-
14 July 2025 | Country Update
Plans to reduce the burden of cardiovascular diseases -
17 October 2022 | Policy Analysis
Increasing capacity for health management and human resources in health
2.5. Planning
Approaches to planning in the Romanian health system have not changed much since 1980. The planning functions are highly centralized, reflecting the overall centralization of the health system (see section 2.4). The main institutions involved in planning at the central level are the Ministry of Health, the NHIH and the Ministry of Public Finances. The DPHAs and DHIHs are involved in planning at the local level, usually by way of submitting proposals; for example, for the acquisition of expensive equipment or building of new hospital facilities, following calls for proposals from the central level (this also applies to human resources planning; see section 2.8.3). The link between planning decisions at the central level and population health needs is weak. The existing information systems do not allow for identification of health priorities and rapid evaluation of needs, or for providing feedback to decision-makers (see section 2.7.1), which may lead to inefficient and discretionary spending (for an example of such inefficiencies, see Vlădescu et al., 2008a). Also, the link between the local-level institutions and the communities they serve, plus the organizational accountability for the way in which they respond to local health needs, is very weak.
The key medium-term planning tool in the health sector is the National Health Strategy (see section 5.1). The first such strategy was developed in 2004. The 2004 Strategy remained a mere programming document. Its implementation was neither monitored nor assessed. The current Strategy came into force in December 2014 and covers the period 2014–2020 (Ministry of Health, 2014). The Strategy covers three areas: public health, health services and system-wide measures. The general objectives in the field of public health are: improving the health and nutrition of mother and child; reducing mortality and morbidity of communicable diseases; and slowing down the increase of morbidity and mortality from noncommunicable diseases. The main objective in the area of health services is to ensure equitable access to quality and cost-effective health services. System-wide measures comprise: strengthening planning capacity at all levels (national, regional, local), including the establishment of a planning unit within the Ministry of Health, and in various areas of the health system (cancer control, hospital services, human resources, etc.); increasing efficiency in the health system through e-health; and reducing inequities in access by developing the health care infrastructure. The Strategy also mentions specific national plans targeted at distinct diseases or services (strategic priorities): prevention, cancer control, diabetes control, cardiovascular diseases control and rare diseases – but these plans have not been elaborated or implemented up to now.
The implementation of this strategy is one of the conditions for accessing the new EU funding. Efforts are currently under way to make the Strategy operational and to develop a comprehensive and detailed monitoring framework in order to facilitate the implementation. These goals are to be achieved by the end of 2016.
The government’s election programme, which is approved by parliament when the new Cabinet is appointed (see section 7.1), is consistent with the National Health Strategy. After being approved, the programme is developed into specific programmes and policies in the Budget Law, which is passed every year. The specific programmes and policies are also debated and voted on in parliament. As with all other regulations, these are subject to public debates and must meet certain transparency criteria.
Health sector preparedness
Between 1994 and 2004, responsibility for multisectoral health system preparedness was the responsibility of the governmental Commission for Disasters, under the leadership of the Prime Minister, and its subordinated commissions, reporting to different ministries, such as the Commission for Emergencies in Epidemics and Disasters under the Ministry of Health, or the Commission for Floods under the Ministry of Environment. In 2004, the National System for the Management of Emergencies was created, composed of the National Committee for Emergencies and various committees at the ministerial and local levels. However, there was no coordination among these committees and no operative administrative structure and, in 2014, it was replaced by the interministerial Commission for Emergencies and Emergency Preparedness, under the supervision of the Ministry of Internal Affairs and Administration. The Commission coordinates all relevant structures from other ministries, including the Ministry of Health (e.g. the Department of Public Health) and other institutions (e.g. the NIPH; see section 5.1).
Cardiovascular and cerebrovascular diseases are the main cause of death and disability in Romania. The Romanian Government has approved, at the proposal of the Ministry of Health, the National Strategy for Combating Cardiovascular and Cerebrovascular Diseases 2025–2030. The document has five strategic directions: creating an integrated data system, increasing access to diagnosis and treatment, developing medical rehabilitation, strengthening human resources, and stimulating research and innovation in the field.
Among the measures envisaged are:
- a 10% increase in early diagnosis capacity;
- the establishment of 20 community centres for the care of patients with chronic cardio- and cerebrovascular diseases;
- a 20% increase in the number of ICU units and funding for complex procedures;
- the development of the network of cardiovascular and neurological rehabilitation centres;
- the establishment of a National Registry of Patients with High Vascular Risk;
- implementing mobile applications and online platforms for patients; and
- attracting specialized personnel, including cardiologists, physiotherapists, psychologists and specialized nurses.
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.
References
Aleksandar Džakula, Maja Banadinović, Iva Lukačević Lovrenčić, Maja Vajagić, Antoniya Dimova, Maria Rohova, Mincho Minev, Silvia Gabriela Scintee, Cristian Vladescu, Dana Farcasanu, Susannah Robinson, Anne Spranger, Anna Sagan, Bernd Rechel, A comparison of health system responses to COVID-19 in Bulgaria, Croatia and Romania in 2020, Volume 126, Issue 5, May 2022, Pages 456–464, https://www.sciencedirect.com/science/article/pii/S0168851022000525 (accessed 17 October 2022).
Scintee S. G. and Vladescu C. Overview of the main incremental health care reforms introduced between 2014 and 2020 in Romania. (Original research). SEEJPH 2022. http://seejph.com/index.php/seejph/article/view/249.
EC (2021), ANNEX to the Proposal for a Council Implementing Decision on the approval of the assessment of the recovery and resilience plan for Romania {SWD(2021) 276 final}, Brussels, 27.9.2021, COM(2021) 608 final, https://gov.ro/ro/stiri/unda-verde-de-la-comisia-europeana-pentru-pnrr&page=1, (accessed 17 October 2022).
MIPE (2021) [Ministry of European Projects and Investments]. Romînia a primit prima tranșă din PNRR [Romania received the first instalment for National Resilience and Recovery Plan]
MonitorPNRR (2022) [Project supported by Renew Europe Group]. Buletin de sănătate PNRR [Recovery and Resilience Plan Health Bulletin] https://monitorpnrr.eu/ (accessed 17 October 2022)