Investing for a safe and healthy Republic of Moldova: WHO Health Emergencies Programme at the country level

UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel.: +45 45 33 70 00 Fax: +45 45 33 70 01 E-mail: euwhocontact@who.int Website: www.euro.who.int The WHO Reg The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czechia Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav R public of Macedoniaurkey Turkmenistan Ukraine United Kingdom Uzbekistan North Macedonia Investing for a safe and healthy Republic of Moldova WHO Health Emergencies Programme at the country level Investing for a safe and healthy Republic of Moldova WHO/EURO:2019-3791-43550-61166 © World Health Organization 2019 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the nam es of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. Design and layout: Djordje Novakovic 5WHO Health Emergencies Programme at the country level Disasters and emergencies disrupt communities and destroy livelihoods – most of all they threaten people’s health. In a typical year, Europe suffers economic losses of € 10 billion from disasters and emergencies,1 which result in hundreds of people dying or becoming severely ill. Europe’s 21st century emergencies include a wide range of hazards: • Many countries have measles epidemics. • Countries in southern, central and eastern parts of the Region have outbreaks of vector-borne diseases, such as West Nile Virus and Crimean-Congo haemorrhagic fever. • All national health systems in the European Region have to respond to outbreaks of foodborne diseases, and antimicrobial resistance is growing at an unprecedented pace. • Many countries are prone to floods, heatwaves, forest fires and other extreme events. Climate change means Europe is likely to see many more such emergencies in the coming years. • The threat of earthquakes and other natural disasters in Europe – possibly combined with chemical or nuclear contamination – never goes away. • Conflicts and terrorist attacks affect European countries directly and as spill-over effects from neighbouring countries and regions. 1 Estimate quoted in EFDRR. High-Level Dialogue Communiqué from 2017. European Forum for Disaster Risk Reduction, Istanbul, 26–28 March 2017. Geneva: European Forum for Disaster Risk Reduction; 2017. (https://www.preventionweb.net/files/52533_2017efdrrhlcommuniquefinal.pdf, accessed 23 August 2019). 6 7 The European Region is part of a highly interconnected world. Diseases can spread at the speed of an aeroplane, and people fleeing emergencies often cross international frontiers. Recent striking examples of international emergencies with repercussions in Europe are the outbreaks of the Ebola and Zika viruses, and the Syrian humanitarian crisis. Republic of Moldova: The case for action The Republic of Moldova’s most recent health risk assessment identified foodborne outbreaks, civil unrest, antimicrobial resistance, earthquakes, influenza and vaccine preventable diseases, such as measles and pertussis, as high priority hazards. This relates to the inevitability of their occurrence, transmission potential, the high rate of fatalities matched with the coping capacity for the management of these events. Severe weather conditions (linked to climate change), chemical, biological and radiological hazards were considered as moderate priority events, although vulnerabilities to, and coping capacities for these events vary widely. The Ministry of Health recognizes that the country needs to strengthen its health emergency capacities. This is why the Republic of Moldova is one of the WHO Health Emergencies (WHE) Programme’s priority countries in the European Region. The WHE Programme will continue to scale up support to priority countries and territories to help them to strengthen their International Health Regulations (IHR) core capacities. Each of the priority countries faces significant hazards, and each has vulnerabilities in their health emergency response capacities. This means health emergencies can have a high impact in these countries and territories. It also means they are the places in the Region where investment in IHR core capacities can produce the greatest return. 1 1 BOX MAP Key emergency threats in the Republic of Moldova • Earthquake and flood hazards (Maps 1 and 2) • Food-borne outbreaks • Vaccine-preventable diseases • Civil and armed conflict • Antimicrobial resistance • Influenza and vaccine-preventable diseases Republic of Moldova: Seismic hazard map2 2 WHO. The WHO E-Atlas of Disaster Risk for the European Region. Volume 1. Exposure to Natural Hazards. Version 2.0. Copenhagen: WHO Regional Office for Europe; 2011. (http://www.euro.who.int/en/health-topics/ emergencies/disaster-preparedness-and-response/publications/2011/who-e-atlas-of-disaster-risk-for- the-european-region-the.-volume-1.-exposure-to-natural-hazards.