Moldovan GP, a start has been made
Moldovan people feel that access to primary care in their country is sufficient. However, patients often need to pay for services and the planned changes in health care develop slowly. These are results from a NIVEL study commissioned by the World Health Organization (WHO) Regional Office for Europe.
The Republic of Moldova is a poor country where the life expectancy is relatively low. Health threats of the population are poverty, smoking and excessive alcohol consumption. Since 2008, the Moldovan government is trying to strengthen primary care with family doctors in a central role. In rural areas, however, there is a severe shortage of family doctors. The average practice size is 1900 people per family doctor whereas 1500 is the official norm. Furthermore, it will take time to see the effects of recent policies and regulation on quality of care. Available professional guidelines and protocols are insufficiently used by family doctors and nurses.
Although Moldovan people feel that access to primary care in their country is sufficient, patients often need to pay for services, such as medical drugs and home visits by family doctors. Too often, family doctors refer patients to medical specialists. Another reason for the high referral rate is the poor access of family doctors, especially those in rural areas, to X-ray diagnostic services. NIVEL-researcher Wienke Boerma: “This is among the reasons why the intended broadening of services provided by family doctors is not realized yet.”
Another gap in the service profile of family doctors are medical procedures, such as wound suturing and the treatment of warts. Boerma: “Family doctors indicated that more training would result in better performance in this respect, resulting in fewer referrals.”
Primary Care Evaluation Tool
The researchers have also examined policy development for primary care in the republic of Moldova. For the study they have used the Primary Care Evaluation Tool (PCET). The PCET methodology results in a structured overview of strengths and weaknesses of primary care in a country, with a focus on policy development as well as the voice of physicians, nurses and patients. It enables policy makers and politicians to work more evidence based. The surveys in Moldova included 250 family doctors, 2102 patients and 25 nurses working in remote primary care centres. The PCET instrument has been applied by WHO in a series of countries, including: the Russian Federation, Turkey, Slovenia, Uzbekistan, Kazakhstan, Ukraine, Belarus, Serbia, Romania, Slovakia. At present evaluations are in process in Tajikistan and Andorra.
WHO Regional Office for Europe