National Center for Disaster Medicine

REPUBLIC OF MOLDOVA
HOSPITAL SAFETY
ASSESSMENT REPORT
Chisinau, 2010
Authors:

Mihail Pisla Head, National Center for Disaster Medicine, NCRCEM, MOH senior expert in
disaster medicine, MD
Silviu Domente Coordinator, Health Systems, WHO CO in the Republic of Moldova
Leonid Chetraru Deputy head, National Center for Disaster Medicine, NCRCEM
Radu Ostaficiuc Expert physician, National Center for Disaster Medicine, NCRCEM

Guidelines endorsed by the Expert Committee of the Ministry of Health

(Minutes #1 as of 26 March 2010)
Contents
I. Ensuring Hospital Safety – an imperative of time............................................................................. 4

II. “Republic of Moldova Hospital Safety Assessment” project........................................................7

III. “Hospital Safety Index” Assessment Tool.......................................................................................... 9

IV. Hospital Sector in the Republic of Moldova.................................................................................... 13

V. Republic of Moldova Hospital Safety Assessment Results.........................................................15

VI. Conclusions................................................................................................................................................. 32

VII. Strengthening Hospital Safety in the Republic of Moldova Recommendations.............34

Annexes:
Annex 1. Distribution of hospitals in Moldova by types & categories.................................36
Annex 2. National Hospital Safety Assessment Results...........................................................40
Annex 3. Municipal Hospital Safety Assessment Results........................................................40
Annex 4. District-level Hospital Safety Assessment Results..................................................41
Annex 5. Hospital safety scores (low, average, high) for safety parameters of
sections (structural safety, non-structural safety, functional capacity)
for national hospitals.......................................................................................................... 42
Annex 6. Hospital safety scores (low, average, high) for safety parameters of
sections (structural safety, non-structural safety, functional capacity)
for municipal hospitals...................................................................................................... 44
Annex 7. Hospital safety scores (low, average, high) for safety parameters of
sections (structural safety, non-structural safety, functional capacity)
for district-level hospitals................................................................................................. 45
Annex 8. Timeframe for the construction and commissioning of the main
hospital buildings in the Republic of Moldova.........................................................48
Annex 9. Power supply for hospitals in the Republic of Moldova.......................................51
Annex 10. Drinking water supply for hospitals in the Republic of Moldova......................54
Annex 11. Sewer status of hospitals in the Republic of Moldova...........................................56
Annex 12. Heating supply for hospitals in the Republic of Moldova.....................................58
 I.
Ensuring Hospital Safety –
an Imperative of Time

G iven the risks and threats that the society is facing today as a result of possible negative

impacts caused by natural or manmade disasters, there is a clear need to actuate all
efforts to prevent and mitigate such negative influences, while ensuring a timely and
efficient response, abatement of adverse consequences and getting back to business as usual as soon
as possible.
Under this circumstance, the health system in general, and the health care facilities in particular, are
playing a critical role to that end. By and large, the quality and volume of health care that the
population is provided with, and as such – the number of human lives subsequently saved – are
contingent on the system’s resilience to the impact, its capacity to keep up or recover in short times
and under complex conditions the functionality of its infrastructure and working abilities of its staff.
At the same time, natural disasters, catastrophes and large-scale breakdowns, which have been
plaguing the world’s population in recent decades, proved that the health care facilities in general and
hospitals in particular have been extremely vulnerable to the blows of disasters. One of the most
recent and telling examples is the earthquake that has stricken Haiti on 12 January 2010. The quake
has basically made all of the country’s 11 hospitals located in the capital city – Port-au-Prince –
inoperative, significantly limiting to the point of depriving the disaster stricken population of health
care at a time when it was most needed. Unfortunately, such examples are not exceptions to the rule.
The distress or disaster damages to the health care facilities are not merely a human tragedy, but
rather results in huge economic loss. Moreover, hospitals somehow represent one of the community’s
most valuable assets, in which most community members find their life emerging and oftentimes
death coming, and at times of hardship hospitals become a true cradle of hope and they build people’s
trust in a government’s ability to overcome deadlocks.
Therefore, protecting health care facilities in general and hospitals in particular from the impact of
disasters is both a must and an imperative as the means to save people’s life and is an economic
requirement, and also a political, social, moral, and psychological necessity.
The scale of disasters from recent times, as well as the growing frequency of those, could not leave
international community aside. Governments of countries, a number of international organizations
and facilities, have reviewed their approach to disaster-related issues and have channeled their efforts
towards curtailing the impact that those have been having on the society. To a great extent, the actions
advocated for in this area are boiling down to the protection of health care facilities and to ensuring
the safety of health care facilities during disasters, as duly proven by a number of events undertaken
over the last years, such as:
– Under the key objectives of the Hyogo Framework for Action 2000 – 2015: “Building the
resilience of nations and communities to disasters”, adopted on 22 January 2005 at the World
Conference on Disaster Reduction organized in the town of Kobe (Japan), there was a measure
outlined that was directly linked to the safety of health care facilities: “4.(ii)(e) Advocate for the
goal of “hospitals safe from disasters” by ensuring that all new hospitals are built with a level of
resilience that strengthens their capacity to remain functional in disaster situations and
 implement mitigation measures to reinforce existing health facilities, particularly those
providing primary health care.”;
– The UN International Strategy for Disaster Reduction (UNISDR) secretariat, jointly with the
World Health Organization, and with the World Bank support, launched the “Hospitals Safe from
Disasters” 2008-2009 campaign on 25 January 2008 aiming at accomplishing three key
objectives: make sure that health care facilities and health services are able to function during
crises; protect the health and lives of patients and health workers by ensuring the structural and
non-structural resilience of health care facilities; and improve the disaster risk reduction
capacity of health workers and health system;
– The World Health Organization decided to celebrate the World Health Day 2009 under the slogan
“Save lives. Make hospitals safe in emergencies” as an opportunity to sensitize the world
community about that subject matter.
The aforesaid events, together with many other such actions, aim at strengthening the efforts bent
worldwide, regionally and nationally towards protecting the health care facilities during disasters,
building their capacity to withstand to the impact and stay operational under the harshest conditions.
The issue of safety of health care facilities during emergencies is quite a hot topic for our country, too.
The Republic of Moldova is at risk of impact of several hazards, be those natural, manmade or
biosocial, which may lead to emergencies or even disasters. The geographical proximity of Moldova to
the seismic region of Carpathian Mountains poses a threat of earthquakes of up to 7-9 on the Richter
magnitude scale. Over 200 locations and extensive lands are vulnerable to flooding caused by water
overflows, hydrotechnical node accidents or by damages to the protective dams located on the
Dniester and Prut rivers. About 40 per cent of the country’s communities are at risk of landslides. A
current threat is posed by potential epidemics and imported highly pathogenic conditions caused by
high population migration rates. Nuclear power plants and chemical processing companies in the
neighboring countries may pose a threat of radioactive or chemical pollution of the country in the
wake of possible breakdowns occurring at such structures. A major threat to the country’s population
and economy is posed by heavy snow falls, frost, hailstorms, hurricanes, fires, droughts and other
natural adverse phenomena.
Besides the above, during the transition to a market economy and while building up a democratic
society, the Republic of Moldova has faced multiple and various challenges, of which one may single
out the economic downturn, which has had a major negative impact on the health system as a whole
and on the hospital sector in particular. Scarce investments made in the up-keeping and renovation of
buildings and infrastructure of health care facilities led to the decay of the latter, with potential for
disruptions and break in operations during the day-in day-out use of services, let alone emergencies.
Much of the medical equipment has been operating way beyond its intended term, it is morally and
physically outdated, and may no longer meet the current requirements. There is much room for
improvement in many of the health care facilities in the country in terms of health worker (including,
managers) education about what and how to do things in emergencies. There are issues reported in
keeping the stocks of drugs, consumables and other required material resources.
Therefore, it is quite obvious that there are threats in place, which together with high vulnerability and
low preparedness of health care facilities, put the latter at high risk of adverse effects in the wake of
eventual emergencies and urgently require the need to develop and implement an array of measures
aimed at mitigating such events.

