The second-tier authorities at the time sharply criticized this reform. There were fears that the central government was seeking to appoint “its” people to the posts of chief doctors, and that the hospitals themselves would be politicized. Today, the former health minister claims that since the beginning of the reform, about 1.4 billion lei has been invested in the modernization of district hospitals, a record amount in the history of the system.
Hospital reform in the vision of former Minister Alla Nemerenco
Logos Press asked the author of the reform project, former Health Minister Alla Nemerenco, for a comment. She said that the main goal of transferring district hospitals to the subordination of the Ministry of Health was to bring medical services closer to the people, especially to the population of rural areas. “Paradoxically, decentralization of services required administrative centralization of hospitals.”
Alla Nemerenko: “The law was changed to accelerate the modernization of hospitals, which at that time had poor infrastructure: outdated engineering networks, lack of ventilation, high risk of hospital-acquired infections, low level of patient safety, lack of basic and modern equipment. At the same time, the changes were aimed at improving the population’s access to quality inpatient medical services and ensuring that hospitals have conditions that meet international standards. A 2014 WHO study showed that district hospitals remain “islands” stuck in outdated management models. The changes were designed to improve the management of the hospitals, which by then had accumulated serious debts and some were even on the verge of bankruptcy.”
As founding members, district councils were obliged under the Health Protection Act to invest in hospital infrastructure. In 2020, the total investment of district councils in all district hospitals amounted to 76 million lei, and in the first six months of 2021 – 35 million lei. Moreover, this was the period of the COVID-19 pandemic, when more resources were provided than ever before. Moreover, the financing of district hospitals was uneven due to differences in the economic development of the regions. The lack of necessary equipment caused significant revenue losses and put public hospitals at odds with private institutions. This led to a deterioration in the quality of services, staff outflow and the inability to coordinate regional medical care. Modern technologies, including minimally invasive surgery, were practically absent in the districts, which reduced the interest of young doctors. “Today the situation is changing – many district hospitals are already equipped with endoscopic equipment,” the former minister specified.
For example, Soroca district hospital has received investments of about 50 million lei in the two years after the beginning of the reform, the largest hospitals – 30-40 million lei, small hospitals – 8-20 million lei. “This is incomparable with several hundred thousand or at most one million lei per year, which they received from local authorities. And the point is not that local authorities are bad, but that they simply do not have such finances, they cannot collect enough taxes locally to invest such sums,” emphasizes Alla Nemerenco.
According to her, the reform allowed to change the internal structure of hospitals, to develop a bed fund for stroke, palliative, geriatric patients, rehabilitation and emergency services. District hospitals have been given a chance to become modern: they are equipped with thousands of pieces of equipment, from ventilators and anesthesia machines to tomographs, sterilization systems, oxygen stations and generators. Solar panels have been installed in eight hospitals, and 12 other buildings are undergoing major energy-efficient modernization as part of the INSPIREE project worth about 40 million euros.
The Ministry of Health has established 13 stroke centers (9 district centers), which has halved hospitalization time, increased thrombolysis by 5 times and thrombectomy by 110%. In 2024, 4,795 patients were examined, 3,377 had their diagnosis confirmed and treated. 12 perinatal centers were strengthened, free audiological screening of newborns was introduced; maternal mortality decreased to 2 cases per year (9.8 per 100,000). There are 14 early intervention centers for children, 12 colposcopy centers, 5 hospitals provide chemotherapy, 11 institutions help victims of gender-based violence. The employment rate of young doctors in districts and rural areas has increased from 14.8% to 48%. Doctors have accessed training and internships abroad.
“Hundreds of wards and laboratories have been overhauled. The reform improved working conditions for medical staff, increased the population’s access to quality services, reduced waiting times, simplified administrative procedures and eliminated corruption schemes. From 2023 to mid-2025, about 1.4 billion lei was invested in the modernization of district hospitals – a record sum in the history,” Alla Nemerenco said.
What the beneficiaries think
District hospital managers say that after the redistribution of bureaucratic functions, the situation in many institutions has improved. Funding for modernization and equipment has increased, and cooperation with district councils continues. The only disadvantage is that superiors are far away.
Nadezhda Ulinich, chief physician of the Nisporeni district hospital, said:
“We have financial support for projects and equipment. We are very grateful, and at the beginning of each year we meet with the Minister. We put on the table the projects and actions that need to be done, and where possible we get financial support. We have the same relations with the district council as before – every week on Mondays we meet – all decentralized services – to report on the work done during the week and discuss joint projects for the future”.
Nisporeni district is led by a PAS chairman. In such a situation, one might assume that the Ministry of Health shows favor to their hospital. But, as Logos Press interlocutors pointed out, even in the districts where the chairman does not represent the ruling party, there is no infringement of the district hospitals, and in some districts the financing has even improved considerably.
Artur Kovacs, head doctor of the Tarakli district hospital, said:
“The renovation of laboratories, replacement of the elevator were financed, and the oxygen station received equipment worth 1.5 million lei. We are satisfied with the result. The only change is that now all bureaucratic issues are solved through the ministry, not through the district council. But it is not difficult, especially considering the possibility of working online. The district council still helps, participates in TB and hepatitis prevention programs, finances blood transfusion departments. I can’t say how things are in other districts, but our attitude towards the hospital has not changed – it is still a district hospital.
Olga Gorban, a councillor of the Cimislia City Council, acknowledged that although the district health care system had previously received investments for modernization, the investments have increased since the hospital was transferred to the Ministry.
Olga Gorban: “A lot of things were done before. Our colleagues from Romania allocated funds for the major reconstruction of the surgical department. Funds were allocated to pay the travel expenses of doctors who traveled to work from other settlements. A building with 49 social apartments was constructed for the doctors in order to provide them with housing in Cimislia. At present, it is planned to insulate the polyclinic building, where the hospital is located, and new financial injections are expected. But the hospital team is working closely with the district council, which continues to help. Although, it must be admitted that patients complain that when dealing with emergencies, more attention is paid to procedures and documents than to their immediate needs. But in general, we have to call things by their names – things are going well in the district hospitals.
In defense of the district councils
District hospital management is generally loyal to the central government and the ministry because they are their employers. But there are problems that are perhaps embarrassing to talk about. For example, the fact that the “divorce” from hospitals has left district councils as debtors.
PCRM deputy Inga Sibova points out that the hospital reform proposed by the ruling party at the end of 2022, like many of their initiatives, was put on the Parliament’s agenda as a matter of urgency, discussed, approved and implemented.
Inga Sibova: “I must say that many district chairpersons, councilors, employees of the medical system, were extremely indignant at this approach, as direct subordination of hospitals to the Ministry of Health meant a disconnection from local realities, peculiarities, as well as financing of particularly remote hospitals on a residual principle. It should be noted that many district councils over the years have invested huge funds in district hospitals, even taking large loans to improve the infrastructure of hospitals, to make major repairs, and in the end the hospitals were transferred under the Ministry, and the district council remained a debtor and obliged to repay the loan.
When the hospital management actively works, demands, achieves, both patients and employees feel the improvement. But there are hospitals, unfortunately, which do not get the favor of the Ministry, and there is no improvement, and the quality is worse, and the district council has removed this responsibility, and the hospital falls into disrepair”.
