Abstract
Introduction: To achieve lifelong well-being and productivity, children need supportive environments, particularly during the critical period from maternal conception through the early years of life. The health sector, as a first point of contact, can assume a major role in identifying those children and families that need enhanced and specialist services from other sectors and ensuring a smooth transition to and collaboration with other sectors [1]. However, as indicated by recent UNICEF assessments in the region, home visiting systems, unlike other components of the health care system, have been left relatively unattended and are inefficient and uninformed by evidence and best practices. Aims: Evidence collected in Romania from 2012 to 2013 revealed a multitude of weaknesses in the provision of community-based services for vulnerable children and their families. Such weaknesses include i) the absence of an integrated approach for socially deprived children; ii) poorly defined CHW responsibilities are limited understanding at local level; and iii) lack of standardised monitoring and evaluation tools used by the County Health Directorates. Furthermore, there is a large variation from county to county and community to community in approaches to delivering basic care to rural populations and vulnerable groups. Yet, international and national evidence shows that home visitors (CHWs, community nurses and Roma health mediators), more than any other category of health professionals, have the potential to contribute to improved child survival, health and well-being, as they meet families in their home environment, often repeatedly, and over an extended period of time [2]. Results: An external evaluation of the model project for developing integrated community based services, with special focus on social assistance and community health, has produced overwhelming proof that the role of polyvalent home visits and outreach services is highly relevant to the rural communities in Romania. The evaluation also advocates an urgent and determined policy response [3]. Conclusions: The health reform initiated last year is promising. The draft National Health Strategy 2014-2020 has a specific objective promoting integrated community health services; this is also based on the evidence and best practices provided by UNICEF and the Centre for Health Policies and Services, during the 2012-2013 implementation of the model project. Furthermore, in order to achieve expected results by 2020, collaboration with other initiatives in this field (Swiss – Romanian Cooperation programme, EEA programme, other projects funded by EU structural funds) should be considered to avoid overlap and to build up a sustainable and coherent framework for further developing integrated community-based services. In this context, developing an enhanced and polyvalent role for community professionals is key for moving beyond child
Highlights
To achieve lifelong well-being and productivity, children need supportive environments, during the critical period from maternal conception through the early years of life
Evidence collected in Romania from 2012 to 2013 revealed a multitude of weaknesses in the provision of community-based services for vulnerable children and their families
Such weaknesses include i) the absence of an integrated approach for socially deprived children; ii) poorly defined CHW responsibilities are limited understanding at local level; and iii) lack of standardised monitoring and evaluation tools used by the County Health Directorates
Summary
To achieve lifelong well-being and productivity, children need supportive environments, during the critical period from maternal conception through the early years of life. The health sector, as a first point of contact, can assume a major role in identifying those children and families that need enhanced and specialist services from other sectors and ensuring a smooth transition to and collaboration with other sectors [1]. As indicated by recent UNICEF assessments in the region, home visiting systems, unlike other components of the health care system, have been left relatively unattended and are inefficient and uninformed by evidence and best practices.
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