103191 S MIN ND IS FU R T Y AN OF EUROPE Background Study for the National Strategy on Social Inclusion and Poverty Reduction 2015-2020 Coordinators: Emil Teșliuc, Vlad Grigoraș, Manuela Stănculescu Bucharest, 2015 ISBN 978-973-0-20534-3 Th is p age inte ntio nal ly l eft bla nk Th is p age inte ntio nal ly l eft bla nk Disclaimer This volume is a product of the staff of the International Bank for Reconstruction and Development/ the World Bank. The findings, interpretations, and conclusions expressed in this paper do not necessarily reflect the views of the Executive Directors of the World Bank or the governments that they represent. The World Bank does not guarantee the accuracy of the data included in this work. This report does not necessarily represent the position of the European Union or the Romanian Government. Copyright Statement The material in this publication is copyrighted. Copying and/or transmitting portions or all of this work without permission may be a violation of applicable laws. For permission to photocopy or reprint any part of this work, please send a request with the complete information to either: the Ministry of Labor, Family, Social Protection and Elderly (Dem. I. Dobrescu Street, No 2-4, Sector 1, Bucharest, Romania); or (ii) the World Bank Group (Vasile Lascăr Street, No 31, Et 6, Sector 2, Bucharest, Romania). ISBN 978-973-0-20534-3 Designed by HIPPOS www.hipposgroup.com Acknowledgments These inputs into the Government’s Strategy on Social and DGASPCs on February 10-11, 2015. First draft versions Inclusion and Poverty Reduction (2014-2020) were of the National Strategy on Social Inclusion and Poverty conducted under the supervision of Mr. Andrew Mason, with Reduction 2015-2020 and the draft Action Plan based on overall guidance from Ms. Elisabetta Capannelli and Mr. this background study were posted on the website of the Christian Bodewig. Ministry of Labor, Family, Social Protection, and the Elderly on December 26, 2014 for feedback. These consultations The report was coordinated by Mr. Emil Teșliuc, Mr. Vlad have been critical in getting early input on how to fine-tune Grigoraș (task team leaders), and Ms. Manuela Sofia both the Strategy and this report. Stănculescu. The document includes contributions from Miglena Abels, Daniel Arpinte, Cosmin Briciu, Bogdan The report’s team members would like to express their Corad, Diana Chiriacescu, Sabin Chiricescu, Cătălina gratitude to their counterparts in the Ministry of Labor, Iamandi-Cioinaru, Eimar Coleman, Dana Fărcășanu, Family, Social Protection, and the Elderly, in particular Andy Guth, Adrian Hatos, Marcel Ionescu-Heroiu, to Mr. Codrin Scutaru, Ms. Lăcrămioara Corcheș, Ms. Ulrich Hoerning, Liviu Ianăși, Fidelie Kalambayi, Sandor Elena Dobre, Ms. Rodica Cărăușu, Mr. Alexandru Alexe, Karacsony, Frank Kavanagh, Mihai Magheru, Monica Marin, Ms. Gabriela Coman, and Ms. Elena Tudor for the Georgiana Neculau, Ana Rădulescu, Irina Râmniceanu, guidance, timely feedback, and continuous support in Dumitru Sandu, Alina Sava, Oleksiy Sluchynskyy, Ken the development of the report. The report benefitted also Simler, Andreea Trocea and Claudiu Tufiș. Simona Anton, from the continued coordination with UNICEF, particularly Irina Boeru, and Alexandru Toth helped the team to cover in the areas of vulnerable children’s social problems and the data collection activities. The team benefitted from the integrated services. We also want also to thank to Ms. Lidia support of Oana Maria Caraba, Corina Grigore, Carmen Onofrei from the Ministry of Health, Ms. Steluta Jalia, Mr. Laurente, Alina Petric, and Camelia Gușescu. Fiona Teofil Gherca and Mr. Bogdan Ghinea from the Ministry Mackintosh edited the report. The pictures were taken by of Regional Development and Public Administration, the research team, during fieldwork. The report was peer Ms. Dana Gafițianu from the Ministry of Agriculture and reviewed by Christian Bodewig, Roberta Gatti, Lucian Bucur Rural Development, as well as Ms. Viorica Preda from the Pop, Pedro L. Rodriguez and Istvan Vanyolos. Two of the Ministry of Education who helped us with data and provided thematic chapters of this volume have been informally peer feedback on the early versions of the background study. reviewed by World Bank colleagues working on Romania The local authorities from more than 3,100 localities across on those sectors (education by Penny Williams and the country provided information on their social assistance Janssen Teixteira, and health by Richard Florescu, Cristina activities, in May 2014. County and local authorities from Petcu and Marcelo Bortman). Arad and Botosani counties helped us in carrying out the qualitative study in July-August 2014. Mayoralties and A first draft of this background study was also shared with local people from Vrancea, Bacău and Suceava helped the counterparts for early feedback in October 2014. Three us to understand what are the main problems related to rounds of early consultations have been carried out: (i) with the Guaranteed Minimum Income. The local authorities institutional stakeholders (experts from all key ministries) from 303 cities participated in October 2014 in the survey on October 18, 2014; (ii) with a broad range of stakeholders on social housing. Overall, a very large number of people (NGOs, trade unions, research organizations, and academia) took time to share with us the main challenges they have on January 29, 2015, led by the Prime Minister and faced in tackling poverty and social exclusion in the field, the Minister of Labor, Family, Social Protection, and the and provided creative ideas on what and how should be Elderly; and (iii) the Social Service Forum, led by Caritas changed for the benefit of the poor and vulnerable. Confederation with the participation of the Ministry of Labor The volume was coordinated by: Emil Teșliuc Vlad Grigoraș Manuela Sofia Stănculescu Authors (in alphabetical order): Miglena Abels Fidelie Kalambayi Daniel Arpinte Sandor Karacsony Cosmin Briciu Frank Kavanagh Bogdan Corad Mihai Magheru Diana Chiriacescu Monica Marin Sabin Chiricescu Georgiana Neculau Cătălina Iamandi-Cioinaru Ana Rădulescu Eimar Coleman Irina Râmniceanu Dana Fărcășanu Dumitru Sandu Andy Guth Alina Sava Adrian Hatos Oleksiy Sluchynskyy Marcel Ionescu-Heroiu Ken Simler Ulrich Hoerning Andreea Trocea Liviu Ianăși Claudiu Tufiș Contents INTRODUCTION 13 1. POOR AND VULNERABLE GROUPS 25 Status and Forecasts of Poverty or Social Exclusion 1.1.  28 1.1.1. Status and Dynamics of Poverty or Social Exclusion 30 1.1.2. Relative Poverty Forecasts (AROP) 42 1.2. Main Vulnerable Groups 45 2. PEOPLE-BASED POLICIES 49 2.1. Employment 52 2.1.1. Activating People in Poverty not in Education, Employment, or Training 53 2.1.2. Reducing Informal Employment and Increasing the Productivity of Small and Medium-sized Farms 64 2.1.3. Reducing the High In-work Poverty Rate 65 2.1.4. Increasing the Institutional Capacity and Resources of the Public Employment Service 65 2.1.5. Increasing the Employment Rates of Vulnerable Groups 69 2.1.6. Developing the Social Economy to Increase Employment Opportunities for Vulnerable Groups 77 2.2. Social Transfers 82 2.2.1. Improving the Performance of the Social Assistance System 82 2.2.2. Providing Adequate Financial Support for the Disabled at Risk of Poverty or Social Exclusion 93 2.2.3. Protecting Elderly People at Risk of Poverty or Social Exclusion 94 2.2.4. Protecting Poor and Vulnerable Consumers against Energy Shocks 102 Social Services 2.3.  106 2.3.1. Fostering the Participation of Beneficiaries in the Planning and Provision of Social Services 108 2.3.2. Improving Needs Assessments and the Management Information Systems and Ensuring They Align Local Decision-making Policies and Practices 109 2.3.3. Improving the Financing of Social Services 111 2.3.4. Strengthening and Enhancing Social Assistance at the Community Level 116 2.3.5. Developing the Integrated Intervention Community Teams 125 2.3.6. Developing Social Services for Vulnerable Groups 133 2.4. Education 180 2.4.1. Improving the Early Childhood Education and Care System 182 2.4.2. Increasing Participation and Improving Outcomes in Primary and Secondary Education for All Children 186 2.4.3. Promoting Broader Access to Tertiary Education by Under-represented Groups 197 2.4.4. Increasing Access to Lifelong Learning and Training for Disadvantaged Youths and the Working Age Population 197 2.4.5. Increasing Access to Quality Education for Children from Vulnerable Groups 198 2.4.6. Enhancing the Effectiveness of Welfare Programs in Education 216 Health 2.5.  224 2.5.1. Improving Health Equity and Financial Protection 225 2.5.2. Improving Healthcare Provision in Specific Areas Relevant to Poor and Vulnerable Groups 230 2.5.3. Increasing the Access of Vulnerable Groups to Quality Healthcare 240 Housing 2.6.  256 2.6.1. Increasing the Affordability and Improving the Quality of Housing, Especially for the Vulnerable Population 256 2.6.2. Developing Social Housing Services 262 2.6.3. Ensuring Efficient Emergency Support for the Homeless while Building Capacity for Social Reintegration and Early Prevention 267 2.7. Social Participation 272 2.7.1. Improving the Social Climate and Increasing Trust in Institutions 272 2.7.2. Increasing Tolerance and Decreasing Discrimination 274 2.7.4. Empowering Poor and Marginalized Communities through Active Social Participation 276 2.7.5. Increasing Access to Information and Knowledge through Social Innovation 280 3. AREA-BASED POLICIES 283 Geographical Dimension of Poverty 3.1.  286 3.1.1. Reducing Geographical Inequalities 286 3.1.2. Improving the Quality of Life in Rural Communities 291 3.1.3. Improving the Quality of Life in Small Urban Communities 302 Integrating Marginalized Communities 3.2.  312 3.2.1. Integrating Rural Marginalized Communities 314 3.2.2. Integrating Urban Marginalized Communities 317 3.2.3. Integrating Roma Communities 322 3.2.4. An Integrated, Cross-sectoral, Area-based Approach to Marginalized Areas 327 4. STRENGTHENING INSTITUTIONAL CAPACITY TO REDUCE POVERTY AND PROMOTE SOCIAL INCLUSION 333 Enhancing Capacity for Policy Formulation and Management at all Levels 4.1.  336 Developing an Integrated Approach in the Field of Social Policy Development 4.2.  340 Developing an Integrated Approach in the Field of Social Policy Development 4.3.  341 Improving Service Delivery with Information and Communication Technologies 4.4.  342 Modernizing Payment Systems 4.5.  344 REFERENCES 347 ANNEXES 365 Research Activities Underpinning this background study Annex 1:  366 Annex 2: Poor and Vulnerable Groups 367 I. Statistical Data 367 II. Assumptions of the Poverty Forecasting Model 374 Annex 3: Employment 376 I. Statistical Data 376 II. Profiling of Job Seekers 377 III. Evaluation of the Outcomes of ALMPs 379 IV. Youth Guarantee Program in Romania, 2014–2015 379 V. A Staff Training Initiative to Professionalize the Work of NEA Advisers and Mediators 380 Annex 4: Social Transfers 382 Annex 5: Social Services 385 I. Statistical Data 385 Methodology of Census of Public Social Assistance Services at the Community Level II.  388 Medical Rehabilitation Services for People with Disabilities III.  389 IV. Support Services for People with Disabilities 390 Organization and Provision Principles of Services for Drug Users in Romania V.  391 Organization and Types of Services for Victims of Human Trafficking in Romania VI.  392 Organization of Services for Victims of Domestic Violence in Romania VII.  394 Annex 6: Education 395 I. Statistical Data 395 Legislative Framework and Education Network for People with Disabilities II.  395 Annex 7: Health 397 Annex 8: Housing 398 I. Statistical Data 398 II. Situation of Social Housing (SSH) Survey 400 Annex 9: Social Participation 407 Annex 10: Area-based Policies 409 Statistical Data on Small and Very Small Villages and Those with Aging Populations I.  409 Statistical Data on Small Communes (with Fewer than 2,000 Inhabitants) II.  413 Statistical Data on Small Urban Towns (fewer than 20,000 inhabitants) III.  414 IV. Statistical Data on Marginalized Areas 420 Acronyms and Abbreviations ADHD - Attention deficit hyperactivity disorder ECDC - European Center for Disease Prevention and Control AIDS - Acquired immune deficiency syndrome ECEC - Early childhood education and care AJOFM - County Employment Agency EMCDDA - European Monitoring Centre for Drugs and Drug AJPIS - County Agencies for Payments and Social Addiction Inspection ERDF - European Regional Development Fund ALMP - Active Labor Market Program ESF - European Social Fund ALOFM - Local Employment Services ESI - European Structural and Investment Funds ANA - National Anti-Drug Agency ESL - Early School Leaving ANP - National Administration of Penitentiaries ESSPROS - European System of Integrated Social Protection ANPIS - National Agency for Payments and Social Statistics Inspection EU - European Union ANITP - National Agency against Trafficking in Human Beings EU-SILC - European Union Statistics on Income and Living Conditions AROPE - People at risk of poverty and social exclusion FEAD - Fund for European Aid to the Most Deprived AROP - At risk of relative poverty after receiving social transfers FSA - Family Support Allowance CASPIS - Anti-Poverty and Promotion of Social Inclusion GD - Government Decision Commission GDP - Gross Domestic Product CCS - Community Consultative Structures GEO - Government Emergency Ordinance CDD - Community Driven Development GMI - Guaranteed Minimum Income CF - Cohesion Fund GP - General Practitioner CHNs - Community Health Nurses HB - Heating Benefit CIA - Centers for Assistance and Care HBS - Household Budget Survey CITO - Residential rehabilitation centers for disabled people and centers for occupational therapy HFA - European Health for All database (Centrul de Integrare prin Terapie Ocupațională) HIC - Helping Invisible Children, UNICEF project CJRAE/ - County Center for Resources and Educational CMBRAE Assistance HIV - Human immunodeficiency virus infection CPECA - Drug Prevention, Assessment, and Counseling ICT - Information and Communication Technology Centers IEC - Information-education-communication CRB - Child Raising Benefit ILO - International Labour Organization CSR - Country Specific Recommendations IMF - International Monetary Fund DDAC - Department of Development and Community ISJ - County School Inspectorates Assistance (Direcția de Dezvoltare și Asistență Comunitară) IVET - Initial Vocational Education and Training DGASPC - County Directorates of Social Assistance and LAG - Local Action Groups Child Protection LCA - Latent Class Analysis DOT - Direct Observed Treatment LEADER - Liaison Entre Actions de Développement de DOTS - Direct Observed Treatment Strategy l'Économie Rurale (Links between the rural economy and DPH - Department for Protection of Persons with development actions) Disabilities (National Authority for Persons with Disabilities) LIOP - Large Infrastructure Operational Program DSP - County Directorates for Public Health LHDI - Local Human Development Index EAFRD - European Agricultural Fund for Rural LLL - Lifelong learning Development LWI - Low work intensity Indicator EC - European Commission MARD Ministry of Agriculture and Rural Development RHM - Roma Health Mediator MDR-TB - Multidrug resistant cases of tuberculosis RDP - Rural Development Project M&E - Monitoring and evaluation ROP - Regional Operational Program MIS - Management Information Systems RRS - Regional Roma Survey MoE - Ministry of Education RSDF - Romania Social Development Fund MoH - Ministry of Health SCA - State Child Allowance MLFSPE - Minister of Labor, Family, Social Protection and SEN - Special education needs the Elderly SIP - Social Inclusion Project MRDPA - Ministry of Regional Development and Public Administration SME - Small and medium-sized enterprises MSII - Minimum Social Insertion Income program SMURD - Emergency, Intensive Care and Rescue Mobile Service MTR - Marginal Tax Rate (Serviciul Mobil de Urgență, Reanimare și Descarcerare) M/XDR- - Multi-drug and extensive drug-resistant TB tuberculosis SOP HRD - Sectoral Operational Program Human Resources Development NAPCRA - National Agency for Protection of Children's Rights and Adoption SP - Social Pension NEA - National Employment Agency SPAS - Public Social Assistance Services NEETD - Adults who are not in employment, education, SSH - Situation of Social Housing Survey training, or disabled TB - Tuberculosis NGO - Non-Governmental Organization TIMSS - Trends in International Mathematics and Science NRDP - National Rural Development Program Study NTP - National TB Control Program TVET - Technical and Vocational Education and Training NUTS - Nomenclature of Units for Territorial Statistics VAT - Value-Added Tax OHCHR - UN’s Office of the High Commissioner for VET - Vocational education and training Human Rights’ USAID - United States Agency for International OECD - Organization for Economic Co-Operation and Development Development UNESCO - The United Nations Educational, Scientific and PAYG - Pay as you go Cultural Organization PES - Public Employment Service UNODC - United Nations Office on Drugs and Crime PDU - Problem Drug Users UNFPA - United Nations Population Fund PIRL - Progress in International Reading Literacy Study UNICEF - United Nations Children’s Fund PISA - Program for International Student Assessment UNCRPD - UN Convention on the Rights of Persons with Disabilities PNDL - National Local Development Program WHO- - WHO Regional Office for Europe POCU Operational Program Human Capital EURO Development 2014-2020 UNDP - United Nations Development Program PPS - Purchasing Power Standard WHO - World Health Organization PROST - Pension Reform Options Simulations Toolkit (WB) Th is p age inte ntio nal ly l eft bla nk 12 | INTRODUCTION INTRODUCTION 14 | INTRODUCTION Romania aims to be a country in which all citizens are provided with an equal opportunity to participate in society, where their basic needs are met and their differences respected, and where all people feel valued and can live in dignity. Romania aims to become a country where: will reach their potential and that communities will • pro-actively use this potential. • A  ll citizens have equal opportunities. Everyone deserves the opportunity to participate  ll people feel valued and can live in dignity. A fully in the economic, social, political, and cultural All human beings are born free and equal in dignity life of their society and to enjoy the benefits of and rights (Article 1 of the UN Declaration of Human doing so. Equal opportunities mean that individual Rights). When a person feels valued and lives in circumstances beyond their control do not determine dignity, they are more likely to be in control of their people’s outcomes. lives and to participate in and become an active • member of society. The basic needs of every citizen are met. Romania’s society is still far from this ideal. At present, Along with respect for and protection of fundamental according to the European Union’s methodology, one in five human rights, one of the main preconditions for a Romanians lives in relative poverty (is income poor). decent quality of life is meeting citizens’ basic needs A large share of income poverty is persistent, meaning that for housing, food, sanitation, and security as well as over three-quarters of the poor were poor in the reference for basic community services such as education, year as well as in at least the previous two or three years. healthcare, and social services. These key elements According to the national definition of absolute poverty, enable people to live in dignity, to have control over about 5 percent of the population cannot afford to purchase their lives, and to actively participate in the life of a minimum consumption level of products and services. their communities. The responsibility for developing One-third of the population is severely deprived materially their own social integration capacities and for being in the sense of not being able to afford items considered actively involved in handling difficult situations rests to be desirable or even necessary to lead an adequate life with every individual as well as with his or her family, by the standards of the EU member states. There are still and public authorities should take action to ensure children in Romania who have never attended school, and equal opportunities for all or, in their absence, provide the percentage of youths without an adequate education adequate social benefits and services. for the labor market is extremely high. Many people are •  ifferences between individuals are respected. D Each individual is unique. Individual differences can be along the lines of race, gender, ethnicity, still inactive or are illegally employed, with little chance of gaining proper access to the labor market. There are major inequalities in primary healthcare coverage, and the majority of the poor continue to have to pay for medicine. To socioeconomic status, age, sexual orientation, and compound matters, there is a significant number of deprived beliefs (religious and otherwise) as well as physical, communities in which all of these problems come together, cognitive, or social abilities. The concept of diversity making it almost impossible for the members of those goes beyond tolerance; it encompasses acceptance communities to break the exclusion cycle without sustained and respect. Valuing diversity in a positive and and integrated external support. nurturing way increases the chance that everyone Introduction | 15 Strategic Actions at the National Level for Reducing Poverty and Promoting Social Inclusion This document aims to continue the series of strategic actions undertaken in the area of poverty reduction and promotion of social inclusion for the past 20 years. A short historic of the most important phases achieved so far is presented below. 1998 Setting up in 1998 of a Commission for Prevention and Fight Against Poverty under the patronage of the Romanian Presidency. The Commission drafted and passed a ”Strategy for the Prevention of and Fight against Poverty,” which, although it was not adopted by the government, represented the first strategic document to lay down the principles of social policies. 2001 Setting up of an Anti-Poverty and Promotion of Social Inclusion Commission (CASPIS), which operated between 2001 and 2006. This institution together with the County Commissions under its coordination (which were responsible for developing and implementing social policies at the county level) anticipated Romania’s participation to the EU’s Open Method of Coordination. In the period of CASPIS operation, several actions were taken to strengthen the fight against poverty: (i) the setting up of a methodology for computing absolute poverty; (ii) the building of a set of national and county indicators to be monitored; and (iii) the development of the first poverty map at the local level. In addition, the Commission drafted the National Anti-Poverty and Social Inclusion Promotion Program and county plans that explained and adapted the national objectives to the local needs. 2005 Signing in 2005 of a Joint Social Inclusion Memorandum by the Government of Romania and the European Commission as a first phase of a European social policy to be implemented jointly. The document, coordinated by the Ministry of Labor and drafted jointly by a significant number of relevant actors, aimed to identify the key challenges faced by Romania in promoting social inclusion as well as the needed policy responses. 2006 Passing of the Government Decision no. 1217/2006 that contained a national mechanism for promoting social inclusion. The same piece of legislation also set up a National Social Inclusion Committee within the Inter-ministerial Council for Social Affairs, Health, and Consumer Protection. The National Commission includes a representative at the level of secretary of state or president from the ministries, authorities, agencies, and other governmental institutions with responsibilities in the field of social inclusion. It has a consultation role and is managed by the Ministry of Labor, Family, Social Protection, and Elderly. 2010 Approval in July 2010 of the Memorandum that contains the final values of the national targets for the Europe 2020 Strategy, including the poverty target according which Romania has committed to lift out of poverty 580,000 people by 2020.1 2011 Approval of the Social Assistance Reform Strategy in 2011, which contained a series of key objectives that have acted as guiding principles for the government in the past few years, namely: (i) targeting social benefits to low-income people; (ii) reducing the costs of access for the recipients of social benefits; (iii) reducing system error and fraud; (iv) reducing the number of working age people who are dependent on social assistance; (v) consolidating social assistance benefits; and (vi) increasing capacity for forecasting, strategic planning, and monitoring and evaluation. 2015 Approval of the National Strategy on Social Inclusion and Poverty Reduction 2015-2020 and the corresponding Action Plan by the Government of Romania through the Government Decision no. 383 from May 27, 2015. This National Strategy and its Action Plan were drafted based on the background study presented this volume. 1 The poverty reduction target at the EU-28 level is to reduce the number of people at risk of poverty or social exclusion by 20 million between 2008 and 2020. The Government of Romania has committed itself to contributing to this target by reducing the population at risk of relative poverty after social transfers from 4.99 million in 2008 to 4.41 million by 2020. 16 | INTRODUCTION The Main Policy Areas Addressed The Approach of the Volume in this Volume To fight social exclusion, the main goal is to make equality This background study for the National Strategy on Social of opportunity a reality for Romanian citizens throughout Inclusion and Poverty Reduction 2015-2020 sets out a plan their lifecycles. The final outcome for any individual is the to enable Romania to make substantial progress in reducing result of two types of influences: circumstances and effort.3 poverty and in promoting social inclusion for vulnerable Circumstances are all of the external factors over which individuals, families, and groups over the next seven years. the individual has no control, whereas effort comprises all This volume outlines a structured set of policy measures for of the factors within the individual’s control and sphere of achieving the Europe 2020 targets for Romania.2 The current responsibility. Any resulting inequalities related to effort study has aimed to coordinate and update the set of strategic are ethically acceptable, whereas any inequalities due to actions for poverty reduction that have been implemented in circumstances are not and should be eradicated. In addition, Romania so far. Moreover, to ensure complementarities and a growing body of evidence shows that unequal opportunity coordination with other endeavors in this area, the volume often leads to wasted productive potential and to the incorporates elements from various sectoral strategies and inefficient allocation of resources, thereby undermining from particular domains of the government’s social inclusion economic efficiency. Ensuring that all individuals have an policy (such as tackling child poverty, reducing discrimination equal opportunity to develop their potential throughout their against Roma, and integrating marginalized communities). lifecycle is therefore essential from both a moral and an The background study has also taken into account the economic perspective. recommendations of the European Commission’s 2013 Combating poverty and social exclusion requires a taking National Reform Program and Convergence Program for lifecycle approach to individual needs. 2012-2016, as shown in Box 1. SCHEME 1: Lifecycle Approach For children (those between the ages of 0 and 17 years old) For working age adults For people beyond working age The goal is to ensure that all children have the opportunity to develop their full potential regardless The goal is to ensure that the elderly are valued and of their social background by ensuring the conditions The goal is to ensure that everyone respected, that they remain independent necessary to develop the skills, knowledge has the opportunity to fully participate in the and can participate in all aspects of life acquisition, and experience needed to achieve their economic, social, and cultural life of Romania. as active citizens, and that they enjoy full potential as successful students, confident a high quality of life in a safe community. individuals, responsible citizens, and effective contributors to society’s development. 2 Relative poverty (AROP) is the indicator that is used by the Government of Romania to monitor whether the poverty reduction target is being met. 3 Roemer (1993). Introduction | 17 BOX 1 Comparative Overview between the European Commission Council Recommendation4 and the Policy Areas Addressed in this Volume Country-specific Recommendations Policy Areas Addressed in this Volume Step up reforms in the health sector to increase its efficiency, 2.5.1. Improving Health Equity and Financial Protection quality and accessibility, including for disadvantaged people and 2.5.3. Increasing the Access of Vulnerable Groups to Quality remote and isolated communities. Increase efforts to curb informal Healthcare payments, including through proper management and control systems. Strengthen active labor market measures and the capacity of the 2.1.4. Increasing the Institutional Capacity and Resources of the National Employment Agency (NEA). Pay particular attention to Public Employment Service the activation of unregistered young people. Strengthen measures 2.1.2. Reducing Informal Employment and Increasing the to promote the employability of older workers. Establish, in Productivity of Small and Medium-sized Farms consultation with social partners, clear guidelines for transparent minimum wage setting, taking into account economic and labor 2.1.3. Reducing the High In-work Poverty Rate market conditions. Increase the quality and access to vocational education and 2.4.4. Increasing Access to Lifelong Learning and Training for training, apprenticeships, tertiary education and of lifelong learning Disadvantaged Youths and the Working Age Population and adapt them to labor market needs. 2.4.2. Increasing Participation and Improving Outcomes in Primary Ensure better access to early childhood education and care. and Secondary Education for All Children 2.4.1. Improving the Early Childhood Education and Care System In order to alleviate poverty, increase the efficiency and 2.2.1. Improving the Performance of the Social Assistance System effectiveness of social transfers, particularly for children, and 2.1.5. Increasing Employment Rates for Vulnerable Groups continue reform of social assistance, strengthening its links including Roma with activation measures. Step up efforts to implement the envisaged measures to favor the integration of Roma in the labor 2.4.5. Increasing Access to Quality Education for Children from market, increase school attendance and reduce early school Vulnerable Groups including Roma Children leaving, through a partnership approach and a robust monitoring mechanism. Step up efforts to strengthen the capacity of public administration, 4. Strengthening institutional capacity to reduce poverty and in particular by improving efficiency, human resource promote social inclusion management, the decision-making tools and coordination within and between different levels of government; and by improving transparency, integrity and accountability. Accelerate the absorption of EU funds, strengthen management and control systems, and improve capacity for strategic planning, including the multi-annual budgetary element. Tackle persisting shortcomings in public procurement. Continue to improve the quality and efficiency of the judicial system, fight corruption at all levels, and ensure the effective implementation of court decisions 4 European Commission (2014b) COUNCIL RECOMMENDATION on Romania’s 2014 national reform program and delivering a Council opinion on Romania’s 2014 convergence program (CSR). 