II.
 “Republic of Moldova Hospital Safety
Assessment” Project

O ne component of disaster risk reduction strategies employed in the health sector, among other,
is assessing the safety of health care facilities, identifying of their vulnerable links, as well as
setting the priorities in dealing with existing gaps and building the capacity to respond to
emergencies. Given the role that hospitals play in ensuring health care delivery during disasters,
assessing hospital safety is of utmost importance.
For the reasons above, the Ministry of Health decided to assess the safety of hospitals from the
Republic of Moldova, and requested technical assistance from the Regional Office for Europe of the
World Health Organization (RO/Europe WHO) to successfully accomplish this task, following which
the latter agreed upon a proposal to start up and support a joint project “Assessment of Hospital Safety
in the Republic Moldova” through technical assistance and financing. The National Center for Disaster
Medicine (NCDM) was designated accountable for running the project.
From the very beginning the challenge was that the few existing tools available for hospital safety
assessment are quite expensive, time-consuming, are complex in nature and oftentimes are not
meeting all the components for the health facility safety assessment.
Following the review of several tools and in line with WHO RO/Europe recommendation, the “Hospital
Safety Index” was selected as an assessment tool, which was designed by a group of experts from the
Pan American Health Organization (PAHO) used in a number of Latin America countries.
In order to ensure a better understanding and apprehension of the aforesaid tool, WHO RO/Europe
provided for the training of NCDM representatives within the framework of two workshops organized
in the towns of Hammamet (Tunisia) and Pristina (Kosovo), during which they had the opportunity to
discuss with the authors of the tool and get in-depth knowledge about its available features.
The “Republic of Moldova Hospital Safety Assessment” project started in July 2009. Prior to the
assessment per se there was an assessment team selected and trained, consisting of experts of various
backgrounds (disaster management, civil protection, building construction, emergency health care,
medical equipment). At the same time, the WHO RO/Europe financed the translation and adjustment
of tool papers, and provided the assessment team with equipment.
Given the lack of experience in making use of the aforesaid selected methodology, it was decided to
have it piloted in several hospitals first before rolling out. During an inception phase, there were 3
hospital facilities assess during August 2009, as follows: National Research and Clinical Hospital for
Emergency Care, Clinical Hospital of the Ministry of Health, and the District Hospital of Anenii Noi.
The key conclusions resulting from the review of assessment findings are as follows:
1. The “Hospital Safety Index” methodology is an important, relatively inexpensive, simple and
rapid tool for the general overview of hospital safety levels.
2. This methodology does not supply in-depth data about the various safety aspects of the health
care facility being assessed (such aspects could be drawn from specific specialized assessment
only), yet it makes it possible to identify the weak links requiring priority interventions.
3. Although this tool was designed for Latin America countries in the first place, it could be easily
adjusted and used in the settings of the Republic of Moldova.
4. It makes sense to use the “Hospital Safety Index” to assess a cluster of hospitals (or the entire
hospital sector) for the purpose of identifying the most vulnerable health care facilities, outlining
 the key safety gaps within those, and prioritizing investments in strengthening the preparedness
of the whole hospital sector.
5. The methodology has a bias embedded inside, as in assessing hospital safety, to a great extent it
draws on the professionalism and personal experience of evaluators running the assessment
process. Therefore, for the reasons stated above, as well as in order to ensure one common
approach to assessing the safety of hospitals under review, preference is given to having such
assessment conducted by one and the same team of evaluators.
The resulting findings and experience gained from the piloting of the above tool corroborated the
usefulness of carrying on the hospital sector assessment countrywide, which the subsequent project
phases built upon. It lasted from 10 March 2010 until 10 October 2010. There have been 58 / 63
hospitals assessed during the aforesaid reference period: 15 national (republican), 10 municipal, 33
district-level, and 5 departmental.
Hence, there have been 66 hospitals assessed overall as part of the “Republic of Moldova Hospital
Safety Assessment” project, as follows: 17 national, 10 municipal, 34 district-level and 5
departmental (Table no. 2, Annexes 2 - 4).
The results of hospital assessments were put down in the relevant forms and reports, accompanying
the findings and suggestions put up by evaluators, along with photographs taken on the spot, and
submitted to the relevant administration of the hospital facility being assessed.
The project was completed by having an overview report drafted on the hospital safety in the Republic
of Moldova, which was further filed with the Ministry of Health together with all enclosed reports on
the hospital safety of all assessed hospitals.

III.
“Hospital Safety Index”
Assessment Tool

T he “Hospital Safety Index” tool has been developed in 2007-2008 by a group of experts within a
Disaster Mitigation Advisory Group (DIMAG) from the Pan American Health Organization /
Regional Office of the World Health Organization (PAHO/WHO), who have aimed to develop a
low-cost, rapid and easy to apply tool for estimating the probability that hospital is able to withstand
and to remain functional in case of potential disaster.
The corner-stone of the tool is the term of “safe hospital”, which is defined as “the facility the services
of which remain accessible and operational at maximum capacity and in the same infrastructure,
during and immediately following the impact of the emergency”.
Depending on the underlying features they characterize, parameters are grouped in clusters building
up sub-sections, with a group of sub-sections adding up to make a section, reflecting one of the three
key areas that hospital safety rely upon, namely:
Structural safety;
Non-structural safety; and
Functional capacity
Parameters under the “Structural safety” section are indicative of the safety of the structural elements
of a facility’s building (frameworks, pillars, load bearing walls, base, roofing, flooring, bars etc.); type
and quality of construction materials made use of; tear and wear of the building and compliance with
construction and refurbishment standards.
Parameters of the “Non-structural safety” section are indicative of the safety of critical supply systems
(power grids, water supply piping, heat supply, servicing of the plumbing system, ventilation system
and climate control (air conditioning), supply of medical gases etc.); safety of nonstructural elements
of construction (partition walls, windows, doors, decorative elements, access venues etc.); safety of
medical equipment and devices, furniture; conditions for the storing of assets and fire security.
Parameters of the “Functional capacity” section are indicative of the way the hospital management is
organized as to implement disaster response plans, resources available for emergency preparedness
and response to emergencies, staff training and education attainments, keeping safe the hospital
services ensuring hospital operations.
Data on the assessment scores (high, average, or low) for each individual parameter is processed by
making use of the “Safety Index Calculator” – a software application specifically designed by the
authors of the aforesaid tool, which is automatically computing a relevant safety index and,
subsequently, the vulnerability index for the hospital being assessed. The Hospital Safety Index is
attributing values to a health care facility’s ability to operate during emergencies, with a score range
from 0 to 1.0 (Figure 1). It is worth mentioning that various sections have a different weight under the
methodology used to compute the Index as follows: the “Structural Safety” section accounts for 50 per
cent of the Index value, the “Non-structural Safety” section accounts for 30 per vent of it, whereas the
“Functional Capacity” section contributes to 20 per cent of its value.

Figure1 Hospital Safety Index (green) and Hospital Vulnerability Index (red) (varying)

At the same time, the “Safety Index Calculator” is also the graphical representation of the assessment
scores being assigned (high, average, or low) for all of the hospital safety sections (Figure 2), and is
classifying the hospital that is being assessed based on the relevant safety index score in either of the
three 3 safety groups as follows - A, B, or C (Table 1).

Figure 2 Graphical representations of the levels of safety of the assessed hospital safety sections
 Hospital

Safety
group
Safety Safety Group Description
Index

0.66 – 1.0 A A hospital is able to withstand the impact and to keep its capacity to operate during disasters.
However, further measures to strengthen prevention and response capacities in the medium to
long term are recommended in order to raise the safety level of the hospital during disasters.

