ADAMSlatina-Timis a best practice community health center and model in social innovation:

Brief description of the project:

Fifteen years ago we have set up a social-medical community health centre in Slatina-Timis, Romania, steered by a mutualistic organisation. People in the community as well as people in surrounding communities can become member of this “Mutual help” organisation called Asociatia de Ajutor Mutual Slatina-Timis (ADAMSlatina-Timis) by voluntarily paying a modest membership fee. All members are part of the General Assembly and they elect the board which is in charge of the organisation. A contract is made between ADAMSlatina-Timis and the health insurance body CJAS (Casa Judeteana de Asigurari De Sanatate, Caras Severin). The mutualistic organisation is receiving money from the health insurance, but has also other incomes as there are membership fees. They hire the medical staff and other needed personnel and take care of all logistic and practical matters. The additional budget allows the organization to hire more staff than usually available in Romanian communities, (i.e. 1 nurse for 1000 inhabitants). ADAMSlatina-Timis has 9 employees. Members get reductions on payable acts.

Partners:

This project was developed and supported by VZW Geels Roemeniëkomitee (Geel, Belgium), LCM Mutuality (Brussels, Belgium), ADR-Vlaanderen (Turnhout, Belgium), The Open Network for community development (Iasi, Romania) and CM Mechelen-Turnhout (Turnhout, Belgium).

Social Purpose:

ADAMSlatina-Timis addresses the lack of a “Qualitative, Accessible and Affordable health care for everyone” in Romania. The healthcare sector in Romania is characterised by its pitiful conditions, lack of services especially in rural area and for disadvantaged groups of the population, and still no clear payment system. Much needed reform has started in recent years, although progress is limited, sometimes “the baby being thrown away with the bath water”, as was the case with community nurses that lost their employment once the transition to the self managed family medicine practices were enacted . First line healthcare, as well as second line (specialists and hospitals) is poorly developed in most rural areas. This results in a less healthy population with big consequences for the future and financial consequences for the state as well as for the patients. Health promotion is weak and home care unexploited and underfinanced. The whole health system is under enormous pressure and financial means are lacking.

Innovative character:

Our experience shows that people can and want to identify sustainable solutions to the health of their communities. Our project sets up a first line healthcare centre with social character, steered by the people in arural area. The centre is an open door for the whole population and is working in close collaboration with the state-organised health insurance, second and third line healthcare system, NGO’s and different institutions. The centre emphasizes prevention and health promotion, provision of home care services and renting of revalidation materials, working together with the local council, the social department, schools and social civic organisations such as the women-, men-, elderly- and youth organisations. Finally, ADAMSlatina-Timis also encompasses a Vizidom (home visit to lonely elderly or chronically sick people) and emphasizes voluntary work. The combination of all these, makes this project a “unique selling product”. ADAMSlatina-Timis is steered by an elected board enlarged with co-opted representatives of the local council (mayor) and social organisations representing the local civil society.

Social Impact:

A rural village, but also the entire region (for the moment membership comes from half of the communities in the county Caras Severin), is working together with ADAMSlatina-Timis. ADAMSlatina-Timis serve as such more than 8.000 patients at the moment. More than 80 volunteers are engaged with ADAMSlatina-Timis. The centre is a multidisciplinary centre with family doctor, dentist, social pharmacy, home care, revalidation room, social fund, meeting rooms and is defending the rights of the patients. It takes care of a better follow-up of vaccinations, other prevention measures for non communicable diseases, proactive monitoring of the chronically illnesses, provision of emergency care and home care,etc. meaning that people can leave the hospital earlier and recover further at home. The centre maintains good contacts and networks with specialists and hospitals (second line) in order to seek the best solution for referrals and follow-up. Moreover, the existence of this project allows people in this region to have access to Qualitative, Accessible and Affordable healthcare, which they would not have access to otherwise.

Monthly reporting is done to the health insurance body CJAS Caras Severin, different inspections by state departments are carried out and a monthly overview of treated people, members, income and expenses, voluntary engagements, etc. is provided to the board. On a regular basis, the whole system is evaluated by Belgian and Romanian partners and lessons learned are formulated. The board of the organisation ADAMSlatina-Timis is meeting every two months. The board assesses the work of the social-medical centre, adjusts where necessary and sets out the way forward to develop further. Volunteers thus decide themselves on which topics their social-medical system will focus.