-version-2.0, accessed 23 August 2019). Country Emergency Preparedness Programme in the European Region: alert@euro.who.int Further information e-atlas: vram@who.int Disclaimer The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. All reasonable precautions have been taken by WHO to produce this map. However this map is being distributed without warranty of any kind, either express or implied regarding its content. The responsibility for its interpretation and use lies with the user. In no event shall the World Health Organization be liable for damages arising from its use. © WHO 2010. All rights reserved. 0 80 16040 Km Projection: Geographic Geographic coordinate system : WGS 84 : Seismic Hazard Distribution Map Significant earthquakes 2150 B.C. to 2010 0,1 - 1,9 (Unfelt) 2,0 - 2,9 (Very minor) 3,0 - 3,9 (Minor) 4,0 - 4,9 (Light) 5,0 - 5,9 (Moderate) 6,0 - 6,9 (Strong) 7,0 - 7,9 (Very strong) Legend Major cities (Geonames, 2010) International boundaries Very low Low Medium High Very high No data (0 - 0.2) (0.2 - 0.8) (0.8 - 2.4) (2.4 - 4) ( >4) Plate boundaries (NOAA, 1998) Significant volcanic eruptions 435 B.C. to 2010 (NOAA, 2010) (NOAA, 2010) Richter scale magnitude >8,8 (Catastrophic) 0,0 or Unknown (before instrumentation) Seismic hazard (PGA, m/s )2 Republic of Moldova Orhei Cahul Balti Soroca Ungheni Rîbnita Tighina Dubasari Tiraspol Chisinau (Modified from Giardini et al. 1999) (United Nations, 2010) Disclaimer The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. All reasonable precautions have been taken by WHO to produce this map. However this map is being distributed without warranty of any kind, either express or implied regarding its content. The responsibility for its interpretation and use lies with the user. In no event shall the World Health Organization be liable for damages arising from its use. © WHO 2010. All rights reserved. Legend Seismic hazard (PGA, m/s2) (Modified from Giardini et al. 1999) Very low (0 - 0.2) Low (0.2 - 0.8) Medium (0.8 - 2.4) High (2.4 - 4) Very high ( >4) No data Significant earthquakes 2150 B.C. to 2010 (NOAA, 2010) Richter scale magnitude 0,0 or Unkonown 0,1 - 1,9 (Unfelt) 2,0 - 2,9 (Very minor) 3,0 - 3,9 (Minor) 4,0 - 4,9 (Light) 5,0 - 5,9 (Moderate) 6,0 - 6,9 (Strong) 7,0 - 7,9 (Very strong) >8,8 (Catastrophic) (before instrumentation) 8 9 2 MAP Republic of Moldova: Flood hazard map3 The Republic of Moldova is striving to achieve Universal health coverage (UHC), in line with the UN’s Sustainable Development Goals (SDGs). Investing in health emergency capacities supports the country’s progress towards these and other SDGs. The investment will safeguard social and economic progress, by reducing the impact of emergencies when they happen. 3 Ibid. “Universal health coverage and health emergencies are two sides of the same coin” Dr Tedros Adhanom Ghebreyesus Director-General of World Health Organization Universal health coverage and health emergency capacity, or emergency preparedness, are two sides of the same coin in a people-centred health system. When countries strengthen their emergency preparedness and response capacities, they also strengthen their health system’s ability to provide universal health coverage. In the same way, when countries strengthen their health systems, they strengthen their capacity to be prepared for and respond to emergencies. True universal health coverage means people can access quality, affordable, safe and culturally sensitive life-saving services when they need them most – including when they have been hit by an emergency. Disclaimer The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. All reasonable precautions have been taken by WHO to produce this map. However this map is being distributed without warranty of any kind, either express or implied regarding its content. The responsibility for its interpretation and use lies with the user. In no event shall the World Health Organization be liable for damages arising from its use. © WHO 2010. All rights reserved. Legend Flood hazard (index) (World Health Organization, 2010) Very low (0 - 0.2) Low (0.2 - 0.8) Medium (0.8 - 2.4) High (2.4 - 4) Very high ( >4) No data Country Emergency Preparedness Programme in the European Region: alert@euro.who.int Further information e-atlas: vram@who.int Disclaimer The boundaries and names shown and the designations used on this map do not imply the expression of any opini n whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. All reasonable precautions have been taken by WHO to produce this map. However this map is being distributed without warranty of any kind, either express or implied regarding its content. The responsibility for its interpretation and use lies with the user. In no event shall the World Health Organization be liable for damages arising from its use. © WHO 2010. All rights reserved. 