Health Challenges in Romania: A Global Public Health Perspective

This article discusses the major health challenges faced by Romania including communicable and non-communicable diseases, healthcare system, and progress towards SDG 3.8. The article highlights the need for improvement in the health and social care system at a global level to attain a stable and sustained system which provides quality care to all citizens, especially vulnerable people.

Global Public Health

Table of Content
SECTION A: INTRODUCTION....................................................................................................1
SECTION B: THE MAIN HEALTH ISSUE/ CHALLENGES .....................................................1
SECTION C: DESCRIPTION OF HEALTH SYSTEM IN COUNTRY.......................................4
SECTION D: ASSESSMENT OF PROGRESS OF COUNTRY IN REACHING A NAMED
SUSTAINABLE DEVELOPMENT GOAL (SDGs)......................................................................6
SECTION E: ADVOCACY STATEMENT....................................................................................8
CONCLUSION................................................................................................................................8
REFERENCES..............................................................................................................................10

SECTION A: INTRODUCTION
Romania country is located in Europe, at central, Eastern and Southeastern part. Romania
have temperate continental climate. Its population is estimated to be around 19 million with area
of about 92,046 square meter. Romania country is the 12th largest country of Europe. Capital of
Romania is Bucharest, which is the largest city also. Romania is included in the name of
developing countries and it also have high income economy. Romania is included in the
European region under Global strategy, World health organisation. Romania has global health
care system where the total expenditure on health by government is 5% of GDP. This includes
medical examinations, surgical operations, post operative care and fee for several diseases. The
life expectancy of Romania is 76.23 years on average, by 2021. fertility rate was measured to be
1.76 births per woman by 2019. Demographics of Romania shows, 15.8% of population to be
under the age of 0-14 years, 68.1% of population in age of 65 and over. Maternal mortality rate
of Romania for 2017 was estimated 19.00, which was lower than 2016 (Romania, 2022).
Currently, the main health challenges that Romania is facing, which is also contributing for main
cause of death includes ischaemic heart diseases. Other includes infectious disease, tuberculosis
etc. The unhealthy behaviour, socioeconomic inequalities and substantial deficiencies of health
services are considered to be the primary cause for low life expectancy of Romania. Unhealthy
lifestyle and substances abuses contribute in the cause too (Hărăguș and Földes, 2020).
SECTION B: THE MAIN HEALTH ISSUE/ CHALLENGES
Romania have a range of health issues that contributing in mortality and deleterious
health of people of Romania. The major health issues of Romania includes:
Communicable diseases: The majority of communicable diseases include infectious
disease. Romania is highly impacted with tuberculosis and measles. The cases of tuberculosis
have fallen from the past decades in Romania but still the rate of cases are high in Europe.
Measles also contribute for major public health issue in Romania.
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Source: ECDC Surveillance Data, Tuberculosis.
The above data represents the tuberculosis cases in per 100,000 population. The rate of
tuberculosis is high in Romania since 2000, which is constantly high from other countries of
Europe even after years of management and national health programmes launched by WHO. The
prevalence of Tuberculosis is significantly decreased from 2008 to 2017 in Romania but still it is
more than other European countries (Cosma and et. al., 2020).
Romania - Tuberculosis death rate (per 100,000 people)
(Source: World Bank)
Tuberculosis death rate in Romania in 2020 was reported to be 4.8% as per the World
Bank collection (Romania- Tuberculosis Death Rate (per 100,000 people), 2022). The above
data signifies that within Romania the incidences of tuberculosis have been significantly reduced
but consistent since 2018. The risk factors for TB spreading include behavioural aspects.
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Romania have launched E- DETECT TB Screening Programme for early TB detection in
Vulnerable people. National Tuberculosis Programme in Romania was organized in joint by
WHO Regional Office for Europe and European Centre for prevention and control of TB.
Government of Romania is taking effective initiatives for stopping the prevalence of TB and it
has seen to be effective (Astarastoae, 2020).
Non- communicable disease: Ischaemic heart disease is the leading cause of death in
Romania which comes under the category of non-communicable cardiovascular disease.
Ischaemic heart disease and strokes both account for more than 550 death in per 100,000
population. The death rate due to ischaemic heart diseases are three times higher in only
Romania than the whole Europe (Romania, 2022).
Number of deaths as a result of ischaemic heart disease (IHD) in Romania from 2000 to 2014
(Source: statista)
The risk factors that contribute for ischaemic heart disease prevalence are substance
consumption and unhealthy lifestyle including bad eating habits, stress and psychosocial
attributes. Government of Romania has taken initiative for controlling Ischaemic heart disease by
promoting healthy lifestyle, low salt consumption, sugar and calorie intake. The Romania
Government has implemented National programmes for treating heart diseases.
