HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text (PDF) Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lüdicke, F. Articles by Campana, A. Search for Related Content PubMed PubMed Citation Articles by Lüdicke, F. Articles by Campana, A.

Frank Lüdicke, MD, Mihai Horga, MD and Aldo Campana, MD

Frank Lüdicke and Aldo Campana are with the WHO Collaborating Centre for Research in Human Reproduction, Clinic of Infertility and Gynaecologic Endocrinology, Department of Obstetrics and Gynaecology, Geneva University Hospital, Geneva, Switzerland. Mihai Horga is with the East European Institute of Reproductive Health, Targu-Mures, Romania.

Correspondence: Requests for reprints should be sent to Frank Lüdicke, Geneva University Hospital, 30 Bd de la Cluse, CH-1211, Geneva 14, Switzerland.

	ABSTRACT

TOP ABSTRACT INTRODUCTION DISCUSSION AND EVALUATION NEXT STEPS HIGHLIGHTS References

 

Since the fall of the Berlin Wall, fundamental political changes in eastern Europe have affected the Soviet-style health care systems that formerly provided basic care for everyone. Many of these systems have collapsed, and the new systems of social insurance that have replaced them often are inadequate.

Advanced Training in Reproductive Health in Romania aimed to create an authority in family planning and reproductive health in selected Romanian university centers and to improve training and research capabilities. Initially, the project had 2 main goals: to provide advanced training in reproductive health and family planning to Romanian obstetrics–gynecology specialists from the main university centers—which would allow them to train other physicians (obstetricians, gynecologists, and general practitioners) and medical students—and to develop, test, and finalize specific training materials in Romanian to be used by the new trainers.

	INTRODUCTION

TOP ABSTRACT INTRODUCTION DISCUSSION AND EVALUATION NEXT STEPS HIGHLIGHTS References

 
REFORM HAS CREATED AN important role for international organizations such as the World Health Organization (WHO) in fostering former Soviet-bloc countries' transition to effective health care systems.¹ The United Nations Development Program (UNDP), the United Nations Populations Fund (UNFPA), the WHO, and the World Bank have initiated efforts to address the health care needs of eastern Europe by drawing on the technical expertise of scientists from western Europe.² As part of a strategy to identify primary national research needs in modern human reproductive health care, in 1994 the WHO established the Scientific Working Group on Reproductive Health in Eastern Europe.³ Among the group's projects was the development of a collaborative training program for reproductive health care in Romania.

From 1966 to 1989, Romania followed a strict pronatal policy; contraception and sex education were largely unavailable. In the subsequent climate of economic and political change, health planners attempted to improve family planning practices, but they encountered a lack of knowledge and met with resistance from the public and health care providers.^4–7 The Ministry of Health in Romania and several nongovernmental organizations (NGOs) created a network of more than 250 family planning clinics all over the country, provided basic training for health care providers, and imported modern contraceptives on a large scale. Few of the physicians involved in the family planning network had recently received any training in modern contraceptive technology, however—a problem compounded by the fact that the trainers themselves were inadequately tutored. Although specialists in obstetrics and gynecology clinics were aware of modern methods of family planning and counseling, their knowledge lagged behind western European standards.

Eight selected gynecologists from different universities throughout Romania took part in a 6-week postgraduate training course in Geneva, Switzerland. Lectures and practical lessons were given by members of the Faculty of Medicine at the University of Geneva and the WHO Special Programme of Research, Development and Research Training in Human Reproduction. The training course was designed to help participants acquire general, structured knowledge in reproductive health, including the social and demographic dimensions of reproductive health problems in developed and developing countries. Components of the course included contraception, infertility, safe motherhood, and reproductive biology. During the course, the Romanian doctors prepared a literature review on different contraceptive methods in collaboration with members of the clinic in Geneva and of the WHO's Human Reproductive Program.

After participants completed the course, they attended a 1-week workshop with the project team. The workshop's aim was to transform the literature reviews created during the course into teaching material—including learning objectives for different training sessions, visual aids, guidance for trainers, and handout material for trainees. An information and communication consultant from the Program for Appropriate Technology in Health (Washington, DC) provided guidance on communication skills and presentation of different chapters. At the end of the workshop, the first draft of a manual of contraceptive technology was produced in English. The material was reviewed by invited members of the faculty, clinicians, and medical students before the final editing and translation into Romanian. The main family planning organization in Romania (the Society for Education on Contraception and Sexuality) assisted in adapting the manual for use in family planning training across Romania. Final review and editing were done by the authors and by the professional staff at the East European Institute of Reproductive Health, under the coordination of the editors.⁸

	DISCUSSION AND EVALUATION

TOP ABSTRACT INTRODUCTION DISCUSSION AND EVALUATION NEXT STEPS HIGHLIGHTS References

 
A remarkable feature of the project was the support it received from a range of different bodies, including national and international NGOs, university centers, the Romanian Ministry of Health, the private sector, and international organizations. This support stemmed from a stepwise strategy whereby, after completion of each phase, new partners for collaboration and funding were identified for the succeeding phase. This stepwise strategy can be risky, of course. Indeed, printing of the training manual was in jeopardy until financial assistance was provided by the Swiss National Science Foundation.

The professional and clinical skill levels of Romanian doctors in the university center are high, although they often feel that they need more information on modern standards and especially on new research. This collaboration, on the grounds of mutual respect and common interest, has improved the standard of reproductive health training in Romania. We hope that this example of East–West collaboration in the field of reproductive health may provide a blueprint for the development of similar programs in other eastern European countries.

