1. Palliative Care in Republic of Moldova: a short overview

2. Moldova is a small country, located in South- Eastern Europe. According to the latest census (2004), it has 3,938,679 inhabitants (including Transnistria region).

3. Healthcare services are the responsibility of the MoH. There are regional health administrations for the different districts, which directly manage care at that level, but they report to, and follow directives issued by, the MoH. Public hospitals are directly run by the MoH, which also co-ordinates a number of national programmes. In 2004, there were only 11 private hospitals in the country. Funding for public health services comes from the national insurance system, special state funds (for specific programmes, ex: The National Program against Diabetes, the National Program for Mental Health. There used to be National Programs against cancer but it was not approved for the last 2 years) and external donors. Efforts have been made to decentralise the healthcare system.

4. Throughout Moldova, cancer is a serious problem, with an estimated 42,000 people living with the disease every year. Out of this group, 5,600 people will lose their lives, making cancer the second most common form of death in the country According to the most recent needs assessment (2006, dr. Daniela Mosoiu), 25,000 patients need palliative care every year, more than 60% of them living in rural areas.

5. In 2009 the morbidity rate of cancer in Republic of Moldova was 209,9 (compared to 152,6 in 2000 and 149,0 in 1999) The mortality is considerably increasing, from 9,7 in 1990 to 12,2 per 1000 in 2010.

6. Mortality in RM, 2010 Circulatory diseases - 24512 cases Tumors – 5699 cases Digestive diseases – 4342 cases Traumas and poisons – 3691 cases Respiratory diseases – 2432 cases Other – 1581 cases

7. General mortality rates, per 100 000, 2010

8. Palliative Care: legal framework There is a concept paper on Palliative Care The Ministry of Health adopted the Order no. 884 on December 30 th 2010, on approval of the National Palliative Care Standards A working group is promoting the approval of the reviewed and redrafted legislation on opioids There are no real costs of PC services estimated by the MoH The National Company of Medical Insurances contracted three main PC providers, but with extremely low costs

9. Palliative Care: service providers There are several service providers of Palliative Care in Moldova – Hospice Angelus (home PC), – Hospice Zubresti (inpatients unit for PC), – three new mobile teams of palliative care in Ocnita, Taraclia and Cimislia, – PC mobile team within the Institute of Oncology, – a newly opened inpatients unit in the center of Chisinau (initiated by the National PC Society) – Other medical care providers, offering home care

11. Palliative Care: training A curriculum for the basic training of nurses in palliative care has been developed. Initially, the course comprised 200 hours, but it was reduced to 62 so that it could be integrated into the existing undergraduate curriculum.

12. Qualitative analysis Strong points: 1. strong willingness to develop palliative care by PC providers 2. Example of succesful PC mobile teams in teritories 3. legislation has been adjusted to define palliative care Weak points: 1. palliative care is not recognised as a subspecialty 2. opioid legislation is not yet approved, even if reviewed and redrafted 3. small number of PC providers

13. Main dilemmas & challenges Dilemmas: - palliative care expertise is still weak in the country Challenges: - frequent political changes