Moreover, ADAMSlatina-Timis is doing more than providing health care for the people in the region of Caras Severin. This model of organisation enables people to take their health into their own hands. Through mutual decision making, meetings and workshops, local people can express their needs and can thus decide on the working agenda of the social-medical centre. Finally, this way of organising first line healthcare also creates a basic level of trust between people and towards healthcare. In Romania, it is often the case that individualism is chosen over solidarity, partly because of the communist history. Through the social-medical centre, people can learn again what it is to be a volunteer as well as to have a social structure within their society to exert pressure on government officials.

Proof of concept:

This project is catalogued as “best practice” in Romania, but also valuable and attractive to other countries. We are now trying to implement this in other places in Romania together with the Romanian Ministry of Health. Moreover, the National Health Strategy 2014-2020 of the Romanian ministry of health is in line with our goals and try-outs. In the future we will work together with the RepublicMoldova and we will seek for cooperation possibilities in Bulgaria and Poland.

Scalingup the project:

We have set up a new foundation in Romania in 2012, “The Open Network for community development” (TON), in which a strong health department is present. Since April 2014, a former consultant of the Romanian Ministry of Health joined the team to prepare a proposal for a local health policy plan, a master plan as well as to seek appropriate EU sources to support the project. This is done to disseminate our ideas and to export our good practices all over Romania and other countries. In Belgium a strategy to support these projects is being developed in order to stimulate other NGO’s working on healthcare to tune in with our projects and to attract business and companies to partner with us.

Our recent initiatives as spelled out in the above paragraphs show as well that there is an interest in further scaling up this concept and practice. We have evaluated our own project in which we have gathered fifteen years of experience. We developed a SWOT-analysis of the ADAMSlatina-Timis centre to be aware of our strengths and weaknesses and to be aware of where we still need to improve, adapt and to prove for ourselves what is actually working. With this picture of our own project in mind, we have approached new employees, new volunteers, new partners and possible business partners. A second equal centre, ADAMMoldovita is ready for take-off in Suceava County. Several partners have already indicated their interest in further scaling up this idea (New employees, HICT, Moldovan Ministry of Health, to just mention a few). Support from business partners in the form of a tax deductible sponsorship (percentage of a tax on profit or of the company turnover) is another option we are trying to follow as a win-win solution for a healthier society. This year TON started cooperation with BEROBA (Belgian Romanian Business Association) by an exchange of letters.

Growth targets:

At the start, the primary goal was to reinstall a primary healthcare system in Slatina-Timis. As a result of the privatisation and reforms in healthcare in the nighties, General Practitioner’s left rural areas. Furthermore, the choice was made to develop a new primary healthcare system together with the local people and to make the patient the stakeholder of this system. Throughout time, different services were added and voluntary work was set up and intensified. The cooperation with the local population as well as with other NGO’s, local councils, institutions and official bodies was developed. Doing that way, this project became the ownership of the Slatina-Timis population. The project further expanded as a regional centre, and acquainted branches in different localities of the county. On the other hand, discussions with public authorities, up to ministerial level, have been setup in order to promote this approach of primary health care and to advocate for implementing it in the future national health program. More effort needs to be deployed for systematic application of evidence based practice as well as on disseminating lessons learned to othercommunities.

These two organizational models, the Associations of Mutual Support and the Local Health Committees can be implemented in any of the Romanian communities with a direct involvement of beneficiaries, with respect to principles of solidarity and mutual support. They have proven to generate a better interdisciplinary approach and an increased accessibility and hence a better quality of services for people in remote rural communities.

Long-term Vision:

In 2024, we would like to see that Romanians want to engage and invest in their own country again. We would like to see a Romania where people can have trust in their political and judicial system, as well as in the holders of those positions. Such a Romania will also attract investors. We hope that a good healthcare system can be part of this new Romania and that this healthcare system is organised according to ADAM’s model and Local Health Committees (CLS), another healthcare consultation model ADR-Vlaanderen and TON are promoting. Crucial in such a healthcare system are the premises that it is Affordable, Accessible and Qualitative and that the providers are having an appreciated and honestly enumerated job in, thus stopping the brain drain and begging for ‘under the table money’. We could contribute to this Romania 2024 by increasing our number of involved members, volunteers and projects in which we are engaged. By creating a bigger movement of active citizens, we hope that people start to realise again that they can take their lives and health into their own hands and that they can build their own future.

That’s the reason we are writing now a Master Plan for the coming 10 years and this as well for healthcare as for the other departments within TON.

Contact:

  • Ioan Suru, coordinator ADAMSlatina-Timis, +40-722-36.98.10,
  • Cristina Vladu, Health Policy Expert TON, +40-722-45.89.37,
  • Jozef Goebels, president ADR-Vlaanderen and TON, +32-477-72.84.00,