PHIRE – Public Health Innovation and Research in Europe Country Report

ROMANIA

November 2012 EUPHA European Public Health Association P.O. Box 1568 3500 BN Utrecht The Netherlands

PHIRE – Public Health Innovation and Research in Europe 2

This report has been compiled by:

Florentina Furtunescu, Romanian Public Health and Health Management Association

Acknowledgements

This report was compiled based on the valuable contribution of some enthusiast public health

professionals from the National Institute of Public Health (As. Prof. Alexandra Cucu, Adriana

Galan) and from the Universities of Medicine from Bucharest (Prof. Dana Minca), Cluj Napoca

(Prof. Ioan Stelian Bocsan) and Sibiu (Prof. Carmen Domnariu).

The members of the Romanian Association of Public Health and Health Management had also a

major involvement in collecting information for PHIRE project and in discussing the role and

visibility of public health research in Romania.

This publication arises from the project ‘PHIRE - Public Health Innovation and Research in Europe’, Agreement Number 2009 12 14, which has received funding from the European Union, in the framework of the Health Programme. PHIRE is implemented from 1 September 2010 until 28 February 2013. PHIRE is coordinated by the European Public Health Association (EUPHA). Associated partners are: EHESP, School of Public Health (FR); Faculty of Public Health (FPH, UK); Institute of Hygiene (LIH, LT); Karolinska Institute (SE); Ministry of Health, the Elderly and Community Care (MHEC, MT); NIVEL – Institute for health services research (NL); Slovak Public Health Association (SAVEZ, SK).

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Contents Contents ................................................................................................................................................................................. 3

1. PHIRE Innovation Projects ........................................................................................................................................ 4

2. Public Health Research System in Romania ....................................................................................................... 7

3. National and European Research ........................................................................................................................ 11

4. Recommendations of workshop participants and conclusions .............................................................. 12

Appendix 2. Photos of the meeting .......................................................................................................................... 14

Appendix 3. List of participants ................................................................................................................................ 16

Appendix 4. List of distributed documentation .................................................................................................. 17

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1. PHIRE Innovation Projects 1.1. Romanian involvement in the projects

Eight projects financed under the first EU Public Health Programme were reviewed in terms of

implementation, dissemination and impact in the specific countries (Table 1).

Table 1: PHIRE Innovation Projects

Innovation project Project website

VENICE - Vaccine European New Integrated

Collaboration Effort http://venice.cineca.org

CHOB - Children, obesity and associated avoidable

chronic diseases

www.ehnheart.org/projects/children-a-

obesity.html

EURO-URHIS I - European system of urban health

indicators www.urhis.eu

HA - Healthy Ageing n.a.

EAAD - European Alliance Against Depression www.eaad.net

ENHIS - Environmental and Health Information

Systems in Europe www.enhis.org

CSAP - Child Safety Action Plans, Phase I www.childsafetyeurope.org/actionplans/index.ht

ml

EUCID - European Core Indicators in Diabetes

Mellitus n.a.

These projects involved a various number of countries (11 – 29). However, Romania was

involved only in four of the projects. Feed-back on the implementation and impact was received

for three of these projects (Figure 1). From the four implemented projects, the participants to

the workshop were aware of two (EURO-URHIS I and ENHIS).

1.2. Dissemination

Most common channels of dissemination were websites, reports, national conferences,

international networks, co-operation with other researchers and/or organizations. The two

projects considered as “most well-known” about the participants to the national workshop had

used five and six respectively dissemination channels, this being probably a key for a wider

dissemination. The EUCID project is however specific. Even though the final report does not

specify how the dissemination was done, according to the feed-back provided by Romania in the

first phase of PHIRE, seven channels of communication were used to disseminate the results.

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Figure 1: Situation of the projects in Romania

Most informed entities regarding the project results seemed to be the government, the health

authorities and the universities. The participants agreed to this conclusion.

Two projects, ENHIS and EUCID, seem to be still disseminated to a limited extent in the country.

1.3. Impact, policy changes and lesson learned

Most of the projects were considered in PHIRE - phase I as having a limited impact on

Knowledge/awareness, policy and reform, projects initiation and regulation change. Two

exceptions were revealed: ENHIS and EAAD – considered as having considerable impact on

policy and reform, projects initiation and regulation change (high impact for ENHIS). The

participants totally agreed to conclusions related to ENHIS, but they were not aware about

EAAD.

Main factors hindering the projects’ impact were scarcity of financial resources, lack of

infrastructure and not enough priority recognized for the projects. Main factors facilitating the

projects were: high priority topic, existing national and international connections and dedicated

persons. Participants to the national workshop agreed that these are the most common

strengths and limitations in implementing projects in general. The projects’ topics are almost

always very important for the country, because Romania has a wide health status gap compared

to other member states. Having national and international connection is also very important for

finding about the project, establishing consortiums etc. Also having dedicated persons for

implementing the project is a crucial condition for the success of the project, because the experts

are usually closer to the research field, but less experienced in operational issues. Sometimes

they are facing difficulties in spending the money or in planning the activities according to the

general rules/conditions.

