Court of Accounts
Republic of Moldova
During the meeting held on the 30th of January this year, The Court of Accounts has examined the Report on performance audit of the National Program on combating the viral hepatitis B, C and D.
The aim of the audit mission was to evaluate the implementation of the National Program on combating the viral hepatitis B, C and D during 2017-2021 and its effects on the health of the patients. Also the audit mission aimed to evaluate the commitment of the responsible entities and how efficient and effective was their involvement.
The viral hepatitis B, C and D are infections that are transmitted by blood or other human fluids, as a result of unsafe medical and paramedical procedures or through unsecure injections. The viral hepatitis are the most common and persistent infection diseases.
The National Program on combating the viral hepatitis for 2017-2021 is the forth national program that was approved by the Government of the Republic of Moldova in May 2017.
The audit mission encompassed the entities and systemic and complex processes within all the levels existing, by collecting evidence from: the Ministry of Health, Labor and Social Protection (MHLSP), the National Public Health Agency (NPHA), the Public Procurement Centralized in Healthcare Center, the National Medical Assurance Company (NMAC), the Medico-Sanitary Public Institution (MSPI) Infectious Diseases Clinical Hospital “Toma Ciorba”, 2 MSPI in Chisinau, 19 regional medical institutions and other involved entities.
As a result of evaluating the implementation of the mentioned Program, the audit mission stated that the medical institutions involved have carried out the necessary actions in order to achieve the estimated indicators. Nevertheless, there were discovered some systemic problems and difficulties that have determined only the partial accomplishment of the desired results.
The failure to achieve the objectives set by the Program was related to the insufficiency of financial resources that were planned and allocated. When approving the National Program there were allocated over 271,1 mil.lei with a budgetary deficit of 18,7 mil.lei because of the lack of financial resources.
For the implementation of the National Program during 2017-2019 there were allocated 101,8 mil.lei and 54,6 mil.lei were used only for the treatment of the patients suffering of viral hepatitis. The public funds with a value of 10,6 mil.lei that were not used in 2018 have caused the failure to achieve certain objectives of the National Program.
In this context, it should be mentioned that, the audit mission did not have exact data of the number of patients that suffer of viral hepatitis, because the National Register of the people suffering of hepatitis does not exist. This attribution was delegated to the MHLSP and NPHA. The lack of achieving of this objective of the program has made difficult the initiation of the antiviral treatments, as well as the evaluation, monitoring and reporting of data.
One of the objectives of the National Program of combating the viral hepatitis is to assure the antiviral treatment for the patients. During the audited term 18665 patients were registered for treatment.
The process of registering a person infected with hepatitis for treatment is a very complicated one, because it takes a lot of time and involves a lot of institutions and responsible people. Subsequently, analyzing the phases of addressing, diagnosing, accepting, approval, prescription and releasing the medicine for the antiviral treatment the audit mission discovered that the patients have to wait 14 or up to 311 days.
The public medico-sanitary institutions were obliged to present every trimester or when it was requested, a report to the Specialized Committee. The Report included information about the results of the antiviral treatment: the number of patients that receive the treatment, the number of cured patients and the dynamic of their general condition, the quantity of the medicine used and the stocks that remained, a.m. Nevertheless, the audit mission has stated that, in this regard, there is no Report of summoning up the monitoring of the antiviral treatment.
In case if the Specialized Committee rejects the request of initiating a treatment, they do not have a template document that could be released, so the patient cannot be informed about the rejection. Such situations were discovered in 312 cases within the audited entities and the patients that were rejected did not know about their right to repeatedly address the request. This circumstances cause the worsening of the comorbidity in the country.
The audit mission has shown that within 216 records of patients 80 of them lacked the investigation that determines the genotype of hepatitis C, which depends on the geographic zones. Unfortunately, because of the massive migration of the population, in the Republic of Moldova there can be found all the genotypes of the viral hepatitis.
Also, within 6 medical institutions the patients were not fully assured with the necessary medicine and in some other cases the patients received a surplus of medicine. Subsequently, the mission discovered that the Infectious Diseases Clinical Hospital “Toma Ciorba” did not comply with the instructions of the MHLSP that contain the nominal lists of the persons that must receive the treatment.
Within 4 medical institutions, the data contained by the tax receipts did not correspond with the actual data regarding the medicine received by the public medico-sanitary institutions and the quantity of the medicine given to the patients. Subsequently, the bookkeeping of antiviral medicine has significant deficiencies.
The evaluation of the data written in the Register of the persons that have received antiviral treatment during 2017-2019 has shown that in 299 cases the treatment was discontinued, which has determined the inefficiency of the antiviral treatment and, subsequently, decreased the effect of the administration of the medicine.
The procurement process of the antiviral medicines did not assure the achievement of any of the objectives regarding economy, effectiveness and efficiency. So:
The lack of actions targeted at the specific and non-specific prophylaxis did not assure the achievement of the objectives set by the Program of reducing the incidence of viral hepatitis and might cause the infestation with the named virus.
Referring to the vaccination of the people that is included in the group of high infestation risk, the audit mission has revealed that during 2017 within the audited institution were vaccinated over 8931 people, but the overall calendar referred to the vaccinations was not fully respected and implemented.
During 2018 and 2019 (the 1st semester) the majority of the named institutions did not benefit of vaccines against the viral hepatitis B, because the vaccines were not procured due to the lack of financial resources within the Program. As a result, within 7 audited institutions, 4613 people that belong to the group of risk were not vaccinated, but the unities that received the vaccines, have used the ones delivered for the immunization of newborn babies instead.
The audit mission concluded that the National Program on combating the viral hepatitis does not have the necessary efficient and effective measures that could help achieve the specific established objectives. As a result the patients do not receive qualitative services, that could decrease the morbidity rate and minimize the socioeconomically consequences.
The existing systemic processes and mechanisms do not assure the expected achievement of the objectives within the Program and subsequently do not offer the necessary data regarding the real results in comparison with the established monitoring indicators. As a result the process of informing, screening and treating the patients is not fully functional.
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