EVALUAREASERVICIULUIDEASISTEN MEDICAL PRIMAR DIN

REPUBLICAMOLDOVAPRINPERSPECTIVAINTEGR RIISERVICIILORDE
S N TATEMINTAL NMEDICINAPRIMAR
Jana Chihai, Larisa Boderscova
Catedra de Psihiatrie, naroopsoo USMFNoTs n

Summary
Assessing Primary Healthcare Services in the Republic of Moldova
as to the integration of mental health services into PHC
Upon pops s s or ssn opn o n non.
Reforming and consolidation of the PHC is a distinct example of accomplishing Government
programs aiming at curbing inequities and improving the accessibility of health services. Mental
health disorders and somatic conditions are associated and cross-linked. Integration of mental
health services into PHC provides for a comprehensive treatment of patients, catering to the
mental health needs of people with physical disorders, as well to the physical needs of people
with mental disorders. Integration of mental health services into PHC facilitates the access of
people to quality health care services. Whenever mental health is embedded in PHC, mental
srs r osr o pn, ons rsn, pon nr n no
interfering with daily activities of the beneficiaries. The article contains analysis of primary
healthcare services in Moldova and proposed how to integrate mental health services at the
primary care level.

Rezumat
Mn nr s n pop nr-o sr n s o on oor pnr
or r or r n n. Rorr onsor ssn prr
rprn n p sn rr proror rnn ndreptate spre
rr n or sporr s sror . Pro s n
n i cele somatice sunt legate. Mul on sr pro , n .
Inrr sror s n n n ssn prr sr rr onor nr-o
nr os ,rnnnos n n prsonorr r,pr
no s n prsonor r r n. Assn prr
pnr s n n n e s. An n s n n s nr n
asisten prr , on po s sr s n n prop
casele lor, men nn s or prn n ile lor de zi cu zi.
Aro on n n sr n prr n Rp Moo s propn
onrrsrors n nnnprr.

Introducere
Anror ss oror s n or r r orn p orr
pror ssn sp n n n noor. n n 1978,
Conrn A-A (Ksn), rs n spr proor n prr.
Dr A-Ata a s s n ons rp o
rnsnrsponssrrsrp norororrsror
orspn or,nsrpnrnrsop. Asst m prmr constituie
ssn sn , r s nrs s pnr n n
on,sor prnop,prprorpn ,nospr
on rpos -pr (Alma-Ata, 1978). nonorDr
Alma-A30n,Assn M Prr osrnos osr-cheie
pnrns pn nn2000,S n pnrTo . Republica Moldova, de comun cu

615
 rs-ns rn,onrnn orprnp
Dr A-Ata.
Conrn Orn MonS n prnrorssors n
Ljubljana, Slovenia, 17-20 iunie 1996 la fel a accentuat rolul nn nrror
s n prr n nr prnpor o roror ssor s n
orrs n nrso .
Prsptr rS t MtMPrmr
Por r r n s r. Tr r n sn pronn n o
so .Er opor ssn prsonororsor,i produc
r onososn,r sonnss .Prome
s n n i cele somatice sunt legate. Mulonsr pro, i
n . Inrr sror s n n n ssn prr sr rr
onor nr-o nr os , rnn no s n n prsonor
r r , pr no s n prsonor r r n.
Ln rn pnr rr ps sn nor. n o r, s n
sn nr prn rror psihice, pe de o o parte, n r prson r
primesc tratament nrr,p pr.Assn prr srs n
n r p opr s . Assn prr pnr s n n
n e s. An n s n n s nr n ssn
prr ,onpossrs n n propsor,nnn
sorprn n ile lor de zi cu zi. Asisten prr
pnr s n n , sn, or on proor
s n ii mintale, precum i monitorizarea pe termen lung i de gestionare a persoanelor afectate.
Asisten prr pnrs n n proo rsprrproro.
Sror s n n r n ssn prr n sr i
srnr.Dsn,n rsn rrproro,rpos pr
nsppshiatrie. Asisten prr pnrs n n sosn
s .Srs n n nssn n snpnossor
spitalele de psihiatrie, pentru pacien,on i rn.nps,pacienii
osrnrsosornrrspnonp r.Assna
prr pnr s n n nr r n s n . Mor
prsonor r r nrn ssn prr rn,n spn
nsnorsrspnon.
StruturSruuAsst M Prmr
Reeaua de instituii medico-sanitare r or ssn prr
01.01.2012rrprn 5Aso MTror(AMT)nMnpCn ,
noponn ror12CnrMorF.
ConororCnrN onMnnnS n npn2012
prorRpMoo37CnrMorF60Cnr
S n ono. n srr n on r ns or prr n on
ono os s p r r Cnror s n , pros r
r s nnn2014(ornMSnr.861n10.11.2011prrpror
Prorrr Cnrors n ).

