Assessing capacities to strengthen intersectoral collaboration in Territorial Public Health Councils in the Republic of Moldova.

BACKGROUND: The government of the Republic of Moldova, endorsed the principle of Health in All Policies (HiAP) through its health sector reforms to address the rising burden of non-communicable diseases and health inequalities. Territorial Public Health Councils (TPHCs) were created to ensure the coordination and management of the population's health in their respective district. This study assessed the capacities of the TPHCs to identify areas in need of support for strengthening their intersectoral collaboration role in public health at local level. METHODS: A mixed-method approach, using qualitative and quantitative techniques, was used to compare the perceptions of all TPHC members (n = 112) and invitees (n = 53) to council meetings from 10 districts covering all geographical areas of Moldova. The quantitative information was obtained using a cross-sectional survey, while the qualitative aspects were assessed within focus group discussions (FGDs). RESULTS: Half of all TPHC members, including 75% from groups with a non-medical background, did not attend a public health course within the last three years. Overall, groups with a medical background were more aware of the legislation that governs TPHC activity and intersectoral collaboration compared with those with a non-medical background. The FGDs of TPHC meetings revealed that members had an insufficient level of understanding of intersectoral collaboration to solve public health issues and lacked clarity about their place and role within the TPHC. CONCLUSIONS: HiAP implementation was found to be suboptimal with insufficient capacity at local level. TPHC members' ability to deal with public health issues were severely impaired by a general lack of knowledge and understanding of how to utilize the TPHC platform for maximum benefit. Reforming TPHC regulation is required in addition to extensive capacity building for TPHC members to increase member understanding of their roles as intended by TPHC regulations, including the facilitation of intersectoral collaborations.

Impact and cost-effectiveness of the 6-month BPaLM regimen for rifampicin-resistant tuberculosis in Moldova: A mathematical modeling analysis.

BACKGROUND: Emerging evidence suggests that shortened, simplified treatment regimens for rifampicin-resistant tuberculosis (RR-TB) can achieve comparable end-of-treatment (EOT) outcomes to longer regimens. We compared a 6-month regimen containing bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM) to a standard of care strategy using a 9- or 18-month regimen depending on whether fluoroquinolone resistance (FQ-R) was detected on drug susceptibility testing (DST). METHODS AND FINDINGS: The primary objective was to determine whether 6 months of BPaLM is a cost-effective treatment strategy for RR-TB. We used genomic and demographic data to parameterize a mathematical model estimating long-term health outcomes measured in quality-adjusted life years (QALYs) and lifetime costs in 2022 USD ($) for each treatment strategy for patients 15 years and older diagnosed with pulmonary RR-TB in Moldova, a country with a high burden of TB drug resistance. For each individual, we simulated the natural history of TB and associated treatment outcomes, as well as the process of acquiring resistance to each of 12 anti-TB drugs. Compared to the standard of care, 6 months of BPaLM was cost-effective. This strategy was estimated to reduce lifetime costs by $3,366 (95% UI: [1,465, 5,742] p < 0.001) per individual, with a nonsignificant change in QALYs (-0.06; 95% UI: [-0.49, 0.03] p = 0.790). For those stopping moxifloxacin under the BPaLM regimen, continuing with BPaL plus clofazimine (BPaLC) provided more QALYs at lower cost than continuing with BPaL alone. Strategies based on 6 months of BPaLM had at least a 93% chance of being cost-effective, so long as BPaLC was continued in the event of stopping moxifloxacin. BPaLM for 6 months also reduced the average time spent with TB resistant to amikacin, bedaquiline, clofazimine, cycloserine, moxifloxacin, and pyrazinamide, while it increased the average time spent with TB resistant to delamanid and pretomanid. Sensitivity analyses showed 6 months of BPaLM to be cost-effective across a broad range of values for the relative effectiveness of BPaLM, and the proportion of the cohort with FQ-R. Compared to the standard of care, 6 months of BPaLM would be expected to save Moldova's national TB program budget $7.1 million (95% UI: [1.3 million, 15.4 million] p = 0.002) over the 5-year period from implementation. Our analysis did not account for all possible interactions between specific drugs with regard to treatment outcomes, resistance acquisition, or the consequences of specific types of severe adverse events, nor did we model how the intervention may affect TB transmission dynamics. CONCLUSIONS: Compared to standard of care, longer regimens, the implementation of the 6-month BPaLM regimen could improve the cost-effectiveness of care for individuals diagnosed with RR-TB, particularly in settings with a high burden of drug-resistant TB. Further research may be warranted to explore the impact and cost-effectiveness of shorter RR-TB regimens across settings with varied drug-resistant TB burdens and national income levels.

