Strong chain of care links sectors to deliver essential health services and leave no one behind in Romania

“I came to the centre to get my second dose of vaccine – I am happy to get any. I have heard of COVID, how could I not? Everyone is talking about it on the streets, in the centre. I hear about it on the radio, I see it on TV,” says Alexandru, aged 53, from Bucharest. After working for 35 years as an operator in a chemical plant, he is now without work and, following a family break-up, is also homeless.

Alexandru is one of the dozens of people dealing with underlying health conditions and living in difficult circumstances who have been vaccinated against COVID-19, thanks to joined-up health services in Romania’s capital that seek to leave no one behind.

“Romania appreciates the essential contribution of the WHO Regional Office for Europe in these difficult times generated by the COVID-19 pandemic,” says President of Romania Mr Klaus Werner Iohannis. “The cooperation and solidarity of the entire international society is our common response to a challenge of this magnitude, and the World Health Organization is a cornerstone in guiding this process.”

From community outreach to governmental support

This chain of care begins with community outreach undertaken by the nongovernmental organization (NGO) Carusel. Its staff speak to people living and working on Bucharest’s streets, advising them on when and where they can receive health services, including vaccinations, and referring them to social-care centres to register for the COVID-19 vaccination.

Established a decade ago, Carusel focuses on harm reduction and seeks to improve the quality of life for drug and alcohol users, sex workers, people who live on the streets, socially and economically challenged people, and those at risk of illness or facing social exclusion.

Vaccination sessions take place at social-care institutions such as Sfântul Ioan, the largest in the city. Both a day and a night centre, Sfântul Ioan provides health and social services and shelter to up to 450 people. Capacity has now been reduced by half because of COVID-19 restrictions. The centre’s 45 staff, comprising social workers, health-care professionals, a chef, a driver, cleaning staff and security services, are employed by the Bucharest General Directorate for Social Assistance, a specialized institution under Bucharest’s General Mayoralty.

A mobile medical team from Saint Pantelimon Hospital was assigned to Sfântul Ioan, and during 2 sessions it administered COVID-19 vaccines to over 150 people. The team’s activities are managed and financed by the Ministry of Health.

By bringing together a community-level NGO, municipal health services and coordinated support from several national ministries, Bucharest can provide accessible, tailored services to people most in need.

Witnessing joined-up services first-hand

WHO Regional Director for Europe Dr Hans Henri P. Kluge is currently on an official visit to Romania, where he is witnessing this chain of care and the importance of ensuring that health services and support are available to everyone, including during the COVID-19 pandemic.

“Tackling health inequities is at the top of my agenda. It is more important than ever as we rebuild after the pandemic,” Dr Kluge explained at a high-level dialogue on climate change, the human–nature relationship and public health, held today.

“One of the goals of WHO’s European Programme of Work until 2025 is to leave no one behind. That is a centrepiece of the work of the Regional Office as it strives to support Member States in building back better. We do this through technical support, capacity-building, partnerships and alliances – aiming for fairer, healthier recoveries and further investments in what has been coined well-being economies,” he added.

World Health Day focuses on health equity

On this year’s World Health Day – 7 April – WHO’s focus is on promoting health equity. COVID-19 has hit all countries hard, but its impact has been harshest on communities that were already vulnerable. These groups are more exposed to the disease, less likely to have access to quality health-care services, and more likely to experience adverse consequences as a result of measures implemented to contain the pandemic. Yet these inequities – due to living conditions, social and human capital, access to quality health care, and employment and working conditions – are not new.

Alexandru’s greatest wish is to find a job. “It’s very difficult to have no activity and no money of your own. I’ve been working since I was a kid. Sitting around doing nothing is not good,” he concludes.

Today, there is an urgent need to protect, test and treat the whole global population: only when this happens can we end the pandemic. As well as assuring an equitable supply of vaccines, tests and treatments, we must strengthen health systems to deliver them. A strong health workforce and primary health care are key to ensuring people can obtain services when and where they need them, as close to home as possible, without financial hardship.

Through its chain of care, Romania offers a positive example of how vulnerable people can receive appropriate support and health services, and some hope, during the COVID-19 crisis and beyond.