HEALTH NEEDS ASSESSMENT OF THE POPULATION IN DEJ-GHERLA AREA: QUANTITATIVE RESEARCH.

• Author: Pandrea, Mihai

1. Introduction

   Presently, even under the decentralization that took place in the Romanian health system, the planning for health services only occurs at a central level, without studies on the communities for assessing their needs and strengths, which would be the basis for identifying priority areas of intervention, even though there are data supporting their significance (Watson, 2011).

   In Romania, the first step towards involving local authorities in the hospital management was made with the hospitals' decentralization started with Government Emergency Ordinance (GEO) no. 48/2010, through which hospitals were placed under the responsibility of local authorities. Although the stated intention of this ordinance was that people could decide for themselves in terms of health, and that hospital services are to bedelivered to the public through 'flexible structures capable of capturing closely and expeditiously the real needs of the community's population' (GEO no. 48/2010), the results of applying this normative act had only a partial effect, because the role of local authorities remained limited to the financial support for investments in hospitals, while the strategic prerogatives remained the same at the central level.

   Thus, the organizational structure, the reorganization and restructuring of sanitary units remained a prerogative of the Ministry of Health, as well as unlocking and occupying positions of doctors, all of these processes unfolding very slowly.

   The establishment of health care needs in the territory is done by the Insurance House, a process determined not only by a real necessity of services in the community, but also by the health suppliers existent in the said area. According to the type and number of suppliers, the Insurance House distributes funds between them, so that if there is a higher number of suppliers in a region (usually urban, well developed) it does not necessarily mean that the health needs of that community are higher than those of a less developed one, economically speaking, with less health suppliers.

   During the hospitals' decentralization, the issue of the local or county authorities being involved in conducting studies in order to assess the health needs of a community has not been raised, because the assessment is being done centralized by structures under the Ministry of Health according to reports made by the medical services suppliers (County Public Health Departments and the National School of Public Health and Health Management Bucharest). At local and county levels there are no specialized structures on health issues, or qualified personnel.

   The paper explores how needs assessment in the context of health care is performed in other countries, how differences between communities in terms of health care status can be mitigated through better tailored health care services. It then moves toward analyzing the health care needs from a specific region/county of Romania and based on this, it offers some recommendations concerning how the planning of health care services at community or county level can be designed.

2. Needs assessment in the context of modern health care systems

   In other states of the European Union, such as Slovakia, a national assessment of the population needs model has been adopted, which is conducted by local or regional authorities through multidisciplinary teams of doctors and social workers subordinated to them (Brichtova,2011).

   In order to measure the health state of the population, demographic, medical and anthropometric indicators are usually used as well as socio-economic, health services efficiency and hygiene indicators. The main issue however is represented by the fact that in order to take the best measures, the decision makers need analytical indices for each issue, given that synthetic indices do not highlight the variability of the problem enough (Borzan, 2007, p. 77).

   In countries such as Great Britain and the United States of America, it is typical for the health needs of a community to be periodically evaluated (most often at five years intervals), an evaluation which provides the basis for establishing and developing strategies for health services in the region (regional allotment of resources for healthcare). Thus, in Great Britain, for a more equitable divisions of resources, in 1976 RAWP (Resource Allocation Working Party) was developed, the formula for calculating the resources for each region, according to the number of inhabitants, age structure of the population and the standardized mortality ratio, ratio given up in 1998, and replaced by indices of adjustment for population needs and regional average costs (Abel-Smith, 1995). It has been noticed that by applying the said formula, in 1985 compared to 1975 there has been a higher territorial equity in the relation between needs and resources (Powell, 1991). At local and regional level there are also some non-profit organizations which include representatives of the community involved in the health needs assessments.

   In the United States of America, the responsibility for health policy planning and organization is divided between federal and state authorities, and local ones. National Health Interview Survey (NHIS) monitors the health of the nation since 1957, collecting data from American families on individual health status and access to health services in order to promote national health policies (Centers for Disease Control and Prevention). Also, the non-profit hospitals who wish to be exempted from federal taxes are obliged to conduct every three years studies to assess the needs of the community they serve and to develop program proposals according to the problems they have identified.

   NICE (National Institute for Health and Clinical Excellence) was originally established in 1999 as a UK special health authority, in order to reduce variations in the availability and quality of care in the National Health System (NHS). In 2005, after the merger with the Health Development Agency, the development of public health guidelines to help prevent disease and promote a healthy lifestyle began. According to the NICE guidelines, the health needs assessment is a systematic method through which we review the major health issues facing a population, leading to the prioritization and allocation of resources in order to improve its health and reduce inequities in access to health services (Cavanagh and Chadwick, 2005).

   This method is used in public health for many reasons, namely: it provides information about the population on which it intends to implement health strategies; it offers the possibility of greater involvement of the community in decision-making; it causes better collaboration and teamwork between the various institutions involved in health services; it especially involves a better use of resources by directing them towards where they are most needed.

   The importance of involving local authorities in planning health services is shown by several studies, especially in rural areas where partnerships between local health departments and community are encouraged in order to improve services (Bruckner and Barr, 2014).

   The needs assessment represents an important part of each planning process, being a form of identifying the issues so that the limited resources can be directed towards implementing the solutions. The once assessed needs of a community help the local authorities to change their policies and elaborate action plans centered on these needs. Specifically, the evaluation process of the needs of a community follows the next steps: establishing the research problem (which is the evaluated population, what are the desired results, what are the needs to be achieved, what are the resources to be involved, what are the risks); identifying the problems (collecting data, establishing the demographic profile, identifying and assessing the health needs and their determining factors); establishing a priority (choosing a health problem and its determinants with the highest impact in terms of size and severity, establishing effective and acceptable actions); planning (clarifying the goals of the interventions, planning activities, monitoring and evaluating strategies and management risks); revising (what has been learned from the project, impact measurement, and finally electing the next priority).

   When the needs assessment refers to the health state of a population, the process follows the same steps, but a multitude of aspects with an impact on health need to be taken into consideration, such as the environment (socio-economic factors, education, pollution, workplace), behaviors (alcohol consumption, smoking, diets, physical exercise), genetics (a person's heredity, the genetic vulnerable factors), the available healthcare system. Literature data indicates the fact that improvement efforts of the community's health have a higher success rate when there is a tight collaboration between the professionals in the health domain and other active organizations in the social domain (Rosenbaum, 2013).

   An important issue in assessing the health needs is represented by the way in which its results are integrated within the healthcare planning process, because the information becomes useless if it does not fit into a clear plan to determine which are the needs that must be met, the time interval in which the results are expected, and the persons or institutions responsible. There are studies in the European Union showing that there are inequities in health between various states because of the socio-economic differences, but also between different regions within these countries. An ample study described by Vervoordeldonk (2013) has been conducted in seven states (Bulgaria, Croatia, Estonia, Hungary, Lithuania, Slovakia and Spain) evaluating the different health needs, and elaborating a plan of action for each of the identified issues.

   For example, in Bulgaria it has been noticed...