Adrian Pană Bogdan Ileanu Cristina Vladu Ioan Suru

I. Slatina-Timi - Background

 Creation of ADAM structure  Refurbishment of health center  Staffing of the health center (one family doctor, 3 nurses for the population of 3000 persons, one stomatologist, etc)  Creation of a home care service  MEDIATEQUE service  Social pharmacy  Ensuring sustainable funding through contracts with the Insurance House, membership contribution, etc

 Home care services  82 % of diabetes patients have received a glucometers and 150 strips, direct relationship with the specialist doctor, diabetes passport (information about the disease, types of insulin, etc.)  24% of patients with HTA have received blood pressure meters, 65%have benefitted from  Patients that need revalidation materials whatever their illness receive materials form the MEDIATEQUE (special beds, toilet chairs, mattresses anti pressure sore, etc.)

II. Slatina-Timi- demographic indicators

III. Slatina-Timi- health risks profile

IV. Slatina-Timi- hospitalized morbidity

V. Slatina –Timi - Health outcomes

VI. Conclusions and reccommendations

 The risk profile of the community highlights risk factors as eating red meat, consuming salt, drinking alcohol as factors that are above of the national average;  Slatina-Timi faces high challenges such as increased risk profiles doubled with an accelerated growth of the population over 65 years old;  Even if Slatina-Timi is confronted with an increased burden of diseases appearing on a rapidly growing older population (rate of increase higher that the national and county one), the results in terms of health status are good: general mortality is on a decreasing trend although such tendencies are not found at national or county level

 The ratio of community nurses versus the number of the population existent in Slatina-Timi seems to be one of the determinant of the better health outcomes and lower resources utilization;  The MEDIATEQUE within ADAM is a good example for fulfilling the need of the community persons; it allows community members to understand in concrete terms what are thier rights/ entitlements, it enables them to trust the health team and be confident in the services received  Health data at present is collected and aggregated at county and national level; this leaves poor health data availability at the community level, with no proper information about its results in terms of population health.

 Slatina-Timi consumes considerable less resources from the health budget as the most expensive level of care, the hospital, is the less utilized by Slatina-Timi patients.  The ratio of one community nurse per one thousand population has proven useful and successful in activities such as the proper monitoring of newborns and pregnant women, for monitoring chronic diseases, arranging patients’s appointments to specialist care/ hospital;  The recipe of success is comprised of several factors: fully staff Health Center, proactive personnel, community organization into Belgian mutualistic principles and values  Monitoring systems of health data at local level is of tremendous importance for health systems that should be designed at county and national level in order to enable comparisons between results of different communities

 Prevention campaigns in Slatina-Timi should focus on healthy lifestyle education for lowering the consumption of red meat/ salt intake, alcohol and tobacco reduction.  The local level should have better access to information with regard to its population health, the trends of main health indicators, etc.;  Templates for collecting data and software to analyze data in real time and present decision makers with main findings may be developed at national level;

 As a model of cost effective intervention, Slatina-Timi model should be further documented and disseminated nationwide.  The example of the ratio of community nurses per number of population as well as their role in the provision of preventive activities, home care services that are associated with the good results in health outcomes and health resources consumption could represent the basis of a public policy / be disseminated countrywide;  The health system should recognize trends of increasing needs and provide adequate funding and resources for solving the issues as close as possible to the beneficiary (at community level); this would prevent much of the unnecessary spending that otherwise appear in overutilization of the upper levels of care.

As a general conclusion, Slatina –Timi is a valuable example of organizational set up, good performance of a health care team at community level resulting in more trust of the community towards its health care team, better health of the population and lower consumption of resources. Defining policies to complement this model – i.e. support with additional monitoring and evaluation efforts-, ensuring adequate sustainable funding, defining policies to enable the dissemination of this model of health care organization would be beneficial to the health of other communities as well as to the nation’s health.