Does training on the WHO package of essential noncommunicable (PEN) disease interventions enhance consultation quality? A real-world assessment of adherence to PEN protocol in primary health centres in the Republic of Moldova.

BACKGROUND: Noncommunicable diseases (NCDs) pose a significant global health challenge. Primary health centres are pivotal in addressing this challenge by providing essential care to NCD patients. The WHO Package of Essential Noncommunicable (PEN) disease interventions has been designed to enhance the quality of NCD consultations and ensure adherence to the protocol. This study investigates the effects of PEN training in Moldova. OBJECTIVES: The primary objective of this study is to assess the effects of training on WHO PEN on the quality of NCD consultations and adherence to the PEN protocol in a real -world setting in primary health centres in Moldova. METHODS: An observational, cross-sectional study was conducted, comparing primary health centres where health personnel received PEN training, provided by the Healthy Life project, to those where such training was not provided. In total, 24 family doctors and 24 medical assistants were observed for 233 workdays and covering 2,166 NCD consultations. RESULTS: Intervention primary health centres (PHCs) showed longer NCD consultation durations, with family doctors and medical assistants spending an added 1 minute 43 seconds and 3 minutes 10 seconds, respectively. These PHCs also reported a higher proportion of primary NCD consultations, indicating better screening for new NCD patients. Medical assistants in the intervention group took on a more pronounced role in NCD care. However, the findings also highlight the necessity to refine aspects of the PEN training, especially concerning follow-up consultations, risk assessments, and task delegation. CONCLUSIONS: The findings suggest that the PEN training contributed to improvement of both the quality of NCD consultations and adherence to the PEN protocol. Yet, there is a need for enhancing the identified aspects of the PEN training. The findings highlight the potential of PEN training in primary healthcare settings for improved NCD management.

Hepatitis C Elimination in Moldova Is Feasible and Cost-Saving: A Modeling Study.

BACKGROUND: Moldova, an upper-middle-income country in Eastern Europe, is facing a high burden of hepatitis C virus (HCV). Our objective was to assist the National Agency of Public Health of Moldova in planning to achieve the World Health Organization's HCV elimination goals by 2030. METHODS: This study adapted a previously developed microsimulation model to simulate the HCV epidemic in Moldova from 2004 to 2050. Model outcomes included temporal trends in HCV infection, prevalence, mortality, and total cost of care, including screening and treatment. We evaluated scenarios that could eliminate HCV by 2030. RESULTS: Multiple strategies could lead to HCV elimination in Moldova by 2030. A realistic scenario of a 20% annual screening and 80% treatment rate would require 2.75 million individuals to be screened and 65 000 treated by 2030. Compared to 2015, this program will reduce HCV incidence by 98% and HCV-related deaths by 72% in 2030. Between 2022 and 2030, this strategy would cost $17.5 million for HCV screening and treatment. However, by 2050, the health system would save >$85 million compared to no investment in elimination efforts. CONCLUSIONS: HCV elimination in Moldova is feasible and can be cost saving, but requires resources to scale HCV screening and treatment.

Barriers to access adequate maternal care in Romania, Bulgaria, and Moldova: A cross-country comparison.

BACKGROUND: Eastern European health system indicators (e.g., number of health workers and care coverage) suggest well-resourced maternity care systems, but maternal health outcomes compare poorly with those in Western Europe. Often, poor maternal health outcomes are linked to inequities in accessing adequate maternal care. This study investigates access-related barriers (availability, appropriateness, affordability, approachability, and acceptability) to maternity care in Romania, Bulgaria, and Moldova. METHODS: This cross-country study (n = 7345) is based on an online survey where women who received maternity care and gave birth in 2015-2018 in Bulgaria (n = 4951), Romania (n = 2018), and Moldova (n = 376) provided information on their experiences with the care received. We used regression analysis to identify factors associated with accessing maternity care across the three countries. RESULTS: Results show high rates of cesarean births (CB) and a low number of antenatal and postnatal care visits. Informal payments and use of personal connections are common practices. Formal and informal out-of-pocket payments create a financial burden for women with health complications. Women who had health complications, those who gave birth by cesarean, and women who gave birth in a public facility and had fewer antenatal check-ups, were more likely to describe facing access-related barriers. CONCLUSIONS: This study identifies several barriers to high-quality maternity care in Romania, Bulgaria and Moldova. More attention should be paid to the appropriateness of care provided to women with complicated pregnancies, to those who have CBs, to women who give birth in public facilities, and to those who receive fewer antenatal care visits.

