INCREASED ACCESS TO FP AT PHC LEVEL IN

ROMANIA

Dr. Mercè Gascó

THE CONTEXT OF FP IN ROMANIA

• Low use of modern contraception: 30% of married women (RRHS 1999)

• Abortion as main method of fertility control: 2.2 lifetime abortions per woman (RRHS 1999)

• Need for modern contraceptive methods: 34 % (RRHS 1999)

HEALTH SYSTEM IN ROMANIA

• Policy barriers

• Barriers to increasing access and quality

• Emergence of RH as a health priority

• Primary Health Care reform: GPs as gatekeepers for integrate RH services

THE ROMANIAN FAMILY HEALTH INITIATIVE (RFHI)

– The FP/RH services strategy is being implemented though The Romanian Family Health Initiative (RFHI), a partnership comprised of MoH, JSI R&T, and Romanian NGOs supported by USAID

RFHI NATIONAL FP STRATEGY

• Increase access to FP services for vulnerable population, by integrating them into PHC

• Increase the number of PHC clinics (GP+nurse) offering basic RH services, especially in rural areas

• Increase the number of couples using modern contraceptive methods

RFHI MULTI-FACETED APPROACH

• Improving the legal regulatory and policy framework

• Improving the overall management of RH services

• Improving the skills of the RH service providers

• Increasing citizens awareness and demand for RH services

• Developing innovative models to improve accessibility and utilization of RH services for people with special needs: youth, roma…

THREE PILLARS APPROACH

BCC/SERVICES

MARKETING TRAINING HEALTH PROVIDERS

CONTRACEPTIVE SUPPLIES+ +

DIPLOMA

Counselling

Contraceptive technology

Pre-post natal care

STIs

LMIS

THREE PILLARS APPROACH

SUSTAINABILITY AS A KEY PROGRAMMATIC OBJECTIVE

• Integration with national health programs and effective national resource mobilization

Co-financing for RFHI activities to fill the National gaps

Partnership in planning and implementing the national FP program between donors, MoHF and local implementers

Institutionalization of training Cost-efficiency Capacity building Community involvement

RESULTS• The MoH has established the National FP/RH

Strategy including Standars & Protocols • Free Contraceptive distribution for elegible

population is ensured though a national LMIS

• Success is demonstrated by the consumption levels.

• The right populations are being reached.

• The program is valued by the providers and the clients.

GEOGRAPHICAL COVERAGE WITH FP

PROVIDERS IN PHC, (September 2003)5 – 20 %

20 – 50 %

over 50%

TIME TRENDS IN NUMBER OF PROVIDERS TIME TRENDS IN NUMBER OF PROVIDERS AND VOLUME OF SERVICES (CYPs) AND VOLUME OF SERVICES (CYPs)

2001 – 20032001 – 2003

260

18.050 1.080

53.570

1.906

108.850

2001 2002 By September 2003

Number of FP service providers

Couple Years of Protection

LESSONS LEARNED• A concerted effort of the government, NGOs and private

sector is needed to promote universal access to RH services

• Local Consultative Committees have facilitated the participation of NGOs and local government in RH strategy development

• Success is a result of efforts by a partnership providing training, IEC, commodities, and ongoing supervision and TA.

• Community participation is critical to increasing the demand for and quality of RH services

• Access to modern contraceptives is a key component of the success of the project, NO PRODUCT?- NO PRODUCT?- NO SERVICES !NO SERVICES ! - NO - NO PROGRAM !PROGRAM !