50 lei per day…
The authors of the report found that the approved budget for a patient’s food, according to the IMSP SCM “Gheorghe Paladi” contract with the National Medical Insurance Company, is approximately 50 lei per day, which is a very low and insufficient price for the 4 meals served daily to a patient. The amount is even more insufficient in the context of food price increases.
Also, the members of the Commission found that the hospital’s food purchases are in compliance with the law on public procurement.
Hospital food
Image sent by an AGORA founder
Among the causes identified by the authorities for the modest menu offered to patients are insufficient control and reduced managerial responsibility over the activity of the food block on the part of the administration, the chief accountant and the head of the economy and planning section of IMSP “Gheorghe Paladi”;
“Utensils in the food block for slicing food products are outdated and are not replaced according to wear and tear,” the report also states.
The members of the Commission stated that in the context in which the allocation of financial sources for the feeding of hospital patients is carried out by the National Medical Insurance Company, through the contract with the medical institution on the “per case treated” formula, it is necessary to immediately revise, by increasing, the formula calculation assigned for feeding patients.
As a recommendation…
Following the verification visits, the Commission members created a set of recommendations for the relevant authorities. The report suggests, among other things, that the formula for calculating the amount allocated per patient be adjusted by CNAM and the Ministry of Health, regularly, to the rate of inflation and the increase in food prices;
It is also recommended that CNAM and the Ministry of Health carry out a comparative analysis on the integral costs for feeding patients in hospitals, but also potential contracting of catering type food, from professional public catering institutions, based on menus made by nutritionists.
The authors of the report emphasize that the benefits of the catering system would be that patients in all republican and municipal hospitals (at least in Chisinau municipality) would receive the same menus, all meals would be analyzed and approved from a nutritional point of view by specialists licensed dieticians, patients would have options for special diets and food safety and cost-effectiveness of food in hospitals would be ensured.
What does the Ministry say?
Ala Nemerenco, Minister of Health
Facebook/Ala Nemerenco
Although when the hospital food scandal started, many questions were directed towards the Ministry of Health. AGORA journalists tried to find answers to several questions on this topic, but the press officer from Health, Elena Mudrîi, explained that all the hospitals in the capital are under the management of the City Hall, and the money allocated for food is allocated by CNAM.
Later, the Minister of Health, Ala Nemerenco, wrote on his Facebook page:
“I do not shirk responsibility for everything I have taken on under the name of the ‘health system’. I want you to know that we have amazing doctors who do top surgeries, save lives, doctors who care.
But I also picked up on something else – those who don’t care. Who cheat on food purchases, because they get a bargain on macaroni instead of meat, or beans instead of fruit. Which one boils, what portion, yes, not food. Who put the food in cauldrons and take it through the wards like in a camp of sad memories.
The country is not changed only by the President through his efforts, nor even by the Government. The country is changed by the people. Maybe most of them.
The one who prepares tasty hospital soup like at home; the one who spreads butter on the bread of the little one from kindergarten and doesn’t put the package in his bag; the one who doesn’t stuff the “cottage cheese” pie with stuff that kills an elephant, etc.
The commission of the ministry for the control of patients’ nutrition has subjected some of the concerned institutions to verification. I will make the report public. I will return to this topic.
Until then, let’s think seriously about a lot of what’s going on around us”
Hospital food
Photo sent by an AGORA reader
The reality from the documents…
the law says that the coordination processes of food organization and control activities are carried out by the head of the medical-sanitary institution, who can delegate this function, by order, to one of the deputies.
Responsible for the organization, correct indication and differentiated use of patients’ nutrition based on standard diets in the medical and sanitary institution is the dietician and attending physician.
In each medical institution, the dietitian/nurse dietitian, in coordination with the chef, prepares the “7-day model menu”. In the menu, the name of the dishes according to the season is indicated and the “Distribution Menu” forms are filled out.
In the distribution menu, compiled on the basis of the “Technical Sheet”, the dietitian nurse indicates details about the amount of food products needed to prepare a portion, and in the denominator the accountant indicates details about the amount of products needed to prepare all the ordered portions.
Before the distribution of the dishes prepared in the hospital wards, they are tasted in order to appreciate their quality by the members of the special commission.
The “Tasting Committee” is approved by order in the following composition: the doctor on duty (president), the dietitian nurse and the chef-chef. At the same time, the tasting is carried out permanently by the dietician, and selectively, monthly, by the representative of the administration.
According to the Legislation, the diet in hospital medical institutions must consist of at least 4 meals a day.
Hospital food
Photo taken by an AGORA reader
On the sheets, the products are of high quality…
On the other hand, on the documents for the purchase of products for IMSP SCM Gheorghe Paladi the situation is equally ideal as in the case of legislation. 82% butter, 18% cheese, cream – organic 15% fat, chicken breast, beef, vegetables, dried fruit.
