MEASURES INTRODUCED IN 2020
The health workforce in Romania is in a relatively low supply to EU averages. There are shortages of hospital staff (doctors, nurses and allied health professionals) and also of public health workers in the district public health authorities and regional public health centres that have to manage and control the outbreak. Several measures have been taken to increase the availability of human resources. The measures aim to both increase the number of staff where needed whilst also ensuring the retention of existing health workers.
To increase the number of staff dealing with COVID-19 outbreak:
• 2000 temporary jobs (6 months) have been created: 1000 jobs at district public health authorities level and 1000 jobs at the district emergency ambulance services; in October 2020 the Government decided to extend the measure for 6 more months;
• A legislative basis has been created to allow the compulsory redeployment of doctors and nurses;
• Residency programmes have been interrupted and all young doctors have been asked to contact authorities for redeployment. Medical students have been asked to volunteer for help at a later stage if developments require more human resources. Residency programmes that were supposed to end in March have been extended until October 31; starting from November, around 200 residents and residency programmes graduates from the areas of intensive care, emergency, epidemiology, infectious diseases, pneumology and radiology will be deployed in hospitals with personnel deficits.
The measures taken to support the workforce consist of:
• Allowances for paying for childcare during the emergency period when schools are being closed, if the other parent cannot take paid leave;
• Ensuring accommodation for medical staff treating COVID-19 cases to isolate them from their families;
• Paying a monthly 500 euros bonus to health workers dealing with surveillance and management of COVID-19 cases, including staff working in the areas of pathology and legal medicine, during the State of Emergency;
• Paying a bonus of up to 30% of the base salary during the State of Emergency and for 3 months thereafter for health workers who might have been in contact with COVID-19 cases (e.g. family doctors, pharmacists, staff working in hospitals and long term social and medical facilities, etc.)
• Since August, during the State of Alert, staff of district health authorities engaged in COVID-19 prevention and control activities are paid a 30% increase of their base salary (40% if they hold a managerial position);
• Bereavement grants and survivor benefits for children of health personnel who died from COVID-19;
• Since the end of October 2020, family physicians have been paid 105 RON (approx. 21 Euros) for every COVID-19 patient monitored online at home.
Once the schools reopened in September 2020, the Ministry of Health increased the budget for hiring needed health personnel in the understaffed medical and dental offices in schools and universities. Thus, 256 school physicians, 109 dentists and 679 nurses will be employed.
Medical staff have not received any additional specialized training, but methodologies, case definitions, surveillance algorithms, biosafety and PPE donning norms and rules were developed and published by the National Centre for the Surveillance and Control of Communicable Diseases (CNSCBT). In addition, staff from the CNSCBT are guiding and supporting local authorities in dealing with the outbreak.
There have been many initiatives to support mental health of health workers taken by the National Center of Psychology and Behavioural Health of the Ministry of Defense, psychiatry hospitals, centers of psychological counselling or psychological support groups created at medical universities, NGOs in the field of mental health, and private medical clinics. The support is offered online or through dedicated phone-lines.
Since November 2020, health workers employed in the public services have been eligible for an epidemic risk allowance. The allowance is set at 80% of the basic salary for those working in the emergency ambulance services, and ranges from 75% to 85% of the basic salary for health personnel working in other settings.
The low number of qualified health personnel constitutes a major problem, especially since the existing workforce is also suffering from fatigue and burn-out. Besides redeployment of health workers, other strategies that have been used to tackle shortages include mobilizing medical students to help with the epidemiological investigation, the vaccination campaign and in the COVID-19 hospitals.