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Description
The overall objective of the project is to increase access to healthcare services for vulnerable groups, including Roma, by developing an innovative prevention and intervention model for burn patients.
The specific objectives of the project have also been set as follows:
ObS1. Improve access to health services and provide health services for 655 vulnerable people.
ObS2. Train a minimum of 100 health professionals
ObS3. Increase awareness of the general population but especially vulnerable groups on the impact of long-term burns on the health status of the burn patient.
Summary of project results
Health and poverty are strongly interdependent. Health contributes significantly to poor health, while poor health is a major cause of poverty, by reducing a person’s ability to work and by the high costs of treatment and care. Poor people are vulnerable, get sick more quickly and die early compared to the general population. Poverty creates poor health through various social determinants such as: poor nutrition, unhealthy diet or inadequate living conditions (lack of decent housing, lack of water or poor housing, lack of water or poor hygiene). Burns are a problem of poverty, for example, burns from fires are primarily due to faulty electrical installations, improvised or unattended heating devices, smoking and open fires. The fire hazard is given by the specific activities carried out within the homes, amplified by certain favorable circumstances. In rural localities, the following dangerous situations are present, generated by:
- The tendency of housing agglomeration due to the fact that more and more people are opting to reduce the size of the area of land within the built-up area of a household;
- Building homes without obtaining the necessary permits in advance and therefore without observing minimum fire safety measures;
- Building household annexes without observing safety distances from the neighbors;
- Using combustible construction materials without them being properly protected against thermal actions;
- Storing feed in inappropriate and inadequate places from the point of view of fire prevention;
- Operating electrical installations with improvisations;
- Using open fire in closed spaces;
- Operating defective, improvised or improperly placed heating means with respect to combustible materials;
- Lack of supervision children;
- The existence of large quantities of combustible material (especially in the autumn-winter period) used for heating the home and preparing food;
- Failure to clean chimneys, which leads to the formation of pyrophoric coal on the inner walls of the chimneys;
- Burning of vegetable debris and garbage resulting from household activities;
When we talk about fires, children remain the most vulnerable category. In most situations, they cannot appreciate the dangers around them and lack the strength to save themselves from the fire. Of the total number of those who lost their lives, approximately 69% come from rural areas, and 31% from urban areas. According to a survey conducted by IRES for the General Inspectorate for Emergency Situations, one in four Romanians admits that they leave their children under 10 years old unattended in their homes. The study also highlights that permanent supervision of children is the most important thing to ensure the safety of little ones in the home or household. According to ISGU data, in the last 8 years, 378 children were victims of house fires, and 104 of them lost their lives. Most were unsupervised at the time of the fire. Burns are a global public health problem, leading to a significant number of deaths each year. At the same time, burn victims are a significant cause of morbidity due to the need for medical care in the acute period, as well as the subsequent physical and psychological sequelae, all of which place a significant burden on health systems worldwide. According to the Center for Disease Control and Prevention, every day over 300 children aged 0 to 19 years are treated in emergency rooms for burn injuries and two children die from burns. There are a number of risk factors for burns, both demographic and socioeconomic. Children under 5 years of age are prone to burns both due to inadequate supervision and in the context of child abuse. On the other hand, burns, regardless of their etiology, occur more frequently in communities of low socioeconomic status, those with limited schooling or literacy, in large families living in small spaces, where cooking and bathing facilities are the only available space, when there are health problems and when family members abuse alcohol and tobacco, when the heat source is improvised or smoke exhaust chimneys are poorly maintained. In addition to the many preventable diseases that are seen in health promotion practice, there is one health threat that the public still accepts as a given—accidents. Accidents, which include both unintentional injuries and violence, are a major public health problem that affects individuals, families, and the communities in which they live. Injuries and violence are widespread, affecting populations worldwide. Most events that result in injury, disability, or death are predictable and preventable. To do this, targeted information, awareness and education campaigns are needed, so that relevant information reaches precisely the groups that present the highest degree of risk. Burn prevention has a strong scientific basis and many strategies are cost-effective, but effective intervention efforts are not fully implemented or integrated into the community.
In the case of Romania, there is still a significant degree of disparity between the way of life of urban communities and that of the rural population, a factor that increases the risk of burns of any kind among vulnerable groups. Grigore Alexandrescu Hospital monitors approximately 50-1000 burn patients aged between 0 and 18 years, of which an average of 4000/year require hospitalization, sometimes long-term, specialized care for post-burn sequelae and frequently reconstructive surgical interventions, the failure to perform which in time results in the installation of irreversible functional disorders (locking of joints, inability to raise arms or move fingers). It is important to know that some of these children are social cases, abandoned, neglected children from large families with living conditions on the verge of subsistence with a suboptimal level of education for whom traveling to periodic check-ups from Bucharest is an unsustainable expense. In addition, for cases of mild and moderate burns, the lack of knowledge of the health and life risks that burns pose causes some cases to reach a specialist late, worsening the functional prognosis and increasing the risk of long-term mobility. Another aspect concerns the correct long-term follow-up of people who have suffered moafter a burn. It is not only about an adequate caloric intake, but also microelements, electrolytes and vitamins. Simultaneously with the correction of internal deficiencies, the burned patient needs psychological counseling, as well as long-term functional rehabilitation and periodic specialized interventions, so that they can integrate as well as possible into the family and society. Another problem identified is the lack of data at the national level on burn patients, as there is currently no registry of burn patients that provides data/information on their situation. The lack of reliable data on risk factors further hinders the development and adoption of effective burn prevention strategies; incomplete reporting of burn events leads to an underestimation of the extent of the public health problem.