	NEXT STEPS

TOP ABSTRACT INTRODUCTION DISCUSSION AND EVALUATION NEXT STEPS HIGHLIGHTS References

 
There is now a family planning teaching base of 8 university clinics throughout Romania. The family planning manual that was developed as a result of the project has been adopted by the Ministry of Health in Romania and was selected as teaching material for Romanian general practitioners who work in the family planning network.⁸ A first training course was held in Bucharest in October 2000 for 25 participants from several family planning clinics countrywide, and a second training week, with 18 participants, was held in Bucharest in April 2001. After trainees complete the course, they will receive a "certificate of competency" in family planning that enables them to obtain a distinct subspecialization and a recognized title in family planning. The manual will also be used for less intensive courses for the 17 000 family doctors who are the backbone of the health care system in Romania.

The manual will be used in training medical students. There are ongoing discussions with the Ministry of Education about the possibility of including family planning as a distinct discipline in the family practice curriculum, making it an integral part of pregraduate medical training in Romania.

	HIGHLIGHTS

TOP ABSTRACT INTRODUCTION DISCUSSION AND EVALUATION NEXT STEPS HIGHLIGHTS References

 
• The World Health Organization's Scientific Working Group on Reproductive Health in Eastern Europe sought to create an authority in family planning and reproductive health in selected Romanian university centers and to improve training and research capabilities .

• The resulting university-touniversity venture involved centers in Romania and Switzerland and was supported by several nongovernmental, governmental, and private organizations.

• The project has improved the standard of reproductive health training in Romania.

• This example of East–West collaboration in the field of reproductive health may provide a blueprint for the development of similar programs in other eastern European countries.

	Acknowledgments

 
Many institutions contributed technically and financially throughout this project. We express special thanks to Schering AG, Berlin, for technical and financial support during the first phase of the project; the United Nations Population Fund (UNFPA), Bucharest, for helpful advice and for technical and financial support during the second phase of the project; the Swiss National Science Foundation, Bern, for financial support during the last phase of the project; the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Geneva, for reviewing chapters and providing overall technical support to the authors of the training manual; the WHO Collaborating Centre in Human Reproduction, Geneva University Hospital, for technical support;. the East European Institute of Reproductive Health, Targu-Mures, Romania, for coordination, monitoring, and technical support for the project; the Program for Appropriate Technologies in Health, Washington, DC, for the conduct of a family planning training communication workshop at Chavannes-de-Bogis, Switzerland; the Society for Education on Contraception and Sexuality, Bucharest, for assistance with the development, review, and training adaptation of the manual; and the University of Medicine and Pharmacy and the Center of Public Health, Targu-Mures, for ongoing support of the project.

The following university clinics actively contributed to the project: Clinic of Obstetrics and Gynecology of the Emergency Hospital Sf. Pantelimon, University of Medicine and Pharmacy, Carol Davila, Bucharest; Clinic of Obstetrics and Gynecology, Cuza Voda (Gr. T. Popa Iasi); Clinic of Obstetrics and Gynecology, University of Medicine and Pharmacy, Carol Davila, Bucharest (Dr I. Cantacuzino and Prof. P. Sarbu); Clinic of Obstetrics and Gynecology Bega, University of Medicine Timisoara; First Clinic of Obstetrics and Gynecology, University of Medicine and Pharmacy, Targu-Mures; Second Clinic of Obstetrics and Gynecology, Hospital Filantropia, University of Medicine and Pharmacy, Craiova; First Clinic of Obstetrics and Gynecology, University of Medicine and Pharmacy, Cluj-Napoca.

	Footnotes

 
F. Lüdicke coordinated the project at the Swiss institution and wrote this paper. M. Horga coordinated the project at the Romanian institution and contributed to the writing of this paper. A. Campana contributed to the writing of this paper.

Peer Reviewed

Accepted for publication December 13, 2000.

	References

TOP ABSTRACT INTRODUCTION DISCUSSION AND EVALUATION NEXT STEPS HIGHLIGHTS References

 
1. McKee M. Does the WHO have a role in Europe? There is more to "Europe" than you might think. BMJ. 1998; 316:1402–1403.[Free Full Text]

2. The Szeged declaration. Assessment of research and service needs on reproductive health in eastern Europe—concerns and commitments. Hum Reprod.1994;9:750–752.[Free Full Text]

3. WHO/HRP Annual Technical Report 1998. Geneva, Switzerland: World Health Organization; 1999:239–241.

4. Healy J, McKee M. Health sector reform in central and eastern Europe: the professional dimension. Health Policy Plann.1997;12:286–295.[Abstract/Free Full Text]

5. Johnson BR, Horga M, Andronache L. Contraception and abortion in Romania. Lancet.993;341:875–878.

6. Kovacs L. Abortion and contraceptive practices in eastern Europe. Int J Gynaecol Obstet.1997;58:69–75.[Medline]

7. Horga M, Lüdicke F. How can the rates of induced abortions be reduced? In: Lindmark G, Horga M, Campana A, Kasonde J, eds. Towards Better Reproductive Health in Eastern Europe: Concern, Commitment, and Change. Budapest, Hungary: Central European University Press; 1999:99–128.

8. Horga M, Lüdicke F, Campana A, eds. Family Planning Manual. Targu Mures, Romania: East European Institute of Reproductive Health; 2000.

This Article Abstract Full Text (PDF) Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lüdicke, F. Articles by Campana, A. Search for Related Content PubMed PubMed Citation Articles by Lüdicke, F. Articles by Campana, A.