Directory of European Resources > Eurocleft Clinical Network > Registered Clinical Teams > Romania

Clinical Teams in ROMANIA

Brasov Bucharesti (Central Children's Hospital Grigore Alexandrescu) Bucharesti (Marie Curie Hospital)

Bucharesti (University of Medicine "Carol Davila") Cluj-Napoca Târgu-Mures Timisoara

Population
Approximately 22.3 million.

Health Service
The health service in Romania has traditionally been supported by the state using a percentage of the state budget paid by salaried workers and enterprises. There has been in recent years a move towards establishing a decentralised national insurance system based on income tax. The Ministry of Health governs a primary health care structure consisting of medical dispensaries. These at one time were under the authority of the local community but now report directly to the medical authorities. However, the dispensaries are still closely related to community health. Decentralisation is placing an emphasis on more autonomy of the medical dispensaries and for the authorities to be more responsive to patient need. The success of the changes will be affected by the success of economic reform in different parts of the country which is not uniform at present. There is a need for a social medical system to decrease mortality rates in vulnerable groups and to provide work for medical staff in a competitive environment.

Cleft Care Organisation
Romania sees 375* babies with clefts of the lip and/or palate born each year. There are no specialised centres treating these patients. Cleft care is not delivered by designated teams but rather surgery tends to be performed by surgeons in university clinics with patients then being sent on to the orthodontic clinic at the same university. Treatment is therefore given by individual clinicians who team up by choice. In the capital Bucharest alone there are four different locations offering some level of cleft care, each with a different surgeon from varying surgical disciplines. In addition there are five more locations dispersed throughout the country where treatment is provided. All treatment is free of charge except for orthodontic fixed appliances and private orthodontics.

Challenges to Attaining the Eurocleft Consensus Recommendations
Communication between clinicians is problematic. There is no designated training pathway for cleft specialists and as yet no association for professionals. Romania does not have an official policy or special law on cleft services. Travel time to clinics can be long and the costs for patients great. There is no organisation for parents. There have been no studies of outcome of care, no intercentre studies and no involvement in clinical trials.

Future Plans
There have been some changes in attitude although the process is a slow one. The Ministry of Health has been very receptive to the proposals of the Eurocleft BIOMED II and INCO network. The creation of a national register of malformations has been approved and will shortly be implemented. Involvement in the INCO network in particular has been useful in this process since examples of well organised centres and good practice in the countries of central and eastern Europe may serve as suitable role models for Romania. If progress can be made in terms of the financial and legal infrastructure, it is hoped that specialised cleft centres will be founded.

* Estimated number of clefts per annum using World Fact Book figures of 22.3 million population, birth rate of 10.09 per 1,000 population and assuming incidence of clefting at 1:600.