Addressing the needs of the vulnerable populations in Romania ACSM Subgroup Meeting Cancun, Mexico 30 November -1December 2009 Dana Farcasanu Foundation.

Addressing the needs of the vulnerable populations in Romania

ACSM Subgroup Meeting Cancun, Mexico 30 November -1December 2009

Dana FarcasanuFoundation Center for Health Policies and Services

ROMANIA

Located in Eastern Europe

Surface: 237500 km2

21,7 million inhabitants, 45% in rural areas

Gross national income/person: 7140 USD

Natural population growth: -2,7

Life expectancy: 71 years

Minorities: Hungarian (7.1%), Roma (2%), others

WHO HIT,2008

TB notification rates (EU1995-2006)

0

20

40

60

80

100

120

140

160

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

TB cases / 100,000

Romania

Lithuania

Latvia

Bulgaria

Estonia

Poland

Hungary

Slovakia

Slovenia

Czech Rep

Malta

Cyprus

countries joining the EU since 2004 Euro TB, March 2008

The TB and TB control in Romania

• TB incidence- the 1st place in EU, the 3rd in the WHO/EURO

• 25.567 cases notified in 2007 (115 cases per 100,000) • 3.500 TB deaths reported in 2007 (16 per 100,000).

• Presently, DOT coverage 100% • Average treatment success rate of 82% - getting closer

to the global target of 85%. • NTP – at its 3rd cycle:1997-2000, 2001-2005, the present

one • WHO technical assistance and significant financial

contribution provided by the GFATM grants

ACSM interventions within the TB controlin Romania (1)

• Funded presently mainly from external sources (GFATM, KNCV/Achmea, Red Cross (USAID/DOW-before 2007)

• Implemented through a proactive partnership NGOs (CHPS, Red Cross, Save the Children, Association of the TB patients, Romanian Angel Appeal etc) - NTP

• Innovative good practices at local and national level, based on strategic documents (The National TB Control Strategy, The National TB/IEC Strategy and Action Plan, The Mass-media Communication Strategy and Plan, a first draft of the ACSM Country Action Plan)

• Started with education/communication, shifting toward social mobilization and advocacy – still work to do

ACSM interventions within the TB controlin Romania (2)

Targeted levels at present:+++ patients, vulnerable communities (roma

communities, poor rural villages, street children, penitentiaries), professionals (general practitioners, community nurses, roma health mediators)

++ mass-media, local leaders/“champions”, local authorities

+ politicians, central government

Achieved results (1)

More than 16.000 beneficiaries/224 communities reached through an IEC campaign in the last 2 years (preventing TB infection, increasing case detection and care, fighting stigma and discrimination)

Achieved results (2)

11 communities from 2 high TB incidence counties reached by ongoing social mobilization and community involvement interventions (partnership with the local authorities, school interventions) -evaluation 2010

Examples of good practice – several schools took over the initiative, by organizing several education campaigns in their communities.

Achieved results (3)

Increase treatment adherence in TB patients - 70.000 patients and/or their relatives exposed, informed, educated over the last two years

Incentives for patients countrywide (Red Cross)

800 general practitioners and 60 NTP staff trained in advocacy and communication

Achieved results (4)

TB open events, involving communities and stakeholders – for ex. WTBD (national and local level)

Workshops with journalists (60persons trained) webpage and newsletter dedicated to the journalists (www.tbnews.ro)

Open competition with consistent prizes for journalists, students and patients

About the future ………..Challenges: knowing the weaknesses Low interest in the TB control area at political level /low

financial commitment

High turnover of the decision-makers

Lack of coherence within the decentralization process

No systematic approach or systematic funding of the ACSM interventions (from national sources)

Weak knowledge and interest of the local public administration to acknowledge the roma population and their problems (including TB)

About the future ………..BUT building on strengths Partnership and network at national level ( NTP-NGOs-

Association of TB patients-the network of penitentiaries, other institutions involved in the TB control area

Examples of good practice at local level/community involvement and community responsibility - to be documented and disseminated; innovative interventions

Enhanced ACSM capacity within the NTP staff

Mass-media at local level- reliable partner

Technical assistance and support provided by WHO Stop TB Partnership, DOW, KNCV; still GFATM grants

Still time to advocate !

And to empower our communities!

THANK YOU !