Context

Despite the implementation of the National Anti-Drug Strategy for 2022–2026, illicit drug use, measured in terms of lifetime consumption, increased among adult Romanians aged 15–64, from 10.7% in 2019 to 12.8% in 2024. The consumption is even higher among people aged 15–34, increasing from 16.9% lifetime users in 2019 to 18.2% in 2024.

The strategy is implemented under the coordination and supervision of the National Anti-Drug Agency, subordinated to the Ministry of Internal Affairs, that had been in charge also of the anti-drug policy development, monitoring consumption and assisting consumers through 47 anti-drug prevention, evaluation and counselling centres.

Impetus for the reform (what prompted it)

The existing anti-drug policies, as the previous ones, were highly criticized. Critics argue that they are mainly prone to punishing drug users, who are often declared to be dealers, instead of focusing on prevention and treatment.

In December 2024, the government decided to reorganize the Anti-drug Agency as the National Agency for Policies and Coordination in the Field of Drugs and Addictions, under the subordination and coordination of the Prime Minister. In addition, mental health and addiction prevention centres were developed under the coordination of the National Centre for Mental Health and Drug Control of the Ministry of Health.

Main purpose of the reform

The main purpose of this reform was to attain a better and integrated coordination of the anti-drug policies. Also, the reform will support the Mental Health Action Plan 2024–2029 and in the long run is expected to contribute to the decrease of illicit drug use in Romania.

Content/characteristics

Besides the reorganization of the National Anti-drug Agency that under the direct subordination of the Prime Minister will guarantee better coordination among different sectors and resource pooling, mental health and addiction prevention centres will be created with specific roles in prevention, treatment and rehabilitation of drug users. Further, hospitals will be allowed to establish inpatient wards for the treatment of substance-related addictions.

Implementation steps taken (or scheduled)

The National Agency for Policies and Coordination in the Field of Drugs and Addictions became functional in March 2025 through Government Decision no. 186 that details the roles of the institution, including of the focal point for the European networks and rapid warning system. It also lays out the internal structure, financing and external collaboration.

In May 2025, the MoH published Order no. 1562 on the organization and operating of the mental health and addiction prevention centres, setting their roles, structure and staffing. They are expected to be fully functional in two years.

Outcomes to date and any evaluation

It is too early to evaluate the outcomes. An up-to-date legal framework has been created for better intersectoral collaboration, strengthening governance in the area and ensuring a more preventive and medical approach to the addictions, rather than a corrective one. It is expected that the new approach, guided by the examples of best practices in other countries, will decrease the use of illicit drugs in Romania and improve the mental health of the population.

Cardiovascular and Cerebrovascular Diseases are the main cause of death in Romania, as in most EU countries, but standardized circulatory disease mortality rate is three times higher than EU average: 1005 deaths in Romania compared to 343 deaths in the EU average per 100 000 population in 2021. This difference is associated with a range of socio-economic factors, but also with differences in both the prevalence of risk factors and quality of care.

On 18 October 2024, the Ministry of Health displayed a 2024–2030 National Strategy to Fight Cardiovascular and Cerebrovascular Diseases for public debate, which includes integrated and comprehensive actions towards prevention, early diagnosis and treatment, and patient rehabilitation.

The project of drafting a national strategy on cardiovascular and cerebrovascular diseases was first announced to the public in September 2022. The first draft was published for public debate in January 2024 and a revised draft to be approved by Government Decision was displayed in October 2024. 

Overuse of inpatient care and high amenable mortality rates in Romania are due, among other factors, to insufficient preventive services. Screening rates in Romania are very low compared to EU averages (that is, 9% in Romania compared to 66% in the EU for breast cancer, 25% compared to 60% for cervical cancer, and 4% compared to 33% for colorectal cancer in 2019).

One proposed measure to increase the population participation in screening programmes is to grant two paid leave days per year for employees, two free-from-school days per year for students, and two paid leave days per year for employees of the military, security, intelligence, telecommunication or other similar structures.

