Abstract
Background: Moving towards an intersectoral and more integrated response to the burden of noncommunicable diseases (NCD) is recognized as the wider 2030 Vision of Moldovan SDG, Health Strategy and NCD program. In agreement with the Ministries of Health (MoH) and of Labour and Social Protection, the Integrated Community Care (ICC) concept was developed and piloted, having the multidisciplinary teams trained, by the Swiss Development and Cooperation’s Healthy Life Project (HLP). This included the development of a common vision and promoting cooperation of the health and social sectors through policy dialogs, also embedded in district-level strategic documents, the promotion of Community Nursing (CN), and the introduction of an integrated care management approach. By the end of the 2024, the application of (ICC) was extended nationwide, reaching the country’s 35 districts and 2 municipalities with 75 pilot communities as a model (two in each district). Also, there is a dynamic in number of the CN employed, increasing from 132 to 306, according to MoH.
Methods used: Given the absence of an ICC regulated M&E tool, to assess ICC progress the administrative data were collected in 2020 – 2023 period. The practitioners from the primary health care (PHC) and social work (SW) from the 40 pilot communities (20 districts) reported their ICC interventions delivered for more than one year. Complementary, the HLP conducted the Quality-of-care (QoC) survey in 2019 and 2023, having assessed also the perception and use of the CN position and the specific elements of the ICC delivery. The opinion of the managers and practitioners from 90 PHC and 90 SW facilities was studied.
Results: In the timeframe of 2020-2023, a total of 18,130 persons with NCDs in 40 communities of 20 districts had gained access to both health and social care through the ICC approach. In proportion of 73.4% these people were covered with preventive and self-management actions, mostly having their health follow-up. Moreover, in 20% was initiated an intersectoral complex case management for those facing multiple NCDs and vulnerabilities, half of them being provided with home care.
From the quality perspective, the perception of the CN and multidisciplinarity improved. There is an increasing agreement of PHC facilities that CN should be steered more towards NCD prevention and management (28.6 % to 70.8%) and the outreach and home visits (80% to 92.8%). The level of those perceiving the quality of cooperation as excellent and good is quite high (73% SW, 72.6% PHC). While understanding specific sectorial terminology, especially the definition of vulnerability was flagged as the most confronted existing bottleneck (79.8% SW, 60.7% PHC).
Conclusions: The combined analysis of administrative and quality of care data show that NCD and vulnerability are well targeted and must continue by increasing the availability of the integrated support in communities. Regarding progress in ICC delivery, the main contributory factors are considered the cooperation of health and social sectors anchored in local strategies, more CN employed in the system, the reciprocal understanding of responsibilities and use of common tools to foster collaboration and joint work.