Snowball roll out approach in education on PEN 1 and 2 protocols for PHC teams in the Republic of Moldova

Natalia Zarbailov, Maria Muntean, Salaru Virginia, Angela Anisei, Zinaida Alexa, Diana Chiosa, Tudor Vasiliev, Ala Curteanu, Helen Prytherch, Manfred Zahorka, Tatiana Zatic, Ghenadie Curocichin

Keywords: primary health care teams, non-communicable diseases, essential interventions, education


The Republic of Moldova is known in the European region with a high prevalence and mortality caused by non-communicable diseases. The WHO package of essential non-communicable disease interventions for primary health care (PEN) is recommended for LMIC. After the feasibility study and adjustment for national PHC capacity it was approved for countrywide implementation by the Ministry of Health. PEN training of primary care teams to integrate the PEN 1 and 2 protocols in practice was taken over by the Swiss TPH with the Swiss Development and Cooperation Agency support. Training facilitation was insured by Healthy Life Project.


There are 1249 primary health care (PHC) facilities, including family doctors' centers, medical centers, family doctor’s offices, and health centers, around the country, mainly located in rural areas. Around 4 thousand family doctors and PHC nurses are employed in the primary health care sector and had to be trained for NCDs care. WHO experts trained seven national trainers only. That’s why to achieve 50% coverage of PHC teams with training; the process was conducted in a snowball roll out manner.


The trainings lasted 13 months since March 2019 and are to be finished in 2023, having been suspended for the duration of pandemic. 98 PHC professionals (52 FDs and 36 nurses) have been trained as PEN trainers. They conducted one-week training for 252 FDs and 457 PHC nurses in the first stage (2019-2020) and for 263 FDs and 571 PHC nurses in the second stage (2022-2023). In addition, 207 Health Center Managers and 151 primary care senior assistants were informed about the importance of the PEN implementation by National PEN trainers.


The involvement of the target groups’ representatives as PEN trainers contributes to capacity building at the local level, stresses the tasks shifting and provides trustful education activities.

Points for discussion:

Snowball approach in rollout process allows speeding up the training activities.

PHC teams’ involvement in education process stressed equal importance and allows a better understanding of individual professional roles as well provides trustful education environment.


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