0 80 16040 Km Projection: Geographic Geographic coordinate system : WGS 84 : Flood Hazard Distribution Map Legend Flood hazard (index) (World Health Organization, 2010) International boundaries (United Nations, 2010) Major cities (Geonames, 2010) No data Very low Low Medium High Very high (0 - 122) (123 - 350) (351 - 628) (629 - 1073) (1074 - 3764) Republic of Moldova Orhei Cahul Balti Soroca Ungheni Rîbnita Tighina Dubasari Tiraspol Chisinau Public Health Emergency Management (PHEM) training course organized by WHO/Europe in Chisinau, 2015 Photo credit: WHO 10 11 2 BOX Investing in emergency preparedness makes economic sense Many health emergencies are partly or fully preventable. Where they are not, harm can often be reduced through prevention, preparedness, early detection and rapid response. Total global investment required over the coming five years to effectively prepare for, prevent, detect and respond to health emergencies is estimated at US$ 28.9 billion. Success will be measured against the goal of better protecting at least 1 billion more people from health emergencies and providing life-saving health services to 100 million vulnerable people. It will save approximately 1.5 million lives and provide estimated economic gains of US$ 240 billion. Extract from A Healthier Humanity: The WHO Investment Case for 2019–20234 The return on investment is US$ 8.30 for every US$ 1 provided – a more than eightfold return. The investment pays back in multiple ways: • it saves people, society, economy from the next emergency • it strengthens the health system • it helps to meet several Sustainable Development Goals • it contributes to global efforts to protect 1 billion more people worldwide. 4 WHO. A Healthier Humanity: The WHO Investment Case for 2019–2023, pp. 24–28. Geneva: World Health Organization; 2018. (https://apps.who.int/iris/bitstream/handle/10665/274710/WHO-DGO-CRM-18.2- eng.pdf, accessed 23 August 2019). 3 BOX Investing in health emergency preparedness is key to achieving the SGDs Investing in health emergency preparedness and response is key to achieving SDG 3 “Ensuring healthy lives and promoting the well- being at all ages is essential to sustainable development”. It is particularly relevant to target 3.D, which deals with strengthening health emergency capacity, and targets 3.1 (maternal mortality); 3.2 (infant mortality); 3.8 (universal health coverage) and 3.9 (deaths from chemical contamination). Investment in health emergency capacity also plays an important role in achieving other SDG goals such as: eliminating poverty and hunger (SDG 1, SDG 2); gender equality (SDG 5); decent work and economic growth (SDG 8); reduced inequalities (SDG 10); Climate Change (SDG 13); and Peace, justice and strong institutions (SDG 16). Local experts assess hospital for safety in emergencies Photo credit: WHO 12 13 4 BOX The International Health Regulations: a framework to protect people from health emergencies Since 2007, the IHR have made a difference to the way the world prepares for and responds to emergencies. The IHR (2005) is a central mechanism within the WHO Health Emergencies (WHE) Programme to guide countries towards achieving common approaches and capacities to detect, assess and respond to health threats. The IHR (2005) is a legally binding treaty signed by all WHO Member States. What it commits them to is: 1. Sharing information with WHO, and each other, about all hazards – disease outbreaks and other health threats (e.g. chemical or nuclear contamination) – that could spread across international borders. 2. Developing and maintaining the core capacities needed to prepare for, detect and respond to disease outbreaks, and other health threats. 3. Reporting annually on their implementation of the IHR. The IHR have already strengthened international cooperation and country capacities to deal with health emergencies. Nonetheless, many Member States in the European Region, and indeed around the world, have scope to further strengthen their IHR core capacities. For more information about the IHR see: https://www.who.int/topics/international_health_regulations/en/ 5 BOX IHR core capacities for monitoring and evaluation 1. Legislation and financing 2. IHR coordination and national IHR focal point functions 3. Zoonotic events and the human–animal interface 4. Food safety 5. Laboratory 6. Surveillance 7. Human resources 8. National Health Emergency Framework 9. Health Service Provision 10. Risk communication 11. Points of entry 12. Chemical events 13. Radiation emergencies 14 15 6 BOX Republic of Moldova’s emergency preparedness and response capacities Overview of IHR monitoring and evaluation in the Republic of Moldova Four complementary components of monitoring and evaluation help to provide a comprehensive overview of the current status of IHR country capacities.5 The States Parties Annual Reporting is mandatory; the Joint External Evaluation (JEE), After Action Reviews (AARs) and Simulation exercises are voluntary. In particular the JEE fosters a peer-to-peer discussion between international and national experts to identify strengths and weaknesses in emergency preparedness and response within the national health system. Results and recommendations from these activities are the basis for the development of a National Action Plan for Health Emergency Preparedness. Done or in process: • States Parties Annual Reporting: 2019 • Joint External Evaluation: 2018 • National Action Plan for Health Emergency Preparedness: in process Recommended: • After Action Reviews • Simulation exercise (SIMEX) 5 WHO. IHR Monitoring and Evaluation: A Key Element for Public Health Emergency Preparedness and Response. Copenhagen: WHO Regional Office for Europe; Europe; 2018 (http://www.euro.who.int/__data/ assets/pdf_file/0006/375819/IHR-Brief_WEB.pdf?ua=1, accessed 23 August 2019). 