According to World Health Organisation’s principles, an important function of the health care system is to meet population’s expectations and needs, which are to be approached in a fair and reasonable manner, considering universal human rights to life and health. Thus, the right to health is the right of every person to have access to and use services of institutions, commodities and the needed conditions to reach an optimal health condition. The laws in force set the responsibility for people’s health care, prosperity and security on State’s shoulders, while the public health care system takes social responsibility towards general health condition and the best use of resources, in order to achieve the universal sanitation targets. Ensuring the right to health necessarily includes ensuring access, fairness, quality and continuity of health care for every citizen.

We note that the term patient refers not only to sick persons, but also to healthy persons who need or use health care services, enjoying, thus, the right to health care – a fundamental human right. In this context, the right to health is, nowadays, analysed from the perspective of international approaches to patients’ rights, stipulated in the Declaration on the Promotion of Patients Rights in Europe, authorised by the WHO European Consultation on the Rights of Patients, from 1994. This Declaration represents a set of principles for the promotion and implementation of patients’ rights in European states, members of WHO, and stipulates the following fundamental rights of the patient:

• observing human rights in health care;
• right to information;
• right to consent;
• right to confidentiality;
• right to care and treatment.

A more detailed description of patients’ rights is provided in the European Charter of Patients’ Rights, developed in 2002 by the “Active Citizenship Network”, and approved and recognized in 2005 by the European Economic and Social Committee. The Charter sets out the following 14 rights to: preventive measures; access; correct information; informed consent; free choice; privacy and confidentiality; respect of patients’ time; compliance with quality standards; safety; innovation; avoiding unnecessary suffering and pain; customized treatment; complain; compensation.

The Law on Patient’s Rights and Responsibilities No 263 of 27 October 2005 and the Law on Health Care No 411 of 13 March 1995 provide a detailed description of patients’ rights and responsibilities, their safeguarding and protection in the Republic of Moldova.

In spite of an ample national-level regulatory framework that covers and protects human rights, during the past years, the Ombudsperson's Office (previously called Centre for Human Rights) warned, more than once, about some shortcomings and irregularities identified in the system. Their existence and improper solving were and continue to be a danger to the proper enjoyment by our citizens’ of the right to health care.

The problems generating alarming violations of the right to health care, with a major impact on the access to, quality and continuity of health care services are found predominantly in ensuring fair coverage with funds from the compulsory health care insurance; in the procedure of reviewing complaints and medical errors; in conducting accreditation procedure and accreditation of doctors and pharmacists; in respecting the patients’ right to private life by medical staff; in ensuring efficiency of the existent control system and prevention of tuberculosis, in insufficient measures of protection of reproductive and sexual health. At the same time, the health care system is deeply marked by the imminent danger of corruption – a phenomenon caused by poverty and lack of some efficient anti-corruption tools.

According to the statistics provided by the Ombudsperson's Office – it received, in 2015, 37 notifications alleging problems in the field of health care. Some of these notifications were beyond Ombudsperson’s scope of competence, others could not prove the allegations, but most of them were about real problems that the citizens have to deal with when they go to health care facilities.

The analysis of the complaints regarding the health care provided during 2015, shows the following fundamental rights of the patients are violated frequently: limited access to health care services, due to irresponsible attitude of the medical staff; lack of skilled medical staff, particularly in rural settlements; limited access to emergency services in rural settlements.

The quality standards are not met, some of the complainants mentioned the poor quality of health care services, the failure to ensure enough quality and safety of health care services; outdated infrastructure of health care facilities and unsatisfactory sanitary, hygienic and technical condition of health care facilities; poor technical and material endowment.

A particular focus should be put on the terrible endowment of emergency vehicles, which are lacking the strict minimum, for example: cricothyrotomy catheter set, O₂ fixed system, continuous positive airway pressure mask, “autopulse” resuscitation device. As a result, the Ombudsperson found cases when the lack of vital equipment needed for emergency health care services was the reason why patients passed away or their health condition worsened, which violated, thus, the fundamental right to respect patient’s time[1], i.e. patient’s right to optimal time needed for the required intervention to be performed.