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1.4. Additional information of RPHHMA on national impact, policy changes and lessons

learned, recommendations

The Romanian Public Health and Health Management Association (RPHHMA) members were

aware about the ENHIS and EURO-URHIS I projects which had a high impact on the health

information system, especially by increasing awareness of professionals and decision-makers

about the need for health information.

They believe that institutional commitment is very important both in project implementing and

in sustainability of the results for the health system of the country.

The Romanian involvement in EU Projects in general (Health, Research and others) was

considered rather weak.

1.5. What should be done? Actions needed to assess impact, policy changes and lessons

learned with these projects at national level.

Stronger mechanisms should be developed by the institutional bodies in order to increase this

participation and visibility.

The CSOs – professional bodies, NGOs, experts groups, associations (like RPHHMA) – should

become more active in networking and finding opportunities for projects.

Transferring the projects results and formalizing the mechanisms developed within the projects

frame is very important for sustainability and for adding value to the society.

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2. Public Health Research System in Romania

2.1. Short description of public health research, based on Steps Country Profile

The situation related to research in public health remained quite stable as it was described in

STEPS projects.

The Ministry of Education, Research, Youth and Sport (http://www.edu.ro ) remained the

national governmental authority in charge with supervising the research field. It is responsible

for organizing, managing and financing the national research system. The ministry delegated the

research responsibilities to the National Authority for Scientific Research (ANCS)

(http://www.ancs.ro). The National Authority for Scientific Research exercises the

responsibilities of the state authority for research-development and carries out its activity in

compliance with the provisions of the Government Ordinance No. 57/2002 on the scientific

research and technological development, with subsequent amendments. According to the law,

The Authority’s mission is to ensure the elaboration, application, monitoring and evaluation of

the policies in the field of research-development and innovation, consistent with the strategy

and the Governing Programme, for the purpose of ensuring on this basis the enlargement of the

national and international technological and innovation patrimony, the sustainable economic

development, the access on the internal, European market and on the global markets, the

creation of the informational knowledge-based society, the satisfaction of the citizens and

Executive Unit for Financing of Higher Education, Research, Development and Innovation

(UEFISCDI) (http://uefiscdi.gov.ro/ ) it’s a public body subordinated to the Ministry of

Education, that has responsibilities related to higher education. It has as mission to promote

quality and leadership in higher education, research, development and innovation. Main

responsibilities are related to:

a. coordination of some programs from the National Plan for Research, Development and

Innovation (PNCDI II);

b. developing and implementing projects related to higher education, research,

development and innovation.

This body was recently founded through the fusion of the Executive Unit for Financing of Higher

Education and Scientific Research in Universities, the National Centre for Programme

Management and the Managerial Agency for Scientific Research, innovation and technology

Transfer, this being a change compared to STEPS research report.

The Ministry of Health (www.ms.ro ) is the national governmental authority responsible for

health and public health.

2.2. Roles, responsibilities and collaboration between Ministry of Science, Ministry of

Health and other funders

The main institutional bodies at national level have clear roles defined by legislation. The

Ministry of Education and its subordinated bodies are responsible of research and the Ministry

of Health is responsible of public health. The Ministry of Education is implementing the national

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strategy for research, development and innovation 2007 - 2013 (approved by the Government

Decision no. 217/2007)

(http://uefiscdi.gov.ro/userfiles/file/ROST/1188314177strategia%20ro.pdf). This strategy has

a chapter dedicated to health, but with low representation of public health topics.

Commissioning is included in the national strategy for research. The funds for research are

distributed by competition (public calls for projects, announced by ANCS or UEFISCDI). All the

research topics (including public health issues) are legally open to a wide range of research

bodies, including CSOs. However, for accessing research funds at national level, the applicants

need a special national accreditation for research, but the specific criteria for this accreditation

are difficult to fulfil, especially by CSOs.

The Ministry of Health doesn’t finance and promote “research activities”, as they are defined by

the law. However, this ministry finances national health programs that involve also a research

component (assessing health status, identifying public health problems, assessing the impact of

some public health interventions, data collection and analysis for some public health issues like

communicable diseases, cancer registry etc.). The ministry finances the National Institute of

Public Health and other public bodies (hospitals, local councils, public health directorates)

involved in implementing the national programs. The financing flow is done based on needs

assessment and based on historical criteria, but not through competition. The ministry of Health

does not finance CSOs involved in research activities.