616
 Figura 1. SrrSrssn prr
Ins ssn prr rn sr prr r
pn nsrpspropr,n rr psonorprnpr r,
nrn s prson (sr s nsr ), ns n ns n
rn o-rr,ss snpnr. Ins
ssn prr ,nrnorr ornr,snproponn
a Nomenclatorulu ns or ssn prr , r s pro Mnsr
S n n o s. Sop prnp ns or ssn prr s
orrs n pop prnororronn inii de familie cu
nrprorr p srprnrorpop .
Rsursumsst m prmr
Asrrpop RpMoos 38,8%
comparativ cu Uniunea Europeana. As s n n or r
srornprr rnsrs n pop prn ,n sp,
prin povara maladiilor non-rnss: n rosre, diabet, tumori maligne etc.
N ror nrp s1877,rn r
pop pr s 1896 oor. Cr 15% n o n
Rp Moo sn M F. N r ssnor medicale de familie este
proprorror. Norornsn r
pn pr MF s 1500 pn . As p s sp n Orn Nr. 100 n
10.03.2008MnsrS n privire la Normativele de personal medical.
Sss n nprnsonrn rrsor
ror n s Erop, n: srr ror nnor n or ,
ns prnnsn rornrrsrpsornrn.
Dsrrorssnorn r snnor - n
617
rn s, n r pop pr MF s 2500, r n regiunea de nord
1900prson.CrnsMFsnrsr nCn ,nn r
prMFs1450oor.D o1500pn prMFsonsr
rponor ,nnornn rpsnrsr op rn
nor, nn onsn r n r . Conform
orMnsrS n pnrn rs srrns or
primare cu medici de familie, este necesar angajarea a circa 290 de medici de familie, ce
rprn ,sprp,prooproo rn ,pron ,USMF
NoTs n.Drrnnp ,nn60son e familie,
or25son sn nrr,sno12npnrspns
,on nnnspnsonnp r sor.
Exmpuprttrttrrs t mtm
prmr .
Ppnnrn ons prnrrs n nnnprr .
D p, n Arnn n nrr prr nos, rn
rr pn ilor cu tr r n sr. Pn n n rn
or n on or. Psr i speciali s n n snt disponibili
pnrnonsprrr.Unnronrrror
nrr opnr n sr o nsrr pnr rn n
n nr prn n nrr prr . Pror rs rr
pentr nrr s n n prs prsonor r r pshice s r n n
on ors nr so.Dorpsrsnso osnrr
ns on s , osr sn i accesul la serviciile necesare este
n it. n Asr nr sr s n n n n prr pnr
prson n rs , n pr nr Innr Sn. M nrs sr
nrr prr pnr s n n , onsr sprn r
asistente onr,psoo,psrnrr.nBrsrs n
n osnrnnprr norSor.Prnnssn
primr rns n pnrto pn .Eor rn
pnrpn sso ornprnps n n sp,
rrnrs n .Cons ronsnnrsp
s n n prn n nrr prr . As o n n sr o
n nrr s n ii mn, r, sn, srte ca un instrument de
instruire sprr pnr prn n n prr . n Mr Brn ssn
prr pnr s n n s or pnr on ile dezavantajate din
Lonr.Opr nrrprr nsLonrooolitate inovatoare de a
npop iile defavorizate ds ,nsrn orprson r pos,r
s on nrr os prr n pnr s n n , identificarea
proi de comorb,srrs ,nnso .Prr ,
de asemenea, progressnnorrssn pso-so pnrpnn
rr. O rrs sn s n pr s r srns sr
onrs n ,prosrorni servicii ce se ocup pro
ocupror n ,on i juridice.

Rm rptrutrrsrrs ttmt um

Inrr sror s n n n n prr po n

primare:

numai prin pons n n ,rsnponr s n ,

r pn n p sr s n n n prr. Po pnr

618
minister r s n ssn prr pnr s n n , r s

Esnsrn no,nor pn,pnrs

conceptul fundamental de succes.

n oporn so , r prosonor n AMP. Ao s n

aspect important al inter rs n nnnprr .
Este necesar de sens onr po n on o s n ,
or ile, APL-r, n n nrr prr rror porn nr r
s n n.Es rprevalen r rorn,porpropro
s n n , r n nr, rpr o, n r r or pr n
sp psr, pr sn nor nrr prr n sn rne

Insrr n or n on ssn prr s nsr .

importante.

Formarea person n on ssn ei primare pe probleme d s n n s o

on sn pnrnrrs n ii mintale. Cu toate acestea, personalul din domeniul
medicinii primare, r spr spti din domeniul SM de-a lungul timpului.
Trs s ooorrsoonnrr,nrons ron
nrn snnoorrnrprosonnnrrprr n
s n n .
Srnssn prrnpros n n rs
r.Do,ssn prr n on nnnsrn
lor sunt clar stipulate. Deciziile cu privire la on sp opn r s
p onsr r p r i interesate din comunitate, evaluarea resurselor umane
spon i rsrsor nnr, pr i o an n pnor or i a punctelor
ssss n prnorrs n ii mintale.
Sp n s n n r s spon pnr or spor
prnor n ssn prr . Inrr sror s n n n
ssn prr ssn ,rrs nso sropnr,oponn
sp snr nrr r prson n ssn prr s s po
adresa pentru recomn r, sprn, i supervizie. Acest sprijin poate veni din partea centrelor
onrs n n sprn i.
Pn r s s n psorop sn n ssn
prr .Asnte psihorop ssn ial pentru integrarea cu succes a
s n n n ssn prr . As r ns n
psorops srnor rssn prr ,r
prin cabinetepsrsppsr..
E necesar de organizat un comitet sau coordonator de integrare a serviciilor de
s n nnnprr .Inrrs n nnssn prr
po oporn , nrsarea sau sr r , pro np po nn a,
uneori, rsrspr uirea reformei.
Resurse financiare n sn nsr. D ssn prr pnr
s n n srn ,rsrsnnr sunt nsrpnrsn n n
sr. Cosr orr r s opr, pr n spn pnr
prsonnnprr spns n n .

Bibliografie
1. Integrating Mental Health into primary care. Global perspective. WHO, WONCA,
2008
2. WHO. Atlas. Country Profiles on Mental Health Resources. World Health
Organization. 2011

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