Main diseases as causes of death
Men
Women
Cardiovascular disease
696.2
727.2
Cancer
264.4
170.3
Gastrointestinal
89.0
55.6
Respiratory
75.4
40.0
Infectious
17.5
5.9
Tuberculosis
12.8
2.7
The specific morbidity rates of communicable diseases are shown in Table 15.2. Tuberculosis remains one of the main concerns, with about 20,000 new cases each year and an increasing percentage of multidrug-resistant cases [3].
Table 15.2
Morbidity rates of communicable diseases in Romania in 2008 (per 100,000 inhabitants)
Disease | Morbidity rate |
|---|---|
Acute diarrheal diseases | 342.0 |
Tuberculosis | 87.3 |
Syphilis | 18.7 |
Viral hepatitis A | 14.7 |
Viral hepatitis B | 3.4 |
Other viral hepatitis | 3.6 |
15.3 The National System for Emergency Situations Management
The national system for emergency situations management is organized in order to prevent and to manage emergency situations, providing and coordinating human, material, financial, and other resources. Its goal is to keep or to restore the normal status of life and society. The system is organized by the national public administration and consists of a network of bodies and structures with responsibilities in emergency situations management, organized in levels and areas of competence, which have the necessary resources in order to fulfill their legal duties. The main objectives and principles of emergency management are:
Prediction and prevention,
Saving people’s lives,
Respect for human rights and freedoms,
Cooperation on a national and international level,
Continuity from local authorities to the central public administration, and
Efficiency, active cooperation, and hierarchy in decision-making.
During emergency situations or potential status of emergency, specific measures are taken in accordance with the legal framework:
Warning people and institutions of all risks,
Declaring the state of an imminent threat,
Preventive and protective measures against a specific risk and, if needed, the decision of total or partial evacuation of the affected area,
Operative intervention forces and resources available in order to limit or eliminate negative effects,
Emergency aid,
Declaring the state of emergency according to conditions stipulated in Article 93 of the Romanian Constitution, and
Requesting or providing international assistance.
The main components of the National System for Emergency Situations Management are:
National Committee for Emergency Situations,
General Inspectorate for Emergency Situations,
Ministerial emergency committees,
County and local committees for emergencies, and
Operational centres for emergency situations.
The National Committee for Emergency Situations is acting under the authority of the Minister of Administration and Interior. When needed, it may be coordinated by the Prime Minister. An Interministerial Committee manages the ordinary activities, which is a body composed of decision makers and experts appointed by the ministries with responsibilities in managing emergencies. A Government Decision from 2004 established the organization and functioning of the National Committee [4]. The Minister of Administration and Interior is the Chairman of the National Committee for Emergency Situations, and a Secretary of State from the same Ministry is the Vice-Chairman. The members are secretaries of state from each ministry or a deputy head of each central public institution. Consultants are also included and they are experts from each ministry and central public institution. The Permanent Technical Secretariat of the National Committee for Emergency Situations functions as a specialized department within the National Operational Centre of the General Inspectorate for Emergency.
The General Inspectorate for Emergency Situations is a specialized department within the Ministry of Administration and Interior, which ensures coordination of activities for prevention and management of emergency situations. The Operational Center of the General Inspectorate is a technical body responsible for evaluation, notification, early warning and operational coordination of national level emergencies. It also ensures functioning of the Permanent Technical Secretariat of the National Committee for Emergency Situations.
The General Inspectorate coordinates and controls specialized public services in emergency situations, ensures cooperation with national civil protection, and is responsible for defence against fire and other emergency situations.
Ministerial emergency committees are established by Ministers or the heads of central public institutions and include decision makers and experts from the ministries and subordinate agencies, with responsibilities in specific emergency management activities. The Ministry of Health has its own committee able to respond and to mobilize resources for public health threats. The composition of a ministerial committee may include representatives of other ministries and institutions involved in the same area of activities.
A county committee for emergencies may be organized under the Prefect, the local representative of the government. The County Committee Board includes heads of decentralized services, local institution managers carrying out functions of county interest, and managers of relevant economic agents. The organization, powers and operational tasks of county committees are established by the decision of the Prefect. In the cities, towns, district of Bucharest, and other administrative divisions, local emergency committees may be established. A local committee is coordinated by a mayor and includes representatives of key public services and institutions from the administrative territory. The organization, powers, and functioning of local committees are established by decision of the mayor, endorsed by the prefect of the county.
15.4 Romanian System of Surveillance and Control of Communicable Diseases
The Ministry of Health (MoH) is responsible for all public health issues, including communicable diseases. The National Institute of Public Health (NIPH) was established in 2009 under the authority of the MoH [5]. Together with the National Institute of Research and Development in Microbiology and Immunology “Cantacuzino” and the National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, it coordinates the surveillance and control of communicable diseases, early warning and response to health threats, the public health microbiological laboratory capacities, and preventive measures that should be taken in case of epidemics.
15.4.1 Short History
In 2001, the MoH decided to assess the capacity of early warning and response in order to better control communicable diseases. For this purpose it received technical assistance from the WHO/Regional Office for Europe, and a team of Romanian and international specialists made a comprehensive assessment of the institutional, technical and legislative situation and capacities. In order to improve the existing situation and to develop a surveillance system compatible with the EU, the MoH accepted the recommendations made by the WHO/Europe team. The opportunity to develop the surveillance system came with an EU-sponsored PHARE project “Improving the Romanian System for Epidemiological Surveillance and Control of Communicable Diseases” that lasted from early 2003 until October 2004. The beneficiaries and participants involved in the PHARE project were the MoH through the Department of Public Health, the four regional public health institutes (Bucharest, Cluj, Iasi, Timisoara) and also the 42 district public health directorates and the National Institute for Research and Development in Microbiology and Immunology “Cantacuzino” through its national reference laboratories [1]. Two other institutions with responsibilities for specific surveillance networks are the National Institute for Infectious Diseases “Prof. Dr. Matei Bals” for HIV/AIDS and the Institute for Pneumology “Marius Nasta” for tuberculosis, but they did not directly participate in the PHARE project.
The recommendations made by the international expert team involved in the PHARE project were taken into account in developing a national action plan for the improvement of the communicable disease surveillance system in Romania. The main point was to establish a national competent body, which should be able to:
Be responsible for the funding and performance management of the regional and district public health structures;
Maintain consolidated national health surveillance databases for communicable diseases;
Use surveillance data for the development, publication and dissemination of national policies and good practices in the field of public health;
Represent the interests of the MoH, in respect of training in the field of communicable diseases, with all national training bodies (undergraduate and postgraduate);
Represent Romania in all specialist public health functions related to communicable diseases necessary for international cooperation and legal purposes.
The MoH, through Order 123/2003, approved the national action plan. Based on those recommendations, a National Centre for Communicable Diseases Surveillance and Control (NCCDSC) was established. This centre became operational in January 2005. It was located in the Institute of Public Health Bucharest, with the main objective to coordinate the whole national communicable diseases network. Other roles mentioned in the national action plan included monitoring of the national immunization programmes, coordinating the system of early warning and rapid response at the national level, and the management of a dedicated information system.
15.4.2 Current Situation
At present, the NIPH is a coordinating body of a communicable diseases network (Fig. 15.1), through the NCCDSC. NIPH is a body designated to represent the Romanian Government for the purposes set out in the EU decisions 2119/98/EC, 2000/57/EC and all subsequent amendments, and in the reporting functions designated in 2003/542/EC. Recently, NIPH has been designated an ECDC Coordinating Competent Body. Main tasks of the NIPH are:
Coordination of the national surveillance and control of communicable diseases network;
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