Contribution to the Confidence Building Measures Programme in Transnistria region - Health Sector (Phase 2)

Project Summary:

The overarching goal of the is to make sure that the population of Republic of Moldova, including in Transnistria region, has improved health status, financial protection, equitable access to and satisfaction with health services. The overall objective is that the population of Transnistria region benefits from comprehensive quality health services, with specific focus on Maternal and Child Health (MCH) and Immunization.

The project is implemented by WHO, UNICEF and UNDP and funded by Swiss Development Cooperation Agency through Multi Partner Trust Fund (MPRTF-UNDP).

Objectives:

The overall objective of the project is that the population of Transnistria region benefits from comprehensive quality health services, with specific focus on Maternal and Child Health (MCH) and Immunization.

Expected results:

  • Newborns and mothers from Transnistria region benefit from qualitative integrated perinatal services, including nutrition.
  • Vaccine coverage and immunization rates for traditional and new or underutilized vaccines are improved on both banks of Nistru River (entire Moldova, including Transnistria region).
  • The population on both banks of Nistru River has increased their MCH-related health literacy related to infant feeding and awareness about availability of MCH services and their right to access them.

Accomplishments:

1.       Specialized health professionals in Transnistria region (obstetricians, midwives and neonatologists) have improved capacities and knowledge to provide MCH hospital care according to international standards:

  • Following the Effective Perinatal Care (EPC) missions to the Transnistria region conducted between 2014 and 2016, WHO undertook EPC training in Chisinau, as well as follow-up missions were organized back to back to both banks of the River in 2017 to track progress on the implementation of former recommendations.
  • Based on the provided recommendations the training center on perinatal care emergencies will be organized in Tiraspol maternity. The study visit to Kaunas, Lithuania was organized during summer 2017. Currently the renovation of the premises for the future training center is ongoing.
  • There was a needs assessment conducted in terms of medical consumables in five perinatal care facilities in Rabnita, Grigoriopol, Tiraspol, Bender and Slobozia. Pursuant to recommendations, medical consumables and accessories are being purchased and will be provided to all five facilities.

2.       Primary health care professionals (family doctors and nurses) have improved their knowledge and capacity in ante- and postnatal care, including home visiting:

  • There were international consultations on nutrition and pregnancy organized in Riga, Latvia, in 2016 realized in update of ‘mothers’ diary and development of the National guideline on nutrition during pregnancy; the approval, dissemination and user training of which being scheduled for 2018.
  • A training course on the WHO e-training package on Managing of the MCH programs was conducted in Chisinau and Tiraspol in September 2017. Before this training, the quality of hospital care to children and assessment on child rights observance in hospitals were conducted in 2013 and 2015, along with several trainings on WHO Pocket Book for improvement of the hospital care for children and the mission on Supportive Supervision in Child Care in 2016.
  • Child care and development standard for Transnistria region has been developing in 2017 by a mixt group of experts from both bank of Nistru river. The draft child care and development standard was developed in accordance with the latest recommendation of WHO on Parenting for Lifelong Health, the latest evidences on Early Childhood Development Series Steering Committee, The Lancet, 2016 and UNICEF framework on Home Visiting.
  • An Assessment of child care and development standards, including home visiting component was carried out. The assessment revealed that 75% of children up to 1 y.o.  were supervised by primary health care in accordance with child care and development standard. The results of the assessment will inform development of the training curricula for nurses, that is planned for May – September 2018.

3.       Supportive environment for breastfeeding is created at primary care, hospital care and policy level:

  • An initiative to support the strengthening of exclusive breastfeeding practices was undertaken in all maternity wards in the Transnistria region during October 2017. Pregnant women, mothers and medical staff from maternities in Tiraspol, Bender, Slobozia, Grigoriopol, Dubasari, Camenca and Rabnita improved their knowledge and skills in breastfeeding, infant health and maternal health. It is the first module of lectures organized by WHO CO in order to disseminate information on WHO principles and modern criteria for successful breastfeeding in practice. Certified breastfeeding consultants from the “Mamica Alapteaza” initiative group were also involved. This initiative was followed by a training for breastfeeding consultants was conducted in November 2017 in Tiraspol. The training was conducted by ‘Mamica Alapteaza’ based on the WHO standard 18-hours training program for breastfeeding consultants.
  • An assessment of the content and existing practices of antenatal classes for pregnant women has been conducted in all 8 districts on the left bank on Nistru river and in 8 districts on right bank of Nistru River. During 2018, the classes will be renovated and equipped.
  • Country report on assessing policies and practices on breastfeeding in the country, in accordance with Worlds Breastfeeding Trends Initiative (WBTi) tools, was developed and submitted to the International Baby Food Action Network (IBFAN). The results of the report on 10 managerial indicators and 5 clinical indicators will be validated by the MHLSP in 2018 and inform decision maker on further strengthening of Baby Friendly Hospital Initiative in the country.

