A system for licensing of medical workers will be established in Moldova. This means that every specialist in the field of healthcare will be required to have a license. It is one of the plans of the Ministry, implemented with the support of the European Union. Adapting Moldovan legislation to EU standards is a priority for the authorities in Chisinau, who are currently reporting progress in the reform agenda. Secretary of State Svetlana Nicolaescu discussed the challenges of the healthcare system and the measures taken to overcome these problems, including those related to medical personnel and the quality of services, in an interview with IPN News Agency.
How can Moldova reach the European level in medicine? The legal framework – fundamentally to be adapted to EU standards.
The health systems of the European Union member countries are regulated by European legislation and aim at ensuring patient safety, using electronic health records, as well as high standards for hospital infrastructure. Moldova must harmonize its national legislation with the EU acquis, and the question is: what measures are already being implemented to reach the level we aspire to and which is required of us in order to ultimately become part of the European family?
This is a very important and priority subject for the Ministry of Health. Moreover, the major actions and activities of the ministry during this period are focused on aligning with the European acquis. It is important to note that, in the European Union, the organization of health systems falls under the responsibility of the member states. Although certain aspects are regulated at the European level – especially consumer protection, safety, freedom of movement of products and services – the actual provision of medical services remains the responsibility of each country.
The European Union provides support in this regard. The community legislation mainly targets areas such as medicines, medical devices, management of epidemiological risks, and particularly, the prevention and control of cross-border transmission of threats to public health. The field of e-health is also regulated, especially from the perspective of data security. In this case, the EU issues recommendations, and the member states decide how to develop their own systems.
There are also European policies in the field of public health, promoted by member states, which do not constitute mandatory standards, but rather recommendations – the so-called “soft acquis”. However, the Republic of Moldova aligns with these policies wherever possible.
Overall, efforts are focused on controlling communicable and non-communicable diseases, with an emphasis on oncology, mental health, and rare diseases. All these areas were recently discussed in Brussels, during the meeting dedicated to Chapter 28 – “Health and Consumer Protection” – where the delegation of the Republic of Moldova, together with the experts of the European Commission, presented the current level of transposition of European legislation, as well as plans for the next decade regarding its alignment and implementation.
How do experts from the European Union evaluate the progress of the Republic of Moldova in the field of healthcare?
The official appreciation is expected to come through the screening report, which we are awaiting in the upcoming period. However, from the discussions had so far, we can say that we are advanced in several areas regarding the transposition of European legislation. These advances have been possible, in part, due to the fact that the Republic of Moldova has been working since 2014 on aligning legislation, since the signing of the Association Agreement with the European Union, which contains a chapter dedicated to public health.
In these past 10 years, major efforts have been made to harmonize the legislation, but the processes have considerably accelerated after obtaining the status of a candidate country. Today, we are very advanced in areas such as blood transfusion and organ transplantation. Essentially, the national legislation is aligned with the current European regulations. Of course, we must keep pace with future developments – for example, in 2024 the EU adopted new regulations that will come into effect starting from 2027, and Moldova will have to adopt them at the appropriate time.
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There are also fields where we are at an intermediate stage, such as that of drugs and medical devices. Although many European provisions are already reflected in national legislation, they require substantial revisions. In this regard, the Government recently approved a new bill, which is now under parliamentary debate. A law dedicated to medical devices is also being prepared, in order to bring the legal framework up to European standards. At the same time, it should be noted that certain aspects are missing in the national legislation, such as the right of citizens to cross-border medical services – a principle that allows an EU citizen to benefit from treatment in any other member state, with the costs being covered by the system in the home country.
Is the state obliged to offer these services?
Yes, in some cases, a portion of the costs is indeed reimbursed. We are talking about systems in which, for now, Moldova does not participate. We are in an intense process, in collaboration with the National Medical Insurance Company, to regulate the way of accessing these services and the interaction between the entities in our health system and those in the member states of the European Union.
Strict rules for quality medical services
Mrs. Nicolaescu, European integration is not just a bureaucratic process. It must bring concrete benefits for citizens. In the European Union, patients have access to quality medical services, innovative treatments and medicines, and high-level medical practices. Unfortunately, in our country there are still unfortunate cases. What would work in Moldova to ensure safe and quality medical practice for patients? I am referring, for example, to the fact that social networks are full of “specialists” – psychologists without a license, nutritionists with only a few short courses, or “cosmetic doctors” with no medical studies. Such situations can lead to serious cases, which we often hear about in the media. What solutions do you see to regulate this problem and protect the patient?
