Assessing the field of prevention and control of non-communicable diseases in the Republic of Moldova through legal framework

Catedra Igiena generală, Catedra Medicina de Familie, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction. The Republic of Moldova is faced with a high prevalence of non-communicable diseases related to lifestyle and health behavioural factors. Non-communicable diseases account for 85.6% of deaths annually in the country. In the last decade, the Government of the Republic of Moldova has taken important steps to tackle these diseases through the adoption of numerous national intersectoral programs. The implementation of the legal framework developed in the field of prevention and control of non-communicable diseases is the central element for a harmonious, sustainable and inclusive development of the Republic of Moldova. Purpose. Revealing the destabilizing factors for the implementation of policies developed in the field of prevention and control of non-communicable diseases (NCDs) in the Republic of Moldova that contribute to the regression in the field.Material and methods. A descriptive cross-sectional study was carried out. It was used the SWOT analysis of the intersectoral programs developed in the field of prevention and control of non-communicable diseases in the Republic of Moldova.Results. In general, public policy making is a complex process and it is done accordingly with the provisions of Law no. 317-XV of 18.07.2003 and the requirements of Government Decision no.33 of 11.01.2007 on the elaboration of rules and unified requirements for the policies. As a result of the evaluation of the intersectoral programs a series of challenges were identified for the health sector related to the legislative, organizational, financial, etc. fields. Public authorities often fail to inform stakeholders (citizens, non-governmental organizations, the media, etc.) about the initiation of a policy paper, limiting the possibility for those interested to promote their own point of view in the field of prevention and control of NCDs. Ensuring access to draft decisions and related materials in the field can become a challenge. This can be caused by the lack of information on the website for various reasons such as: internet connection, lack of technologies, etc.A worrying aspect for the health system is the presence of an insufficient coordination between the central and local levels as well as between the public and private sectors in implementing the legal framework in the field. Another peculiarity is the limitation of the process of citizen consultation on the projects of decisions: debates and public opinion polls, expert opinions, working groups permanent or ad hoc with the participation of civil society and mass-media. To ensure this process, public authorities must draw up a detailed list of stakeholders and experts in the field. In the same time, there is a short period (maximum 15 working days) to present the recommendations by the interested parties on the draft decisions (Law no. 239 on transparency in the decision-making process of 13.11.2008). This makes difficult the intersectoral process of consultations and significantly reduces stakeholder input and involvement. In some cases, the ad for recommendations and decisions that were taken for approval of NP is missing and the person who contributed to the preparation of the draft does not know which are the further actions. Another problem is insufficient functioning of the permanent structure for coordination and control of the implementation of the NP. The Advisory Council for the coordination of the NP in the field of prevention and control of NCDs in the Republic of Moldova is often changed due to political situation and it can be difficult to ensure the continuity and sustainability of the actions in the field. In addition to underfunding of the NP, a poor allocation of funds has also been identified. Therefore, prevention and control of NCDs is placed among the last places, although it is the most cost-effective measure for the health system and in general for the country. Thus, it is recommended to change the structure of health expenditures with increasing the proportion of spending on prevention of NCDs and promotion of healthy lifestyle among the population. There can be added taxes for unhealthy food, smoking, alcohol, etc. Conclusions. The lability of the national legal framework together with the continuous reforms in the field of health lead to the instability in the system and make hard the coherent and sustainable implementation of policies in the field of prevention and control of non-communicable diseases in the Republic of Moldova

Abordarea domeniului de prevenire și combatere a bolilor netransmisibile în Republica Moldova

Background. The implementation of policy documents developed in the field of prevention and control of non-communicable diseases in the Republic of Moldova is the central element for a harmonious, sustainable and inclusive development of the European Union. Objective of the study. Revealing the destabilizing factors for the implementation of policies developed in the field of prevention and control of non-communicable diseases in the Republic of Moldova that contribute to the regression in the field. Material and Methods. A descriptive study was carried out with SWOT analysis of documents implemented at national level in the field of prevention and control of non-communicable diseases. Results. As a result of the evaluation of the legal framework in the field, a series of challenges were identified for the health sector related to the legislative, organizational, financial, etc. sphere. These include: (1) lack of intersectoral coordination in drafting and implementing acts, (2) insufficient functioning of the permanent structure for coordinating and controlling the implementation of the action plan, (3) lack of benchmarks on the competences of Local Public Authorities and other bodies, (4) underfunding of national programs. Conclusion. The lability of the national legislative framework together with the continuous reforms in the field of health lead to the instability in the system and prevent the coherent and sustainable implementation of policies in the field of prevention and control of noncommunicable diseases in the Republic of Moldova. Introducere. Implementarea documentelor de politici elaborate în domeniul de prevenire și combatere a bolilor netransmisibile în Republica Moldova reprezintă elementul central pentru o dezvoltare armonioasă, durabilă și favorabilă incluziunii Uniunii Europene. Scopul lucrării. Relevarea factorilor destabilizatori de implementare a politicilor elaborate în domeniul de prevenire și combatere a bolilor netransmisibile în Republica Moldova ce contribuie la regresul în domeniu. Material și Metode. S-a efectuat un studiu descriptiv cu analiza SWOT a documentelor implementate la nivel național în domeniul de prevenire și combatere a bolilor netransmisibile. Rezultate. În rezultatul evaluării cadrului legal în domeniu s-au depistat un șir de provocări pentru sectorul de sănătate legate de sfera legislativă, organizatorică, financiară, etc. Printre acestea se evidențiază: (1) lipsa coordonării intersectoriale în elaborarea și implementarea actelor, (2) funcționarea insuficientă a structurii permanente de coordonare și control al implementării planului de acțiuni, (3) lipsa unor repere privind competențele Autorităților Publice Locale și ale altor organisme, (4) subfinanțarea programelor naționale. Concluzii. Labilitatea cadrului legislativ național alături de reformele continue în domeniul sănătății conduc la instabilitatea din sistem și împiedică implementarea coerentă și durabilă a politicilor în domeniul de prevenire și combatere a bolilor netransmisibile în Republica Moldova