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Road Accidents: Road accident is one of the common issues of Romania. As per the
latest data of WHO, the death rate of Romania due to road accidents reached 0.85% of total
death. Romania is on the rank of 130 in world. The 69% of total Road accident fatalities and
injuries occurred in age group of 15-64 years and total of 723 people affected due to disability
from road accidents in per 100,000 people (Romania: Road Traffic Accidents, 2020). The
majority of road accidents occurred due to substance abuses, drink and drive cases. Undiagnosed
mental issues, aggressive behaviour etc. contribute in road accidents death rate of Romania.
Romania in order to reduce the road accidents and injuries due to it, created a general action plan
of road safety (Balan and Mantaluta, 2019.). The Ministry of European Funds in Romania
supported the authorities in order to review the present state of road safety measure and to
control it.
Number of road traffic fatalities in Romania from 2006 to 2020
(Source: Statista)
SECTION C: DESCRIPTION OF HEALTH SYSTEM IN COUNTRY
a. The health system have various level in health care practice, which are described as the
pyramidal structures, which represent the specialisation degree and technical sophistication with
high cost of care. Romania is at the last place of European countries in European Health
Consumer Index. Healthcare in Romania is underfunded and inefficient in providing the quality
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of care. Romania have universal health insurance programmes, where a mandatory payroll tax is
used by country to provide coverage to Romania's entire population. Romania spends about 4%
of its GDP to healthcare that is the lowest rate in Europe. Along with health insurance, the
Romania government operates a majority of number of hospitals, among which there are large
numbers of are chronically underfunded. Romania has built new hospital from the end of
communism along with that Romania has opened the private insurance and hospitals from past
few decades. Low salaries of employees of health care increases the possibilities of corruption
within the health sector (NiŢu and et. al., 2017). Wealthy patients receive better treatment
whereas the one who are lacking the amount face discrimination. Romania have implemented
Universal healthcare concept, but patients are still required to pay medical costs and which is
high in few cases too. Healthcare is virtually available for middle class and upwards. The
working class is in the position where they utilise free clinic service or hospital which are run by
charities.
b. WHO framework describes health system by six building blocks which are, services
delivery, health care workforce, health information system, accessibility to essential medicines,
financing and leadership. The one building block of WHO which is described here include,
health care work force. Romania face challenges in health workforce for ensuring sufficient
numbers of service providers and with right skills. A concern is generated in regards to the
number of health workers in Romania. By 2020, there are approx 66k physician in Romania and
over 18.5 k dentist. Overall 152,686 health care professionals are working in Romanian medical
system which is quite low in comparison to overall population of Romania (Number of medical
personnel in Romania 2020, 2020). The low wages, gaps in wages according to gender, poor
working conditions of health care system, outdated infrastructure and technology along with low
flexibility and attention of work place safety are the reason of decreased health care employees
in Romania. Healthcare workers get strong incentives for migrating into Western European
health system which also a main reason for decreased health workers numbers (Golli and et. al.,
2019).
Romania government has implemented Code of Practices to fulfil the gaps in regards to
the various aspect of Romanian health system. The aspect includes support for health
professionals, organising training and recruitment to increase health providers number. The focus
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was developed on migration of health professionals, in order to keep track of that national policy
is required for health human resources.
Number of medical staff in Romania in 2020
(Source: Statista)
SECTION D: ASSESSMENT OF PROGRESS OF COUNTRY IN REACHING A
NAMED SUSTAINABLE DEVELOPMENT GOAL (SDGs)
Sustainable development goals are the base for achieving the better and a sustained future
for all by providing valuable health and social care. The addressing of global challenges that is
faced in achieving a sustained future involve poverty, inequalities, climate changes, peace,
justice and degradation in environmental. The sustainable development goal of Romania is to
achieve health coverage (SDG 3.8) for all including accessibility of healthcare services to all the
people of Romania. The goal includes objectives like, preventing the death rates of newborns and
children including boarding the economic and social inequalities, climate crisis and urbanisation.
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SDG Target 3.8| Achieve universal health coverage (UHC), including financial risk protection of
Romania
(Source: World health statistics)
The data by World Health Statistics represent that accessibility of services of
healthcare for all the people has increased significantly from past years, that is from 2009 to
2019 it has bought a change. To achieve universal health coverage with accessibility to
essential health care services, financial risk protection and access for effective, safe and
affordable essential medicine including vaccines for all the people of Romania, the objectives
were planned (Ashish, Kumar and Yeligeti, 2021). For reaching the sustained goal Romania
have initiated universal healthcare system, which state finances for healthcare in primary,
secondary and tertiary care. Government of Romania is financing Public health campaigns.
