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,
mutualite_csro@yahoo.com
 Cristina Vladu, Health Policy Expert TON, +40-722-45.89.37,
cristina.vladu@theopennetwork.ro
 Jozef Goebels, president ADR-Vlaanderen and TON, +32-477-72.84.00,
Jozef.Goebels@med.kuleuven.be