18 | INTRODUCTION Because children who grow up in poor households Moreover, even when a service is provided free of charge, face a higher risk of poverty in the future, breaking the people may decide not to access it if they consider the intergenerational cycle of poverty makes it essential for the transaction or opportunity costs involved to be too high. government to adopt programs that can tackle both child The approach is illustrated in a synthetic way in Scheme 2. and adult poverty in the same household simultaneously. Thus, this book aims to contribute to better the lives of the Particularly in the case of the persistent poor and the Roma poor and vulnerable people by treating in an integrated and population, the various dimensions of exclusion tend to comprehensive framework: (i) the actors who will implement be mutually reinforcing and perpetuated from generation the recommended policies; (ii) the targeting of the policies to generation. The intergenerational cycle of exclusion is themselves (either people-based/social policies or area- perpetuated when low educational achievement and poor based interventions); and (iii) the main sectoral policies. health severely limit the labor market opportunities that are accessible to the next generation of children. Breaking the Identifying and responding to the particular needs of intergenerational cycle of poverty and exclusion will require the poor and vulnerable groups is a key element in the targeted interventions designed to address the multiple implementation of effective social inclusion policies. Because drivers of inequality. vulnerable groups face specific problems for which generic policies may not provide a valid solution, the government A coordinated approach is needed to the provision of policies, plans to put in place tailored and integrated services to programs, and interventions that are targeted to poor and increase their social or economic participation (especially vulnerable people and poor and marginalized areas. There with the help of the Public Social Assistance Services and is already a large spectrum of sector policies, programs, and community workers). interventions in existence in Romania aimed at reducing poverty and social exclusion, and the instruments and the Given the economic and social sectors from which individuals experience needed to identify poor people and poor areas might be excluded, the geographical patterns of exclusion, have improved in recent years. The key missing ingredient and the severity of the social problems that many people is the coordination between these policies, programs, and experience, our study broadly divides the various types of interventions. Given the strong correlation between poverty intervention into people-based and area-based policies. In and social exclusion, making progress on both fronts will this document, people-based policies cover policies aimed require more and better social interventions that will connect directly at reducing poverty and increasing social inclusion people with jobs, cash support, and services. It will also be in several key domains: incomes (social benefits and social essential to increase capacity for accurately assessing need insurance rights), employment, education, health, housing, at all levels and to coordinate social services, employment social participation, and social services. services, and healthcare services in order to bring the non- Because poverty has a starkly geographical aspect in working but work-capable beneficiaries of social protection Romania, one major objective is to ensure that the allocation into employment. Thus, this approach to tackling poverty and of resources is accurately correlated with the distribution social exclusion is built on the concept of providing integrated of need within the country (by developing area-based services and on ensuring that different programs and policies). In Romania, nearly one-half of the population is interventions are harmonized and aligned by empowered, based in rural areas, and many are heavily disadvantaged well-trained social workers at the level of both the individual in terms both of their monetary incomes and of basic and the community. infrastructure and services. There is also a large variation In delivering interventions, it is important to address both among urban areas as well, with small towns (particularly supply-side and demand-side challenges. In poor and those whose status changed from rural to urban over the last marginalized communities, in both rural and urban areas, and 15 years) being the most disadvantaged. The government among both Roma and non-Roma, merely providing new aims to reduce the gaps between rural and urban areas infrastructure or services will not necessarily mean that they and between poor/undeveloped urban areas and more will be used. Demand-side bottlenecks, such as those related developed urban areas. In addition, the area-based policies to user awareness, financial means, capacity constraints, and programs recommended in this volume represent a opportunity costs, social norms, and risks (to safety, dignity, coordinated effort to substantially reduce poverty and social and reputation, for example), all need to be assessed and exclusion in marginalized communities, which are the most addressed. Even if a service is provided, people will not use disadvantaged communities in Romania (both Roma and it if they are not aware of its benefits or if it is too costly. non-Roma and in both rural and urban areas). Introduction | 19 This document is based on a combination of desk research, survey data. A snapshot of the research activities can be qualitative data analysis, new data collected by the World found in Annex 1. Bank team and analyses of administrative, census and SCHEME 2: Policy Response To Reduce Poverty And Promote Social Inclusion POLICY TYPES POLICY IMPLEMENTATION POLICY DOMAINS Social Policies & Area-based Incomes interventions for SPAS & Community workers Emplyment Social services Education -Poor regions Social work Health Education & Health -Rural areas Social benefits Housing -Small cities Social participation -Marginalized areas (urban/rural, Roma) 20 | INTRODUCTION Key Interventions at a Glance policy areas in the 2015-2020 period. From the set of policies and interventions covered by the study, the World For each policy area covered in this book, we spelled out Bank team has also developed detailed implementation specific objectives together with challenges and actions plans for a subset of nine flagship interventions that could to take to tackle each of these problems. This section puts have the greatest impact in terms of reducing poverty and forth a selection of interventions that we think that, among promoting social inclusion, which are highlighted in the text. others, could become national priorities for each of these Employment (Flagship Initiative #1) Increase funding for cost-effective active labor market policies, expand access to these services for the inactive poor and vulnerable, and link them with tailored remedial or employment services, through a statistical profiling of the out-of-work but work-capable population from the target group. Target vulnerable youths, including through EU-wide programs such as the Youth Guarantee. Use EU funds to strengthen the monitoring and evaluation of these active labor-market policies, to learn what works and how to increase the supply of existing programs. (Flagship Initiative #2) Introduce a pro-work benefit formula in the new consolidated means-tested benefit (see the Social Transfers line), that exempts part of the earnings of the households from the definition of the family means. Improve training for small- and medium-sized farm holdings by: (i) strengthening, professionalizing, and upgrading existing advisory and support institutions for smallholder farmers and family-based subsistence agriculture and (ii) broadening coverage of agricultural vocational schools and technical colleges to improve the skills base of (future) farmers. Social Transfers (Flagship Initiative #2) Consolidate the means-tested programs into a flagship anti-poverty program (the Minimum Social Insertion Income - MSII program). The three small social assistance programs should be replaced with a single and larger program, which would be better targeted towards the poorest 5 million Romanians and would provide incentives for the in-work poor to receive social assistance even while they are earning a wage. The MSII program will be better linked with employment services, education, children’s health services, and housing services. Address demand-side bottlenecks related to access to social assistance benefits and social services, such as those related to user awareness, financial means, opportunity costs, social norms, and risks (safety, dignity, and stigma). Simplify the access of people with disabilities to the social protection system by harmonizing medical criteria for invalidity pensions and disability allowances and by unifying the institutional framework for assessing disability allowances and invalidity pensions. Develop reform to provide affordable old age income provisions for the rural population currently without insurance-based pension coverage. Social Services Ensure that public funds are available for the development of the social services sector in parallel with funding from the European Union. (Flagship Initiative #3) Strengthen and enhance social assistance at the community level by: (i) developing a minimum intervention package as a mandatory responsibility for each local authority; (ii) financing from the state budget a national program - Social Program Opportunity and Responsibility (SPOR) - to ensure that in each locality at least one full- time employee does Introduction | 21 social work, has consistent outreach tasks in their job description, and works one-to-one with people in vulnerable situations and their families; (iii) financing from the state budget a national program to train employees with social assistance duties and to draft methodologies, guidelines, and tools to strengthen the implementation of case management at the level of the SPAS, especially in rural and small urban areas; and (iv) developing a strong monitoring and evaluation system of the social assistance services at the community level. Develop integrated intervention community teams, within the same intervention SPOR, to provide social services (in education, employment, healthcare, social protection, and other public services) and social intermediation and facilitation programs at the local level, especially in poor and marginalized areas, rural and urban areas, and Roma and non-Roma communities by: (i) developing clear methodologies, protocols, and work procedures for community-based workers and (ii) developing, in the larger marginalized areas, multi-functional community centers to provide integrated services primarily though not exclusively to families in extreme poverty. (Flagship Initiative #5) Strengthen social services for child protection by: (i) developing and strengthening the capacity of community- based prevention and support services; (ii) reconsidering the ways and means (including cash benefits) of providing family support in order to prevent child-family separations; and (iii) revising the existing child protection services to enhance the quality of care provided while reducing the duration of stays in the child protection system to the minimum necessary. Develop social services for vulnerable groups by: (i) increasing the financing of social services and improving the procedures for contracting out social services to non-government and private providers and (ii) strengthening the role played by the DGASPCs in strategic planning and methodological coordination and in supporting SPAS at the community level, as well as in monitoring and evaluating service providers within the county. Education Extend the network of kindergartens and crèches in order to provide access to all Romanian children. Design and implement a national program focused on children at risk of dropping out or who have already dropped of primary and secondary education by: (i) designing a coherent referral system to education, with entry points from all systems dealing with children from vulnerable families; (ii) implementing a monitoring system for those children at highest risk of dropping out of school or skipping enrollment; (iii) tightening the monitoring of schools in order to ensure that these cases are followed-up; and (iv) designing a program that monitors the households of out- of-school children of compulsory school age and provides them with assistance, support, and parental education. Increase the availability of second-chance programs in rural areas and beyond the lower secondary school level, and provide funding to support disadvantaged groups attending second-chance education to cover their educational costs and other indirect costs. Increase the access of children with special education needs (SEN) and/or disabilities to quality education by: (i) revising the institutional, financing, and legal arrangements for the education of children with SEN/disabilities, (ii) creating further programs to train parents, tutors, and teaching staff in interacting with and helping children with SEN and/or disabilities, possibly using funds from the Human Capital Operational Program (POCU); (iii) including the topics of tolerance for disabled people and diversity in the educational curriculum in order to reduce the stigma and rejection associated with disability and SEN; (iv) investing in the County Resources and Educational Assistance Centers (CJRAEs) to enable them to become real resource centers for inclusive education; and (v) improving the knowledge base on children with disabilities and SEN and on their access to education. (Flagship Initiative #4) Ensure that all children have access to equal opportunities by (i) reviewing the school financing methodology to improve the allocation of resources to children in need, and (ii) ensuring that the money is used to deliver effective interventions that will increase access to and improve the quality of education for vulnerable groups. Redesign the welfare programs in education in order to increase participation of and the quality of education for poor and vulnerable pupils. 22 | INTRODUCTION Health Increase the coverage of basic healthcare service providers (family doctors, community nurses, and Roma mediators) at the local level countrywide. Design evidence-based health promotion interventions, and implement, monitor, and evaluate these programs. In particular, these would include reducing harmful alcohol consumption, especially in rural areas, with a focus on those who are less well-educated, and focusing more on outreach interventions in specific communities identified as the most vulnerable. Redesign the National TB Control Program (NTP) against multi-drug and extensive drug-resistant tuberculosis (M/ XDR-TB) to include social support and targeted interventions, with a dedicated budget, to meet the needs of poor and extremely vulnerable populations such as injection drug users (IDUs), street children, homeless, prisoners, and Roma. Housing Design and finance a social housing program for vulnerable groups who cannot afford to pay rent or utilities, such as the homeless, post-institutionalized youths, ex-prisoners, victims of domestic violence, people evicted from restituted houses, and people with drug dependencies. Introduce a housing component into the new the Minimum Social Insertion Income (see the Social Transfers line) for families living in social housing in addition to the heating subsidy targeted to low-income families living in their own dwellings. This housing benefit will cover the cost of their rent and a part of their heating-related costs in order to prevent homelessness by reducing evictions. Shift the emphasis of efforts to reduce homelessness from emergency services to long-term integration programs. Social Participation Ensure that open and responsive grievance and complaints mechanisms are built into the institutional organization of social services. Promote evidence-based awareness and advocacy campaigns about diversity (including various categories of marginalized or discriminated groups) to complement other actions in addressing stigma and discrimination. Foster civic engagement and volunteering by further improving the law on volunteering and by mobilizing mass media and civil society to raise awareness of best practices and the value of participation. Area-based Policies Boost the territorial development of rural, sub-urban, and peri-urban areas around urban growth engines, especially large dynamic cities and growth poles by: (i) defining cities, especially the most dynamic ones, as functional urban areas; (ii) implementing adequate institutional arrangements for the management of functional urban areas to enable them to grow; (iii) expanding metropolitan public transport systems to areas with high population densities and with strong commuter flows; and (iv) investing in the infrastructure of villages incorporated within cities. Continue to invest in the expansion and modernization of the physical infrastructure in rural areas such as roads and basic utilities (mainly water, sewerage systems, and natural gas). Provide training and facilitation to the local authorities and other stakeholders of the LEADER program and use the LAG (local action group) framework to make the best use of ESI funds in alleviating poverty and social exclusion in rural areas. (Flagship Initiative #6) Develop a tool for geographic targeting, monitoring and evaluating interventions for reducing poverty and promoting social inclusion, with a focus on poor localities and marginalized communities, both rural and urban, and both Roma and non-Roma. Integrate marginalized communities by implementing packages of integrated social services consisting of integrated intervention community teams and multi-functional community centers providing coordinated access to education, health, employment, and housing services (see the Social Services line). Introduction | 23 Strengthening Capacity to Promote Poverty Reduction and Social Inclusion Establish functional inter-sectoral coordination policies (the MLFSPE, MRDPA, MoE, and MoH) and enhance cooperation between the central and local authorities to foster the integrated approach to reducing poverty and promoting social inclusion policies. (Flagship Initiative #7) Expand the coverage and functionality of the social assistance Management Information System (MIS) by: (i) developing local customer relationship management solutions to enable the local authorities to maximize the automation of all local social assistance processes so that they can link all local databases with the social assistance MIS, and (ii) developing a new social assistance MIS to automate processing and to carry out validations (both ex-ante and ex-post). (Flagship Initiative #8) Develop a modern payment system that will use modern technologies and service delivery methods to: (i) centralize the payment processing function; (ii) compute automatically the necessary funds; (iii) rationalize budgetary requests from the Treasury; (iv) use modern payment transfer technologies; (v) provide clients with a range of secure and convenient payments channels; (vi) cease making direct payments to third parties; and (vii) incorporate best practice audit and reconciliation functions. (Flagship Initiative #9) Strengthen the national capacity to monitor and evaluate the measures under the National Strategy on Social Inclusion and Poverty Reduction 2015-2020 by: (i) improving mechanisms for collecting both administrative and survey data on a regular basis; (ii) building the capacity of staff at different levels to analyze quantitative and qualitative data in the areas of poverty and social exclusion; and (iii) developing a national social inclusion monitoring and evaluation system. Structure of the Volume sectors - social services, education, health, housing, and social participation. Special attention is paid to taking an The book is organized in four broad parts. The first part integrated, coordinated, and cross-sectoral approach to starts with an analysis of the trends in poverty and social the provision of social services in order to respond to the exclusion over the past few years and with a poverty complex challenges of poverty and social exclusion in a forecast for the next five years (2015 to 2020). The section more effective way. concludes with a short presentation of the main vulnerable groups considered in this background study. The third part turns its focus to area-based policies and discusses regional disparities, urban-rural differences The second part analyzes the sectoral policies that must and specific problems in small towns and villages, rural be implemented to tackle the problems identified in the first and urban marginalized areas, and Roma and non-Roma part of the volume. Firstly, the subset of policies that have communities. a direct impact on the earnings of the poor and vulnerable are discussed, namely employment and social protection The book continues in the fourth part with a discussion of transfer policies (social assistance and social insurance the actions needed to strengthen the capacity of the public benefits). It continues by presenting the main issues system to reduce poverty and increase social inclusion. related to poverty and social inclusion in the other relevant Finally, it closes with references and annexes rich in data and methodological notes. Th is p age inte ntio nal ly l eft bla nk 24 | POOR AND VULNERABLE GROUPS | 25 1. POOR AND VULNERABLE GROUPS 1 POOR AND VULNERABLE GROUPS Poor and Vulnerable Groups This chapter presents the main characteristics and the evolution of poor and vulnerable groups in Romania as well as a forecast for the period from 2015 to 2020. The section ends with a succinct presentation of the vulnerable groups at risk of social exclusion. Chapter Structure Status and Forecasts of Poverty or Social Exclusion 1.1.  28 1.1.1. Status and Dynamics of Poverty or Social Exclusion 30 1.1.2. Relative Poverty Forecasts (AROP) 42 1.2. Main Vulnerable Groups 45 28 | POOR AND VULNERABLE GROUPS Status and Forecasts of Poverty or 1.1.  Social Exclusion In acknowledgment of the complex nature of poverty People at Risk of Poverty SCHEME 3:  and social exclusion, the Government of Romania uses or Social Exclusion a large set of indicators to measure this phenomenon.5 The broadest indicator (AROPE), which is also used to measure whether the European Union’s social inclusion target is being met, tracks people at risk of poverty or social People at risk of poverty after social transfers exclusion who are in at least one of the following three situations: •  hey are at risk of relative poverty after receiving T social transfers (AROP indicator). These are people whose annual income (including social protection transfers) is lower than 60 percent of the median income as expressed per adult equivalent. Disposable People living in People severely income is the sum of all revenues (including those households with low materially deprived work intensity from social protection) minus the amount of taxes (income or property-based) and social insurance paid. •  hey live in households with very low work intensity, T meaning households where the members aged 18 to 59 years old have worked in a paid activity for less than 20 percent of their work potential in a given BOX 2 reference year. • T  hey are exposed to severe material deprivation, meaning people from households that are in at least four of the following nine situations: (1) they cannot Definition and Measurement of Poverty There is no unitary, generally accepted afford to pay their rent, mortgage, or utility bills; (2) methodology for identifying poor people – they cannot afford to keep their home adequately each of the various existing methods holds different warm; (3) they cannot meet unexpected expenses; assumptions and consequently leads to different (4) they cannot afford to eat meat or protein every results. Generally, two elements are needed to second day; (5) they cannot afford to go on a determine poverty levels using a one-dimensional one-week annual holiday; (6) they cannot afford to approach: (i) an indicator that reflects household purchase a television set; (7) they cannot afford to welfare or resources and that makes it possible to purchase a washing machine; (8) they cannot afford make comparisons between households and (ii) to run a car; and (9) they do not have a telephone.6 a poverty line (a standard level of the household 5 The indicators are computed according to a national methodology (Decision no. 488/2005 on the national system of social inclusion indicators) and to Eurostat methodology. 6 The indicator distinguishes between individuals who cannot afford a certain item or service and those who do not have this item or service for another reason, for example, because they do not want or need it. Status and Forecasts of Poverty or Social Exclusion | 29 BOX 2 (continued) welfare indicator against which the wealth level of of scale within a household; and (iii) the sampling each household can be compared). In Romania, design used in Households Budget Survey (HBS) several methodologies have been tested over time, to estimate poverty, needs to be readjusted to take and two are the most relevant in the context of this account of the results of the 2011 Population and volume: (i) a national-level method for calculating Households Census. In order to ensure that the absolute poverty and (ii) a Europe-level method for government has accurate information on the size computing relative poverty. and profile of the people living in poverty, adequate financial and human resources will need to be The national-level method for measuring absolute allocated to revise the methodology for updating poverty was developed by experts from the absolute poverty data. The support of key actors World Bank, the National Anti-Poverty and Social such as the National Institute of Statistics, research Inclusion Commission, and the National Institute of institutes, and academics with expertise in this Statistics and was approved by the government in field will also be needed. It will also be important to 2005 (Government Decision no. 488/2005). This analyze the accuracy of the new normative method method aims to identify those households that are of measuring poverty that is being piloted by the EU unable to meet their basic needs for food, services, with the explicit goal of improving the targeting of and non-food goods by estimating the household’s support for people in need. minimum costing needs per adult equivalent. In order to take into consideration the economies of According to the relative poverty measurement scale (the supplementary costs of each additional used by Eurostat, the poverty level (below which person being lower than those for the first person in a household is considered to be poor) is set at 60 the household) and the different costs of children percent of the national annual median disposable compared to adults, the number of adult equivalents income for an adult equivalent. Because this in a household is computed as the number of people threshold is computed based on individual income aged 14 and over plus half of the actual number at a specific moment, this method tends to reflect a of people under 14 years old raised to the power country’s inequality measurement without showing 0.9. Moreover, the method uses consumption whether the poor/non-poor people are able to expenditures, which are better than income for meet their basic financial needs (for instance, if a estimating household wealth in the case of Romania country’s revenues were to double or half for all (taking into consideration the significant share of individuals in a year, then the number of relative non-monetary revenue from informal activities in poor people would remain constant). One way to the total household budget). However, this method overcome the problem of the relative threshold and has several limitations: (i) the structure of the basket consequently of the lack of comparability between of food and non-food items used to compute the years can be solved by comparing the values poverty threshold has significantly changed since each year to a line anchored in time (using a line 2002, which means that indexing it to inflation (in from a previous year expressed in current prices). current prices) is not an accurate way to identify Nevertheless, the Government of Romania uses the people who are in a financial difficulties; (ii) the this methodology of relative poverty to monitor formula for computing the number of equivalent achievement of the national poverty target so this adults is probably outdated and inadequate for will be the main method that we will use to identify measuring both children’s needs and economies poor people in this study. 30 | POOR AND VULNERABLE GROUPS 1.1.1. Status and persistent poverty, and their risk of being in such a state is much higher than that for any other age group. Moreover, Dynamics of Poverty or children’s risk of being in persistent poverty increased by almost 3 percent between 2008 and 2012, while the risk Social Exclusion for all the other age groups increased by less than 1 percent or even decreased. In this section we will analyze each of the dimensions of the AROPE indicator separately, looking at their evolution Regional Disparities over the 2008 to 2012 period and at the socio-demographic In Romania, whether a household is in an urban or a profile of the individuals and households at higher risk of rural area is a significant predictor of its level of social poverty or social exclusion. exclusion or poverty. Unfortunately, the EU-SILC does not distinguish between urban and rural locations so we have People at Risk of Poverty had to approximate this distinction with a variable that distinguishes between three levels of urbanization - densely People at risk of poverty after social transfers (AROP) is populated areas, intermediate areas, and thinly populated the first of the three indicators that are used to assess risk areas.10 For simplicity of analysis, we have decided to group of poverty and social exclusion in the European Union and together densely populated areas and intermediate areas is also the indicator that is used in Romania to monitor and refer to them as urban areas.11 whether the country’s poverty reduction target is met. Poverty is three times more likely in rural areas than in The relative poverty rate (AROP) in Romania has not urban areas. The differences that characterize the urban/ significantly changed since 2008. Although the poverty rural divide in Romanian society can be identified in the very rate decreased by 2.3 percentage points between 2008 large difference between the values of the AROP indicator and 2010, it showed an upward trend between 2010 and for the two areas. In 2012, while only 11 percent of people 2013 (Table 1). As a result, the decline in poverty between living in densely or intermediate populated areas were at 2008 and 2013 was 0.9 percentage points (representing risk of poverty, 38 percent of those living in thinly populated only 211,000 people rising out of poverty compared with areas faced such a risk (see Figure 1). the national target of 580,000).7 Not only did the poverty Much of the difference in poverty can be easily explained rate not change much during the 2008 to 2012 period,8 by the structural characteristics of a typical rural locality but the poverty gap (which measures the distance of the in present-day Romania. The rural population has a lower poor from the poverty threshold) remained almost constant share of working age individuals than urban areas (62.5 as well. Anchored poverty, which measures the dynamics percent versus 70.9 percent) where people tend to have of poverty against a poverty line with constant purchasing significantly lower poverty rates than the population as a power in time, indicates that there was a reduction in whole (Annex Table 2.1). Also, rural areas tend to have aging absolute poverty between 2008 and 2010, followed by a populations with few sources of monetary income. Also, slight increase between 2011 and 2013. the percentage of self-employed workers in agriculture is Persistent Poverty much higher in rural areas than in urban areas (15.8 percent versus only 2.3 percent), the self-employed being one Most of the people living in relative poverty in Romania of the groups with the highest risk of poverty in general are in persistent poverty. Among the population living in (Annex Table 2.2). Even between residents with the relative poverty in 2012, 81 percent were in persistent same characteristics, there is still a significant difference poverty (a person is living in persistent poverty if he/ in poverty rates between those in rural areas and those she has had an income below the at-risk-of-poverty in urban areas. For example, while 11.6 percent of rural threshold in the reference year and in at least two of the employees were in poverty in 2012, only 3.5 percent of preceding three years).9 Almost one-third of children live in employees living in urban areas were poor. This may be 7 Relative poverty is the indicator that is used by the Government of Romania to monitor whether the poverty reduction target is being met. 8 Because of some problems of survey comparability between 2013 and the other years, the 2012 EU-SILC survey will be the most recent year used in this chapter. 