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The Global Health Preparedness Project in Moldova
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About the Programme and the International Health Regulations
In 2015, the Norwegian Institute of Public Health (NIPH) launched the Global Health Preparedness Programme (GHPP). Through this initiative, NIPH collaborates with Malawi, Ghana, Moldova and Palestine in building and enhancing global health preparedness and security in these countries through implementation of the International Health Regulations (IHR, 2005), contributing to the global efforts and initiatives to improve the IHR capacity assessments, implementation, and prioritisation.
The overall goal for the GHPP is to contribute to improved capacity to prevent, detect and respond to public health events of national and international concern. The international health regulations are legally binding regulations for all WHO member states, that aims to support the international community to prevent and respond to public health crisis.
Paragraph 44 of the IHR (2005) states that “State Parties shall undertake to collaborate with each other to detect and assess events, to provide or facilitate technical support, to mobilize resources, and to formulate legislation to support the implementation of the Regulations.”
This paragraph incentivised the NIPH to establish the GHPP in order to support the strengthening of the required IHR (2005) core capacities in Moldova. The activities included in the GHPP are also a part of Norway’s contribution to the Global Health Security Agenda (GHSA).
History for Collaboration
Norwegian and Moldovan health authorities have supported collaboration in the public health field in several years. In 2014, the Norwegian Ministry of Health and Care Services signed a Memorandum of Understanding (MoU) with the Moldovan Ministry of Healthcare, which provides the framework for cooperation between the Moldovan Public Health Institute (NCPH) in the capital city Chisinau and NIPH.
NIPH has since then explored areas for collaboration with NCPH on preparedness and IHR implementation. Both Norway and Moldova expressed interest in establishing a collaboration project within the Global Health Preparedness Programme. Representatives from NIPH participated in a Norwegian mission to Moldova to explore the possibilities further. Both parties shared interest and several areas were discussed as potential interest fields for the collaboration.
During the visit it was clear that, although Moldova had not asked for a second extension to the deadline for development of the national core capacities specified in Annex I of the IHR in 2014 , there was room for improvement and collaboration in order to facilitate the resilience of the system. Following the discussions, a joint mission was held in Moldova with support from technical experts from NIPH.
Health Profile – Moldova
Moldova is a landlocked country in the Eastern part of Europe situated between Romania and Ukraine. The high consumption of alcohol and tobacco in the country is a main public health concern. Moldova counts as the poorest country in Europe and the health status of the population fell after independence as a result of the economic hardship. But since 2005, deaths caused by ischemic heart disease, stroke, cirrhosis (alcohol) and COPD are declining, while hypertensive heart disease and Alzheimer disease have increased and were in 2017 the fourth and fifth leading causes of death in Moldova.
Leading causes of premature death in 2017 and percent change, 2007-2017. Source: Institute for Health Metrics and Evaluation, University of Washington
The Moldova Project
The global health preparedness project in Moldova is implemented in close collaboration between the Norwegian and Moldovan Public Health Institutes and the WHO Country Office. In order to identify areas for collaboration, an IHR evaluation mission was conducted in Moldova with support from technical experts from the Norwegian Public Health Institute. All activities in the project are prioritised based on findings from the conducted evaluation missions and tabletop exercises on IHR capacities.
The four main areas for collaboration to strengthen the international health regulations in-country are:
- Strengthen public health preparedness and response, including surveillance of communicable diseases and public health events
- Human resources training
- Evaluation of the core capacities at Points of Entry (PoE) and support for implementation of future steps
- Enhancing laboratory capacities
During the spring 2017, workshops in Moldova were organised by support from the global health preparedness programme aimed to support the priority areas. A workshop was organised aiming to design future implementation of a national point’s prevalence survey of healthcare associated infections and antibiotic consumption. The next steps in this work is a training in Romania for Public health specialists from Moldova and a pilot in Moldovan hospitals later this year.
Another workshop was held in June 2017 on early warning and response to food and water borne outbreaks to enhance/increase the capacities of national authorities on early detection, risk assessment and response to public health events with focus on outbreak of food and water borne diseases in the context of IHR implementation. During this event, it was a special focus on how coordination mechanisms between sectors can improve in the case of a public health event as well as a review and update of the legislative framework on early warning and response and IHR implementation.
Sharing of experiences between countries are valuable, especially helpful if systems share similarities since a successful implementation is dependent on several factors. Romania and Moldova, as a neighbouring country, share similar contexts as both countries have the same official language and health systems based on the previous Soviet model. As Romania has experienced a similar transmission after independence, collaboration between the two countries of particular relevance. Colleagues from Romania has shared experiences in technical workshops in Moldova, and visits are planned to Romania from Moldovan colleagues to learn from their surveillance system on health-care associated infections.
National Centre for Public Health in Moldova
The National Centre for Public Health (NCPH), with a staff of 320 people, is directly accountable to the Ministry of Health, and is responsible for most core public health functions at the national level. The Centre was restructured in 2010. The Centre monitors and assesses the public health and the healthcare systems, especially in the area related to development of infection control guidelines and recommendations, and gives expert health policy advice. It provides data and reports on principal health indicators; prepares national programs and measures for the prevention of disease; strives for the professional development of public health experts, and performs public health research.
World Health Organization (WHO)
The WHO Country Office, in Chisinau, Moldova was established in 1995 to provide continuous support to health authorities and partners in improving population health through evidence-based, sustainable public health and health care interventions and provide advice on integrating health in all policies. Over the years the Office has been the focal point for all WHO activities in Moldova.
The Country Office team consists of over ten persons, including experts covering health systems and public health, public health services, maternal and child health, communicable diseases, NCDs, human resources for health, disaster preparedness and response. NCPH has close collaboration with WHO country office.