Support to the Reform of Mental Health Services in Moldova (MENSANA)


Since 2014, Switzerland supports Moldova in the implementation of a systemic reform of mental health (MH) services, aiming at promoting proximity and patient-centred community-based provision, reducing stigma against people with mental health problems and limiting expensive and unnecessary hospitalizations. The third four-year (exit) phase will focus on shifting the project’s key functions to local stakeholders / institutions, in order to guarantee the continuity on the gains achieved so far beyond Swiss support.

Country/region Topic Period Budget
Moldova
Health
Mental health & well-being
Primary health care
Health systems strengthening
01.10.2022 - 30.06.2026
CHF  5’844’500
Background Despite the ongoing reform, MH patients in Moldova have substantially greater care needs and lower quality of life compared to the overall European average. This is mainly due to a medicalized MH care approach and the difficulty to implement community-based care models in the face of a chronically underresourced healthcare and welfare system. The highly volatile political context, system-wide constraints, coupled with the consequences of Covid-19 pandemic and the spillover effects of the war in neighboring Ukraine hindered the progress. Anxiety and depressive disorders among the population, continuously on the rise in the face of a still largely unripe care system, undermine coping mechanisms and further fuel an already intense outmigration (incl. within the health sector). The pandemic-related restrictions and repurposing of resources have disrupted treatment and contributed to modifying promising patients’ healthcare seeking behavior, as well as to the increase in social isolation of stigmatized and marginalized groups.
Objectives People in Moldova have access to suitable supports, resources and services to experience and maintain mental health and mental well-being.
Target groups

Ministries of Health, of Labour and Social Protection, of Education and of Interior; health and non-health sector professionals providing MH services; National Health Insurance Company and other public funds targeting patients with MH issues; local public authorities; National Employment Agency; relevant civil society organizations / community based organizations (incl. various professional associations and constituency-based organizations).

Final beneficiaries are people with existing MH issues and the general population living in Moldova.

Medium-term outcomes

Outcome 1 (service delivery level): The existing network of MH services is able to strengthen and further develop its service provision without support and intermediation of MENSANA.

Outcome 2 (societal level): Population (incl. professionals in various sectors, service users and general population) have increased awareness, literacy and tolerance, promote MH, and support people with MH issues in their recovery and inclusion.

Results

Expected results:  

  • The MH system has the knowledge, skills, tools, processes and mechanisms in place to enable all key actors to deliver MH care according to the model of care
  • Evidence and insights are available to inform decision-making and policy processes in MH
  • The content for MH promotion and prevention programs is developed for different settings (workplaces, care settings, schools) and targeting different age groups (children, youth, adults, older adults)
  • Local communities are supported and equipped to be more accepting of people with MH issues and use opportunities for social inclusion and participation of people with MH issues
  • Models are developed and tested for supportive employment of people with MH problems


Results from previous phases:  

The community-based model of MH care was piloted in phase 1 and, in phase 2, it was rolled out to cover the whole country with a network of 40 Community Mental Healthcare Centres (CMHCs). CMHCs operate within primary health care (PHC) facilities and are contracted by the National Health Insurance Company (NHIC). Currently, NHIC funding for the functioning costs of the CMHCs network amounts to ~ CHF 1.6 million / year. The regulatory framework on the work and roles of MH professionals and CMHCs is in place. Relevant health professionals have been trained to work with people suffering from MH problems. And an interdisciplinary coordination mechanism has been initiated and includes relevant non-health sector services.

The project has supported the shift from centralised and stigmatising hospital care to better coordinated, community-based and patient-centred services, which resulted in rationalization of resources, while making the available services more fit to users’ needs. The unnecessary and preventable hospitalizations of people with MH disorders decreased by ~37%, while the demand for alternative care at the community level among patients, general population, as well as concerned professionals increased.

During the pandemic, the project has become the go-to source for MH information and expertise in the country, which clearly speaks about the high relevance and timeliness of the intervention, both during stable times, and during times of crisis.


Directorate/federal office responsible SDC
Project partners Contract partner
International or foreign NGO
Foreign state institution
  • Central State of South East
  • Other international or foreign NGO North
  • Trimbos Institute (Netherlands)


Coordination with other projects and actors Synergies with other Swiss projects in health, but also in local governance and economic development & employment domains will be fostered, especially on topics related to accessibility and affordability of various health and non-health sector services (esp. social protection/welfare, education and employment), participation, social inclusion/ ”leave no one behind”. Collaboration with humanitarian interventions in the area of MH in emergencies, work with refugees and displaced populations.
Budget Current phase Swiss budget CHF    5’844’500 Swiss disbursement to date CHF    5’230’608 Total project since first phase Swiss budget CHF   8’508’821 Budget inclusive project partner CHF   14’353’321
Project phases Phase 3 01.10.2022 - 30.06.2026   (Current phase) Phase 2 01.08.2018 - 30.09.2022   (Completed) Phase 1 15.05.2013 - 31.07.2018   (Completed)