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1. Policy framework

2. Stakeholders

3. Guidance to stakeholders

4. Target groups

5. Funding

Policy framework

Since 2002 the prophylactic medical examinations of the health conditions are carried out annually for kindergarten children (at the entrance to the kindergarten), pupils of 7, 11, 15 and 19 years old, pupils in vocational school. The examinations are carried out at in the school collectives by the school doctor and nurse, both in urban and rural areas, in order to find out the level of physical development, for the prevention of illnesses, the early detection of diseases or deficiencies, the application of rehabilitation treatment, school and professional orientation depending on the state of health. The programme is a part of the National Programme of Health Evaluation approved annually by the Ministry of Health.

The examinations are coordinated by the National Public Health Institute, which publishes annual reports. The examinations have not been carried out during the COVID-19 pandemic, in 2020 and 2021.

The dynamics of the number of children examined in the period 2002-2019 has an oscillating evolution, with an increase from 480 693 children examined in 2002 to 666 869 in 2015, but a subsequent decrease, correlated with the decrease in the number of school population in Romania, according to the report on children and youth health in Romania 2019.

However, these examinations have mainly a statistical aim of informing the policy makers on the health condition of children and young people until 19 years old. Due to the limited coverage, they have no impact in the detection and signposting of young people facing health risks.

On the other hand, among the national health programmes funded by the Ministry of Health and the National Health Insurance House, nine include clear early detection components, respectively:

1. the national HIV prevention, surveillance and control program;
2. the national program for prevention, monitoring and control of tuberculosis;
3. the national program for surveillance and limitation of infections associated with medical care and microbial resistance, as well as for the monitoring of the use of antibiotics;
4. national program for early detection of cancer through organised screening;
5. the national cardiovascular disease program;
6. national oncology program;
7. the national diabetes program;
8. the national program for the treatment of neurological diseases;
9. the national program for the treatment of haemophilia and thalassemia.

All the above mentioned programmes include free screening components for all patients, including young people, available on state or authorised health care providing institutions. The screening is available based on a recommendation from the family doctor.

Stakeholders

Doctors and health practitioners are the main stakeholders for the mechanisms of early detection and signposting of young people facing health risks. Among these the most important are family doctors, school doctors and nurses.

Health care in Romania is dominated by a public system that is financed mainly through mandatory social health insurance contributions. Family doctors a gatekeeper role for the public system but not for the private system. This means that those benefiting from free services can't access any other service unless they are seen first by their family doctor, according to regulation in the system, mainly the Law no. 95/2006 on Health Care System Reform.

School medicine is a separate specialization and schools should have employed school doctors. However, a school doctor is available at every 2 500 pupils, making the system generally inefficient.

Guidance to stakeholders

Within a project funded by the Norwegian and EEA Grants, the National Institute of Public Health developed in 2016 the Guidelines for Health Nutrition and Physical Activities in Schools and Kindergartens, covering activities that can also be implemented for young people in the secondary schools.

Target groups

The prophylactic medical examinations of the health conditions are carried out annually for kindergarten children (at the entrance to the kindergarten), pupils of 7, 11, 15 and 19 years old, pupils in vocational school.

All young people have access to the screening measures included in the national health programmes. Pupils or students until 26 years old are insured according to the law. The young NEETs that are not registered to the Public Employment Services (the County Employment Agencies) are not insured in the national system, but they can be included in the national health programmes at request, if they register with the County Employment Agencies or if they are diagnosed with a serious illness that falls within the scope of national health programs, according to regulations in the Fiscal Code and the Law no. 95/2006 on Health Care System Reform.

Funding

Among the national health programmes some are funded by the state budget and others are funded by the social security budget, as follows:

1. National health programmes funded by the Ministry of Health, including screening and detection components are:

• the national HIV prevention, surveillance and control program;
• the national program for prevention, monitoring and control of tuberculosis;
• the national program for surveillance and limitation of infections associated with medical care and microbial resistance, as well as for the monitoring of the use of antibiotics;
• national program for early detection of cancer through organised screening;

2. National health programmes funded by the Social Security Budget through the National Health Insurance House include screening components, are:

• the national cardiovascular disease program;
• national oncology program;
• the national diabetes program;
• the national program for the treatment of neurological diseases;
• the national program for the treatment of haemophilia and thalassemia.