9 In Romania, the persistent at-risk-of-poverty rate is almost double the EU-28 rate – 18.2 percent compared with only 10.2 percent. 10 In 2012, 33.7 percent of the population was living in densely populated areas, 23.9 percent in intermediate areas, and 42.5 percent in thinly populated areas. 11 Because of a change in the definition of densely populated, intermediate, and thinly populated areas in 2012, the 2008-2011 and 2012-2013 data are not comparable. Status and Forecasts of Poverty or Social Exclusion | 31 TABLE 1: Relative Poverty Rate and Poverty Gap, 2008-2013 2008 2009 2010 2011 2012 2013 Relative poverty rate 23.3 22.4 21 22.1 22.5 22.4 Poverty gap 8.3 8.2 7.1 7.9 8.2 Anchored poverty rate* 23.4 18.2 16.2 17.9 19.9 20.4 Source: World Bank calculations using data from the 2008-2013 EU-SILC. Note: *Anchored at the 2008 poverty line. FIGURE 1: Relative Poverty Rates by Residential Area and Development Region, 2012 40 38 33 30 29 30 21 20 19 20 16 11 10 3 0 Urban Rural N-E S-W S-E S W C N-W Buch- Ilfov Area Region Source: World Bank calculations using data from the 2012 EU-SILC. explained by differences in education and in past and Children and Youths in Poverty current labor market opportunities (Annex Table 2.2). One-third of Romanian children live in poverty, and this There are huge differences between Romania’s regions percentage has not decreased over time. Over the 2008 to in the probability of being poor. As of 2012, the lowest 2012 period, the poverty rate for children was consistently proportion of people at risk of poverty was recorded in the much higher than the overall national rate (by about 10 Bucharest-Ilfov region where only 3 percent of people percentage points). Also, the risk of being in poverty was by were AROP (Figure 1). The North-West, Center, and West far the highest among all age groups (Table 2). Moreover, regions also had lower proportions than the national while the overall poverty rate decreased (although only average. The regions with the highest percentages of people slightly) over those five years, the poverty rate among at risk of poverty were the North-East (33 percent) and children actually increased by approximately 1 percentage South-East (29 percent) regions (Moldova and Dobrogea) point. One in every two children in rural areas lives in plus the South-West region (Oltenia). Although part of the poverty. In 2012, more than 50 percent of children in differences were due to the shares of people living in rural rural areas were living in poverty, while only 17 percent areas (as the regions with the highest poverty rates also of children in urban areas were in this situation. This have the largest rural populations), inequalities seem to large discrepancy coupled with an approximately even exist for people living in similar areas as well. 32 | POOR AND VULNERABLE GROUPS TABLE 2: Poverty Rates by Age, 2008-2012 2008 2009 2010 2011 2012 0-17 32.8 32.3 31.6 32.6 34.0 18-24 24.4 25.6 25.6 28.5 31.4 25-49 20.5 20.6 20.1 22.0 21.8 50-64 17.4 16.2 14.8 16.1 16.4 65+ 25.4 20.6 16.4 13.9 14.9 Source: World Bank calculations using data from the 2012 EU-SILC. distribution of children between urban and rural areas means that over 74 percent of poor children live in rural areas (see FIGURE 2: Poverty Rates for Children Figure 2 and Annex Table 2.3). What is alarming, as can be (0-17 years old), 2012 seen in detail in the sectoral chapters, is that the absence of material resources coupled with the lack of access to 60 53 basic services (health and education) and an inefficient labor market increases the vulnerability of these children to persistent poverty even after they grow into adults. 40 Households with many children are more prone to poverty. In 2012, households with no children had a marginally lower poverty rate than the national rate (Annex Table 2.4). However, as the number of children increases, poverty 20 incidence also increases significantly. Although the poverty 17 rate for households with only one child is not significantly higher than the national poverty rate, households with two children have a poverty rate more than 10 percent higher 0 than the national rate. Approximately 20 percent of children Rural Urban live in households with three children or more (Annex Table Source: World Bank calculations using data from 2.5), which have a risk of poverty of 57 percent (the risk the 2012 EU-SILC. is even higher for such children living in thinly populated areas). Youths have the second highest poverty rate, being the main group affected by the economic crisis. In 2012, youths aged between 18 and 24 years old had an extremely high The Elderly in Poverty poverty rate (31.4 percent),12 very close to the high risk Although for all other age groups the situation remained of poverty encountered by children. What is worrying is the same or deteriorated, the poverty rate for the elderly that, in the case of youths, the poverty rate has increased significantly declined. In 2008, the elderly, defined as significantly over time. For example, the poverty rate for those aged 65 or older, had the second highest poverty rate those aged between 18 and 24 increased by 7 percentage after children (25 percent). However, two years later, after points between 2008 to 2012, while the increase was only a massive increase in the levels of contributory and social 1.2 percentage points for children over the same period. This pension benefits, the poverty rate for the elderly had been increase may have been due to the growing vulnerability reduced to such an extent that it was lower than that for any and risk faced by young people in the labor market during other age group (see Table 3). those years. 12 The same conclusions apply to the 16 to 26 age group. Status and Forecasts of Poverty or Social Exclusion | 33 TABLE 3: Relative Poverty Rates at the Household Level by Number of Elderly People (aged 65 and over) Number of Elderly Household Members 2008 2009 2010 2011 2012 0 20.5 20.7 20.9 21.9 22.8 1 30.1 25.3 21.6 20.5 21.2 2 19.9 14.8 10.1 6.3 6.9 Total 22.8 21.2 19.9 19.9 20.7 Source: World Bank calculations using data from the 2008-2012 EU-SILC. The presence of elderly members decreases household for women against 9.2 percent for men). The difference is poverty incidence. In 2012, the poverty incidence among even larger for people aged 80 and over (Annex Table 2.7). households with one elderly member (21.2 percent) was Although single women represent only 16 percent of the 1.6 percentage points lower than the incidence of poverty in population aged 65 and over, they constitute 28 percent households with no elderly members (see Table 3). By the of the poor aged 65 and over (Annex Table 2.8). This is same token, the incidence of poverty among households because the poverty rate for single women aged 65 and with two elderly members in 2012 was only 6.9 percent. over is much higher than that of elderly people living in any It is important to note that in 2008 the situation for other type of household (see Table 4). households with one elderly member was actually worse This gender difference is explained by the difference in than for households with no elderly members. Similarly, pension incomes (see Section 2.2 on Social Transfers) as households with two or more elderly members experienced women on average have worked fewer years than men only a marginally lower incidence of poverty in 2008 (if at all). More importantly, urban versus rural residence than households with no elderly members. However, the is an important predictor of poverty for the elderly. Single situation of households with one elderly member improved elderly women in rural areas have the highest poverty rate dramatically between 2008 and 200913 because of the within their age group. For other elderly people, the pension significant increases in the real value of the pension in probably acts as a safety net that keeps them from having 2008 and 2009 (Annex Table 2.6). a higher poverty rate than other types of households. Although the relative welfare of the elderly has improved As shown before, it is noteworthy that households with over the years, there is a large gender gap within that age no elderly members (in other words, with no old person group. The difference in poverty between men and women contributing a pension to the household budget) have a aged 65 and over is 10 percentage points (19.3 percent higher poverty rate than all other types of households. TABLE 4: Relative Poverty Rate at the Household Level for Different Types of Households, 2012 Densely populated/ Thinly populated Households with… Total Intermediate areas areas Lone elderly (65+), out of whom… 25.8 9.9 39.5 - Single men aged 65 and over 13.8 6.0 20.9 - Single women aged 65 and over 30.2 11.3 46.1 - Elderly couple (both 65+ and married) 5.8 2.4 9.1 - Other types of households with elderly members 14.4 7.0 21.9 - Households with no elderly members 22.7 11.6 43.4 Source: World Bank calculations using data from the 2012 EU-SILC. 13 Because of the reference period of the survey, the EU-SILC data for a specific year refer to the previous year; in other words, the poverty rates in 2008 reflect the economic situation in 2007. 34 | POOR AND VULNERABLE GROUPS Individuals with Low Levels of Education and Those who are FIGURE 3: Relative Poverty Rate Out of the Labor Market or by Education among People over 16 Years Old, 2012 Self-employed in Poverty 40.0 Education has a strong relation both to the AROP and to the anchored poverty indicators. More than one-third of the 35.3 people who managed to complete only lower secondary 35.0 34.4 education are at risk of poverty. The percentage drops significantly to only 15 percent among those who managed to complete high school and/or some post-secondary 30.0 school and drops even further to only 6 percent among those who have obtained a college degree (see Figure 3). Interestingly, between 2008 and 2012, the incidence of 25.0 relative poverty among those with a primary education declined but still remained quite high compared with the national average (Annex Table 2.9). 20.0 Another strong predictor of poverty is the respondent’s 15.2 occupational status. Among employees aged between 15 15.0 and 64, only 5.6 percent are considered to be at risk of poverty, a percentage close to that of employers (see Figure 4). At the lower end, only 8.4 percent of retired people aged 10.0 between 15 and 64 are at risk of poverty. The self-employed in agriculture are in the worst situation, as more than half of 5.6 them are at risk of poverty. An extremely high percentage 5.0 3.1 of the unemployed are at risk of poverty as well. This is not surprising given that the reference social indicator, which is 0.0 used for determining unemployment benefits, is only RON Post Lower Upper 500 (2014 value) and that unemployment benefits are paid Primary secondary secondary secondary Tertiary on the basis of people’s wage levels in their last job and of non tertiary the number of years during which they had contributed to Source: World Bank calculations using data from the 2012 EU-SILC. the pension system. Inactive people (such as housewives or the disabled) are also at high risk of being in poverty. Our analysis indicates that people with the same occupational status can have different poverty rates depending on whether they live in a rural or an urban area. Roma in Poverty The poverty rate for employees aged between 15 and 64 is Roma have a much higher risk of being in poverty than the 11.6 percent in rural areas, whereas for those living in urban general population regardless of their age, education, or areas the poverty rate is only 3.5 percent. This happens area of residence (Table 5). Based on the national absolute because the incomes are generally lower in rural areas poverty threshold measured using the consumption level even for people with similar occupational statuses but also from 2013, Roma have a 10 times higher risk of being poor because poverty is estimated at the household level and, than non-Roma, with 33 percent of Roma being in absolute consequently, takes into account the incomes of the other poverty in 2013 while only 3.4 percent of non-Roma were household members as well (Annex Table 2.10). During the below the poverty line. The difference between Roma 2008 to 2012 period, two groups registered a high increase and non-Roma does not change significantly whether the in poverty – the unemployed (from 41.5 percent to 52.1) and individuals live in rural or in urban areas (Annex Table 2.12). the self-employed with no employees (from 34.5 to 41), as What is worrying is that the poverty risk is extremely high shown in Annex Table 2.11. for Roma children – their poverty rate is 37.7, whereas the national poverty rate is only 4.3 percent. Status and Forecasts of Poverty or Social Exclusion | 35 National Poverty Rate by Age and Ethnicity, 2013 (%) TABLE 5:  Non-Roma Roma 0-17 year olds 5.6 37.7 18-64 year olds 3.1 31.5 65+ year olds 1.7 17.7 Total 3.4 33.1 Source: World Bank calculations using data from the 2013 HBS. FIGURE 4: Relative Poverty Rates among the Working Age Population (15 to 64 years old) by Occupational Status, 2012 0 10 20 30 40 50 60 70 Self-employed without employees, skilled or 61 unskilled workers in agriculture, forestry or fishery Unemployed 52 Fulfilling domestic tasks and care responsabilities 46 Permanently disabled or/and unfit to work 43 Self-employed without employees, other 41 occupations Other inactive person 37 Pupil, student, further training, unpaid work 27 experience In retirement 8 Employees 6 Self-employed (including family workers) with 6 employees Source: World Bank calculations using data from the 2012 EU-SILC. 36 | POOR AND VULNERABLE GROUPS In-work Poverty percent), which is larger than the average household in Romania (4.4. people compared with 2.8). Another quarter Despite Romania’s relatively low unemployment rate, the of them are families with no children. Slightly over half of country has a very high rate of poverty for in-work people, all in-work poor families have only one earner, but another with 18 percent of employed workers being below the 43 percent have two earners striving to make a living but relative poverty threshold in 2010. This is double the EU-27 remaining poor nonetheless. The large majority of in-work rate (9 percent). poor combine earnings with the receipt of social protection In-work poverty affects one in two adults in Romania. A transfers (80 percent of the total), child allowances being profile of the working poor summarized in Table 6 indicates the most common form of support. Two-thirds of the in- that 92 percent of them are located in rural areas, 95 work poor individuals are male and one-third female. percent of them have at most secondary education, with In-work poverty is the direct result of low productivity, the a large share having only primary or lower secondary scarcity of formal employment, and weak overall labor education (50 percent of the total), and most of them live demand in the economy. In-work poverty is concentrated in in sparsely populated areas. The typical family of in- rural areas, mainly in the agriculture sector. work poor has two adults with two or more children (57 TABLE 6: Distribution of Characteristics across Samples of 2100 EU-SILC Cross-section Data, 2011 Working agea/ Out-of-workb/ Working poorc/ Working adult No 27.9 36.5 32.4 Yes 72.1 63.5 67.6 Work experience Never worked 11.2 34.1 1.0 Less than 2 months 19.9 58.2 3.9 2 or more months 69.0 7.7 95.1 Self-assessed physical incapacity Strongly limited 4.8 12.8 1.8 None/limited 95.2 87.2 98.2 Age groups 16-24 years old 8.2 8.3 13.8 25-34 years old 25.6 18.0 24.1 35-59 years old 57.4 50.2 59.3 60-64 years old 8.8 23.5 2.8 Gender Male 50.2 32.7 64.7 Female 49.9 67.3 35.3 Education Primary 22.9 33.7 50.2 Secondary 58.0 54.0 44.6 Tertiary 15.5 7.1 0.9 NA 3.6 5.2 4.4 Residential Area Urban 40.3 37.5 7.7 Rural 59.7 62.5 92.3 Working spouse Yes 48.2 35.5 42.7 No 21.7 33.3 24.9 NA 30.1 31.2 32.4 Spouse economic status Working 48.2 35.5 42.7 Unemployed 1.7 1.8 1.5 Retired 11.5 26.3 4.3 Inactive 8.5 5.1 19.1 Status and Forecasts of Poverty or Social Exclusion | 37 TABLE 6 (continued) Spouse economic status Student/military 0.1 NA 30.1 31.2 32.4 Household size Number of persons 3.8 3.7 4.4 Tenancy status Owner 96.3 96.6 97.0 Tenant 1.2 0.9 0.5 Reduced rate 0.9 1.0 0.9 Free 1.6 1.5 1.7 Household composition One person 4.8 6.7 3.8 Single parent 1.0 0.6 1.8 2+ adults with no children 38.3 43.2 25.3 2+ adults with 1 child 14.3 9.1 12.0 2+ adults with 2+ children 41.7 40.4 57.1 Working age /a Out-of-work / b Working poorc/ Parents in the household At least one 9.7 8.0 11.4 Both parents 14.2 10.6 13.7 None 76.2 81.4 74.9 Children under the age of 6 17.7 20.8 22.9 Three or more children 3.6 3.6 9.5 Elderly household members (over 64) 15.0 17.1 10.1 Ever worked No 11.2 34.1 1.0 Yes 20.2 60.8 99.1 NA 68.6 5.1 Years of work experience 19.0 25.5 16.5 Worked in last year 2 or more months 69.0 7.7 95.1 Less than 2 months 31.0 92.3 4.9 Able to keep dwelling warm No 15.5 19.8 24.7 Yes 84.5 80.2 75.3 Degree of urbanization Densely populated 39.1 36.2 7.5 Intermediate area 1.2 1.4 0.3 Sparsely populated 59.7 62.5 92.3 Region RO1 - Nord-Vest, Centru 24.4 23.5 17.4 RO2 - Nord-Est, Sud-Est 28.9 28.8 45.9 RO3 - Sud, Bucharest-Ilfov 28.0 28.4 15.4 RO4 - Sud-Vest, Vest 18.7 19.4 21.4 Any benefits 63.1 76.5 80.8 Source: World Bank calculations based on cross-section data from 2011 EU-SILC for Romania. Note: Individuals aged 16 to 24 who are out of work and enrolled in education (1.5 million individuals) are excluded from the sample. a/ The working age population aged 16 to 64 years old, excluding those who are out of work and those aged 16 to 24 years old in education. b/ Inactive or unemployed individuals aged 16 to 64 years old, excluding those who are out of work and those aged 16 to 24 years old in education. c/ Working age individuals who are at work and live in poor households where equivalized disposable income is lower than 60 percent of the median. 38 | POOR AND VULNERABLE GROUPS Low Work Intensity people living in thinly populated areas, for instance, is only 3.5 percent (Annex Table 2.13). Normally, it might be The second component of the AROPE aggregated indicator expected that the percentage of people with LWI would be measures the proportion of the population that lives in significantly higher in thinly populated areas than the actual households with very low work intensity (LWI). According 9 percent. to this indicator, very low work intensity households are Regional differences also follow the same surprising trend. those in which adult members aged between 18 and 59 Only 5 percent of people living in the North-East region are have worked less than 20 percent of their maximum work considered to live in a very low work intensity household, potential during the year preceding the survey.14 The even though this is the region that holds the Romanian importance of this indicator lies in the fact that being out of record for the highest percentage of people at risk of poverty work can be a source of both poverty (through lost income) (33 percent) and the highest percentage of people who are and social exclusion (less money means fewer opportunities severely materially deprived (37 percent). This apparent to socialize with friends and/or family, while being out of contradiction might be explained by the fact that the North- work can mean losing some social connections). East region has probably the highest number of workers The EU-SILC data show that only 7.4 percent of the migrating elsewhere for work in Romania and is also one of Romanian population under the age of 60 lived in the regions with a very high number of people working in households with very low work intensity in 2012. In agriculture. Conversely, the South-East region, which has comparison, the average for the European Union as a whole the lowest percentage of people working abroad, also has was 10.4 percent. A possible explanation for Romania’s the highest level of LWI - 13 percent. unexpectedly good showing on this indicator may be the The data show that the probability of living in a very low large number of Romanians working in other European work intensity household is negatively associated with Union countries. While the official Romanian statistics education. Eighteen percent of people aged between 16 on this topic are not very reliable, the number can be and 59 with a primary education live in such households, approximated from official data from Italy and Spain, the a value that drops to 9.6 percent in the case of those with most common work migration destinations for almost a lower secondary education, to 6.6 percent in the case of 2.5 million Romanians who live abroad. Furthermore, high school graduates, and to only 3.8 percent in the case the Romanian labor market is characterized by an of people with a tertiary education (Annex Table 2.14). extremely large number of people working in informal self-employment in subsistence agriculture whose income returns are extremely low, thus making them very likely Multiple Deprivation to be thrown into either absolute or relative poverty. This The indicator of the population at risk of poverty and social oversized agricultural sector combined with the absence exclusion (AROPE), as defined at the beginning of this of those who have migrated abroad for work reduces the chapter, focuses not only on poverty as defined in terms pressure on a labor market that is already unable to offer of financial resources but also on employment status jobs to everyone and, thus, leads automatically to an and on material deprivation as primary causes of both artificially low score for Romania on the low work intensity poverty and social exclusion. Thus, people suffering from indicator. severe material deprivation15 are also targeted by the EU’s The influence of temporary work migration and of measures for reducing poverty and social exclusion. subsistence agriculture on the LWI indicator can also be The EU-SILC data for 2008 to 2012 point to a series of seen in how the value of the indicator varies among different characteristics that explain the distribution of all indicators population subgroups and does not conform to the trend used for assessing poverty and material deprivation. observed in the case of the other indicators. The difference Policymakers should take these characteristics into account between people living in densely populated areas and 14 Households comprised only of children, of students under 25 years old, and/or people aged 60 or over were completely excluded from the indicator calculations. 15 The indicator adopted by the Social Protection Committee (the EU advisory policy committee for the Employment and Social Affairs Ministers in the Employment and Social Affairs Council) measures the percentage of the population that meets at least four of the following nine criteria: (1) they cannot afford to pay their rent, mortgage, or utility bills; (2) they cannot afford to keep their home adequately warm; (3) they face unexpected expenses; (4) they cannot afford to eat meat or other protein regularly; (5) they cannot afford to go on holiday; (6) they cannot afford to purchase a television set; (7) they cannot afford to purchase a washing machine; (8) they cannot afford to run a car; and (9) they do not have a telephone. The indicator distinguishes between individuals who cannot afford a certain item or service and those who do not have this item or service for another reason, for example, because they do not want or need it. Status and Forecasts of Poverty or Social Exclusion | 39 FIGURE 5: Percentage of People Suffering from Severe Material Deprivation 90 80 70 60 50 40 30 20 10 0 2008 2009 2010 2011 2012 Holiday Expenses Car Total Meal Heat Washing Phone Color TV Arrears machine Source: World Bank calculations using data from the 2008-2012 EU-SILC. when designing new poverty reduction strategies or when materially deprived, while in rural areas the percentage modifying and fine-tuning the existing ones. is 36.9). The differences between rural and urban areas persist for almost all items included in the deprivation index Between 2008 and 2012, the value of the multiple (except for arrears and heat) but are close to or larger than deprivation indicator slightly decreased. The overall 10 percent for five of the nine items (being able to afford a indicator dropped by 3 percentage points from 32.9 holiday, a car, meals with meat, or a washing machine), as percent to 29.9 percent, but the decrease was not uniform shown in Annex Table 2.16. for all of its components (Annex Table 2.15). The nine items of material deprivation can be categorized into three Geographically, Romania is affected by uneven groups. The first group consists of coping with unexpected development, with a significant gap between the Eastern expenses, being able to afford meat with meals, avoiding and Western regions of the country. The Eastern part of arrears, and keeping the home adequately warm. Between the country (the North-East and South-East regions) is 2009 and 2012, this set of indicators has worsened. The characterized by the highest levels of poverty and severe second group (being able to afford a holiday or a color TV) material deprivation. The Southern part (South Muntenia remained more or less constant over the four years. Finally, and South-West Oltenia) also contains pockets of poverty the third group of indicators (owning a car, a phone, or a and material deprivation levels that are either higher than washing machine) improved over the four-year period. the national average or at least at the same level. The Central and Western regions have poverty and material Romania is also characterized by huge disparities deprivation levels that are below the national average. associated with levels of urbanization. For the entire 2008 to 2012 period, the EU-SILC data show that people living Education is probably the most effective individual- in thinly populated areas are 3.5 times more likely to be level factor that can help a person to avoid both poverty at risk of poverty and 1.5 times more likely to be severely and severe material deprivation. The data show a very materially deprived than those in more densely populated consistent pattern across all nine items of material urban areas (in urban areas 24.8 percent of individuals are deprivation: the higher the education level, the lower the 40 | POOR AND VULNERABLE GROUPS chances that the respondent is unable to afford a particular all people living in this type of household (96 percent) item from the list.16 For example, while virtually all college cannot afford a one-week holiday away from home. The graduates can afford three of the items (a color TV, a phone, percentage of people unable to afford four other items and a washing machine), the percentage of people with a (having a car, dealing with unexpected expenses, having primary education who cannot afford one of these items a meal with meat every other day, and avoiding arrears) rises to 38 percent. The differences in material deprivation is 49 percent or higher. Two other, less common types of among people with varying levels of educational attainment households - single parent households and households did not decrease significantly between 2008 and 2012 composed of three adults and at least one child - are also (Annex Table 2.17). having difficulties avoiding material deprivation. Only children under 18 years old are affected by severe The social and economic inclusion of Roma is essential if material deprivation to a higher extent than the general Romania is to meet its Europe 2020 targets. Roma are not population. In this age group, the percentage of severely only significantly poorer than non-Roma but are also at a materially deprived people was 37.9 percent in 2012, higher risk of social exclusion. In fact, the vast majority of whereas in all other age categories, it was around 28 Roma in Romania, as in other Eastern European countries, percent. The household structure is also a factor that continue to live in poverty, while as many as 90 percent significantly influences the risk of poverty and social of Roma households face severe material deprivation exclusion. The only type of household in a better situation (compared with 54 percent of their non-Roma neighbors than households with no child members is that composed living in the same or nearby communities and compared of two adults and a single child. The type of household with the Romanian national average of 32 percent).17 that has the greatest chance of being materially deprived The EU is currently testing new indicators of material comprises two adults and three or more children. Virtually deprivation based on the additional indicators used in the FIGURE 6: Core Material Deprivation Indicators by Levels of Education, 2012 100 Primary 90 Lower Secondary 80 (Post-) Secondary 70 Tertiary + 60 50 40 30 20 10 0 Holiday Car Meal Expenses Arrears Heat Washing machine Phone Color TV Source: World Bank calculations using data from the 2012 EU-SILC. Note: The figure presents the proportion of population (by category) living in households that cannot afford a given item even this is wanted or needed. 16 The only case that contradicts this pattern is the intersection between having a car and primary education. It seems that people with only a primary education own cars in significantly higher proportion than might be expected. In fact, the percentage of people not owning a car among this group (34 percent) is smaller even than among high school graduates (40 percent). The explanation might be data-driven but is most likely to be a result of people with only a primary education attaching greater importance to owning a car than high school graduates. 