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tred, as it works directly with families with children
under five who are at risk. The work of the local
multidisciplinary teams is focused on prevention, early
intervention, and assistance to reduce all risks to
children’s lives and health. This means that an individ-
ualised approach is used for each child, from planning
the assistance to delivering the necessary services to
the child and family.
Before the project started, institutionalisation of
the child was the usual method to respond to these
child protection risks. This study and project have
focused on how best to support families in caring for
their children at home, and thus reducing the risk of
institutionalisation.
THE MODEL:
Close cooperation of all
stakeholders
The assessment of children under-five is conducted
in accordance with existing health care protocols,
which provide for home visiting in the pre-natal
period. The first visit from the family doctor occurs
three days after the mother is discharged from the
maternity ward; and this is followed by visits from
the community nurse – twice a month during the first
three months, then monthly until the age of 12 months.
When an assessment raises concerns about the
well-being of a child or when concerns about the
social situation of the family are identified, the
medical staff inform the local authorities. At that point
the community team – including the family doctor,
community nurse, community social worker, repre-
sentative of the guardianship authority, and other
specialists as required – carry out an assessment of
the situation of the child and his/her family. Depend-
ing on the level of urgency, the assessment is carried
out immediately or within 24 hours after the concern
has been reported. During the next seven days a
more complex assessment is conducted. As a result,
the multidisciplinary team develops an Individual
Assistance Plan (IAP) for the child, which is imple-
mented and revised according to procedures of case
management. The child’s parents are involved in all
stages of the IAP implementation.
Multidisciplinary teams cooperate
According to the data provided by the Ministry of
Health, in 2015 there were 4.6 family doctors per
10,000 people registered at the national level, which
equates to approximately one family doctor per 2,174
persons. In the pilot regions, the number of family
doctors per 10,000 was 4.1 for Floresti and 5.0 for
Ialoveni.
However, the situation for paediatricians is very dif-
ferent. In 2015 there were only 1.2 paediatricians per
10,000 people at the national level, a slight increase
from 1.0 in 2012. This lack of human resources has a
negative effect on access to services for remote rural
populations, on monitoring quality, and on the efficient
involvement of multidisciplinary teams aimed at pre-
venting and reducing infant and under-five mortality.
While the project is implemented at the community,
district, and central level, the most intensive work is
realised at the community level through the direct in-
volvement of health specialists (general practitioners,
medical assistants, community nurses) and social
protection specialists (community social workers).
These specialists are part of the local multidiscipli-
nary teams, which may also include other specialists,
depending on identified needs.
At the district level, two specialists coordinate the
work: the medical specialist who supports the moth-
er and child and works within the districts medical
institution; and the social worker who works with
families and children at risk, assigned by the district
Social Assistance and Family Protection Depart-
ment. These two specialists monitor the implemen-
tation of the mechanism at the community level
and offer methodological assistance to members of
the local multidisciplinary teams in the process of
intervention.
Various levels of government are involved
At the central level, the Moldovan Ministry of Labour,
Social Protection, and Family and the Ministry of
Health coordinate the activity of territorial structures
responsible for the medical and social sectors. The
process is monitored via an annual report on the
implementation process of the inter-sector cooper-
ation mechanism at the national level. Based on this
report, the ministries further develop the normative
framework.
At the district level, two specialists
coordinate the work: the medical
specialist and the social worker