ADDRESSING THREATS TO ADDRESSING THREATS TO SUSTAINABLE SUSTAINABLE REPRODUCTIVE HEALTH REPRODUCTIVE HEALTH SERVICES SERVICES

Gabriela Paleru, M.D.Gabriela Paleru, M.D.

Susan Monaghan, Dr.P.H.Susan Monaghan, Dr.P.H.

USAID/ROMANIAUSAID/ROMANIA

Is RH a priority for the health Is RH a priority for the health officials?officials?

● ● Children dying of Children dying of AIDS AIDS

● ● Babies dying due Babies dying due to the nosocomial to the nosocomial infectioninfection

● ● Disease outbreaks Disease outbreaks

● ● Residents on strike Residents on strike for their salariesfor their salaries

Crisis Crisis managementmanagement

Health systems in CEECHealth systems in CEEC

● ● Chronic under-fundingChronic under-funding

● ● InefficiencyInefficiency

● ● Over-staffingOver-staffing

● ● Resource flowing to urban, Resource flowing to urban, currative, and hospital-based carecurrative, and hospital-based care

● ● CorruptionCorruption

● ● Lack of enforcementLack of enforcement

Medical Care Expenditures in Medical Care Expenditures in Romania 2001Romania 2001

Hospital care67%

Medical devices0%

Emergency3%

Drugs in ambulatory14%

Stomatology1%

Primary care7%

Rehabilitation1%

Ambulatory care (including ancillary)

7%

How to make the How to make the politicians to change politicians to change priorities?priorities?

Help them: Help them: • to reallocate resourcesto reallocate resources• to ensure transparency in use of to ensure transparency in use of

public moneypublic money

……

so they will listen when it comes to so they will listen when it comes to focusing on RH.focusing on RH.

Where the money goes in Where the money goes in hospitals? top-10 hospitals? top-10 diagnosis ALOSdiagnosis ALOS

0

2

4

6

8

10

12

H

yper

tens

ion

N

orm

al V

agin

al

Del

iver

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ia

<17

yea

rs

Nor

mal

new

bor

n

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k pr

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ms

C

ardi

ac f

ailu

re

A

bort

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Min

or h

epa

tic p

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s

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my

w/

com

plic

atio

ns

ALOS US

ALOS Rom

WhereWhere the money goes in the money goes in hospitals?hospitals?

0,0%

0,5%

1,0%

1,5%

2,0%

2,5%

3,0%

H

yper

tens

ion

Nor

mal

vag

inal

del

iver

y

O

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< 1

7 ye

ars

Nor

mal

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-bor

n

B

ack

prob

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s

Car

diac

fa

ilure

Abo

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n.

M

inor

hep

atic

pro

ble

ms

Oth

er o

steo

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cula

r

s

urgi

cal i

nter

vent

ions

% cases Hungary% cases Romania

What to do?What to do?

● ● Admission criteriaAdmission criteria

● ● Reduction of ALOSReduction of ALOS

● ● Incentives for ambulatory vs. hospital Incentives for ambulatory vs. hospital carecare

● ● Ensure insurance reimbursement for RHEnsure insurance reimbursement for RH

Hospital Hospital PHC PHC

Ambulatory Ambulatory

Hospital waste Hospital waste PHC and PHC and sustainable RH servicessustainable RH services

Primary &Primary &

Ambulatory CareAmbulatory Care

● ● FPFP

● ● STI screeningSTI screening

● ● Breast/Cervical Breast/Cervical CancerCancer

● ● Other preventive Other preventive programsprograms

HospitalsHospitals