17 World Bank calculations using data from the 2011 EU-SILC and the 2011 UNDP/World Bank/EC Regional Roma Survey. Status and Forecasts of Poverty or Social Exclusion | 41 2013 round of the EU-SILC survey.18 These indicators are no indoor plumbing. If the government in cooperation with likely to become the main instrument for monitoring and local authorities developed a plan to finance this type of evaluating the population at risk of poverty and social infrastructure, this is likely to have a significant effect not exclusion for the purposes of the Europe 2020 targets. We only in reducing the number of people at risk of poverty but strongly recommend that the Government of Romania draw also in improving the quality of life for both individuals and up strategies to maximize the chances that Romania will communities. improve its ranking on the new indicators. Otherwise, when the new measure is implemented across the EU, Romania People at Risk of Poverty or will continue to be in last place in the ranking of member states. Social Exclusion (AROPE) Our analysis of multiple deprivation identified two priority We used the three indicators discussed above to construct areas on which the government could focus in order to a single, aggregated indicator that indicates people at risk achieve the 2020 poverty targets. These intervention of poverty or social exclusion (AROPE). According to this areas are expected to lead to the highest poverty reduction indicator, a person is considered to be AROPE if he or she for the lowest amount of money spent. Based on both the fulfills at least one of the three component indicators: (i) core indicators and the indicators included in the material he/she is at risk of monetary poverty (AROP); (ii) lives in a deprivation module in the 2009 EU-SILC, it seems that the very low work intensity household (LWI); or (iii) is severely most cost-efficient investments aimed at reducing multiple materially deprived (SMD). People at risk of poverty or deprivation and that would avoid adverse or unintended social exclusion constitute the main target group for the consequences in the economy at large would be: (i) a piped programs devised by the EU and its member states to water supply to people’s homes and (ii) the acquisition of reduce poverty, and progress towards the Europe 2020 outdoor leisure equipment for children. About two-thirds of poverty reduction target is assessed in terms of the number Romanians who are at risk of poverty or social exclusion of people in that group. do not have indoor plumbing (the absence of an indoor The data for 2012 show that, of the total population, 42 flushing toilet as well as a bath or shower). In the poorest percent of Romanians are considered to be at risk of poverty regions of the country (the East and the South), more than or social exclusion. During the 2008 to 2012 period, the one-half of all people, not only the poor (AROPE), have percentage of AROPE slightly decreased, from 44.2 percent TABLE 7: Percentage of People at Risk of Poverty or Social Exclusion by Individual Indicators, 2008-2012 2008 2009 2010 2011 2012 People AROP ONLY 8.2 7.8 7.7 8.2 8.8 People in LWI households ONLY 2.1 2.0 1.9 1.7 2.0 People SMD ONLY 17.4 17.4 17.3 15.5 16.1 People AROP and in LWI households ONLY 0.9 1.0 0.8 0.9 1.0 People AROP and SMD ONLY 11.8 11.6 10.9 11.1 11.0 People in LWI households and SMD ONLY 1.2 1.1 1.1 0.9 1.0 People AROP, in LWI households, and SMD 2.4 2.0 1.7 1.8 1.7 People at risk of poverty or social exclusion AROPE 44.2 43.1 41.4 40.3 41.7 Source: World Bank calculations using data from the 2008-2012 EU-SILC. 18 Three items - the inability to afford a washing machine, a TV, and a telephone - have no impact on the proportion of people who are deprived in most EU member states (Nolan and Whelan, 2011:83-86). For this reason, these three items are being dropped, and the inability to afford seven new items will be included within the core definition. These are (for adult individuals): (1) new clothes; (2) two pairs of shoes; (3) some pocket money for oneself; (4) leisure activities; and (5) a drink or meal out monthly; and (for households): (6) the ability to replace worn-out furniture and (7) ownership of a computer and access to the Internet. In addition, the list of items retained in the multiple deprivation indicator related to the childpopulation (aged 1 to 15) will include 13 new items (besides the two new household items already mentioned), namely the inability to afford: (1) new clothes; (2) two pairs of shoes per child; (3) fresh fruit and vegetables daily; (4) meat, chicken, or fish daily; (5) suitable books; (6) outdoor leisure equipment; (7) indoor games; (8) a place for doing homework; (9) leisure activities; (10) celebrations; (11) inviting friends over; (12) school trips; or (13) a holiday (Eurostat, 2012a: 81-82). 42 | POOR AND VULNERABLE GROUPS in 2008 to 41.7 percent in 2012. Material deprivation is the employment and wage rates of the poor and at augmenting main cause of being considered at risk of poverty or social the volume of social protection funds available to the poorest exclusion, followed by AROP, and then, making only a quintile of the population. minor contribution, LWI (see Table 7 and Annex Table 2.18). (A) Assumptions of the Model 1.1.2. Relative Poverty The simulation model used to forecast the reduction in Forecasts (AROP) relative and anchored income poverty included a set of macroeconomic and demographic assumptions.19 Three possible economic growth scenarios were modeled - In our calculations for the for the current background study, a low, a base, and a high economic growth scenario (Table we used a micro simulation model to predict the evolution 8, middle panel). The forecasts correspond to the forecasts of relative income poverty and anchored poverty between of the IMF, the World Bank, and the European Union as of 2012 and 2020. We used the model to assess under what September 2014. Under the low economic growth scenario, conditions Romania would achieve its poverty target (a Romania’s per capita GDP is expected to grow by 2.2 to 2.5 reduction in relative income poverty of 580,000 people by percent per annum over the forecasting period. Under the 2020 as measured by the EU-SILC) and what combination high economic growth scenario, per capita GDP growth is of economic growth, employment, wage growth, and policies forecast to increase gradually from 3 percent in 2014 to 5 aimed at increasing the earnings and transfer income of the percent between 2018 and 2020. poor would secure the achievement of the target. With the model, we used 2012 EU-SILC data to simulate the at-risk- There are also three employment growth scenarios that of-poverty and anchored poverty indicators for 2013 to 2020. correspond to each economic growth scenario (Table 8, first panel). Under the low scenario, the share of employed This section is divided into two parts: (i) a description of the people in the 20 to 64 year old cohort is expected to grow assumptions (exogenous variables) of the model, which from 63.8 percent in 2012 to 64.9 percent by 2020 or spell out the likely paths of overall economic growth, of by 1 percentage point over the eight years. This forecast employment, productivity, and wages, of demography, and is consistent with the weak employment growth achieved of the expected coverage and generosity of the pension during the previous decade. Under the base scenario, system over the forecasting period and (ii) an analysis of employment is expected to grow by 3.6 percentage points. three scenarios of economic and employment growth that Under the high (rather optimistic) growth scenario, the assume that all other policies prevailing in 2012 will not employment rate is expected to increase gradually to change significantly over the 2013 to 2020 period. In addition, reach 70 percent by 2020, which is Romania’s EU 2020 in the Employment and Social Transfers chapters, we will employment target (a total increase of 6.2 percentage describe other scenarios that take into account the expected points over eight years). Labor productivity is assumed to be impact of the key poverty reduction policies recommended in the same in all cases, while we assume that Romania will the volume (the targeted employment measures, the Youth meet its EU 2020 national education targets by 2020. Guarantee program, the increased social assistance resources targeted to the relative income poor, and the increased We then incorporated the assumed changes in economic resources allocated to marginalized urban and rural areas). growth, employment, labor productivity, and educational attainment from Table 8 into a microeconomic model using The key message of our modeling work is that, in the data from Romania’s 2012 EU-SILC survey, the same absence of the measures recommended in the National survey that is used to track progress toward the relative Strategy on Social Inclusion and Poverty Reduction 2015- income poverty target (AROP). For each of the forecast 2020, economic and employment growth will not be years, we changed the income of the households in the sufficient to achieve the poverty target except under the very survey sample using the assumed changes in education optimistic but highly unlikely scenario of high economic and distribution, employment, labor productivity, and expected employment growth. Therefore, in order to achieve its poverty GDP growth. The model also adjusted the education target, the Government of Romania will need to put in place distribution of individuals in the 20 to 34 age group to the Strategy’s recommendations aimed at increasing the reflect the projected education distribution in that particular 19 The details of the simulated model are discussed in Annex 2, Section II. Status and Forecasts of Poverty or Social Exclusion | 43 year. The employment rates of the 20 to 64 age group model. Between 2012 and 2020, Romania will experience in each year were also adjusted by switching the status significant changes in the numbers and structure of the of the unemployed/inactive individuals with the highest population (see Table 9), with the total population expected probability of being employed until the total number of to fall by 177,000 people. This change will be distributed employed people reached the projected employment level differently across age groups. While the old age cohort for that year. (people aged 65 years old and older) is expected to increase by 436,000 people, the working age population We imputed earnings for these individuals who were (those aged 20 to 64) will shrink by 557,000 people, and predicted to move from inactivity to employment based on the number of children (up to 20 years old) by 56,000. their level of education, sector of activity, work experience, Over time, the working age population will decline while and other variables from the survey data. All individuals the elderly population will increase, putting further strains employed (or predicted to move from inactivity to on government revenues derived from income taxes and employment) received a flat increase in their earnings equal leading to an increasing demand for pensions, health care, to the assumed increase in labor productivity. The value and elder care. of the social protection transfers received by households was assumed to remain at the same level in real terms In the micro model, the employed population was derived (increased only in line with expected inflation). Having from the predicted working age population (Table 9) and changed the incomes of the sample households according the low, base, and high employment rates (Table 8). We to these assumptions, the model generated a new, used further assumptions about the rate of unemployment simulated income distribution for each year of the forecast to estimate the number of unemployed over the forecasting period. period. The sum of the employed and the unemployed represented the total active population in each year. We The model was also calibrated with predicted changes introduced changes in the size of the employed and the in demographics and labor market participation. The unemployed groups in the micro model by altering the demographic forecast was taken from the National weights of the respective categories. Institute for Statistics. Other demographic changes, such as change in formal employment, informal employment, Finally, the model incorporated the predicted changes and the change in the number of pensioners and the real in the coverage and real value of the old age pension as value of their pension, was simulated using the World forecast by the PROST model. Between 2014 and 2020, Bank’s PROST (Pension Reform Options Simulation) the share of the old age population receiving pensions TABLE 8: Growth Scenarios for Romania Employment rate % of 18-24 with Tertiary GDP Growth rate Labor productivity (20-64 years old) at most lower educational (growth rate, secondary attainment in 30- Low Base High Low Base High per hour) education 34 age group 2012 63.8 63.8 63.8 2013 63.6 64.1 64.5 3.5 3.5 3.5 1.5 14.8 20.2 2014 64.0 64.6 65.2 2.5 2.7 3.0 1.7 14.3 21.3 2015 64.4 65.1 65.9 2.6 3.1 3.5 2.0 13.8 22.1 2016 64.6 65.6 66.7 2.5 3.7 4.0 2.4 13.3 23.0 2017 64.7 66.1 67.4 2.5 3.9 4.5 2.7 12.8 24.0 2018 64.8 66.5 68.1 2.5 4.0 5.0 2.7 12.3 25.0 2019 64.8 66.8 68.9 2.2 4.1 5.0 2.7 11.8 26.0 2020 64.9 67.4 70.0 2.2 4.1 5.0 2.7 11.3 26.7 Source: World Bank estimations based on multiple sources. The economic growth forecasts are based on IMF, World Bank, and EU projections as of September 2014. The low case scenario is based on the forecast of the EU Active Aging Working Group and the Ministry of Finance, Romania. Employment growth for the base and high scenarios, for productivity, and for educational attainment are World Bank projections. 44 | POOR AND VULNERABLE GROUPS is forecast to decline slightly, by about 1 percent, due to employed), is the relative poverty level likely to decrease. an increase in the uninsured population in rural areas, If the population size does not change and the optimistic especially among individuals who derive their incomes scenario occurs, the number of poor people is expected from informal agriculture. This relatively small change was to decrease by 181,000 people between 2012 and 2020 not incorporated into the model. The ratio of the average (Annex Table 2.20). Moreover, if we take into account the pension to the average wage, however, is predicted to fall expected evolution of the population over the 2012 to 2020 by about 10 percent between 2014 and 2020 as a result of period (as predicted by the PROST model using census the Swiss indexation formula used in the first pillar of the data), the number of people in poverty will be reduced only pension system in Romania. This change was incorporated by 237,000 (as the number will be reduced by 56,000 into the model. alone due to the expected population decrease). The expected economic and employment growth over the (B) Poverty Forecasts Based 2014 to 2020 period is not enough to achieve the poverty on Economic Growth and target except under the very optimistic but highly unlikely scenario of high economic and employment growth. Employment Growth Therefore, in order to achieve this target, the Government of Romania will need to put in place the policies recommended We used the model described above to predict relative and in this volume that are aimed at increasing the employment absolute poverty in each year. The simulations took into and wage rates of the poor and augmenting the volume of consideration three scenarios. The low scenario was based social protection funds available to the poorest quintile of on the EU Aging Working Group (AWG) projections, the the population. high scenario took into account employment adjustments to achieve the 2020 target, while the base scenario was an Anchored poverty declines in all three growth scenarios. average of the low and high scenarios. The model implicitly Because the poverty line itself changes with income assumed that employment and social protection policies distribution over time, we fixed the poverty line at the would not change between 2012 and 2020. 2012 level and estimated absolute poverty using the 2012 poverty line. Poverty will decline by 6.6 percentage Relative poverty changed only marginally between the points between 2012 and 2020 if the low growth scenario different growth scenarios. Our simulations indicate that prevails (see Figure 7 for trends or Annex Table 2.19 for poverty is likely to increase slightly between 2012 and detailed figures). Importantly, in this scenario, the anchored 2020 in the low growth and moderate growth scenarios poverty rate is expected to reach 15.9 percent in 2020, (by 0.6 percentage points and 0.2 percentage points which implies that, even at that point, about 16 percent of respectively). Figure 7 shows the trends, while Annex Table the population will have real incomes lower than the 2012 2.19 displays the detailed figures. Only in the high growth poverty line. The high growth scenario is expected to make (optimistic) scenario, in which the employment target is a larger impact, but poverty is still projected to be at about 11 met (when 70 percent of the working age population is percent in 2020. TABLE 9: Main Demographic Changes, 2014-2020 (in thousand people) Year Change Age-groups 2014 2015 2016 2017 2018 2019 2020 2014-2020 0-14 3,133 3,127 3,117 3,116 3,117 3,113 3,110 -24 15-19 1,093 1,088 1,092 1,090 1,081 1,071 1,061 -32 20-64 12,464 12,368 12,270 12,174 12,083 12,002 11,907 -557 65+ 3,297 3,381 3,457 3,524 3,592 3,656 3,733 436 Total 19,987 19,964 19,935 19,904 19,873 19,842 19,810 -177 Source: World Bank's PROST model for Romania. Main Vulnerable Groups | 45 FIGURE 7: Projected Relative and Anchored Poverty Rates, 2012-2020 Relative poverty rate Anchored (2012) poverty rate 24 Low Growth 24 22 Moderate Growth 22 High Growth 20 20 18 18 16 16 14 14 12 12 10 10 2012 2013 2014 2015 2016 2017 2018 2019 2020 2012 2013 2014 2015 2016 2017 2018 2019 2020 Source: World Bank calculations using data from EU-SILC in the three main scenarios. 1.2. Main Vulnerable Groups A number of groups face various forms of social exclusion become an active part of society. Table 10 summarizes the or are at high risk of exclusion in ways that are sometimes main vulnerable groups in Romania.20 Some are extremely but not always associated with poverty. Because vulnerable large, while others are much smaller in number (not groups face particular problems for which generic policies exceeding a few hundred people nationwide). For example, may not work, they often need tailored and integrated in 2012 to 2013, the group of vulnerable people included services in order to increase their social and economic an estimated 1.85 million Roma,21 about 1.4 million poor participation. Identifying and appropriately responding children (aged between 0 and 17), over 725,000 people to the particular needs of vulnerable groups is essential aged over 80 years old, 687,000 children and adults with for designing and implementing effective social inclusion disabilities living in households and another 16,800 living in policies. institutions, more than 62,000 children in special protection (either in residential centers or in family-type care), and All vulnerable groups, irrespective of their size, should be approximately 1,500 children abandoned in medical units. offered similar opportunities to reach their potential and 20 In addition to the groups listed in Table 10, another vulnerable group consists of injured and disabled troops and survivors of deceased soldiers. This vulnerable group comprises fewer than 200 people. Besides the existing social protection measures, the injured and disabled are young and need medical care, such as orthoses, prostheses, and other medical devices, while survivors of the deceased require psychological and material support. However, regarding this group, we consider that allocating a discretionary budget to the Ministry of National Defense would be more efficient for developing a dedicated system of home-based medical care and social services for those who are immobile and without a family. 21 Given the likelihood that many Roma respondents do not report their ethnicity on the national census, an alternative set of expert estimates is commonly used. According to the Strategy of the Government of Romania for the Inclusion of Romanian Citizens Belonging to Roma Minority 2012–2020, estimates range from 535,140 (2002 Census), to 730,000– 970,000 (Sandu,, 2005), to 619,000 (the 2011 Census), and to 1.85 million (European Commission, 2011a). 46 | POOR AND VULNERABLE GROUPS TABLE 10: The Main Vulnerable Groups in Romania Main groupa/ (Sub)groups 1. Poor people Poor children, especially those living in families with many children or in single-parent families In-work poor, especially under-skilled (mainly rural) workers; the self-employed in both agriculture and non- agriculture Young unemployed and NEETsb/ People aged 50-64 years out of work and excluded from benefits schemes Poor elderly, especially those living with dependent household members, and lone elderly 2. Children and youths deprived Children abandoned in medical units of parental care and support Children living in large or low-quality placement centers Youths leaving residential care Children and youths living on the streets Children with parents working abroad, especially those with both parents abroad and those confronted with long-term separation from their parents Children deprived of liberty Teenage mothers 3. Lone or dependent elderly Elderly living alone and/or with complex dependency needs 4. Roma Roma children and adults at risk of exclusion from households without a sustainable income 5. People with disabilities Children and adults with disabilities, including invalids, and with a focus on those with complex dependency needs 6. Other vulnerable groups People suffering from addiction to alcohol, drugs, and other toxic substances People deprived of liberty or on probation Homeless people Victims of domestic violence Victims of human trafficking Refugees and immigrants 7. People living in marginalized Rural poor communities communities Urban marginalized communities Roma impoverished and marginalized communities Notes: Each of the vulnerable groups has specific problems and should be offered similar opportunities. Therefore, the order in which they are listed does not reflect any particular ranking of the vulnerable groups. a/ Some of the groups may overlap. For example, a child living in a single-parent family may experience poverty and/or multiple deprivations as well. b/ NEET stands for “Not in Education, Employment, or Training.” This document does not analyze22 each group separately attend school), Roma (mainly because of their segregation/ but focuses on defining area-based and people-based discrimination problems), and children with disabilities (sectoral) interventions to meet their needs, discussing the (because of the lack of educational services adapted for specificities of each vulnerable group whenever needed. For their needs). Table 11 offers a birds’ eye view of the chapters example, in the education chapter, in addition to the general in which the specific problems of each of the vulnerable social inclusion aspects of the sector, special attention problems are tackled. is paid to poor children (who do not have the means to 22 An analysis of these groups was included in the socioeconomic analysis for programming the European funds for 2014-2020, which was carried out in November 2012 by Romania’s Technical Working Group on Social Affairs and Social Inclusion, coordinated by the MLFSPE. Main Vulnerable Groups | 47 TABLE 11: Specific Analyses in Each Chapter of Each Vulnerable Group Children and People living in Lone or Other Poor youths deprived People with rural and urban Chapters dependent Roma vulnerable people of parental care disabilities marginalized elderly groups and support communities Employment Social Protection Social Services Education Health Housing Social Participation Integrated Services Area-based Policies Th is p age inte ntio nal ly l eft bla nk 48 | PEOPLE-BASED POLICIES Employment | 49 2. PEOPLE-BASED POLICIES 2 PEOPLE-BASED POLICIES 2.1. Employment To tackle poverty and social exclusion in the labor market, we recommend that the government create employment opportunities and promote equality of opportunity by: (i) increasing the skills, education, and labor market experience of people who are income-poor and of those from other vulnerable groups; (ii) increasing the employment rate of this segment of population; and (iii) putting in place measures that could increase the wage rate of the target group (such as measures aimed at reducing discrimination). However, these measures will only be partially effective if they are not accompanied by economic policies on the demand side that create well-paid and sustainable jobs. The main priority in this area should be increasing the employment of the poor and vulnerable by expanding active labor market programs. Main Objectives Employment 2.1.  52 2.1.1. Activating People in Poverty not in Education, Employment, or Training 53 2.1.2. Reducing Informal Employment and Increasing the Productivity of Small and Medium-sized Farms 64 2.1.3. Reducing the High In-work Poverty Rate 65 2.1.4. Increasing the Institutional Capacity and Resources of the Public Employment Service 65 2.1.5. Increasing the Employment Rates of Vulnerable Groups 69 2.1.6. Developing the Social Economy to Increase Employment Opportunities for Vulnerable Groups 77 52 | PEOPLE-BASED POLICIES 2.1. Employment To lift 580,000 people out of income poverty between terms, this means: (i) increasing the skills, education, and 2008 and 2020, the government will need to enact labor market experience of the income-poor (net assets); measures to increase the income-generating capacity of (ii) increasing the employment rate of this segment of the poorest 4.8 million Romanians so that their incomes population (intensity of use); and (iii) putting in place will grow faster than the average income. The total income measures that could increase the wage rate of the target of the population is the sum of household earnings plus group (such as measures aimed at reducing discrimination). social and private transfers. Household earnings, in turn, Based on the same approach, the other assets of poor depend on the productive assets that households own households, namely land (smallholdings) and livestock, (labor, capital goods, livestock, or land), the intensity of could be increased. their use, and their actual market value (Scheme 4). To The other factors that determine the total income of poor reduce relative income poverty, our strategy is to enhance households are transfers, whether private or from social the income-generating capacity of the poorest segment of protection programs. These topics will be addressed in the population over the programming period. In practical Section 2.2 on Social Transfers. SCHEME 4: Conceptual Framework for Reducing Relative Income Poverty GROWTH EXTERNAL CONDITIONS SECTOR COMPOSITION KEY PRICES SUSTAINABILITY SUSTAINABILITY Net assets X Intensity of use X Prices + Transfers = INCOME GENERATION CAPACITY DISTRIBUTION CHANGE IN INCOME GENERATION CAPACITY Source: World Bank (Bussolo and Lopez-Calva, 2014). Employment | 53 2.1.1. Activating and the remaining one-third to the provision of tailored job intermediation services and ALMPs. In the optimistic People in Poverty scenario in which 23 percent of MSII beneficiaries who are not in employment, education, training, or disabled (NEETD) not in Education, find work, relative poverty would decrease by 3 percentage Employment, or points in 2016, while in the pessimistic scenario (assuming that only 10 percent of the NEETD find work), relative Training poverty would decrease by 1.4 percent. Employment in return for decent wages is the surest path Romania’s changing demographics between 2014 and out of poverty. This background study sets out a number of 2020 will dramatically alter the labor market. By 2020, the policies aimed at increasing the labor market participation of number of individuals of working age is predicted to have the poor, reducing the seasonality of their employment, and declined by 4.5 percent, while the elderly are likely to have augmenting their income either by increasing their earnings increased by 13 percent. Romania will have to mobilize or by allowing the working poor to combine their relatively all of its potential workers and to invest in their education low earnings with cash assistance. and skills to make them more productive. This makes it However, ALMPs can only grease the wheels of the vital to mobilize all of the working age adults in the poorest labor market, making social protection more effective, for quintile who are currently not working although they are example, by improving the chances of some vulnerable capable of doing so. This group represents 26 percent of individuals entering the labor market at the expense of the total number of adults in the quintile (approximately others. They cannot be the principal engine behind job 730,000 people). One-third of these adults who are not in creation, and they cannot combat a lack of labor demand employment, education, training, or disabled (NEETD) or in when the economy is weak.24 In order to be effective, early retirement could resume working relatively quickly, ALMPs need to be accompanied by economic policies whereas another one-third would need the assistance influencing the demand side, in other words, that create of active labor market programs (ALMPs) and social jobs.25 services to access the labor market, while the last third is very unlikely to become employed. International studies A Profile of the Working Age estimate that about 10 to 23 percent of non-working adults in the poorest quintile could join the labor market by 2020 Population in the Poorest if they were to receive assistance from ALMPs and social Quintile services and if they were allowed to combine their labor earnings with social assistance benefits.23 In 2016, the government plans to implement a new social assistance program for the poor, the Minimum Social To see to what extent the increase in ALMPs would reduce Insertion Income (MSII) program, with the goal of providing poverty, we simulated the effects of such a program on the assistance to those in the bottom quintile of the Romanian beneficiaries of Romania’s new consolidated means-tested population while improving work incentives for work- program, the Minimum Social Insertion Income program able adults.26 To achieve this goal, the new program will (MSII), which is described in the next section. International merge the three existing means-tested programs into a evidence suggests that the work incentives offered single one, will reduce the implicit marginal tax rate (MTR) as part of a new benefit formula for MSII beneficiaries on earnings to enable program beneficiaries to combine supplemented by tailored job intermediation services receiving social assistance with working, and will increase and ALMPs could help between 10 and 23 percent of the availability and relevance of the ALMPs for this target those who currently do not work to work while receiving group. Importantly, the MSII program will also serve as a social assistance benefits. About two-thirds of this effect tool for identifying the poor population. can be attributed to the new benefit formula of the MSII 23 The assumptions behind this forecast are detailed in Bachas (2013) and Gerard (2013). 