2.3. Public health research fields (including health promotion, health services

epidemiology, surveillance, management, wider determinants) commissioned in 2010

No calls related exclusively to public health were launched in 2010, but public health issues

were eligible in few calls with considerable amount of money. Five opportunities were identified

in the first phase of PHIRE, by searching on internet – websites of main public bodies /CSOs that

possibly launch calls:

The Ministry of Education, Research, Youth and Sports has clear roles related to research in

general (no specification of public health research). There is a national strategy for research in

place and accessing the research call is possible based on open selection. There are clear

transparent criteria to be nationally accredited for research but these criteria are quite high for

CSOs.

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Table 2: Research programmes in Romania

Name of the call Launching Authority Key areas of intervention Budget Comments Operational Sectoral Program “Increasing Economic Competitiveness” Priority Axis 2 –Research, Technological Development and Innovation for Competitiveness http://amposcce.minind.ro

1) National Authority for Scientific Research http://www.mct.ro + 2) Ministry of Economy, Trade And Business Environment – Authority for Management of Operational Sectoral Program “Increasing Economic Competitiveness”

2.1 – R&D partnerships between universities/research institutes, and enterprises for generating results directly applicable in economy

€5bn This program is not specific for public health, but “HEALTH” is a major fields of intervention. Public health topics are not excluded if the main issue could be classified as Health related projects.

Operational Sectoral Program “Increasing Economic Competitiveness” Priority Axis 2 –Research, Technological Development and Innovation for Competitiveness http://amposcce.minind.ro

1) National Authority for Scientific Research http://www.mct.ro + 2) Ministry of Economy, Trade And Business Environment – Authority for Management of Operational Sectoral Program “Increasing Economic Competitiveness

2.3 – Supporting ICT use and creating new working places - Modernising the existing

infrastructure through purchasing new equipments;

- Building new establishments for creating new research centers or laboratories

Not specified Funding per project: up to €10m

The call was not specific for public health, but public health research activities could be eligible as part of modernizing projects in the health fields. Private universities, hospitals and private clinics were not accepted, but SME in public health field could be eligible.

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Name of the call Launching Authority Key areas of intervention Budget Comments Operational Program “Administrative Capacity Development” Priority Axis 1 – Structural and process improvements of the public policy management Cycle http://www.fonduri-structurale.ro/Detaliu.aspx?t=capacitate

Ministry of Internal Affairs

Improvement the political – administrative decision-making process

Not specified Funding per project: up to €5m

Health was priority sector.

Operational Program “Administrative Capacity Development” Priority Axis 1 – Structural and process improvements of the public policy management Cycle http://www.fonduri-structurale.ro/Detaliu.aspx?t=capacitate

Ministry of Internal Affairs

Improving the CSOs effectiveness in supporting the reform in public administration

Not specified Funding per project: €62,500 – 125,000

Health was priority sector.

Operational research in TB field – Round 2 Center for Policies and Health Services

Not specified; maximum funding per project €3,000

The call is specific for public health, because TB control is a serious challenge for the Romanian Health system.

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3. National and European Research

As it was mentioned above, there are public health interventions unfolded by the Ministry of

Health, which are not classified as “research programs”. These interventions contain research

steps (eg, evaluating the vaccination coverage trends or barriers, analysis of child obesity,

analysis of environmental or behaviour determinants, analysis of mortality or infant mortality

by cause, by region etc). Health indicators are routinely collected by the National Institute for

Public Health (it includes the National Office for Health Statistics) and published, as part of the

national health information system. Additional reports are prepared for describing the most

important public health problems (http://www.ccss.ro/public_html/?q=content/date-statistice-

0). The Ministry of Health decides the priorities and funding for the national health programs

every two years. The priorities are decided in order to address public health problems which are

nationally important. These national health programs are approved by Government decision.

They are usually implemented by public institutions subordinated to MoH (but not only) and

selected by the MoH based on performance criteria. The universities are not commonly involved

in the national health programs. National Institute of Public health is one of these, having major

roles in implementing the national health programs.

The MoH is not usually involved in funding at European level, except from particular

international conventions, affiliations or particular engagement.

However, the MoH is involved in EU group related to the Public Health Program, having – as

every Member State - one representative in this group. This representative attends the meetings

and communicates the Romania’s decision (based on a national mandate), and votes.

There is a strong connection between national calls and European projects, the national themes

being in line with the European documents and having complementary areas of research.

No formal position of the Ministry of Health expressed publicly on its website or in formal

document related to Horizon 2020. This is somehow normal, because Research is under the

responsibility of the Ministry of Education. The Ministry of Education did organize public

consultation on the priorities of the Horizon 2020.

