1. 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

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 notification rates (EU1995-2006)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 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
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: , , the present one
WHO technical assistance and significant financial contribution provided by the GFATM grants

5. ACSM interventions within the TB control in 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 control in 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 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 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

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