Policy responses for Republic of Moldova - HSRM

Republic of Moldova


Policy responses for Republic of Moldova

2. Ensuring sufficient physical infrastructure and workforce capacity

ENSURING SUFFICIENT PHYSICAL INFRASTRUCTURE AND WORKFORCE CAPACITY is crucial for dealing with the COVID-19 outbreak, as there may be both a surge in demand and a decreased availability of health workers. The section considers the physical infrastructure available in a country and where there are shortages, it describes any measures being implemented or planned to address them. It also considers the health workforce, including what countries are doing to maintain or enhance capacity, the responsibilities and skill-mix of the workforce, and any initiatives to train or otherwise support health workers.

2.1 Physical infrastructure

2. Ensuring sufficient physical infrastructure and workforce capacity

ENSURING SUFFICIENT PHYSICAL INFRASTRUCTURE AND WORKFORCE CAPACITY is crucial for dealing with the COVID-19 outbreak, as there may be both a surge in demand and a decreased availability of health workers. The section considers the physical infrastructure available in a country and where there are shortages, it describes any measures being implemented or planned to address them. It also considers the health workforce, including what countries are doing to maintain or enhance capacity, the responsibilities and skill-mix of the workforce, and any initiatives to train or otherwise support health workers.

2.1 Physical infrastructure

Based on the transmission scenarios, the MoHLSP with support of WHO estimated the available resources and needs for COVID-19 response. The requirements are updated periodically, tacking into account the stocks available (public procurements, facilities' own procurements, donations, etc.). The estimates of available resources are paper based: PPE, medical devices (ventilators, pulse oxymeters, oxygen, concentrators O2), medicines, medical personnel, lab tests and consumables, etc.

Based on the estimated needs, the Centralized Centre for Acquisition in Health started public procurement using mandatory health insurance funds and the government reserve fund (see Section 4.1). Also, medical providers have organized individual procurement for all the items that are needed for the COVID-19 response (PPE, medicines, disinfectants, etc.) where available via local suppliers. At the beginning of the outbreak, there were shortages of PPE and specific antiviral drugs due to existing challenges associated with the annual procurement process, but the main issue was the global shortages of health care goods. Donations of PPE, medical devices, disinfectants, etc are managed and distributed as required between public facilities by MoHLSP.

All designated hospitals for the COVID-19 response were assessed using the WHO Hospital Readiness Checklist for COVID-19. A hospital emergency, preparedness and response plan was developed as part of the generic hospital EPRP plan.

On 4 March 2020, 4 hospitals in Chisinau (512 health workforce) were designated for the treatment of COVID-19 patients, two for severe cases (34 ICU beds) and two for mild and moderate cases (134 beds) https://msmps.gov.md/sites/default/files/legislatie/file_1.pdf.

The first case of COVID-19 was registered on 7 March and two more hospitals in Chisinau were added for mild and moderate cases (474 beds and 231 medical personnel). https://msmps.gov.md/sites/default/files/legislatie/ordinul_nr._263_din_13.03.2020_cu_privire_la_modificarea_ordinului_nr._222_din_04.03.2020.pdf

At the same time, national capacity was increased to 2780 beds (including 481 ICU beds), and a total of 53 hospitals were designated for COVID clinical case management, including some specialized tertiary level hospitals (eg: Institute of Oncology, Institute of Cardiology, etc.) along with all district hospitals. The number of available ventilators was increased to 452 ventilators and oxygen equipment and 3570 medical workers were appointed to assure health care service availability.  https://msmps.gov.md/sites/default/files/ordinul_msmps_nr._385_din_09.04.2020_acordare_asist_med_covid-19_la_etapa_de_transmitere_comunitara_a_infectiei.pdf.

With community spread of COVID-19, MoHLSP decided to create additional capacity for triage and case management. From 10 April 2020 a Triage Centre at MoldExpo in Chisinau was established with a capacity of 250 beds.

To manage cases in the most extreme scenario, additional triage/hospital capacities were explored by the MoHLSP (an additional MoldExpo pavilion for 150 beds); additional medical devices (ventilators) will be transferred from routine public providers.