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Chapter 11. The next steps
Chapter 11. The next steps
During the last 2 days of work, after completing the field work, the team members gathered to share the main findings and the recommendations. Then they grouped and prioritized the recommendations and developed a plan of actions for their implementation.
The recommendations were discussed and completed during the National Dissemination workshop of the Strategic Assessment.
The improvement and enforcement of policies and regulations
The assessment team stated the need to improve the policies and regulations on family planning and abortion, to satisfy to a greater extent the necessities of Moldovan people, to continuously diminish the number of unwanted pregnancies and the number of abortions. This may be achieved by comparing and adjusting the national legislation and other regulatory acts of the Republic of Moldova on health care and the sexual and reproductive rights to the EU and WHO standards.
Enhancement of the information, education and communication (IEC) and abortion prevention measures
Through:
- quality and IEC strengthening through the cooperation of MHSP, Ministry of Education, NHIC, „Nicolae Testemitanu” SUMP, international organizations and agencies, local public administration authorities, mass-media, schools, chemists, NGOs, FDC, HC, FPC and the gynecological medical assistance;
- larger involvement of the community in advocacy campaigns, elaboration of educational materials, evaluation of the population opinion, to better address the needs of different community groups.
- development of a coherent mechanism of approval, production, and dissemination of the comprehensive, informative materials (kinds of abortion, contraception, legislative acts);
- establishment of a logistic system of acquisition and equitable distribution of free of charge contraceptives, so that they reach the main beneficiaries ( the women from socially vulnerable groups and teenagers), firstly those from rural area;
- the elaboration of methodological regulations of the national Program of family planning;
- offer contraceptives and the informative materials to abortion services providers;
- provide post abortion contraception immediately after the procedure;
- use the insurance money to cover the costs for the contraceptives offered to women from socially vulnerable groups and teenagers, including after abortion;
- monitor the provision of post abortion consulting and contraceptives.
Improve the quality of abortion services
To improve the quality of abortion services introducing the concept of patient-oriented service and Comprehensive Care in Abortion (CCA). These include:
- implementation of the abortion methods in the I and II semesters, counseling , pain control and infection prevention, recommended by WHO;
- development and implementation of a model of Comprehensive Care in Abortion, including the provider – patient interaction, post abortion counseling and contraception;
- establishment of a Model abortion Center, that can be used for providing services, for the trainings of the abortion providers and for pilot- testing of the Assessment’s recommendations.
- improvement of the mechanisms of confidentiality respecting /ensuring and intimacy in the RH services;
- development of monitoring mechanisms of the standards and protocols implementation and the compliance with the quality monitoring regulations in force.
Improvement of the access to the fertility regulatory services for the socially vulnerable categories and teenagers
The assessment team stated that the access to the services of the socially vulnerable groups and teenagers is limited and needs to be improved. This can be achieved by:
- defining the criteria of social-vulnerability, mechanisms of their proof by the respective people to obtain the free of charge services;
- development by the MHSP of a explicatory document on the mechanism of obtaining of the free of charge abortion services;
- enhancement of the abortion on medical and social grounds, the abortion for the socially and vulnerable groups and teenagers, with costs covered by NHIC;
- including the abortion and contraceptive service on the list of the cases that allow direct visits of the insured people to specialized doctors;
- the abortion services provision and out-patient assistance, provided that the staff is equipped and trained.
Meeting the young people’s needs for contraception and abortion
The young people represent a group with special needs that nowadays are not satisfied at an adequate extent. This this situation can be improved through the:
- development of the youth – friendly contraception and abortion services;
- providers training in the youth-friendly services provision and the cooperation with the educational, psychological assistance and social system;
- reduction of the age of the abortions for which the parents consent is required to 16.
- In some special cases, when an young women under the age of 16 request an abortion, the decision of pregnancy termination to be made in accordance with the decision of three medical workers, among who the specialist who is performing the abortion.
Improvement of the management of abortion and contraception services providers
By:
- accreditation of the institutions and the doctor for abortion services provision;
- defining and uniting the abortion procedure costs in correlation with clinical standards;
- improving the financial management of abortion services to equip the facilities and remunerate doctors ;
- displaying the price list in a visible place for the abortion procedure and post abortion contraception and information about free of charge services provision for the women from socially vulnerable groups
- providing private institutions that offer RH services with the same rights and liabilities and the state owned ones and have them contracted by NHIC.
Improvement of the reporting system, the monitoring system implementation and the evaluation of the services functioning
This objective can be achieved by:
- developing standards and protocols on abortion services;
- developing new indicators and the modernizing the reporting system in the services of fertility regulation;
- fighting against unregistered abortions, motivating doctors , evaluating and eliminating the existing barriers.
The providers training
Improve providers’ knowledge, including those of the primary level is crucial for the amelioration of the functioning of the whole system.
- establish a continuous medical training system in qualitative abortion care, the formatters instruction
- adjust the curricula for providers training in the abortion and contraception domains in accordance with the EU standards and WHO recommendations
- organize training seminars for the providers of the nationally covered abortion services, -select persons for training in Comprehensive Care in Abortion (CCA)
- train family doctors, family doctors' assistants in the pre and post abortion counseling, contraceptive advice provision and IEC organization.
- train the medical assistants from schools in IEC, family planning
The decrease of maternal mortality and morbidity connected with abortion
The maternal mortality and morbidity caused by abortion can be diminished by:
- using the confidential enquiry results of MM and the analysis of the proximity cases at the institutional level to increase the quality of the abortion services;
- removing any barriers to abortion according to the social and medical indications, facilitating the access to abortion in the II semester of pregnancy;
- implementing the safe abortion methods, including in the II semester, recommended by WHO, the complications management standards and referential protocols in case of complications;
- increasing the familiarization of the community with the risks of a clandestine abortion, the sexual and reproductive rights of the women.
Organization of operational studies on the reproductive health care in RM:
- study the reproductive health financing;
- study the impact of the free of charge contraceptives offer immediately after the abortion to all the women;
- study of the community perception of the distribution of the condoms free of charge in the public places;
- study of the causes of non-use of contraception by women with repeated abortions;
- study of the causes of unregistered abortions.