When the Republic of Moldova was part of the Union of Soviet Socialist Republics and during the ten years following the collapse of the Union, the focus of health service provision in country was on delivering a defined set of - mainly - curative health services to the population as a whole .
Young people were required to seek care from doctors providing health services to all segments of the population in their catchment areas. However, some specialised services were available - health units in educational institutions and adolescent health offices in some polyclinics. The main focus of these units was to screen young people for health problems and provide curative care .
The tumultuous societal changes that occurred in the 1990s led to a deterioration of the health status of all segments of the population. Young people were especially affected. Deaths from injuries, trauma (including self-inflicted trauma) and intoxications; and levels of STI including HIV, early pregnancy and mental difficulties and disorders all rose alarmingly .
The health system was not geared to respond to the rapidly changing needs and problems of young people. Even as importantly, young people were not willing to seek care because they did not trust or like it. The Ministry of Health of the Republic of Moldova (MOH) realized the pressing need to reform the health system to make it respond more effectively and sensitively to young people .
With the support of the United Nations Children’s Fund, the MOH opened three pilot youth-friendly health centres (YFHC). The first two clinics were set up in Chisinau, the capital city in 2001 and 2002. The third one was set up in 2003 in Stefan Voda. All three clinics were housed in existing community-based health facilities. Some medical and support staff from the health facilities they were housed in, were seconded to them on a full-time or part- time basis. The clinics provided health services in addition to – and complementary to – the standard set of health services being provided in the community-based health facilities. They included preventive sexual and reproductive health services, and responses to adolescent-specific physical problems such as acne and psychological ones such as body-image concerns. They guaranteed privacy and confidentiality, and provided nonjudgemental care in a comforting environment. In 2005, the MOH set up nine more YFHC across the country, with support from the International Development Agency, the World Bank, and the Swiss Development Cooperation Agency .
No formal assessment of the work of the YFHCs was carried out. But from the reports that both the funding bodies and the MOH received, they had a positive impression of their work. Further, through discussions with development partners and participation in regional meetings, they were aware that similar efforts were under way in other countries of the region, and were broadly supportive of them.
The MOH recognized that there were four challenges in building on the initial gains of the 12 YFHC and developing a nationwide initiative. First, apart from a small circle of people directly associated with the 12 YFHC, most health workers in the country were not clear about what youth friendly health service provision meant. Second, even though anecdotal reports suggested that the 12 YFHCs were successful in attracting young people and responding to their needs, there was no objective assessment of this. Third, the 12 YFHC had at best a modest coverage. This meant that a large proportion of young people in the country had no access to these services. Finally, the MOH was concerned about the sustainability of the 12 YFHCs, given that donor funding was for a limited period.
The problem of promising pilot projects dying a natural death when the funding comes to an end is a real one, in many countries and in many fields of public health including adolescent health [3, 4].