Minimizing health inequalities in rural population through pilot integrated medico-social centres

Abstract

Abstract Problem In Romania about 45% of the population (about 9 million people) still live in rural settings, having more detrimental health indicators and a poorer access to medical and social services compared to population living in urban. Description of the problem Under the Swiss-Romanian Cooperation Programme, a public health intervention was implemented in seven rural remote communities from Romania, aiming to increase access to basic medical and social services for the people living in those communities, with focus on the most vulnerable ones and to facilitate integration between medical and social services at the community, county and national level. In the first phase a decentralized training in health projects has been provided for local teams coming from eighteen rural remote communities which expressed their interest to be involved in the intervention. after the training, each local team developed its own pilot project for building a local model of integrated medico-social services. In the second phase, best projects were selected for implementation and received financing. All local teams were supported in the implementation of the model by a central coaching team, which had the role to provide technical advice and to facilitate mediation with the county and central authorities from the medical and social protection sector. The third phase aimed to capitalize the experience from the field and the lessons learned on three layers: local community, county level and central authorities. Results Seven medico-social centres were founded in the rural communities and continued to operate after the project end, serving around 20000 inhabitants, among which around half have medical and/or social vulnerabilities. Lessons Using a bottom up strategy in building medico-social integrated models of care in rural and remote communities is a key premise for the success and sustainability of the model. Key messages Involvement of local actors is essential when trying to increase access to medical and social care for rural, underserved communities. Facilitating access to general health and social protection systems is a key element for sustainability, instead of building new or specific models of services.