3. Providing health services effectively
The section on PROVIDING HEALTH SERVICES EFFECTIVELY describes approaches for service delivery planning and patient pathways for suspected COVID-19 cases. It also considers efforts by countries to maintain other essential services during periods of excessive demand for health services.
3.1 Planning services
On March 23, all admissions of non-acute cases were banned and medical units were urged to discharge non-acute cases within 48 hours. A week later, the Ministry of Health issued an Order on the Action plan for preparing the hospitals for managing COVID-19 cases. According to this plan:
- Hospitals reduce planned admissions by 80% and outpatient visits by 50% during the State of Emergency; exemptions are made for chronic patients and pregnant women whose survival could be affected by the postponement of necessary treatment or investigation. After the end of the State of Emergency, planned admissions and interventions, and outpatient visits can be performed depending on the local epidemiological situation; hospitals (both public and private) must provide daily reports on the bed occupancy, number of ICU beds and number of beds equipped with functional oxygen/compressed air to the electronic centralized operational coordinating centre of the Ministry of Health (see Section 2.1.);
- Hospitals treating COVID-19 cases were designated as phase I or phase II hospitals. Phase I hospitals are infectious disease hospitals that treat COVID-19 symptomatic patients. Phase II hospitals are other hospitals with intensive care units and ventilation capacity, which will admit COVID-19 patients after capacity at infection disease hospitals has been exceeded;
- Infectious diseases hospitals have a support hospital network coordinated by the district public health authority and district committees for special emergencies. This includes 57 hospitals (full hospitals or separate wards of hospitals), 44 maternities and maternity wards and 60 dialysis centres that will take over the COVID-19 patients who also need other treatments or interventions. In addition, the Nephrology Commission of the Ministry of Health developed a specific treatment methodology for the COVID-19 patients that need dialysis. Some of the support hospitals will take over severe COVID-19 cases when their number will be over the ICU departments of infectious diseases hospitals capacity; depending on the local epidemiological situation, hospitals dealing with COVID-19 cases may also treat non-COVID-19 patients, if they have separate pathways in place for such patients and an approval from the district public health authority; in addition, facilities for isolating asymptomatic patients, or for patients with mild symptoms with no risk factors have been included within the support hospital network - the list of these units in provided by each district public health authority;
- The infectious diseases hospitals and their support hospital network will prepare for treating COVID-19 cases by procuring medical equipment, pharmaceuticals, and PPE, ensuring the workforce availability and training the personnel on the optimal and effective use of PPE and on other measures of limiting COVID-19 transmission; in addition, they have to comply with specific rules regarding pathways and patient flow guidelines, especially with respect to the maternities and dialysis centres.
During the epidemics, the hospitals administrated by local authorities will be coordinated by the Ministry of Health.
Measures were taken to support vulnerable persons in home isolation, focusing on persons in low socio-economic groups, persons at risk of disease, especially those living in rural areas and Roma ethnic groups. The measures include provision of healthcare services in the community and a food allowance of approximately 7 euros per day. Besides access to regular healthcare services, a community health nurse or a Roma mediator provides services that are aimed at limiting the transmission of COVID-19, including:
- Checking compliance with the isolation measures;
- Monitoring health status, especially for persons not registered with a family doctor;
- Identifying persons who travelled abroad and reporting this to district public health authorities;
- Food and medicine supply;
- Post-discharge healthcare;
- Information and awareness rising on limiting COVID-19 transmission measures.
In June-July, the Ministry of Health has procured 115 million masks to be distributed free of charge to disadvantaged people: families that receive social benefits, pensioners with incomes under the minimum guaranteed pension (146 euros), people with disabilities. It is estimated that 2,300,000 people will benefit from this.
To ensure a sound scientific basis for further planning of services and surveillance measures, the Ministry of Health allocated 1.6 million lei (approx. 330 thousand euros) to fund a serology testing study to be implemented nationwide between June and September 2020 by the National Institute of Public Health.