Budget impact of next-generation sequencing for diagnosis of TB drug resistance in Moldova.

BACKGROUND Diagnosing drug resistance is critical for choosing effective TB treatment regimens. Next-generation sequencing (NGS) represents an alternative approach to conventional phenotypic drug susceptibility testing (pDST) for diagnosing TB drug resistance.METHODS We undertook a budget impact analysis estimating the costs of introduction and routine use of NGS in the Moldovan National TB Programme. We conducted an empirical costing study and collated price and operating characteristics for NGS platforms. We examined multiple NGS scenarios in comparison to the current approach (pDST) for pre-treatment drug resistance testing over 2021-2025.RESULTS Annual testing volume ranged from 912 to 1,926 patients. For the pDST scenario, we estimated total costs of US$362,000 (2021 USD) over the 5-year study period. Total costs for NGS scenarios ranged from US$475,000 to US$1,486,000. Lowest cost NGS options involved targeted sequencing as a replacement for pDST, and excluded individuals diagnosed as RIF-susceptible on Xpert® MTB/RIF. For all NGS scenarios, the majority (55-80%) of costs were devoted to reagent kits. Start-up costs of NGS were small relative to routine costs borne each year.CONCLUSION NGS adoption will require expanded resources compared to conventional pDST. Further work is required to better understand the feasibility of NGS in settings such as Moldova.

Experience in radiological risk assessment of a surface waste disposal facility in Chisinau, Moldova.

The long-term condition and potential radiological consequences of legacy radioactive waste stored in a RADON-type of near-surface disposal facility outside the city of Chisinau is of concern to the central government and health protection authorities of the Republic of Moldova. A 'zero alternative scenario' risk assessment has been undertaken in order to evaluate the potential radiological impact on humans and the environment of the facility, were it to be left in its current state with no remediation. The results have been used as a basis for regulatory decision making regarding remediation and decommissioning of the legacy radioactive waste facility. The aim of this study was two-fold: first to demonstrate a complete radiological risk assessment of a real site using a combination of methodologies developed by the IAEA (ISAM and BIOMASS), the second to illustrate the current state-of-the-art in respect of extracting site-specific information from site-descriptive material. We illustrate the practicality of employing geographic information systems techniques on site-specific topographic data to identify relevant biosphere dose objects, thereby allowing customisation of the generic ISAM model framework to site-specific conditions. As a result, a simple method is suggested to bound activity concentrations in well water based on an understanding of water balance in the local catchment area in which the biosphere dose object is embedded. With conservative assumptions, estimated doses from the calculation cases of the design scenario remain lower than the IAEA's dose criteria and environmental screening values. However, the results also indicate that human intrusion activities after the institutional control period could lead to radiological exposures above the IAEA's criteria for a period up to 100 000 years. The long-lived radionuclide239Pu dominates doses for the on-site residence scenario. Remediation measures should be implemented were the waste to remain at its present place of disposal.

STEPS: prevalence of noncommunicable disease risk factors in the Republic of Moldova, 2021

Noncommunicable diseases (NCDs) represent a major threat to human and economic development. The burden imposed by NCDs could be lessened by reducing their leading behavioural and metabolic risk factors. The national household survey on the prevalence of NCD risk factors was conducted in the Republic of Moldova in 2021 using the WHO-approved standardized STEPwise approach to NCD risk factor surveillance (STEPS). The purpose of the survey was to determine the current prevalence of common modifiable risk factors among the country’s population; to evaluate trends in comparison to the results and findings of the 2013 STEPS survey; and to contribute to monitoring and evaluation of the implementation of the various national programmes in the area of NCD prevention and control. The survey was a population-based survey of adults aged 18–69 years and performed in three steps comprising a questionnaire, physical measurements and biochemical measurements. A three-stage cluster sampling process was carried out to select participants from among the target population in such a way as to be nationally representative. The current prevalence of NCD risk factors among the adult population of the Republic of Moldova, both overall and in eight age/sex groups and in rural/urban areas of residence, is presented in the report.

