Assessing The Respect Of Children’s Rights In Hospital In .
The WHO RegionalOffice for EuropeThe World HealthOrganization (WHO) is aspecialized agency of theUnited Nations created in1948 with the primaryresponsibility forinternational health mattersand public health. The WHORegional Office for Europeis one of six regional officesthroughout the world, eachwith its own programmegeared to the particularhealth conditions of thecountries it serves.Member sBelgiumBosnia and HerzegovinaBulgariaCroatiaCyprusCzech groNetherlandsNorwayPolandPortugalRepublic of MoldovaRomaniaRussian FederationSan TajikistanThe former YugoslavRepublic of MacedoniaTurkeyTurkmenistanUkraineUnited KingdomUzbekistanASSESSING THE RESPECT OF CHILDREN’S RIGHTS IN HOSPITAL IN THE REPUBLIC OF MOLDOVAThis report describes findings and recommendations of theassessment of children’s rights in hospital in the Republic ofMoldova that took place as part of overall efforts of the Ministryof Health in improving quality of paediatric care in hospitalssupported by WHO. In the framework of the assessment ofquality of paediatric care in hospitals, a set of specific tools wereused for the assessment and improvement of the respect ofchildren’s rights in 21 children’s’ hospitals.Assessing the respect ofchildren’s rights in hospitalin the Republic of MoldovaWorld Health OrganizationRegional Office for EuropeWHOLIS numberOriginal: EnglishUN City, Marmorvej 51, DK-2100 Copenhagen Ø, DenmarkTel.: 45 45 33 70 00Fax: 45 45 33 70 01Email: contact@euro.who.intWebsite: www.euro.who.int
Assessing the respect ofchildren’s rights in hospital inthe Republic of MoldovaBy: Ana Isabel Fernandes Guerreiro
ABSTRACTThis report describes findings and recommendations of the assessment of children’srights in hospital in the Republic of Moldova that took place as part of overall efforts ofthe Ministry of Health in improving quality of paediatric care in hospitals (QoC)supported by WHO. In the framework of the assessment of QoC, a set of specific toolswere used for the assessment and improvement of the respect of children’s rights in 21children’s hospitals.KeywordsCHILDREN, HOSPITALIZEDPATIENTS’ RIGHTSPEDIATRICSAddress requests about publications of the WHO Regional Office for Europe to:PublicationsWHO Regional Office for EuropeUN City, Marmorvej 51DK-2100 Copenhagen Ø, DenmarkAlternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on theRegional Office website (http://www.euro.who.int/pubrequest). World Health Organization 2014All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission toreproduce or translate its publications, in part or in full.The designations employed and the presentation of the material in this publication do not imply the expression of any opinionwhatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area orof its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximateborder lines for which there may not yet be full agreement.The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed orrecommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors andomissions excepted, the names of proprietary products are distinguished by initial capital letters.All reasonable precautions have been taken by the World Health Organization to verify the information contained in thispublication. However, the published material is being distributed without warranty of any kind, either express or implied.The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World HealthOrganization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do notnecessarily represent the decisions or the stated policy of the World Health Organization.
CONTENTSPageAcknowledgement . 1Executive Summary . 1List of annexes . 2Introduction . 4Part 1: Work methodology . 4Summary Chart 1. General information on the self-evaluation process and workmethodologies . 6Part 2: Analysis of the assessment results in hospitals . 8Standard 1. Quality services for children. 8Standard 2: Equality and non-discrimination . 11Standard 3: Play and Learning . 12Standard 4: Information and participation . 13Standard 5: Safety and environment . 15Standard 6: Protection . 16Standard 7. Pain management and palliative care . 17Part 3: Recommendations for hospitals and Ministry of Health in Moldova . 18Annexes. 21Annex 1. Hospital names and abbreviation . 21Annex 2. Standard 1: Quality services for children: 1.1. The hospital/health serviceensures that all institutional activities are based on the best evidence available and thatstaff are adequately trained: inputs from the self-evaluation teams. 21Annex 3. Standard 1: Quality services for children: 1.1. The hospital/health serviceensures that all institutional activities are based on the best evidence available and thatstaff are adequately trained: Children’s and parents’/carers’ views and evaluation . 22Annex 4. Standard 1: Quality services for children: 1.2. The hospital/health serviceensures that all types of services provided within the organization are regularly monitoredand evaluated: inputs from the self-evaluation teams. 23Annex 5. Standard 1: Quality services for children: 1.3. The hospital/health service has aCharter on Children’s Rights, in line with the United Nations Convention on the Rights ofthe Child: inputs from the self-evaluation teams . 23Annex 6. Standard 1: Quality services for children: 1.4. The hospital provides thepossibility for parents/carers to stay with their child at all times during hospitalization:inputs from the self-evaluation teams. . 24
