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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 !
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