7 BOX Highlights from the Republic of Moldova’s 2019 self-assessment report on its IHR core capacities6 Analysis of the Republic of Moldova’s annual reporting data for 2019 shows the IHR core capacities with most room for improvement in the Republic of Moldova are currently: • Human resources • Chemical events • Radiation emergencies • Laboratory • National Health Emergencies Framework The Ministry of Health is showing political commitment and leadership on health emergency capacities. In the context of implementing the IHR (Box 4), it volunteered the Republic of Moldova to undergo a Joint External Evaluation (JEE) of its health emergency core capacities which took place in 2018. Following the JEE, the Republic of Moldova prepared a National Roadmap (IHR- PVS) to strengthen collaboration and coordination between animal health & public health service in 2019. 6 WHO. Joint External Evaluation of IHR Core Capacities of the Republic of Moldova. Geneva: World Health Organization; 2019. (https://www.who.int/ihr/procedures/mission-reports-europe/en/, accessed 3 September 2019). 16 17 8 BOX Key findings from the 2018 Joint External Evaluation of Republic of Moldova’s IHR core capacities Though the Republic of Moldova has good public health legislation and policies in place, the JEE identified four over-arching systematic challenges in its health emergency capacities. Of these challenges, the main one identified was lack of resources including, in particular, human resources. Key recommendations: • Adopt a 5-year National Action Plan for Public Health Emergency Preparedness, with a clear definition of funding and a time frame for each action. • Develop a public health emergency management training programme, integrated into the civil protection plan, for all sectors from local to national level, emphasizing joint work, cooperation, standard operating procedures and understanding of the entire system. • Adopt and implement the One Health and All-hazards approaches throughout government, across sectors and between ministries. • Update electronic systems for surveillance of communicable diseases and public health events, and implement IT solutions for data collection and communication. Republic of Moldova’s health emergency preparedness initiatives Strategic risk assessment The Republic of Moldova has undergone a strategic risk assessment to identify priority risks for the development of emergency response systems, including contingency plans, strengthening laboratory and surveillance systems. Food- borne outbreaks, civil and armed conflict, antimicrobial resistance, earthquakes, influenza, and vaccine-preventable diseases like measles and pertussis were identified as high priority risks. Local strategic risk assessments have also been completed, allowing for contingency planning for more localised emergencies. The Republic of Moldova has commenced the development of an Emergency Operations Plan as the preliminary step to the strengthening of the emergency response capacity of the health sector. Hospital safety In the Republic of Moldova, 68 hospitals were assessed, including all public hospitals, one private hospital and five departmental hospitals. Moldovan experts have been trained and the Ministry of Health has instituted mandatory application of the Hospital Safety Index for hospital accreditation. Infection prevention and control (IPC) According to the 2018 Global Monitoring of Country Progress on Antimicrobial Resistance, in Moldova a national IPC programme and operational plan are available and national guidelines for health care IPC are disseminated. Selected health facilities are implementing the guidelines, with monitoring and feedback in place. In 2018, WHO supported the pilot in the Republic of Moldova of the European Centre of Disease Prevention and Control (ECDC) point prevalence survey of health care acquired infections (HAIs) and antimicrobial use. 18 19 One Health A National Bridging Workshop on the IHR and the World Organisation for Animal Health (OIE) Performance of Veterinary Services Pathway was organized in 2019 to strengthen coordination between the animal and human health sectors. Opportunities for further progress The JEE conducted in 2018 gives an in-depth analysis of the Republic of Moldova’s health emergency