Moldova Experience in reduction of Health Inequity

1. Moldova Experience in reduction of Health Inequity Larisa CATRINICI Minister of Health SEECP Health Ministerial Meeting Chişinău, 7 November 2008

2. Health inequities a promotional point for the system reform 1. Low access to the medical services 2. Disadvantaged situation of the patients with social-economical related diseases 3. Non corresponding between expectations, needs, supply and amount of medical services 4. Inequity in providing of the medical services in rural arias 5. Patientsunsatisfaction regarding medical services quality 6. Respecting of the patient rights in health services decisions-making process

3. 1. Inequity:Lowaccess to the medical services • Implementation of the Mandatory Health Insurance (2004) • Establishment of the National Health Insurance Company • Elaboration and adopting of the legislation regarding funding and health services providers contracting within MHI framework • Autonomy of public medical services providers contracted on the per capita (PHC) and fee for services basis Solutions :

4. 1998 – 1427.19 2006 – 1368.87 Standardized Mortality per 100 000inhabitants Life expectation at birth

5. Infant mortality per 1000 alive born Child mortality under 5 years old per 1000 alive born

6. Maternal mortality per 100000 alive borne

7. 2. Inequity: • Disadvantaged situation of the patients with social-economical related diseases

8. Solution: • State budget coverage of the uninsured patients suffering of social related diseases • State financed National Programs: • For non-communicable disease control • Healthy life style promotion • MoldDiab • Iodine deficiency diseases • Mental Health • Oncology • Narcology and drug addiction • Transplant • For communicable disease control • Tuberculosis • HIV/AIDS and sexual transmitted infections • The Viral Hepatites (B and C) • Choleraand another acute diarrhea diseases • Immunization • Blood Transfusion Safety and blood products assurance

9. National Programs State financing

10. HIV/AIDS Incidence per 100 000 inhabitants TB Morbidity per100000 inhabitants

11. 3. Inequity:Non corresponding between expectations, needs, supply and amount of medical services • Establishing a centralized fund, designed for a sustainable and needs adjusted health system • Approving a basic package of health services (Unique Programm) • Renovating and improving the technical and material capacities of health services public providers Solution:

12. Pooling of all financial recourses for the health system

13. MHI fund increasing trend including the financial transfers from the state budget

14. 4. Inequity:The low amount of the medical services delivered in rural area Solution: • Strengthening the PHC, particularly in rural area • Financial autonomy of the PHC providers • Socio-economic support for the specialists employed in rural area

15. 5. Inequity:Low quality of the medical services Solution: • Standards and clinical protocols elaboration • Health services providers accreditation • Internal Audit implementation • Systemic approach of the health issues: • National Health Policy • Health system development Strategy (2008-2017) • Republic of Moldova - European Union Action Plan • National Development Strategy (2008-2011) • Information Technologies Implementation • Re-orientation to disease prevention • Healthy life stile promotion

16. 6. Inequity:Non respecting of the patient rights in health services decisions-making process Solution: • Adopting the Law on Patients Rights and Responsibilities • Adopting the Law on Medical Professional Obligations • Adopting the Deontological Codex • Assurance of the medical services providing transparency • Improving the communication on health related issues

17. Inequity Solution

18. Thanck you for your attention!