We advise governments in different countries on the development of health systems. This advise could be an assessment of the health system but also on more strategic issues like introducing more competition and efficiency in the health sector with quality indicators at the same time.
Report published on the Assessment of the Healthcare System Development Strategy 2008–2017 of the Republic of Moldova (September 2020)
Ilaria Mosca is the single author of the report that describes and analyses the developments and results achieved in health governance, funding, service delivery, and resource management between 2008 and 2017. It also maps areas targeted for future work, to enable sound health policies to be developed, thus enhancing health system performance in the Republic of Moldova.
The key recommendations are to strengthen governance to improve health outcomes; to increase financial protection—in particular for poor people and chronic users of health services—by targeting coverage policy and other factors; to enhance the quality of health services; to invest in and commit to the implementation capacity and institutional strengthening.
The assessment was possible thanks to the financial support provided by the Swiss Agency for Development and Cooperation. Ilaria is grateful to Marcela Ţîrdea, head of the Division of Policies Analysis, Monitoring and Evaluation in the Ministry of Health, Labour and Social Protection for her continuous support and strong motivation. Thanks are also extended to the WHO Country Office of the Republic of Moldova for the support provided as well as all representatives of the Ministry of Health, Labour and Social Protection; the National Centre of Public Health; the National Centre of Health Management; the National Health Insurance Company; the National Bureau of Statistics; and all stakeholders interviewed for their contributions and cooperation.
Financial Protection in the Republic of Moldova (May 2020)
Ilaria was extensive involved in several projects in the Republic of Moldova the past four years. She is one of the authors of the report “Can people afford to pay for health care? New evidence on financial protection in the Republic of Moldova“.
The Republic of Moldova has demonstrated strong commitment to universal health coverage through reforms aimed at improving the accessibility, affordability and quality of publicly financed health services. This has led to greater use of health services and fewer people reporting unmet need due to cost. However, persistent gaps in coverage and other factors undermine financial protection for people using health services, increasing their exposure to out-of-pocket payments, particularly for medicines.
The report can be downloaded from the website of the WHO Barcelona Office for Health Systems Strengthening.
Visit to Ukraine (Trade mission Life Science and Health Care)
In February 2020, Tagliente joined the trade mission life science and health care in Ukraine. This mission was organized by RVO (Netherlands Enterprise Agency), Taskforce Health Care and the Netherlands Embassy in Kyiv. Health system transformation in Ukraine is ambitious and on a fast track. It was for us a special opportunity to talk to the Deputy Minister of Health, several Members of the Parliament, the World Bank, the World Health Organization and the National Health Service of Ukraine (NHSU)—established in 2018 as a single purchaser agency and in charge of introducing new health financing regulations with a special emphasis on strengthening public health services and health institutions. Between 2015–2017, the health reform focused on primary care. People choose their own family doctor and health financing was changed with the principle of money follows the patient. This year the focus is on hospitals. Ukraine has currently more than 1,200 hospitals. Tagliente has discussed the possibility to support mental health in Ukraine. High priorities are deinstitutionalization of people with mental illness, the reduction of stigma and the strengthening of community mental health with a strong role for primary care professionals. We believe our expertise and experience with mental health system transformation in the Netherlands and the Republic of Moldova could be helpful.
- Montenegro – WHO European Primary Health Care Impact, Performance and Capacity Tool (PHC-IMPACT) (2020)
Ilaria was asked by the WHO European Centre for Primary Health Care in Almaty, Kazakhstan to study the structures, performance and impact of primary health care in Montenegro. This has resulted into a report that signals a high burden of cardiovascular diseases and cancer among other noncommunicable diseases for which primary care has an important role to play: in particular, for early detection and risk factor management. Estimates of avoidable hospitalizations for conditions amenable to primary care further underscore the potential for improving primary care performance. You can download the report here.
- Policy Dialogue: Strategic Directions of Further Health System Development in the Republic of Moldova (December 2019)
On 5–6 December, Ilaria was invited by the World Health Organization to present the results of the assessment of the Health System Development Strategy for the Republic of Moldova 2008–2017. The meeting was attended by the recently appointed Minister of Health, Labour and Social Protection Ms Viorica Dumbrăveanu, State Secretaries, representatives of development partners, national and local managers of hospitals, primary care centers, mental health community centers and other health organizations. Among the recommendations, a special focus was dedicated to financial protection and outpatient medicines as the main driver of financial hardship among all population quintiles.