0.36 – 0.65 B Generally, a hospital is able to withstand the impact, while the existing level of safety is such
that the lives of patients and staff, and the ability to operate during and after a disaster are
potentially at risk. Intervention measures are needed in the short to medium run.

0 – 0.35 C A hospital’s current safety levels are inadequate to protect the lives of patients and hospital staff
and don’t guarantee the facility’s functionality during and after a disaster. Urgent intervention
measures are required to mitigate such situations.

Table 1 Hospital Safety Groups by Safety Index Scores.

In pragmatic terms, the “Hospital Safety Index” tool consists of 2 assessment forms, evaluator’s guidelines
and one CD with the Safety Index Calculator software application on it.
The assessment forms (1 and 2) come as formalized tables whereby the general data about the
hospital that is being assessed is entered, while elaborating on the characteristic features specific for
the area that the hospital is located in and putting down the data on the safety scores that the
aforesaid evaluators are assigning to each individual parameter.
Evaluator’s guidelines is a manual providing an in-depth description of the way an assessment process
is to be organized and carried out, safety levels assessment criteria and how to fill in the appropriate
assessment forms stated above. At the same time, these guidelines are a reference paper to assess the
safety parameters of the health care facility to be assessed.
The “Safety Index Calculator” is an Excel-based spreadsheet electronic table, used to enter the data
from the assessment forms that were previously filled out. The results of final computations (Hospital
Safety Index, weighted safety levels for various sections and the safety group that the hospital to be
assessed is classified under) are automatically presented as electronic files, or on paper, subject to
one’s preferences. It is worth mentioning that not only this software allows for displaying the safety
levels for each individual section (structural safety, non-structural safety, functional capacity), but it
also outline those for each group and subsection of parameters alone.
The assessment process is to be done in several stages: preparation, field work, processing, results
analysis, drafting a final report and sharing it with the management of the hospital being assessed.
Preparation is about collecting, reviewing and analyzing the data from all available sources, both
relevant for the hospital to be assessed and for the geographical area that such hospital is located in.
Moreover, during preparation one has to coordinate the future steps to be taken with the hospital
management, while making the latter knowledgeable about the ways an assessment is conducted and
requesting the needed support (drafting of info notes, providing free access to the relevant
subdivisions and premises to be inspected, as well as convening meetings with people responsible for
the sectors to be assessed etc.)
Field work is planned and carried out as per the recommendations set out in the Evaluator’s
Guidelines and it consists of direct inspection by evaluators of the structural and non-structural
elements of buildings, engineering networks and systems, specific facility subdivisions, medical
equipment and devices, storehouse etc. The most conclusive issues identified during inspection are to
be taken pictures of. In the same vein, evaluators are to peruse the papers outlining the preparedness
and response measures to emergencies, fire security, maintenance and proper use of vital networks
and systems. Besides inspections there will also be interviews with the stakeholders in charge of areas
critical for hospital safety. The assessment of safety scores (high, average, or low) of the assessment
parameters draw on the results of inspections, paper reviews, dialogue and interviews. Assessment is
done by the expert from the relevant area from the assessment team based upon the criteria set out in
the Evaluator’s Guidelines. Data on the safety levels of evaluated parameters are filled in, together with
appropriate justification, in the assessment forms. Should there be any difficulties or doubts about
assessing one or another parameter, the final decision is taken following consultations between the
assessment team members, as well as with the responsible people from the hospital in question.
Additional information may be requested from hospital representatives and from other relevant
structures (Ministry of Health, civil protection authorities, constructions inspectorate etc.), if needed.
Subsequently, following the entering of data from the forms into a PC and information processing, a
review of assessment results is carried out, as reflected in the assessment report. An assessment
report consists of a narrative part drafted by the assessment team members and of assessment forms.
It is advisable to have the final report, together with all of the findings, conclusions and
recommendations of the assessment team, shared with the hospital management within a meeting to
convene all parties involved in providing for that hospital’s safety.

IV.
Hospital Sector in the Republic of
Moldova

S ince gaining independence in 1991, the Republic of Moldova inherited an extensive hospital

system, yet with scarce funding to support it. The situation worsened in the wake of the
economic crisis of the middle 1990’s, which gave a hard blow to the health system as a
whole, but even more so it adversely hit the hospital system, as it used to be one of the most expensive
segment. Aiming at improving the situation, the Republic of Moldova committed to undertake some
drastic reforms in order to streamline the health system and to ensure a quality health service delivery.
The hospital sector was heavily reformed as well. Following considerable changes occurring throughout
1998 – 2009, the excessive network of hospitals was cut from 276 hospitals with 42,000 hospital beds
overall down to 82 hospital units with some 20,500 beds in total.
Hence, as of 1 January 2010, the hospital system in the country consisted of:
a) 62 public hospitals, including:
- 34 district-level hospitals, the founder of which is the appropriate district boards (councils);
- 10 municipal hospitals, the founder of which is the appropriate municipal boards (councils);
- 18 national hospitals, the founder of which is the Ministry of Health;
b) 10 departmental hospitals, subordinate to other ministries and central public authorities;
c) 10 private hospitals.
Population coverage with hospitals is 2.32 hospitals per 100,000 people.
The total number of public hospital beds is tallying up to 20,021 (561.0 hospital beds per 100,000
people), of which:
- 8,225 beds are within national hospitals (41.1 per cent);
- 3,550 beds are within municipal hospitals (17.7 per cent); and
- 8,246 bends are within district-level hospitals (41.2 per cent).
Over 50 per cent of hospitals (16 national hospitals, 9 municipal hospitals, 8 public departmental
hospitals and 8 private hospitals) with 9,369 beds overall, or 46.8 per cent of the total number of
hospital beds, are in the municipality of Chisinau. The remaining hospitals, most of which are district-
level inpatient facilities, are located all over the country.
As per the ongoing reforms, the hospital classification was reviewed, too. Pursuant to the Government
Decision no.379 of 07 May 2010 “on the Hospital Health Care Development Program for 2010-2012”,
public state hospitals and private hospitals are classified based upon the following criteria (Annex 1):
a) By complexity of health services provided, hospitals could be: primary, secondary and tertiary;
b) By type of ownership, hospitals could be: public, departmental, private, and public with private
wards and/or services;
c) By length of specialized care provided to patients, hospitals could be: short-stay, long-stay,
rehabilitation, and medical/social;
d) By service area coverage, hospitals could be: local or community, regional or national;
e) By the disease profile it deals with, hospitals could be: general hospital care, and specialized
hospital care; and
f) By hosting graduate (university) and postgraduate (post-university) education and health
worker retraining, hospitals could be: university-linked and institute-linked.

V.
Republic of Moldova
Hospital Safety Assessment Results

T here have been 66 hospitals – 17 national, 10 municipal, 34 district-level, and 5

departmental – assessed within the framework of the “Republic of Moldova Hospital Safety
Assessment” project.

ASSESSMENT CAME UP WITH THE FOLLOWING FINDINGS:

All of the assessed departmental hospitals have been classified as pertaining to safety group A (Table 2).
Of the 61 public hospitals being assessed * (Figure 3, Table 2), 15 hospitals (6 national, 4 municipal
and 5 district-level), or 24.6 per cent of all, have been classified as pertaining to safety group A
– indicative of a high degree of resilience to the impact of eventual disasters, as well as of their
capacity to safely operate under the harsh conditions caused by emergencies.
As many as 41 hospitals (7 national, 6 municipal, and 28 district-level), or 67.2 per cent of all,
have been classified as pertaining to safety group B – indicative of an average degree of resilience
to the impact of eventual disasters, as well as of certain drawbacks and gaps in ensuring the safe
operations of hospitals in emergencies.
5 hospitals (4 national and 1 district-level), or 8.2 per cent of all, have been classified as
pertaining to safety group C, usually assigned, as per the methodology in place, to those hospitals
that do not provide resilience to the impact of eventual disasters and do not ensure the safe operations
of those in emergencies.
The highest Safety Index score (0.83) was awarded to the National Center for Dermatovenereology
(NCDV), and the lowest score (0.29) – to the Mental Health Clinical Hospital (CMHH).

