Quality improvement of health services
Title: Quality improvement of health services in the Republic of Moldova
Commissioned by: German Federal Ministry for Economic Cooperation and Development (BMZ)
Country: Republic of Moldova
Lead executing agency: Ministry of Health of the Republic of Moldova (Ministerul Sănătății al Republicii Moldova)
Overall term: 2014 to 2017
The Republic of Moldova is one of Europe's least prosperous countries. The population's health is poor, and life expectancy at birth is lower than anywhere else in Europe. In 2013, the country adopted a National Development Strategy for the period up to 2020. Although it focuses on economic growth, the strategy specifies health as another sector that is important for Moldova's sustainable development alongside culture, social security and environmental protection.
A central element of the country's current health policy is that service delivery, quality assurance and health finance are treated as three separate functions. Health care is provided by health facilities, the services of which are assessed by the National Accreditation Council and which, if they are found to be of adequate quality, are accredited for five years. The national health insurance system uses the revenue from the obligatory health insurance for all employees and from state subsidies to pay the accredited facilities for the medical services they provide.
The long-term strategy to improve health care aims to promote primary health care through family doctors and nursing and to carry out a substantial reorganisation of hospital services. Flexible and efficient networks of service providers are to be created to replace the rigid structures that exist today as a legacy of Soviet planning.
Necessary steps in a strategy to make fundamental changes to the current health care landscape include improving hospital infrastructure, providing modern equipment and reallocating acute hospital beds to long-term care.
The quality and economic efficiency of care has improved in selected hospitals.
The approach focuses on exemplary improvements in the care provided in selected acute secondary care hospitals. These serve as a reference for the primary care level (health centres, doctors' practices, health posts) and as referring bodies for the tertiary care level and convalescent centres.
To this end, the project is setting up quality circles with representatives of the different levels. Quality indicators include a reduction in the length of stay, a decrease in the number of hospital admissions that are not indicated, an increase in satisfactory treatments and user satisfaction.
The proposals made by the quality circles for improvements can only partly be implemented by health care staff alone. Implementation of these proposals is thus being promoted through targeted communication with decision-makers from the Ministry of Health, Moldova's health insurance provider and the regional development councils and through specific subsidies.
In the process, exemplary approaches evolve that are taken up by the Ministry of Health and passed on to various institutions, such as the National Centre for Health Management, training facilities of the Ministry of Health and the National Accreditation Council, with a view to developing a quality management system.
On request, GFA Consulting Group hires national and international advisers to develop and implement the quality circle. It also works with the project to advise the Ministry of Health on matters of quality assurance in public hospitals.