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Description
This project aims to provide free access to medical services for prevention, prophylaxis, diagnosis, treatment and monitoring of patients, while conducting risk awareness campaigns for at least 400 people who are part of the vulnerable population of Calarasi county, of which at least 100 people of Roma ethnicity. These services will be offered by the Romanian Red Cross through an online platform, using telemedicine.
Summary of project results
Romania has one of the highest poverty rates in the European Union. The rural environment remains below the urban environment in terms of social and economic development, facing specific challenges and the emergence of islands of poverty and social exclusion. The health of the population in Romania remains unsatisfactory, as a result of limited access to health services and the inefficient use of public resources.
Regarding the economic and social status of the population, the national objectives are convergent with the objectives of the European Union and with the objectives of the EEA Grants 2014-2021 and the Programme, namely the reduction of social and economic disparities and the strengthening of bilateral relations. This strengthens the internal market, which leads to a more prosperous Europe.
The proposed project is a solution to reduce social disparities within the population of Calarasi County. Through it, access to remote prophylaxis, prevention and curative medical assistance will be provided in a telemedicine system, for a target group of 400 people selected from the vulnerable population in 22 villages of the county, of which 100 will be Roma. Thus, the project also responds to the objectives formulated within the Emergency Ordinance 18/2017 on community medical assistance regarding:
- Facilitating access of the population, especially of people belonging to vulnerable groups, to health and social services;
- Promoting attitudes and behaviors favorable to a healthy lifestyle, including through health education actions in the community;
- Participating in the implementation of programs, projects, actions and public health interventions adapted to the needs of the community, especially people belonging to vulnerable groups;
- In addition to healthcare services, the target group will benefit from 9 health education courses offered online that will increase the awareness of individuals regarding the importance of a healthy lifestyle for maintaining health and will help them identify and become aware of the presence of risk factors to which they are exposed through individual unhealthy behaviors.
- The urban-rural differences are serious in terms of infrastructure. There are isolated areas in the countryside where the population does not have access to primary medical services, or even if there are secondary work points of family doctors, they do not have permanent doctors and the offices have rudimentary equipment. What is more serious is that it is precisely areas with poor or aging populations, and therefore with increased demands for medical care, that have these problems. There are currently policies to attract doctors to these disadvantaged areas, the problem of coverage with family doctors being serious in rural areas, and the population''s access to doctors of other specialties is even more difficult.
- The impoverishment of the population also means the existence of segments that cannot pay the costs of transportation to nearby medical units. According to data, for 40% of the rural population, the existence of a means of transportation and its cost represent a problem of access to medical services outside the locality. Equity in health means ensuring equal opportunities for an optimal state of health for all population groups, regardless of social category, environment, residence, level of education, gender, level of health, work capacity, etc.
- Through the proposed activities, the project will provide health education and promote changes in lifestyle, behaviors and environmental and social conditions. It will educate the target group on the importance of monitoring their health status so that health problems that may arise can be identified early, treated on an outpatient basis and relieve pressure on hospital services.
Moreover, remote medical consultations will be offered, in a telemedicine system, for a vulnerable population group for whom traveling to medical offices and centers is a problem. The estimated result is to reduce social inequities in terms of access to medical services among the population of Calarasi County.
The analysis of some aspects of the health status of the Romanian population based on data provided by studies carried out nationally and within the framework of international collaborations, but also of data from databases such as ECHI (European Core Health Indicators), revealed a poor health status of the Romanian population compared to the EU level. Moreover, the analysis of the socio-economic-medical situation of the rural population shows large differences compared to the urban population. Romania records one of the highest rates of deaths caused by cardiovascular diseases in Europe, cardiovascular diseases being the main cause of death in Romania – this situation is also an effect of the lack prevention programs. It can be said that the healthcare system in Romania is a curative and emergency one, which results in high healthcare costs, pressures on hospital healthcare, inefficient management of human and financial resources in healthcare, high costs for patients and inequitable access to healthcare services.
According to the INS, in 2016, 10,400 medical offices operated in urban areas, while in rural areas their number was 27.2 times lower, namely only 381 offices. Consequently, the number of inhabitants who visited a medical office was 23.4 times higher in rural areas than in urban areas. In 2016, there were only 0.4 medical offices per 10,000 inhabitants in rural areas, compared to 9.8 offices in urban areas, the INS states.
In Romania, the share of the vulnerable population in terms of health status is still high, resulting in high mortality, low life expectancy and healthy life expectancy (13 years lower than life expectancy), high morbidity and infant mortality rates.. Romania had the highest infant mortality rate in Europe in 2018. In 2018, 6 deaths per 1,000 live births were recorded, well above the European average of 3.4. The value is much higher in rural areas, which illustrates the poor sanitary conditions in which children are born in some rural areas. disadvantaged. The maternal mortality rate is decreasing, but Romania is still among the countries in Europe with the highest maternal mortality rate. A number of social groups do not have access to health services or have very difficult access: disorganized families, families with many children, the Roma population, people living in isolated rural areas and do not have the financial resources necessary to access more organized medical services in urban areas, the unemployed and people without a steady income, the elderly and the homeless.
Access to healthcare is difficult for a large segment of the Roma. The situation of the Roma community is showing very little progress. The living conditions of the Roma minority are characterized by informal settlements with poor hygiene. There 3.3% of the population of Romania is of Roma ethnicity, according to the 2011 census. Their living conditions are significantly worse than the national average, being characterized by informal, unhygienic and irregular settlements. 78% of Roma are at risk of poverty (compared to 35% for the non-Roma population); over 60% of Roma went to bed hungry at least once a month (compared to less than 20% for the non- Roma); 84% of Roma households do not have running water, sanitation or electricity (52% for the non-Roma population).