Figure 3 Proportion of hospitals as classified by safety groups

Given the specific nature of tasks and operations run in departmental hospitals, the latter were not included in the
*

general overview of the assessment results.

Table 2 Results of the Hospital Safety Assessment in the Republic of Moldova

Indices

Safety Group
Category

Vulnerabilit
IndexSafety
# Health care facility name

y Index
1 2 3 4 5 6

Public Hospitals

1 National Center for Dermatovenereology (NCDV) National 0.83 0.17 A

2 TB Hospital from Vorniceni National 0.82 0.18 A

3 National Center for Drug Addiction (NCDA) National 0.80 0.20 A

4 Municipal Clinical Hospital for Children no.1 Municipal 0.79 0.21 A

5 District Hospital of Rezina District 0.74 0.26 A

6 Municipal Clinical Hospital no.1 Municipal 0.73 0.27 A

7 District Hospital of Drochia District 0.73 0.27 A

8 Institute of Cardiology National 0.69 0.31 A

9 District Hospital of Soldanesti District 0.69 0.31 A

10 Ministry of Health Clinical Hospital National 0.68 0.32 A

11 Institute of Oncology National 0.67 0.33 A

12 Municipal Clinical Hospital “Sfinta Treime” [Holy Trinity] Municipal 0.67 0.33 A

13 Municipal Clinical Hospital for Children “V.Ignatenco” Municipal 0.66 0.34 A

14 District Hospital of Donduseni District 0.66 0.34 A

 Indices

Safety Group
Category

Vulnerabilit
IndexSafety
# Health care facility name

y Index
1 2 3 4 5 6

15 District Hospital Stefan-Voda District 0.66 0.34 A

16 Municipal Clinical Hospital from Balti Municipal 0.65 0.35 B

17 National Institute of Neurology and Neurosurgery National 0.64 0.36 B

18 District Hospital of Cimislia District 0.64 0.36 B

19 District Hospital of Straseni District 0.64 0.36 B

20 District Hospital of Causeni District 0.63 0.37 B

21 District Hospital of Leova District 0.62 0.38 B

22 District Hospital of Basarabeasca District 0.62 0.38 B

23 National Research and Clinical Hospital for Emergency Care (NRCHEC) National 0.61 0.39 B

24 District Hospital of Ceadir-Lunga District 0.61 0.39 B

25 District Hospital of Cantemir District 0.61 0.39 B

26 District Hospital of Anenii Noi District 0.61 0.39 B

27 District Hospital of Ialoveni District 0.60 0.40 B

28 Municipal Clinical Hospital “Sfintul Arhanghel Mihail” Municipal 0.59 0.41 B

29 District Hospital of Falesti District 0.58 0.42 B

30 District Hospital of Floresti District 0.57 0.43 B

31 NRCI of Maternal and Child Care National 0.56 0.44 B

32 District Hospital of Hincesti District 0.56 0.44 B

33 District Hospital of Nisporeni District 0.56 0.44 B

34 Municipal Clinical TB Hospital Municipal 0.55 0.45 B

35 District Hospital of Cahul District 0.54 0.46 B

36 District Hospital of Orhei District 0.54 0.46 B

37 District Hospital of Glodeni District 0.54 0.46 B

38 Municipal Maternity no.2 Municipal 0.53 0.47 B

39 District Hospital of Calarasi District 0.53 0.47 B

40 District Hospital of Ungheni District 0.53 0.47 B

41 District Hospital of Ocnita District 0.51 0.49 B

42 District Hospital of Comrat District 0.51 0.49 B

43 District Hospital of Criuleni District 0.51 0.49 B

44 National TB Institute “Chiril Draganiuc” National 0.50 0.50 B

 Indices

Safety Group
Category

Vulnerabilit
IndexSafety
# Health care facility name

y Index
1 2 3 4 5 6

45 Mental Health Hospital from Balti National 0.50 0.50 B

46 District Hospital of Briceni District 0.50 0.50 B

47 District Hospital of Riscani District 0.50 0.50 B

48 Municipal Clinical Hospital of Infectious Diseases for Children Municipal 0.49 0.51 B

49 Mental Health Hospital from Orhei National 0.49 0.51 B

50 District Hospital of Singerei District 0.48 0.52 B

51 National Clinical Hospital National 0.47 0.53 B

52 District Hospital of Soroca District 0.47 0.53 B

53 District Hospital of Edinet District 0.47 0.53 B

54 District Hospital Vulcanesti District 0.45 0.55 B

55 District Hospital of Taraclia District 0.44 0.56 B

56 Municipal Clinical Hospital no.4 Municipal 0.39 0.61 B

57 Clinical Hospital of Trauma and Orthopedics National 0.34 0.66 C

58 District Hospital of Telenesti National 0.33 0.67 C

59 National Clinical Hospital for Children “Em.Cotaga” National 0.31 0.69 C

60 Clinical Hospital for Infectious Diseases “T.Ciorba” National 0.31 0.69 C

61 National Clinical Hospital for Mental Health National 0.29 0.71 C

Departmental Hospitals

62 Ministry of Interior Hospital Depart. 0.80 0.20 A

National Hospital of the Treatment and Rehab Association of the State

63 Depart. 0.78 0.22 A
Chancellery

64 State Enterprise (SE) Hospital “Railroads of Moldova” Depart. 0.77 0.24 A

National Experimental Center for Prosthetics, Orthopedics and

65 Depart. 0.75 0.25 A
Rehabilitation, Ministry of Labor, Social Protection and Family (MLSPF)

66 Clinical Central Military Hospital of the Ministry of Defense Depart. 0.71 0.29 A

Notes: District – district-level; Depart. – departmental;

Table 3 Safety indices (green) and vulnerability indices (red) for the hospitals of the Republic of Moldova
There were the following findings outlined following the review of safety indices awarded to various
categories of hospitals:
Of the 17 national hospitals (Annex 2, Figure 4), 6 or 35.3 per cent have been classified as pertaining
to safety group A, 7 or 41.2 per cent – safety group B, and 4 or 23.5 per cent – safety group C. The
highest safety index score was reported for the National Center of Dermatovenereology (0.83) and the
lowest score – to the National Mental Health Hospital (0.29). It is worth mentioning that of the total
number of 5 hospitals graded under safety group C, 4 are national-level facilities.
Figure 4 Share of safety groups by the category of assessed hospitals
A review of the average weights of safety indices assigned to the parameters specific for the safety
sections of national hospitals (Annex 5, Table 4) shows that the average weight of the structural safety
parameters, which were assigned a “low” safety score, is 11.7 per cent, those assigned an “average”
safety score account for 32.4 per cent, and those scoring “high” in terms of safety account for the
remaining 55.9 per cent. The average share of parameters specific for the non-structural safety and
functional capacity had the following distribution: non-structural safety: “low” – 18.5 per cent,
“average” – 47.6 per cent, and “high” – 33.9 per cent; Functional capacity: “low” – 34.8 per cent,
“average” – 39.3 per cent, and “high” – 25.9 per cent.