24 OECD (2013a: 40). 25 Such policies can range from macroeconomic and fiscal policies to policies affecting the investment climate, sectoral policies, labor mobility and migration policies, and business development policies (International Labour Office and the Council of Europe, 2007). 26 This section draws heavily from Bachas (2013). 54 | PEOPLE-BASED POLICIES This subsection identifies the characteristics of the targeted in the top three. This gap is even larger for women - about 30 population, while the next subsection suggests some percentage points. Among the 2.8 million working age adults activation policies tailored to those groups. in the poorest quintile (Figure 9), 50 percent are employed (mostly self-employed or in agriculture), about 20 percent The at-risk-of-poverty (AROP) population is approximated are in education, disabled, or in early retirement, and another in this chapter by the bottom quintile of the income 26 percent are either inactive or unemployed. About 70 distribution, in other words, the poorest 20 percent of percent of those who are unemployed or inactive rely on individuals ranked according to their income (including any social assistance to supplement their income. Among those social protection transfers) per adult equivalent. Within who work, three-quarters are self-employed, many holding the bottom quintile of Romania’s income distribution, seasonal jobs in agriculture or construction, which reduces there is a particular focus on NEETD individuals. These their annual earnings. are individuals with the capacity to work and for whom the policy priority must be to improve their work incentives and In addition to large disparities in total employment, the type of increase their access to the labor market. To achieve this occupation varies greatly across quintiles. Table 12 shows the goal, it is crucial to understand the characteristics of the occupation status for those in the bottom quintile, the second NEETD population and the barriers that they face in trying quintile, and the top three quintiles. As previously seen, the to access the labor market. share of the inactive population - the sum of the unemployed and housewives - is much larger in the bottom quintile A lack of employment opportunities and low labor earnings than in the other quintiles. Another important feature of the are strongly associated with poverty. There is a pronounced bottom quintile is the very large share of self-employment at and persistent employment gap between the work-able 35 percent and the small share of salaried employment at population in the poorest quintile and those in the top three 15 percent (the percentage of employers is marginal). As a quintiles27 (Figure 8). Among prime-age men (aged between comparison, self-employment in the top three quintiles is 10 35 and 44 years old), the employment rate is 16 percent percent and salaried employment is 54 percent. lower among those in the lowest quintile than among those BOX 3 Data and Methodology for the Analysis of the The analysis was carried out at the individual NEETDs level because activation policies target individuals. Even though some labor market The data analysis in this chapter is based on the 2011- challenges are shared by at the household 2013 rounds of the Romanian Household Budget level (such as rural location with low labor demand), Survey (HBS). This survey was used rather than the human capital and the search for employment EU-SILC as the questionnaire is much richer and allows principally involve individual investment and effort. for a more detailed analysis. The HBS was conducted at the household level and was representative of the The total dataset contains 85,242 individuals. Romanian population. It collected extensive information Among these, 55,952 are of working age (defined as on individual characteristics, expenditures, and income those between 15 and 64 years old). Of these, 7,527 sources. In order to obtain the maximum sample size, we individuals belonged to the NEETD group - not in pulled together cross-sections of the HBS, and, based employment, education, training, disabled, in early on adult equivalent consumption, we separated the retirement, or mothers with children under the age of 2 Romanian population into five quintiles. years old. 27 The definition of quintiles used in these estimations is slightly different than the ones used in the data from the EU-SILC. However, the results are very similar regardless of these definitions. Employment | 55 FIGURE 8: Employment and Gender Gap by Income Level, 2011-2012 100 Men, 1st quintile 80 60 Men, 3rd-5th quintiles 40 Women, 1st quintile 20 Women, 3rd-5th quintiles 0 15-24 25-34 35-44 45-54 55-64 Source: World Bank calculations based on data from the 2012-2013 HBS. Note: Quintile of consumption per adult equivalent. FIGURE 9: Working Age Individuals from the Poorest Quintile by Occupation, 2011-2012 (total = 2.8 million) 0% 5% 10% 15% 20% 25% 30% 35% 40% Self-employed 35% Employees 15% Pupil/students 12% Pensioners 9% Others (i.e. dependent) 4% Unemployed 12% (340 thousand) Housewives 14% (390 thousand) Source: World Bank calculations based on data from the 2012-2013 HBS. Note: Quintile of consumption per adult equivalent. 56 | PEOPLE-BASED POLICIES TABLE 12: Occupational Status of 15-64 Years Old by Quintiles, 2012-2013 1st quintile 2nd quintile 3-5th quintiles Total Employee/employer 15 30 54 41 Self-employed in non-agriculture 9 5 3 5 Self-employed in agriculture 26 19 7 13 Unemployed 12 9 5 7 Pensioner 8 12 14 13 Pupil/student 12 12 10 11 Housewife 14 10 6 8 Others 4 2 1 2 Total 100 100 100 100 Source: World Bank calculations using data from the 2012-2013 HBS. Low employment rates among prime-aged adults in the are concentrated in the bottom quintiles of the population. poorest quintile drive higher NEETD rates among the The share of NEETD individuals decreases monotonically poor. Table 13 below displays the breakdown of NEETD by quintile from 26 percent in the bottom quintile to 20 individuals by consumption quintile. NEETD individuals percent, 15 percent, 10 percent, and 5 percent in the fourth, represent 13 percent of the working age population and third, second, and top quintile respectively. TABLE 13: Share of NEETD in the Total Population and in Quintiles, 2011-2012 1st quintile 2nd quintile 3rd quintile 4th quintile 5th quintile Total Non NEETD in the working age total 10.2 13.7 16 20.7 25.9 86.6 population NEETD in the working age total 3.5 3.4 2.8 2.3 1.4 13.5 population Share of NEETD in the total working 25.8 19.7 15.1 10 5.2 13.5 age population from each quintile Source: Bachas (2013) using data from the 2011-2012 HBS. Since many NEETD individuals are concentrated in the bottom quintile, a social assistance program targeted to the Homogenous Groups of NEETD bottom quintile would need to address the specific barriers Adults in the Poorest Quintile that prevent them from accessing employment in addition Given the heterogeneity of the NEETDs and the need to improving work incentives in order to be effective. At the for tailored policies to increase their chances to become same time, the large share of self-employment and small activated, we used the statistical method of latent class share of salaried employment in that quintile suggests a analysis (LCA)28 to separate the NEETD population in need for strategies to encourage entrepreneurship and the bottom quintile into homogeneous groups. LCA is capital accumulation. 28 The advantage of LCA over other clustering techniques is that cases are not absolutely assigned to classes but have a probability of belonging to each class. In addition, it can deal with both continuous and categorical data. The optimal number of classes can be found by using the AIC and BIC criteria to measure how well the model fits. Employment | 57 one of several kinds cluster analysis methods that assign actively looking for work, though 30 percent report observations into subsets (called clusters) according to that they are prepared to work. Thirty percent of the each cluster’s common characteristics. LCA uses clustering people in this group are Roma. • algorithms in data analysis and statistical (rather than mathematical) methodology to construct the clusters. It is Y  oung rural women with families (11 percent of the based on the concept that observations within a group share sample) have an average of two to three children, one similar values for a latent (unobserved) variable that can be of whom tends to be between 2 to 6 years old. Ninety inferred from observed characteristics. LCA estimates the percent have only reached middle school and then likelihood that an observation with specific characteristics dropped out. The members of this group are typically (observed variables) belongs to one of the defined clusters. married to self-employed men and currently receive It estimates parameters for class profiles (the description of benefits. • each class) and class size.  he single Roma youths group (10 percent of the T In profiling NEETD individuals, the latent variable can sample) is entirely composed of young adults under be thought of as barriers to accessing the labor market. the age of 25 who dropped out of school early. Most Using observed characteristics such as gender, location, have at least one child and are currently on social education, number of children, and minority status, the LCA assistance. Only 10 percent are looking for job, but algorithm generated eight clusters that can be described as half say they are ready to begin work if given the follows:29 opportunity. •  ducated urban unemployed men are the largest E NEETD group from the poorest quintile, representing 24 percent of the sample. Eighty-six percent of the •  he educated rural unemployed group represents 8 T percent of the sample. Ninety-one percent of them have a high school education, and 64 percent have men in this group are actively looking for a job, 15 vocational or technical training. A majority are single percent have been inactive for less than six months, men. Therefore, this group faces fewer constraints while 33 percent report they would accept a job to finding work than other groups because of its paying 1,000 RON or less per month and 63 percent potential mobility and existing human capital. The say they would take a job paying 1,500 RON or less whole group is actively looking for work but has fairly per month. Therefore, this group is actively trying high expectations since 89 percent said that they to access the labor market and already has some would only accept wages of 1,000 RON and up. human capital since 65 percent have a high school degree or more. • U  rban Roma women with families (7 percent of the •  arried middle-aged rural women represent 18 M percent of the sample. Sixty-two percent have a high school or higher education, and most of these women sample) are young women often with three children, two of them young (between 2 and 6 years old). All of them have low education (only middle school or less), and their husbands are self-employed. They are not have one child under the age of 15. Although they looking for work and have been inactive for at least face few constraints in accessing the labor market, two years. this group is not actively looking for work, though 62 percent would accept a job if it was offered with an attractive enough wage. • The group of young urban couples (5 percent of the  sample) consists of individuals with two children, • The group consisting of uneducated idle youths  (17 percent) contains a majority of women who, despite not having children to take care of, have low including one under the age of 6, that have recently become inactive in the labor force. A majority of those in this group are actively seeking to reintegrate themselves into the labor market. However, only half educational levels. A large part of this group is not of them have completed high school. 29 More details about the key characteristics of the NEETD groups in the bottom quintile can be found in Annex Table 3.1. See also Sundaram et al (2014). 58 | PEOPLE-BASED POLICIES This categorization offers a clearer picture of the subgroups abroad per year. Another category consisting of groups 3 composing the inactive population in the bottom quintile. It and 5 represents 27 percent of this inactive population but highlights the heterogeneity of their situations and constraints critically lacks the human capital needed to successfully in accessing the labor market. Grouping together clusters 1, integrate into the labor market. This group is not actively 6, and 8 representing 37 percent of the inactive population looking for work but most would accept a job offer. Finally, in the bottom quintile these are individuals actively seeking the remaining 36 percent from groups 2, 4, and 7 are mainly to return to the labor market and for whom job assistance women who are inactive by choice and are looking after policies could prove effective. However, at least some of them their children. Tax incentives and childcare policies might be might look for a job abroad or even work for a few months necessary to increase their labor force participation. TABLE 14: Description of the NEETD Groups in the Bottom Quintile G1: Educated urban unemployed G2: Married middle-aged rural women (size: 24%, # 151,000) (size: 18%, # 114,000) ˆˆ 75% are men ˆˆ Middle-aged but few children ˆˆ 46% have high school or vocational education ˆˆ 61% have high school or vocational education ˆˆ 1 child of school age ˆˆ  Half have been unemployed for less than two ˆˆ 10% take care of a disabled person years, half are in long-term unemployment.  ot looking for work, but 1/3 would work for 1,000 RON or less ˆˆ N ˆˆ 34% would take a job for 1,000 RON or less G3: Uneducated idle youths G4: Young rural family women (size: 17%, # 110,000) (size: 11%, # 70,000) ˆˆ 71% are women ˆˆ 2 or 3 children under 15 ˆˆ 75% have a middle school education or less ˆˆ Often 1 child between 2-6 years old ˆˆ 67% are urban ˆˆ 90% have a middle school education or less ˆˆ 73% are unmarried, no children ˆˆ Self-employed husband ˆˆ Not looking for job, but 30% are ready to work ˆˆ Receiving social assistance ˆˆ 30% are Roma G5: Roma youths G6: Educated rural unemployed (size: 10%, # 63,000) (size: 8%, # 50,000) ˆˆ Half are under 25, 70% unmarried ˆˆ 67% Men ˆˆ 62% are women  4% have vocational/technical training, ˆˆ 6 ˆˆ 100% have a middle school education or less all have high school education ˆˆ 1 child ˆˆ Single, no children  nly 10% are looking for a job but half are ready to take work ˆˆ O ˆˆ Looking for job but will only accepts higher wages ˆˆ Currently on social assistance G7: Urban Roma family women (size: 7%, # 44,000) G8: Urban young couples (size: 5%, # 32,000) ˆˆ 3 children, 2 between 2-6 years old ˆˆ 2 children, 1 between 2-6 years old ˆˆ 100% have a middle school education or less ˆˆ 11% take care of a disabled person ˆˆ Self-employed husband  alf have a high school education, half ˆˆ H ˆˆ Inactive for at least two years, not looking for work have a middle school education ˆˆ Recently inactive ˆˆ 2/3 looking for work but not through government agency Source: World Bank calculations using data from the 2012-2013 HBS. Employment | 59 Activation Policies for the tend to be cost-effective. It is important to keep in mind that these programs are least effective in situations where the NEETDs from the Poorest informal sector is large,32 the targeted population is rural Quintile and lacks mobility, and labor demand is low because of macroeconomic conditions. These caveats are particularly Figuring out the composition of the bottom quintile particularly relevant for the bottom quintile of the Romanian population. that of inactive individuals with the capacity to work, will This reinforces the need for a carefully designed and enable the Romanian government to develop coherent labor comprehensive reform of labor market and social assistance market policies tailored to particular subgroups of NEETD policies in Romania that includes a strong activation policy individuals. All policies aimed at improving matching in the component. labor market are referred to as “activation” policies. Activation Activation policies aim to improve the match between labor policies can take various forms, ranging from vocational demand and labor supply. Their objective is to fix failures education and training programs to counseling and work specific to the labor market and help individuals to overcome subsidies.30 This section reviews evidence of the effectiveness constraints in their access to human and physical capital. of activation policies in a variety of contexts in Romania Labor market issues often fall into one of the following and globally and suggests a range of policies tailored to the categories: previously identified subgroups of the targeted population. One of the key priorities of the government is to increase access to jobs for all job seekers, including the poor and vulnerable. Such policies are referred to as activation and •  uman capital constraints: Insufficient skills and H a mismatch between the job seekers’ skills and employers’ needs. • graduation policies. More specifically, activation policies are defined as social protection and labor policies that help  nformation frictions: On the supply side a lack of I inactive individuals to find jobs and that increase the earnings knowledge of job opportunities and on the demand side of active individuals. “Graduation policies” refer to policies signaling and adverse selection. • targeted to individuals receiving social security with the goal of increasing their income to the extent that they no longer P  hysical capital constraints: Credit constraints and little require social assistance. Activation and graduation policies support for entrepreneurship. are necessary complements to the successful implementation Each constraint calls for different activation policy responses. of social assistance programs, together with the appropriate “parameters” of social assistance programs (benefit level, Table 15 below illustrates the variety of activation programs marginal tax rates, restrictions, and co-responsibilities). that exist around the world and gives examples from several countries. In addition Box 4 presents some experimental Overall, the international literature31 indicates that activation studies that have been regularly cited in the economics programs have yielded modest but significant benefits and literature together with lessons drawn from review studies. 30 Kuddo (2012). 31 Almeida et al (2012) is an extensive review of activation policies in developing countries and draws on several country studies and examples of ongoing programs. The meta-analysis by Card et al (2010) looked at 97 studies containing 199 program evaluations of activation policies in Europe and North America and drew conclusions about their efficiency. 32 Parlevliet and Xenogiani (2008). 60 | PEOPLE-BASED POLICIES TABLE 15: Programs and Barriers to Work Constraints/ Barriers Type of Program Selected Programs to work Stand Alone Wage Subsidies ˆˆ A Youth Wage Subsidy Experiment (South Africa)  onificacion a la Contratacion de Mano ˆˆ B de Obra-Chile Solidario (Chile) Lack of skills / experience and lack ˆˆ Jovenes con Mas y Mejor trabajo (Argentina) of information ˆˆ Idmaj (Morocco) ˆˆ Stage d’initiation a la vie professionnelle (Tunisia) Skills building/ signaling ˆˆ Kenya Youth Empowerment Program (Kenya) Comprehensive Training Programs ˆˆ Youth Internship Subprojects Program (Argentina) for Youths ˆˆ Juventud y Empleo (Dominican Republic) ˆˆ Taehil (Morocco) Lack of skills / General Technical and Vocational ˆˆ ProbeCat (Mexico) experience and lack Training  SKUR Public Employment Agency vocational training (Turkey) ˆˆ I of information Second Chance  fghanistan Primary Education Program – APEP (Afghanistan) ˆˆ A ˆˆ Chilecalifica (Chile) Certification ˆˆ Lifelong Learning and Training Project (Argentina) Employment Services ˆˆ Red CIL Pro Empleo (Peru) ˆˆ Career Guidance Services (Slovenia, Lithuania) Lack of information and lack of working ˆˆ Jobs Clubs (Lithuania) capital ˆˆ Vacancy and Job Fairs (Azerbaijan) Entrepreneurship Support Programs ˆˆ Fomento del Espiritu Empresarial (Colombia) Education ˆˆ Concours de Plans d’affaires Entreprendre et Gagner (Tunisia) ˆˆ Know About Business Program (Syria) Lack of skills / experience; lack of  pprenticeship Training Program and Entrepreneurial ˆˆ A working capital; lack Support for Vulnerable Youth (Malawi) SME support of entrepreneurial ˆˆ Northern Uganda Social Action Fund (NUSAF) (Uganda) skills; lack of ˆˆ Economic Empowerment of Adolescent Girls (EPAG) (Liberia) information  odacom Community Services: Rural ˆˆ V Microfranchising Telephone Access (South Africa) Source: Almeida et al (2012). Employment | 61 BOX 4 Lessons Learned from Experimental Studies program in the UK (Dolton and O’Neil, 2002) on Activation Policies and the Job Fair Program in the Philippines (Beam, 2013). Human Capital: Vocational Training and Second Chance Education The Restart program was launched in 1987 in the UK with the aim of reducing welfare dependency. The Despite increasing youth unemployment, both in Europe program combined counseling and encouragement to and in many developing countries, few studies have job seekers with tighter enforcement of the conditions used a random design to evaluate vocational education necessary to qualify for unemployment benefits. The programs. These programs typically train young inactive Restart program was composed of an interview lasting adults in a specific trade or practice. They tend to last approximately 20 minutes, which served as a stepping- from a couple of months to a year and are often coupled stone to accessing other services such as courses, with a short internship. Two experiments in Latin training, and job clubs. In addition, since the interview America have had different results. On the one hand, a was mandatory, individuals who failed to attend faced study of the Juventud y Empleo vocational education the possibility of having their benefits withdrawn. The program in the Dominican Republic (Card et al, 2010) authors compared a treatment group who attended the found that the program had yielded moderate increases interview with a control group who were phased into in earnings for participants (10 percent), though this the program six months later. Importantly the “control” result masked a wide heterogeneity in results. Only group received the same treatment but by was on youths living in cities with a higher initial level of welfare benefits for six additional months. Therefore, education benefitted from the program. Furthermore, the long-run effect reflected the impact of an additional it is unclear whether the subsidized training provided six months of inactivity on future employment. The by the program was cost-effective or not. On the other authors used administrative data for five years after hand, a study of Jovenes en Accion, a similar program the start of individuals’ participation in the scheme. in Colombia, (Attanasio et al, 2009) found larger returns Interestingly, the program had a strong short-term effect to this program’s vocational training - 12 percent overall on employment but also a significant medium-term and 18 percent for women. In addition, the program was effect. The short-term impact of the Restart program found to be cost-effective. The fact that the Dominican generated a 10 percent higher probability that the Republic program was only implemented in cities might control group would be unemployed than the treatment help to reconcile the results from the two studies. group. When the control group was phased into the These low but positive returns are supported by the program, the effect was reduced, but it increased again meta-analysis in the Card et al (2010) study. The two years later and the treatment group continued to authors found that most classroom and on-the-job have a 6 percent lower probability of being unemployed. training programs have a positive but insignificant short- This result suggests that the long-term cost of inactivity term impact on earnings and probability of employment and welfare dependence is high. but a significant and larger medium-term impact. In any The Restart program was implemented in the UK’s case, the success of these programs is very dependent developed and principally urban economy. By contrast, on the content provided and the extent to which the the experiment described in Beam (2013) took place skill needs of the local labor market are integrated in rural areas in the Philippines. In her experiment, the into the curriculum. In addition, successful programs author gave individuals vouchers enabling them to provide employment information to trainees before attend a job fair where recruiters provided them with job they graduate and are coupled with programs that help information and conducted short preliminary interviews. graduates with their job search at the end of the training Although providing them with information increased period. people’s knowledge of the needs and conditions of the Employment Services and Information Programs labor market, it did not increase their job search effort or Two global examples of successful counseling services the probability of them becoming employed. However, have been evaluated by researchers - the Restart the vouchers to attend the job fair had a large impact 62 | PEOPLE-BASED POLICIES BOX 4 (continued) both on their job search effort and their employment that the additional employment gained by the SSP probability. Job seekers changed their focus from group was reimbursed at a rate close to the minimum searching for work within their province to the capital, wage, and there was no significant wage growth over Manila, where job searches more than doubled. Even time. This result contradicts the on-the-job capital more strikingly, 10 months after the voucher program, accumulation theory that predicts that, when workers the probability of those in the treatment group being acquire experience and skills, they progress in the labor in formal employment increased by 4.7 percent, market and obtain higher wages over the long term. which was a 38 percent increase from the baseline. Therefore, the substantial public spending on work Therefore, this study showed that information and job incentives in the SSP had only a short-term effect that fairs have the potential to generate a significant change had dissipated entirely by the end of the program. in the behavior of rural job seekers with few initial The SSP program is one of many subsidy and training opportunities. programs that have had only limited effects. Card et The positive results from these experimental studies on al (2010) concluded that public and private subsidies job assistance programs are supported by the non- for employment rarely generated large sustained experimental studies reviewed in Card et al (2010) and improvements in labor market outcomes among the Almeida et al (2012), who argued that job assistance sample used in their meta-analysis. programs are generally cost-effective and yield short- Almeida et al (2012) concluded that providing certification term benefits to job seekers. for qualifications and organizing job fairs and career Wage Subsidies guidance are inexpensive policies with potentially high returns. This opinion is supported both by Card Public employment and wage subsidy programs have et al (2010) and by several experimental studies that been much less successful in general at sustaining found that employment services are preferable to positive labor market outcomes for recipients. Card public employment and wage subsidies that yield very and Hyslop’s (2005) evaluation of the Canadian Self low long-term returns and are much more expensive. Sufficiency Project (SSP) provides an illustration of this. Providing opportunities for inactive individuals to The SSP offered welfare recipients a large subsidy for accumulate human capital is a useful and cost-effective three years in return for finding full-time work within 12 policy tool that yields low short-term returns but often months. A total of 5,600 single parents were separated produces much larger medium-term returns. Physical in half between a treatment and a control group. capital accumulation and entrepreneurship support The figure below shows that the program produced programs have also been successful, especially those a significant short-term increase in the number of that include an integrated mixture of grants, microfinance beneficiaries graduating from income assistance. opportunities, and livelihood improvement components However, once the subsidies disappeared, the gap in (Dieckmann, 2008; Helmut et al, 2013). These programs employment between the treatment and control groups help entrepreneurs to set up businesses and to achieve fell back to zero. Welfare recipients who did not receive sustainable increases in earnings. Another program that the incentive merely took longer to obtain a job, which has the potential to yield great benefits in Romania is the was consistent with the fact that they had less of an provision of childcare facilities in order to enable mothers incentive to find a job quickly. The results also showed to enter the labor market. Employment | 63 Studies have found that these various activation initiatives relation to the Romanian population. Column 3 shows the often yield modest but significant returns. Because these probability of individuals in each of the designated groups programs typically cost little to provide, low but positive being employed (either self-employed or an employee) returns are sufficient for them to be cost-effective. This using a probit specification. This provides an indicator of an conclusion is important since Romania currently spends a individual’s distance from the labor market and probability very low share of its GDP on activation policies. Figure 10 of employment. Column 4 suggests activation policies shows that Romania’s spending on labor market policies for each group. The largest two groups, educated urban is among the lowest in the EU. In particular, the difference unemployed men and married middle-aged rural women, between Romania and the other EU countries widens in often have education and previous work experience and live the case of labor market services (in yellow) and labor relatively close to the labor market. Job search assistance market measures (blue). These categories are defined as and short training courses could be particularly effective for job support, training, and incentives and therefore can be them. However, groups constituted of inactive youths are included in the definition of activation policies. often much further from the labor market so they need help to build their human capital and to reach the labor market. It is likely, therefore, that increasing spending on activation policies could play an important role in enabling poor Over the programming period between 2015 and 2020, the and vulnerable groups to find employment. Table 16 government should gradually incorporate these techniques suggests specific activation policies for each subgroup into the practice of the National Employment Agency of the groups of NEETD in the bottom quintile who were (NEA). First, it should offer job intermediation services and identified in the previous sections. Offering vocational and ALMPs to the work-able beneficiaries of the MSII program apprenticeship programs tailored to these subgroups is and should introduce co-responsibilities associated with crucial to increasing their human capital. However, these the receipt of benefits for this target group. Second, the groups often face additional barriers to accessing the labor beneficiaries need to be categorized into groups with similar market related to their minority status and to having many characteristics, for whom the Public Employment Service children per household. Column 1 of Table 16 contains the (PES) to develop and provide tailored packages of services. group description and Column 2 the size of the group in FIGURE 10: LMP Expenditure as a Percentage of GDP, 2010 4.5 4.0 3.5 Total LMP services 3.0 (category 1) 2.5 Total LMP measures (categories 2-7) 2.0 Total LMP supports 1.5 (categories 8-9) 1.0 0.5 0.0 EU- EU- BE BG CZ DK DE EE IE EL ES FR IT CY LV LT LU HU MT NL AT PL PT RO SI SK FI SE UK NO 27 15 Source: Eurostat (2012b:14). 