Year 2020 put whole health system on trial in real time

Summarizing results in healthcare with public health expert Ala Tocarciuc within IPN’s series “2020 in review: good and bad points”.

Ala Tocarciuc considers it was a year that put the whole health system on trial in real time. It was clear in March already that a new, highly contagious disease came and this would affect a lot of people. The health system of Moldova was already outworn in many respects, in terms of limited structural capacities, of human resources and, surely, of the applied technologies. The pandemic revealed all these problems and exposed the shortcomings existing in the system, one by one, on all the medical assistance segments.

Analyzing the developments this year, Ala Tocarciuc said that from structural viewpoint, no major changes occurred in the health system. All the components of the system are in place. No new hospitals were erected. No hospital was closed. The elements are in place, practically in the same technical condition and with the same human resources. From functional viewpoint, no major changes were witnessed at a number of levels. Among the first medical assistance segments that yielded was the primary healthcare sector. The family doctors, being overburdened due to the infected patients, coped with difficulty with patients with chronic and acute illnesses. The specialized medicine segment was close to annulling the planned operations and to keep the figure on the pulse of what’s urgent only. Asked how she authorities have managed the pandemic, the expert said any crisis creates a lot of uncertainty. The current pandemic crisis generated a lot of uncertainty not only in the health system, but also in the social, community and economic sectors. “If you start to criticize harshly in such conditions, you have only one result – you extend uncertainty. I, during over 15 years, have specialized in change and crisis management. There were multiple small-scale crises, including a pandemic one, during my personal experience. I learned very well a life lesson – in crisis situations, you do your best to turn uncertainty into certainty. You don’t criticize and don’t add uncertainty, but do the opposite. Piece by piece, you turn unknowns into knowns,” stated Ala Tocarciuc.

She noted that it’s clear there wasn’t a plan of medical emergencies that should have been activated at the start of the pandemic. There were no reserves of special protective medical equipment and the work algorithms were unknown. Time was needed to reset the health system for responding to the pandemic. Normally, this resetting takes place by maintaining full functionality, but it didn’t happen so. The health system in Moldova responded to the pandemic, being reset to an activity regime reduced at multiple levels.

We are obliged to help doctors cope with pandemic

“The health system remains very rigid to changes. At the same time, the personnel suffer from emotional and physical exhaustion and there are reservations here. The medical personnel are the main resource now.  I would supplement these resources with community resources. I suggested back in May creating groups of patients who were already cured of COVID-19 in each community so as to help and guide those who go through infection and rehabilitation. This is a very widely used practice in the case of persons with many chronic diseases. These groups are very useful in the primary healthcare sector. I haven’t seen something like this in Moldova yet. But it would be a very good and functional flow of human resources and practically no additional costs are incurred,” stated Ala Tocarciuc.

She believes the doctor-patient relations now started to be treated differently. “We are all now simply obliged to help the doctors cope with the pandemic. We are also obliged to learn some lessons,” stated the expert. According to her, health is the most important thing of humans. “If these resources are lost, the work capacity is reduced and the quality of life is reduced. We should listen to the advice and recommendations of doctors and protect us from this very difficult and unpredictable disease. A pandemic of such a scale happens once in 100 years. What will our children say in 10 or 20 years? Haven’t you been able to combine forces and fight a pandemic? Did a lot of people die for the simple reason that the doctors’ advice wasn’t followed? This is how the future generations will judge us. This is how I see the situation now,” said Ala Tocarciuc.

She noted that regardless of the year, any policy document on healthcare should be written for the people and for their benefit. The access to any healthy service, for any citizen, regardless of the social status and earnings, should be ensured nonstop, to full extent and at a high quality. “We are champions in writing policies and less good in implementing them. The achievement of particular points of national consensus is absent, especially on strategic dimensions. We have medical elite, but these elite didn’t reach a consensus at least at internal level, which is in the medical and academic spheres. This was evident during the pandemic. We didn’t reach a national consensus on testing, on medical protocols, on multiple simple decisions in the management of this crisis and efficient use of all the resources in the country,” stated the expert. According to her, this is actually the stage of acknowledgement of the own limitations. Any person has internal limitations. If these are acknowledged, they can be overcome. If they are not observed and someone hides behind them as behind screens, we lose human lives, multiply uncertainty and deepen the crisis. This is what we have now. But this stage can be overcome by discussions, understandings that would be reflected in decisions.”

We will live in pandemic at least until December 31, 2022

Ala Tocarciuc said the algorithms for fighting the pandemic should be reviewed. The flows of patients with COVID-19 should be taken under control at all levels and the health system should be reopened to patients with chronic diseases. There should be assessed the possible pandemic development scenarios until the end of 2022, by including the possible COVID-19 vaccines.

“The pandemic will not end on December 31, 2020. We will live in a pandemic at least until December 31, 2022 and we need to strengthen forces and resources at all levels. But we first of all need a national consensus in this regard,” stated Ala Tocarciuc.


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