International assignments

Authoring the Health Systems in Action (HSiA) Insight for Montenegro and the Republic of Moldova—European Observatory on Health Systems and Policies (2022)

The Health Systems in Action Insights series describes the country health system context in which WHO Europe’s Program of Work is set. It captures country by country: core health systems information and data; how health systems functions are working; and key concerns, progress and challenges. The Insights facilitate comparisons across the WHO European Region’s non-EU Member States and over time. The Insights series is a joint WHO-Observatory initiative.

Ilaria is the lead author of two Insights for Montenegro and the Republic of Moldova. Both publications will soon be available.

Public expenditure review in health for Belize—World Bank (2022)

Ilaria co-authored the public expenditure review (PER) in health for which the Government of Belize had requested the World Bank assistance.

The PER has assessed the efficiency, effectiveness, and equity of health expenditures and their adequacy and sustainability relative to Government goals. Building on existing analytical work in the sector, it has benchmarked countries health outcomes, expenditures, and reform agenda against global evidence and best practice.

This PER reviews trends and patterns in health spending, including how budget allocations have evolved, how they relate to actual spending, how funds flow through the health system, what agencies receive spending, what accountability mechanisms are in place, and how the current system supports efficiency, equity, quality, and accountability in health service delivery.

The work has been conducted with the help from representatives of the Belize Ministry of Health and Wellness who provided primary and secondary data as well as available assessments of the human resources for health and employee satisfaction survey of public health facilities.

Can people afford to pay for health care? New evidence on financial protection in Romania (August 2022)

This review is is part of a series from the WHO Regional Office for Europe of country-based studies generating new evidence on financial protection in Europe. Ilaria has co-authored the report with Gabriela Scîntee and Cristian Vlădescu from the National School of Public Health, Management and Professional Development in Bucharest, Romania.

The incidence of catastrophic spending in health is high in Romania compared to many other countries of the European Union. It is heavily concentrated among poorer households and older people, reflecting gaps in all three dimensions of health coverage (‎population entitlement, service coverage and user charges)‎, weaknesses in purchasing policy, and low levels of public spending on health. Outpatient medicines are the main driver of financial hardship, particularly among poorer households.

Check out the report in English and Romanian to find out more about our policy recommendations.

Financing preventive health services for children and young adults in Romania—UNICEF (2021)

Tagliente was asked by UNICEF Romania to map and analyze the financial flows at national and sub-national level of preventive health services targeting children and young adults (below 18 years of age). The analysis has covered the period 2018–2020 and has monitored the impact of COVID-19 on the use of health services and financial resources allocation.

Between 2018 and 2020, the total budget of the national program for health evaluation, promotion, and education was RON 3,963,000, representing about 0.1% of the total budget of national public health programs (excluding the budget allocated for RT-PCR for SARS-CoV-2). The budget allocation increased by 5.8% in 2019 and 7.1% in 2020, with a budgetary execution above 90% each year.

Over the same period (2018-2020), the total budget of the child and health nutrition subprogram accounted for 50,141,000 RON, representing 2% of the total budget allocated for the national public health programs (excluding the budget allocated for RT-PCR for SARS-CoV-2). The budget per year fluctuated, increasing by 26% in 2019 but decreasing by 30% in 2020.

Improved data collection and availability of more granular data are necessary conditions to monitor and report on the type of services provided, their volume, and funding delivered per child over time. The COVID-19 pandemic further exposed Romania’s difficulty to guarantee sustainable financing in public health and health preventive services, particularly by local governments.

With many thanks to the co-authors of the report from Babeș-Bolyai University in Cluj-Napoca, Romania for the excellent collaboration! Rebeca Sabou, Monica Georgiana Brînzac, Nicoleta Șomlea, Ștefan Strilciuc, and Marius-Ionuț Ungureanu.

Report published on the Assessment of the Healthcare System Development Strategy 2008–2017 of the Republic of Moldova (September 2020)

The report can be downloaded directly from the website of the Ministry of Health, Labour and Social Protection of the Republic of Moldova. It has also been translated in Romanian.

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.

Projects 

  • 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.

Ilaria Mosca, Chisi
  • 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  PolicyAdvice-Malta