Average weights of safety scores assigned to

# Safety Components hospital safety section parameters (per cent)
LOW AVERAGE HIGH
National Hospitals
1 Structural safety 11.7 32.4 55.9

2 Non-structural safety 18.5 47.6 33.9

3 Functional capacity 34.8 39.3 25.9

Table 4 Average weights of safety scores assigned to the section parameters of national hospitals
The biggest share of parameters with “low” scores for the structural safety section was reported for the
Mental Health Clinical Hospital (47 per cent), National Clinical Hospital for Infectious Diseases
“T.Ciorba” (46 per cent) and the National Clinical Hospital for Children “Em.Coţaga” (31 per cent); for
the non-structural safety section – Mental Health Clinical Hospital (30 per cent) and the TB Institute
“Chiril Draganiuc” (30 per cent); for the functional capacity section – Clinical Trauma and Orthopedics
Hospital (62 per cent), National Clinical Hospital for Infectious Diseases “T.Ciorba” (51 per cent) and
the National Clinical Hospital for Children “Em.Coţaga” (51 per cent).
Of the 10 municipal hospitals (Annex 3, Figure 4), 5 apiece, or 50 per cent, have been classified
under the safety groups A and B respectively. There was no hospital listed under the safety group C.
The highest safety index score was assigned to the Municipal Clinical Hospital for Children no.1(0.79)
and the lowest score – to the Municipal Clinical Hospital no.4 (0.39).
A review of the average weights of safety indices assigned to the parameters specific for the safety
sections of municipal hospitals (Annex 6, Table 5) shows that the average weight of the structural safety
parameters, which were assigned a “low” safety score, is 4.0 per cent, those assigned an “average” safety
score account for 44.3 per cent, and those scoring “high” in terms of safety account for the remaining
51.7 per cent. The average share of parameters specific for the non-structural safety and functional
capacity had the following distribution: non-structural safety: “low”– 22.1 per cent, “average” – 35.7 per
cent, and “high” – 42.2 per cent; functional capacity section: “low” – 27.6 per cent, “average” – 28.5 per
cent, and “high” – 43.9 per cent.

Average weights of safety scores assigned to hospital

safety section parameters (per cent)
# Safety Components
LOW AVERAGE HIGH

Municipal Hospitals

1 Structural safety 4.0 44.3 51.7

2 Non-structural safety 22.1 35.7 42.2

3 Functional capacity 27.6 28.5 43.9

Table 5 Average weights of safety scores assigned to the section parameters of municipal hospitals
The biggest share of parameters with “low” scores for the structural safety section was reported for the
Municipal Clinical Hospital for Infectious Diseases in Children (22 per cent) and the Municipal Clinical
Hospital no.4 (10 per cent); for the non-structural safety section – the Municipal Clinical Hospital “Sf.
Arhanghel Mihail” (30 per cent) and Municipal Maternity no.2 (27 per cent); and for the functional
capacity section: the Municipal Clinical Hospital for Infectious Diseases in Children (31 per cent) and
the Municipal Maternity no.2 (31 per cent).
Of the 34 district-level hospitals (Annex 4, Figure 4), 5 or 14.7 per cent have been classified as
pertaining to safety group A, 41 or 82.4 per cent – to safety group B, and 1 or 2.9 per cent – to safety
group C. The highest safety index score was assigned to the District Hospital of Rezina (0.74) and the
lowest – to the District Hospital of Telenesti (0.33%).
A review of the average weights of safety indices assigned to the parameters specific for the safety
sections of district-levels hospitals (Annex 7, Table 6) shows that the average weight of the structural
safety parameters, which were assigned a “low” safety score, is 3.1 per cent, those assigned an
“average” safety score account for 43.6 per cent, and those scoring “high” in terms of safety account for
the remaining – 53.3 per cent. The average share of parameters specific for the non-structural safety
and functional capacity had the following distribution: non-structural safety: “low”– 17.0 per cent,
“average” – 47.6 per cent, and “high” – 35.4 per cent; Functional capacity: “low” – 27.9 per cent,
“average” – 51.5 per cent, and “high” – 20.6 per cent.
 Average weights of safety scores assigned to hospital
safety section parameters (per cent)
# Safety Components
LOW AVERAGE HIGH

District-level Hospitals

1 Structural safety 3.1 43.6 53.3

2 Non-structural safety 27.9 51.5 20.6

3 Functional capacity 17.0 47.6 35.4

Table 6 Average weights of safety scores assigned to the section parameters of district-level hospitals
The biggest share of parameters with “low” scores for the structural safety section was reported for the
District Hospital of Telenesti (36 per cent), the District Hospital of Taraclia (23 per cent) and the
District Hospital of Vulcanesti (23 per cent); for the non-structural safety section – the District Hospital
of Anenii Noi (31 per cent), the District Hospital of Criuleni (29 per cent) and the District Hospital of
Telenesti (28 per cent); and for the functional capacity section – the District Hospital of Basarabeasca
(43 per cent), the District Hospital of Floresti (42 per cent) and the District Hospital of Taraclia (42 per
cent).
A review of the average weights of safety indices assigned to the parameters specific for the safety
sections of all the hospitals in the country (Table 7) shows that the biggest shortcomings in hospital
safety are reported within the “Functional capacity” section (with 26.4 per cent of parameters being
assigned a “low” score and 38.5 per cent – “average”), with the “Non-structural safety” section coming
next (22.4 per cent of parameters were assigned a “low” score, and 44.9 per cent having an “average”
score). The opposite has been ascertained for the “Structural safety” section: 53.6 per cent of
parameters were assigned a “high” score, 40.1 per cent – an “average” score, with merely 6.3 per cent
getting a “low” score.

Average weights of safety scores assigned to hospital

Hospital Category / safety section parameters (per cent)
#
Safety Components
LOW AVERAGE HIGH

National Hospitals

1 Structural safety 11.7 32.4 55.9

2 Non-structural safety 18.5 47.6 33.9

 3 Functional capacity 34.8 39.3 25.9

Municipal Hospitals

1 Structural safety 4.0 44.3 51.7

2 Non-structural safety 22.1 35.7 42.2

3 Functional capacity 27.6 28.5 43.9

District-level Hospitals

1 Structural safety 3.1 43.6 53.3

2 Non-structural safety 27.9 51.5 20.6

3 Functional capacity 17.0 47.6 35.4

Country Average

1 Structural safety 6.3 40.1 53.6

2 Non-structural safety 22.9 44.9 32.2

3 Functional capacity 26.4 38.5 35.1

Table 7` Average weights of safety scores assigned to the section parameters of all assessed hospitals

