USAID Romania Family Health Initiative Romania Family Health Initiative

RFHI Rural Component (2001-2005)

Context · Key Results

Context

In the 1990s, access to family planning was primarily available in the urban areas of Romania. Abortion was the most widespread method of birth spacing and fertility control.

The goal of the RFHI rural component was to scale up integrated family planning nationwide, especially in rural areas. The initiative was also tasked with improving district and central-level capacities in planning and management, service provider training, upgrades in family planning policies, development of an effective logistics management information system (LMIS) for free contraceptives, and implementation of behavior change activities.

Between 2001 and 2005, RFHI rapidly expanded access to family planning services and supplies by integrating family planning into primary health care delivery. The clients, mostly from rural areas, represented the majority of Romania's poor who had limited access to primarily urban family planning services. The success of the program is based on the combination of a family planning-friendly policy environment and the implementation of an innovative Three Pillars Approach.

This strategic approach focused on creating the following three conditions at the same place and at the same time:
  1. Training of rural family doctors and nurses at primary health care centers in modern contraceptive technology and client-centered counseling
  2. Availability of contraceptive supplies, and
  3. Public information campaigns to create demand for FP services.
Immediately after the program was launched, the Romanian Ministry of Public Health identified reproductive health (RH) as a public health priority and incorporated RH as a permanent topic in its public agenda. Moreover, FP/RH services were included into the minimum health package that every Romanian, insured or not, is entitle to receive at the primary health care level.

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Key Results

RFHI helped create a favorable policy environment including strategies, policies, norms, guidelines and protocols.
  • The project trained more than 5,300 family health doctors and more than 3,400 nurses in 42 districts, who are now providing basic family planning services, covering over 80 percent of rural Romania.
  • The 2004 Romania Reproductive Health Survey showed a significant increase in contraceptive prevalence among women of reproductive age in union, from 29.5 percent in 1999 to 38.2 percent in 2004 , more visible in rural areas (from 20.9 to 33 percent within the same period).
  • The Ministry of Public Health increased allocations for the purchase of contraceptives from U.S.$100,000 in 2001 to more than U.S.$1.3 million in 2005 and $1.8 million in 2006.
  • RFHI designed a logistic system and developed an LMIS to track the flow of commodities within the supply chain and support information-based decisionmaking. Later on, RFHI helped develop a Web-based reporting instrument InterCON 1.0 that was adopted nationwide.
Selected impact indicators show improvement in the RH status of women in Romania over the life of the project:
  • The decline of the abortion ratio from 1,156.5 abortions/1,000 live births in 2001 to 684.5 abortions/1000 live births in 2006
  • The decline of the infant mortality rate from 18.4 deaths/1,000 live births in 2001 to 13.9/1,000 live births in 2006
  • The decline of maternal mortality due to abortions from 0.17/1,000 live births in 2001 to 0.05/1000 live births in 2006.

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