GPSA projects

Country: Moldova
Sector: Health
Executing Agency: Center for Health Policies and Studies (PAS Center)
Grant Amount: $730,000
Closing Date: September 2019

Moldova spends significantly more on health than comparable countries, however health outcomes are less than expected given the level of health expenditures, pointing to the need to improve the effectiveness of health expenditures in delivering results for health. The Ministry of Health approved the Roadmap Accelerating health reforms through investment policies, aiming at improving financial protection and equity in accessing quality health care services. Hospitals are at the center of the reform because of many reasons. However, the reform remains incomplete as the activity of public hospitals is generally not based on good governance principles nor provides for implementation of contemporary evidence-based practices and performance standards. The public policies and management practices in hospitals at large do not account for the needs and preferences of patients, who do not have appropriate access to relevant information regarding their care in the hospital.

Primary care centers (PHC) are also at the center of reform. PHCs have been strengthened through the creation of family medicine. Family medicine providers are paid on a capitation basis to provide primary care for a defined population and act as gate keepers to specialist care. Citizens have free access to primary care regardless of insurance status. However, existing formula for performance bonuses in primary care requires revision and routine reporting is hampered by the fragmentation of information technology (IT) systems in primary health facilities and the lack of proper monitoring systems.

Generally, providers’ accountability for results remains limited across all levels. Effective mechanisms are not in place to systematically hold providers accountable for the quality and efficiency of services.

PAS Center, an organization with extensive experience in health policy development, evaluation, advocacy, capacity building and health system reform, has been granted a GPSA award to contribute to enhance citizens’ voice. Participation and voice will be enhanced by informing users of health services in select rayons about the performance of hospitals and primary care clinics within a certain radius of their residence so that they can use this information to make better decisions with respect to their choice of health care facility and the quality of care, and establishing mechanisms for participatory monitoring, thus contributing to better informed policy design and improved service delivery.

This will be achieved by implementing four components geared towards:

1. Promoting citizen monitoring of hospital performance;
2. Strengthening performance based incentive program in family medicine through social audits of primary healthcare institutions;
3. Creating an enabling environment for informed public dialogue in health; and
4. Facilitating knowledge and learning to enhance effectiveness of social accountability interventions.

The GPSA grant has helped PAS Center to attain the following results thus far in the project:

1. A Hospital Performance Report Card (HPRC) is being implemented in 55 public hospitals in nine project rayons (regions), and their results are disseminated to patients.
2. Patient Exit Surveys are conducted in these nine rayons, as well as in nine control rayons where the HPRC is not being implemented.
3. Patients engage in social auditing of services in 72 primary health care centers to inform performance-based financing of the centers.
4. Health Barometer surveys are conducted at the national level and the findings are shared for relevant policy dialogue on health reforms.
5. An online transparency platform collects and presents health system data, patient feedback, and data collected by the project’s social accountability tools.

The design of this grant has benefitted from accumulated experience and lessons learned by PAS Center in implementing various social accountability tools. The interventions are based on good practices, constructive approaches, collaboration and relationship with health authorities and public health services providers established under previous and current projects that will be leveraged to ensure success of GPSA project. Here are some lessons gleaned from the project thus far in the Republic of Moldova:

1. Although there is a fair amount of content produced within the Project, it would be beneficial to add a budget for promotional resources, including social media sponsored content. This would certainly boost this and other projects’ reaches as technology falls into more users’ hands.
2. The PAS Center sought to modify implementation strategy for the Project even while lacking data, once it was realized that there exists a
3. Because government counterparts may take a keen interest in certain aspects of project results, such as the interest of National Health Insurance Company executives in exit polls, it is important to involve the counterparts as actors through implementation and evaluation in order to encourage their support of current and future projects.