64 | PEOPLE-BASED POLICIES TABLE 16: Subgroups of NEEDT in the Bottom Quintile and Relevant Activation Policies Employment Group Group size Type of Activation Policy Probability Educated rural unemployed 76% High 50,000 Job search assistance Married middle-aged rural women 68% High 114,000 Childcare, retraining, part-time work Uneducated idle youths 67% High 110,000 Human capital No. of individuals – high probabilities 274,000 Educated urban unemployed men 63% Medium 151,000 Retraining, job counseling Young rural family women 60% Medium 70,000 Childcare, part-time work No. of individuals – medium probabilities 221,000 Single Roma youths 51% Low 63,000 Integration, human capital Young urban couples 48% Low 32,000 Job services, human capital Urban Roma family women 33% Low 44,000 Integration, childcare No. of individuals – low probabilities 139,000 Source: World Bank calculations using data from the 2012-2013 HBS. 2.1.2. Reducing production, to increase the density of the enterprise structure in rural areas, and to enhance the availability Informal Employment of rural services and infrastructure. The government has committed itself in its various strategies (from rural and Increasing the development to competitiveness) to many policies that Productivity of Small will improve the situation of rural farmers, including more and better value-added food processing and agricultural and Medium-sized production (including forests, fisheries, and bio-mass), increasing farmers’ knowledge and qualifications through Farms technical colleges and agricultural extension services, and the further consolidation of agricultural enterprises. All of these initiatives will have an immediate impact in terms Unemployment in Romania is relatively low. In mid-2014, of increasing social inclusion by providing employment the unemployment level was 7.3 percent and had increased opportunities in rural areas. Chapter 3.1 reviews the only modestly since the 2008/09 economic crisis. The measures needed to reduce the imbalances between rural unemployment rate was 5.8 percent in 2008 and 6.9 and urban areas, as well as the rural development policies percent in 2009. needed to reduce poverty and social exclusion. Informal employment, in contrast, is widespread and is In line with the government’s National Employment concentrated in rural areas. About 70 percent of those Strategy, two key measures will be needed to reduce who are employed are self-employed, the large majority informal employment: (i) reducing the fiscal and in subsistence or small-scale agriculture. Self-employed administrative pressures on formal employment (for farmers face a higher poverty risk than the unemployed example, reducing the tax burden and the paperwork because of low productivity, low enterprise density, the related to formal employment) and (ii) offering fiscal absence of local markets, and limited income support. incentives to attract the unemployed and people from other Their higher risk is also related to the fact that many do not vulnerable groups (who are more likely to be forced to work contribute to the health insurance system or to the social in the informal sector) to enter the formal labor market. The insurance system to secure a pension. introduction of the MSII program, which will exempt 25 In order to reduce the imbalance between urban and rural percent of the estimated value of beneficiaries’ agricultural areas, it is vital to increase productivity in agricultural output or 50 percent of their formal earnings, will allow poor Employment | 65 small farmers to receive social assistance while earning the loss of employment among low-productivity, low-wage agricultural or formal wages, which will increase their workers. income (see Section 2.2: Social Transfers). To reduce the extent of this problem, the government should In order to reduce the rural-urban imbalance in terms aim to: (i) reform the means-tested benefits to include of employment opportunities, between 2014 and 2020 incentives to find formal work and extend the coverage the government should aim to: (i) improve training for of these benefits to households with low work intensity owners of small and medium-sized farm holdings by through the MSII program; (ii) invest in the education and reestablishing modern versions of agricultural outreach skills of low-income workers, either through on-the-job and farmer training schools and by professionalizing farm training or through lifelong learning; and (iii) create labor operations; (ii) provide investment facilities (such as access market regulations and social dialogue to support the ability to credit) for value-added activities of food production or of workers to negotiate for wages commensurate with their other agriculture-related economic activities; (iii) continue productivity and to mitigate the lack of control that many promoting the consolidation of subsistence farm holdings workers currently have over what they earn. in the interests of increasing their productivity and A key measure aimed at reducing in-work poverty is sustainability; and (iv) introduce a national program for the introduction of a 50 percent earning disregard in the young specialists in agriculture. MSII benefit formula (described in the next chapter). This measure will make it possible for beneficiaries to receive 2.1.3. Reducing the social assistance support while working for low wages, effectively extending the coverage of this program to the High In-work Poverty in-work poor and raising their total income. This will be an improvement over the current design of the means-tested Rate programs, which, in the case of the GMI, implicitly tax any extra earnings. Over time, the MSII beneficiaries could Despite Romania’s relatively low unemployment rate, the qualify and obtain tailored ALMPs. This measure, which is country has a very high rate of poverty for in-work people, described in Section 2.2.1, will also help to increase their with 18 percent of employed workers being below the skills and wages. relative poverty threshold in 2010. This is double the EU-27 rate (9 percent). In-work poverty affects one in two adults in Romania (Figure 9). In-work poverty is a direct result of low 2.1.4. Increasing the productivity, the scarcity of formal employment, and weak overall labor demand in the economy. In-work poverty is Institutional Capacity concentrated in rural areas, mainly in the agriculture sector. Thus, in Romania, having a job is not enough to rise out of or and Resources of the escape poverty. Public Employment To partially address this issue, the government has gradually increased the minimum wage. The gross wage Service was increased from RON 800 on July 1st, 2013 to RON The NEA and professional training institutions (such as 850 on January 1st, 2014, then to RON 900 on July 1st, vocational training centers) currently do not have enough 2014 and RON 975 on January 1st 2015. As the minimum staff to be able to serve all job seekers, the unemployed, wage increased, a larger share of employees received the people who have not found a job after finishing school, minimum wage, from an estimated 12 percent in July 2013 those who have a job but would like to change it, refugees to 27 percent in January 2015. A proposed increase of the or people who are protected by international agreements minimum wage to RON 1,050 in July 2015 will increase and are looking for jobs, and people who cannot find a job further the share of employees on the minimum wage to after being repatriated or released from prison. Spending one-third of the total. At this level, additional increases in on active labor market programs (ALMPs) in Romania is the minimum wage might reduce employment in the private among the lowest in the EU (0.029 percent of GDP in 2011). sector for those jobs with a lower marginal productivity Furthermore, there are few institutional links between labor of labor than the (increased) minimum wage. Thus, the market services, economic development promotion, and poverty reduction impact of this measure could be offset by education institutions. 66 | PEOPLE-BASED POLICIES The first two sections of this chapter have illustrated that development) would need to be made at both the county about half of all work-able prime-aged adults in Romania and central levels. The NEA would have to develop are in the poorest quintile. Currently, only a small fraction operational guidelines for how clients should be treated in of them are covered by the GMI program, are receiving the guidance and counseling process. The NEA would need benefits with job-search co-responsibilities, and/or have to develop or extend its contracting skills and its capacity to access to ALPMs. When the MSII program begins in 2016, build local partnerships. This would not be just a question it will extend benefits with job-search co-responsibilities of sub-contracting to a local NGO (although NGOs would and access to ALMPs to almost all poor working age adults. be an important part of the model). A national structure and This could result in an increase in the employment rate of vision would be needed to make it happen if the government the poor of between 7 and 17 percent by 2020. In order to were to decide to pilot these local employment services. ensure this is achieved, the NEA’s resources – both staff In rural areas, especially in marginalized communities with and operational – and the budget allocations for ALMPs will a high share of non-working adults, it will be necessary for have to be increased. the Public Social Assistance Services (SPAS) to provide The administrative capacity of the NEA could be job seekers with information about job intermediation and strengthened if it were to create local partnerships to to refer them to ALMPs. Because this will increase their implement ALPMs, especially in marginalized urban workload, the SPAS will need more staff who will need to communities, and to contract out some of its services receive training in how to access the NEA’s e-services (for to NGOs. These and other measures are included in the example, in job mediation). NEA Strategy and the government’s Operational Program A lower-cost alternative to creating local employment Human Capital Development 2014-2020 (POCU). Given services would be to support social inclusion through ICT the limited resources allocated to the NEA from the state development. Modern customer-orientated ICT systems budget, all of these interventions will have to be supported and “virtual PES” systems can enable PES staff to spend by the European Social Fund (ESF) through POCU 2014- more time on their more demanding and needy clients. 2020, priority axis 3. The NEA’s ICT systems have all the necessary elements, The needs of the long-term unemployed and the future but they need to be harmonized and coordinated. For recipients of the MSII program could be better met by the example, it would be useful to scale up nationwide the development of specialized local employment services current project-based initiatives such as the call center (ALOFM) in marginalized urban areas. These ALOFMs and electronic-clerk booths that have been introduced in would be designed to be client-focused with services Cluj (Box 5) and few other counties. International reviews tailored to marginalized job seekers who want to work suggest that many people are happy to use self-service but have given up hope of ever getting a real job in the tools to access good quality information and guidance tools, formal economy. Therefore, although beneficiaries of the to conduct self-assessments, and to pursue job vacancies MSII would be required to attend their nearest ALOFM in instead of having to come in to the PES office. One or more return for receiving social assistance, they are likely to of these self-service options should be available to most see this as a positive development rather than a negative clients either because they own a mobile phone or because conditionality. they can access the Internet in libraries, cafes, at home, or in school. The recent surge in the use of mobile phones in Creating local employment services in or near Romania has opened up possibilities for social inclusion disadvantaged communities would require a major because now most of the unemployed have access to them management effort on behalf of the NEA. This effort even if their incomes are low. (including extensive management and operational staff Employment | 67 BOX 5 The ICT-supported Pilots Kiosks of the Cluj County The Cluj employment agency has rolled out Employment Agency the kiosk system in six offices throughout the The financial and economic crisis in 2008 led to a sharp county. Job seekers can use the kiosks or the website increase in unemployment in Romania, with a resulting to search the vacancies list. People who are receiving increase in demand for unemployment benefits and unemployment benefit must log in at a kiosk on a given employment services. It was necessary to deploy ICT date each month. The log-in procedure involves using a solutions to enable the National Employment Agency fingerprint and a compact disk, which cross-check with (NEA) to cope with the crisis. In addition, the agency’s each other to verify the person’s identity. The compact administration system – which relied heavily on face- minidisk holds the fingerprint, and a reader attached to to-face contact and paper-based processes – was weak the kiosk reads the fingerprint and cross-checks with and open to manipulation and abuse. the inserted mini-disk. The fingerprint and minidisk are recorded and set up when the job seeker first registers A new strategic ICT system, integrating passive as unemployed. measures (such as paying benefits and compiling job listings) with active measures (such as job-matching, The Electronic Clerk System Piloted in Cluj County job-counseling, and training), was developed with €4 million of support from the EU. This new system makes heavy use of technologies such as automated kiosks and a dedicated call-center that helps clients with job matching, interviews, and training. In addition, the conditionalities associated with the receipt of cash benefits was tightened and now include the requirement that the local Town Hall verifies that recipients have been abiding by conditionality by working in local employment schemes. Essentially, most face-to-face contact with clients was ceased in favor of an automated relationship. Jobs Database The new ICT system revolves around an Internet-based database of jobs advertised by employers in the territory covered by the Cluj County Branch of the NEA and another 10 counties (sso.ajofmcj.ro). It is mandatory for employers to post all job vacancies on the county employment agency’s website within 24 hours, though Call Center they are also free to also use private sector recruitment Once job seekers are logged into the kiosk, they firms. Employers register with the NEA and obtain an automatically receive a printout with the details of account name and password and then post details of vacancies and employers for which they qualify. The their vacancies. The system has apps for users (both employment agency’s call center follows up by arranging employers and job seekers) to download and facilitate interviews. The call center also follows up on cases job searches. Employers with no IT facilities can come where the system identifies any training that might be to the NEA’s office and use the kiosks to advertise their suitable for the job seeker in question. The call center’s vacancies. All job seekers (including those not receiving database records and tracks all job-counseling activities unemployment benefits) can also use the agency’s undertaken in respect of the registered job seeker. website to find jobs. 68 | PEOPLE-BASED POLICIES BOX 5 (continued) connect to and access private agency job websites (in The call center operators all have qualifications in real time) both in-country and abroad. On the one hand, job counseling. Interestingly, the call center does this has the potential to radically increase the number of not accept calls from job seekers or employers. It vacancies available via the NEA’s system through the acts as a mediator and uses the job vacancy and extension of the agency’s already positive partnerships unemployment register databases to connect job with private agencies and with newspapers. Currently, if seekers with employers and vice versa. The call somebody wants to register with the NEA for benefits, they center’s system automatically sends an SMS text must visit an NEA office to complete a registration form, message (including text to speech format) to the job which is a curriculum vitae (CV) with some added questions seeker as a follow-up after every phone call. related to the NEA’s guidance interview. If all job seekers could register online directly, then this would result in Extension of the System savings in terms of both money and staff time. Employment The present system is not designed to cover mediators at the call center could also give live advice seasonal employment or self-employed people who directly to clients over the Internet using voice-over IP. Then have contracts with their employers. In addition, when clients go into the NEA office to see an officer, their legal loopholes mean that vacancies in certain job electronically completed registration would already be in categories, for example, teachers, do not have to be the system, thus making the interview more efficient in reported to the database. There are plans to extend terms of both resources and time. This approach is used in the kiosk service to all town halls in the county, Sweden and Belgium and has been implemented in the call probably within the context of the new Electronic center in Cluj. A further extension of this approach would be Center for the Mediation of Work Project – 2014- to allow job seekers to complete a “profiling” tool online as 2020 to be funded by the EU. is discussed in Annex 3 Section II. Sustainability The NEA has carried out no systematic outcome and impact evaluations of ALMPs, but there is a wealth of data in the The Cluj employment agency’s current NEA ICT system as well as data that can be accessed management information system (MIS) is quite through the system’s connections with other national complex and impressive. It features a blend of databases. It is crucial that such evaluations are done to relatively sophisticated automation and skilled maximize the efficiency of investments in ALMPs and to manual interventions. The job-matching function ensure that the ALMPs are increasing social inclusion. It is client-oriented and seems to work well. The call is currently possible to calculate the job placement rate center function uses specialized call center software achieved by ALMPs using existing ICT systems. If the and relies on skilled staff to operate the system. payroll tax database were added, a longitudinal cost-benefit While the Cluj County branch of the NEA has a analysis could be done. Since such a range of high-quality total of 50 staff, the majority of the staff involved in data is available, it is therefore recommended that the managing the kiosk technology and the call center government explore the possibility of introducing the are private sector contractors, the costs of whom are placement calculation approach from outlined in Annex being funded by the EU project. 3, Section III. The more common approach taken in many Source: Notes of the World Bank team mission’s European countries is to assess the effectiveness of ALMPs visit to the Cluj County Employment Agency. by conducting follow-up surveys of a representative sample of those who completed their participation several months previously. These surveys also gather data on a range of qualitative indicators such as the participants’ perceptions of the quality of the ALMP, the extent to which they used Using ICT to deliver job search services expands the the skills acquired during their participation in the ALMP in number of job opportunities available to job seekers and their subsequent employment, and their perception of the increases the efficiency of employment services. In Europe, extent to which the ALMP helped them to find work. The public employment offices generally display only a small NEA could gradually adopt this survey approach. proportion of the vacancies available nationally in the labor In conclusion, policymakers should make the activation of market on any given day (with some exceptions such as the inactive and unemployed a high priority in the design Sweden and Germany). It is now technically possible to and delivery of services for the socially excluded. Given Employment | 69 the low resource endowment of the NEA, it is difficult to implement effective activation programs. Despite the Roma low labor demand on the Romanian labor market at the The Roma are a young population, and an increasing share moment, policymakers should aim to engage the inactive, of new labor market entrants come from Roma families. the underemployed, and the in-work poor as well as Children and youths aged between 0 and 14 years old - registered unemployed job seekers. This is especially the new generation of labor market entrants - make up important in light of the high poverty risk to which many almost 40 percent of the total Roma population but only 15 inactive and out-of-work individuals are exposed, such percent of the general population. At the same time, about as non-working women in rural areas, the long-term 17 percent of the general population in Romania is 65 or unemployed, and beneficiaries of the Guaranteed Minimum older, a proportion that is projected to grow rapidly in the Income program.33 near future. The youthful nature of the Roma population thus stands in stark contrast to the fast-aging profile of There is a need to increase the resource allocation to - and Romania’s general population. Depending on the estimates improve the management of – labor market institutions of the Roma population, between 6 percent and 20 percent and activation programs for socially vulnerable groups and of labor market entrants in Romania today are Roma. As the the in-work poor. Improving the functioning of the Public overall working age population in Romania is projected to Employment Service and associated institutions such as fall by 30 percent by 2050, the Roma share is expected to secondary schools, TVET institutions, technical colleges, grow. and social assistance offices will require increasing funding from the state budget, making better use of resources Roma men and women are largely excluded from labor from the European Structural and Investment Funds (by market opportunities in Romania. Roma are employed far increasing the absorption rate while using them more less often than non-Roma, even when comparing Roma strategically), broadening access and service channels to their non-Roma neighbors in the same regional labor to the NEA (including via ICT), and developing assistive markets.34 This reflects their low labor market attachment, devices and technologies for work-related situations, which in turn stems from their discouragement about particularly for people with disabilities. It will also be their limited prospects of finding work. The labor force necessary to increase the NEA’s administrative, managerial, participation rates of working age Roma (57 percent among and informational capacity to design, deliver, and monitor men and 34 percent among women) are lower those of labor market programs for job seekers and vulnerable their non-Roma neighbors (67 percent among men and groups. This might include the creation of a delivery unit 42 percent among women). Romanian Roma also have team to support NEA management as well as a customer higher unemployment rates, meaning that many of them segmentation and analysis unit. are looking for work without being able to find it. Moreover, among those who are employed, the jobs they hold are for 2.1.5. Increasing the the most part unstable and informal. Household survey data show that only about 35 percent of Roma employment Employment Rates of is formal (based on a written contract or legal business documents) or covered by health and pension insurance, in Vulnerable Groups contrast with 81 percent of employment among non-Roma living nearby. Many of the jobs held by Roma require only low skill levels - probably as a result of their lack of skills - Many marginalized groups in Romania, especially Roma, and are poorly paid. For example, many working Roma are people with disabilities, NEETD youths, and the long-term employed in low-paying agricultural jobs. unemployed, have markedly lower employment rates than the rest of the population. This is also the case for women, In a typical Roma household, only €101 per month is with the gender employment gap in Romania being 3.7 brought in as income from employment compared to €218 percent higher than in the EU-28. in non-Roma neighboring households. Roma households typically have a lower share of income coming from employment than do their non-Roma neighbors. Their 33 World Bank (2014: 5). 34 de Laat et al (2012) based on the regional UNDP/World Bank/EC regional Roma survey (2011). 70 | PEOPLE-BASED POLICIES alternative income sources are also very limited. For budget, they are unevenly implemented at the local level. example, Roma people have fewer assets that could be Each county employment office may decide to implement used to develop an agricultural livelihood. Most Roma one or more of these programs or not depending on local own plots of arable land smaller than half a hectare. conditions and needs. In partnership with civil society Furthermore, they report that due to the discriminatory organizations, the county employment agencies have restitution procedure, they tended to receive low-quality provided support and programs designed to meet the job- land in unfavorable locations that is of little use for seeking needs of Roma women in particular. cultivation. Traditional trades were strongly discouraged by The participation of Roma in professional training is the former socialist regime and, consequently, have almost low compared with that of non-Roma and amounts to disappeared. Many Roma resort to other activities such as approximately 3 percent of the registered unemployed. collecting empty bottles, paper, or scrap metal and returning In addition, only 5 percent of Roma succeed in finding them for refunds or selling used clothes, livelihoods that are employment (compared with 33 percent of non-Roma). time-consuming, poorly paid, and extremely vulnerable. The evidence suggest that the main causes for the low Roma marry young, begin childbearing early, and have high participation of Roma in professional training are: (i) Roma dependency ratios. About 28 percent of Roma between find it difficult to enroll in training programs, mostly because the ages of 15 and 19 years are married, as opposed to only the prerequisite is to have attended school up to 8th grade 2 percent in the general Romanian population. According (although some courses are available in vocational and to the Regional Roma Survey (RRS) of 2011, the mean technical colleges for low-education entrants such as the desired age to start having children is 21 years old for Roma baking, textiles, and confectioner’s training courses in women compared with 26 years old for non-Roma women. Calarasi); (ii) there is no financial support available for these In part because of early marriage and childbearing, the courses; (iii) there is a mismatch between the skills being Roma population has a higher dependency ratio than the learned in the training and the jobs available for Roma; population at large, meaning that more people who are not (iv) many Roma cannot afford the costs related to the in the labor force depend on community or family members transportation needed to obtain the documents required for who are gainfully employed. This, coupled with low enrollment; and (v) there has not been enough marketing employment rates, exacerbates poverty levels. of the potential benefits of the training and of a marketable certification. Unemployed Roma benefit from the same labor market policies as any other group of the population. The NEA Given that discrimination is a barrier to the employment does not have a separate budgetary allocation for programs prospects of most Roma, the NEA plays a key bridging role aimed at Roma, thus ensuring non-discriminatory access. between prospective employers and Roma job seekers. While this non-discriminatory approach is based on the Other actors that can provide a bridging function include right principles, it results in a lack of budget and capacity at municipal authorities, churches, community-based the local level to deal with issues that are specific to poor, organizations, NGOs, social workers, community mediators, unskilled job seekers, including many Roma. However, it is and Roma mediators. It is important to set realistic but important to note that 72,222 Roma were mediated in 2013 ambitious targets for the inclusion of Roma in the labor according to NEA records but only 4,655 were actively market and to provide adequate human and financial placed in jobs. Since many Roma do not declare their resources to the NEA in order to meet those targets. ethnicity, it is highly likely that more NEA Roma placements Low participation in and restricted access to stable, gainful have happened but were not recorded as such. employment reinforce precarious incomes, a high risk of The NEA delivers some existing ALMPs that target Roma poverty, and social exclusion among Romanian Roma and among other groups. These include Open Days, Job limit the opportunities available to their children. In 1992, Fairs, Employment Caravans, and “Program 140” for it was estimated that 63 percent of Roma families lived communities with a large Roma population, which focuses in absolute poverty. Another 18 percent had total income on disseminating information, mediation, and counseling, greater than the minimum subsistence level but not enough as well as on the promotion of dialogue between the NEA for a decent life.35 Since then, both the incidence and the and local Roma representatives. As these programs have no depth of poverty have remained disproportionally high 35 Zamfir and Zamfir (coord., 1993). Employment | 71 among the Roma population. High rates of joblessness this assessment from one year to another; and (iii) the and job instability not only restrict income and perpetuate connection between the individual’s work capacity and poverty among adults but also take a toll on children, disability status. Thus, the disability indemnity and the leading to absenteeism and dropping out of school, complementary budget are the main sources of income for malnutrition, and chronic diseases. These in turn perpetuate most Romanians with disabilities. the limited labor market opportunities that Roma currently The most common situation encountered by the families face. Because of the low and irregular incomes that they of people with disabilities is that one of the parents (usually earn from work, many Roma households end up relying on the mother) has to quit her or his job and becomes the child allowances and on irregular and low-value streams of personal caregiver for the child or adult with a disability. informal income. In some cases, school-aged children are The minimum income paid to this assistant, along with expected to contribute to their family’s income by working the disability-related cash benefits, barely cover the costs within the household or by seeking informal work. incurred by such families. When these families have two Increasing the social inclusion of Roma is not only a moral children with disabilities, the situation is even more critical. imperative but is also smart economics for Romania. With People with disabilities have the same right to work as an aging population, pension and health care costs are all other citizens, but they often need additional support bound to increase in the near future. Ensuring more equal in order to prepare for, find, access, retain, or regain labor market opportunities could enable faster productivity employment. As in the field of education and access to growth and could yield fiscal benefits in terms of increased all other services of the community, in the labor sector revenue from taxes and lower social assistance spending. people with disabilities often need modifications to the According to a World Bank estimate based on 2008 data, work environment to enable them to perform the essential assuming an equal number of working age Roma men and functions of the job. People with disabilities may need women and assuming that average wages in the economy any or all of the following types of support services for remain unchanged, equalizing labor market earnings in employment: (i) assistance with job seeking; (ii) mediation Romania for Roma could result in potential economic benefits for employment; (iii) a job coach after they have been hired; ranging between €887 million and €2.9 billion annually and (iv) individualized support and supervision in the workplace; in fiscal benefits ranging between €202 million and €675 (v) sign language interpretation; (vi) assistive devices and million annually.36 While these numbers are based on overly technologies; and (vii) the adaptation of the workplace simplified assumptions about adjustments in the economy to create a barrier-free environment with accessible and the labor market, they illustrate the economic potential transportation, buildings, public areas, and information. of Roma inclusion. The challenges related to narrowing the very large gap in labor market outcomes become more In Romania, during the previous regime, support services significant in light of the aforementioned demographic trends for employment and work for the disabled were almost in which Romania will experience a substantial increase in non-existent. Adults with disabilities worked in sheltered the proportion of elderly people and a shrinking of the size workplaces (organized in residential institutions, special of the working age population. Ensuring the labor market schools, cooperatives for the disabled, or specific sections inclusion of the younger Roma population could help to in psychiatric hospitals). The spectrum of professions for address the fiscal and economic challenges presented by the disabled and of the corresponding vocational training these demographic trends. programs organized in the public special schools was very limited in the previous regime, usually consisting of cooking, People with Disabilities painting, woodwork, and crafts, the making of brushes, the operation of telephones, packaging, and massage (usually In Romania, a very low percentage of people with disabilities in the case of people with sight impairments). These are active in the labor market - only 7.25 percent of people qualifications still exist in the curricula of many professional with disabilities between the ages of 18 and 64. special schools in the country. Many disabled people were assessed as being “incapable” of working or told that the The main reasons for this are: (i) the administration of only option available to them was the sheltered work. the disability assessment; (ii) the unpredictable result of The entire system of vocational and professional training 36 World Bank (Anan et al, 2014). 