At the same time, in September 2022, the budget for the daily menu for a patient hospitalized in the hospitals of the Republic of Moldova was 22 lei. On September 29, the Government approved a 25% increase in spending norms for feeding patients in public institutions financed from the state budget.
The situation, between amazement and indignation
The Minister of Health, Ala Nemerenco, stated that the institution carried out an unexpected control in the chapter on the nutrition of patients in the food block of the Oncological Institute. Following these, the inspectors detected several irregularities, including the poor quality of the food, its storage in non-compliant places as well as hidden food packages, which were supposed to be taken home by the canteen workers.
Frozen fish was stored together with disassembled thawed fish, frozen turkey liver and domestic chickens without provenance documents. The greenery was black with moisture
Author: Ala Nemerenco, Minister of Health
On the other hand, several voices in the online environment are indignant at these statements, because the situation has much more serious precedents, against which no measure would have been taken.
“Now, all of us have been or have relatives who at least once in their lives have been through hospitals in Moldova and they all always complain and know what the situation is in terms of food. This is not the first time this subject has been raised… that the food is very bad. What does the minister do? He doesn’t see the problem of food.”
Author: Petru Scalețchi on the Facebook page
Ping-pong of statements and responsibilities…
Although the Ministry of Health claims that the decisions regarding the nutrition of patients are taken by the National Medical Insurance Company. The head of the Municipal Health Directorate, Boris Gîlca, presented a slightly different perspective in the show “Puterea a Patra” on N4.
“I remind Mrs. Ala Nemerenco, that the feeding of patients in hospitals is done directly by the National Medical Insurance Company (CNAM), an institution subordinated to the Government and, regrettably, under your direct supervision – based on the annual contracts with the medical institution.”
Author: Boris Gîlca, head of the Municipal Health Directorate
During the same show, Gîlca specified that the allocation of sources for food based on the contract per treated case is insufficient, and 50 lei for daily food for a patient for 3-4 meals is much too little.
The food is prepared in outdated food blocks, with outdated equipment, understaffed, using products that may not always be the best, but the cheapest
Author: Boris Gîlca, head of the Municipal Health Directorate
As for the limited resources of hospitals, Gîlca says:
“Only the Gheorghe Paladi hospital last year spent over 6 million lei for food. I assure you that if we were catering for 6 million lei, the patient would receive quality products, beautifully packaged, like in Europe. There are colossal losses due to the fact that the products are of poor quality, due to the very high cost of the heat agent, gas or electricity, kitchen equipment, salaries”.
According to the protocol pyramid for managing and allocating food resources in public hospitals, the National Medical Insurance Company claims that they have fully honored their financial obligations, and only the hospital management is responsible for how the money was managed. CNAM specifies that in the current year the institution contracted with the nine municipal hospitals for the planned hospital medical assistance over 1 billion 102 million lei, an increase of 127 million lei compared to the amount contracted in 2022.
Where did it all start?
“Some overcooked pasta and a burn of hooves and mats. Boiled porridges, to weigh as much as necessary on the scale, bors or soleanca with a smell that is difficult to describe, not a single thread of meat muscle. (…) While I was hospitalized I did not see even a slice of apple, salad or cooked vegetables being offered”, writes Irina Perciun, a patient of Municipal Hospital no. 1, in a post on a social media page.
Hospital food
Facebook/Irina Perciun
The post sparked a flurry of comments. Among them are those of patients who faced the same situation:
“I thought that in 7 years something would change there. But it can be seen that it’s not… I could pass out if a friend didn’t come to bring me food, I feed so disgustingly there”.
“In the same way, I was hospitalized when I was pregnant with No. 1, I was lucky that my husband brought me food, so I could feed myself properly, but the food was terrible and tasteless”
“I gave birth in July last year and was hospitalized a week before the birth and had a very bad menu of macaroni with milk and macaroni milk I didn’t go out for 4 days in a row.”
“As many times as I stayed in the hospital (maternity, children’s hospital) I never ate the food there because of the appearance and disgusting and cold. But food for children generally leaves something to be desired”.
“From my own experience, I confirm what was said about the bad nutrition at hospital No. 1. Having health problems during pregnancy, I was hospitalized several times, but, apart from boiled macaroni, I received nothing. At lunch, he would give us a soup for diversification, which was also sometimes with macaroni”.
Hospital food
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p class=”mb-8 px-6 md:px-0 font-bitter text-s17-l170 md:text-s18-l170 text-c121212″>right the study carried out by the National Bureau of Statistics in 2022, 13.5% of the people who were hospitalized had the need to feed themselves additionally. And people hospitalized in republican hospitals most frequently need additional food, approximately 19.6%.