The lack of identification documents and/or property deeds prevents some Roma citizens from accessing public services. The sustainability of programs to stimulate inclusion and increase living standards is difficult, as existing projects are fragmented and rely heavily on external funding. Health inequity results in morbidity, disability, disability and early death being more frequent in disadvantaged categories of the population. Access to care for disadvantaged groups, although more necessary, is more difficult.
One in three Romanians is at risk of poverty and social exclusion. Although it has decreased slightly in the last two years, monetary poverty is one of the highest in the EU, affecting 23.6% of the total population in 2017. In 2014, 72% of families could not provide a minimum acceptable diet for their children under five years of age. The level of poverty and social exclusion in rural areas is twice as high as in urban areas.
Poverty is one of the important social determinants of health. Poverty is associated with a high rate of child mortality and increased morbidity, especially hospital morbidity. In the event of illness, poor people incur direct expenses for health and related services, which exceed 40% of total household expenditure.
Since in Calarasi County there are many localities that are in difficult situations, actions are needed to facilitate the population''s access to medical services. For the implementation of the project, 22 villages were selected from Calarasi County, villages where the following situations are recorded:
- villages where there is no medical office, located at a great distance from the localities where there are medical centers;
- villages with family doctors who do not have daily hours at the medical office;
- villages with family doctors who commute from distant localities, sometimes even from Bucharest
- villages where the doctor is present only 2-3 hours/week, which is insufficient for the health problems of the local community
- during the cold season or during rainy periods there is a risk that the roads will become impassable, doctors will no longer be able to travel to the office
The Romanian Red Cross, as the project promoter, intends to support local communities and contribute to reducing social inequalities in terms of access to medical services.
The project results were obtained through the following activities:
A2 - Carrying out Procurement Procedures Related to the Implementation of the Project. The procurement of technical assistance services in the use of an IT platform for providing specialized medical care remotely, consultancy and training in using the online platform, training in using the platform, respectively:
- equipment procurement: 22 tablets, 25 mobile phones, 47 SIM cards
- Procurement of consumables that will complete the first aid kits
- Procurement of advertising services: includes both mandatory promotion within the project and advertising materials for promotion among the target group.
- Procurement of technical assistance services in the use of an IT platform for providing specialized medical care remotely, consultancy and training in using the online platform, training in using the platform
A3 - Advertising and promotion activities of the project. An advertising link was created on the SNCRR website, through which the public could be informed about the project''s objectives and its implementation status.
A4 - Carrying out the procurement procedure and contracting the medical services company necessary to carry out the activities of online medical consultations and health education. The procurement procedure was carried out and the activity of online medical services and health education was contracted. The medical services purchased were for a minimum of 3,600 consultations offered in the telemedicine system, remotely, for people in the target group. The services offered free of charge to the target group included services preventive/prophylactic or curative medical services in the following categories:
- family planning, pregnancy follow-up and monitoring, childcare, child rearing and care, pediatrics, obstetrics and gynecology
- prevention/prophylaxis, monitoring and treatment of infectious diseases
- prevention/prophylaxis, monitoring and treatment of chronic cardiovascular diseases, cancer, diabetes, respiratory diseases, mental health.
A5 - Training of medical personnel and experts/volunteers involved in the implementation of the project in the use of the online consultation platform. The medical personnel who provided medical services to the target group benefited from individual training on the use of the purchased telemedicine platform. The training was provided by representatives of the service provider contracted following the public procurement process, so that they develop specific skills in operating the telemedicine platform and the remote medical consultation can be carried out without problems that may arise due to reasons related to the use of the technology provided. All participants in the training will receive graduation diplomas.
The training was conducted individually for each of the doctors, online, in the form of a practical course for the use of IT technology in the field of telemedicine, covering the following topics: using a mobile phone to create a doctor profile and become available to be contacted by patients, viewing the electronic medical record and the patient''s medical documents, adding recommendations, configuring response messages for patient appointments, adding prescription-type medical documents to the patient''s file, calling patients by phone or video, useful tips for a successful online consultation.
All volunteers also received individual training in the use of the telemedicine platform. The training was provided by representatives of the service provider contracted following the public procurement process, so that they could also develop specific skills in operating the telemedicine platform in order to provide assistance to the target group in this way so that the remote medical consultation can be carried out without problems that may arise due to reasons related to the use of technology. All training participants received graduation diplomas.
A6 - Identification of the target group and management of the target group and personal data. 423 people from Calarasi County were identified for the target group based on the target group selection form that contained the specific vulnerabilities identified and the socio-economic-medical profile of the inhabitants of Calarasi.
A7 - Conducting trainings for volunteers and the target group. Volunteers involved in the project benefited from two first aid courses and a communication course.
A8 - Delivery of IT equipment and facilities. 22 tablets, 25 phones and 47 SIM cards were purchased and delivered to the project partner for the provision of telemedicine medical services.
A9 - Delivery of consumables. 300 first aid kits and consumables were purchased and delivered to the project partner.
A10 - Conducting and implementing online consultations. Based on the purchased telemedicine platform, 4122 consultations were conducted
A11 - Distribution of promotional materials to the target population and other interested persons
A12 - Conducting webinars for the target group - health education. The necessary infrastructure for conducting webinars was purchased.