Problem addressed

In Romania, the percentage of preventable deaths is almost 50%, much higher than the European average of 33%. For certain areas of rural Romania, the population has very limited access to primary health services due to financial limitations, lack of infrastructure or an insufficient number of doctors.

Innovative solution

Asociatia Caravana cu Medici (Medical Doctors’ Caravan Association) provides free medical services to adults and children in disadvantaged rural areas, raises awareness on the importance of medical screening tests for prevention and educates the rural population on how to take care of their health. Asociatia Caravana cu Medici is a non-governmental organisation (NGO), founded in 2014, and functions as a travelling clinic. A team of volunteer general practitioners, medical students and medical specialists regularly tour Romania, bringing essential healthcare and check-up services directly to the population living in areas that are economically deprived or have reduced access to basic medical services. The project provides 21st century medicine, using technology such as a portable ultrasound machine and a mobile laboratory, directly to the homes of the rural population at high risk of poverty, with limited access to basic health care, children from disadvantaged families, the elderly and people with no health insurance.

The project’s main goal is to reduce the gap in access to medical services between rural and urban patients. Doctors and other health professionals volunteer their time. The project has three branches in Romania and the main team is composed of 50 volunteers. The caravan’s locations are selected on the basis of several indicators classifying rural areas, such as remoteness, income level, the number of uninsured people and the presence of elderly people and children from vulnerable families.

The caravan’s services are free of charge and are offered over 2 days (Saturday and Sunday). Over these 2 days, a multidisciplinary team – composed of students, specialist doctors and residents – carries out medical tests for 150–250 adults and children. The tests are funded by private companies and local sponsors including Synevo, the largest network of laboratories in Romania, as well as Bayer, Servier, ING Bank, and Avon.

In addition to providing healthcare services, the project collects data on the common pathologies in the area. This helps to identify specific medical issues that require additional attention from local physicians and government authorities.

The caravan also delivers training sessions on health and well-being to people living in economically and socially disadvantaged areas, including in schools, delivered by medical students, doctors and local authorities. The volunteers provide information on basic life support, the importance of proper nutrition in avoiding certain pathologies, the ways in which viral hepatic diseases or other contagious diseases can be transmitted, cancer prevention and screening, and encourage people to seek medical help when they first notice symptoms of a disease.

Key results and benefits

In 2019, the project team reached 25 villages from 12 different counties of Romania, consulted 3 025 patients and assessed the health of the rural population by performing complete physical examinations with blood pressure monitoring and electrocardiograms (ECG).

In its four years of activity, the project has contributed to the detection and treatment of cases of hepatitis B and C, which have an extremely high incidence rate in Romania. Most often, patients arriving at the caravan are diagnosed with cardiovascular disease that, if untreated, can lead to life-threatening complications such as a heart attack or stroke. Following diagnosis, they receive long-term treatment to help them control their condition. For example, around 40% of the patients consulted by the project's volunteer doctors did not know that they were suffering from high blood pressure and many of them were not aware of the risks involved. 90% of the women consulted by the project’s doctors had never undergone a breast ultrasound and were not aware of the importance of this test for the early detection of breast cancer, which is currently the main cause of mortality from malignancies in Romanian women.

In total, the project organised classes in 42 schools involving 190 classes, 5 145 beneficiaries, and travelling a distance of 5 189 kilometres.

Potential for mainstreaming

The shortage of clinics and hospitals in rural areas in Romania is likely to continue in the coming years. The work of the caravan project could fill some of the gaps in Romania’s health system. Travelling clinics are a cost-efficient alternative to establishing full-time medical institutions in remote areas. Furthermore, the project’s approach makes it possible to detect symptoms earlier, diagnose and treat potentially serious diseases, and is likely to contribute to long-term cost reductions from a public health perspective.

So far, the caravan project’s model has been successfully replicated by volunteers in the Cluj and Iași counties and is starting in Brașov and Timișoara in 2020. The NGO has already received funding from several national and local sponsors and aims to scale-up the caravan project’s model at national level with the support of public authorities. In the long term, the association also hopes to implement a national programme for the screening and prevention of the most common health problems encountered in rural areas.

There is potential to transfer the project to another context. Key conditions would include having a strong network of volunteer medical professionals to staff the travelling clinic, as well as partnerships with laboratories and medical product companies to provide equipment and testing services for free.

The project won Best Volunteering Project for the healthcare sector at the National Volunteers Gala in 2017 and 2018. In 2019, it won the Partnership for Change Award at the People to People Gala.