financial support of the World Bank / Global Partnership for Social Responsibility.

The "Health Barometer of the Population of the Republic of Moldova 2018" survey was conducted to identify the citizens’ views and opinions about the health services provided within the country health system.   And intends to present the population's perceptions on two important issues: (1) self-assessment of their own health status and (2) evaluation of health services in the Republic of Moldova and access to health services both in primary and hospital care.

This opinion barometer was developed within the project "Implementing Participatory Social Accountability for Better Health" conducted by the Center for Health Policies and Studies (PAS Center) with the  financial support of World Bank / Global Partnership for Social Accountability.

The study on the optimized allocation of financial resources to maximize the results in the TB program control was conducted using the Optima TB model. The analysis reveals the potential options identified for reallocating financial resources and priority interventions to accelerate the decline in the burden of tuberculosis in the Republic of Moldova.

Ensuring continuous access to essential and affordable medicines of good quality is one of the key components of a functional health system. The commitment of the Government of the Republic of Moldova to the implementation of the concept of essential medicines is stipulated by a series of strategic documents: National Health Policy, State Medicines Policy as well as by regulatory documents that translate this concept into practice. This report presents assessment results on the implementation of the concept of essential medicines in the national health system and identifies determinants to improve the application of the concept in practice.

The brochure presents the achievements of civil society organizations in introducing human-centred treatment models for tuberculosis in 11 countries of Eastern Europe and Central Asia: Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Turkmenistan, Ukraine and Uzbekistan.

The publication describes best practices implemented under the 3-year TB REP project. These success stories of the countries participating in the project will enable civil society actors to emulate the successful experiences of their peers in their work.

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.

The Patient Exit Survey: 2018 results is the first of its kind in the health field in the Republic of Moldova and was conducted within the project " Implementing Participatory Social Accountability for Better Health”, implemented by the Center for Health Policy and Analysis (PAS Center) in collaboration with the Ministry of Health, Labor and Social Protection, with the financial support of the World Bank / Global Partnership for Social Responsibility.

The main purpose of the survey was to measure the satisfaction of the hospitalized patients in a comparable and objective way for 55 public health-care institutions in the country and to give a general score to the hospital. Also, the survey measures the satisfaction of patients regarding the quality of interaction and communication with doctors and medical staff, participation in decision-making and training on post-discharge behavior, opinion on the conditions of hospitalization, as well as evaluation of suggestions made by outpatients regarding aspects that need improvement in hospitals.

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. 

The study on the optimized allocation of financial resources to maximize the results in the TB program control was conducted using the Optima TB model. The analysis reveals the potential options identified for reallocating financial resources and priority interventions to accelerate the decline in the burden of tuberculosis in the Republic of Moldova.

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 evaluation report focuses on providing more effective options for development of sustainable financing models for TB control, and provider payment mechanisms to align financial incentives to increased role in TB care for outpatient settings (home, community, primary care specialist care) and decreasing contribution of inpatient settings.

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.

This report presents an assessment of the human workforce (HWF) in the health system involved in the treatment and support of tuberculosis patients in the Republic of Moldova. The evaluation referred to each stage of human workforce training in the health system, such as the prevention, diagnosis, treatment and evaluation of tuberculosis (TB), using the standard tools and terms of reference to assess HWF policies, operations, workload and working conditions. There was focus on the country's capacity to deliver integrated people-centered care by inter-disciplinary teams for outpatient patient care. This report has focus on TB personnel at services delivery level like doctors, nurses, non-medical specialists working and community centers.

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 Integrated Bio-Behavioural Survey (IBBS) 2017 among people who inject drugs, sex workers, men who have sex with men and people in detention and other closed settings  Republic of Moldova was  conducted as part of the grant Strengthening HIV Control in the Republic of Moldova, funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and implemented by the Centre for Health Policies and Studies. This summary report present key findings

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%).

The assessment of opioid substitution therapy (OST) in Moldova was organized by joint efforts of PAS Centre, UNODC and WHO Offices in Moldova. The assessment aimed at identifying constraints towards ensuring OST coverage among injection drug users (IDU), accessibility and quality of OST services and most important steps for achieving progress and efficiency in OST implementation through provision of comprehensive and integrated care to OST patients, cost-efficiency analysis including future cost implications on national budget.

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.

The goal was to identify and measure factors associated with DOT failure and default, in order to suggest suitable measures to increase the treatment success rate. The study was designed to examine qualitatively and quantitatively the factors associated with TB defaults and failures. The goal of the quantitative part of the study was to identify and measure factors associated with DOT failure and default, in order to suggest suitable measures to increase the treatment success rate. A case-control study was conducted in patients with new pulmonary smear-positive active TB case registered between January 1, 2006 - March 31, 2007, who have started treatment for TB with known or unknown outcome. The study sample consisted of 99 cases and 198 controls matched by sex and age. The study measured major risk factors including factors associated to onset of TB, model of TB care, communications between patient and physicians and patient knowledge; personal and economic factors. The qualitative study explores the opinion of providers (primary health care and TB specialists) on factors associated with poor treatment outcomes.

Following the interests of this study there was evaluated the level of knowledge of medical staff and representatives of local public authorities regarding the process of decentralization in the domain of health care, described the attitude of medical staff and representatives of LPA towards the existent degree of decentralization and necessity in decentralization or centralization of the health care system, as well as the attitude of the respondents towards the process of autonomisation or privatization in the field of primary medical assistance and other levels of health care administration.

The operational research had the goal to estimate HIV prevalence among newly registered TB cases in 2007 in the Republic of Moldova. Besides, it evaluated knowledge and attitudes towards HIV/AIDS and HIV VCT of TB patients.  The study obectives were to: (1) To estimate HIV prevalence among TB new detected cases in Moldova; (2) to estimate HIV knowledge among TB patients in Moldova; (3) to explore TB patients attitudes towards HIV/AIDS; (4) To measure HIV VCT coverage of TB patients. A prospective cohort study was conducted. The study had two components: serological and quantitative components. The serological component allowed estimating HIV prevalence among new TB cases, the knowledge and behavioral component one allowed assessing key knowledge on HIV/AIDS and reveal attitudes towards HIV/AIDS of the target group. sample size of the Sample size was 436 respondents. Results showed that if routine testing is offered to all TB patients, the HIV prevalence in TB patients is much higher than previously reported. An alarming 12.2% HIV prevalence among TB patients was reported in Balti city. The integrated knowledge indicator showed a lower level of knowledge in TB patients (18.5%) compared to 28.3% in the general population. A high level of misconceptions about HIV transmission and high level of stigma towards PLWH among TB patients.