Rețeaua „Grijă de Mamă” Sprijin și servicii complete pentru mame și copii

Cursuri de pregătire pentru medici, moașe, asistenți medicali din îngrijirea primară și maternități să lucreze direct cu femeile și copiii

  • 6 cities, 250 participants: medici de familie, asistente medicale din îngrijirea primară, medici de obstetrică-ginecologie și neonatologie, moașe, asistente medicale de neonatologie și de obstetrică-ginecologie
  • Objectives: to improve access to health care and support for mothers and children, including those who are refugees in Romania, to increase access to antenatal care, pre- and post-natal education, health literacy, prevention of sexual and gender-based violence
  • Solutions: better connection of the levels of care with each other, equipping health workers with all the necessary tools to be able to provide care for pregnant women, mothers and newborns in line with best practice and evidence-based recommendations
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In Romania, the medical system for women’s and children’s health is frequently under pressure, with major problems affecting health in various forms.

It is essential that health professionals in maternal and child care specialties work together and are equipped with all the necessary tools to be able to provide better care and services to pregnant women, mothers and newborns, according to best practices and evidence-based recommendations.

Cu acest obiectiv, cu sprijinul UNICEF în România, în 2022 am pus bazele unei rețele de profesioniști medicali – “Caring for Mothers” Network – cu scopul de a realiza o mai bună conectare a nivelurilor de îngrijire între ele și de a furniza personalului medical instrumentele necesare, astfel încât femeile și copiii români, dar și cei refugiați în țara noastră să beneficieze de servicii medicale complete, sigure, ușor de accesat și echitabile.

Thus, between septembrie 2022 – martie 2023with the support of UNICEF in Romania, our association delivered in six cities in Romania ((Bucharest, Constanța, Brașov, Vaslui, Suceava, Iași) o serie de cursuri de pregătire pentru medici, moașe, asistenți medicali din îngrijirea primară și maternități – să lucreze direct cu femeile și copiii, inclusiv refugiați în România, fiind the first initiative of its kind that brings together medical professionals from primary, secondary and tertiary care..

During this period, 250 health professionals din orașele menționate – medici și asistenți medicali din cabinete de medicină de familie, moașe și medici rezidenți și asistenți medicali de obstetrică-ginecologie și neonatologie – au beneficiat de formare bazată pe cele mai noi și eficiente practici privind îngrijirea antenatală, dar și cu privire la alfabetizarea în domeniul sănătății, măsuri de sănătate publică, educație postnatală, consiliere și sprijin în domeniul alăptării, îngrijire medicală și prevenție pentru nou-născuți și copii, promovarea vaccinării pentru populația pediatrică din România, inclusiv cea refugiată, și combaterea violenței sexuale și de gen.

The training sessions were structured in three sessions of four modules each and were delivered by eight specialists - midwives, neonatologists, health literacy experts, psychologists, breastfeeding (IBCLC), public health, and sexual and gender-based violence consultants. In addition to their academic and professional training, the trainers who taught the courses also benefited from specialist training to develop skills in facilitating and promoting services for mothers and children, including refugees in Romania.

As a result of the debates and active participation in the courses, the participating health professionals and the eight specialists reiterated or identified a number of problems faced by pregnant women and medical staff on all these topics, as well as solutions that will help to solve them.

Indiferent de orașul în care profesează cadrele medicale care au participat la sesiunile de curs, de diferențele culturale sau economice din regiunile în care au fost susținute cursurile, personalul medical a semnalat, în general, subfinanțarea serviciilor de sănătate, lipsa resurselor umane, dificultatea colaborării sau comunicării interdisciplinare, între medicii din diferite specialități, asistenți, moașe, lipsa educației și a alfabetizării pentru sănătate, a cursurilor de formare continuă pentru personalul medical, de comunicare personal medical – pacient, precum și nevoia de debirocratizare și degrevare a personalului medical pentru a putea acorda mai mult timp pacientului.

One of the main benefits appreciated by our course participants has been that this is the first time that such specialists have been brought together in a training program dedicated to primary care and hospital medical teams.

In terms of access to antenatal care services,the following problems faced by health care staff or women with direct consequences on the health of pregnant women, mothers and babies emerged from the course sessions, discussions and feedback:

  • Access to antenatal care is severely restricted, the main reasons being budgetary, time-related and determined by lack of qualified staff and dedicated programs;
  • Apart from Bucharest, there are no specific antenatal education programs, carried out according to a uniform national program, to which mothers have access free of charge; in rural areas of the regions where the courses have been held there are no qualified staff to provide antenatal education;
  • Access to antenatal care for pregnant women in rural/disadvantaged areas is restricted due to lack of qualified staff or family doctors, and mothers cannot travel to other cities for follow-up due to lack of financial resources;
  • It is difficult for medical staff to provide antenatal education because discussions about medical conditions or best practices have to start from scratch during the consultation in too short a time; for hospital staff, the time spent with the mother in the maternity ward is not enough to prepare parents for the postpartum period and life with the newborn;
  • The lack of midwives in the system and the ability to provide the full set of services for women reduces access to antenatal care;
  • Lack of funding for investigations and non-payment by the state of certain antenatal care services (e.g. morpho-fetal ultrasound, complex tests);
  • Lack of campaigns to educate and promote the role of family doctors and midwives in antenatal care;
  • Difficulties in navigating the health system and accessing health services for refugee women, language barrier and excessive bureaucracy in the procedure for taking refugees into the care of family doctors; reporting problems to the National Health Insurance House and errors in the Single Integrated Information System;
  • Lack of patient communication courses and training courses on dealing with pregnant minors.