Reducing salt consumption and its negative impacts in the Republic of Moldova: EVIPNet evidence brief for policy, number 9

High salt intake is one of the main dietary risk factors for death and disability-adjusted life years globally, and one of the main risk factors for hypertension, cardiovascular disease, stroke, stomach cancer and renal disease. Reducing salt consumption and improving dietary habits requires comprehensive policies targeting multiple sectors of the food system and active collaboration among of a variety of stakeholders. The Ministry of Health, along with “Nicolae Testemitanu” State University of Medicine and Pharmacy and the WHO Country Office in the Republic of Moldova developed this EBP, supported by technical experts from WHO Regional Office for Europe, to be published under the guidance of the WHO European Evidence-informed Policy Network, to make available evidence-informed options for policy-makers to tackle the problem of reducing salt consumption in the Republic of Moldova. A working group convened by the Ministry of Health identified, selected, appraised and synthesized best available evidence on the problem; formulated the options for tackling it; and weighed up considerations in implementing each option. The seven options grouped across two approaches are: Approach 1 Structural population-level interventions, including (1.1) Food product reformulation; (1.2) Food labelling; (1.3) Food procurement policy in specific settings; (1.4) Restrictions on marketing to children; (1.5) Pricing interventions; and Approach 2 Population-level behaviour change interventions, including (2.1) Health education; and (2.2) Information campaigns.

Primary health care financing: policy options for the Republic of Moldova

The Republic of Moldova has a well-developed family medicine-centred primary health care (PHC) system. PHC system development has being supported by the strategic goals set out in the Strategy for the Development of Primary Health Care for 2010–2013. Although the strategy has not been updated, the Republic of Moldova continues to build on past success in moving towards a strong PHC-centred health system. This policy paper aims to describe the current challenges facing PHC financing in the Republic of Moldova and to present policy options to improve health outcomes and increase value for money in public spending, reflecting relevant international evidence and experience. Moldovan PHC financing has several strengths, including a relatively high level of public spending and a fairly generous PHC services package, which is available free at the point of use to the entire population. The country also has a relatively long experience of organizing the purchase of PHC services. Nevertheless, several challenges exist. To strengthen PHC financing, the Republic of Moldova could consider improving its PHC budgeting and contracting practices, refining the PHC services package, improving the payment design, and making outpatient prescription medicines more affordable. Beyond health financing, further efforts are needed to invest in the PHC workforce, improve digital data collection, and strengthen PHC governance.

Do catastrophic costs impact treatment outcomes in people with rifampicin-resistant tuberculosis in the Republic of Moldova?

The Republic of Moldova is among the 30 Rifampicin-Resistant and/or Multidrug-Resistant (RR/MDR) Tuberculosis (TB) high burden countries in the world. Despite free TB diagnostics and treatment, TB patients face substantial economic losses and this may impact overall treatment outcomes. We assessed if there is an association between TB-related catastrophic costs and TB treatment outcomes. We conducted a cohort study using data from patient records and a survey that quantified catastrophic costs among RR/MDR-TB affected households in the Republic of Moldova in 2016. We included adult patients (age ≥18 years) with RR/MDR-TB who had been in inpatient (intensive phase) or outpatient (continuous phase) treatment for at least 2 months. Unfavourable treatment outcome, such as failure, death or lost to follow-up, was the primary outcome variable. The definition of catastrophic TB-related costs followed the World Health Organisation (WHO) guidelines: costs due to TB ≥20% of annual household income. Log-binomial regression was used to assess association between the outcome and catastrophic TB-related costs adjusting for other socio-demographic, behavioural and clinical covariates.  In total 287 RR/MDR-TB patients (78% males, mean age 42 years) were included. Of them, 30% experienced catastrophic TB-related costs. Overall, one in five patients (21%) had unfavourable treatment outcome, such as treatment failure (5%), death (8%) or lost to follow-up (8%). The experience of catastrophic TB-related costs was not associated with unfavourable treatment outcome [adjusted relative risk (aRR)=0.88, 95% CI: 0.50-1.50]. Major factors independently associated with unfavourable TB treatment outcomes were poverty (aRR=2.07; 95% CI: 1.06-4.07), urban residence (aRR=1.99; 95% CI: 1.12-3.52) and positive HIV (Human Immunodeficiency Virus) status (aRR=2.61; 95% CI: 1.31-4.89). As a result, we failed to find an association between catastrophic costs and treatment outcomes of RR/MDR-TB patients in the Republic of Moldova. However, we found that patients from poor households and urban areas were twice more likely to achieve unfavourable TB treatment outcomes disregarding whether they experienced catastrophic costs or not. Also, TB/HIV patients and urban residents were identified as the most vulnerable groups with higher risk of unfavourable treatment outcome and TB-related costs.

