The Republic of Moldova is working towards achieving UHC: making quality health services accessible to the whole population without financial hardship. But how will Moldova measure progress towards UHC? A new mobile application developed by WHO helps countries to collect and analyse data on medicine prices and availability. This information enables policymakers to identify strategies to improve availability and reduce prices and to assess the impact of health reforms. Ensuring affordable access to medicines and health products for everyone is central to UHC. One of the biggest barriers to affordable access to medicines and health products is that people have to pay for them out-of-pocket. New evidence from the WHO Regional Office for Europe shows how out-of-pocket payments lead to financial hardship for over 15% of households in Moldova – especially the poorest households – and that financial hardship is largely driven by out-of-pocket payments for outpatient medicines. This level of financial hardship reflects Moldova’s heavy reliance on out-of-pocket payments to finance the health system – out-of-pocket payments accounted for 46% of current spending on health in 2016 – as well as coverage policy and other factors. 

Financial hardship and unmet need are particularly problematic for people in rural areas. A WHO study on financial protection in the Republic of Moldova finds that over 70% of households with catastrophic health spending live in rural areas. Rural populations also face geographical barriers to access due to a lack of services in their locality. "When I or my family is ill, I have to go to the district center and buy medicines in a pharmacy. Sometimes, I get a special prescription from family doctor and then I pay very little for medicines. But usually, I do not have this prescription and I have to cover the full cost of medicines. As I am the only working member of my family, the cost of medication is a high burden for our household.” Said Alexandru Zaporojan, farmer, Zaicana village, Criuleni district. 

New WHO application

A new WHO application makes monitoring the availability and price of medicines easier and cheaper. Moldova is among the first countries in the European Region to pilot this new mobile application – MedMon – designed by WHO to help countries monitor the availability and price of medicines in the context of the SDGs (specifically, SDG 3.b.3). Previously, paper-based data collection was a cumbersome process. The new MedMon app makes data collection and analysis easier, faster, and significantly less expensive. In Moldova, it has reduced data collection time by up to 1.5 hours per pharmacy, reduced the number of data collectors from 20 to 4 and allowed for access to data in real time, improving the data validation process. "The medicines policy evaluation process takes on another dimension when the data is available in this way, allowing faster decision-making and opportunities for focused interventions.” Said Gheorghe Gorceag, head of Medicines and Medical Devices unit, Ministry of Health, Labor and Social Protection. 

With this new tool, four data collectors were able to survey 60 settings in community, private and public pharmacies and primary health care centers, in rural and urban areas, in two weeks. They collected data on the price and availability of 50 medicines with a total of 297 brand names. The medicines were selected based on national and international priorities through the SDG core tracer list. "I am happy that I could take part in the pilot project and contribute to the better monitoring of medicines availability and prices in my country. This is very important from the perspective of patients’ access to treatment and essential medicines. The mobile tool was user friendly and allowed us to collect a lot of data in a short time.” Said Cristina Tverdohleb, Data Collector. The data collected is now under analysis by local experts with support from all levels of WHO: Country Office, Regional Office and Head Quarters. Findings will provide evidence for a national report on access to essential medicines in the Republic of Moldova, which will evaluate the impact of policy interventions in pricing and reimbursement implemented from 2011-2018 and will inform further policy development in this area. Open configuration options Image/s The MedMon app. Photo: WHO/Igor Vrabie. As Moldova works hard to make progress towards UHC, this new data collection and analysis tool increases efficiency. The information MedMon generates enables policymakers to identify strategies to improve medicine availability and reduce prices, to assess the impact of health reforms and – alongside indicators of financial protection and unmet need – to demonstrate progress towards UHC. "It was very exciting to work on this project. I found this process beneficial for the national system. I hope that Moldovan health authorities will continue to use this tool for regular price monitoring at different levels of the health system.” Said Dr Zinaida Bezverhni, Health systems officer, WHO Country Office, Republic of Moldova.