EUR/00/50page 2Annex 7. Standard 1: Quality services for children: 1.5. The hospital/health service paysspecial attention to the rights of adolescents to health care: inputs from the selfevaluation teams . 25Annex 8. Standard 2: Equality and non-discrimination: Right 2.1. The hospital/healthservice fulfils the rights of access of all children without discrimination of any kind: inputsfrom the self-evaluation teams. . 25Annex 9. Standard 2: Equality and non-discrimination: Right 2.1. The hospital/healthservice fulfils the rights of access of all children without discrimination of any kind: inputsfrom the self-evaluation teams: Children’s and parents’/carers’ views and evaluation. . 26Annex 10. Standard 2: Equality and non-discrimination: 2.2. The hospital/health servicedelivers a patient-centred care, which recognizes not only the child’s individuality anddiverse circumstances and needs, but also those of his or her parents or carers: inputsfrom the self-evaluation teams. . 26Annex 11. Standard 2: Equality and non-discrimination: 2.3. The hospital/health serviceensures the respect of children’s privacy at all times: inputs from the self-evaluationteams. 27Annex 12. Standard 2: Equality and non-discrimination: 2.3. The hospital/health serviceensures the respect of children’s privacy at all times: Children’s views and evaluation. . 27Annex 13. Standard 3: Play and Learning: 3.1. The hospital/health service ensures theright to play for all children without discrimination of any kind: inputs from the selfevaluation teams. . 28Annex 14. Standard 3: Play and Learning: 3.1. The hospital/health service ensures theright to play for all children without discrimination of any kind: inputs from the selfevaluation teams: Children’s and parents’/carers’ views and evaluation. . 29Annex 15. Standard 3: Play and Learning: 3.2. The hospital/health service planning takesinto account children’s views of what is needed: inputs from the self-evaluation teams. . 29Annex 16. Standard 3: Play and Learning: 3.3. The hospital/health service providescomplementary play and educational activities: inputs from the self-evaluation teams. . 30Annex 17. Standard 4: Information and participation: 4.1. The hospital/health serviceensures an environment based on trust, information-sharing, the capacity to listen andsound guidance that is conducive to the child’s effective participation: inputs from theself-evaluation teams. . 30Annex 18. Standard 4: Information and participation: 4.2. The hospital/health serviceensures that all appropriate staff has the skills to engage in dialogue and informationsharing with children of all ages and maturity: inputs from the self-evaluation teams. . 31Annex 19. Standard 4: Information and participation: 4.3. The hospital/health serviceengages with children for the development and improvement of health care services:inputs from the self-evaluation teams . 32Annex 20. Standard 5: Safety and environment: 5.1. The hospital/health serviceinfrastructure is designed, furnished and equipped to meet children’s safety and mobilityneeds: inputs from the self-evaluation teams. 32Annex 21. Standard 5: Safety and environment: 5.2. The hospital/health service policiesand practice support the best possible nutrition for children: inputs from the selfevaluation teams. . 33
Annex 22. Standard 5: Safety and environment: 5.3. The hospital/health service policiesand practice ensure a clean environment for children at all times: inputs from the selfevaluation teams. . 33Annex 23. Standard 6: Protection: 6.1. The hospital/health service has in place a systemthat ensures protection of the right of the child against all forms of violence: inputs fromthe self-evaluation teams. . 34Annex 24. Standard 6: Protection: 6.2. The hospital/health service ensures that allappropriate staff has the adequate skills to protect, treat and refer children who havebeen a victim of any kind of abuse or unintentional injury: inputs from the self-evaluationteams. 34Annex 25. Standard 6: Protection: 6.3. Clinical research and trials are strictly regulated byhospital/health policy: inputs from the self-evaluation teams. . 35Annex 26. Standard 7: Pain management and Palliative care: 7.1. The hospital/healthservice policy ensures the prevention and management of pain: inputs from the selfevaluation teams. . 35Annex 27. Standard 7: Pain management and Palliative care: 7.2. The hospital’s/healthservice’s policy and practice ensure that palliative care is provided to all children who facelife-threatening illness: inputs from the self-evaluation teams. . 36
Assessing the respect of children’s rights in hospital in the Republic of Moldovapage 1AcknowledgementThis report was written based on the results of the paediatric hospitals surveys in Republic ofMoldova that aimed at identifying and assessing gaps between the full respect of children’s rightsin hospitals and the actual practice. The assessment was supported by the Ministry of Health andthe WHO Regional Office for Europe.The original set of tools developed by the Task Force on Health Promotion for Children andAdolescents in and by Hospitals and Health Services (Task Force HPH-CA) was adapted to thecountry context. In overall, a process of the assessment and report writing was coordinated byVivian Barnekow and Aigul Kuttumuratova from Child and Adolescent Health programme ofWHO Regional Office for Europe and Larisa Boderscova from the WHO country office. Thereport was prepared by WHO consultant Ana Isabel Guerreiro.We would like to thank Dr Jarno Habicht and the WHO Country Office team in Moldova and, inparticular, Dr Larisa