The Ministry of Health has formal institutional relations with the Ministry of Education. They

collaborate formally in areas under shared responsibility. There are National Contact Points for

FP 7 and (MER) and for Public Health Programme (MoH). There is a general mechanism of

collaboration between the central administration bodies (ministries) in national issues

(approved by law). They all meet and collaborate in issues of common interest.

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4. Recommendations of workshop participants and conclusions The Romanian workshop was unfolded on 24 of May 2012 (agenda in appendix one), having 23

participants from University of Medicine from Bucharest (5), National Institute of Public health

(3), WHO Romania(2), National School of Public Health, Training and Health Management (2),

young researchers (6), professionals working in public or private hospitals (5), members of the

RPHHMA (many of the participants). Unfortunately the participation of the MoH representative

was cancelled in the last minute, due to an emergency, but the conclusions of the workshop were

discussed with the general secretary of MoH after the meeting.

The information gathered in the PHIRE project was presented and discussed with the

participants. The second point of discussion was the role and visibility of PH Research in

Romania.

The participants concluded the following:

1. Romania has still a small visibility in the EU research field related to health and stronger

mechanisms need to be developed in the future. This visibility shound be increased in

the future.

2. This is a common responsibility for the public bodies, but also for researchers, academic

institutions and CSOs to develop the PH research in Romania and the visibility of the

country at EU level.

3. The national accreditation criteria for research are fulfilled by universities but hard to

comply with by the CSOs, even there are CSOs involved in PH research.

4. The formal connection between MoERS and MoH should be strengthened in the future in

deciding and the health priorities (including Public health).

5. The MoH needs especially public health research for supporting the national health

programs and there is research expertise in the National Institute of Public health (3

national & 6 regional centres) and in the universities. The current legal frame does not

recognise the scientific activities done by NIPH as research activities. This has as

consequence a low motivation both for the senior and young researchers to build a

career in the NIPH. The recent decentralization in health was followed by a decreasing

role of the public health institutions. Both combined, these situations wii decrease the PH

capacity on medium term.

6. the traditional involvement of the medical universities in PH research is low represented

today. By tradition, the PH departments of the medical universities are located in the

NPHI (Bucharest, Iasi, Cluj), but the connection between the university staff and the

NPHI attributions and roles decreased in the last years. There is a need to strength this

connection in the near future.

7. Further efforts are needed for strengthening the CSOs capacity and involvement in the

formal mechanisms of decision at national level. The Romanian Public Health Association

will try to become an umbrella in this sense.

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Appendix 1. Agenda of the meeting

Workshop – Proiect PHIRE,

24 mai 2012, INSP, Sala de Consiliu, ora 18.00

AGENDA

Opening floor, approval of agenda 18.00 – 18.15

PHIRE Project – goals objectives 18.15 – 18.30

Tracer projects – presentation of the available information, discussion 18.30 – 18.45

Public health research in Romania – visibility, importance, main

institutions, EU connections

18.45 – 19.15

Role of the RPHHMA in increasing the visibility and contribution of

Romania in PH research at EU level

19.15 – 19.45

Concluding remarks 19.45 – 20.00

Asociaţia Românǎ de Sǎnǎtate Publicǎ

şi Management Sanitar

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Appendix 2. Photos of the meeting

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Appendix 3. List of participants

Name Organisation

Bratu Eugenia UMF “Carol Davila” Bucuresti

Brinduse Lãcrãmioara INSP Bucuresti, Medic rezident

Botescu Sorina UMF “Carol Davila” Bucuresti, Medic rezident

Butu Cassandra OMS

Cioran Nicoleta Institutul “Marius Nasta” – Medic rezident

Chiriac Nona SNSPMS

Chirilã Sergiu Spitalul Clinic de Urgentã, Constanta - Medic rezident

Costeá Radu Virgii UMF “Carol Davila” , Bucuresti, SUUB

Cucu Alexandra INSP

Damian Ciprian UMF “Carol Davila” Bucuresti, Medic rezident

Drãgoescu Antoaneta UMF “Carol Davila” Bucuresti

Dumitru Ionut Eduard Spitalul “Sf. Ioan”

Eclemea Irina UMF “Carol Davila” Bucuresti

Florescu Silvia SNSPMS

Furtunescu Florentina UMF “Carol Davila” Bucuresti

Mineã Dana Galieta UMF “Carol Davila” Bucuresti

Mitran Mihai Spitalul “Panait Sârbu”

Olsavszky Victor OMS

Panã Bogdan Medicover

Preda Alin Liviu SNSPMS

Solomon Teodora UMF “Carol Davila” Bucuresti, Medic rezident

Tiganiuc Benoni Universitatea “Titu Maiorescu”

Ungurean Carmen INSPB

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Appendix 4. List of distributed documentation 1. PHIRE Flyer;

2. Power Point Presentation;

3. STEPS country profile.