MANAGEMENT of the national program to prevent and control HIV/AIDS and STI for the 2011-2015 period S tefan Gheorghi t a

1. MANAGEMENT of the national program to prevent and control HIV/AIDS and STI for the 2011-2015 period Stefan Gheorghita NPHC deputy head June 27th, 2011

2. Legal framework • National Program-approved by GD 1143 of december 16th, 2010 (published in Official Monitor Nr. 254-256 of 24.12.2010) • Central public authorities are obliged : - to create and approve operational plans for the implementation of National Program provisions - to inform the Ministry of Health on an annual basis on the accomplishment of the program by March 5th • Municipal and district councils are reccomended to : - create and approve territorial programs - to insure the realisation of territorial programs - to create territorial commissions for the prevention and control of HIV/AIDS and STI

3. Program Implementers: • Government of the Republic of Moldova • Ministry of Health and relevant institutions • Ministry of Labour, Social Protection and Family • Ministry of Education • Ministry of Justice, Department of Penitentiary Institutions • Ministry of Youth and Sports and relevant institutions • First and second degree local public authorities • UN technical agencies (UNAIDS, WHO, UNFPA, UNICEF, etc.) by providing technical and assistance and informing on international standards • National and international NGOs specialized in interventions, including the ones planned for PLWH

4. Government of the Republic of Moldova • Coordinating the measures of response to HIV and STIs for the 2011-2015 period • Developing NCC coordinating capacities in the accomplishment of the National Program • Strengthening networks of NGOs working in the fields of HIV/AIDS/STIs and with PLWH • Providing financing priority, political support for HIV/AIDS

5. Structure of the control system in HIV/AIDS, national and subnational level

6. Ministry of Health • Creating policies in the field of HIV/AIDS • Coordinating response to HIV with central and local authorities • Coordination of prevention, treatment and support activities carried-out by public and private healthcare institutions • Creating strategies and plans of professional training the field of HIV/AIDS and STI • Developing and promoting in international organisations of projects for financing and technical support in the field of HIV/AIDS/STI • Monitoring and evaluation

7. The scheme of interactions between medical institutions in the HIV/AIDS service provision system

8. Service management

9. Service management

10. Service management

11. The center provides the foundamentation of public health policies and strategies, developed projects of normative acts, regulations and methodologies and other papers, insures, highly specialised activities and expertise in the HIV/AIDS compartment AIDS Center (I)

12. AIDS Center (II) • Methodical and practical support in the surveillance and control of HIV/AIDS infection • The development and monitoring together with the partners of the National Program for the Prevention and Control of the HIV/AIDS infection and STI for the period 2011-2015 • Developing a legal and normative framework which would reflect international and EU standards • Surveillance and evaluation of the epidemical situation, monitoring the indicators of the National Program to Prevent and control HIV/AIDS and sexually transmitted diseases

13. AIDS Center (III) • Organizing and conducting epidemiological studies, including behavioral studies in populational groups with the determination and assessment of behavioral risk factors and development of forecasts • Practical and methodological assistance to government institutions, NGOs in the surveillance, prevention, treatment and support for people with HIV / AIDS • Facilitating public access to information and shaping public opinion on the state policy to prevent the spread of HIV, treatment monitoring and support for people living with HIV, preventing discrimination

14. AIDS Center (IV) • Planning, monitoring and coordinating activities related to diagnosis, ARV and opportunistic infections treatment, palliative care and prevention of mother to child transmission • Providing strategic framework and implementation of activities related to human resources capacity building through trainings, continuous education, conferences and workshops • Planning and coordination of activities related to curriculum development, operational standards (standards, guidelines, protocols, training manuals)

15. AIDS Center (V) • Planning and coordinating activities related to public relations, relations with the mass-media, website management • Planning and coordinating activities related to program monitoring, routine reporting, national reporting • Planning and coordinating of reporting related to the National Program for Prevention and Control of HIV/AIDS, on the international treaties, conventions and documents signed by the Government • Cooperation with the WHO, UNAIDS, UNICEF and other international organizations active in the HIV/AIDS field, under agreements concluded at the Government level through the Ministry of Health

16. Ministry of Labour, Social Protection and Family • Support, consulting and cooperation with social and non-governmental organizations in preventing HIV/AIDS and STIs • Coordination of social interdepartmental support with local authorities and NGOs • Provision of social assistance for people living with HIV/AIDS and their families through the territorial social assistance system and community centers

17. Establish, insure and optimise the functioning of the unique system of forming life skills and promotion of a healthy lifestyle in preventing HIV/AIDS and STIs, of youth studying in educational institutions Ministry of Education (I)

18. Ministry of Education (II) • Development and monitoring of the “Life skills” curriculum • Organizing and carrying out continuous training and preparing of teaching staff on the subject targeted • Develop and publish educational and methodical materials for teachers, pupils, students and parents • Creating conditions to involve students of the "Nicolae Testemitanu" State University of Medicine and Pharmacy and students of medical colleges and pedagogical education institutions in voluntary activities of prevention programs

