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Project proposal

Health monitor for good governance in Moldova

Period covered: January – December 2016

Basic information about the organization / institution which apply for funding

 The name of the institution/organization which apply for funding: Center for Health Policies
and Studies (PAS Center);
 Postal address and phone number of the institution / organization: 99/1 Vasile Alecsandri
Street, MD 2012, Chisinau, Republic of Moldova, Phone number: /+373 22/ 22 63 43, Fax:
/+373 22/ 22 63 87; E-mail:office@pas.md
 Legal status: Private Institution
 List of founders: Institute for Public Policies, Viorel Soltan
 Bank name and bank account: (CB) “Victoriabank” JSC , 17 branch office, banc account
225120000104013
 Tax code: 1011620002537
 VAT code : N/A
 Number of institution’s/organization’s members: 18 people
 Name, address and phone number of the director of the project: Program coordinator PAS
Center, Telephone: /+373 22/ 22 63 43 ext.112, E-mail: andrei.mecineanu@pas.md
 The CV of project’s director: is attached
 The CV of project’s key-persons: The CV of Mr. Ghenadie Turcanu, Program Coordinator,
PAS Center, is attached
 Status and registration certificate(copies of the original): are attached
 Audit Report (if it is possible): is attached

Project Background

During approximately twenty years of independence, Moldova has made progress in establishing
governmental institutions, but is still facing problems and challenges that impede its transition to
democracy. The largest of these obstacles was the excessive consolidation of executive authority that
was built on Moldova’s Soviet heritage of central authority and citizen apathy.

Consolidated executive power threatens both the development of the rule of law, competition,
inclusion, and consensus and, in consequence, good governance. One of the results was a government
that was neither transparent nor accountable, thus dampening individuals’ willingness to become
involved in civic life.

The main elements of good governance - effectiveness, transparency, and accountability of


governmental institutions - are in short supply. Therefore, a shortage of capacity and the lack of
transparency and accountability in central authorities allow, in several spheres, for the existence of
“old system practices”. Despite statements, ruling bodies naturally prefer a free hand in devising and
implementing policies that advance group-interests or their own economic interests. Also, with the
political changes in Moldova, the basis for governmental hiring is represented by the political
patronage rather than merit, having as a consequence there are less technically competent people
staffing ministries and less competition. Policies often favor the already well connected instead of
helping to create a legal and regulatory environment conducive to broad-based development.

This background situation, with all existing regularities, can be applied to the health system and
healthcare authorities which, ultimately, led to distrust of citizens in their capacity as consumers of
healthcare services. For the most part, citizens feel powerless to influence governmental decision-
making. Healthcare officials also have not internalized the concept of “public service,” that is, seeing
themselves as responsible to the people rather than to the politician, party or group of interests. On
the other hand, the good governance of the health system at the level of EU and other western
countries has become a reference framework for citizens of the Republic of Moldova. In this regard,
the citizens of the Republic of Moldova, as consumers of health care services, have unsatisfied needs.
The lack of qualitative and transparent public debates, with the participation of all actors, undermines
public faith regarding the administration of the health system and the capacity of ensuring an
adaptable system, capable of rapid reaction and which would respond efficiently and at reasonable
costs to the real needs of the population.

Healthcare authorities developed parallel, dependent organizations meant to undercut civil society
groups that have the potential to challenge the power structure (e.g., establishing physicians’
professional associations, League of physicians from the Republic of Moldova, etc.). In consequence,
the management of problems/crises, decision-making, dialogue with civil society and mass media is
largely maintained according to the old system’s practices and patterns. Also, central administration
faces a variety of problems in monitoring public institutional defficiencies, lack of resources,
structural challenges in monitoring and evaluation processes.

Moldova’s health authorities at national and local levels are the key interface between the supply and
the demand for good governance in health system, between Government and the people, as consumers
of health services. It is therefore a critical „location” for social accountability initiatives.
Accountability is a key element of a human rights-based approach, which emphasizes the relationship
between the duties of the state and the corresponding entitlements of the individual. It helps identify
who has a responsibility to act to ensure that rights are fulfilled.

Mass media plays a key role to vehicle information and communication in a society between
governmental bodies and the different stakeholders within society. Besides the potential of being a
platform for information relevant to development, mass media - following essential governance
criteria - can be a key factor for social accountability.

