Quality of health services
Health care service reform started late and the quality of many services is still far from what is desired. More emphasis needs to be placed on community-based, better quality and more accessible services, especially for vulnerable groups. Because people in rural areas and poor communities having less access to health care, it has been observed, for instance, that the infant mortality rate in such areas is higher than in other parts of the country. The infant mortality rate among Roma children was found to be twice that of Romanian children.
The low level of breastfeeding negatively impacts on the health of babies and children. The concept of exclusive breastfeeding is widely unknown, and infants are given other liquids as early as the second month. The average duration of breastfeeding in Romania has consistently remained at around 5 months, while WHO recommends exclusive breastfeeding for 6 months, to be continued up to age 2 and over. Consequently, anemia rates have soared, with the highest levels found in children under 12 months in Transylvania, which has the lowest level of poverty and the earliest weaning practices.
The maternal health situation is equally of serious concern. Romania still has an unacceptably high rate of maternal mortality, higher than in other Eastern and Central European countries. Of the some 75 maternal deaths recorded every year, half are abortion-related, and half are obstetric-related. Women sometimes use abortion as a means of controlling the number of children in the family. Another piece of data pointing to the need for improvement in the system indicates that only 60% of pregnant women consulted a doctor in their first trimester. It is estimated that half of the women who die during delivery did not benefit from any pre-natal care.
Another challenge is the fact that doctors and nurses avoid working in rural areas. This led to a Ministry decision in 2004 to offer a EUR 2,500 start-up bonus to any doctor who decides to take a job in a rural area.
Plans exist for the rehabilitation of 600 village primary care units, with funds from the World Bank; another 2,000 units will receive equipment, according to an announcement by the Health Ministry. Romania has a total of 6,000 primary health clinics and 17,000 general practitioners. The system requires more than just rehabilitated clinics; it needs good human resources, well trained and motivated doctors and nurses.
At the recommendation of UNICEF and other players, the Ministry of Health set out in 2002 to form a national network of community nurses to tackle the problem of people whose health is not monitored because they have not registered with a doctor. The nurses work in the community in which they live, and because they know the people there, their interaction is easier. As soon as health problems are identified, the community nurses act as a link between the members of the community and the medical and social services. Their main task is to provide preventive health care services for children, mothers and pregnant women, as well as any other vulnerable people. They do a lot of field work, are therefore very knowledgeable about health needs in the community, and can be effective advocates with the local administration. The network does not presently extend to all Romanian communities, but because results have been very good in the past two years, it has started to grow. UNICEF is actively involved in this project in over 120 communities in six counties.
UNICEF launched a campaign in 2001 to promote breastfeeding, and directly supported the re-establishment of the National Breastfeeding Committee. All studies show that breastfeeding is very important for the health of both the child and the mother. Various studies also indicate that early initiation and longer duration of breastfeeding contributes to better bonding between mother and child, thus lowering the risk of abandonment and increasing the chances for the child’s proper emotional and intellectual development. In spite of benefits of breastfeeding being huge for the future development of the child, the rate in Romania continues to drop.
• UNICEF initiated and supported the awareness-raising campaign on the benefits of breastfeeding, through posters, brochures and billboards to promote breastfeeding, and a mother’s handbook which is distributed in maternity wards to all new mothers. TV and radio spots carried important components of the campaign and the message to mothers in rural and urban areas.
• UNICEF helped develop the National Strategy Paper for Breastfeeding Promotion 2003-2012 and the National Plan of Action for 2003-2005, which was officially launched by the Ministry of Health.
• 10 maternity hospitals have become baby-friendly hospitals, with support from UNICEF; another 9 have initiated this process.
• Training on breastfeeding has been offered to hundreds of health professionals (neonatologists, family doctors, nurses) in 20 counties.
• Over 250 community nurses were trained and 24 community nurse trainers were certified with UNICEF’s support.
• UNICEF supported the Institute for Mother and Child Care to finalize a study identifying the main causes of infant and under-five deaths at home. The results will be used to identify the links between infant deaths and the quality of perinatal services, and between under-five deaths and the quality of community health services.