6 cities, 250 participants: midwives, family doctors, primary care nurses, obstetrics-gynecology and neonatology doctors, neonatology and obstetrics-gynecology nurses
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.
With this objective, with the support of UNICEF in Romania, in 2022 we set up a network of medical professionals - the “Caring for Mothers” Network - with the aim of better connecting the levels of care with each other and providing medical staff with the necessary tools so that Romanian women and children, as well as refugees in our country can benefit from comprehensive, safe, easily accessible and equitable healthcare services. “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.
“Mothers who are refugees from the war in Ukraine need all our support to access the services they need for themselves and their children’s well-being. To achieve this, we need to work with institutional, civil society and business partners to increase the capacity of service providers. The project we are working on together with the Independent Midwives Association is one of the best examples of concrete actions that will ultimately benefit not only refugees in the country, but also other vulnerable groups in Romania, as health professionals will be better equipped to provide the services they need” - Anna Riatti, UNICEF Representative in Romania.
Anna Riatti, UNICEF Representative in Romania.
Thus, between September 2022 and March 2023with the support of UNICEF in Romania, our association delivered in six cities in Romania ((Bucharest, Constanța, Brașov, Vaslui, Suceava, Iașia series of training courses for doctors, midwives, nurses from primary care and maternity - to work directly with women and children, including refugees in Romania, this being the first initiative of its kind that brings together medical professionals from primary, secondary and tertiary care..
During this period, 250 health professionals from the mentioned cities - doctors and nurses from family medicine practices, midwives and resident doctors, and obstetrics-gynecology and neonatology nurses - received training based on the latest and most effective practices in antenatal care, but also on health literacy, public health measures, postnatal education, breastfeeding counselling and support, medical care and prevention for newborns and children, promoting vaccination for Romania’s pediatric population, including refugees, and combating sexual and gender-based violence.
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.
Regardless of the city in which the health professionals attending the sessions work or the cultural or economic differences in the regions where the courses were held, health professionals generally reported underfunding of health services, lack of human resources, difficulty in collaboration or interdisciplinary communication, between doctors from different specialties, nurses, midwives, lack of health education and literacy, of continuing education courses for medical staff, of doctor-patient communication, as well as the need for de-bureaucratization and de-tasking of medical staff in order to be able to spend more time with patients.
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;
Campaigns to educate and promote the role of the family doctor and midwife in antenatal care, the Pregnancy Record Book and multidisciplinary collaboration between family doctor - obstetrician - midwife;
Courses on doctor-patient communication, focusing on empathy towards the patient and patient involvement in the medical act, i.e. collaboration in networks and multidisciplinary teams to meet the needs of pregnant women and couples;
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.
Medical staff feedback – “Caring for Mothers” Network
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 women, among the respondents to the feedback questionnaire:
82,29% consider that accessible public antenatal care services, paid from the Single National Health Insurance Fund - FNUASS (e.g.: medical examinations, antenatal screening, paraclinical investigations etc.) are necessary;
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% - Running “Parenting School” programs in disadvantaged communities;
78,64% - Involving midwives in pregnancy monitoring and antenatal education;
76,04% - Free support groups for future parents offered by maternity hospitals;
71,87% - Public access to prenatal education for parents-to-be;
2,08% - Other (mobile caravans in localities with difficult access to health services, courses for parents, compulsory, more detailed and attractive Pregnancy Record Book).
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.
Every participant’s voice is heard in the “Caring for Mothers” Network and we know that health professionals need to have their needs met and be given all the necessary tools to be able to provide care for pregnant women, mothers and newborns according to evidence-based recommendations.
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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.