It was found that the right to safety was violated in the context of the health care services provided in some health care facilities, as well as that outdated equipment which was not subject to a metrological and standardization check was used, which endangers, severely and irreversibly, patients’ life and health.

Given the applications filed with the Ombudsperson, the complainants often allege the violation of the right to informed choice and of the one to consent as regards the treatment and procedures applied by the medical staff to patients; the failure of the medical staff to provide clear information on patients’ health condition and undergone treatment, and the discharge from health care facility without being sure of full recovery. The complainants expressed their dissatisfaction with the fact that they were administered treatments without being asked for their informed consent, without being informed about the side effects and other potential complications after these treatments. Thereafter, the patients suffered for the decision that doctors took, as their rights to autonomy and to choice, respectively, were severely violated.

Some complaints allege disrespectful attitude of the medical staff towards patients; that the medical staff does not show full availability, fairness and respect for the patient. Such attitude makes one feel unease, and sometimes even humiliated.  In some cases such attitude causes mental and physical harm, as the right to a respectful treatment, avoiding suffering and any inhuman treatment, was violated.

During the analysis of the complaints and visits made to some Family Doctors Offices, subdivisions of Emergency Health Care, hospitals across the country, it was found that the identified violations were the result of both the human factor and of the poor organization at management level of health care facilities, bad management, which was worsened not only by poor endowment, but also by gaps in the organization of the health system.

Shortcomings and violations of internal rules and regulations were found at all the stages of the health care system that all those who seek health care services go through: family doctors from Health Care Centers, health care teams from Emergency Health Care Stations, medical staff from district and republican hospitals. The competent authorities were repeatedly notified by the Ombudsperson about the failure of health care facilities’ managers and medical staff to know and/or respect the documents issued by the Ministry of Health (orders, decisions etc.) which set health care workers’ tactic of intervention/operation in different situations.

It was often found that there is bad collaboration between some authorities and representatives of the health care system. The answers from different health care facilities, received during the analysis of complaints received by the Ombudsperson, are often perfunctory or evasive, inane. The Ombudsperson's Office found there is a low level of responsiveness to the recommendations made by the Ombudsperson, particularly, regarding the reviewed cases.

In this context, the Ombudsperson intends to establish and develop an efficient collaboration with the authorities from the health care system: The National Council for Evaluation and Accreditation in Health, authorities of emergency service, and so on. The awareness of these structures must be raised in order to increase control and monitoring of the quality of services provided in health facilities.

It is absolutely necessary to develop, as a matter of urgency, legal mechanisms and procedures, that would satisfy patients’ request to obtain compensations when poor quality services provided by health care workers caused particular damages to patients.  If the health care facility is responsible for the quality of health care services, it must be obliged to answer to the dissatisfaction of the patient, who is the beneficiary of the provided services.

Protection and enjoyment of the right to health care must be a priority of the government. In spite of the economic crisis, all funds and technical equipment necessary to ensure the health of the population must be identified and allocated. It is only if these prerequisites are fulfilled that a strong, healthy and development-and-progress-oriented society can be created.

RECOMMENDATIONS:

1. For the Ministry of Health to create an independent Medical Expertise Committee that would examine patients’ requests or complaints;

 2. Improve the process of operative management of available intervention resources, and to operatively involve, in all the cases, additional staff resources, means of transportation, equipment, medical devices and medicines;

3. Ensure effective collaboration between Emergency Medical Stations and the Primary Health Care and Hospital Services, in providing operative emergency health care services, including in exceptional situations;

4. Periodically assess the extent to which the staff of public health care facilities fulfil their job duties, according to the job description and internal regulations;

Inform the subordinate medical staff about the Orders issued by the Ministry of Health;

5. Organise ongoing trainings of doctors, medical assistants and auxiliary staff, in the field of health care, in compliance with the requirements in force.

6. Strengthen and unify the training of medical staff and health care workers, considering the observance of patients’ rights.