72 | PEOPLE-BASED POLICIES was segregated into special schools, professional special access to jobs, apprenticeships, traineeships, or continued schools, and sheltered workshops. education. Romania is actively implementing the measure, and the NEA will play a central role in its implementation, Nowadays, despite many obstacles, people with disabilities although it will not directly manage it. The “guarantee” can enter the open (and highly competitive) labor market. is that all young people under 25 – whether registered A study by the Motivation Foundation and the Academic with employment services or not – get a good-quality, Society of Romania (SAR) from 2009 showed that only 1 concrete job offer within four months of them leaving formal percent of employed people with disabilities were working education or becoming unemployed. The offer should be for in sheltered units at that time, and most were choosing a job, apprenticeship, traineeship, or continued education to find work on the open labor market. A quota system and should be adapted to each individual’s needs and exists in Romania, as in the majority of EU member states. situation. Under the latest Youth Guarantee initiatives, Romanian law specifies that companies with more than the government aims to ensure the delivery of 7,000 50 employees must ensure that at least 4 percent of their apprenticeship places during 2014 and 2015. staff are comprised of people with disabilities. If not, they need to pay an amount equivalent to half of the minimum This has important resource implications for the NEA and income for all positions that are not occupied by people other implementing agencies. The NEA will be the main with disabilities or to buy products from the sheltered units. catalyst for the implementation of the Youth Guarantee This system was designed to create an estimated 140,000 initiatives. In a departure from past approaches, the new positions for people with disabilities. However, the current Youth Guarantee Centers are to be directly managed by number of disabled people in formal employment is only the MLSFPE jointly with the Ministry of Education and approximately 29,000. The penalties that are collected Youth, and the registration database is being expanded go into the general state budget and not in a budget that to capture more data from the educational institutions might be used to stimulate the creation of jobs or to adapt and other services. The Youth Guarantee database will workplaces for disabled people. ultimately be integrated into the NEA’s ICT system. As a joint initiative, the Youth Guarantee will require an effective People with complex dependency needs, challenging and coordinated management structure. The PES are functional limitations, or severe medical conditions have expected to be the main Youth Guarantee service providers, the option of working in sheltered units. It is important but local authorities will also play a vital role in terms of to avoid the perception that this type of employment is providing education and training services as will the new associated with people with disabilities. In all European regional authorities to be established following the planned countries, sheltered units are designed as a solution for reorganization of the territorial administration. Currently, any individuals who have very little ability to function in the a significant number of local authorities are involved in competitive labor market. the implementation of projects under the previous Social Operational Program, Human Resources Development NEETD Youths and the Youth 2007-2013. Guarantee Program According to the EU Commission,37 the most important challenges that will need to be overcome in order to deliver Although unemployment stood at 7.3 percent in 2012 the Youth Guarantee in Romania are: and had barely increased after the 2009 economic crisis, youth unemployment and the proportion of young people not in education, employment, or training (NEET) had both increased since 2009 as a result of the economic crisis (to • T  here is insufficient administrative capacity in the PES to offer individualized services to all young unemployed and to unregistered NEETs. 22.7 percent and 16.8 percent respectively in 2012). Both figures have recently started to decline, but the NEET rate is still well above the EU average (13.2 percent in 2012). The Youth Guarantee is a European Union program for •  here is too little flexibility and diversity in terms of T activation services and of the training and education available to young people. tackling youth unemployment by providing tailored 37 European Commission (2014d). Employment | 73 •  here are not enough outreach activities to non- T registered young NEETs and in particular to young Roma. BOX 6 Characteristics of Successful • T  here is a lack of genuine involvement by the private sector in providing apprenticeships, dual training initiatives, and traineeships for university graduates. Active Labor Market Programs for Young People The OECD Employment Outlook for 2006 suggested that successful programs appear to share The main NEA measure providing customized support to some characteristics as follows: • disadvantaged and socially marginalized youths, including those leaving institutional care, is the Solidarity Agreement J  ob-search assistance programs are often the Program. Through this, the NEA provides young job seekers most cost-effective among ALMPs in terms of with professional guidance and mediation services and providing positive returns in the form of higher matches them with suitable employers. In 2014, the NEA’s earnings and employment. Some wage and target was to place 1,400 young people in jobs through employment subsidy programs have yielded mediation, job fairs, referral to specialized providers, positive returns, but these measures tend to perform poorly in terms of their net impact on the provision of basic skills training, and the provision of participants’ future employment prospects. • subsidies to employers. The program placed 894 youths in jobs in 2013 and 1,221 in 2012. The companies are also  raining programs are most successful when T provided with a bonus when they award an indefinite they are carefully tailored to local or national employment contract to a job seeker after the end of the labor market needs. In this respect, mobilizing and involving the private sector and solidarity agreement. community leaders to assess local or national During the preparation of this of this background study, demand for skills is important. a set of simulations was used to estimate the impact of introducing this program on young high school and university graduates who are NEET. The simulations showed that • G  ood targeting is important. For instance, there is a need to distinguish between teenagers and young adults and to fully implementing the Youth Guarantee38 would reduce devote particular attention to early school the overall poverty rate by 0.4 percentage points by 2016. leavers. The most desirable solution to the The impact was even more significant when the analysis employment problems of teenagers is to focused on the Youth Guarantee target group - youths aged help them to remain in (or return to) school, between 18 and 25 - for whom poverty would decline by 1.7 whereas for young adults in their twenties, percentage points, with the decrease being much greater for it is more important to help them to acquire work experience. • men than for women. t is important to make participation in I Work-able GMI Beneficiaries programs compulsory after young people have been looking for a job search for no more The availability and quality of activation services are of than six months. While this may increase particular importance to the current beneficiaries of the GMI costs and reduce the average effectiveness program and will continue to be so for the beneficiaries of of the programs, making participation compulsory is likely to be the only way to the MSII program after 2016. The GMI clients of the PES ensure that the programs will reach the adults are not a homogenous group. Generally GMI beneficiaries and youths who are most at risk of social include older people living on their own, unemployed exclusion. people, the homeless, young people leaving institutional Source: OECD (2006). care, and those who have never been employed. Job intermediation and ALMP services need to be more tailored in order to take this heterogeneity into account. 38 In this simulation, the assumption was that all school graduates (high school and university) are offered continuous education, training, or jobs. The focus of the simulations was on those individuals who had finished school in the previous year (the cohort aged 18 to 25 years old) who are unemployed or are out of the labor force. For those with a high school education, we assumed that two-thirds would move into continuous education and one-third into jobs (we estimated wage levels for the individuals most likely to find jobs). For those who finished university, the assumption was that 20 percent would go on to training and 80 percent would move into jobs (the same methodology was used to estimate their wages). 74 | PEOPLE-BASED POLICIES The inconsistent way in which social assistance and more resources were available to fund more intensive employment services at the local level deal with GMI pre-employment preparation of clients (such as basic recipients is one reason for the apparent lack of positive social and technical skills training or remedial education). employment outcomes for these beneficiaries. The SPAS However, no incentives exist for the NEA and SPAS to refer GMI beneficiaries to the county employment agencies support the higher-cost GMI beneficiaries. Introducing a (AJOFM) where they are required to register every three differentiated cost-per-placement budgeting system that months to demonstrate that they are seeking work. For takes into account the higher cost of serving the GMI clients both GMI beneficiaries and recipients of other types of could make it financially possible to reallocate some of the social assistance, a SPAS occasionally by-passes the AJOFM services toward this group. AJOFM and contacts employers directly about particular The decentralization of responsibility for GMI clients to clients. The lack of a coordinated approach between the the counties means that the approach taken varies widely two services may be because some AJOFM staff assume across the country. Stronger central coordination at the that GMI beneficiaries lack the motivation to look for a national level, perhaps in the form of a joint working job and are only signing on to qualify for the transfer and group involving representatives of both the SPAS and the to access other benefits such as health services. Some CEAs, might improve processes and outcomes as would hard-pressed AJOFM local staff feel that scarce ALMP linking their ICT systems to facilitate the tracking and case resources might be better spent where in their view a result management of GMI clients. In addition, a customized is more likely to be achieved. At the same time, some holistic multi-agency approach, with perhaps a specialized SPAS social workers feel very dissatisfied with the services employment service, will be needed to maximize the provided by some AJOFM offices. SPAS representatives number of GMI clients (and future MSII clients) who can believe that GMI beneficiaries would be employable if enter or re-enter the labor market. TABLE 17: Number of GMI Beneficiaries Registering with the NEA, 2013-2014 2013 1st quarter of 2013 1st quarter of 2014 Registration inflows 826,142 180,189 214,265 GMI registrant inflows 117,484 29,947 41,993 Proportion of GMI registrants 14.2 16.6 19.6 Source: National Employment Agency Head Office. The tracking of the employment outcomes of GMI job the years 2013 and 2014 to track which GMI clients had seekers is currently weak, and the NEA does not provide found employment. This would be in line with the OECD such disaggregated data. In order to do such an analysis, approach that: “the effectiveness of measures for activating it would be necessary to access the databases of the non-employment-benefit recipients will often be enhanced National Agency for Payments and Social Inspection by improved coordination - or even integration - of the (ANPIS), which manages the GMI, and the databases main PES organization with welfare services and disability of the Labor Inspection Institution, which manages all employment services. Where separate administrations labor contracts signed in Romania. Analysts would first exist, they may not regularly share client information have to check the database of ANPIS for job seekers who and resources such as job vacancies, and they may have benefitted from the GMI in 2013, for example, and then different management views on issues such as work- crosscheck this list with the Labor Inspection database for availability requirements.”39 39 Carcillo and Grubb (2006: 42). Employment | 75 Support Services for the services designed to facilitate access to employment for people with disabilities in Romania are the following: Employment of Vulnerable Groups The system of support services for employment is not •  ainstream services for vocational training and M employment including: • Vocational training clearly regulated and receives only limited public funds. Job coaches have occupational standards, but there are County Employment Agencies (CEAs) •  none for mediators or counselors yet. Nor are there any Annual workplace fairs (târgul locurilor de muncă) •  training programs for these professions at the national level, Fiscal incentives for employers who hire people •  except for some provided by NGOs. with disabilities (196 were funded in 2013 There is a case to be made for PES to be staffed by according to the NEA) specialists who have been trained to address the particular A quota system (the requirement that all •  needs of Roma job seekers. This is the practice in some institutions with over 50 employees must hire national PES, for example, in the Czech Republic. The people with disabilities) • outsourcing of employment services for Roma is also common in many PES, and there have been some  pecific services for people with disabilities including: S examples of outsourcing in Romania such as the RUHAMA Special professional schools •  foundation in Bihor County.40 The government’s main role Public Occupational Centers (CITO/ DPPD) •  should be to set realistic but ambitious targets for Roma  heltered units • S inclusion in the labor market and to provide adequate and specifically targeted budgets for ALMPs. The actual provision of job search services, guidance and counseling, self-employment, and training services can be contracted • S  ervices to support inclusion: Job search assistance and mediation for •  employment out to a network of specialized providers.  upported employment • S For people with disabilities, the approach taken in many European countries has been to include them in • Job coaching during the working period in semi- mainstream employment services. If this approach were sheltered units taken in Romania, it would require all NEA mediators and • Individualized support and supervision in the counselors to be trained to deal with people with disabilities workplace as part of their mainstream services. Support could be • Sign language interpreters provided by the existing cadre of regional specialist centers • Easy-to read information for people with disabilities, which could also in turn, take on more mainstream mediation roles if required and if time • A dapted transportation were available. A Guidance Resource Center (GRC) for job •  ICT and assistive devices for employment. seekers is available in some counties, and some may also be able to provide for people with disabilities. Most of these resource centers are very sparsely staffed with insufficient In Romania, several NGOs, as well as a small number of numbers of trained guidance counselors. For example, there DGSACPs have initiated or supported employment projects is only one GRC in Bucharest, and its resources in terms aimed at securing long-term employment for people with of both staff and space are limited. The current National disabilities. The Center for Resources and Information for Employment Strategy 2014-2020 proposes to increase the the Social Professions (CRIPS) has taken the first steps to numbers of and resources for such centers. The provision ensure that “job coach” is a recognized profession in the of one-on-one guidance and counseling for people with Romanian Classification of Occupations. Several NGOs disabilities seems to be quite sparse, mainly as a result of have created social enterprises that employ disabled the shortage of human and physical resources. The main people such as toy factories, bakeries, printing, packaging, tailoring, and craft activities and have had significant results 40 www.carierebihor.ro 76 | PEOPLE-BASED POLICIES (including Pentru Voi in Timisoara, Alpha Transilvana in BOX 7 Targu Mures, Alaturi de Voi in Iasi, Motivation in Clinceni, and Hans Spalinger in Simeria). The Corporate Social Successful EU Approaches for Responsibility has gradually become an instrument for Integrating the Low-skilled and including people with disabilities in the labor market or for Long-term Unemployed into the financing projects related to supported employment. Labor Market Romania could consider contracting out services with Taking an individualized approach to helping the performance-based staged payments as a way to target long-term unemployed to find work is one of the resources to the long-term unemployed or to other specific key recommendations of a recent OECD report. disadvantaged or vulnerable groups. This has been tried The report evaluated several successful person- in Germany, the Netherlands, the USA, and Australia and centered approaches and found that they had the is currently being introduced in Ireland. In Australia, the following common characteristics: • government contracts out the placement of clients to either private organizations or NGOs and pays their fees in stages  hey provided continuity of support and the T right support at the right time. • according to how many of the contractor’s clients stay in their placements. If a client remains in the placement for, say, six T  hey were holistic interventions rather than months, then the government pays the contractor the full focusing on only one aspect of employability. placement fee, whereas if a client leaves the job after, say, only three months, the government pays the contractor only 60 percent of the fee. The fees are also based on the client’s •  igh-quality personal advisors were available H to support an individual’s needs. Having the same person act as coach and mentor helps distance from the labor market. In the case of Romania, the to build client confidence and to establish a government could specify that it will pay maximum fees positive relationship. for successful placements for GMI beneficiaries and Roma, for example. Intermediate payments could also be made based on the achievement of an interim target such as the • T  hey made an early assessment of each client’s basic skills and devised a plan to enhance them. • completion of a vocational training program designed to enhance a client’s employability. In Australia, the government T  hey provided continuity of training even after the client found a job. • pays the contracted agency a fee of 80 dollars for placing a recently unemployed person whereas it would pay 1,200 They helped the clients in their job search activities. dollars for placing a long-term unemployed person. This will pay for itself if the client stays in the job for, say, 12 months, as the government will save on benefit payments and will •  hey took a long-term approach and T continued to provide their clients with support even after they are employed. receive both income and purchase tax (due to increased purchasing power) from the newly employed worker. Lower Evidence from other EU countries confirms that costs and higher placements have been recorded in some of the most successful services also provide intensive the national PES that have pursued this approach. person-centered counseling to re-motivate the long-term unemployed to resume their job search An inclusive labor policy should aim to increase employment with frequent sessions with the same counselor. rates for vulnerable groups and women. Young people in Intensified support brings positive results. These general, rural residents, women, and specific vulnerable types of integrated approaches require collaboration groups (including Roma, disabled workers, youths leaving between or even the integration of different agencies institutionalized care, and ex-prisoners) face higher and organizations around a central caseload barriers to entering the labor market. These groups can be management and tracking system. helped to access the labor market by specific programs and robust anti-discrimination policies in companies and Source: European Commission (2014c: 13-14) and public institutions. Romania already has anti-discrimination OECD (2013c). legislation in place in all laws in the employment and social assistance fields. Additional efforts are needed to increase the awareness and impact of this legislation. Employment | 77 In order to ensure that vulnerable groups are able to access 2010). Although there has been no evaluation of the impact the labor market, the government should aim to: (i) reduce of EU funds on the social economy, the main EU-funded discrimination against vulnerable groups, especially Roma, research project reports have indicated that the results disabled, and female job seekers; (ii) develop support during the 2007 to 2013 programming period were not services to facilitate the employment of vulnerable groups, satisfactory.42 For instance, during that period, EU-funded especially Roma and people with disabilities; (iii) increase projects related to the social economy created only 274 access to housing and transportation for the unemployed, jobs or 10 percent of their initial target.43 The various entities especially for those from rural areas; (iv) develop fiscal working in the area of the social economy are insufficiently facilities for entrepreneurs starting businesses in rural or inadequately supported, and most of the social economy areas and creating jobs for disadvantaged groups; (v) activities developed with EU funds have been experimental. create guarantee schemes for disadvantaged people The main activity funded by the EU was the provision of from rural areas as well as for youths; and (vi) support training regardless of actual development needs. The main entrepreneurship activities, particularly for young people.41 problem is that the regulations governing EU funds are not oriented towards addressing the needs of the social 2.1.6. Developing the economy sector. Current social economy initiatives tend to be concentrated in the most developed areas, while Social Economy to there are very few in the poorest localities.44 The complex and changing financing rules that govern EU funds has Increase Employment increased these disparities and make it difficult for less developed and well-financed providers to prepare proposals Opportunities for and to ensure adequate project management. As a result, Vulnerable Groups the allocation of EU funds has followed the expertise of providers rather than needs of the poor and vulnerable in Romania. A recent movement in the Romanian labor system has Although the legal framework exists to allow NGOs to been the introduction of a social economy sector law in raise money to finance their social projects, there are June 2014, which provides for the registration, regulation, some practical problems with putting it into practice. The and intended expansion of a social and work integration current legislation allows an NGO to carry out an economic enterprise sector for vulnerable groups. In light of the fact activity without paying any tax on profits if their profit that over.4.1 million people in Romania were “out of work” does not exceed €15,000 or 10 percent. This low limit is a (unemployed and inactive) in 2012 and suffered from social considerable obstacle for the development of any economic exclusion and faced multiple labor market barriers, the activity, particularly when the NGO is looking to provide development of a diverse social economy sector including employment for socially vulnerable people, and use their community-based social service providers could play an profits to finance their social projects. In effect, NGOs important role in promoting the inclusion of these citizens cannot fully exploit the potential of the economic activities into the productive economy. in question as a way to raise money to support its project (or Despite the significant amount of budgetary funds that to co-finance the project if funding is available from external the government has allocated to finance social economy sources). Therefore, what is needed is for the government to projects, the efficiency of these interventions remains put in place regulations that will enable NGOs to raise their questionable. Between 2007 and 2013, the government own resources to fund their own social economy activities. allocated over €600 million to social inclusion. Of Although sheltered workplaces, in which vulnerable this, the largest share was assigned to developing new people are employed in a separate defined workplace, social economy initiatives (over €350 million, of which are potentially a way to foster the inclusion of vulnerable approximately €150 million was for projects approved up to 41 These recommended policy measures are in line with the Employment Strategy (GD 1071/2013) and the Ministry of Economy Strategy for the Development of Small and Medium-sized Enterprises and the Business Environment in Romania – 2020 Horizon (GD 859/2014). 42 Arpinte et al (2010), ADV (2011), Stănescu, Cace and Alexandrescu (coord., 2011) Constantinescu (2012), Stănescu et al (2013), MLFSPE (2013), and Barna (2014). 43 MLFSPE (2013). 44 Constantinescu (2012). 78 | PEOPLE-BASED POLICIES groups,45 they are not sufficiently encouraged. The In order to increase the role played by the social economy sector has significantly increased since 2006, mainly sector in providing social assistance, between 2014 and focused on including disabled people in the labor market. 2020 the government aims to: (i) identify the relevant However, although there are approximately 500 protected European financing interventions for all types of social workshops nationwide, there is scope for much more of economy entities and provide them with technical this kind of employment. These sheltered workshops need assistance to prepare and submit their proposals for subsidies and preferential credits to retain their market European funding; (ii) develop the secondary legislation competitiveness as well as specific regulations to support required for the sustainable development of the social their capacity to employ disabled people. economy; and (iii) encourage NGOs to get more involved in these activities. 