The project proposes, through its activities, to contribute to improving prevention and reducing inequalities in the field of health. The general objective of the project is to increase access to healthcare services for vulnerable groups, including Roma, by developing an innovative prevention and intervention model for burn patients. The main activities develop specific tools that improve access to health services for vulnerable groups by
- Providing prevention services
- Training of medical personnel who interact with burn patients or vulnerable people presenting risk factors
- Developing an intervention guide that will be made available to stakeholders
- Creating a registry for burn patients that can be taken over at national level
- Raising awareness of the primary and secondary target group on the risk factors for burn accidents and the measures they can take for recovery and reintegrationderate and severe burns and who need nutritional and metabolic support, monitored permanently for at least the first year.
Creation of the burn patient registry and its population with information
- The technical specifications of the registry have been finalized and documented
- All requirements have been clearly defined and are in line with the needs of the users and the purpose of the project
- The specifications have been communicated and validated with all parties involved in the project
- A functional burn patient registry has been created and implemented
- The registry includes essential information about each patient, such as personal data, stage of burns, treatments performed and their evolution
- Population of the registry with patients from all over the country has begun
Results obtained
- 1 analysis of existing registries at national and international level
- Technical specifications for the creation of the burn patient registry developed
- 1 burn patient registry created
- 1 consensus workshop on the database structure organized
- creation of a database with potential support networks and their contact details;
- preparation of collaboration protocols and agreement on their format at the partnership level;
- sending invitations to the organizations identified and included in the database and signing collaboration protocols with NGOs;
- signing collaboration protocols with public organizations and NGOs for the development of support networks for burn patients.
- Invitations for collaboration were sent to various relevant organizations, including DSPs (Public Health Directorates) and NGOs
- Invitations were designed to initiate solid partnerships and to bring additional expertise and resources to the project
- Collaboration protocols were signed with organizations that agreed to get involved in the project
These protocols clearly establish the roles and responsibilities of each collaborating entity, as well as the method of information exchange
Results obtained
-Collaboration protocols signed with: Agora 2013 Association (NGO), Foundation for the Resource Center for Vocational Education and Training (CREFOP – NGO), Association for Health and Medical Programs (NGO), Association for the Economic Resources and Education for Development (CREED – NGO), Association for the Evolution of ROTAS (NGO)
- A consensus workshop was successfully organized with the participation of relevant stakeholders in the field of intervention for burn patients
- The workshop facilitated discussions, exchange of ideas and establishment of a consensus on the future direction and priorities of the project
- 3 online training sessions were organized for people from the Secondary Target Group
- The sessions covered the application of the intervention guide and ensured adequate training of staff for its effective implementation
- A qualitative research was conducted to analyze, validate real-life information regarding knowledge, attitudes, practices regarding burn prevention at the level of relevant groups. Based on the analysis, the content of the intervention guide was adapted
- A detailed intervention guide was developed and finalized, which will serve as an essential tool in the care and management of burn patients
Results obtained
- Intervention guide
- 1 consensus workshop organized
- 3 training sessions on the implementation of the intervention guide organized
- 1 intervention guide developed
A2. Training needs analysis
During the reporting period, the analysis of the activity calendar was started and work began on the notification for its update.
During the RIT2 reporting period, the project team conducted a training needs analysis in order to harmonize the proposed general topics with the real needs of the secondary target group. Interviews were held with each category of secondary GT for which training programs will be organized within the project.
Results
Interview guide for family doctors
Interview guide for community nurses and health mediators
- A total of 6 training sessions were organized and delivered, covering relevant aspects for the care of burn patients
Each session was structured to address specific topics, including medical interventions, burn management, effective patient communication, and other relevant aspects
- The medical staff that benefited from the training services provided within the project included medical professionals with various specializations, thus contributing to the enrichment of the collective skills needed in the management and treatment of burn patients
Results obtained
- Training material in the pathology of the burn patient
- 6 training sessions organized
- 18 days of training provided
During the RIT3 reporting period, the following activities were carried out:
- Collection of direct feedback from participants to assess how they perceive the quality of the program, the structure of the sessions, and the usefulness of the information acquired
Results obtained
- 1 evaluation report on the impact of the training program carried out
A3. Provision of prevention services
During the RIT2 reporting period, the experts employed in the project developed the recruitment and selection procedure for the target group for the project. Also, the activity of identifying the communities in which the prevention services will be provided was started.