Profilaxia Pre-expunere la infecția HIV: protocol clinic național PCN-313

USMF „Nicolae Testemiţanu”, Centrul Național de Sănătate Publică, Centrul de Sănătate Publică, mun. Chișinău, IMSP Spitalul de Dermatologie și Maladii ComunicabileProtocolului clinic Profilaxia Pre-expunere la infecția cu HIV se adresează tuturor actorilor implicați în abordarea, planificarea, introducerea și implementarea profilaxiei Pre-expunere orale. Elaborarea Protocolului clinic Profilaxia Pre-expunere la infecția cu HIV se bazează pe protocoalele de utilizare a preparatelor antiretrovirale in profilaxia pre contact al infecției HIV (PrEP). Protocolul face referința la recomandările bazate pe dovezi ale OMS-ului din 2017 cu privire la PrEP. De menționat ca focusarea e axata pe abordările practice de utilizare a PrEP. Este în obiectivul Ministerului Sănătăţii perfectarea permanentă a asistenţei medicale persoanelor cu infecţia HIV şi SIDA. Astfel, Protocolul va actualiza cunoştinţele de screening, conduită, tratament, efecte adverse PrEP, monitorizare şi consiliere în cadrul profilaxiei pre-contact. Protocolul a fost discutat și aprobat inclusiv și de organizațiile nonguvernamentale din domeniul HIV din Republica Moldova. Protocolul clinic național: "Profilaxia Pre-expunere la infecția cu HIV" a fost elaborat cu suportul financiar din cadrul Grantului HIV a Fondului Global pentru combaterea SIDA, TB și Malaria și asistența tehnică a experților internaționali și a biroului din țară OMS și UNAIDS

Эпидемиологические особенности внутрибольничных инфекций у хирургических больных в мун. Кишинэу

Centrul de Sănătate Publică, mun. Chișinău, Conferința științifico-practică cu participare internațională Centrul de Sănătate Publică din municipiul Chișinău – 70 de ani la straja sănătăţii 23 octombrie 2014This paper provides the analysis of nosocomial infections in surgical patients registered in Chisinau city in the period of 2008-2013 years. The analysis shows that the incidence of nosocomial infections in surgical patients is higher in Chisinau city than in Moldova, being higher with 1 per 1000 surgeries. The level of hospital morbidity among surgical patients is 2,6 per 1000 surgeries in Chisinau and 1,6 per 1000 surgeries in Moldova. The registered level of morbidity does not show the real situation, it is lower because of insufficient diagnostic and registration of nosocomial infections. In the general structure of Nosocomial Infections prevail purulent septic infections, with the rate of 93,7% to 97,3%. The etiology of septic purulent infections is very wide, including 16 species of opportunistic pathogens. More frequently were isolated association of different microorganisms – 24,7%. Isolated microorganisms are resistant to 36.4% of the most used antibiotics. The causes of hospital-acquired infections are varied and require the concerted action of employees from medical institutions and the Center of Public Health.В данной работе приводится анализ внутрибольничной заболеваемости у хирургических больных в мун. Кишинэу в период 2008-2013 г. Анализ свидетельствует о том, что уровень внутрибольничной заболеваемости у хирургических больных составляет 2,6 на 1000 операций и не соответствует действительности, имеет тенденцию к снижению из-за неполной регистрации. В структуре общей внутрибольничной заболеваемости у хирургических больных преобладают гнойно-септические инфекции, удельный вес которых составляет 95%. Возбудителями гнойно-септических инфекций является широкий спектр микроорганизмов, в которых преобладает ассоциация микробов – 24,7%. Выделенные возбудители являются резистентными в 36,4% случаев к большинству использованных антибиотиков. Причины возникновения внутрибольничных гнойных инфекций разнообразны и преобладает связь с основным заболеванием пациента

Особенности эпидемического процесса и циркуляция возбудителя менингококковой инфекции в муниципии Кишинэу

Centrul de Sănătate Publică din municipiul Chişinău, Conferința științifico-practică cu participare internațională Centrul de Sănătate Publică din municipiul Chișinău – 70 de ani la straja sănătăţii 23 octombrie 2014In this work is presented the epidemiological situation in the Chişinău municipality and in Republic of Moldova. There are described the particularities of the epidemiological process of meningococcal infection in Chişinău municipality. It has been determined that the meningococcal infection affects preponderant children. In the structure of the clinical forms predominate the generalized forms with a serious and extremely serious evolution.В данной статье представлена эпидемиологическая ситуация в муниципии Кишинэу и в Республике Молдова. Описаны особенности эпидемического процесса менингококковой инфекции. Установлено, что менингококковая инфекция поражает чаще детей. В структуре клинических форм преобладают генерализованные формы с тяжёлым и крайне тяжёлым течением заболевания