Examining the foreign policy attitudes in Moldova.

This paper aims to examine the correlates of foreign policy attitudes in Moldova by a multilevel analysis, and to also reveal some characteristics of the Moldova's difficult geopolitical and economic context, such as the ethnical conflicts and poverty. A set of four foreign policy attitudes are explained upon individual- and regional level socio-economic and demographic correlates, of which poverty is the main focus, being represented here by several objective, subjective, uni- and multidimensional indicators. An indicator of deprivation is derived from a group of poverty indicators by the method Item Response Theory. Deprivation, subjective poverty, ethnicity and the Russian media influence are found to be associated with negative attitudes toward all foreign policies, while satisfaction with economic conditions in the country and a positive attitude toward refugees are both associated with positive attitudes toward all foreign policies.

Варианты политики в сфере возмещения стоимости лекарственных средств в Европе

Настоящий доклад содержит обзор и анализ различных вариантов политики, используемых в странах Европейского региона ВОЗ в сфере возмещения стоимости лекарственных средств. В рамках исследования применялись смешанные методы, в том числе сбор первичных данных с помощью вопросников, адресованных компетентным органам власти, входящим в Информационную сеть по ценообразованию и возмещению стоимости лекарственных средств (PPRI); обзор научной литературы; содержательные собеседования с представителями органов власти и исследовательского сообщества в отдельных странах, где проводились ситуационные исследования; а также межстрановой анализ реального финансового бремени для пациентов. В ходе исследования выяснилось, что в то время, как почти все страны обеспечивают полное возмещение стоимости лекарств в секторе стационарной медицинской помощи, пациентам в амбулаторном секторе может быть предложено вносить сооплату за возмещаемые лекарственные средства. Широко применяется сооплата, при которой пациенты возмещают определенную часть стоимости лекарств. Помимо этого, в некоторых странах осуществляется отпуск лекарств по льготным рецептам и/или применяются налоговые вычеты по расходам на медикаменты. В странах Европейского региона ВОЗ созданы механизмы для защиты определенных групп населения от чрезмерно высокой сооплаты за лекарства. Главными основаниями для снижения уровня сооплаты или освобождения от нее являются низкие доходы, определенные заболевания, инвалидность, а также пожилой возраст. Анализ реального финансового бремени показал, что сооплата может создавать существенную финансовую нагрузку для пациентов, особенно в странах с низким уровнем дохода. В докладе представлены некоторые принципиально важные меры по улучшению ценовой доступности лекарственных препаратов и защите населения от чрезмерно высокой сооплаты из собственных средств. К ним относятся четкая расстановка приоритетов, принятие решений на основе фактических данных, обеспечение транспарентности всех процессов, учет интересов уязвимых групп населения, использование менее дорогих лекарственных средств в случае их эффективности, проведение регулярных оценок, а также выработка мер политики с учетом стратегической концепции.

Economic evaluation protocol of a short, all-oral bedaquiline-containing regimen for the treatment of rifampicin-resistant tuberculosis from the STREAM trial.

INTRODUCTION: A December 2019 WHO rapid communication recommended the use of 9-month all-oral regimens for treating multidrug-resistant tuberculosis (MDR-TB). Besides the clinical benefits, they are thought to be less costly than the injectable-containing regimens, for both the patient and the health system. STREAM is the first randomised controlled trial with an economical evaluation to compare all-oral and injectable-containing 9-11-month MDR-TB treatment regimens. METHODS AND ANALYSIS: Health system costs of delivering a 9-month injectable-containing regimen and a 9-month all-oral bedaquiline-containing regimen will be collected in Ethiopia, India, Moldova and Uganda, using 'bottom-up' and 'top-down' costing approaches. Patient costs will be collected using questionnaires that have been developed based on the STOP-TB questionnaire. The primary objective of the study is to estimate the cost utility of the two regimens, from a health system perspective. Secondary objectives include estimating the cost utility from a societal perspective as well as evaluating the cost-effectiveness of the regimens, using both health system and societal perspectives. The effect measure for the cost-utility analysis will be the quality-adjusted life years (QALY), while the effect measure for the cost-effectiveness analysis will be the efficacy outcome from the clinical trial. ETHICS AND DISSEMINATION: The study has been evaluated and approved by the Ethics Advisory Group of the International Union Against Tuberculosis and Lung Disease and also approved by ethics committees in all participating countries. All participants have provided written informed consent. The results of the economic evaluation will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: ISRCTN18148631.