REVIEW OF HOSPITAL SAFETY SECTIONS AND UNDERLYING PARAMETERS

STRUCTURAL SAFETY

O n this section, one may say that the Republic of Moldova is located in an area of intense seismic
activity and the biggest challenge for the resilience structure of hospital buildings is posed by a
potential earthquake. Moldova has already experienced a number of earthquakes over the last
century, the most powerful of which was reported on 10 November 1940, 4 March 1977, 31 August
1986 and 31 May 1990. Another important factor to account for is that the implementation of quake-
proof construction norms started in Moldova only at the end of 1960’s. Subsequently, in the wake of
the earthquakes from 1977 and 1986, the aforesaid norms have been updated and tightened.
Therefore, the older a building is, less likely it is that it was built in line with all quake-proof norms,
having already been exposed to previous earthquakes over long periods of time. Climate factors play a
significant destructive role, along with improper use of buildings. It is quite obvious that the aforesaid
factors have been having a negative impact on the structural elements of hospital buildings, leading to
a growing vulnerability of those in time.
In this vein, one may notice (Annex 8) that the main buildings of 17 hospitals (6 national, 3 municipal
and 8 district-level), or 27.9 per cent of the hospitals in the country, have been built before 1970, with
the main buildings for 4 of them (3 national and 1 municipal), or 6.6 per cent, being built at the end of
the 19th century – beginning of 20th century (National Clinical Hospital for Trauma and Orthopedics
(1817-1825), National Hospital for Infectious Diseases “Toma Ciorba” (1890-1897), Mental Health
Clinical Hospital (1895-1910)) and Municipal Clinical Hospital no.4 (1880, 1917)). Most of the
buildings belonging to those hospitals have 1-to-4 floors, on a basement made of rubble stone, with
bearing walls made of rubble stone, bricks or white limestone, and usually wooden floorings. There
were signs of previous earthquakes revealed during the assessment mission in basically all the
hospitals built prior to 1940.
At the same time, 44 (72.1 per cent) of the hospitals from the country have been built since 1970
onward, including 32 hospitals (8 national, 7 municipal and 17 district-level), or 52.5 per cent, have
been built during 1970 – 1989, whereas 12 hospitals (all of them district-level), or 19.7 per cent, have
been commissioned since 1990 onward. The basement of all hospital buildings built after 1970 was
made of pre-cast reinforced concrete blocks, frameworks cast or mounted from pre-cast reinforce
concrete elements, load-bearing walls of reinforced concrete or white limestone walls and reinforced
concrete flooring between building floors. As per the standards in place during that time, the above
buildings provide for improved resilience to seismic events with a magnitude of up to 7-8 degrees on
the MSC scale (Mercalli intensity scale). By and large, due to the aforesaid measures taken, the
earthquakes occurring over the last four decades in the Republic of Moldova (1977, 1986 and 1990)
resulted in no damage to the structural layout of most buildings belonging to hospital complexes
(there were no papers or overt signs of damage identified indicative of some negative impact exerted
on the structural elements of buildings following earthquakes during the assessment mission).
During this timeframe, there have been renovation works performed on the buildings of basically all
hospitals, as well as reconstruction and upgrading works done in some other. Works have been
completed as per the relevant blueprints and had no impact on the structural safety of buildings; on
the contrary, those contributed to retrofitting some of those.
The assessment findings show (Annexes 6-8, Table 4) that in most of cases the structural safety of
hospitals in the country is deemed as average or high. Most of such problems were reported in 10, or
16.4 per cent, of the hospitals in the country: 5 (29.4 per cent) national hospitals, 2 (20 per cent)
municipal hospitals, and 3 (8.8 per cent) district-level hospitals. Most of these hospitals have been
built between the end of the 19th century and the first half of the 20th century.
Among the factors adversely affecting the structural safety of those hospitals are, first of all, multiple
cracks in the bearing walls, lintels and flooring, as well as occasionally damage to the basement. A
problem common for most of the hospitals in the country is the degrading pitching (tamping and
holes), which following water flows may cause damage to the basement. In particular, there is a
burning problem of degrading pitching reported at the Municipal Clinical TB Hospital, Municipal
Clinical Hospital for Infectious Diseases in Children, Municipal Clinical Hospital no.4, as well as for the
district-level hospitals from Comrat, Telenesti, Hincesti, Drochia and Cimislia. Likewise, there have
been unsealed joints identified between panels in several buildings made of pre-cast elements,
allowing moisture to get through, thus potentially leading to damage to the outer walls.
It is worth mentioning that the structural safety assessment was considerably more difficult to
perform because some or all of the technical papers on the buildings were missing in most hospitals.
Moreover, no hospital (except for the National Research and Clinical Hospital for Emergency Care –
NRCHEC) had or has been filling in the Technical Card of the building, which has to be kept up filled
out pursuant to article18 (2) under the Republic of Moldova Law no.721 of 2 February 1996, ‘on the
quality of constructions’, and which is duly checking on the design, raising, commissioning, use and
building follow-up related data, by entering all the relevant information needed to identify and assess
a building’s technical (physical) status and changes in status over time.

NON-STRUCTURAL SAFETY

POWER SUPPLY (ANNEX 9)

Of the total number of hospitals, 35 or 57.4 per cent, including 9 (52.9 per cent) national hospitals, 7
(70 per cent) municipal hospitals, and 19 (55.9 per cent) district-level hospitals, are connected to 2
standalone sources of power. As many as 26 hospitals, or 42.6 per cent, are connected to one power
source only. At the same time, an automated turning on of an alternate power source following an
outage in the first power source is available in 9 hospitals, while one has to turn it on only manually
for the remaining hospitals connected to double power sources, therefore delaying the time of turning
on an alternate power source from 0.5 up to 1.5 hours.
Regarding the availability of alternate power sources in hospitals, one may notice the following
situation: 15 or 24.6 per cent of hospitals in the country have no power generator at all, 9 hospitals or
148 per cent have generators available, yet those are either not operational or not connected to the
facility’s power grid. In 18 hospitals (or 29.5 per cent) a generator is able to cover only 30 per cent of
all needs, in 8 hospitals (or 13.1 per cent) – only up to 70 per cent of needs, and only in the remaining
12 hospitals (or 19.7 per cent) in the country a generator can cover 100 per cent of all needs.
Of all hospital categories, the direst plight is reported in municipal facilities, 6 of which (or 60 per
cent) are not equipped with a power generator at all, whereas other 2 (20 per cent) have generators,
which are either non-operational or not connected to the power grid. Therefore, only 2 (i.e. 20 per
cent) of the municipal hospitals have generators, of which only one (MCH “Sfinta Treime”) is able to
cover 100 per cent of all of the facility’s needs, as the second one (Municipal Clinical Hospital in Balti)
is covering only 30 per cent of the facility’s needs.
Out of the 17 national hospitals in the country, 5 (or 29.4 per cent) have no power generator in place, 4
(or 23.5 per cent) have a generator which is either non-operational or not connected to the power
grid, in other 4 hospitals (23.5 per cent) generators covers 30 per cent of their needs, in 2 hospitals
(11.8 per cent) generators cover 70 per cent of their needs, and only in the TB Hospital (Vorniceni)
and in the Mental Health Hospital (Orhei) the generator covers 100 per cent of the facility’s needs.
Slightly better is the status of district-level hospitals, of which only 4 (11.8 per cent) are missing
power generators, and another 3 (8.8 per cent) have generators available despite the latter not being
operational. In 13 (or 38.2 per cent) of hospitals generators cover only 30 per cent of their needs, and
in 6 (17.6 per cent) those cover up to 70 per cent of such needs, and only in the remaining 9 (26.5 per
cent) of district-level hospitals a generator is covering 100 per cent of all their needs.
One issue shared by all hospitals in the country is that of the high wear of internal power grids. In 36
hospitals (59 per cent of all) the wear of power grids is raising to about 70 per cent, whereas 100 per
cent of the power grids in other 4 hospitals (Mental Health Clinical Hospital, Mental Health Hospital
(Orhei), MCH no.4 (municipality of Chisinau) and the District Hospital of Telenesti) require full
renovation.

WATER SUPPLY (ANNEX 10)

Hospital water supply sources vary by geography. Almost all hospitals located in municipalities (12
national hospitals and 10 municipal hospitals) are tapping to the municipal water supply system, of
which only 7 (25 per cent) have at least two waster access points. As many as 5 national hospitals, of
which 2 are located outside municipalities and 3 – in the suburbs area, get their water from their own
artesian wells.
Of the total number of district-level hospitals, 17 (50.0 per cent) have own water supply sources
(artesian wells), 10 (29.4 per cent) get their water from the local water supply systems and networks,
with another 6 (17.7 per cent) having mixed modalities of water supply – by both tapping into a local
water supply network and from one’s own water supply source.
A key piece in ensuring a hospital’s functionality during emergencies is the availability of alternate
water supply sources and/or stocks of potable water. None of the municipal hospitals currently has an
own water supply source (be it a common water well or an artesian well) or a tank with drinking
water. Should those be potentially cut off the municipal water supply, the only thing to do is to have the
supplier carry water by vehicles with water tanks, as well as counting on the help of local public
authorities, making those vulnerable to possible emergencies. One may find a similar situation in 7
national hospitals (41.2 per cent), all of which are located within the municipality of Chisinau. Another
7 national hospitals have tanks with potable water, 3 of which also have regular water wells dug in the
courtyard. Another 2 hospitals (Institute of Oncology and NRCCEM) have artesian wells as a backup in
the courtyard, while there is regular water well equipped with a power-driven pump acting as a water
tank for the Ministry of Health Clinical Hospital.
Unlike the national and municipal hospitals, there are only 6 district-level hospitals (17.7 per cent)
that have no alternate sources of power and water supply. As many as 24 district-level hospitals (70.6
per cent) of district hospitals have tanks with drinking water, with 12 more of them also holding
regular water wells in their backyard besides the tanks, some of which are equipped with water
pumps. In 2 district-level hospitals (5.9 per cent) water wells from the backyard are used as tanks.
A burning issue for all hospitals in the country is the high wear of the water supply networks (internal
and external). The assessment results show that the water supply systems report a wear of about 70
per cent in 7 national hospitals (41.2 per cent), 5 municipal hospitals (50.0 per cent) and in 20
district-level hospitals (58.8 per cent), whereas the wear of water supply networks and piping in the
Mental Health Clinical Hospital, MCH “Sfinta Treime”, MCH TB, Municipal Maternity no.2 and district
hospitals of Anenii Noi, Floresti, Nisporeni and Comrat is reaching 80-90 per cent, requiring
replacement.