This proposal was voted in the senate on 14 October 2024, and it was submitted to the Deputies Chamber on 21 October 2024, and it is currently under the parliamentary specialty commissions’ approval process.

Antimicrobial resistance (AMR) has been placed among the official public health priorities in Romania, as one of the 2023–2030 National Health Strategy objectives refers to the control of AMR.

The Ministry of Health has issued an order (Order no. 63/2024) approving the outpatient prescription guideline for antibiotics and antifungals. This guideline holds a provision that pharmacists are required to collect several pieces of information when handing out antibiotics and antifungals, including: specific series and number of the prescription generated by prescriptors, patient data, patient diagnosis, and prescribed drug details. Prescriptions will be retained in the pharmacy and, if necessary, they can be dispensed in fractions only within the same pharmacy, without exceeding the total amount prescribed.

This order does not apply to those outpatient prescriptions that are  free of charge or partially compensated. 

The order also provides that, in medical emergency situations, pharmacists can release certain antibiotics and antifungals without a medical prescription in the maximum amount related to an emergency dose. The emergency dose can be issued only once during a treatment regime, based on a written and signed statement on the patient’s own responsibility.

More information (in Romanian): https://www.ms.ro/ro/centrul-de-presa/nou%C4%83-metodologie-de-monitorizare-a-prescrierii-%C8%99i-de-raportare-a-eliber%C4%83rii-medicamentelor-antibiotice-%C8%99i-antifungice-de-uz-sistemic-%C3%AEn-contextul-riscurilor-generate-de-utilizarea-excesiv%C4%83-a-acestora

Context

Vaccination coverage is very low in Romania, compared to WHO-set targets, and is decreasing over time. For example, influenza vaccination reached 21.3% of the population in 2022, while the WHO set target is 75%. A law on mandatory vaccination drafted in 2017 (following a significant measles outbreak that occurred in Romania in 2016) was withdrawn from the parliamentary debate after facing strong opposition both at political and public levels. The only measures taken to increase the vaccination rates over the last years were to include the pharmacists among the vaccinators for influenza, and to make certain vaccines available in community pharmacies.

Impetus for the reform

The necessity for a vaccination strategy was acknowledged by the Ministry of Health as a measure to prevent possible outbreaks or re-emergence of certain communicable diseases. Further, the need for defining strategic directions in this area was driven by international requirements and initiatives, such as the Council Recommendation of 7 December 2018 on strengthened cooperation against vaccine-preventable diseases or the WHO Immunization Agenda 2030: A Global Strategy to Leave No One Behind, and by national strategic documents such as the National Health Strategy 2023–2030 and the 2030 National Strategy for the Sustainable Development of Romania.

Main purpose of the reform

The main purpose of the reform is ensuring equitable access to safe and effective vaccination services, contributing to better population health so that everyone, at any time, at any age can benefit from vaccines for their own health and well-being.

Content/characteristics of the reform

The strategy has a holistic approach intending to act on multiple directions, namely: 

• ensuring the proper policy and regulatory framework to encourage vaccination uptake, 
• ensuring lifelong universal access to vaccination,
• ensuring continuity in the vaccine supply and their efficient use,
• continuously improving the vaccine safety monitoring systems,
• strengthening the monitoring and evaluation of the National Vaccination Programme by analyzing the data from the national vaccination register (RENV) and the surveillance data of vaccine-preventable diseases,
• ensuring sufficient numbers of trained human resources, hence, increasing surveillance capacity for vaccine-preventable diseases,
• improving communication to increase the population's confidence in the benefits of vaccination through sustainable social partnerships, and
• enhancing the implementation of the European region vaccination policies.

Implementation steps taken (or scheduled)

The strategy has an Implementation Action Plan with specific tasks, responsible institutions, monitoring indicators, expected results, deadlines, estimated costs and a source of financing for each specific objective. For most of the tasks, the responsibility is shared among the Ministry of Health, district health authorities, specialized institutions, professional organizations and civil society. Further, institutions from the education and social sectors are involved. 

