The GOVERNANCE of the health system with regard to COVID-19 relates to pandemic response plans and the steering of the health system to ensure its continued functioning. It includes emergency response mechanisms, as well as how information is being communicated, and the regulation of health service provision to patients affected by the virus.
The intersectoral Influenza Pandemic Response Plan was developed and approved in 2009 (https://www.legis.md/cautare/getResults?doc_id=33051&lang=ro). The new draft of the plan was developed by the National Agency for Public Health in 2019 but not was endorsed by the government. The Health Sector Response Plan as well as district emergency preparedness and response plan were also in place. After the COVID-19 declaration on 31 January 2020, the National Emergency Preparedness and Response Plan was developed and endorsed by the National Committee for Public Health Emergency https://msmps.gov.md/ro/content/ordine-covid-19
Preparedness for and response to public health emergencies are the competence and duty of the state and is a shared responsibility at government level, between civil protection and public health. At the national level, in accordance with Government Decision No 1340/2001, the Commission for Emergency Situations of the Government of the Republic of Moldova is responsible for implementing preventive measures, verifying emergency preparedness and managing emergency situations.
In the case of COVID-19, the National Extraordinary Public Health Commission (NEPHC) was responsible for an integrated approach, applying prevention and management measures, multisectoral mobilization and coordination of the response (Government Decision No 820/2009). The Commission is headed by the Prime Minister and includes representatives from all ministries and departments. The National Agency for Public Health is the implementing body of the NEPHC. The NEPHC is empowered to adopt decisions on the declaration/cancellation of a public health emergency at the national level, coordination of the activities of the central public administration authorities, legal entities and persons in order to prevent, mitigate, respond to and eliminate the consequences of public health emergencies. With COVID-19, the NEPHC approved and declared yellow, orange and red alerts – a code red alert was declared on 13 March 2020. All NECPH decisions are published on the Government's website (https://gov.md/ro/content/informatii-privind-coronavirus). The meetings started on 1 February 2020 and take place at least two times per weeks.
The National Commission for Emergency Situations (NCES) declared a state of emergency on 17 March 2020, to run until 15 May 2020 and their decisions are enforceable for central and local authorities, legal entities and persons. (https://www.legis.md/cautare/getResults?doc_id=120817&lang=ro). A National Public Health Emergency has been declared from 16 May to 30 June, following on from the expiration of the National State of Emergency. The National Public Health Emergency was extended to 31 August and then 15 September and 30 September. The Public Health Emergency lifted on 1 October and replaced by a new ‘Traffic Light’ system. Under the traffic light system: (red zones) are regions which will declare a public health emergency within their territory (high impact and includes high risk of transmission with severe impairment of public health and requires strict control, surveillance and response measures); (orange zones) are where the burden of disease is moderate, spread is mitigated through small clusters or single outbreaks; (yellow zones) are where the burden of disease is low, sporadic cases; (green zones) are where cases/clusters or outbreaks are rare.
From 13 October, 35 of the 38 territorial states in the Republic of Moldova were red zones and therefore declared a State of Public Emergency. Only 3 states are yellow zones, none are green zones. On 30 November, a nationwide State of Emergency was declared.
NCES decided to use fast-track procedures for the regulation and procurement of medical devices, ventilators, PPE, treatments, Lab consumables and reagents.