Implementing the WHA resolution on palliative care – Romania

In Romania, the inclusion of a palliative care component in the World Bank project concerning Health Sector Reform: Improving Health System Quality and Efficiency Project for Romania [1] has been a major development for palliative care.

The project aims to develop specialised services throughout Romania between now and 2020, including 29 inpatient services, 90 outpatient services and 90 homecare teams and also basic palliative care services. This will be achieved through the training of GPs and nurses alongside adjustments of policy and funding mechanisms.

A Technical Working Group for Palliative Care was appointed [2] and this group, together with the Project Management Unit in the Romanian Ministry of Health, has worked on a situation analysis concerning palliative care in Romania, the initiation of a work plan, identification of consultancy requirements, and initiation of policy reviews. 

Policy

Palliative care has been included in the National Comprehensive Cancer Plan with objectives concerning education, service development and access to medication. This was launched in April 2016. Basic and specialised palliative care has been included in the Regional Development Plans.  Basic requirements concerning palliative care have been included in hospital accreditation for all hospital and quality criteria for palliative care inpatient units.

Education

A ministerial order for specialisation in palliative care for nurses has been drafted and the first specialisation programme for nurses is expected to be launched in September 2016.

Implementation

A pilot project to develop a basic palliative care model for cancer patients in the community through GPs [3] has been launched. In this three-year Swiss/Romanian project based on complex research (case studies, focus groups, national survey, national consensus), a model for basic palliative care for cancer patients in the community was developed.

In addition, 168 GPs were trained, out of them 25 GPs were selected to apply the model to 146 patients, an electronic patient file was developed, implementation data were analysed, cost calculated and at present dissemination and advocacy activities are being implemented.

There is also a project to develop volunteering programs for palliative care at the national level [4].

A consensus meeting was held for agreeing the basic palliative care model for cancer patients in the community in pilot project PF5: ‘Overcoming disparities on access to quality basic palliative care in the community: Partnerships to identify and improve clinical, educational, legal and economical barriers’.

Civil society have produced a report detailing progress on implementing the WHA Palliative Care resolution including case studies from Romania and other countries. You can access the report on the Worldwide Hospice Palliative Care Alliance website. 

References