The aspects you referred to need to be clearly delineated from the start. We have clear applicable regulations – the law regarding the practice of the medical profession. It is stipulated who has the right to provide medical services. The cases you mentioned actually pertain to the violation of the law, not the lack of legislation. In other words, the law exists, but it is not respected.
The law looks good on paper, but unfortunately, it is not enforced. We still see numerous individuals presenting themselves as specialists, without having any studies in the field.
Here, the employer’s responsibility also comes into play. Any institution that employs medical staff must, without fail, verify whether the individual has the necessary studies and qualifications. The law is strictly applied to medical professions – meaning only those specialists officially recognized. Those you mentioned, such as unlicensed nutritionists or people offering “consultation”, but lacking medical training, cannot approach a patient, cannot recommend investigations or treatments. Employers must ensure not only that the staff is qualified at the time of hiring, but also that they maintain their qualifications throughout their professional practice.
News in medicine: a license will be mandatory for all specialists
Unfortunately, in Moldova, we cannot rely solely on the good judgement of doctors, specialists, or patients. We need clear and even strict rules, for the existing laws to be truly respected.
What we aim for, and is already included in the plans of the Ministry of Health, is the establishment of a licensing system for medical workers, a system that does not currently exist in the Republic of Moldova. This would imply that, mandatorily, before entering the medical profession, any graduate, any specialist, should obtain a license issued by a competent authority.
The license should be kept active, and in the event that, during the practice of the profession, the doctor does not accumulate a minimum number of professional development hours or commits disciplinary or legal infractions, the licensing authority will have the right to intervene. It may even withdraw the license, which would mean that the respective medical worker will no longer have the right to practice, either temporarily or permanently.
Is there such an initiative in process?
Yes, this initiative is indeed planned and we aim to implement it with the support of the European Union. It is included in the reform agenda that will be backed by the support program announced by the European Union. Within this package, one of the priorities set for the health sector is indeed the creation of the licensing system.
We all know that there is also the Psychologist Law, and in this field things seem to be moving. There is a plan to establish a college of psychologists, similar to the one in Romania, which would offer the licenses that you mentioned to psychologists and psychotherapists working in the field.
It is crucial that, regardless of the specialty – whether we are talking about clinical psychologists or psychologists involved in solving health issues – there should be a competent authority that grants the right to practice this profession and monitors the correctness of its exercise.
Based on regulated studies and qualifications…
Exactly. Whether we’re talking about a professional college – the models vary from one country to another – what we propose, through the licensing system mentioned earlier, is to establish a model adapted to the specifics of the health system in the Republic of Moldova. It won’t necessarily be a College of Physicians, but it is essential to have such a mechanism and a clearly designated authority to regulate that particular segment.
EU Financing and Assistance for Moldova’s Healthcare System
I would like to ask you about cooperation projects with the European Union. We know that the EU’s support for candidate countries, including in the healthcare sector, is consistent – from technical assistance to funding for hospital infrastructure, such as the case with the European Investment Bank. What financing and assistance projects have already been accessed by the Republic of Moldova and what is planned for the immediate future?
Regarding technical assistance, it is essential – no country has joined the European Union without benefiting from EU support. Assistance is provided through various programs. The Republic of Moldova, including the health system, also benefits from this support, both in the development of new projects and regulations, as well as in aligning with European standards.
There are also programs focused on infrastructure. For example, through the “EU4Moldova” program, Moldova benefited from 3 million euros, resources utilized during and after the pandemic. The project focused on strengthening the resilience of the health system, on preparing for and responding to public health emergencies, as well as on training doctors, especially in the context of the refugee crisis. Interventions were also made on hospital safety, in preventing nosocomial infections, and on combating antimicrobial resistance, a major issue for both Moldova and the EU.
Regarding investments, there are already clear priorities: the construction of two regional hospitals – in Balti and Cahul – supported by funds from the Council of Europe Development Bank and the European Investment Bank. These funds are largely provided in the form of loans, but also include grant components. The goal is to facilitate access for the population in the north and south of the country to high-performance medical services. High-performance equipment, such as MRI, computed tomography or angiographs, have been purchased with European support, and now allow for early diagnosis of pathologies and efficient intervention.
Recently, the Reform and Growth Mechanism, which includes the health sector, has been approved. It aims at developing the primary healthcare infrastructure – renovating relevant institutions – as well as expanding oncological services, with a focus on modern laboratories and early diagnosis. Projects for emergency medicine are also a priority, with the aim of strengthening the national infrastructure in this vital segment.
Digital medical system, for streamlining and quality care for patients
The European Union strongly promotes the digitalization of healthcare systems through the use of electronic health records, telemedicine, and artificial intelligence in diagnosis. Programs such as “You for Digital” support the development of digital infrastructure in partner states, including Moldova. What impact would these programs have in Moldova? And are patients and doctors here prepared to work with these programs, understand them correctly, and access them.
