www.euro.who.int – The Ministry of Health with WHO support has initiated a process of assessing the quality of health care, documenting the situation and developing a national plan for quality improvement that would involve all stakeholders and follow a systematic approach. To start the process, a rapid external assessment of quality of health care in the Republic of Moldova was conducted on 1–9 April 2014.

A half-day seminar to discuss the findings took place on 9 April 2014, involving 60 participants, including representatives of institutions visited by the assessment team and directors of about 35 medical institutions. The mission to support the Ministry of Health was the first in a series planned for the year.

Health system reform

Quality improvement lies at the centre of service delivery and health system reforms. Most countries in this process, including Republic of Moldova, face difficulties in ensuring equity and access to health care services, respecting patient rights, and achieving an appropriately trained health workforce, good medical technologies,  sufficient available resources and evidence-based medical practice.

A number of reform initiatives have been implemented by health care institutions and authorities in the Republic of Moldova, however there is still room for improvement and a systematic approach is needed.

First step: external assessment

The assessment initiated by the Ministry of Health used a tool developed by WHO/Europe and looked at the health care quality management system through a framework comprising 4 domains for evaluating national quality activities: policy, organization, methods and resources.

Various meetings with those responsible for regulating, monitoring, evaluating and improving quality were conducted at the Ministry of Health, the National Accreditation and Evaluation Council, the National Health Insurance Company, the National Center of Healthcare Management, the State Medical University and School of Public Health, public medical institutions of hospital and primary care, and a private hospital.

This first mission reviewed:

  • policies and normative documents in place to regulate quality; 
  • organizations responsible for quality management, and their scope of work;
  • methods used for quality improvement;
  • resources available to evaluate quality improvement;
  • the extent to which these factors are institutionalized in a single system and act in a coordinated manner.

Findings

The rapid assessment found that:

  • the health system has national monitoring organizations; 
  • institutional quality systems are developed, such as quality councils at large medical facilities; 
  • organizational and clinical standards are in place, such as national clinical protocols, guidelines and medical standards; 
  • measurement systems are applied in some of the medical institutions; 
  • the National Centre of Health Management collects an extensive amount of data that can be used to provide indicators of how quality is improved in the systems and in each medical institution.

However, the system also faces challenges, such as:

  • lack of a strategy to integrate quality systems and organizations; 
  • overregulation;
  • inconsistent standards and measurements; 
  • inefficient assessments and data capture; 
  • lack of data sharing, feedback and learning; 
  • weak incentives and capacities to manage.

Seminar to discuss findings

In his opening speech at the seminar, Andrei Usatîi, Minister of Health said: “There are instruments, data and organizations for quality management in place at the moment, however more initiative and responsibility is necessary at institutional level; and also an integrated approach is necessary at the system level to achieve a higher level of quality of care.”

The team’s lead expert, Charles Shaw, mentioned in his presentation that better coordination of the quality management system would lead to improved efficiency and effectiveness and ultimately to better health outcomes.

Dr Jarno Habicht, WHO Representative to the Republic of Moldova added that there is time to address the quality of care more systematically as we move towards universal health coverage. Improved quality of care systems would lead to better health outcomes as well as greater satisfaction among patients and health professionals.

Next step: documentation

The next step in this process will be an internal assessment of the quality of health care in the country using the tool developed by WHO with guidance and coaching by the WHO expert. This assessment will involve key stakeholders who will later participate in the development of a national plan to improve the quality of the health care system.

The process is organized as part of the biennial collaborative agreement (BCA) 2014–2015 between the Ministry of Health of the Republic of Moldova and WHO/Europe.  It is related to the European Union/WHO joint initiative to support policy dialogue and universal health coverage.

Sumber: http://www.euro.who.int/en/countries/republic-of-moldova/

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