Strengthening public health priorities through multisectoral approaches: insights from Moldova’s healthy life project 2017–2024

Abstract

Context. Non-communicable diseases (NCDs) remain a leading cause of morbidity and mortality in Moldova, posing major challenges to the health system and requiring coordinated responses across all levels. In alignment with national public health priorities, the Healthy Life Project (HLP) was launched in 2016 to strengthen primary healthcare (PHC) and health promotion as strategic pillars for NCD prevention and control. To date, complex interventions from policy to rayon have been implemented in collaboration with multisectoral partners. We share key lessons and strategic recommendations based on patient-level data collected between 2017 and 2024, offering insights to guide national and local health management. Methods. Knowledge, attitudes, and practices (KAP) surveys on NCDs were conducted in 2017 (baseline), 2020 (endline), and 2024 (follow-up) across 20 raions. Ten Batch-1 raions received HLP interventions in Phase 1 (Jun 2016–Sep 2020), and ten Batch-2 raions during Phase 2 (Oct 2020–Sep 2021). This abstract focuses on changes observed from 2017 to 2024 in both batches, presenting key findings on NCD risk factors and behaviors (blood pressure, diet, physical activity), NCD knowledge, and patient rights awareness. Time trends and group differences were assessed using multivariate mixed-effects linear and logistic regression models. Analyses were conducted with and without population weights, adjusted for sex, age, education, location, and batch-by-time interactions. Indicators were selected to reflect progress on key health promotion and NCD management targets. Results were disaggregated by sex, age group, area, region, and education level, aiming to inform public health decision-makers within the PHC system. Results. Systolic and diastolic blood pressure levels decreased between 2017 and 2024 by 2 mmHg and 3 mmHg, respectively, with tangible improvements observed among women, younger patients (aged 18–44 years), individuals with lower education, and residents of the northern region. Physical activity declined overall, from 34% in 2017 to 26% in 2024, though initial gains were noted among younger patients and those with lower education. Healthy eating improved slightly; sugar intake declined, while fast food consumption increased. NCD knowledge scores more than doubled, rising from 21% in 2017 to 50% in 2024, with the highest gains in the northern region. Awareness of patient rights increased from 78% in 2020 to 89% in 2024, particularly among older patients (aged 45–69 years) and less-educated individuals. Efforts to reduce salt intake improved modestly, while trans-fat reduction remained consistently high (above 75% in both 2020 and 2024), though with variation across subgroups. Discussion. By building capacity in public health and health promotion—including engagement with LPAs and other sectors—investing in family medicine-oriented PHC with a focus on prevention, and improving population health literacy, the HLP contributed to measurable health improvements, particularly in blood pressure reduction and enhanced NCD knowledge. These results underscore the importance of sustained, community-oriented, and data-driven strategies in public health management. Despite these achievements, ongoing challenges—including pandemic-related setbacks, geopolitical instability, economic pressures, and regional disparities— require strong coordination and long-term investment. To advance Moldova’s public health priorities, it is essential to strengthen prevention through PHC, secure structural funding for health promotion, and align multisectoral efforts with local needs. Tailored strategies for high-risk groups, combined with continuous health education, communication campaigns, and monitoring, should be part of sustainable public health action. The HLP offers valuable insights for scaling community engagement and institutionalizing locally adapted practices in public health management.