In the context of the apparent problems and frequent setbacks, Moldova’s civil society and
policymakers alike have become aware of the crucial role of the media in processes of
democratization and consolidation. Health system and medical community are much closed, similar
as judges’ community, which make them less accountable and transparent. Therefore, the potential
of the media is not only untapped, it is sometimes blocked. Also, these particularities underline the
right of freedom of expression, hinder journalists in fulfilling their duties, restrict access to
governmental information or simply intimidate single media organizations in order to make self-
censorship a common habit. In other cases, the lack of economic resources doesn‘t allow for free
media, be it for a lack of professional education – journalism in the health care field, for a lack of
means to do research, or for a lack of infrastructure to produce and distribute information. In many
cases the level of professional standards in reporting is very low, thus giving business and political
interests the chance to get their biased messages regarding health care (tenders, public-private
partnerships, etc.) across unnoticed or even to set the political agenda.
Vast majority of media institutions have a tendency to sensationalism, mostly in order to attract more
audience or advertisements and these prevail over the media’s will to provide comprehensive, truthful
information on relevant issues regarding health system and Government’s actions. Some of the most
important aspects that guide this selection of news are conflict, impact, deviance, negativity,
proximity, high status actors, and timeliness. On the other side, vast majority of media organizations
remain too close to political power holders to be able to act as effective watch-dogs and political
reporting is regarded as too opinionated to provide balanced gate-keeping. Media institutions are
taking side in favor of particular political parties, candidates, societal groups or ideologies whereas
neutral or balanced news coverage is clearly an exception.

The chances for successful watchdog journalism are even more restricted in Moldova’s health system
due to the fact the functional interdependence between politicians and journalists is still
overshadowed by the legacy of suppression and censorship. Political leaders, health officials and civil
servants find it hard to accept an adversarial press that demands public justification of policy
decisions and political conduct. In fact, the relationship between governments and the general media
is characterized by frequent clashes – quite tellingly dubbed ‘media wars’ – over the boundaries of
government interference into the operation and structure of the media and even the content of news
reporting.

Another important factor that affects the way in which the Moldova’s generalist media report on
health matters is partisanship. The audience of a biased media learns only half of the truth and hence
might be less equipped to make informed and effective choices.

PAS Center in partnership with e-Sanatate (e-Health) platform developed, in May 2013 an on-line
media portal focused on communication and information to citizens as consumers of health services.
This news portal is designed to initiate and regularize general public information, civil society and
consumer involvement processes in decision-making and monitoring health sector decision-making.
Sanatate INFO portal (www.sanatateinfo.md) acts as an independent, neutral and alternative mass
media source, in order to present and reflect realities in the health care sector.

The results registered during implementation of 2014 and 2015 Health Monitor for Good Governance
Project (presented in the Final Narrative Reports) demonstrate that watchdog journalism and media
utilization as a social accountability tool are generating very good results in health policy monitoring
(including media coverage1), as well as health authorities accountability and transparency.

Also, another dimension of the proposed project is designed to realize civic monitoring and to
increase participation in decision-making processes at the national levels of healthcare sector, as well
as to identify and to advocate for corrective actions and health policy formulation. In this context, the
project will address the issues mentioned above by realizing an independent and neutral monitoring
and evaluation, in order to increase transparency and accountability of central public administration
from the healthcare sector. In this context, the project will approach public policy issues and the
process of public policies development on the basis of the governance program, sectoral strategies
(National Strategy for the Development of the Health System, National Health Care Policy, etc.) and
general strategies, challenges that occur during governance and which have a significant socio-
economic impact, by implementing a reliable, best-practice-oriented monitoring tool, capable of
comprehensive reporting, commenting and recommending on changes and policy processes.

In the current deadlock situation, the project looks for narrowing the gap between governmental
institutions from health sector and CSOs, establishing links between CSOs, mass media, academic

1
In accordance to audience and traffic monitoring (Google Analytics), for the period January 2015 – November 2015
media portal registered a total number of 463.703 unique visitors and 1.665.931 page views.
society, policymakers, political decision-makers, healthcare authorities, stimulating transparency and
accountability, and, in consequence, promoting good governance.

Implementation of Health Monitor for Good Governance Project in the period 2010 - 2014 ensured
better information of decision-makers, community and development partners obtained information
about performances achieved in health sphere, and people’s perception about the quality of services.

