IPN News Agency presents a picture of the year in different areas in the view of governmental authorities and independent experts. “2018: how it was and how it wasn’t!?” No.7: Health, labor and social protection
Year with many good things, but also with challenges
Secretary general of state at the Ministry of Health, Labor and Social Protection Boris Gîlca said 2018 in the field of health was with many good things, but also with challenges. The cooperation with the partners from the EU was intensified as part of the third Health Program. There were signed eight international multilateral development treaties. The Republic of Moldova joined the Statutes of the International Center for Genetic Engineering and Biotechnology.
In 2018, the public health reform advanced. There was launched the primary medical assistance reform and the free family doctor’s practice. The medical services were brought closer to the people through the campaign “A doctor for you”. A number of medical-sanitary institutions were outfitted with modern medical equipment.
The Government purchased 110 new ambulances with budget funds. Another 170-180 ambulances will be soon bought for the emergency medical assistance service. There will be about 300 new ambulances in the system, as never before. The situation concerning knee and hip prostheses was unblocked in 2018. There was bought the largest consignment of endo-prostheses ever, with over 1,700 units, and the waiting lists for such surgeries was updated.
Mobile clinics for early detecting breast and lung cancers were purchased. The Moldovan doctors managed to perform surgical and neurological operations of global level, in endovascular surgery, liver transplantation, etc. The population’s access to essential medicines increased with the augmentation of allocations for compensated drugs.
Boris Gîlca said the phenomenon of corruption remains one of the biggest problems faced by the Moldovan health system. The behavior of some of the doctors is regrettable as this affects the image of the system and the whole medical community. He referred to the Tomographer cases, the scandal involving pharmaceutical companies and the one concerning the prescription of medicines.
Next year, the medical reforms and the quality of services are to be consolidated. The conception for the modernization and reformation of hospitals will be finalized through external expert appraisals and public consultations. Investments will be made in the continuous education of medical personnel, in the most modern medical technologies and equipment. The health system will be fully digitized. “Harsh measures will be taken in case of any act of corruptibility in the system. We will be attentive and will react promptly to all the petitions and needs of people,” stated the secretary general of state.
In the labor sector, 2018 was a year when efforts were concentrated on the adjustment of the national legislation to the community acquis and implementation of the launched reforms, especially the state inspection reform in safety and health at work. There was adopted a law to amend and supplement the Labor Code that is aimed at increasing the legal protection of salary earners.
In 2018, the organization and functioning of the State Labor Inspectorate was ensured. The duties and powers of the institution were defined as a result of the inspection system reform. Work is now done on the compilation of the verification lists that will be used in state inspections. The discussions within the national commission for collective consultations and negotiates were consolidated. In 2019, the authorities will focus on the modernization of the labor legislation and its adjustment to the labor market requirements. The finalization of the National Occupational Safety and Health Program for 2019-2023 is another priority.
In the field of social protection, the state social allowances for persons and children with disabilities were raised in 2018. The local authorities were subsidized to strengthen the personal assistance services for persons with disabilities. The National Council for the Determination of Disability and Work Capacity was reformed. The deinstitutionalization of persons with intellectual and psychosocial disabilities continued, with 16 mentally disabled persons being deinstitutionalized in 2018. Four alternative services were developed and the institutionalization of 16 persons was prevented.
The approval of the mechanism for providing concessions on the import of units of transport for persons with locomotor disability, regardless of the disability degree, was a novelty for Moldova. In 2018, the pension valorization stages were implemented before time as part of the pension system reform. The procedure for recalculating old-age pensions was regulated and there was adopted a law on additional financial support for particular recipients of pensions. The social protection and security reforms will be extended next year according to European good practices.
Reform declared at start of year failed
Expert of the Center for Health Policies and Studies Gennady Țurcanu said 2018 saw the failure of the health services market and the medical consultation campaigns in rural areas and patients’ negative experiences in relation to health services are a proof of this. The cases of corruption show the people do not enjoy appropriate medical assistance.
Gennady Țurcanu said the biggest mistake in health financing policies was made in 2018 as the old method of calculating the transfers from the state budget to the mandatory health insurance funds for insuring the unemployed persons was restored. This is a risk for the success of a patient-centered health care system.
According to the expert, even if 2018 was preceded by the implementation of policy documents that lasted for ten years, the objectives weren’t achieved. The mortality of the able to work people and private costs for health remain the highest in the states of the WHO European Region. The health services reform declared at the start of the year failed. The structure of the public health services is nonfunctional because the reform wasn’t discussed with all the players of the health system, especially the population.
The reform of the work of public hospitals hasn’t been initiated and remains inefficient from economic viewpoint. The government’s inaction results in the poor quality of hospital services, with exodus of qualified personnel from hospitals. The regulations on the structural organization of the work of family doctors is only one of the many elements needed for a successful reform.
Excessive politicization of the public administration is one of the biggest obstacles to reforms in Moldova’s health sector. The authorities take measures to raise salaries, purchase goods and others only in the election period only and do not use the support of ruling parties to do reforms in healthcare.
We enter 2019 with a deficit of 200 million lei as regards the spending of the mandatory health insurance funds and the National Health Insurance Company should assume more risks in 2019. The providers of medical services can face risks related to the subcontracting of services. However, 2019 can bring about changes in the health sector. A new parliamentary cycle of four years can offer stability to the Government and can create preconditions for implementing reforms in healthcare.
Government should promote decent work agenda
Expert of the Institute for Development and Social Initiatives “Viitorul” Mariana Yatsko said 2018 in healthcare can be characterized by the reform to reduce the number of inspection bodies and the transfer of inspection powers from the State Labor Inspectorate to another ten authorities. But the given changes haven’t been yet made in accordance with the international provisions. The institution’s functional capacity was reduced and the potential of occupational safety wasn’t ensured in the ten authorities that took over. This compromised the quality of inspection of safety and health at work. During the first three months of this year, there were recorded almost 100 workplace accidents and drawn up reports on these.
The Government should strengthen the dialogue with the EU so as to promote the decent work agenda as regards safety and health at work, social protection, social inclusion and others and contribute to increasing the number of jobs, reducing poverty, ensuring sustainable development and improving the quality of life.
In the social protection sector, 2018 generated many social problems, such as the expansion of poverty, discrepancy in revenues, irregularities in providing social welfare and services that affected the quality of life of different sections of the population. Even if the public budgets in the social sectors increased in terms of costs, these do not equally cover the social assistance needs and do not have a real impact on the welfare of recipients of social welfare and services.
As to drawbacks, Mariana Yatsko said these are related to the functioning and applicability of the system for assigning/transferring powers between the central and local authorities. The role and functions of these, including the mechanisms for exercising the powers, are not clear. The available resources haven’t been appropriately correlated with the capacities of the local public authorities and this generates non-uniform provision of social services.
According to the expert, the authorities should continue the policies to reform the network of social services in accordance with quality and control standards and to optimize the costs of social services. The deinstitutionalization reform should be continued. The private sector is expected to be active in the provision of social services to different beneficiaries and clarity is to be ensured in the procedures for providing services for socially deprived categories of people.
Maria Procopciuc, IPN
Other materials of the campaign “2018: how it was and how it wasn’t!?”:
Agriculture, regional development and environment
Defense
Education
Justice
Transnistrian settlement
Economy and Infrastructure
