Reform where it matters most: one country’s experience
Dr Jarno Habicht is WHO Representative in Moldova. Faith McLellan spoke with him about how reform is taking shape at country level.
Q: What are the main changes taking place in WHO’s work in Moldova?
A: The country, one of the poorest in the European region, faces a number of political, economic and social challenges. Population migration is especially high, which affects the health care workforce. Droughts, floods and trade issues have enormous effects on agriculture, the main source of livelihood for many Moldovans.
In line with the reform objective of better supporting country needs, we have shifted our work from direct implementation to a focus on capacity building, change management and policy advice.
We are working towards the goal of universal health coverage, one of the reform leadership priorities.
Moldova’s health system has undergone a great deal of transformation since the country became independent. Primary health care is now universally accessible and availability of medicines is increasing. Health insurance is mandatory and covers most of the population but out-of-pocket expenditures remain high.
"We are moving towards the reform objective of being more efficient and effective at responding to country needs."
Dr Jarno Habicht
Q: Which of WHO’s leadership priorities are especially relevant for your work?
A: Tackling noncommunicable diseases (NCDs) is a high priority for us. Moldovans are among the greatest consumers of alcohol in the world, and smoking rates among men are the fourth highest in Europe. Cigarettes are the cheapest in the region; smoke-free public spaces are very few. Although 40% of the population has hypertension, only about one-fourth of these are being treated.
In 2013, we began to apply an innovative analytical tool that focuses on health system strengthening for better NCD-related health outcomes. The tool not only brings together many different stakeholders throughout the country, but also in programmatic areas across the three levels of the Organization.
Another way we are addressing NCDs is through mobilizing communities using public campaigns:
Q: What types of reform initiatives have been implemented in the country office?
A: We are moving towards the reform objective of being more efficient and effective at responding to country needs. Country office staff have been actively involved in the reform process, including hosting a visit by the Joint Inspection Unit of the United Nations System in 2012 to discuss needed administrative and technical capacities.
We have also participated in strengthen organization-wide priority setting and planning process, including ensuring early discussions with government to address targeted priority areas.
We have been involved in mobilizing other UN organizations around the universal health coverage goal. Of course, direct partnerships and resources allocated for country priorities are also facilitating our work in Moldova.
To increase mutual accountability with other countries in the region, a harmonized approach to national counterparts and technical focal points is in place. In this way we intend to share the responsibility for outcomes and impact.