During the RIT3 reporting period, the following activities were carried out:
- Specific materials were created to support the prevention services
- Prevention services were provided to a number of 244 people from vulnerable groups
- These services include awareness campaigns, preventive examinations and other interventions adapted to the specific needs of these groups.
- 700 first aid kits were purchased for the target group to be distributed to them in January 2024
Results obtained
- target group selection methodology (GT)
- prevention service provision protocol
- 461 vulnerable people included in the project target group
During the reporting period, the analysis of the activity calendar was started and work began on the notification for its update.
- Specific quantitative research methodologies were created for the 3 researches that were carried out within the activity
Relevant support materials were developed for the substantiation and implementation of the campaigns
- 3 CATI-type research and 3 research reports were carried out on:
- 1. evaluation study on the knowledge, attitude and behavior of the general public regarding the risk of burn injuries in children and their prevention
- 2 identification of the stages of the “Patient Journey” in the recovery/regaining of the functional level phase
- 3. Study on the level of awareness of the population regarding the importance of functional rehabilitation for the fastest and best quality integration, in the family and in society
Results obtained
- 3 CATI-type research and 3 research reports
- An advertising agency was contracted with which the creative process within the awareness campaigns was started
- 440 people from the target group of vulnerable people were approached 1 on 1 by the project''s community nurses and received relevant information about the project and were included in the target group
- Support materials were created that were then used in relation to the target group, regarding the importance of reducing the risk of burns in the home environment, the importance of supervising minors and the role of the community in raising awareness of the risks and effects of burns
- Project experts went to the field, to vulnerable communities and communicated directly with the target group to better understand the concrete needs and provide relevant and specific information to their needs
Results obtained
- Support materials created
During the RIT3 reporting period, the following activities were carried out: The process was started procurement for campaign evaluation services, which will be implemented in March 2023
During the reporting period, the project header was created and approved by the Program Operator. Also, the press release was sent to the OP for verification and approval. During the RIT3 reporting period, the following activities were carried out:
- Visual materials specific to the project''s communication needs were created
- Photo-video sessions were organized in Grigore Alexandrescu Hospital to reflect the real situation of the burn patient and the treatment and recovery process
Results obtained
- Project header
- Project overview
Social media posting plan
- visual materials specific to communication needs
A5. Project management
During the reporting period, PP carried out the administrative steps to organize the implementation team and the recruitment and selection competition for extra-organizational staff.
A1.1. Creation of the burn patient registry and its population with information
Results obtained
- 1 analysis of existing national and international registries
- Technical specifications for the creation of the burn patient registry carried out
- 1 burn patient registry created
- 1 consensus workshop on the database structure organized
A1.2. Development of support networks for burn patients and their maintenance
Results obtained
- Database with Potential Support Networks
Collaboration protocols signed with: Agora 2013 Association (NGO), Foundation for the Resource Center for Vocational Education and Training (CREFOP – NGO), Association for Health and Medical Programs (NGO), Association for the Economic Resources and Education for Development Center (CREED – NGO), Association for the Evolution ROTAS (NGO)
- Protocols concluded with support networks
A1.3. Development of the intervention guide
Results obtained
- 1 literature review report
- Technical specifications qualitative analysis
- Intervention guide draft 1
- 1 consensus workshop organized
- 3 training sessions on the implementation of the intervention guide organized
- 1 intervention guide developed
A2.1. Training needs analysis
Results obtained
- Interview guide for family doctors
- Interview guide for community nurses and health mediators
A2.2. Development of training materials and implementation of the training program
Results obtained
- Training material in burn patient pathology
- 6 training sessions organized
- 18 days of training provided
A2.3. Evaluation of the impact of the training program
Results obtained
- 1 evaluation report of the impact of the training program carried out
A3. Provision of prevention services
Results obtained
- target group selection methodology (GT)
- prevention service provision protocol
- 461 vulnerable people included in the project target group
A4.1 Organization and conduct of the studies necessary to substantiate the campaigns
Results obtained
- 3 CATI type research and 3 research reports
A4.2 Development of the campaign concept and campaign implementation
Results obtained
- Support materials created
A4.4 Project information and publicity
Results obtained
- Project header
- Project overview
- Social media posting plan
- visual materials specific to communication needs
A5. Project Management
Results Obtained
Activity in Progress
- Publication of the results of the recruitment and selection competition for extra-organizational personnel
- Notification No. 1
- Notification No. 2
- Notification No. 3
- Addendum No. 1 to the Financing Agreement
- Advance Request 1
- Advance Request 2
- Personnel files engaged in the project
- Monitoring and reporting procedure
- Financial procedure.