Project:  Implementing Participatory Social Accountability for Better Health
Country: Moldova
Sector: Health
Executing Agency: Center for Health Policies and Studies (PAS Center)
Grant Amount: US$ 730,000
Closing Date: September, 2019


Moldova spends significantly more on health than comparable countries, however health outcomes are less than expected given the level of health expenditures, pointing to the need to improve the effectiveness of health expenditures in delivering results for health. The Ministry of Health approved the Roadmap Accelerating health reforms through investment policies, aiming at improving financial protection and equity in accessing quality health care services. Hospitals are at the center of the reform because of many reasons. However, the reform remains incomplete as the activity of public hospitals is generally not based on good governance principles nor provides for implementation of contemporary evidence-based practices and performance standards. The public policies and management practices in hospitals at large do not account for the needs and preferences of patients, who do not have appropriate access to relevant information regarding their care in the hospital.

Primary care centers (PHC) are also at the center of reform. PHCs have been strengthened through the creation of family medicine. Family medicine providers are paid on a capitation basis to provide primary care for a defined population and act as gate keepers to specialist care. Citizens have free access to primary care regardless of insurance status. However, existing formula for performance bonuses in primary care requires revision and routine reporting is hampered by the fragmentation of information technology (IT) systems in primary health facilities and the lack of proper monitoring systems.

Generally, providers’ accountability for results remains limited across all levels. Effective mechanisms are not in place to systematically hold providers accountable for the quality and efficiency of services.


PAS Center, an organization with extensive experience in health policy development, evaluation, advocacy, capacity building and health system reform, has been granted a GPSA award to contribute to enhance citizens’ voice by informing users of health services in select rayons about the performance of hospitals and primary care clinics within a certain radius of their residence so that they can use this information to make better decisions with respect to their choice of health care facility and the quality of care they demand within facilities, and establishing mechanisms for participatory monitoring, thus contributing to better informed policy design and improved service delivery.

This will be achieved by implementing four components geared towards: 1) Promoting citizen monitoring of hospital performance; 2) Strengthening performance based incentive program in family medicine through social audits of primary healthcare institutions; 3) Creating an enabling environment for informed public dialogue in health; and 4) Facilitating knowledge and learning to enhance effectiveness of social accountability interventions.

Expected Results

The GPSA grant will help PAS Center attain the following results:

  1. Hospital Performance Report Card (HPRC), as a tool to improve information flow about hospital performance and to leverage participatory monitoring and evaluation, will be implemented in 55 countrywide public hospitals;
  2. HPRC results will be disseminated as part Policy experiment on citizen engagement in 9 selected raions (treatment);
  3.  A patient exit survey will be conducted in 18 rayons as part of a policy experiment exercise on citizens’ engagement in 9 treatment and 9 control rayons;
  4. PHC-PIA tool - a social audit of PHC institutions activity in the context of performance-based incentive program will be rolled out in targeted sample of 72 primary health care institutions;
  5. Health Barometer Surveys (HBS) at national level will be conducted and findings disseminated and used for relevant policy dialogue on health reforms;
  6. A transparency platform for disseminating and using health systems’ data and project results, for feedback collection, promotion and monitoring of social accountability tools in healthcare will be developed;
  7. Government institutions including the Ministry of Health, the National Health Insurance Company, as well as hospitals and Primary healthcare institutions, will benefit from new sources of data, information and citizen feedback;
  8. Results of social accountability tools will serve as guidance to leverage participatory monitoring and evaluation and provide stronger evidence-based support to the reforms promoted by the MoH.

Lessons Learned

The grant is at its early stages and lessons will be added as they become available. However, the design of this grant benefits from accumulated experience and lessons learned by PAS Center in implementing various social accountability tools. The interventions will be based good practices, constructive approaches, collaboration and relationship with health authorities and public health services providers established under previous and current projects that will be leveraged to ensure success of GPSA project.