Outcomes to date and any evaluation

The strategy was approved in October 2023. First steps for the implementation to be taken in 2024 would consist of legislative adjustments and additions, vaccines procurement and reserve stocks procedures, updated methodologies for the surveillance of postvaccination adverse reactions and quality assurance of the National Electronic Vaccination Registry data.

The National Plan for Beating Cancer, officially launched in November 2022, includes as a specific objective the development of a National Cancer Registry (NCR) linked to the European Network of Cancer Registries (ENCR). In August 2023, the Romanian Government passed the decision of establishing the NCR under the administration of the National Institute of Public Health. The NCR objectives include gathering information on all cancers to support the monitoring of cancer incidence, the evaluation and control of the disease, and substantiating health policies in the field.

In September 2023, an order by the Minister of Health approved the reporting template to be used, the “minimum dataset” (that is, the minimum information to be included in the database), and the organization of the reporting activity (including, for example, the description of activities and responsibilities of each structure and the relationship among them). The data to be reported are in accordance with the recommendations of the Joint Research Centre of the EU and of the ENCR. The order also establishes eight regional coordination centres, their structure, tasks and responsibilities, ranging from data collection to dissemination of information, including provisions related to data protection and confidentiality.

More information (in Romanian):

https://lege5.ro/gratuit/geztsmjqgezdq/hotararea-nr-663-2023-privind-infiintarea-registrului-national-de-cancer

https://legislatie.just.ro/Public/DetaliiDocument/274655

Existing national health programmes are typically renewed annually through a Government Decision, and incorporate changes put forward by the Ministry of Health. In June 2019, the following changes have been approved:

(1) The National Programme for the evaluation of vitamin D deficiency in the population at risk has been introduced in response to increased incidence of rickets and other diseases related to vitamin D deficiency.
(2) The National Programme for Cancer Screening was supplemented with a sub-programme dedicated to the early detection of tumour markers in the population at risk. This is hoped to ensure earlier treatment, decrease cancer mortality rates and lead to cost savings.
(3) The National Programme for Mental Health and Prophylaxis of Psychiatry Pathology was supplemented with training in approaching patients with autism spectrum disorders. Training will be available to health professionals and patient’s family and is expected to increase service quality.

The National Programme for Prevention, Surveillance and Control of Tuberculosis covers passive case finding, diagnostics, epidemiological surveys and preventive treatment of persons who have been in contact with diagnosed cases as well as information, education and communication campaigns. Despite a decreasing trend, Romania has the highest TB incidence among the EU countries, with  9 818 new cases reported in 2018.

Since 2018, an active TB screening programme has been introduced among the more vulnerable populations. The new screening programme was introduced within the project ”Organization of early detection (screening), diagnostic and treatment programmes for TB, including latent TB infection” co-financed from the EU structural funds. The project will end in 2023 and has a total cost of 64 million lei (approx. 13.6 million euros). It will covers over 75 010 thousand vulnerable individuals, including people from rural communities, homeless people, alcohol and substance addicts and prisoners.

At the end of September 2018, the National Health Insurance House (NHIH) announced that Hepatitis C treatment will be made available to 13000 patients in all stages of fibrosis. The number of contracted providers was also increased. Access to innovative treatment for Hepatitis C has been extended since 2016, when an innovative interferon free treatment was made available to 5860 patients with advanced stage of fibrosis (F4). In 2017 treatment was offered to almost 10000 patients, including those in stages F3 and F2 (see Reform Log dated 22.05.2017).

Prevalence of Hepatitis C virus infection stands at 3.3% of the Romanian population (over 660 thousand people), which is the highest rate in the European Union. The measures described above are meant to contribute to the WHO and EU efforts to eliminate Hepatitis C by 2030.

More information (in Romanian): http://www.cnas.ro

Mobile health units were introduced by the Law 95 on Health Care Reform in 2006. They were meant to improve access to health services in rural or remote areas and in areas where access to health services is limited by lack of human resources or economic factors. However, their organization and functioning was not regulated and their availability was limited to a few private initiatives.

