Biennial Collaborative Agreement (BCA) 2018-2019

Health situation analysis

In the last decade all the health indicators have improved, but despite this Romania’s population still has a poorer health status compared to the European Union (EU) average: a life expectancy at birth of 75.5 years (71 and 78 in males and females). The crude mortality rate reached 11.7 deaths/1 000 inhabitants in 2013, with decreasing trends by main causes of disease.

The main causes of death in 2013 were cardiovascular diseases (58.0%), followed by malignant tumours (20%), communicable, maternal, perinatal and nutritional conditions (4.0%), injuries (4.0%), respiratory diseases (4.0%), and diabetes (1.0%). Romania is currently one of the WHO European Region’s 18 high-priority countries for tuberculosis (TB) control. In 2015 the WHO estimates of TB incidence and mortality were respectively 84 (72-97) cases and 5.8 (5.3-6.4) deaths per 100 000 population (8).These rates have been decreasing slowly but steadily since the early 2000s. In 2015, the National TB Programme (NTP) detected 14 225 new/relapse TB cases, equivalent to 89% (75-100%) of the estimated cases occurring. HIV co-infection is estimated in 2.6% (2.4-2.8%) of TB patients.

Romania has the highest incidence of cervical cancer and the highest associated mortality in the European Region; in 2012 age standardized ratios were 28.6/100 000 for incidence and 10.8 for mortality. Incidence and mortality had both increased between 2005 and 2010.

The infant mortality in Romania is almost twice the European average of 4.3 per 1 000 live births but in a decreasing trend. Maternal mortality (11.04 maternal deaths per 100 000 live births) has also a decreasing trend but still the highest in EU. The immunization rate has a decreasing trend, and since 2016 Romania has been facing a severe measles outbreak. Since the beginning of the outbreak there have been more than 8 900 reported measles cases, 95% of which were unvaccinated, and 33 measles-related deaths.

The health system functioning is stipulated by Law regarding the reform in health no 95/2006. According to the law, many categories of people are insured with exemption from the payment of contribution for health (children, disabled, retired (partially), persons with low income, unemployed etc.), thus burdening the active population. The insured people have access to a basic package of medical services while the non-insured have access to a minimum package, including some preventive services, services for communicable diseases and emergency care.

Tuberculosis, noncommunicable diseases and immunization remain main challenges for the health sector along with health system performance improvement.

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Priorities for collaboration

The National Health Strategy 2014-2020 is based on Health 2020 and has a focus on has as a main base “equitable access to essential services, cost-effectiveness, evidence substantiation optimization of health services, with emphasis on preventive services and interventions, decentralization, partnership with all actors that can improve health.” The three main strategic areas of interventions are public health, health services and cross-cutting measures for a sustainable and predictable healthcare system. The key approaches for its implementation are represented by: coordinated/integrated healthcare delivery with strong focus on primary care; public health operations with strong focus on health promotion and community services; building resilient communities; mainstreaming of health of vulnerable in national policies and programmes.

Romania adopted the sustainable development strategy in 2008 which serves as a basis  for the implementation of the 2030 agenda, thus will review the National Strategy for Sustainable Development to integrate the Sustainable Development Goals.  Romania fully supports the idea that the 2030 Agenda must be implemented by local institutions, responding directly to citizens’ needs by formulating local and national development strategies.

The WHO Regional Office for Europe will support the Ministry of Health of Romania in reporting on the status of health-related Sustainable Development Goals at country level within the voluntary national review, which Romania is to submit in July 2018, during the session of the United Nations high-level political forum on sustainable development.

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Linkage of BCA with national and international strategic frameworks

The national health strategy was approved for the time frame 2014-2020. In addition there are some mechanisms in place for addressing and integrating health across national policies such as legal requirements for impact assessment and interministerial working groups, councils and committees.

This Biennial Collaborative Agreement (BCA) for Romania supports the realization of Romania’s National Health Strategy 2014-2020. This BCA has already identified the related key Sustainable Development Goals (SDGs) targets and indicators.

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Programmatic priorities for collaboration

The collaboration programme for 2018–2019 as detailed in the Annex is based on the country specific needs and WHO Regional and global inititatives and perspectives. It was mutually agreed and selected in response to public health concerns and ongoing efforts to improve the health status of the population of Romania. It seeks to facilitate strategic collaboration enabling WHO to make a unique contribution. The programme budget outputs and deliverables are subject to further amendments as stipulated in the Terms of Collaboration of the BCA. A linkage to the related Sustainable Development Goals targets and Health 2020 targets is provided for every programme budget output, as described in Annex.

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