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Equipping Moldova to Respond to Infectious Disease Outbreaks
Victor Neagu, Communications Associate in the Moldova
World Bank Office, offers this story.
                                                                   Photo Gallery
When avian flu outbreaks in 2005 hit Central and Eastern
Europe hard, governments, healthcare and veterinary
institutions went on high alert. Countries rallied efforts to
design contingency plans and boost their emergency services
to respond to imminent epidemics.

A series of outbreaks near Moldova's western border with
Romania and Ukraine that resulted in the culling of thousands
of birds showed how possible, and how risky, it would be for
avian flu to cross borders. It underscored the need for sound      Related Links
and well-planned interventions to address the spread of
infection.                                                         The World Bank in Moldova
                                                                   Avian Influenza Project
Moldova's laboratory equipment was outdated. Its medical
                                                                   Centrul National de Sanatate Publica
and veterinary personnel had little training and experience        (National Center for Public Health)
detecting the virus, and the public was poorly aware of risk
                                                                   Centrul Republican de Diagnostica
associated with avian flu and other infectious diseases.
                                                                   Veterinara (National Center for Veterinary
What's more, there was little compensation for farmers whose       Diagnosis)
chickens had to be culled. All of this presented a big
                                                                   Ministerul Sanatatii al Republicii
challenge to an effective government response.                     Moldov a (Moldovan Ministry of Health)

"Outbreaks of avian influenza accelerated at the end of 2005       Ministerul Agriculturii si Industriei
and continued into 2006. Neighboring countries were affected       Alimentare al Republicii Moldova
                                                                   (Moldovan Ministry of Agriculture and Food
and in these circumstances Moldova was in stringent need to        Industry)
build up its capacities to respond to possible outbreaks," said
Anatol Gobjila, Task Team Leader and Senior Operations
Officer at the World Bank.

At the request of the Government of Moldova, the World Bank stepped in to coordinate a multi-donor
effort to strengthen Moldova's capacity to respond and mitigate outbreaks of avian influenza and other
infections, and increase the country's preparedness for possible pandemics.

The task was a tough one, as it had to address human, institutional and financing constraints. The first
challenge was to increase the country's ability to diagnose viruses in people and animals. This was done
through a full-fledged rehabilitation of Moldova's main human and animal virology labs. A second step
was to build surveillance, response and treatment capacity across the entire spectrum of healthcare and
veterinary institutions in charge of infectious disease response.

Adoption of IT-based, real-time tools for human epidemiological surveillance has meant that health
authorities now have accurate data on the scale and extent of the spread of dangerous viruses.
Improvements in the ability to monitor the health of poultry make it easier and more effective to localize
and contain outbreaks.

But the financial costs of a government response are measured by the extent to which financing and
compensation capacity can support a system under stress. Moldova's traditional dependence on
agriculture and the high level of subsistence farming raised greater challenges for farmers and
authorities. Livelihoods in rural Moldova had to be maintained.

The World Bank joined with the government to establish streamlined and transparent compensation
mechanisms to assist farmers whose chickens had to be culled. Regional simulation exercises carried
out under real life scenarios polished the quality and quickness of interventions and increased capacity
all the way down to the local level.

                         On the human health side, the renovation of an intensive care unit within the
                         premises of the National Infectious Diseases Hospital has meant that every
                        Moldovan infected with a deadly strain of influenza virus now has a better
                        chance of survival. Indeed, this was tested in 2009 when Moldova experienced
                        hundreds of cases of swine flu. Had it not been for improved diagnosis and
                        treatment of infected patients, supported by the project, the number of fatalities
                        would have exceeded by far the registered figures.

Ion Bahnarel             The project's lasting effect is that it has also managed to change people's
                         attitudes and behavior when it comes to prevention of infectious diseases.
Extensive communication and public awareness campaigns targeted all age groups and stimulated a
high level of social awareness.

"Moldova's improvements have built a shield around the country. Moldova today has the best indicators
in the region, including the Balkans, when it comes to responding to infectious disease outbreaks," said
Ion Bahnarel, General Director, National Center of Public Health.