SEWER SYSTEM (ANNEX 11)

According to the assessment data, the wear of the sewer system, specifically that of the internal
networks (joints, vertical and horizontal pipes) in 23 hospitals (37.7 per cent) (7 national, 6 municipal
and 19 district-level) is reaching 70 per cent, whereas the wear of the sewer system is getting close to
90 per cent in another 6 hospitals (3 national, 2 municipal and 1 district-level) (9.8 per cent). The
wear of sewerage in the remaining 32 hospitals (52.5 per cent) is close to 30 per cent.

HEATING (ANNEX 12)

Of the 17 national hospitals, 10 facilities are located in the municipality of Chisinau and get their
heating from the municipal heating networks. Another 3 hospitals (National Clinical Hospital, Institute
of Oncology and NHID “Toma Ciorba”), also located in the municipality of Chisinau, are both connected
to the municipal heating networks and are holding own boilers. The boiler of the NHID “Toma Ciorba”
is not currently able to heat the facility and it generates hot water for technical needs only. The
remaining 4 hospitals generate heat in their own boiler rooms.
All of the 9 municipal hospitals from the municipality of Chisinau are supplied with heat through the
municipal networks of the JSC “Termocom”. No hospital has a boiler room. The main building of the
MCH in Balti is supplied with heat from its own boiler, whereas its two branches are getting heat from
the local municipal network.
Out of the total number of 34 district-level hospitals, only 7 (20.6 per cent) are getting heat from the
local networks. The remaining district-level hospitals – 27 (79.4 per cent) have their own boilers,
owned by the founder, but are intended to provide the hospitals with heat.
It is worth mentioning that most of the heat-producing plants and larger boiler rooms, as well as the
hospitals’ own boiler rooms, are fueled by natural gas, having no technical means to shift to another
type of fuel (oil, coal, diesel). Therefore, supplying heat is to a great extent contingent on the natural
gas supply. Should the natural gas supply cease or decline, only 2 national hospitals and 5 district-level
hospitals would be able to cope with their heating needs by switching to a different type of fuel. The
remaining hospitals may only use power heaters as alternate heating options only.
A burning issue for all hospitals in the country is the high wear of the heating systems and networks
(pipes, radiators, link-ups etc.) The assessment results show that there is urgent need to perform
refurbishment works today to replace up to 90 per cent of the heating piping in 4 national hospitals
(11.8 per cent) and 6 district-level hospitals (17.6 per cent). The wear of heating networks in 6
national hospitals (35.3 per cent), 8 municipal hospitals (80.0 per cent) and 14 district-level hospitals
(41.2 per cent) is getting close to 70 per cent.
Making hot water available in hospitals is mostly done through the power-driven boilers of various
capacity mounted in the clinical wards, if needed, and only partly through the available municipal
networks and one’s own boilers.

FIRE SAFETY
To a greater or lesser extent, fire safety is a burning issue for absolutely all hospitals in the country.
The shortcomings identified are by and large common for all facilities. For instance, no hospital, except
for the district hospitals of Ceadir-Lunga and Glodeni, has a fully-operational automated system for
fire alarm and fire control; likewise, no hospital, except for the Institute of Cardiology, has a system in
place for prompt notification and alert of patients, staff and visitors of any potential hazards or about
the onset of any emergencies. Under such circumstance, it is planned to have the information passed
over by phone or through couriers, which is a time-consuming effort; the number of fire extinguishers
does not meet the requirements set forth in the relevant regulatory papers; some of the fire hydrants
are not connected to a water source, are not equipped with hoses, or the faucets are not operational;
there are not enough building exit marks and evacuation plans or such are missing at all; there are not
enough or none at all spare stretches and wheelchairs needed to evacuate patients who cannot move
on their own; fire teams exist on paper only; there were no fire drills organized for the staff in
hospitals.

ROOFING
The assessment results show that 34 hospitals have ridged roofing, whereas 27 have flat roofing. The
condition of roofing is good in 28 hospitals, while 21 hospitals need some current roof renovation
works, and another 13 hospitals – capital roof refurbishment works.
At the same time, there is room for improvement in terms of water gutters to drain rainwater form the
rooftops in 19 hospitals, thus resulting in the water seeping down a building’s walls and pitching,
causing damage.

HOSPITAL ACCESS PATHWAYS

Most hospitals have a perimeter fence with 2-3 gateways, which make the access to the hospital
relatively unhindered. At the same time, access to some hospitals, in particular to the admissions area,
is difficult due to the crowding of private vehicles or staff at the gateways or due to heavy road traffic
on neighboring streets. This results in major challenges both for the health vehicles and special
services (firefighters, rescuers, utilities services etc.), in particular at the Municipal Clinical Hospital
“Sf. Arhanghel Mihail”, Municipal Clinical Hospital “Sfinta Treime”, National Clinical Hospital, National
Research and Clinical Hospital for Emergency Care (NRCCEM), and the National Research Institute for
Maternal and Child Care (NRIMCC). Relevant markings are displayed in most hospitals, yet such marks
are not enough visible, clear and self-explanatory. Likewise, there are no marks in place in many
communities providing directions to the hospital and its accurate location.

ELEVATOR AND STAIR LANDING STATUS

All elevators in hospitals have been used for at least 25 years now, many of those are outdated,
frequently out of order, and some elevators not operational on the grounds of missing spare parts and
have been turned off.
There were no drawbacks reported during the assessment of stair landings.

VENTILATION AND CLIMATE CONTROL

Despite the main buildings of all hospitals built since 1970’s onward having centralized air ventilation
and climate control systems, none of those is operational for the time being, with some of it being in
part demolished, except for the Municipal Clinical Hospital for Children “V.Ignatenco” and the Institute
of Oncology that have working ventilation systems only. This issue has been partly dealt with by
having individual climate control units, local ventilation systems and window ventilators mounted in
many of the hospitals, yet this is not enough, in particular during heat waves.

INNER AND OUTER LIGHT SYSTEMS

In most hospitals the inner lighting is relatively good, or at least the main hospital premises are lit at
night. Outer lights are usually deficient. The main reason for that is the lack of light bulbs, as well as
the high wear of light devices and networks.