19. Cooperation with local and central public administration authorities in carrying out prevention activities undertaken by youth experts and NGOs Ministry of youth and sports

20. Ministry of Internal Affairs • Fighting ilicit drug trafficking and ilicit drug business. • Training personnel on HIV/AIDS, STI issues • The compulsory introduction of the "Prevention of AIDS, STIs and drug addiction" subject in the staff training curriculum; • Ensuring control over compliance with rules on combating pornography, sexual violence and drug addiction

21. Ministry of Finance • Providing financial support within the means provided by the state budget law for the respective period, in order to accomplish the activities planned in this program • Auditing of funds used in implementing the "National program for the prevention and control of HIV/AIDS and STIs for the 2011 - 2015 period"

22. Ministry of External Affairs and European Integration • Informing foreign citizens, through embassies and consulates, upon opening a visa, on the basic provisions of the Moldovan legislation on HIV / AIDS • Participation in international forums held in the field of HIV/AIDS • Protecting rights and interests of Moldovan citizens abroad, as regards HIV/AIDS prevention

23. Ministry of Justice • Examine the current legal framework and its harmonization with international standards for securing and defending the rights of persons with HIV/AIDS, including those deprived of their liberty • Insuring the organisation of activities and implementation of measures to prevention and fight HIV/AIDS and STIs in prisons by further implementation of harm reduction programs and substitution treatment • Provide specific treatment, social and palliative care for people with HIV/AIDS deprived of their liberty • Training DPI staff on issues of HIV/AIDS prevention and control • Providing the readaptation of prisoners to society after their release

24. Creation of inter-territorial and multi-sectoral commissions for the prevention of HIV/AIDS and STIs Allocation of special funds to local budgets for the priority financing of major strategies and activities specified in territorial plans Strengthening state institutions and NGO activities in the implementation of regional programs. Local public administration authorities

25. Development and accomplishment of educational programs Non-Governmental Organisations (I)

26. Non-Governmental Organisations (II) • Participation in the development of policies and programs to prevent and control HIV/AIDS and STIs • Providing aid and support services to HIV positive people and AIDS patients • Carrying out preventive work in groups with high risk of infection • Organizing and training volunteer groups among people living with HIV / AIDS • Conducting preventive, educational and support activities among vulnerable groups • Attracting additional financial resources for projects and programs in the field

27. Mass-media • Creating and implementing special TV and radio programs and broadcasts and publishing printed press articles dedicated to HIV/AIDS, STIs and drug addiction • Organizing campaigns for prevention of discrimination and social ostracisation of people with HIV / AIDS • Usage, abidance and promotion of a non-discriminatory language in articles on HIV/AIDS/STI

28. XXI CENTURY MEDICINE IS BASED ON THE ISSUES OF HEALTHY PEOPLE BASED ON THE FOLLOWING SCHEME: Successor of initiated reforms: • Health protection law, 1995; • Reorganisation and reform of the Primary Healthcare, started in 1997; • Law on compulsory health insurance, 1998; • Reorganisation of Emergency Medical Assistance, 2003; • Implementing Compulsory Health Insurance, 2004; • Reorganisation of the state public health service, 2009

29. Fundamental values of the health systems(WHO, 2008)

30. Demographic indicators 30

31. Population mortality by main causes of death in the year2010

32. Dynamic of total healthcare expenses and their share in the GDP

33. Sources of financing for healthcare, year 2010

34. Expense structure 2010

35. State burden in the financing of the healthcare system

36. Optimising collections and financial allocations Financial protection of people having health problems Equity in financial contributions for health Access to a well defined health services package Financial sustainability of the health system Transfer of the financial burden from the State Budget to the Consumer through AOAM

37. Healthcare System in the Republic of Moldova Emergency healthcare Primary healthcare Preventive medicine service Hospital service • 18 Republican Hospitals - 49 Family doctors centres (CMF) - 1 NPHC - 34 CSP - 5 area stations • 34 District Hospitals - 41 substations • 242Health Centres (CS), inclusiv 47 autonomous • 10 Municipal Hospitals - 2 MunicipalCSP • 618Family doctor offices (OMF), including 62 autonomous • 359Health offices, inclusiv 38 autonomous -85 Emergency healthcare points - 11 Stomatological clinics

38. Percentage of doctors and specialists with medium education per 10.000 population

39. Elimination of bareiers and deficiencies in the activity of healthcareservices

40. Population access to compensated medication With the purpose of organising a transparency in the formation of medication prices, the Service for examination and registering of manufacturers’ prices was created. 5.370 positions registered in the price catalogue, showing a 29,7% decrease

41. Intermediary objectives Instruments Final objectives Access Equidad y Condición de Health conditions Acceso Salud Quality Efectivdad y Calidad • • Regulation • Financing • • Organization Protección contra Financial risk protection Equity in financing Sustenabilidad • • Payment(remuneration) Riesgo financiero Financiera Abilities to convince Productivity and efficiency Productividad y Eficiencia User satisfaction Satisfacción Particapación Social participation Usuarios social Optimisation of management and healthcare provision services •

42. Thank you!!!