The pandemic deepens child vulnerabilities

A community nurse in every community can help those most in need and reduce the pressure on doctors and hospitals

Mihaela Spânache, a social worker in the town of Moinești (left) and colleague Roxana Asăndoaiei walk to reach the vulnerable children and their families in the community.
27 April 2020

Opinion article by Pieter Bult, UNICEF Representative in Romania


These days we all watch and praise doctors and nurses as they go to heroic lengths to provide assistance and treatment to the sick in hospitals, now the frontline in the fight against the COVID-19 pandemic.

As authorities poise for when the peak will reach us, we are all asked to do our part and stay indoors. Slowing down the spread of the virus will alleviate the pressure on the health care system.

At extraordinary times such as these we are more aware than ever of our need to be safe, to protect and provide for our families and loved ones. We are called to prioritise our needs in lockdown, adapt our work practices and adjust to unprecedented changes in the economy that are still unfolding.

For the most vulnerable children, these changes mean even higher risks of illness, poverty and social exclusion. Particularly, the pandemic increases their exposure to potential family separation, lack of access to medical services, violence, abuse, and neglect

Over 40 per cent of all children in Romania run these risks together with their families, especially rural poor children, Roma children, and children with disabilities. And one in 10 children in Romania is given birth by an adolescent mother.

Despite unprecedented improvements in the last 30 years, much remains to be done, as poverty and vulnerabilities faced by Romanian children are still among the highest in the EU, and major disparities persist.

Which is why I would like to commend another group of incredible professionals – community nurses, whose service is essential in the context of the pandemic and beyond, particularly to those who need it most, the vulnerable members of our society.

Although less visible these days, their work has made a tremendous difference in assisting those in need and relieving the pressure on the health care system.

The field work of community nurses has not only provided the much-needed medical care and immediate response assistance to the society’s most vulnerable, but in doing so, they have helped frontline pandemic fighters better focus on emergencies.

In the commune of Sarata, the community nurses make daily trips to check on the children and families in isolation, the disabled and the elderly who live alone, and do their groceries and medicine shopping. They also closely monitor the chronically ill and the pregnant women, especially the young first-time mothers and see that patients under treatment receive their medication and care. For that, they are in close contact with family and specialist doctors, who instruct the nurses and help them decide when a trip to the hospital is absolutely necessary.

Sarata is one of the communities in a program UNICEF in Romania has implemented with our partners, national, regional and local authorities, in 45 communities in Bacau, reaching over 46,000 households, including 21,000 children, with health, education, social and child protection services.

The external evaluation showcases fantastic results for the children, their families, and the entire community: 93 per cent of previously unregistered children are currently listed with a family physician, with 100 per cent of children at separation risk still living with their families. The number of babies with low weight at birth has decreased to zero, all children are receiving vitamin D and iron, almost all children under 6 months are exclusively breast fed, the percentage of underdeveloped children under 5 years old decreased three times and the percentage of unvaccinated children decreased with more than 40 per cent.

As we are encouraged by such outcomes, we gain perspective on the tremendous contribution community nurses could bring to all of Romania. We urge communities that have community nurses to fight to keep them and the ones that do not have to start recruiting using also the recent legislation changes that are allowing recruitment of essential personnel under the current crisis.

A million children are in Romania every year for at least one week, with most health services provided directly in the already overused tertiary healthcare sector. Community health services are less frequent, with self-reported unsatisfied need levels reaching 15 per cent for poorest families, a steep high compared to Norway and Austria’s 0.4 per cent.

Community nurses can change that, especially in the context of the pandemic. And while we only have 1650 community nurses in the country, World Bank estimated a need of 6.000.

There has never been a better time to act. As the COVID-19 pandemic evolves, it is a pivotal moment in community care, the availability and access to healthcare needs to be continued for all vulnerable members of our society. For children in disadvantaged communities and their families, the presence of community nurses is essential.

As in other sectors, health prevention and community health-based services bring a bigger return of investment, reducing the burden for the children and their families and the pressure on health specialized services.

Without timely and appropriate information and support, protection and measures to promote health, the difficulties these children and their families face in the pandemic can become more severe and trigger even irreversible consequences.

Our recent work has taught us a most needed lesson we can use to help prevent such consequences. And there has never been a better time to put it to work. As the vulnerable stand to become more vulnerable, community nurses are essential in every community in Romania.