FUNCTIONAL CAPACITY
A number of issues have been looked at when assessing this section, such as the way the hospital
management is organized, actions taken by the Committee for Emergency Situations from within the
facility, implementation of disaster response plans and programs, disaster preparedness and response
resources, staff’s educational attainments and training, availability of stocks, safe running of vital
services etc.
As the review of the assessment results point out to, the biggest share of parameters scoring “low” in
all of the assessed hospitals belong to the “Functional capacity” section, being indicative of quite a few
gaps and drawbacks in this area. One should also mention, though, that a number of parameters under
the assessment questionnaire scored “low” because their requirements were not set forth in the
guiding and regulating papers in place and, as such, those were not mandatory for the assessed facility
to comply with at the time the assessment was run.
The following findings were made following a check-up: to set up a Hospital Committee for
Emergencies (HCE) to prevent, reduce and ensure an efficient response to any occurring emergency in
most hospitals, as per the director’s ordinance. HCE members are usually the representatives of all
relevant subdivisions and services. HCE regulations have been designed in all hospitals, together with
the functional responsibilities of its members. At the same time, it is worth keeping in mind that most
of such regulations need to be updated and that not all HCE members know well their responsibilities
in emergency situations.
For the purpose of timely steering the disaster response and consequence mitigation measures in
emergencies, there shall be an Incident Command Group (ICG) established in each hospital, yet no
hospital has any regulations or relevant methodological guidance on the operations undertaken by
such entity. All hospitals have to designate the premises to host the ICG should an emergency strike in.
Such premises are usually the offices of directors or the office of one of the deputy directors of any
given facility, yet no hospital has designated any backup ICG premises. Premises designated to host the
ICG operations shall have enough transmitting means, PC and copying machines, furniture, office
supplies etc. ICG shall have the lists with external telephone numbers (telephone numbers of key
decision-makers from within the Ministry of Health and other relevant stakeholders from the local and
central public authorities), as well as those of the decision-makers from any given facility, yet such lists
and rosters have to be updated in most hospitals.
Measures to be taken related to the threat posed by any hazard or should there an emergency occur
are to be entered into the hospital emergency response plans. Such plans have been designed in all the
assessed facilities. The quality of drafted plans is approximately comparable across all units, in most
cases emphasizing somewhat similar gaps in the planning process, such as: basically, all plans are
generic and are, by and large, declarative in nature. Most actions and procedures need to further be
specified. For instance, many of the plans are lacking provisions for the following: plan enforcement
modalities; subdivision or whole facility evacuation modalities (procedures, evacuation pathways,
aggregation areas etc.); confidentiality and evacuation of medical files; triage in case of significant
casualties; actions to be taken by guards should an emergency occur during weekends or holidays and
outside office hours; logistics and financial support to the staff involved in dealing with the
consequences of emergencies outside office hours; moral and psychological support to patients, family
members and staff. There is no clear-cut policy on the media and public relations ties, and how to
communicate with the relatives of patients in emergencies, when the number of data inquiries is over
ten times higher. An issue in terms of planning common for all hospitals is poor outline of the
cooperation measures carried out together with local public authorities and relevant municipal
services, which have to provide the hospitals with all the necessary support in terms of services,
transport, specialized technical units, human resources, assets, aiming at liquidating the consequences
of possible emergencies.
There are only occasional drills and simulation exercises for the response measures taken in case of
various emergencies or disasters and those are, most of the time, merely demonstrative in nature
rather than capacity building per se.
The modality of service delivery and hospital operation support systems, including in emergences, is
outlined, in particular, in the technical papers of devices and equipment, and it is seldom specified in
the terms of reference.
Most hospitals hold certain stocks of drugs, medical supplies and some other equipment in various
quantities and variety to ensure the work of any given hospital during the first days following the
onset of disaster. At the same time, there still is room for improvement in the planning of stocks,
replenishments and up-keeping of such stocks.

VI.
Conclusions
1. Following the completion of the “Republic of Moldova hospital safety index assessment” project,
there have been assessed 66 facilities out of a total number of 82 hospitals overall (80.5 per cent)
running currently operations in the country, with an appropriate safety index assigned to each,
which is a value representation of their ability to withstand and carry on running in the wake of
some possible disasters striking.
2. Safety index scores for the assessed hospitals vary quite significantly: from 0.29 up to 0.83.
3. 15 hospitals (6 national, 4 municipal, and 5 district-level), or 24.6 per cent of public hospitals in
the country, were listed under the safety group A, being indicative of high resilience to the impact
of some possible disasters, as well as of their ability to run operations safely under the adverse
conditions caused by emergencies.
41 hospitals (7 national, 6 municipal, and 28 district-level), or 67.2 per cent, were listed under
the safety group B, being indicative of an average resilience to the impact of some possible
disasters and of some shortcomings in securing a hospital’s operations during emergences.
5 hospitals (4 national and 1 district-level), or 8.2 per cent, were listed under the safety group C,
encompassing those hospitals that as per the used methodology fail to ensure resilience to the
impact of disasters and can not ensure safe running of operations during emergences.
4. Of the 17 national hospitals in place, 6 (35.3 per cent) were listed under the safety group A, 7
(41.2 per cent) – under the safety group B, and 4 (23.5 per cent) – under the safety group C.
Of the 10 municipal hospitals, 5 apiece, i.e. 50 per cent, were listed under the safety groups A and
B respectively.
Of the 34 district-level hospitals in place, 5 (14.7 per cent) were listed under safety group A, 41
(82.4 per cent) – under the safety group B, and 1 (2.9 per cent) – under the safety group C.
5. Most of the gaps and deficiencies reported under the safety of hospitals in the country are
related to the “Functional capacity” section – on average 26.4 per cent of parameters scored
“low”, including 34.8 per cent of the national hospitals, 27.6 per cent of the municipal hospitals,
and 17.0 per cent of the district-level hospitals.
The “non-structural safety” section ranked second, with 22.9 per cent of parameters on average
scoring “low”, including 18.5 per cent of national hospitals, 22.1 per cent of municipal hospitals,
and 22.9 per cent of district-level hospitals.
The “structural safety” section is relatively on a safer side, with 6.3 per cent of parameters on
average getting a “low” score, including 11.7 per cent of national hospitals, 4.0 per cent of
municipal hospitals, and 3.1 per cent of district-level hospitals.

VII.
 Strengthening hospital safety in the
Republic of Moldova
Recommendations
Based upon the above assessment results, the assessment team came up with a number of measures
aiming at strengthening the hospital safety in the country, as follows:
o Design and implement a national program to strengthen the safety of public health care facilities,
with focus on hospitals, in emergencies.
o Have the management of each of the assessed hospitals, together with its respective founder,
review the assessment results, identify weak links in ensuring hospital safety, develop and take
measures towards liquidating existing shortcomings, as to beef up hospital safety in emergencies.
o Have the Ministry of Health, National Health Insurance Company, and health care facilities earmark
funds specifically allocated to build the response and liquidate the consequences of possible
emergencies.
o Review and operate amendments, as appropriate, based on modern approaches, the hospital
emergency preparedness and response plans and develop one methodology for all to that end.
o Coordinate and update on a regular basis the emergency preparedness and response plans of
health care facilities, jointly with other relevant entities responsible for ensuring response and
mitigating the consequences of emergencies (local public authorities, civil protection authorities,
utilities etc.)
o Plan for and provide the necessary technical means and assets for the options to beef up hospital
capacities to render health care services and treatment to a growing number of patients.
o Develop and add up a specific chapter on hospital safety in emergencies to the hospital
accreditation and evaluation standards.
o Perform renovation works, rebuilding, retrofitting, alterations, and scaling up of health care
buildings only based on the projects designed and checked upon as per the legal framework in
place and in full compliance with the normative instructions set forth for constructions.
o Enforce technical cards for the buildings in each health care facility by entering all relevant
technical data on the buildings and status of use.
o Plan for and take measures to provide all health care facilities with alternate sources of power,
water supply, heating etc.
o Keep up and use properly, together with timely renovation, the engineering networks of health
care facilities.
o Create and keep up stocks of drugs, consumables, general maintenance supplies, drinking water,
food, fuel etc. in all hospitals
o Ensure unhindered access to hospitals and neighboring territories for the specialized means
(ambulances, motorized units of fire fighters and rescuers, utilities etc.), together with appropriate
land marks.
o Strictly observe fire control measures in all health care facilities.
o Develop and carry out training programs for all relevant staff (managers, health workers, logistic
experts etc.) on their actions during emergencies.
o Plan for and run on a regular basis simulation exercises for emergencies in health care facilities.