Strategies to sustain and scale up quality health care services for adolescents in the Republic of Moldova Andrei USATÎI Minister of Health 1

Progress toward universal health coverage requires a transition from adolescent-friendly projects to adolescent-responsive health systems. HEALTH FOR THE WORLD'S ADOLESCENTS. A second chance in the second decade. WHO

Summary of the presentation Rationale for strengthening the quality of health care services for adolescents in the Republic of Moldova Strategies to sustain and scale up quality health care services for adolescents Impact Unresolved issues and ways forward 3

Rationale for strengthening the quality of health care services for adolescents in the Republic of Moldova Why better health services for adolescents in Moldova? Demographic argument Health status argument Unsupportive environment 4

Demography and health status Demography 23,4% of total population are youth people (10-24 years), 1 January 2012 * 14 % of total population are adolescents (10-19 years), 1 January 2012 * Health Proportion of years old adolescents who had experience of sexual intercourse increase from 28,1% in 2003 to 36% in 2012** Proportion of years old adolescents who used condom at the first sexual intercourse increase from 35,7% in 2003 to 52,3 % in 2012** Proportion of years old adolescents who not use currently any contraceptive method increase from 5,6% in 2003 to 9% in 2012 and decrease proportion of those who use pills as contraception – from 17,4% in 2003 to 8,8% in 2012** HIV incidence among youth – 18,4/ in 2011 (total HIV incidence was 13,9 / ) and 10,5/ in 2001* The suicide rate among adolescents is increasing last years* (by 40% from 2007 to 2011) and boys is more than 10 time higher than in girls (see figures below) 4. Near one half of adolescents know somebody form peers involved in physical violence and one fifth - somebody involved in sexual violence** Every eleventh adolescent (10-19 years) indicated that currently smoke, 15.4% - use alcohol in present 1-2 times in a month and more frequently and 3% of the adolescents indicated that they have experience of use narcotic substances.** sources: *National Statistics Office in Republic of Moldova, National Centre of Preventive Medicine **KAP, Studies , Health for Youth Association 5

Adolescent grow and develop in unsupportive environment - Near 1/3 from years old adolescent live without at least one parent and 10% of adolescent live without both parents ** Only 15% of them had access to YFHS yet** Life skills development is not yet a mandatory course in school curricula sources: *National Statistics Office in Republic of Moldova, National Centre of Preventive Medicine **KAP, Studies , Health for Youth Association 6

Using a WHO 5S approach to inform strategic actions Supportive policies & strategies Strategic information Services & commodities Strengthening & supporting other sectors Strategic resources: Financing HR capacity 7

S ervices: the Youth Friendly Health Services initiative The goal To increase the access of young people to information and qualitative health services, as well as other services that correspond to the definition and criteria of “youth friendly” developed by the UN Interagency Group (YFHS National Conception, 2005) Health priorities : STI/HIV/AIDS. Adolescent pregnancy. Mental health problems as a result of substance abuse (alcohol, drug addiction). Psycho-emotional and identity disorders. Health problems occurred as a result of violence. Nutritional deficiencies and malnutrition (I, Fe). Development disorders during the puberty. 8

S ervices & commodities: scaling up pilot YFHC, with the support from UNICEF 2005 – creation of 12 YFHC Network with GF & WB and UNICEF support all YFHC integrated into the public health system as a subdivision of PMSI in which they were created was initiated YFHS scaling up process YFHC were contracted by the National Health Insurance Company 9

S trategic resources for sustainability Financing Human resources YFHC began to be financed by the NHIC In service Trainings Curriculum Review (MFSU "N.Testimiţanu, NMC) including primary care providers’ curriculum Guides (adaptation of WHO materials: WHO OP, JOB AID etc.) 10

S trategic information Youth Health and Development KAP Study, 2003, UNICEF, HFY MARA Study, 2007 (UNICEF) Surveillance studies of HIV among young people, 2006, 2008, 2010, 2012 (UNAIDS, NCPH) Adolescent Health and Development KAP Study, 2003 HFY Epidemiological/ behavioral studies mostly is not disaggregated by age Demographic and medical statistics YFHS Quality assessment, 2009 (WHO) SHS Mapping Survey, 2011, UNFPA Baseline YFHS coverage survey, 2012 CPS Economic analysis study of YFHC, , UNICEF, CSRGM Implementation research studies of access to health care: 11

S upportive policies & strategies National Reprodu ctive Health Strategy, Nation al Concep tual Frame work of YHFS, 2005 Regulati on of Youth Friendly Health Centre, 2006 National Health Policy, National Youth Strategy, Quality Standar ds of Youth Friendly Health Services, 2009 YFHS Scaling up MoH Ordinan ce, 2011 Law in Reprodu ction Health, 2012 Regulat ion of activiti es of YFHC, 2013 CAHD Strategy in final draft,

S trengthening & supporting other sectors - SHS reorganisation process, , WHO - Peer programs, UNFPA - Capacity building of school resource persons in adolescent health promotion, Health For Youth Association, SDC - Piloting reviewed mandatory curricula of civic education with component of health promotion, Neovita YHFC 13

Main Impact -From 2011 to 2013 access to YFHS increased by 3 time from 5% to 15% for y.o. In 2014 we expect an increase in this figures. -Prevention of 9 cases of HIV by all YFHCs (1 case by 4 YFHC) per year, at least, providing full range of HIV prevention services (information, counseling, testing, condom provision) can be potentially cost saving for medical system. 14

Unresolved issues and ways forward (1) Health in all policies Health laws and policies Workforce capacity Coverage Quality Areas for future actions 15

Unresolved issues and ways forward (2) Improve the quality and expand the comprehensiveness of services Assure continuous quality improvement and increase the efficiency of youth friendly health services, including implementation of the YFHC certification process Assure the provision of the full package of YFHS, especially by improving and diversifying financing sources, with the special attention for vulnerable adolescents and youth at risk. Coverage - continue scaling up Scaling up YFHS to all districts and all primary care facilities 16

Unresolved issues and ways forward (3) Further develop the legal and normative framework assure a stable status of YFHC within primary care develop amendments to the health legislation in order to remove barriers for adolescents’ autonomy in decision-making, in line with the international human rights standards (CRC) and with the principles of evolving capacity and best interests of the child Workforce capacity Assure the sustainability of professional development in adolescent health (finalize the revision of the universities’ curricula, develop evidence based protocols of care) Health in all policies Strengthen the inter-sectorial cooperation to increase safe environment and implementation of educational programs for adolescents 17

THANK YOU FOR YOR ATTENTION 18