Recommendation Report Moldova III

1. Introduction
   Objective
2. General
3. Children's Hospital I
4. Outpatient Clinic Medical School
5. St. Michael Hospital (Municipal Clinical Spitalul Saint Arhanghel Mihail)
6. Children's Hospital II
7. Trinity Hospital (Spitalul Clinic Municipal Sfanta Treime)
8. Summary
9. Recommendations

Children's Hospital I: Spitalul Clinic Municipal Pentru Copii nr 1

Director: Dr. Serghei st Simco
Address: str. Serghei Lazo 7, Chisinau MD-2004
Tel: 373-22-243123
Fax: 373-22-241693
(int. access code not included)

The Children's Hospital I is a clinical hospital without operation facilities for children from 1 month up to approximately 14 years. There is another separate hospital for 14 to 18 year old adolescents. The hospital is specialized in lung diseases. It exists from five departments with a total of 120 beds:

1. children up to 1 year with breathing problems (bronchitis etc.)
2. children up to 1 year with gastro-enterology diseases without infections, microbiological disorders
3. children from 1 up to 14 years with respiratory problems
4. general pediatric department which has been established since January 2005
5. children from outside Chisinau, suffering from serious sicknesses, but also patients who have become seriously sick during their stay

The hospital is a local hospital with training capabilities for the medical school of Chisinau.

The hospital is financed through the medical insurance system in Moldova. There is a contract for an annual admission of 3,840 patients at a fee of 95 euro per patient. The contract states that the patient only leaves the hospital when declared fully healthy. If the patient should be referred to another hospital or the parents should decide to take the patient home, the insurance pays nothing.

Previous year (2004), the contract was largely exceeded so a full inspection was carried out by the insurer if the hospital had met the conditions. It was determined that 100 cases did not meet the conditions and the costs for those cases were entirely for the hospital's own account. Furthermore, there were some budget difficulties: 300 more approved cases than calculated. Overall, the insurer was not unhappy with the end results but failed to pay for the 300 cases. For the record: we're talking about pure medical costs (no facilitary or other costs).

The length of admission has been calculated at 8 days. In reality however, the average admission time is around 10 days.

In the hospital, there are 31 doctors, 101 medical assistants (mainly part-time), and other personnel like kitchen, transports, nurses, bookkeeping and technicians. In total 141 effective fte's.

Next to the treatment department, there's also a number of other departments like:

1. a micro-biological, clinical and bio-chemical laboratory
2. a pharmacy for the production of glucose solutions: it's too expansive to buy it from commercial corporations
3. a physiotherapy department for admitted patients
4. a radiology department
5. an ECG and EEG department
6. an echograph department

The building was constructed in 1934 and is in a deplorable state. Little or no maintenance has been done throughout the years due to a lack of money. Recently, the ICU (4 beds) has been renovated. Oxygen- and compressed air systems have been installed but are out of order. Respiration of infants can only be done with an Ambu Bag Valve Mask. There is a total of 3 incubators which aren't hooked up to the medical gasses system.

The medical equipment is in a bad state. There is an adult respiration system on the resuscitation department but it is of no use to children. It is not being used at all!

The ward on the second floor has been renovated. There are 6 patient rooms which all look nice and well-taken care of. It's too bad though, there's nothing in these rooms especially for children like paintings/drawings.

Both floors are a good example of what you can do with some money. In 2003, the hospital was supported by an Italian organization, which helped with the modernization of the electrics. Too bad, all electrics have been fitted straight on the ceilings and walls; it would have been better if it all was done IN the walls and ceilings. Now, all the electrics have to be removed first before any other renovating.

The roof, which has been renovated some years ago, is of moderate quality. Leakages occur regularly. The hospital plans to replace the (flat) roof with a V-shaped construction with tiles. This way, extra room is created as well.

The hospital has set the following priorities:

1. renovation of the roof: calculated at 2 million euro
2. list of equipment needs (add. 1)
3. office furniture, tables and beds

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