This report was prepared by:
Dr Victor Rudi, MD, PhD
Head of the Department of monitoring, evaluation and integration of cardiology service in Moldova
National CVD Prevention Coordinator for Moldova
with the kind assistance from:
• Angela Marina, MD, Cardiologist, collaborator of the Department of monitoring, evaluation and integration of cardiologycal service in Moldova
• The Department of monitoring, evaluation and integration of cardiology service
in Moldova, Institute of Cardiology
Documents to download
Health care
Republic of Moldova is a country in Eastern Europe. Due to a decrease in industrial and agricultural output following the dissolution of the Soviet Union, the service sector has grown to dominate Moldova's economy and currently composes over 60% of the nation's GDP (total GDP/PPP [gross domestic product / purchasing power parity] - 20.207 billion International Dollars, 2017 estimate). The economy is the poorest in Europe in per capita terms. The implementation of structural reforms outlined in the National Development Strategy (NDS) Moldova 2020—especially in the business environment, physical infrastructure, and human resources development areas, would help boost potential growth and reduce poverty. Moldovan GDP/ PPP per capita is 2,089 International Dollars (2017, estimate).
Family doctors play an important role in diagnosing/detecting early stages of CVD and/or in referring the patients to the CV specialists. The “Health 2020” Strategy: The European policy framework to support action on public health and welfare at government and society level sets out an ambitious and forward-looking agenda for the protection of the health of the population. Health has improved over the past few years, but inequalities in this area are still severe.
The share of total health expenditure spent on outpatient care is one of the lowest in Europe. Weight of health expenditures in GDP (gross domestic product )varies between 5,1% - 5,3%.
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Risk factors
The summary of combined risk factors demonstrates that 1 in 3 Moldovan adults aged 18–69 and 1 in 2 adults over 45 years of age had three or more behavioural non-communicable disease (NCD) risk factors. Young men had a 2.5 times higher risk for NCDs than young women, and over half of adults over 45 years of age are at high risk for NCDs.
- Smoking: The prevalence of tobacco use, especially smoking, has decreased but remains high: 25.3%
- Alcohol consumption: Moldova ranks first in the world at annual alcohol consumption, equivalent to 17.4 litres of pure alcohol per capita.
- The prevalence of Hypertension is 36 3250 patients, 1022,7 per 10 000 population and of Diabetes is 97 048 patients, 273,2 per 10 000 population (according to national health statistics from 2016).
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Main actors
The main actors in prevention in the Republic of Moldova are:
- the Ministry of Health, Labor and Social Protection
- the National Center of Public Health
- the National Center for Health Management
- the Institute of Cardiology
- the General practitioners.
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Prevention activities
General practitioners are the main actors of both primary and secondary prevention, but their main role is to detect cardiovascular risk factors in the general population. School doctors are also important for the implementation of a healthy lifestyle during childhood. Secondary prevention is offered to the public by cardiologists, internal medicine specialists, and general practitioners.
At the national level: primary prevention is provided by the Ministry of Health, Labor and Social Protection through the:
- National Strategy for Non-Communicable Disease Prevention and Control 2012-2020
- National Program for the Prevention and Control of Cardiovascular Diseases for the years 2014-2020
- National Health Promotion Program for the years 2016-2020.
The Ministry of Health, Labor and Social Protection made a habit of initiating public campaigns targeting the detection of cardiovascular risk factors and promotion of physical activity, on a yearly basis with the occasion of the World Heart Day. The main radio stations and TV channels are also involved in everyday advertising for a healthy lifestyle.
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Cardiac Rehabilitation
“National Program of prevention and control of cardiovascular diseases for the years 2014-2020” includes measures for the implementation of rehabilitation programs.
Cardiac rehabilitation (CR) is recommended after cardiovascular surgery and after acute myocardial infarction, but in CR programs patients are also enrolled with stable coronary artery disease, peripheral arterial disease, heart failure, arterial hypertension and metabolic syndrome.
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Aims for the future
In Republic of Moldova we aim to decline CVD mortality with 10% in the next 3 years through legislation and support from the parliament and government.
The ongoing "National Program for the Prevention and Control of Cardiovascular Diseases for the years 2014-2020" is a main effort and considers primary prevention as its main priority. The purpose of the program is to increase the life of the population and reduce cardiovascular mortality.
In order to achieve the basic objectives included in the program, the health system in the Republic of Moldova has continued to develop health service capacities through the basic functions of the health system:
- Governance
- Funding
- Resource generation
- Provision of medical services
There is a need for more funding in order to provide effective CVD prevention programmes and a need for full reimbursement for cardiac rehabilitation - outpatient (after acute Myocardial Infarction [MI] and stroke, cardio vascular surgery, etc.).
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Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.
Our mission: To reduce the burden of cardiovascular disease.