In order to remedy this situation, in May 2018 the Ministry of Health issued an order regulating the establishment, organization and operation of mobile medical units. Eight mobile units for provision of screening services for cervix cancer were procured within an ongoing project financed by the World Bank.

For more information (in Romanian) see: https://www.caravanacumedici.ro

https://lege5.ro/Gratuit/gi4dcojugm4a/ordinul-nr-606-2018-pentru-aprobarea-normelor-metodologice-privind-infiintarea-organizarea-si-functionarea-cabinetelor-si-unitatilor-medicale-mobile (in Romanian) 

https://romanialibera.ro/sanatate/opt-unitati-mobile-in-programul-de-screening-pentru-cancerul-de-col-uterin-748733 

Context

Population aging and the increasing incidence of cancers and chronic illnesses have resulted in an increase of people with life-limiting illnesses and with specific care needs such as relief from pain and other symptoms of a terminal illness. Palliative care was developed in Romania after 1990, through initiatives organized by various NGOs and with international financial support. However, the lack of supporting legislation and appropriate training has resulted in poor availability of palliative care in Romania.

A study conducted within the EU-financed pre-accession programme to assist applicant countries from Central and Eastern Europe (PHARE) in 2010 showed that 76.5% of terminally ill persons were cared for only by family members, with 20.7% of the Romanian population (approximately 4.3 million people) having to provide such care to their relatives (Hospice Casa Speranței, 2013).

Impetus for the reform

Improving palliative care is included as one of the goals in the main policy frameworks that guides the ongoing development of health services to ensure the health and wellbeing of Romanian citizens: the National Sustainable Development Strategy 2013–2020–2030 aims to expand coverage of palliative care needs to 60% by 2020 (Government of Romania, 2008), and the National Health Strategy 2014–2020 includes measures for the development of these services (Ministry of Health, 2014).

Content of the reform

Measures to develop palliative care are supported by the 2014 Improving Health System Quality and Efficiency project financed by the World Bank which aims to establish, by 2020, 29 palliative care units in hospitals (by allocating some of the existing acute care beds to palliative care), 90 home care teams and 90 outpatient clinics. The project also includes funding to develop training of GPs and community nurses to deliver basic palliative care (Moșoiu et al., 2918).

Further developments of palliative care services are also supported by two recently passed regulations. In 2017, an order of the Ministry of Health included palliative care among the specialties available to nurses after finishing their basic nursing training. Another order, from March 2018, set out the framework for the organization and functioning of palliative care services: it classifies palliative care services into three complexity levels; defines the beneficiaries of palliative care; establishes standards for palliative care professionals (e.g. the type and number of professionals needed for each level of care and their qualifications; patient pathways and ways of communication among different health personnel involved in order to ensure coordination and integration of services provided).

Besides the goal of reaching 60% coverage of palliative care needs by 2020, as set by the National Sustainable Development Strategy 2013–2020–2030, some outcome indicators to evaluate the implementation of this policy are set by the National Health Strategy 2014-2020. In particular, the number of newly established palliative care providers and the number of palliative care providers contracted by the National Health Insurance House (NHIH) are used to assess the development of palliative care in Romania. At the time of writing, the number of palliative care providers contracted by the NHIH is the only indicator available, which has increased from 56 to 69 in the period 2013 - 2015 (Ministry of Health, 2016). In 2016, less than 10% of the estimated palliative care needs in the country were covered (Ministry of Health, 2017).

In April 2018, the Minister of Health announced the introduction, by the end of the year, of screening programmes for breast and cervical cancers and for risk factors for cardio-vascular diseases. Funding will come from the EU structural funds and from the World Bank, with a certain percentage of the programmes costs covered from national sources.

Breast cancer screening and cervical cancer screening are estimated to cost 21 and 45 million euros, respectively. Programmes will be implemented through eight regional cancer screening centres, which will be established within district hospitals. Five such centres are already being established and will be functional by the end of the year.

