Regionalisation of comprehensive care for Non-Communicable Diseases – involving local authorities

Abstract

Introduction: The Moldovan Government is committed to reducing the burden of non-communicable diseases (NCD) by strengthening family medicine-based community services. In its recent primary health care (PHC) reform it created the Ministry of Health, Labour and Social Protection to improve inter-sectoral collaboration at central level. The newly created National Agency of Public Health is the central agency to coordinate the public health agenda in the country. At regional level public health activities are coordinated through the Raion Public Health Councils (RPHC), involving local authorities and a variety of sectors including health and social services relevant for NCD control. Goal: The present assessment study analysed the capacity of the RPHCs and identified support needs to enable them to fulfil their mandate of promoting health and coordinating a regional people centred integrated response to NCDs. Method: A mixed methods approach was employed, including a review of the current regulatory environment and its adaptation through the on-going reform measures, a series of exploratory interviews with key stakeholders and application of an assessment tool. Results: The assessment was piloted with RPHC members in Orhei and Edinet raions. RPHC consist of 11 representatives mostly from the medical and education sector, and Local Authorities (LPA). The Councils tasks include the coordination of epidemiologic control, environmental protection, health promotion, food security, and the management of public health issues. Their tasks are well regulated in principle, however in practice the leadership, level of participation and functionality of the RPHC differ widely between raions. RPHC members often have little awareness on health matters and the need for an integrated response to NCDs. Moreover, awareness of their potential coordination role is also limited. Although most of the key stakeholders required for an integrated approach to NCDs are members, issues tend rather to be delegated to the sectoral representatives (e.g. raion public health office, PHC team) than followed up as an inter-sectoral team. There is a lack of an evidence based assessment and planning process for health interventions with little or no follow up on outcomes. Community health promotion is currently not a priority for most RPHCs, except for those where current or previous development projects have provided some impulses. Conclusions: There is a significant need for capacity building and awareness generation for RPHCs in terms of their role in health promotion, risk reduction and overseeing a coordinated response to NCDs. Skills need to be developed for health needs assessments, priority setting, comprehensive health action planning as well as monitoring and evaluation. Lessons learnt: With the correct support RPHCs can form an ideal platform for developing raion public health action plans and setting the stage for cross-sectoral response to NCDs. The starting point lies with joint health and social service engagement, while other sectors can then follow, e.g. school-based services, occupational health. Assessment of people’s health literacy and people-centred needs for NCD care (e.g. geriatric assessments, joint health and social service assessments of the elderly) hold potential as entry doors for intersectoral health intervention planning.

Keywords

• local authorities
• inter-sectoral planning
• non-communicable disease
• patient-centred