Context
The COVID-19 pandemic revealed numerous longstanding problems in the health system that weakened its reaction to the new threat. Shortages of human resources and the relative weakness of primary health care (PHC) provision, including lack of digital tools in PHC, were among the key shortcomings. As a result, access to basic care and preventive measures were severely obstructed during the pandemic, and this contributed to outbreaks of infections in the hospitals (Džakula et al., 2022). The COVID-19 pandemics constituted a step back from the advances reached by 2019, both in terms of health and socio-economic development (Scintee and Vladescu, 2022). In this context, the European Commission’s Recovery and Resilience Facility was seen as a great opportunity to support the post-pandemic recovery in Romania.
Impetus for the reform
Following the publication of the technical guidelines by the European Commission (EC) in 2021, the Romanian Ministry of Health started a comprehensive public consultation process to identify the main reforms to be included in the health pillar of Romania’s Recovery and Resilience Plan. The proposals were also inspired by the European Council’s specific country recommendations for Romania issued in 2019 and 2020 (EC, 2021). The Plan was approved by the EC in September 2021 and the first instalment of 1.85 billion Euros, out of a total of 14.2 billion Euros in approved grants, arrived in December 2021 (MIPE, 2021). The Plan’s health component includes three main reforms:
- Increased capacity for the management of public health funds;
- Increased capacity to undertake investments in health infrastructure; and
- Increased capacity for health management and human resources in health.
The three components are implemented in parallel, but have different implementation timelines
Content of the reform
Increasing capacity for health management and human resources in health consists of three elements:
- Reforming health services management;
- Developing human resources for health; and
- Increasing integrity, reducing vulnerabilities and reducing risk of corruption in the health system.
Implementation of these reforms is publicly monitored through a dedicated project (https://monitorpnrr.eu/) supported by the Renew Europe Group – a political group of the European Parliament. At the time of writing, all reform targets have been met and the legislative modifications and additions have been issued to set the ground for further changes in the area of health management and human resources. The latter includes the establishment of the National Institute for Health Services Management, which will be in charge of health management training at all management levels, and the preparation of the Strategy for Human Resources Development for 2022–2030. The deadline for the full implementation of the health management and human resources reform is June 2025.