- World Health Organization – Health system performance: from assessment to action (2018)
Prior to the WHO high-level meeting held in Tallinn on 13–14 June 2018 in conjunction with the 10th anniversary of the signing of the Tallinn Charter, a technical workshop “Health system performance: from assessment to action” took place on 12 June. During the workshop, successful examples of policy use of performance information were presented. Challenges and enablers to triggering policy decisions and actions from performance indicators were discussed among the group of researchers and policy-makers.
Ilaria participated to the workshop as health system expert and will be in charge of the report summary that will be available in the summer.
- World Health Organization – Ambulatory Care Sensitive Conditions in Montenegro (2018)
In week 27–31 May we participated to a WHO in-country mission in Montenegro to start a study on Ambulatory Care Sensitive Conditions. These conditions can be effectively treated at primary care level if the right health system circumstances are in place. Often people are hospitalized instead, leading to inefficient use of resources. During the in-country mission several meetings took place with key national stakeholders (Ministry of Health, Health Insurance Fund, Institute of Public Health and Monstat) and health professionals at primary, secondary, and tertiary care level. The study will use a health system approach as key input for policy recommendations and will be concluded in autumn 2018.
- Swiss Agency for Development and Cooperation / Trimbos Institute – Republic of Moldova (2017-2018)
Trimbos Institute started in 2014 a pilot project in four rayons (districts) in Moldova with funding from the Swiss Agency for Development and Cooperation (SDC). The project consists in the reorganization of mental health services; the creation of an enabling policy environment; the development and application of clinical guidelines; generation of capacity building; and the preparation of the communities to tackle stigma and discrimination. Tagliente will lead the project on the costs of scaling up mental health community services to understand if it will be financially sustainable to roll out the pilots to the whole country. The costs of scaling up the four pilots will reflect how much it will cost the health system to implement the same typology and organization of mental health services in Moldova.
- World Health Organization – Republic of Moldova (2017)
I am currently working on the assessment of the Health System Development Strategy (HSDS) that the Republic of Moldova has launched in 2007. The HSDS covers the period 2008 to 2017 and has the goal of strengthening the performance of the healthcare system in the country. It aims to ensure continuous improvement of the population health, to guarantee the financial protection of its citizens, and to increase the healthcare system responsiveness towards the population expectations. The assessment is both quantitative and qualitative.
- World Health Organization – Monitoring progress towards universal health coverage (2017-2018)
The WHO has initiated a multi-year project to monitor financial protection in health systems across WHO’s European Region. The broad aims of the project are to strengthen the evidence base on universal health coverage and to support policy development at national and regional levels. To this end, I provide technical support for four country reviews in the WHO’s European Region.
- World Health Organization “ Health System Performance Assessment” (2017)
I am supporting WHO with Health System Performance Assessment in two countries belonging to the WHO European Region. It involves work with key performance indicators and a technical analysis of the different domains such as financial protection and responsiveness of the health system.
- World Health Organization “Primary Care in Greece” (2016)
Advising the Minister of Health of Greece regarding the set up of pilot projects (family health units) to give a quality impulse to primary care and to improve access to primary care for the Greek population (Presentation Heine van Wieren in Athens). In Greece there is a shortage of general practitioners and nurses in primary care. The pilots should result in a shift from hospital care to primary care and bring young Greek GPs and nurses back to Greece.
- Malta “Advising on modernizing the health system” (2015)
We advised the ministry of Health on Malta on public-private partnership in healthcare and more specific on the privatization of Gozo General Hospital. Next to these PPS issues Tagliente was involved in advising on modernizing the health system with attention to governance, competition, quality assessment, finance and benchmarking. We did work together with Prof. dr. Niek Klazinga (OECD/AMC) and his team. In November 2016 we gave a two-day workshop in Amsterdam for a Maltese delegation to support them implementing the necessary changes. A final advisory report was delivered by the end of November (Advisory Report Malta