4.       Basic quality management mechanisms for the perinatal and child health services in place in Transnistria region:

  • The near-miss case review (NMCR) implementation continues in the institutions (maternities/perinatal center) on both banks of Nistru river. During the next implementation period the mechanism to improve sustainability of the activities will be developed and implemented.
  • Following the initial training courses on Pocketbook of Hospital Care for Children conducted in in Chisinau and Balti in 2016, there were several rounds of training courses organized in Chisinau and Tiraspol in 2017, including two training courses for supervisors in July 2017.
  • There were 7 protocols developed and endorsed by health authorities from Tiraspol, aiming to align current standards in use in the Transnistria region with the WHO standards in obstetric care, based on recommendations provided during the mission conducted and facilitated by WHO expert, back in 2016, as presented to professionals in October 2017.
  • Antenatal care standard and Clinical protocol for non-complicated (physiological) pregnancy for Transnistria region were developed by a mixt group of experts from both bank of Nistru river. The antenatal standard and protocol was developed in accordance with WHO recommendations on antenatal care for a positive pregnancy experience, 2016.
  • The national antenatal care standard in Chisinau was also adjusted to the WHO recommendations on antenatal care for a positive pregnancy experience. In accordance to new provisions, pregnant women will benefit from one additional visit (home visit). Moreover, pre-service and in-service curricula for obstetricians- gynecologists were adjusted to the new evidences as per WHO recommendations on antenatal care for a positive pregnancy experience, 2016.

5.       Relevant health professionals have necessary knowledge and guidelines about vaccine contraindications, adverse events following immunizations, and effective vaccine management.

  • Following the training workshop on adverse events following immunization (AEFI) surveillance, causality assessment and communications in Montenegro in 2016, there was an in-country WHO mission on AEFI surveillance assessment during in June 2017. Mission recommendations have been developed for follow-up, including, development of national AEFI surveillance guidelines and AEFI training sessions.
  • At the end of the AEFI surveillance mission, a national training was organized for 114 specialists from all relevant areas, including public health specialists from all districts and municipalities, focusing on general vaccination issues, such as vaccine safety and contraindications, with particular focus on AEFI and management of those.
  • Acting upon the recommendations of previous AEFI surveillance assessment missions, the WHO organized an in-country mission to support developing the national guideline on AEFI surveillance in December 2017. The main purpose of the mission was to provide guidance and technical advice to the MoHLSP in developing a national guideline on AEFI surveillance. The national guidelines shall be finalized in the first half of 2018.
  • There was organized the third UNICEF Vaccine Procurement Practitioners Exchange Forum (VPPEF) on in October 2017 in UNICEF Supply Division Copenhagen, Denmark. The purpose of the VPPEF was to ensure participants exchange and learn from each other on how to develop adapted procurement practices that ensure supply to meet national demand for vaccines.

6.       Public authorities have the tools to better plan, budget and implement immunization activities.

  • Following the global switch from the trivalent oral polio vaccine (t-OPV) to bivalent OPV (b-OPV) worldwide as prescribed by the Global Polio Eradication Initiative (GPEI) and the unforeseen delay in the delivery of inactivated polio vaccine (IPV) to Moldova (and many more other countries) through UNICEF Supply Division due to the shortage of global manufacturing powers, it was advised that Moldova strengthens its acute flaccid paralysis (AFP) surveillance, which continued throughout 2017. Hence, support was provided to the national reference laboratory (poliolab) at the National Center for Public Health to continue AFP surveillance to keep the country’s polio-free status, by collecting samples and transporting those to the international polio reference laboratory in Moscow, Russian Federation, based on a multi-year agreement, while benefiting from on-site training. It is expected that the IPV shall arrive in the country during Q1 of 2018, through UNICEF SD.

7.       Community-based parents’ support groups set up with the support of civil society in the Transnistria region promote breastfeeding; provide peer-support and information about access to MCH services

  • Community parents support groups shall be organized throughout 2018 following the launch of the mothers’ schools. Specific materials related to the exclusive breastfeeding were developed and distributed during the World Breastfeeding week that is celebrated yearly in August 2017. Two events for target population dedicated to World Breastfeeding week were organized: one in Slobozia and one in Orhei.
  • Calendar “We promote and support breastfeeding in 2018” with 12 evidence based key-messages on promotion of exclusive breastfeeding and adequate nutrition of pregnant and lactating women was developed. The calendar will be distributed through health care professionals to pregnant and lactating women.

8.       Health professionals enabled to promote better parenting, child care practices and immunization

  • Following the success of previous campaigns in 2015 and 2016, European Immunization Week activities have been organized in April 2017, with partners’ support, including flash mobs at selected sites or healthcare facilities, advocacy materials, and specific information flyers targeting selected audience groups (e.g., care givers, health workers). In addition, UNICEF conducted a social media campaign starting with a media statement from the Regional Director on urging governments to invest in immunizing the most vulnerable children and addressing vaccine hesitancy in the region.
  • A behaviour-change communication strategy for vaccines 2017-2020 has been approved in July 2017, based on communication for development (C4D) approaches. Experts provided comments, guidance and suggestions on implementing the external communication activities by National center in Public Health (NCPH) officials and experts to ensure a positive communication and awareness raising around immunization, with special focus on HPV and measles given the context.
  • During October 2017, the UNICEF International expert conducted an assessment study of attitudes and practices in Moldova and other three countries from CEE/CIS Region (Romania, Ukraine and BiH) in regard to immunization aiming to increasing demand for immunization. The visit was successfully conducted, including organized field visit.
  • Moldova successfully applied to the Gavi Vaccine Alliance for a two-year ‘demo’ project to introduce the human papillomavirus (HPV) vaccine for 20 thousand 9-10 years-old girls in 2018-2019 before considering scaling up nationally. Many of the aforesaid activities, as well as the development of the HPV vaccine cost-effectiveness study and HPV vaccine introduction training sessions, national conference etc., have been co-funded by WHO and other partners.
  • National Action Plan for implementation of the Governmental Inter-Sectorial Strategy on development Parenting Abilities and Competencies 2016-2022 was drafted by a team of experts in health, education and social protection under the lead of Ministry of Education, Culture and Research. As the final draft will be compiled, it will be shared with national stakeholders for consultation and validation.