Taking steps towards deinstitutionalizing mental health care within a low and middle-income country: A cross-sectional study of service user needs in the Republic of Moldova.

AIM: The current research was conducted in the context of an ongoing reform of mental health services in the Republic of Moldova since 2014, where efforts have been devoted to creating community-based mental health services. This article presents a snapshot of the needs of mental health service users in the Republic of Moldova and helps to understand how and with which services their needs can be addressed. METHODS: This cross-sectional study compared the levels of needs (CANSAS scale), quality of life (EQ-5D 3L), mental health status (MINI for psychotic disorders) and functioning (WHO-DAS) among mental health service users in the psychiatric hospital in Chisinau, Moldova. All service users resided in districts where community mental health services were being developed. Correlations between quality of life, functioning and unmet need were explored. RESULTS: Of 83 participants, one third had a psychotic or a mood disorder. On average, participants reported needs in 9.41 domains (SD = 4.41), of which 4.29 were unmet (SD = 3.63). Most unmet needs related to intimacy and relation to others. The level of functioning and quality of life were reported. We found strong, negative associations between the number of unmet needs and level of functioning, as well as the quality of life. We also found that higher functioning levels were positively associated with higher quality of life. CONCLUSION: There were a high number of unmet needs among this inpatient population, particularly social needs and service-related needs. A continuum of inpatient and outpatient care and individual treatment plans can help address the different needs of different patients. Individual treatment plans for patients and the choice of the appropriate treatment for patients could be guided by an assessment of service users' (unmet) needs of care and level of functioning.

Can people afford to pay for health care? New evidence on financial protection in the Republic of Moldova

This review is part of a series of country-based studies generating new evidence on financial protection in European health systems. Financial protection is central to universal health coverage and a core dimension of health system performance.

Assessments of sexual, reproductive, maternal, newborn, child and adolescent health in the context of universal health coverage in six countries in the WHO European Region: a synthesis of findings from the country reports

Achieving universal health coverage (UHC) – meaning that everyone, everywhere can access essential high-quality health services without facing financial hardship – is a key target of the Sustainable Development Goals. Sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) is at the core of the UHC agenda and is among the 16 essential health services that WHO uses as indicators of the level and equity of coverage in countries. In this context, WHO undertook an assessment of SRMNCAH in six countries (Albania, Azerbaijan, Kazakhstan, Kyrgyzstan, the Republic of Moldova and Romania) in the WHO European Region. This report summarizes health system barriers to UHC for SRMNCAH, including from a gender and rights perspective. By pointing to three major challenges and making related policy recommendations, it highlights specific issues around SRMNCAH. The challenges and recommendations cut across different aspects of the health systems and involve other sectors. The problems encountered are thus likely to affect the system beyond the scope of this assessment, making it a marker of the overall health system functions. The recommendations are intended to contribute to efforts in accelerating progress towards UHC.

Assessment of sexual, reproductive, maternal, newborn, child and adolescent health in the context of universal health coverage in the Republic of Moldova

Achieving universal health coverage (UHC) – meaning that everyone, everywhere can access essential high-quality health services without facing financial hardship – is a key target of the Sustainable Development Goals. Sexual, reproductive, maternal, newborn child and adolescent health (SRMNCAH) is at the core of the UHC agenda and is among the 16 essential health services that WHO uses as indicators of the level and equity of coverage in countries. In this context, WHO undertook an assessment of SRMNCAH in the Republic of Moldova. This report examines which SRMNCAH services are included in policies concerning UHC in the specific country context; assesses the extent to which the services are available to the people for whom they are intended, and at what cost; identifies potential health system barriers to the provision of SRMNCAH services, using a tracer methodology and equity lens; and identifies priority areas for action. A set of policy recommendations provides the basis for policy changes and implementation arrangements for better SRMNCAH services and outcomes in the context of UHC.