capacities and clear recommendations on how to strengthen them. Substantial additional resources are needed to implement the recommendations of the JEE and the National Action Plan for Health Emergency Preparedness that is based on it. WHO, national and international partners are ready to support the Ministry of Health in: • rapid development of a National Action Plan for Health Emergency Preparedness; • the Government of the Republic of Moldova’s adoption of the plan; • the Republic of Moldova’s mobilization of substantial additional domestic resources to implement the Plan. As the Plan takes shape and starts to be implemented there may be a significant number of areas where expertise and support from international partners is needed to strengthen the Republic of Moldova’s IHR core capacities. Success stories Tackling measles outbreak (2018–2019) The Republic of Moldova has sustained elimination of endemic transmission of measles since the close of 2015. However, 340 measles cases were registered in the country, including in the Transnistrian region, in 2018 and 18 in the first 3 months of 2019. Health workers demonstrating hygiene at work at the Institute of Emergency Medicine. Photo credit: Nursing Association of Moldova 20 21 The country took early action with WHO support to stop the outbreak and sustain high routine immunization coverage. This included communication and social science interventions, training for paediatricians and family doctors on early detection and isolation of measles cases, and availability of kits for laboratory testing. Following a peak in August 2018, the number of measles-affected people has started to decline. Protecting people from health emergencies together: The way W(H)E work The WHE Programme is providing the Organization’s response to increasingly demanding crises. Mainstreamed across all levels of the Organization, it is geared to better protect people from health emergencies by establishing people- centred health systems which can detect, assess, communicate and respond to crises in a matter of hours. Since each country is unique, the Programme tailors its support to countries’ specific hazards, vulnerabilities and systems. It recognizes that structures and people with the right skills need to be in place where disease outbreaks occur, where disasters and conflicts strike, and where people fall sick and die. Therefore the Programme places countries at its centre. The health emergency management cycle defines the rhythm of the Programme. Its four phases – prevention, preparedness, response and recovery – are grounded in the requirements of the IHR and seamlessly complement each other to save lives. Here’s how it works: 1. Prevention and control of infectious diseases – through vaccination, for example – help prevent outbreaks in the first place. 2. At the same time, countries need to develop, test and evaluate their national plans and strengthen their capacities to be prepared for the next emergency of any type. This includes, for example, assessing hospitals for safety and functionality, establishing a laboratory network of excellence, setting up systems for disease surveillance, and engaging communities to communicate risks. 3. During the response, life-saving health interventions and pre-positioned essential health packages are delivered in collaboration with health partners to ensure that affected populations have timely access to quality health services, leaving no one behind. 4. The recovery phase is the time to learn from experience and build back better; it is the opportunity to make health systems stronger for the future. Bridging health emergencies and universal health coverage – two sides of the same coin – will pave the way for countries to achieve the related Sustainable Development Goals. To make this a reality, the WHE Programme has tailored the global strategy into a European Action Plan. The Plan bonds countries with comparable levels of capacity and capability to avert or respond to emergencies. This requires cooperation across sectors and across borders. As a strong believer in partnership, WHO invites all governments, sectors, partners and people in the European Region to implement the Action Plan jointly. Together we have the expertise and know-how, and together we can support global efforts to prevent, prepare for, respond to and recover from all health emergencies, while contributing to protecting 1 billion more people worldwide. 22 UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel.: +45 45 33 70 00 Fax: +45 45 33 70 01 E-mail: euwhocontact@who.int Website: www.euro.who.int The WHO Reg The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czechia Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav R public of Macedoniaurkey Turkmenistan Ukraine United Kingdom Uzbekistan North Macedonia Investing for a safe and healthy Republic of Moldova WHO Health Emergencies Programme at the country level WHO/EURO:2019-3791-43550-61166