Support to the reform of mental health services in Moldova
In 2013 Switzerland started supporting Republic of Moldova in a systemic reform of the mental health (MH), aimed at bringing MH services closer to users by providing treatment in a community setting. The project second phase will contribute to further increase the access to and utilization of quality community-based mental health services and health education programs by the means of a nationwide scaling-up.
Primary health care
Health and social care professionals within the network of community-based mental health services are equipped with the knowledge and skills to work according to the new model of care.
Mental health related legal and regulatory frameworks across sectors are aligned with international standards.
A minimum set of relevant performance indicators developed and applied, as a basis for quality management system.
Community-based mental health services are empowered and supported to provide integrated gender sensitive outreach services to ensure that most vulnerable and excluded persons/groups have access to appropriate care.
Responsible entities institutionalize mental health promotion and prevention, as well as are build cross-sectorial partnerships in this regard.
Opportunities identified to enhance social inclusion and re-integration of people with mental health issues.
- Other international or foreign NGO North
|Background||Mental health disorders represent a high burden of disease in Moldova. Their incidence and prevalence, as well as the disability caused by depressive disorders, has continuously increased. The suicide rate is 14.3 per 100,000 of population, which ranks Moldova #50 in the world, with men being almost 6 times more affected than women. The mental health system faces important challenges as health and social care are not yet sufficiently integrated at users’ level and due to an absence of national programs on prevention and promotion. In addition, a number of structural constraints continue to impede the equitable access to MH services as part of integrated package of health services, notably lack of resources and structures for social care at local level, delays in the territorial reform and regionalization process, heavy administrative workload for CMHCs’ staff, massive labor migration (both physicians and nurses), low mental health literacy among population.|
|Objectives||People with mental health issues in Moldova receive care appropriate for their needs and reach their recovery goals.|
Target groups include providers of mental health care (psychiatrists, psychologists, nurses, social workers, family doctors, PHC psychologists and nurses), as well as the Ministry of Health, Labour and Social Protection (MHLSP), National Health Insurance Company (NHIC), Local Public Authorities (LPAs).
Final beneficiaries are women and men with all levels of severity of mental health problems, as well as their carers (indirectly impacted target group). There is a particular focus on vulnerable groups: young people, the elderly, and people living under the poverty line, women and men, girls and boys, returning migrants, ethnic minorities).
Outcome 1: A country-wide network of community-based facilities for mental health ensure equitable access to quality and affordable integrated services, responsive to users’ needs.
Outcome 2: People across Moldova are aware of the importance of their own and others’ mental health, improve their mental healthcare-seeking behavior, and support the social inclusion/recovery of people with mental health problems.
Results from previous phases: In the first phase, the project concentrated its efforts on reforming service delivery in four selected districts, targeting the relevant primary care services, community mental health centers (CMHCs), district general hospitals, and national level psychiatric hospitals. MH services were included in the integrated package of health services in the four pilot regions. The project also contributed to an enabling environment for MH care reform at policy level (revision of the regulatory framework) and to the capacity building of health professionals working with people suffering from mental health problems. The total number of persons assisted in CMHCs and by home visits increased, while the admission rates, bed occupancy and length of stay in psychiatric hospitals considerably decreased in the four pilot districts, in contrast to other districts, where they remained stable. At the same time, the review identified a number of challenges and bottlenecks to be further addressed by the project. Most of the country’s CMHCs – set up by the Ministry of Health (now Ministry of Health, Labour and Social Protection) in every district based on regulations promoted by the project (36 in total) – grapple with insufficient capacities, a heavy administrative workload, limited resources, and lack of incentives.
|Directorate/federal office responsible||
Swiss cooperation with Eastern Europe
International or foreign NGO
Trimbos Institute (Netherlands)
|Coordination with other projects and actors||Healthy Generation and Healthy Life projects, Job Creation and Skills Development project (implemented by GiZ), Nurturing Active and Responsible Citizens projects, and Engaging Citizen and Empowering Communities in Moldova Program.|
|Budget||Current phase Swiss budget CHF 3'229'300 Swiss disbursement to date CHF 2'200'000|
|Project phases||Phase 2 01.08.2018 - 31.07.2022 (Current phase) Phase 1 15.05.2013 - 31.07.2018 (Completed)|