Strategies to sustain and scale up quality
health care services for adolescents in
the Republic of Moldova
Andrei USATÎI
Minister of Health
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Progress toward universal health coverage
requires a transition from adolescent-friendly
projects to adolescent-responsive health
systems.
HEALTH FOR THE WORLD'S ADOLESCENTS.
A second chance in the second decade. WHO 2014
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Summary of the presentation
Rationale for strengthening the quality of health care
services for adolescents in the Republic of Moldova
Strategies to sustain and scale up quality health care
services for adolescents
Impact
Unresolved issues and ways forward
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Rationale for strengthening the quality of health care services for
adolescents in the Republic of Moldova
Health status
argument
Unsupportive
environment
Demographic
argument
Why better
health
services for
adolescents
in Moldova?
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Demography and health status
Demography
• 23,4% of total population are youth people (10-24 years), 1 January 2012 *
• 14 % of total population are adolescents (10-19 years), 1 January 2012 *
Health
• Proportion of 15 -19 years old adolescents who had experience of sexual intercourse increase
from 28,1% in 2003 to 36% in 2012**
• Proportion of 15 -19 years old adolescents who used condom at the first sexual intercourse
increase from 35,7% in 2003 to 52,3 % in 2012**
• Proportion of 15 -19 years old adolescents who not use currently any contraceptive method
increase from 5,6% in 2003 to 9% in 2012 and decrease proportion of those who use pills as
contraception – from 17,4% in 2003 to 8,8% in 2012**
• HIV incidence among 15-24 youth – 18,4/100000 in 2011 (total HIV incidence was 13,9 / 100000)
and 10,5/100000 in 2001*
• The suicide rate among adolescents is increasing last years* (by 40% from 2007 to 2011) and
boys is more than 10 time higher than in girls (see figures below)4.
• Near one half of adolescents know somebody form peers involved in physical violence and one
fifth - somebody involved in sexual violence**
• Every eleventh adolescent (10-19 years) indicated that currently smoke, 15.4% - use alcohol in
present 1-2 times in a month and more frequently and 3% of the adolescents indicated that they
have experience of use narcotic substances.**
sources: *National Statistics Office in Republic of Moldova,
www.moldstatistica.md, National Centre of Preventive Medicine
**KAP, Studies 2003-2012, Health for Youth Association
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Adolescent grow and develop in unsupportive environment
- Near 1/3 from 10-19 years old adolescent
live without at least one parent and 10% of
adolescent live without both parents **
Only 15% of them had access to YFHS yet**
Life skills development is not yet a mandatory
course in school curricula
sources: *National Statistics Office in Republic of Moldova, www.moldstatistica.md, National Centre of
Preventive Medicine
**KAP, Studies 2003-2012, Health for Youth Association
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Using a WHO 5S approach to inform strategic actions
Supportive
policies &
strategies
Services &
commodities
Strategic
resources:
Strategic
information
Financing
HR capacity
Strengthening &
supporting other
sectors
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Services: the Youth Friendly Health Services initiative
The goal
• To increase the access of young people to information and qualitative health
services, as well as other services that correspond to the definition and criteria of
“youth friendly” developed by the UN Interagency Group (YFHS National
Conception, 2005)
Health priorities :
• STI/HIV/AIDS.
• Adolescent pregnancy.
• Mental health problems as a result of substance abuse (alcohol, drug addiction).
• Psycho-emotional and identity disorders.
• Health problems occurred as a result of violence.
• Nutritional deficiencies and malnutrition (I, Fe).
• Development disorders during the puberty.
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Services & commodities: scaling up
2014 - 38
YFHC were
contracted by
the National
Health
Insurance
Company
2007 - all YFHC
integrated into
the public health
system as a
subdivision of
PMSI in which
they were
created
2001-2002 - 3
pilot YFHC,
with the
support from
UNICEF
2005 –
creation of 12
YFHC Network
with GF & WB
and UNICEF
support
2011 - was
initiated
YFHS
scaling up
process
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Strategic resources for sustainability
Financing
• 2008 - YFHC
began to be
financed by the
NHIC
Human
resources
• In service Trainings
• Curriculum Review (MFSU
"N.Testimiţanu, NMC)
including primary care
providers’ curriculum
• Guides (adaptation of
WHO materials: WHO OP,
JOB AID etc.)
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Strategic information
Epidemiological/
behavioral studies
• Youth Health and Development KAP Study, 2003, UNICEF, HFY
• MARA Study, 2007 (UNICEF)
• Surveillance studies of HIV among young people, 2006, 2008, 2010,
2012 (UNAIDS, NCPH)
• Adolescent Health and Development KAP Study, 2003 HFY
Demographic and
medical statistics
• mostly is not disaggregated by age
Implementation
research studies of
access to health
care:
• YFHS Quality assessment, 2009 (WHO)
• SHS Mapping Survey, 2011, UNFPA
• Baseline YFHS coverage survey, 2012 CPS
• Economic analysis study of YFHC, 2012-2013, UNICEF, CSRGM
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Supportive policies & strategies
National
Reprodu
ctive
Health
Strategy
, 20052015
Regulati
on of
Youth
Friendly
Health
Centre,
2006
Nation
al
Concep
tual
Frame
work of
YHFS,
2005
National
Youth
Strategy
, 20092013
National
Health
Policy,
20072021
Regulat
ion of
activiti
es of
YFHC,
2013
YFHS
Scaling
up MoH
Ordinan
ce, 2011
Quality
Standar
ds of
Youth
Friendly
Health
Services,
2009
Law in
Reprodu
ction
Health,
2012
CAHD
Strategy
in final
draft,
2014
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Strengthening & supporting other sectors
- SHS
reorganisation process, 2006-2013, WHO
- Peer programs, UNFPA
- Capacity building of school resource persons in
adolescent health promotion , Health For Youth
Association, SDC
- Piloting reviewed mandatory curricula of civic
education with component of health promotion,
Neovita YHFC
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Main Impact
-From 2011 to 2013 access to YFHS increased by 3 time from
5% to 15% for 10-24 y.o. In 2014 we expect an increase in
this figures.
-Prevention of 9 cases of HIV by all YFHCs (1 case by 4 YFHC)
per year, at least , providing full range of HIV prevention
services (information, counseling, testing, condom provision)
can be potentially cost saving for medical system.
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Unresolved issues and ways forward (1)
Areas for future actions
Health in all
policies
Health laws and
policies
Workforce capacity
Coverage
Quality
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Unresolved issues and ways forward (2)
Improve the quality and expand the comprehensiveness of services
• Assure continuous quality improvement and increase the efficiency of youth
friendly health services, including implementation of the YFHC certification process
• Assure the provision of the full package of YFHS, especially by improving and
diversifying financing sources, with the special attention for vulnerable
adolescents and youth at risk.
Coverage - continue scaling up
• Scaling up YFHS to all districts and all primary care facilities
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Unresolved issues and ways forward (3)
Further develop the legal and normative framework
• assure a stable status of YFHC within primary care
• develop amendments to the health legislation in order to remove barriers for
adolescents’ autonomy in decision-making, in line with the international human rights
standards (CRC) and with the principles of evolving capacity and best interests of the
child
Workforce capacity
• Assure the sustainability of professional development in adolescent health (finalize the
revision of the universities’ curricula , develop evidence based protocols of care)
Health in all policies
• Strengthen the inter-sectorial cooperation to increase safe environment and
implementation of educational programs for adolescents
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THANK YOU FOR YOR
ATTENTION
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