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The Court of Accounts evaluated the implementation performance of the National Cancer Control Program

  • 20.12.2022
  • 868

The measures taken by the authorities responsible for reducing cancer mortality among the population of the Republic of Moldova have not been effective.

This is the conclusion of the Court of Accounts of the Republic of Moldova (CCRM), presented today, December 20, during the public meeting to review the performance audit report "Do the actions related to the specific objectives of the National Cancer Control Program, carried out in the period 2017-2022 (I semester) by the responsible authorities, contribute to achieving the expected results?".

Cancer is a major public health problem both globally and nationally, representing the main cause of death. The high burden of cancer in the Republic of Moldova is determined by the high presence of risk factors such as: smoking, alcohol consumption, unhealthy diet, limited physical activity, etc., which lead to a large part of cancer cases. In this context, was approved the first National Cancer Control Program (NCCP) for the years 2016-2025, with the implementation of the Action Plan of the 1st stage covering the period of 2016-2021. The purpose of the Program is to reduce the burden of disease on society in general and on the individual in particular.

The purpose of the audit was to assess the performance of the implementation of the Program's Action Plan and the impact of controlling the burden of cancer through its prevention and control, as well as ensuring access to quality, patient-centered services. The evaluation of the performance was carried out especially through the prism of the element of effectiveness, in the context of the evaluation of the degree of achievement of the objectives of the Program and the achievement of the expected results. These circumstances derive from the specifics of establishing the objectives of the Program and the actions that were to be implemented with the aim of reducing the burden of cancer and ensuring access to quality diagnostic services and effective treatment. Thus, the way to achieve three specific objectives from the NCCP were selected and evaluated, namely:

  • Ensuring the access of at least 80% of cancer patients to quality services for diagnosis, treatment and continuous care until the year 2025
  • The development of palliative and rehabilitation services and ensuring the access of cancer patients to these services
  • Improving and ensuring the operation of the Cancer Registry according to the recommendations of the International Agency for Research on Cancer

The audit was primarily carried out at the PHI Oncological Institute, the Ministry of Health and the National Medical Insurance Company. Also, samples were collected from the Center for Centralized Public Procurement in Health, the Nicolae Testemițanu State University of Medicine and Pharmacy, the entities at the level of primary medical care: PHI TMA Buiucani, 4 district/municipal medical institutions: CFD Balti, CH Balti, HC Cahul, RH Cahul, "Hospice Angelus Moldova" Foundation, as well as from 36 public health centers, 5 TMA and six district hospitals (Ialoveni, Anenii Noi, Căușeni, Călărași, Ungheni, Strășeni).

Examining the results of the audit, the Court of Accounts came to the conclusion that the measures taken by the authorities responsible for reducing cancer mortality among the population of the Republic of Moldova were not effective. The evolution towards achieving the objectives of the Action Plan of the National Cancer Control Program is a slow one, emerging from the situation found when evaluating the three specific objectives of the NCCP.

During the audited period in the years 2017-2022 (I semester), the parties involved carried out a series of actions for the purpose of implementing the NCCP, which were reported annually through data analysis and elucidation of the aspects achieved to achieve the objectives of the Program. For the years 2021-2025, the second stage of the action plan regarding the implementation of the NCCP was not approved and, respectively, was not evaluated and reported by the entities responsible for the evolution and implementation of the actions in 2021.

The Court of Accounts certifies that the institutions involved in the process of realizing the Program and the Action Plan did not have processes in place to ensure the efficient and effective fulfillment of the attributions, objectives and monitoring indicators, a situation expressed by:

  • ineffective planning and non-identification of financial means for financing the actions of the Program, which conditioned the non-fulfillment of the established objectives;
  • the insufficiency of communication regarding the monitoring, evaluation and reporting of result indicators between relevant institutions, which determined the non-adjustment of the necessary regulatory framework, the non-approval of stage II of the NCCP, etc.;
  • the advisory board is non-functional and has not contributed to the development of the NCCP;
  • the failure to achieve the expected level of some actions established in the NCCP, as a result of the insufficiency of the allocated financial means and the non-identification of their funding sources, led to: failure to provide or partially provide the needs of devices and equipment for the diagnosis and treatment of cancer patients; not ensuring the creation of reference centers; failure to provide feasibility studies on iodine treatment and bone marrow transplantation;
  • non-regulation of palliative care services and the National Cancer Registry;
  • the need to adjust the National Clinical Protocols, the provision of palliative and rehabilitation services;
  • the decrease in the number of beds in the premises of the PHI Oncological Institute, which influenced the increase in the waiting period of the population diagnosed with cancer, etc.

The situations found were determined, in particular, by the insufficiency of financial means to carry out the actions established in the NCCP, the non-adjustment of the regulatory framework to the legal norms, the fluctuation or lack of human resources and the low interaction between the parties involved, etc.

In order to remedy the shortcomings and problems found, the Court of Accounts submitted a series of recommendations, which aim to:

  • elimination of identified shortcomings and improvement of the scope and processes subject to audit;
  • strengthening the institutional framework, in order to ensure constructive interaction between the responsible authorities involved;
  • increasing the performance of actions in order to achieve specific cancer control objectives and result indicators through the implementation of the National Cancer Control Program, etc.
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