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.