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 AND VOLUME OF SERVICES (CYPs) 2001 – 2003

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