Summary/ The problem

The project “Health Monitor for Good Governance in Moldova” aims to solve problems in the health
system by establishing a broad dialogue between the central government (Ministry of Health),
consumers of health services, civil society, multilateral and bilateral international institutions, and
the other parties as well, by creating a mechanism to monitor the health system situation and the
impact of policies and interventions on the health reforms stipulated in the governmental policy
documents, sectoral and intersectoral policies in the field of health. This information will be
accessible to the public, for those who will make decisions and also for foreign partners and other
stakeholders.

Aims and objectives of the project

The aim: To maintain and develop sustainable mechanisms for independent and neutral monitoring
of health policies in order to promote good governance in the Moldova’s health system.

Objective: Monitor central and local health authorities’ actions through constant monitoring of public
policy development and subsequent reflection in mass media.

Methods of implementation
1. Promotion of citizen participation in the evaluation and monitoring of hospital care

PAS Center will work towards developing further partnerships with health care institutions and
local/central public authorities (founders of hospitals). Under these partnerships, the parties will
begin joint actions regarding: (a) access to data on clinical and administrative activity of hospitals;
(b) the use of the online tool for comparison and evaluation of public hospitals; (c) increasing
transparency and citizen participation in decision-making about health care and observance of
patients' rights. In this context, the partnership will establish that hospitals will promote the
assessment of delivered services and observance of patients’ rights based on hospitals website. Due
to the fact that data are available to the general public and the obtained results, which are categorized
in areas of assessment (patient rights, informal payments made to doctors, etc.), will determine the
authorities and medical institutions to intervene in a much more promptly manner in order to correct
the situation.

The concluded trilateral partnership will involve parties' commitment regarding the usage of
independent and neutral instruments aimed at increasing citizen participation in the evaluation and
monitoring of hospital care. Thus, at discharge, patients or their relatives will receive a guide
(informative material) that will describe the steps required to make the assessment and provide feed-
back. Along with direct measures, the implementation of which will be borne by the hospital
administration, indirect measures will be undertaken as well, such as the placement of posters and
banners inside and near hospitals. Informational materials will be also placed in outpatient facilities,
with a view to widening the participation of citizens who used hospital services in the past.

The distribution of materials will be made based on the number of registered patients per health care
facility in the previous year.

2. Development of informational passports of public hospitals

The project activity involves the collection by experts of data from 55 public hospitals for preset
indicators. The process involves data standardization and analysis, including the development of
technical interpretations. Passports are inserted into the site; thus information is used by
patients/citizens for assessing, monitoring and comparing hospital activity.

The data will be placed on www.spitale.md (Compare Hospitals) and are accessible for general public.

3. Continues monitoring of key health policy development and health reform issues

The ex-ante analysis of the project identified as the unit of monitoring health policy issues, health
policies and policy processes. As sources for identifying the unit of analysis will serve: governance
program, sectoral strategies (National Strategy for the Development of the Health System, National
Health Care Policy, etc.) and general strategies, challenges that occur during governance and which
have a significant socio-economic impact. The process of identification will be realized by the project
implementation team on a regular basis and over time, in accordance to the selection criteria
(relevance and scope, impact on status quo, degree of innovation - based against national and
international standards, and media coverage/public attention).

The participation of experts in this process will be according to the monitored health policy issues
and derives from the structure of the monitoring tool.

The process of monitoring governmental actions will conventionally comprise a quantitative


monitoring and a qualitative monitoring. The quantitative monitoring will focus on measures
undertaken by governmental institutions related to health policy issue. Qualitative monitoring, in its
turn, will focus on the content of government actions in this field and will be anchored in certain
legal, international, best practices standards, recommendations of international bodies, etc.

The monitoring process of governmental actions, in accordance to the used tool, will be based on
consecutive phases, namely: desk review, analysis of political or socio-economical background,
health policy process, expected outcome/overall assessment of policy, rating the policy etc. For the
final rating of a policy, PAS Center will also look at the policy process: was it consensual, or highly
controversial? While the first monitoring report can only throw a spotlight at these characteristics,
after six-months-period or one-year-period, PAS Center will be able to relate health policy themes
with political interactions. Ideally, the health policy monitor will enable PAS Center to answer
questions about the association or relationship between positions, priorities and influences of actors
toward a policy on one side, and the outcome of a health policy idea or piece of reform on the other:
Which types of negotiation and what incentives or trade-offs are relevant for success, failure or
abolition of a reform?