The screening programme for risk factors of cardio-vascular diseases received funding (25 million euros) for five years of operation. The programme will be implemented by family physicians, who will receive an additional pay for this new task, in collaboration with cardiologists. The programme is among the priorities of the Ministry of Health (and is listed as such in the 2014 National Health Strategy).

More information (in Romanian):

https://www.agerpres.ro/sanatate/2018/03/20/ministrul-sanatatii-anunta-ca-va-fi-introdus-un-program-de-screening-privind-factorii-de-risc-pentru-bolile-cardiovasculare--76313

https://www.agerpres.ro/sanatate/2018/03/16/ministrul-sanatatii-spune-ca-se-vor-infiinta-opt-centre-de-screening-pentru-cancerul-de-san-si-de-col--74306

Context

The reported annual rates of nosocomial or healthcare-associated infections (HAI) in Romania between 1995 and 2015 varied between 0.3% and 0.7% of patients (CNSCBT, 2015). However, a point prevalence multi-country survey conducted by the ECDC in 2012 which included ten hospitals in Romania reported a much higher rate: 2.8% of patients with at least one HAI on a given day, and over 5% for the re-validated data in five hospitals. This is more in line with the EU average rate of 5.7% and indicates that the nationally reported figures are likely to underestimate the actual rates (ECDC, 2017). The following factors may suggest that this is indeed true: the very low number of epidemiologists and hygiene nurses in hospitals; lack of compliance with hygiene and other HAI prevention norms of medical staff; old hospital infrastructure with no advanced isolation units; and high bed occupancy rates in some hospitals. However, the main reason for underreporting is the fact that the rate of nosocomial infections has been included among the indicators against which the performance of hospital managers is evaluated.

Impetus for the reform

The government that acceded to power in November 2015 listed HAI prevention as one of the internal processes to be improved in order to attain its health policy objectives (Government of Romania, 2016). This may have been partly motivated by public pressure following a nightclub fire in Bucharest earlier in October (that also precipitated the change of government). The media revealed that many of the fire’s burn patients died or had to be transferred to clinics outside of Romania due to multi-drug-resistant nosocomial infections.

Consequently, in April 2016, a Strategic Plan for Prevention and Fighting of Nosocomial Infections 2016–2018 was launched. This plan was developed based on findings of site cross-checking evaluation of a sample of 112 hospitals.

Content of the reform

The main objectives of the HAI prevention policy are: (1) Increasing capacity for diagnosis, prevention and control of HAI; (2) Development of an effective reporting system; (3) Improving surveillance and reducing antibacterial resistance in the hospitals; and (4) Reducing the overuse of antibiotics. The measures to be implemented during 2016–2018 include: development of the legislative framework, development of an investment plan in order to improve the endowment of the microbiology laboratories and HAI control and prevention structures of the hospitals, and training the staff involved in the prevention, surveillance, diagnosis and control of HAI (Ministry of Health, 2016a). 

The implementation of this policy will be evaluated based on indicators set out in the National Programme for Surveillance and Reduction of HAI. They include a prevalence study of the HAI and sentinel surveillance in the high risk departments. The targets set for 2018 for the 108 hospitals included in the Programme are: an increase in HAI reporting to 2% of patients, and of HAI incidence to 5% in the sentinel surveillance medical units. The only data available on these indicators for 2015 is the HAI incidence in the sentinel surveillance medical units, which was 2.51% (Ministry of Health, 2016b). The 2016 values are not yet available.

Since 2016, the very expensive interferon free treatment for Hepatitis C has been reimbursed by social health insurance for patients with stage 4 of fibrosis. Hence, innovative treatment has been made available for only 5,860 patients, while the total number of patients registered with Hepatitis C in Romania is 16,000. From 2017, the interferon free treatment for Hepatitis C will be extended to patients with less advanced stages of fibrosis (F3 and F2). The National Health Insurance House has announced that new cost-volume-outcome contracts will be signed to cover the treatment of almost 10,000 patients with Hepatitis C in different stages of fibrosis.

More information (in Romanian):
http://www.cnas.ro