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Dana Farcasanu Foundation Center for Health Policies and Services

Addressing the needs of the vulnerable populations in Romania ACSM Subgroup Meeting Cancun, Mexico 30 November -1December 2009. Dana Farcasanu Foundation Center for Health Policies and Services. ROMANIA. Located in Eastern Europe Surface: 237500 km2

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Dana Farcasanu Foundation Center for Health Policies and Services

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  1. Addressing the needs of the vulnerable populations in RomaniaACSM Subgroup Meeting Cancun, Mexico 30 November -1December 2009 Dana Farcasanu Foundation Center for Health Policies and Services

  2. 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

  3. TB cases / 100,000 160 Romania Lithuania 140 Latvia 120 Bulgaria 100 Estonia Poland 80 Hungary 60 Slovakia Slovenia 40 Czech Rep 20 Malta Cyprus 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 TB notification rates (EU1995-2006) countries joining the EU since 2004 Euro TB, March 2008

  4. 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

  5. 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

  6. 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

  7. 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)

  8. 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.

  9. 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) • 800general practitioners and 60 NTP staff trained in advocacy and communication

  10. 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

  11. 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)

  12. 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

  13. Still time to advocate ! And to empower our communities! THANK YOU !

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