Following the interaction of trainers with medical professionals in training, evaluation and feedback sessions, in order to address some of the needs of medical staff so that services are patient-centered, the following solutions and directions for action were identified:

  • Creation of education and information programs for mothers and creation of dedicated funding lines for antenatal care;
  • Preparation and continuous training of health professionals for the provision of antenatal care based on guidelines, evidence-based practice, collaboration and communication between specialties in the field of maternal and child care;
  • Campanii de educare și promovare a rolului medicului de familie și moașei în îngrijirea antenatală, a Carnetului gravidei și a colaborării multidisciplinare medic de familie – obstetrician – moașă;
  • Cursuri de comunicare personal medical – pacient, axate pe empatia față de pacient și pe implicarea acestuia în actul medical, respectiv colaborarea în rețea și echipe pluridisciplinare pentru a acoperi nevoile gravidelor și cuplurilor;
  • Correct legislation for universal access, so that midwives can provide the full set of services to pregnant women, mothers and couples and carry out their activities autonomously, as required by law, unconditionally or delegated to other medical staff;
  • De-bureaucratize procedures and free up medical staff to give more time to the patient;
  • Free courses for future parents and involvement of midwives in antenatal education; free courses organized in maternity wards;
  • Social programs focusing on specific community problems, involving midwives in antenatal care so that disadvantaged communities without access to obstetricians and far from urban centers can be served;
  • Dedicated programs for medical professionals on collaboration, teamwork and communication.

Feedback personal medical – Rețeaua „Grijă de Mamă” 

Feedback received from health care staff is a critical component in learning about the challenges and issues patients and health care professionals are facing and also in helping us identify solutions so that health care professionals can provide comprehensive, safe, accessible and equitable services for pregnant women, mothers and children.

The results of the feedback questionnaires received from 76.8% of the participants in the “Courses to improve access to healthcare and support for mothers and children” sessions of the “Caring for Mothers” Network were centralized and the following data emerged:

Regarding Solutions for improving access to antenatal care for Romanian and refugee womenamong the respondents to the feedback questionnaire:

  • 82,29% consideră necesare serviciile medicale publice de îngrijire antenatală accesibile, decontate din Fondul Național Unic de Asigurări Sociale de Sănătate – FNUASS (ex.: examene medicale, screeninguri antenatale, investigații paraclinice etc.);
  • 82,29% consider that there is a need for education campaigns on the role of the family doctor and midwife in monitoring pregnant women;
  • 77,6% think that midwives should be involved in public antenatal care services;
  • 70,83% consider that there is a need for accessible antenatal education modules paid for by the UNFUASS;
  • 2,60% others (sex education classes in schools, lactation and breastfeeding education in schools, free services for minors regarding contraception, regulation of the midwifery profession).

Regarding olutions for increasing access to antenatal education, respondents to the feedback questionnaire proposed:

  • 85,93% – Derularea de programe de tip „Școala părinților” în comunitățile defavorizate;
  • 78,64% – Implicarea moașelor în monitorizarea sarcinii și în educația prenatală;
  • 76,04% – Grupuri de sprijin gratuite pentru viitorii părinți oferite de maternități;
  • 71,87% – Acces în sistem public al viitorilor părinți la educație prenatală;
  • 2,08% – Altele (caravane mobile în localități cu acces îngreunat la serviciile medicale, cursuri pentru părinți, Carnetul gravidei obligatoriu, mai detaliat și atractiv).

We were pleased to see in this project such a high level of commitment from medical professionals to work together to find solutions to provide better and more accessible healthcare for women and children

Therefore, in the coming period, we will organize a series of meetings at central and local level with decision-makers and representatives of the authorities to present the findings and solutions identified.

Vocea fiecărui participant este auzită în cadrul Rețelei „Grijă de mamă” și știm că este nevoie ca personalul medical să aibă nevoile împlinite și să primească toate uneltele necesare pentru a putea oferi la rândul său grijă femeilor gravide, mamelor și nou-născuților conform recomandărilor bazate pe dovezi.

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Starting August 2022, the Independent Midwives Association (AMI) provides, as part of the Project “Support Network for Reproductive Health and Increased Access to Pediatric Care for Refugee Women and Children”, implemented with the support of UNICEF in Romania, medical services for refugee women and mothers from Ukraine, consultations for newborns, pre- and post-natal education. Also as part of the project which will run until July 2023, AMI offers breastfeeding counselling, consultations and vaccination for refugee children in Bucharest, support and guidance for accessing health services, information and call center for reproductive health and prevention of gender-based violence, recreational activities for children, translation services and legal support for refugees, as well as training courses for medical staff to work directly with Romanian women and children, as well as with refugees in Romania.

Independent Midwives Association
CUI 31853156
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Headquarters: 16 Victoriei Street, room 046, Buzău Maternity Hospital, Buzău County
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