Снижение потребления соли и уменьшение связанных с ним неблагоприятных последствий для здоровья населения в Республике Молдова. Аналитический обзор EVIPNet для формирования политики, Номер 9

Во всем мире высокий уровень потребления соли является одним из ведущих алиментарно-зависимых факторов риска смерти и сокращения лет жизни с поправкой на нетрудоспособность, а также одним из ведущих факторов риска гипертонии, сердечно-сосудистых заболеваний, инсульта, рака желудка и заболеваний почек. Задачи сокращения потребления соли и улучшения пищевых привычек требуют внедрения комплексной политики, направленной на различные сектора продовольственной инфраструктуры, и активного сотрудничества различных заинтересованных сторон. Настоящий АОФП был разработан Министерством здравоохранения совместно с Государственным университетом медицины и фармации имени Николая Тестемицану и страновым офисом ВОЗ в Республике Молдова, при поддержке технических экспертов Европейского регионального бюро ВОЗ. Обзор публикуется в рамках деятельности Европейской сети ВОЗ по вопросам использования научных данных при формировании политики с целью предоставления лицам, формирующим политику, научно обоснованных вариантов дальнейших действий для решения проблемы сокращения потребления соли в Республике Молдова. Рабочей группой при Министерстве здравоохранения были выявлены, отобраны, оценены и обобщены наилучшие имеющиеся фактические данные по данной проблеме, разработаны варианты ее решения и сформулированы соображения по реализации каждого варианта. В обзоре представлены семь вариантов политики, сгруппированных по двум элементам: Элемент 1. Структурные вмешательства на уровне населения: (1.1) Изменение состава продуктов питания; (1.2) Этикетирование продуктов питания; (1.3) Политика закупок продуктов питания в конкретных учреждениях и условиях; (1.4) Ограничение маркетинга для детей; (1.5) Вмешательства в области ценообразования; и Элемент 2. Мероприятия по изменению поведения на уровне населения: (2.1) Медико-санитарное просвещение; и (2.2) Информационные кампании.

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.

Assessing the capacity of ministries of health to use research in decision-making: conceptual framework and tool.

BACKGROUND: The capacity to demand and use research is critical for governments if they are to develop policies that are informed by evidence. Existing tools designed to assess how government officials use evidence in decision-making have significant limitations for low- and middle-income countries (LMICs); they are rarely tested in LMICs and focus only on individual capacity. This paper introduces an instrument that was developed to assess Ministry of Health (MoH) capacity to demand and use research evidence for decision-making, which was tested for reliability and validity in eight LMICs (Bangladesh, Fiji, India, Lebanon, Moldova, Pakistan, South Africa, Zambia). METHODS: Instrument development was based on a new conceptual framework that addresses individual, organisational and systems capacities, and items were drawn from existing instruments and a literature review. After initial item development and pre-testing to address face validity and item phrasing, the instrument was reduced to 54 items for further validation and item reduction. In-country study teams interviewed a systematic sample of 203 MoH officials. Exploratory factor analysis was used in addition to standard reliability and validity measures to further assess the items. RESULTS: Thirty items divided between two factors representing organisational and individual capacity constructs were identified. South Africa and Zambia demonstrated the highest level of organisational capacity to use research, whereas Pakistan and Bangladesh were the lowest two. In contrast, individual capacity was highest in Pakistan, followed by South Africa, whereas Bangladesh and Lebanon were the lowest. CONCLUSION: The framework and related instrument represent a new opportunity for MoHs to identify ways to understand and improve capacities to incorporate research evidence in decision-making, as well as to provide a basis for tracking change.

Better noncommunicable disease outcomes challenges and opportunities for health systems, n°4: Republic of Moldova Country Assessment

Like many countries, the Republic of Moldova faces a growing NCD burden. This report examines the challengesand opportunities faced in the Republic of Moldova in order to accelerate improvement in NCD outcomes. Inrecent years, the Government of the Republic of Moldova has implemented a number of important reforms thathave increased effi ciency and equity in resource allocation, and have provided incentives to improve servicedelivery, including for NCDs. Challenges include further scale up and implementation of new initiatives inthe area of NCD risk factor management. Major gains can be made through relatively low-cost public healthand primary health care interventions. These include, among others, strengthening tobacco, alcohol, anddietary polices and their implementation, improving detection and treatment of risk factors for cardiovasculardisease, including hypertension and hyperlipidaemia, strengthening clinical protocols, and improving rationalprescribing practice. This report examines in depth the health system challenges and opportunities for improvedprevention and control of NCDs and concludes with policy recommendations for the consideration of policymakers in the Republic of Moldova.

Better noncommunicable disease outcomes: challenges and opportunities for health systems: Republic of Moldova: country assessment

Like many countries, the Republic of Moldova faces a growing NCD burden. This report examines the challenges and opportunities faced in the Republic of Moldova in order to accelerate improvement in NCD outcomes. In recent years, the Government of the Republic of Moldova has implemented a number of important reforms that have increased efficiency and equity in resource allocation, and have provided incentives to improve service delivery, including for NCDs. Challenges include further scale up and implementation of new initiatives in the area of NCD risk factor management. Major gains can be made through relatively low-cost public health and primary health care interventions. These include, among others, strengthening tobacco, alcohol, and dietary polices and their implementation, improving detection and treatment of risk factors for cardiovascular disease, including hypertension and hyperlipidaemia, strengthening clinical protocols, and improving rational prescribing practice. This report examines in depth the health system challenges and opportunities for improved prevention and control of NCDs and concludes with policy recommendations for the consideration of policy makers in the Republic of Moldova.