The access for healthcare services if given by Article 34 within the Constitution of Romania,
which states for guarantee the healthcare sheltering. Healthcare in Romania is cost free and
sometimes insurance paid. The major concern of the SDG 3.8 is that the accessibility of
health care services can't be reached to everyone in the country. A number of barriers occur in
enhancing the reach, which include political factors as political benefits have great influence
over the functioning of healthcare system. Healthcare system is economically provided
funding by government to deliver the services on an effective cost to all the people. If funding
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is hindered then their may be a possibility of hindrance in accessibility of health services to
general public. Economical condition of particular country also have influence over the health
services distribution across the region. In Romania, the economy is shaping complex
interactions of employment, financial access and health cost and coverage. Health outcomes
in Romania are also dependent on economical conditions. Social health insurances, private
health insurance, community care, primary health care, pharmaceutical, national health
programmes etc. are dependent on economical aspects of Romania. Romania have
compulsory social health insurance for all the citizens of country. Romania is significantly
contributing in enhancing its SDG 3.2 goal which also have showed positive outcomes.
SECTION E: ADVOCACY STATEMENT
The above case study shows the need of improvement within the health and social care
system at global level to address the growth and development aspects to attain a stable sustained
system which provide quality care to all the citizen who require care especially to the vulnerable
people. Each Country have its own drawbacks in treating the patients which may include
economical, political or other factors of that country. In Romania, the country is facing multiple
issue in providing the efficient and effective care to its citizen. The sustained development goal
for Romania is to provide accessibility of health services to all its citizens. The SDG of Romania
have effect off multiple factors, still the country improved its past position in terms of health
services accessibility (AdrianaTisca and et. al., 2016). Romania needs to address certain health
deteriorating issues, which include tuberculosis, missiles, ischaemia heart disease and road
accidents. This issues are responsible for high death rate of citizens of Romania. The issues are
described on the basis of statistics that show that these issues are increasing with timing and need
addressing. Romania government have created several laws and legislations regarding to that
which needs proper management and checking.
CONCLUSION
The overall project concludes that every country face health and social care issue within
their health system which needs proper assessment and evaluation. Romania is a developed
country even though it face several issues within its health and social care system. There is a
high death rate due to diseases including communicable disease like tuberculosis and measles,
non-communicable diseases including Ischaemic heart disease and road accidents which needs
proper addressing. In addition to this, the report conclude that the sustained development goal for
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Romania is accessibility of health services is requiring proper management even though the
initiative are providing positive outcomes.
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REFERENCES
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Ashish, L., Kumar, S. and Yeligeti, S., 2021. Ischemic heart disease detection using support
vector machine and extreme gradient boosting method. Materials Today:
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Astarastoae, V., 2020 Is it necessary an ethical analysis of the Romanian healthcare
system?. Revista Romana de Bioetica, 8(1).
Balan, C. and Mantaluta, P.S., 2019. Romanian healthcare system at a glance. Acta Universitatis
Danubius. Œconomica, 9(3).
Cosma, S.A. and et. al., 2020. Measuring patients’ perception and satisfaction with the Romanian
healthcare system. Sustainability, 12(4), p.1612.
Firoiu, D. and et. al., 2019. Achieving sustainable development goals (SDG): Implementation of
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Hărăguș, M. and Földes, I., 2020. The demographic profile of rural areas in Romania. Calitatea
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Ursulica, T.E., 2016. The relationship between health care needs and accessibility to health care
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Romania, 2022 [Online] Available through:
<https://en.wikipedia.org/wiki/Romania#Demographics>
Romania- Tuberculosis Death Rate (per 100,000 people), 2022 [Online] Available through:
<https://tradingeconomics.com/romania/tuberculosis-death-rate-per-100000-people-wb-
data.html#:~:text=Tuberculosis%20death%20rate%20(per%20100%2C000%20people)%20in
%20Romania%20was%20reported,compiled%20from%20officially%20recognized
%20sources.>
Romania: Road Traffic Golli, A.L. and et. al., 2019Accidents, 2020 [Online] Available through:
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<https://www.statista.com/statistics/1139412/romania-number-of-medical-staff/#:~:text=Number
%20of%20medical%20personnel%20in%20Romania%202020&text=In%202020%2C%20there
%20were%20approximately,nearly%2019.5%20thousand%20pharmaceutical%20chemists.>
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