Romania - investing in primary health care and bringing care to where it’s most needed


During their regular visits to households, community nurses in Botosani county give health advice and perform basic check-ups

Interview with Ms Lidia Manuela Onofrei, Senior Adviser, General Department for Medical Care and Public Health, Ministry of Health of Romania

In an effort to speed up progress towards universal health coverage, the Ministry of Health of Romania is prioritizing primary health care. The establishment of a network of community health centres and the strengthening of the role of community nurses within the health system are 2 vital steps the Ministry has taken to ensure health for all.

Improving access to health services for the most vulnerable

“The reason why we initiated the community nurses programme was to increase access to care for vulnerable communities, individuals with chronic diseases, young families, pregnant women and members of the Roma community,” says Ms Lidia Manuela Onofrei, Senior Adviser at the General Department for Medical Care and Public Health of the Ministry of Health of Romania.

In the early stages of the initiative, former midwives became the first community health carers in the country. As the programme grew, collaboration was strengthened with family doctors’ practices, public health departments, and social and educational services.

Currently, community health care includes all programmes, health-care services and public health actions provided at the community level, is centred on prevention, and is delivered by community nurses and health mediators. Health mediators are appointed members of Roma communities that work in health promotion.

A growing network of nurses making a difference

To date, Romania has 1556 community nurses whose work covers 1183 villages and urban localities. “Of course there are communities without a nurse,” says ms Onofrei. “That’s why it is also necessary for the Ministry of Health to strengthen the training programme for community health-care staff and support the further development of community nursing across the country.”

In the counties with community nurses, the impact of their work can already be seen. For example, 5 years ago the rates of abortions, especially among very young women, the number of deaths at home, and maternal mortality rates were much higher in Botosani County in the north and Gorj County in the south-west of the country. “Thanks to the hard work of the community nurses, we have seen a decrease in all these health indicators, as well as growing numbers of people getting vaccinated,” confirms Ms Onofrei.

Recipe for success: familiarity with the community and teamwork

The county departments of public health, in close collaboration with the local public authorities, recruit the health mediators and community nurses. A basic requirement for a health mediator is that they come from the community they will be working with. This ensures that the selected mediators are familiar with the traditions and cultural aspects that may have an impact on the community’s health.

“We have really dedicated staff, because they are devoted to their families and communities and have no plans to leave the community,” says Ms Onofrei. “The nurses know every house and every family in their area. Teamwork with a wide range of other professionals in health and social care is also essential for community nurses. In the community, you can look at people holistically, since you have to be aware of their overall life situation, not just their medical condition. It’s the community nurses’ job to assess and support the patients, and coordinate a care package to give them the help they need.”