Parteneri
Chapter 1. Introduction
Chapter 1. Introduction
The WHO Strategic Approach to the Enhancement of Reproductive Health Policies and Programs is the methodology we used to identify and prioritize the needs for reproductive health services and technologies, test the necessary interventions on the priority needs, and apply the successful interventions at the national level.
The strategic assessment is the main stage of the Strategic Approach and represents a cooperative and versatile process, implemented in Moldova by a team of decision-makers in the field of reproductive health and guided by MHSP, in collaboration with the National Scientific Practical Center of Reproductive Health, Medical Genetics and Family Planning, Mother and Child Health Care Research Institute, "N.Testemitanu” SUMP, Ministry of Justice, NGOs dealing with gender issues, women and young people, mass-media.
This assessment is not a quantitative research study, by a quality and cooperative process, aimed at gathering information from the key informers regarding the current state of the fertility regulation service in Moldova, including the knowledge and perceptions of service providers, community members, quality of health care, the need to improve it, introduce new methods, etc.
The strategic assessment of fertility regulation services in the Republic of Moldova aims at identifying the appropriate sustainable interventions in order to improve the quality of contraception and abortion services, improve the general access to services, diminish the number of unwanted pregnancies and abortions, and decrease the abortion-induced morbidity and mortality.
The strategic questions, developed during the national planning workshop, were used as basis for the evaluation and allowed a wider and deeper examination of the fertility regulation services and their impact on the reproductive health.
The strategic assessment in Moldova focused on the following broad areas:
- How to diminish the use of abortion as a family planning method, the number of unwanted pregnancies and abortions?
- How to extend the general access to high quality family planning and abortion services?
- How can we improve the quality and safety of services currently provided by health facilities of different levels, how can we diminish the number of complications?
- What are the main causes of abortion-induced mortality in Moldova and how can we diminish it?
During the workshop they also formulated a number of secondary questions, related to the aforementioned strategic directions:
- Why abortion is still used as the main fertility regulation method?
- What are the barriers that prevent the access of some categories of women, particularly the teenagers, poor women, and women with many children, to these services?
- What is the quality of abortion services, counseling and and contraceptive methods?
- What are the women’s and men’s opinions about the existing contraception and abortion services?
- Is there any need to change the current abortion practices? What is the opinion of service providers? What strategies shall be used to gain the support of service providers and program managers to introduce new abortion technologies, including manual vacuum aspiration and the medical abortion?
- What is the role of the primary and private sectors regarding the provision of these services?
The strategic assessment, based on the analysis of its findings, permitted to develop recommendations for the second stage of fertility regulation services improvement, focused on the change in policies, interventions, and operational studies.
At the second stage, the major recommendations for program interventions will be tested, and at the third stage the successful interventions will be implemented on a larger scale.
Opportunities for actions will exist at each of those three stages, providing the decision makers with information and time to work out an evidence-based policy and decide on how to enhance and assure the sustainability of family planning services and maximize the positive results in the reproductive health field.
The assessment will have a systematic approach that will examine three interconnected elements – fertility control technologies, the capacity of service providing system, and customer's needs.
The strategic assessment will help the Ministry of Health (MoH) and the National Insurance Company coordinate the public and donated resources aimed at enhancing the abortion and contraception services.