Boderscova, Family and Community Health program officer, for support indata collection and dissemination, as well as for compiling them in summary tables. Special thanksgo to the national focal point Dr Ala Cojocaru and the hospital assessment teams for coordinatingthe process of primary data collection in the project hospitals.This report was produced within the framework of the Biennial Collaborative Agreement (BCA)2012–2013 signed between the Ministry of Health of the Republic of Moldova and the RegionalOffice for Europe of the World Health Organization.Executive SummaryThe assessment of the respect of children’s rights in 21 hospitals in Moldova was carried out uponrecommendation by WHO Regional Office for Europe with the aim to strengthen the evidenceand overall recommendations to the Ministry of Health on improving quality of care for children inhospitals in Moldova and, in particular, the area of children’s and parents’/carers’ rights. A set ofspecific tools were used for the assessment and improvement of the respect of children’s rights inhospitals.The findings and recommendations identified in the assessment of children’s rights in hospitals inMoldova related mostly to the inputs provided by the self-evaluation teams. In future assessments,it is recommended that children and parents/carers play a more significant role in the process. Interms of quality of care, the average answer provided by parents/carers in all participatinghospitals was “probably, we received the best care within the existing conditions”.Concerning the respect of specific rights, the main findings include the following: Moldova has notadopted a Charter on Children’s rights in hospitals at national level, that is why it has not beenadopted by health facilities and it is not displayed in hospitals; all medical doctors and nursesworking in paediatric care have a specialization in paediatrics and health care is delivered inaccordance to national guidelines and protocols, although these should be aligned to internationalstandards; relevant statistical data is collected and made available at the Ministry of Health’swebsite; there are mechanisms in place to ensure that all children have equal access to healthservices, including specific measures addressing Roma children; and attention is paid to the rightto food.The main gaps include: the lack of respect, protection and fulfilment of children’s right to play andlearning, information and participation; several actions are missing to ensure the effectiveness ofthe system in identifying children who have been a victim of abuse and in protecting them againstfurther violence; there are no protocols and procedures for the prevention and management of
page 2pain in hospital; and there is a need to improve the design and equipment of infrastructures in allparticipating hospitals.List of annexesAnnex 1. Hospital names and abbreviationsAnnex 2. Standard 1: Quality services for children: 1.1. The hospital/health service ensures thatall institutional activities are based on the best evidence available and that staff are adequatelytrained: inputs from the self-evaluation teamsAnnex 3. Standard 1: Quality services for children: 1.1. The hospital/health service ensures thatall institutional activities are based on the best evidence available and that staff are adequatelytrained: Children’s and parents’/carers’ views and evaluationAnnex 4. Standard 1: Quality services for children: 1.2. The hospital/health service ensures thatall types of services provided within the organization are regularly monitored and evaluated:inputs from the self-evaluation teamsAnnex 5. Standard 1: Quality services for children: 1.3. The hospital/health service has a Charteron Children’s Rights, in line with the United Nations Convention on the Rights of the Child: inputsfrom the self-evaluation teamsAnnex 6. Standard 1: Quality services for children: 1.4. The hospital provides the possibility forparents/carers to stay with their child at all times during hospitalization: inputs from the selfevaluation teamsAnnex 7. Standard 1: Quality services for children: 1.5. The hospital/health service pays specialattention to the rights of adolescents to health care: inputs from the self-evaluation teamsAnnex 8. Standard 2: Equality and non-discrimination: Right 2.1. The hospital/health service fulfilsthe rights of access of all children without discrimination of any kind: inputs from the selfevaluation teamsAnnex 9. Standard 2: Equality and non-discrimination: Right 2.1. The hospital/health service fulfilsthe rights of access of all children without discrimination of any kind: inputs from the selfevaluation teams: Children’s and parents’/carers’ views and evaluationAnnex 10. Standard 2: Equality and non-discrimination: 2.2. The hospital/health service delivers apatient-centred care, which recognizes not only the child’s individuality and diverse circumstancesand needs, but also those of his or her parents or carers: inputs from the self-evaluation teamsAnnex 11. Standard 2: Equality and non-discrimination: 2.3. The hospital/health service ensuresthe respect of children’s privacy at all times: inputs from the self-evalu
Assessing the respect of children’s rights in hospital in the Republic of Moldova page 1 Acknowledgement This report was written based on the results of the paediatric hospitals surveys in Republic of Moldova that aimed at identifying and assessing gaps between the full respect of children’s rights in hospitals and the actual practice.
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