Reforms and problems of the public health surveillance service in the Republic of Moldova

Abstract

Introduction. Since 1992, the public health surveillance service in the Republic of Moldova has undergone a series of reforms. Thus, he evolved from inspection to surveillance, from a narrow approach to a complex approach, the focus shifted from treatment to prevention and health promotion, and emergency preparedness and response took over the place of eruption investigation. However, the opinions of the employees of this sphere regarding to the efficiency of the reforms remain contradictory. Aim of the study. To study and analyze the latest reforms of the public health surveillance service in the Republic of Moldova, in order to identify the problems and directions of development. Materials and methods. The study was descriptive. Applied research methods: bibliographic, historical, statistical and sociological. The sample: 60 employees from the public health surveillance service. Data collection tools: specialized literature, official statistics, own questionnaire, interview. Data processing carried out with the Epi Info program. Calculated indicators: ratios, proportions, indicators of the central tendency, indicators of the variation, tests of statistical significance and others. Results. The reform of the public health surveillance service resulted in the reduction of the number of institutions of the service by 26, and of the number of employees by over 60%. As a result, the acute shortage of medical personnel is attested, which now is 31.2% per country, in some territories from 35% to 48%. Also, there is a reduced share of medical specialists aged up to 35 years - 16.2% and a high proportion of medical specialists of retirement age - 35.9%, in some territories reaching 80% -100%, which has a negative impact on the activity of the institutions. Most of the employees surveyed, 72% consider the reform as inefficient, and they believe that the motivation did not increase, although the salaries of the employees increased threefold, but the level of stress increased, because of changes and overwork. Conclusions. Most of the employees consider that the reform of the service was not effective and generated the appearance of some problems at the service level. Some of them are the insufficiency of financing, the reduction of the number of employees, the shortage of specialists especially young and well trained, the reduction of motivation and the increasing level of stress.