This field has a major priority when it comes to digitization. In the healthcare system, it’s true that the informational systems currently in use are very outdated and do not meet the needs of specialists, patients, or medical workers. These priorities are reflected in the healthcare strategy developed by the Ministry of Health with the support of experts from the World Health Organization. Our efforts in the coming period will be focused on modernizing the infrastructure, including the development of a digital infrastructure and informational systems that will truly enable the provision of services in electronic format and the digitalization of the system.
It would also contribute to reducing bureaucracy and to more time for doctors, which they can allocate to patients.
It’s important for processes to be oriented in this direction. Unfortunately, current systems often hinder the work of doctors instead of simplifying it. This is because they are not fast enough, do not offer necessary functionalities, and cannot handle the large volume of data required for modern medical practices.
That’s why it’s essential for these systems to be fundamentally modernized and reorganized. The Republic of Moldova has already made significant progress in digitization. We have systems under development that will allow interoperability – that is, access to medical data already stored in other institutions, which will greatly streamline the medical and administrative process.
It would be important to have an effective communication and interaction between all medical institutions and, potentially, the possibility for them to collaborate with institutions from villages?
Yes, and not just medical institutions. We’re talking about certain data that is stored, for example, at the level of the Public Services Agency or the National Health Insurance Company. There is a need for system interoperability, which allows for easy use by both medical workers and patients. But this also implies the development of digital skills.
How prepared are our specialists to operate with sophisticated systems?
It is important that these systems be user-friendly. From the outset, we aim to develop platforms that do not represent an additional burden for medical workers. At the same time, this process does not exclude the development of specific skills, and this aspect is included in the National Health Strategy. A particular emphasis will be placed on the development of digital skills. Patients also need to feel comfortable using these systems. It is essential that they be intuitive, both for users and for medical staff.
Medical staffing shortage: the situation in counties and measures taken by the government
It is good to have accessible and modern infrastructure, but it is equally important to have enough doctors, as we also face difficulties in this area. In Moldova there is a significant shortage of medical personnel. According to Minister Ala Nemerenco, the deficit is around 700 doctors. Additionally, there is an unequal distribution of doctors. For example, there is not a single forensic doctor in 18 districts. These problems are not unique to Moldova – many European Union member states have faced similar situations. The difference is that they have managed to address them through investments in medical education and salary increases. What is the situation currently? Is there any strategy or policy in place to motivate doctors to work in districts, not just in Chisinau where things are stable, while districts are strongly affected by the deficit we mentioned.
It is true that human resources assurance is a challenge for the health system, and not just for the Republic of Moldova. It is a phenomenon that all health systems in the region are facing. It is important to understand that the policies promoted by the European Union have, in fact, not always had a favorable impact, especially when we talk about the new member states of the European Union. One of the fundamental rights guaranteed in the EU is the mobility of the workforce – including medical workers – which means that a health professional from any member state has the right, and is even encouraged, to move and work in another country of the Union, under advantageous conditions.
Yes, to migrate from one country to another, depending on the offered salary…
Indeed, and that’s why it’s very important to anticipate these effects and take measures to mitigate them. It is essential to adopt policies that will lessen the negative impact of this phenomenon. That’s what we set out to do as well.
But in the case of the Republic of Moldova, it’s not just about the migration of medical personnel from one country to another. We are talking about a different phenomenon: many people with medical studies completely give up their profession and choose to leave for another country to work, for example, in the cleaning field, because the pay is better there. It’s a different type of migration, but I understand what you meant to say.
I want to tell you that the phenomenon of giving up medical studies is still very limited. Most young people who choose this path continue to work in the health field. However, when we talk about retaining medical staff in rural areas, concrete initiatives have been launched.
In the year 2024, we have reviewed and increased the single allowance offered to young specialists who, after graduation, choose to practice in rural areas. Starting next year, this allowance will no longer be 120,000 lei, but 250,000 lei, paid in two installments.
Another significant initiative of the Ministry of Health is the reimbursement of round-trip transportation costs for medical workers commuting between their homes and workplaces. This measure was approved at the end of 2023, and in the first three months of the current year, over 3,000 medical workers from more than 100 institutions have been registered in this program.
It is a significant facility, intended to contribute to the retention of medical staff within the system. At the same time, creating suitable working conditions – through the renovation and equipping of hospitals – plays an essential role in motivating both young people and other specialists to stay within the system.
Another measure intended to aid in retaining medical workers is professional development: experience exchange programs, internships and fellowships in other countries. These contribute to the enhancement of skills, but with the retention of specialists in the country.