Assessing the field of prevention and control of non-communicable diseases in the Republic of Moldova through legal framework

Abstract

Introduction. The Republic of Moldova is faced with a high prevalence of non-communicable diseases related to lifestyle and health behavioural factors. Non-communicable diseases account for 85.6% of deaths annually in the country. In the last decade, the Government of the Republic of Moldova has taken important steps to tackle these diseases through the adoption of numerous national intersectoral programs. The implementation of the legal framework developed in the field of prevention and control of non-communicable diseases is the central element for a harmonious, sustainable and inclusive development of the Republic of Moldova. Purpose. Revealing the destabilizing factors for the implementation of policies developed in the field of prevention and control of non-communicable diseases (NCDs) in the Republic of Moldova that contribute to the regression in the field.Material and methods. A descriptive cross-sectional study was carried out. It was used the SWOT analysis of the intersectoral programs developed in the field of prevention and control of non-communicable diseases in the Republic of Moldova.Results. In general, public policy making is a complex process and it is done accordingly with the provisions of Law no. 317-XV of 18.07.2003 and the requirements of Government Decision no.33 of 11.01.2007 on the elaboration of rules and unified requirements for the policies. As a result of the evaluation of the intersectoral programs a series of challenges were identified for the health sector related to the legislative, organizational, financial, etc. fields. Public authorities often fail to inform stakeholders (citizens, non-governmental organizations, the media, etc.) about the initiation of a policy paper, limiting the possibility for those interested to promote their own point of view in the field of prevention and control of NCDs. Ensuring access to draft decisions and related materials in the field can become a challenge. This can be caused by the lack of information on the website for various reasons such as: internet connection, lack of technologies, etc.A worrying aspect for the health system is the presence of an insufficient coordination between the central and local levels as well as between the public and private sectors in implementing the legal framework in the field. Another peculiarity is the limitation of the process of citizen consultation on the projects of decisions: debates and public opinion polls, expert opinions, working groups permanent or ad hoc with the participation of civil society and mass-media. To ensure this process, public authorities must draw up a detailed list of stakeholders and experts in the field. In the same time, there is a short period (maximum 15 working days) to present the recommendations by the interested parties on the draft decisions (Law no. 239 on transparency in the decision-making process of 13.11.2008). This makes difficult the intersectoral process of consultations and significantly reduces stakeholder input and involvement. In some cases, the ad for recommendations and decisions that were taken for approval of NP is missing and the person who contributed to the preparation of the draft does not know which are the further actions. Another problem is insufficient functioning of the permanent structure for coordination and control of the implementation of the NP. The Advisory Council for the coordination of the NP in the field of prevention and control of NCDs in the Republic of Moldova is often changed due to political situation and it can be difficult to ensure the continuity and sustainability of the actions in the field. In addition to underfunding of the NP, a poor allocation of funds has also been identified. Therefore, prevention and control of NCDs is placed among the last places, although it is the most cost-effective measure for the health system and in general for the country. Thus, it is recommended to change the structure of health expenditures with increasing the proportion of spending on prevention of NCDs and promotion of healthy lifestyle among the population. There can be added taxes for unhealthy food, smoking, alcohol, etc. Conclusions. The lability of the national legal framework together with the continuous reforms in the field of health lead to the instability in the system and make hard the coherent and sustainable implementation of policies in the field of prevention and control of non-communicable diseases in the Republic of Moldova.