Romanian Health Care Reform Program

The Challenge

As part of its ambition to join the European Union (EU), the Government of Romania recognized that the country needed to undergo a series of health sector reforms to meet the quality standards for health care that are utilized in Western European countries such as England and France and make their systems more transparent. To accomplish this, Romania implemented a comprehensive set of health reform activities aimed at decentralizing the management of health care and strengthening the capacity of decentralized levels. The reform sought to address long-standing management and service delivery problems that had existed for a long time, including the widespread practice of unofficial payments for services and the lack medications and medical supplies in hospitals (requiring patients to bring their own).  As part of an agreement between the Governments of Romania and the United States, the Romanian Health Care Reform Program (RHCRP) was designed to actively address and implement activities for health care reform, reallocating resources to the primary health care (PHC) system and strengthening and improving services.

Overview and Objectives

Under a task order for the Global Health Technical Assistance and Support Contract (TASC), URC worked in partnership with the Ministry of Health of Romania to implement programs that would improve the quality of care by strengthening the primary health care system. By providing trainings for General Practitioners on good practice models using internationally accepted, standardized protocols, the project supported practitioners to establish a more organized approach to providing patient are and to develop better data management systems. The practice models were developed at three pilot sites in Bistrita-Nasaud, Suceava, and Brasov counties for preventive care services and treatment of hypertension and diabetes mellitus type 2, chronic conditions which were targeted for improvement.

While each of the three pilot sites varied in terms of political and socio-economic conditions, each group of officials under the direction of the public health authority was extremely supportive and fulfilled their commitments as stated in the partnership agreement. The partnership for capacity building succeeded in initiating a process for health care improvement in the pilot sites that addressed many of the reform issues in accordance with the Minister of Public Health’s agenda of high priority reforms. The key stakeholders demonstrated their ability to function in a cooperative manner at the county level to prioritize the most critical health conditions of the public.

Achievements

One of the initial successes of RHCRP was the URC team’s close collaboration with the various departments in the Ministry of Public Health (MoPH) to support the reform laws that had been proposed by the current Minister of Public Health and passed by the Romanian Government and the Parliament. URC supported Minister Nicolaescu’s efforts on the health reforms through the provision of technical assistance primarily to the working groups for the various departments. Through the organization of workshops and the provision of appropriate expertise, focused on priority activities identified by the Minister of Public Health, the RHCRP team empowered stakeholders and promoted sustainable and strong collaboration at the district and local levels. The training workshops as well as multiple expert working sessions culminated in the development of a Health Policy Toolkit that supported health policy capacity building of key stakeholders at all levels.

The development of secondary legislation supporting the new reform laws resulted in significant contributions that were formulated and developed through workshops conducted at the national level, especially in the areas of private health insurance, primary health care, and hospital accreditation. Most of the activities related to the secondary legislation were drafted and then published on the Ministry of Public Health website.

Quality assurance guidelines were introduced in the pilot sites to improve the organization and delivery of primary health care. Based on existing guidelines for PHC prevention, conceptual models were developed and a Quality Assurance (QA) system designed and implemented successfully by 29 PHC physicians in the three pilot counties of Bistrita-Nasaud, Suceava and Brasov. Implementation tools were developed and tested in the pilot sites.  In the preventive care model, the risk assessment tool was designed as a flow sheet to orient adult health maintenance episodes (risk-o-gram) as well as a flow sheet, a chart of age and sex preventive care schedules, a simple preventive care register, patient sheets to document information collected, and other job aides. For the chronic care model, flow sheets, protocols, and clinical pathway forms that assisted in the decision process and improved the patient record of clinical information were introduced, along with a standard referral form for a diabetes diagnosis and a patient register.

Given than more than 30% of the health care budget in Romania was allocated to the purchase of pharmaceuticals, more efficient use of the resources allocated for pharmaceuticals and increased access in the rural areas were key targets of the programs. The RHCRP team provided technical assistance at the county and national levels to develop better forecasting and allocation to improve availability of essential medications and their access in the rural and remote regions. Technical assistance was also provided to develop educational materials to inform patients about their medications for better understanding and compliance.