Decentralizing Made Possible with District Commissions for Women, Child and Family Health (DCWCFH)
In the year 2000, more than half of the 321, 000 inhabitants of the district of Calarasi lived below poverty level and, therefore, qualified for free health care services. However, when a woman needed a family planning (FP) consultation or contraceptives, there was only one medical facility that provided the services —the FP cabinet in the district capital— which was staffed by a part-time family doctor and two nurses. If the woman could afford the transportation to the clinic, she would receive a medical consultation, but not free contraceptives.
By 2004, however, more than 90% of the rural poor and underserved population in Calarasi had access to FP consultations and free contraceptives at family doctor clinics. By then, 55 of the 94 family doctors who provided primary health care (PHC) services in rural communities had been trained to offer basic FP services and had free contraceptives to give. This drastic improvement was the result of the support from the Romanian Family Health Initiative (RFHI), which began in April of 2001 in collaboration with the local District Public Health Authority (DPHA).
DPHA and RFHI partner the Society for Education on Contraception and Sexuality (SECS), formed the Calarasi Task Force, a local consultative committee that included representatives from local public and reproductive health (RH) authorities, and representatives from nongovernmental organizations involved RH and social services. One of the task force's first activities was to assess local FP/RH main needs. After identifying five at-risk communities, the task force set up FP basic trainings for family doctors in those communities.
In 2001, Calarasi received its first large donation of contraceptives, and the task force helped to organize management information system (MIS) seminars for previously-trained health providers to initiate the distribution of free contraceptives. The task force also coordinated the campaign to publicize the free contraceptives by organizing press releases, meetings with local council and mayors, and making sure that campaign materials, such as posters and stickers, were available at each family doctor clinic.
The success of this program, developed subsequently nationwide, demonstrated to the Ministry of Health (MOH) the importance of decentralization and a strategic approach to implement health reform. That approach involved providing district decisionmakers with the necessary skills and resources to identify and solve local problems. As a result, in February 2002, the MOH issued an order to create the District Commission for Women, Child and Family Health (DCWCFH) as representative consultative bodies. The main responsibilities of DCWCFH are to improve local inter-sectorial coordination, promote community involvement and provide the necessary support for activities aimed at increasing access to client-centered RH services, in accordance with district resources and priorities.
In 2003 the Calarasi district DCWCFH demonstrated their important role in decentralizing RH and public health. In response to the local lack of professional integrated assistance in relation to high rates of adolescent pregnancies and child abandonment, they created a Community Services Center on the premises of DCPD. The center provides counseling services (volunteered by an OB/GYN), free contraceptives (by 2 nurses trained in FP), shelter (room and board for 3-6 months), and social reinsertion services (finding employment opportunities for the young mothers). The center serves as a model of a representative consultative committee to other areas of public interest.
By 2004, the DCWCFHs were functioning nationwide and represented an essential asset for determining districts' RH priorities to be funded by MOH under the National Program for mother and child health (MCH). The DCWCFH were, along with DPHAs, the main partners of the RFHI for planning and implementing district-level activities. They met quarterly to analyze public health and reproductive health indicators (maternal and child mortality, morbidity rates, abortion rates), evaluate the local needs, and support DPHA in the development of the annual workplans for the MCH national program, which documented the implementation of the National Reproductive Health Strategy at the district level. Across all these areas of intervention, SECS regional coordinators provided on-going technical assistance. RFHI has come to a close, but the DCWCFH's carry on the important work of improving reproductive and family health on the local level in Romania.
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