For each of identified ‘problematic’ issue, the PAS Center will develop an official position (aviz) by
the project implementation team and experts, which will provide more detailed independent and
neutral evaluations/analyses on formal and informal interactions of all players and stakeholders in
the decision-making process, leading to health reforms or health policy processes and changes. The
monitoring process will allow capturing both the issue addressed and the current stage of the process
from inception to abolition. In some cases deemed of particular importance, the PAS Center will
develop necessary policy briefs and promote public debates. The developed official positions and
policy-briefs (electronic format) will be sent to project stakeholders, namely to governmental
institutions (Parliament and Ministry of Health, etc.), political decision-makers, policymakers, mass
media, civil society, academic society, and opinion leaders.

The methodology was already developed based on reach experience of implementation of this project
during 2010 - 2015, implemented by PAS Center, with the financial support of the Soros Foundation
- Moldova.

4. Reflecting the health monitoring results in mass media

PAS Centre will contract 2 newsmakers to develop media materials – news, analysis/investigation
articles, expert opinions on the actions of health care authorities, as well as coverage of subjects/areas
that are neglected by the press service of the Ministry of Health, NHIC and official media sources
(observance of patients’ rights, cases of corruption, cases of non-application of the law by authorities,
etc.). The average weekly news production is 8-10 news per week. The developed media materials
will reflect the realities of the health system in an impartial and neutral manner in compliance with
the declared editorial policy.2

All developed materials (news, analysis/investigation articles, expert opinions, etc.) will be intended
for the general public, and the estimated distribution/access plan is to at least triple the registered
values.3 Also, all developed materials (news, analysis/investigation articles, expert opinions, etc.)
will be intended for the general public. As result, the health monitoring results will be reflected in
mass media to promote the national and international exchange of experience with implementing
health care reforms and supporting reform initiatives. This support will be founded on a well validated
knowledge base with regard to health care being properly understood and appropriately valued (based
on Lubljana charter).4

The time frame of the project


Project’s Activity Time Frame (months)
1 2 3 4 5 6 7 8 9 10 11 12
1.Continues monitoring of health x x x X x x x x x x x x
policy development
2. Promotion of citizen x X x x x x x
participation in the evaluation
and monitoring of hospital
care
3. Development of informational x X x x x x x
passports of public hospitals
4.Monitoring of hospital activity x x x X x x x x x x x x
based on developed tools
5. Reflecting in mass-media x x x X x x x x x x x x
health policies and actions
undertaken by health authorities

2 http://www.e-sanatate.md/News/Home/Polices
3 Presented in last Project Annual Report
4 http://www.euro.who.int/__data/assets/pdf_file/0010/113302/E55363.pdf
Concrete results expected from this project
The results of this project will be presented:
 10 official positions which will include comprehensive analyzes of policy monitoring and
express-analyses/policy-brief regarding current policies.
 55 Public Hospitals Information Passports by 31.12.2016
 300 media materials (news, opinions, interviews, etc.) on health issues by 31.12.2016

Results’ evaluating criteria


The PAS Centre puts a lot of emphasis on the careful design of M&E framework prior to project
start and appropriate monitoring and evaluation plan throughout its implementation.

The evaluation of the project results will be achieved by applying the following criteria:
planned/realized activities, planned/realized budget, expected/obtained results. As a result of the
project monitoring, responsibility for systematic disclosure (progress reports and final report) is on
the project manager Dr. Ghenadie Turcanu, Program Coordinator, PAS Center.

The relevant publications and mass-media materials and an increase in the number of informed
decision-makers and citizens will be considered the indicators of success. In order to reach these
benchmarks, PAS Center will track the visits to developed materials, the health authorities’ response
to published/reflected subjects, and the hospitals’ response to its recommendations (based on
Hospitals’ Performance Score).

Center PAS will track the visits to the hospitals website, evaluations per hospitals, offered feed-back
(comments left on hospital’s page), comparisons of hospitals, as well as health authorities’/hospitals’
response to patients’ evaluations (measures undertaken to mitigate weak areas identified). Also,
health authorities/hospitals representatives’ involvement in solving of identified problems will be
considered an indicator of success. Increase of Patient Satisfaction Score will be considered an
indicator of success.

Partners involved in this project

PAS Center plan to imply, in the realization of the project, internal and external partners.

Internal partners: Ministry of Health, National Heritage Insurance Company, National Center for
Health Management, civil society and Mass-Media.

External partners: World Health Organization, European Commission’s Delegation, World Bank,
UNICEF and other partners.

Materials produced by the project will be made public and discussed with the participation of
internal and external partners.

The budget of the project is attached.


Viorel Soltan

Director
PAS Center