Background: Community nurses (CN) have only recently been introduced as a primary healthcare resource in Romania, mainly catering for the needs of people residing in small urban, rural and remote communities. The majority of them are funded by state budgets, with limited numbers being funded by local and European Union funding schemes. However, the trends in CN numbers and their beneficiaries, as well as the beneficiary-to-CN ratios, have not been thoroughly studied so far. The aim of this analysis is to analyse the trends in CN numbers and beneciary-to-CN ratios across Romania and provide recommendations from improvements in practice.
Methods: We observed the trends in CN numbers across the eight administrative regions in Romania over four years (2019-2022) and compared them with the equivalent trends in beneficiary numbers based on available data to identify areas with higher or lower reach/efficiency. We also calculated the reported number of beneficiaries per CN for the last year of available data (2022) for comparison purposes.
Results: The Northwest, Southeast and West Regions of Romania demonstrated an expansion in CN numbers, paired with increased beneciaries during the period studies. The Northeast Region increased its CN numbers paired with atlining of beneciary numbers. However, the Bucharest/Ilfov Region decreased its CN numbers while increasing the number of beneficiaries. We must note that data inconsistencies may exist for Ilfov County in 2019, 2020 and 202,1 as the number of reported beneciaries was zero. The Centre, South and Southwest Regions increased their CN numbers, paired with recent decreased numbers of beneciaries in 2021 and 2022. Importantly, the number of reported beneficiaries per CN varied widely across regions, from 316 beneficiary-to-CN in the Northeast region to 1007 beneficiary-to-CN in the Bucharest/Ilfov region in 2022.
Discussion: Our analysis identified significant disparities across the eight development regions in Romania regarding the coverage with community nurses and nurse-to-beneficiary ratios. This can potentially have significant equity implications, impeding access to high-quality health and care services for people in regions with low numbers of CNs. Monitoring the number of CNs and beneficiaries, and beneciary-to-CN ratios is, thus, critically important to identify workforce trends and regions in need of service improvement. It also provides a unique opportunity to identify higher-performing regions and conduct further research into their community-based primary healthcare model led by community nurses, in order to disseminate best practices and improve service delivery and workforce training needs across Romania.