45 This type of employment is in contrast to “open employment” where people with vulnerabilities enter mainstream, competitive employment alongside people without vulnerabilities. Employment | 79 2 PEOPLE-BASED POLICIES 2.2. Social Transfers The goal of social protection is to ensure the incomes of those who cannot work (such as the elderly, the disabled, or children deprived of parental care), to guarantee a minimum income floor for the extremely poor population, and to provide cash benefits to the poor in return for them meeting their co-responsibilities. The main co-responsibility for work-able adults is to find a job on their own or with the help of employment services. The key policy initiatives recommended in the area of social protection are: (i) the introduction of a single program for the poor, the Minimum Social Insertion Income program (MSII), which is expected to reach all poor families by 2016, and (ii) an increase in the overall social assistance budget allocated to the poor. Main Objectives 2.2. Social Transfers 82 2.2.1. Improving the Performance of the Social Assistance System 82 2.2.2. Providing Adequate Financial Support for the Disabled at Risk of Poverty or Social Exclusion 93 2.2.3. Protecting Elderly People at Risk of Poverty or Social Exclusion 94 2.2.4. Protecting Poor and Vulnerable Consumers against Energy Shocks 102 82 | PEOPLE-BASED POLICIES 2.2. Social Transfers This section covers the key policy initiatives recommended in the area of social transfers for the poor and vulnerable population, particularly increasing the volume of social • T  he Child Raising Benefit (CRB) is a monthly cash transfer paid to parents who stay home to care for children. It is equivalent to 85 percent of the average assistance resources that reaches the income-poor and income earned by the person over the previous enhancing the overall progressiveness of social protection 12 months with a minimum of 600 RON and a spending. It is organized according to the traditional pillars maximum cap that varies depending on the duration of the social protection systems: (i) non-contributory cash of the benefit. The CRB is granted until the child turns transfers for the poor and vulnerable (social assistance 2 years old or 3 years old if the child is disabled. transfers); (ii) cash support for people with disabilities; (iii) Parents who opt to benefit for two years receive cash support to protect the poor against energy shocks; a monthly allowance up to a maximum of 1,200 and (iv) cash programs for the older population (consisting RON. Parents who opt to benefit for one year have a of pensions, including social pensions). Social services are maximum cap of 3,400 RON. Parents who opt for the covered in the following section. one-year program and return to work before the end of the program are eligible for a back-to-work bonus 2.2.1. Improving the of 600 RON per month for one year upon returning to work. The CRB is another categorical program, which Performance of the covers mothers with young children irrespective of the means of the mother or of the family. Social Assistance System • T  he Guaranteed Minimum Income (GMI) program is a monthly cash transfer that tops up household income to a GMI threshold. Adult household members who are capable of working are subject Romania’s social assistance policy uses a combination of to a work requirement (they must work on projects categorical and means-tested programs to protect the income that will benefit the community in exchange for their of poor and vulnerable families. According to their objectives portion of the transfer) and an activation requirement and target groups, these programs fall into four categories: (i) (they are required to actively seek work through family policy programs; (ii) means-tested programs for low- the unemployment office). The average per capita income households; (iii) programs for people with disabilities; benefit is around 80 RON per month. The program and (iv) other programs, most notably the social pension. is targeted to the poorest 5 percent of the population Seven programs form the backbone of the social assistance and is means-tested. system. All seven are large both in terms of the number of beneficiaries served and of spending levels, and together they account for two-thirds of total social assistance spending. Because of their size and impact on poor beneficiaries, these • T  he Family Support Allowance (FSA) is a monthly cash transfer to families with children in the poorest three deciles. In order to receive the FSA benefits, the programs are the focus of this background study: school-aged children of the recipient families must •  he State Child Allowance (SCA) is a monthly cash T transfer to all children age 0 to 18 years old (or older if still in school). Benefit levels differ depending on the attend school. The FSA program pays a benefit of 82 RON for each of the first four children of families with a per capita income of less than 200 RON and 75 RON for each of the first four children of families with age and status of the recipients. All children aged 0 to a per capita income of between 201 and 530 RON 2 years old receive 200 RON, while those aged 2 to18 subject to additional asset tests. Benefits are higher years old receive 42 RON. For children with disabilities, for single-parent families in each of these income the rates are 200 RON for those aged 0 to 3 years categories (107 RON and 102 RON). old and 84 RON for those aged 3 to 18 years old. The program uses categorical targeting (age) and covers all children irrespective of the means of their family. • T  he Heating Benefit (HB) is a seasonal cash transfer program targeted through a means test to households Social Transfers | 83 in the poorest half of the population. The program Means-tested programs for low-income households have operates during the winter season (November to very good targeting accuracy, with about two-thirds of March). It covers a share of household heating costs, targeted benefits accruing to those in the poorest quintile. with higher subsidies for households in the lower The targeting accuracy of means-tested programs (the income brackets. There are four service delivery GMI, the FSA, the HA, and the SP) is on a par with the best channels depending on the type of fuel used for last-resort programs in the European Union. This share heating: (i) for households connected to the central is substantially higher than for categorically targeted heating grid; (ii) for those heated with natural gas; programs (for family policy programs or for people with (iii) for households heated with electricity; and (iv) for disabilities), which transfer only about one-third of their those heating their homes with wood, coal, or crude funds to those in the poorest quintile. Overall, the targeting oil fuels. The amount of subsidy varies between 16 accuracy of the system (33 percent in 2013) is quite low RON and 262 RON. due to the prevalence of categorically targeted programs. •  he Indemnity of Disabled Adults and the T Complementary Budget for Disabled Adults are monthly cash payments for people with disabilities The Modernization of the Social Assistance System based on the severity of their disability (major, (2010-2014) severe, and average). The first component provides income support for people with disabilities. The The social assistance system in Romania has strong second component pays the cost of a carer for people foundations and has undergone a series of gradual with major or severe disabilities. The program is improvements over the last four years during the categorical. implementation of the government’s Social Assistance • Reform Strategy which was adopted on March 10, 2011. The  he Social Pension (SP) offers a minimum pension to T main objectives of the strategy, which have largely been elderly people who have not contributed enough to achieved, have focused on: (i) improving equity in the social the pension system to qualify for a contributory old assistance system; (ii) increasing administrative efficiency age pension. The benefit amount is 350 RON. The by reducing the administrative costs of the system and the program is income-tested. private costs for applicants; (iii) reducing error and fraud; (iv) developing a performance monitoring system; and (v) Coverage and Targeting improving the training of the staff employed in the social assistance system and the quality of the services that they Accuracy of the Social offer. It is very important to build on the results achieved so Assistance Programs far and to continue the activities that are achieving these objectives. The social assistance system scores high in terms of its A key objective of the Social Assistance Reform Strategy coverage of the poor (64.8 percent of the poorest quintile was to increase the share of social assistance funds benefitted from at least one social assistance program reaching the poorest 20 percent of the population (targeting in 2013) and of its generosity (in the same year, social accuracy), while reducing the overall cost of the social assistance programs accounted for 23.2 percent of the assistance system. The targeting accuracy of social income of the poorest quintile) (see Table 18). Five programs assistance spending as a whole has increased from 35.8 account for a large share of the income of the households percent in 2009 to 37.6 percent in 2012. The government in the poorest decile - the Child Raising Benefit (CRB), the has taken several different steps to achieve this goal. In GMI, the HB, the benefits for people with disabilities, and the categorical programs with modest targeting accuracy, social pension. The high coverage of the social assistance the benefit level was kept constant in nominal terms. The system is due mainly to the SCA and the HB programs as duration of the Child Raising Benefit was reduced for those all of the others cover less than 10 percent of the population. mothers who opted for the high-replacement option, while The social assistance system has produced mixed results the back-to-work bonus for parents was increased. The in terms of protecting the poor and vulnerable. Targeting number of irregularities in the largest social assistance accuracy varies among the social assistance programs as programs was significantly reduced thanks to a series measured by the 2013 Household Budget Survey (HBS). of thematic inspections done by the National Agency for 84 | PEOPLE-BASED POLICIES Targeting Accuracy, Coverage, and Generosity of the Main Social Assistance Programs TABLE 18:  in Romania, 2013 Targeting Coverage Generosity Accuracy Poorest 20% Population Poorest 20% All beneficiaries Poorest 20% All Social Assistance 33.0 55.6 64.8 7.4 23.2 Family Policy Programs State Child Allowance (SCA) 25.8 51.5 56.4 3.5 9.9 Child Raising Benefit (CRB) 20.4 2.8 3.3 24.0 42.7 Programs for Low-income Households Guaranteed Minimum Income (GMI) 86.7 2.9 12.2 22.7 27.5 Family Support Allowance (FSA) 55.7 3.8 10.5 4.2 6.4 Heating Benefit (HB) 40.7 13.7 34.8 7.1 10.4 Programs for People with Disabilities Allowances for the disabled 40.9 4.0 7.9 16.4 26.1 Other Social Assistance Programs Social Pension (SP) 61.6 0.4 1.1 6.8 11.4 Scholarships or Money for High School 33.8 0.9 2.0 11.5 17.2 Privileges for War Veterans and the Politically 44.1 0.4 0.8 17.6 28.8 Persecuted Other Social Assistance Benefits 7.5 0.4 0.2 18.5 22.0 Source: World Bank calculations using data from the 2013 HBS. Deciles constructed based on per adult equivalent income net of all social assistance transfers (similar to EU definition). Notes: Targeting accuracy is the transfer amount received by the group as a percentage of total transfers received by the population. Program coverage is the proportion of population in each group that receives the transfer. Generosity is the ratio of the transfer amount received by all beneficiaries in a group over the total welfare aggregate of the beneficiaries. By beneficiaries we mean all direct and indirect (other household members) beneficiaries of the transfer. The coverage of the HB program refers to the cold season only (estimated based on the first quarter of the year). Social Payments and Inspection (ANPIS). At the same Another objective of Romania’s Social Assistance Reform time, the number of beneficiaries of well-targeted, means- Strategy has been to reduce error and fraud in the social tested programs (the HB, the FSA, and the GMI) has fallen. assistance benefit system. Significant progress has been One reason is the lack of indexation of the thresholds set made in this area in recent years, placing Romania at in the FSA and the GMI program. Another reason is the the forefront in Europe in terms of improving program introduction of an extensive set of asset filters that has compliance rules. More social assistance programs (the excluded a large proportion of the true poor from means- FSA, the CRB, and the GMI) are now being paid through tested programs (as many as one-third of those in the the National Agency for Social Payments and Inspection poorest decile and 38 percent of those in the poorest (ANPIS), thus reducing discretion in eligibility decisions quintile). After the introduction of these filters, the targeting at the local level and extending controls over more of the accuracy indicator went down. After evaluating household system. Social Inspection has also been strengthened survey data, the Minister of Labor, Family, Social Protection, in terms of numbers, and the inspectors have received and the Elderly (MLFSPE) amended the filters in November training from their counterparts in the United Kingdom’s 2013 to increase targeting accuracy. Fraud Investigation Service. Annual thematic inspections have been carried out on five high-value, high-risk social Social Transfers | 85 assistance programs (the abovementioned three plus the Heating Benefit, and the two disability allowances) Too Much Spending on since 2010. These inspections found levels of irregularity Categorical Programs and ranging from 2.5 percent to 36 percent. Furthermore, a data cross-checking effort has been undertaken for four Too Little on Means-tested large social assistance benefits since 2013, which has Programs meant that suspicious files can be identified in a more Despite these improvements, the social assistance system cost-effective manner. These high-risk suspicious files have is still dominated by universal and categorical programs, been reviewed by the social inspection team, and remedial which reduces the poverty reduction impact of social actions have been taken. assistance spending. In 2011, the budget for means-tested The MLFSPE has been at the forefront of reforming its programs shrank disproportionally more than the budget social assistance programs, based on sound economic and for non-targeted programs (from 21 percent in 2010 to 13 social analysis. Since 2011, the government has committed percent in 2011) and has not recovered since (Figure 11). In itself to dismantling producer subsidies in the energy sector 2014, it represented only 16 percent of the total budget. This while mitigating the effect of increased tariffs on vulnerable has reduced the efficiency of the social assistance system consumers. In 2011, district heating subsidies were in reducing poverty, given that means-tested programs eliminated, and the Heating Benefit program was adjusted channel about 67 percent of their funds to the poorest following ex-ante simulations of the effects of different quintile, while only one-third of the benefits of categorical reform options. These simulations helped the government programs go to those in that quintile. to make the most efficient and appropriate policy choices. To increase the extent to which the social assistance budget During 2013 and 2014, the MLFSPE worked with reduces poverty, the government will need to increase the international partners on a similar analysis to identify the budget of means-tested programs and their share of the best policies to protect vulnerable consumers against the overall social assistance budget. This process started in gradual increase in electricity and gas prices over the 2013 2014 with increases in the budgets and benefit levels of the to 2018 period. Finally, the MLFSPE is preparing legislation GMI and FSA programs to mitigate the impact of increased for the forthcoming Minimum Social Insertion Income (MSII) energy tariffs on the poor among other reasons, and with a program, which will be the country’s flagship anti-poverty doubling of the FSA benefit level in October 2014. program, based on sound microeconomic simulations. The MLFSPE has made strong progress in monitoring the A Fragmented and Costly results of the country’s social assistance policies. ANPIS produces regular reports on payments to beneficiaries using Means-tested Subsystem SAFIR, its management information system. To track the Not only do means-tested programs receive only a small share of social assistance funds going to the poorest 20 share of the overall social assistance budget, but they percent of the population, the National Statistical Institute are also fragmented. Romania has three means-tested has received technical assistance from the World Bank programs that support the income of the poorest people - the to develop a social assistance bulletin. The MLFSPE has Guaranteed Minimum Income (GMI), the Family Support produced an initial estimate of the private costs incurred by Allowance (FSA), and the Heating Benefit (HB). All three beneficiaries in accessing the means-tested programs and have small budgets, limited coverage, and low benefit has developed a plan to track both the administrative and levels. They each have their own separate beneficiary files private costs of providing social assistance programs using and payments, which results in waste and unnecessary an internal monitoring mechanism. duplication of administration. The GMI is targeted to the poorest 5 percent of the population, the FSA to families with 86 | PEOPLE-BASED POLICIES FIGURE 11: Total Budget for Social Assistance and the Percentage Allocated to Means-tested Programs Total Budget for SA, (Bn. RON) % of Means-tested Programs in Total SA Budget 8 7.5 7.3 6.9 6.7 6.9 25 7 21 6 18 20 16 5 13 13 4 15 3 2 10 2 1.5 1.3 1.1 1 1 5 0 0 2009 2010 2011 2012 2013 2009 2010 2011 2012 2013 Means-tested programs (GMI, FA, HB) Other SA benefits Source: World Bank calculations using data from the GMI, the FA, the Heating Benefit (HB), the SCA, the Child Raising Benefit and incentive, scholarships, and allowances for disabled. For the other benefits, the budget was estimated using data from the HBS. Note: The budget is expressed in nominal prices. children in the poorest three deciles, and the HB to families in that heightens the risk of error and fraud and involve the poorest 60 percent of the income distribution. Although higher than necessary private costs for beneficiaries these programs are all targeted to the low-income population, (related to applications, recertification, and payments) and the eligibility criteria vary from program to program,46 administrative costs for the system. In 2013 the private increasing the private costs incurred by applicants to access costs associated with applying, recertifying, and receiving the program, and the administrative costs of the system. benefits amounted on average to 18 percent for the GMI, Moreover, each program currently maintains separate 29 percent for FSA, and about 10 percent for HB. This is paper and electronic records related to processing benefit equivalent to two GMI payments, four FSA benefits, and applications, recertification, and payments. one HB benefit lost in private costs. Table 19 presents the estimates of the average monthly costs per beneficiaries per These differences between the three means-tested month. Administrative costs amounted to about 10 percent programs result in unnecessary administrative complexity of each program’s budget in 2012. 47 46 Before November 2013, each of the three programs used a different means test. However, since November 2013, all three programs use a single methodology to test the means of the households (formal income, imputed informal agricultural income, and asset filters). However, other differences in eligibility criteria remain in terms of the assistance unit (the household or the family), whether or not an equivalence scale is used, the length of the recertification period (three months for the GMI and the FSA and the cold season for the HB), and the payment method (directly to the beneficiary or transferred to the service provider in the case of HB recipients using district heating). 47 Tesliuc et al (2014). Social Transfers | 87 Average Monthly Private Costs of Accessing Means-tested Programs TABLE 19:  (RON/beneficiary/month) HB: District GMI FSA HB: Wood HB: Gas Heating Total private costs, of which: 31.5 16.7 9.2 6.5 5.2 Application costs 5.1 4.0 4.8 6.5 5.2 Recertification costs 14.8 11.6 Unemployment benefit certificate's cost 10.0 Cost of cashing the benefit 1.6 1.1 4.4 Total private cost for all programs/beneficiaries 15.5 Pro memoria: Average number of beneficiaries 194,748 254,714 303,995 115,032 107,709 Total cost per program 6,125,220 4,261,179 2,796,841 744,279 560,576 Total cost for all the programs (GMI+FA+HB) 14,488,096 Number of beneficiaries per month 932,478 Source: Grigoraș (2014) using data from the Citizen’s Score Card Survey carried out by the MLFSPE and World Bank in 2013. Notes: The FSA costs are estimated for beneficiaries of this program only (not those who also receive the GMI). The fragmentation of means-tested benefits also reduces In response to this low coverage, the government has the take-up of the programs by the eligible population. simplified access to these programs and increased their Each means-tested program covers only between one- benefit levels. The new measures included unifying quarter and one-third of the poor, but together they cover means-testing criteria and streamlining asset filters to 46 percent of the poor population during April to November reduce inclusion errors in November 2013, increasing the and 62 percent during the cold season during November generosity and expanding the coverage of means-tested to March (Table 20). The reasons for the low coverage programs to mitigate energy shocks in June 2014, and in are: (i) the high private costs of applying for such benefits December 2014 doubling the FSA benefit for poor families relative to their value; (ii) the fact that some of the asset with children and increasing support for children deprived tests introduced to keep high-asset households out of the of parental care. However, these measures have only partly program still exclude a large number of genuinely poor overcome the existing impediments. households; and (iii) a lack of awareness on the part of To increase the poverty reduction impact of the means- potentially eligible people about the availability of such tested programs, the Government of Romania is preparing benefits. TABLE 20: Share of the Population in the Poorest Quintile Benefitting from Means-tested Programs Coverage of the poorest quintile Cold season Rest of the year Guaranteed Minimum Income 24.7 24.7 Family Support Allowance 30.0 30.0 Heating Benefit 39.2 n.a. Total 61.9 46.3 Source: World Bank estimations using data from the 2012 HBS, first quarter. Notes: Coverage statistics have been corrected for under-reporting. 88 | PEOPLE-BASED POLICIES a legislative and regulatory framework to consolidate the three current means-tested programs (the GMI, the FSA, and the HB) into a single program - the Minimum Social •  he MSII program will be able to cover a larger T fraction of poor beneficiaries (roughly, the poorest 20 to 22 percent of the population) because of Insertion Income (MSII) program. This was announced in economies of scale realized by combining the the Social Assistance Framework Law (292/Dec 2011). means-tested programs. The current means- The new consolidated program will became the key anti- tested programs cover only about 10 percent of the poverty program in Romania. Its main features will be: population. With a budget twice as big as the budgets (i) an increase in the budget of the MSII compared to the of the current programs combined, the MSII program combined budgets of the current programs to ensure that should be able to cover all households in the poorest social assistance funds cover most of the poor and (ii) the quintile. Increasing the coverage of the program will introduction of a benefit formula that gives recipients an also increase the political acceptability of the reform incentive to find work (by making it a co-responsibility or (because there will be more winners than losers), condition of receiving the benefits). The program is expected while reducing poverty. • to become operational at the beginning of 2016. The program will be crucial for achieving the poverty reduction  he MSII (which will exempt a share of the current T target assumed by Romania under the Europe 2020 labor incomes of the members of beneficiary families) strategy. will cover a larger fraction of the in-work poor than its predecessor, the Guaranteed Minimum Income After the introduction of the MSII program in 2016, the program. It will also give work-able adults who budget for means-tested programs will be increased from are currently not working and are living on social RON 1.2 billion in 2014 to RON 2.2 billion in 2016 (when the assistance an incentive to look for work by allowing MSII will be launched) and then to RON 2.5 billion in 2017 them to continue to receive social assistance while and will be maintained at this level in real terms thereafter. they work. Technically, the new formula will replace To create fiscal space within the social assistance system, the provisions of the Guaranteed Minimum Income the government will assess the efficiency and effectiveness program, which puts a 100 percent marginal tax of the universal and categorical programs in achieving their rate (MTR) on earnings, with a benefit formula that objectives and then consider a range of parametric reforms, will have an MTR of around 50 percent. According including the possibility of transforming the categorical to the relevant literature,48 between 7 percent and programs into means-tested benefits during 2015. 17 percent of work-able adults who are NEET could go from receiving assistance to being employed or Rationale for Introducing the could get a job while still receiving a lower level of MSII Program assistance under this benefit formula. The implementation of the MSII program is expected to bring many benefits for applicants and program administrators compared with the current situation: •  he adoption of a benefit formula that exempts T part of beneficiaries’ labor earnings will open the program to a larger number of in-work poor, given • that households with working adults will have higher  y increasing the budget allocated for this program B eligibility thresholds than households whose adult over the combined budgets of the current programs, members do not work. • the MSII program is likely to cover more of the poor and to offer more generous assistance to its B  y strengthening the activation and school beneficiaries. This will restore the balance of social conditionality elements of the original programs (the assistance spending between targeted (means- GMI, the FSA, and the HB), the MSII program is likely tested) and categorical programs. An increase in to increase school attendance and improve the school the absolute and relative budget devoted to a single outcomes of the children of the beneficiary families unified means-tested program is expected to have a and increase the employment rate of work-able stronger poverty reduction impact. adults. 48 Gerard (2013) and Bachas (2013). Social Transfers | 89 •  onsolidating three rather small means-tested C programs into a single program will reduce the amount of information needed to process for the poorest in Romania. This is an opportunity for Romania to use EU funds to stimulate employment for low-income families. • applications. This, in turn, will reduce the administrative costs of the system, the private costs F  rom an operational perspective, the MSII will use incurred by beneficiaries to interact with the program, the EU definition of relative income poverty or AROP and the scope for error and fraud. to identify the poor, including those in marginalized • areas. The government will then be able to use this  y introducing a performance management system B unique, efficient, and effective mechanism to target for the MSII program, the administrators will be other sectoral policies to the poor. able to track whether the program is achieving The MSII program will gradually expand its menu the desired development outcomes - reducing the of interventions to provide not only cash with co- income poverty of the beneficiaries, increasing the responsibilities but also services. The various cash benefits school attendance of the children in the program, and services are all currently delivered separately, which and increasing the employment and earnings of is inefficient and diminishes the positive impact of these work-able beneficiaries. They will also be able to interventions. The MSII is designed to take advantage tell whether the delivery costs are reasonable (by of complementarities between cash benefits and other tracking administrative and private costs), whether social services (such as employment, education, health, the program correctly identifies the poor, and whether and housing services). The mechanism used in the the program maintains low rates of error or fraud. MSII program to identify potential beneficiaries is likely •  he MSII will make it possible to use EU structural T funds to finance supply-side human capital measures such as the reduction in the implicit MTR on earnings to increase the coverage of the poor by increasing the accuracy of targeting (see Table 21). International evidence suggests that the coordination of cash assistance with the provision of social services for the poor improves the living and the introduction of bonuses for occupational and standards of the beneficiaries and helps them to rise more geographical mobility as well as ALMPs and remedial rapidly out of poverty. services that will reduce the barriers to employment 90 | PEOPLE-BASED POLICIES Shifting from Separate to Complementary Provision of Cash Assistance and Social Services TABLE 21:  in the MSII Program Link with: Mechanisms for the Provision of Services Employment The MSII program will have a strong activation component with the following elements: (i) increasing the coverage of the services in-work poor by exempting a share of the current labor incomes of members of the beneficiary families, both from agricultural and non-agricultural activities; (ii) allowing local authorities to replace community work with training and lifelong learning courses to increase the employability of the beneficiaries; and (iii) capping the total benefit per family to a ceiling linked to the minimum wage (for example, 75 percent or 80 percent) to maintain work incentives and reduce the stigma associated with the current GMI. Education The MSII program will include a benefit for children from beneficiary families to stimulate the positive behaviors and parental and health for care: (i) participation in the national program of compulsory vaccination for children aged 0 to 1 years old; (ii) 100 percent children attendance in kindergarten by children aged 3 to 5 years old with only an official certificate from the family physician being accepted for absences; and (iii) 95 percent attendance rate in school by children aged 6 to 16 years old with only an official certificate from the family physician being accepted for absences. During any months when a conditionality is not met, the benefit will be suspended. However, it will not be suspended for a child in cases where that child’s siblings are not in compliance, which differs from the design of the current Family Support Allowance (FSA). The logic of the current FSA program links the school conditionality to parents' obligation to send children to school as stipulated in the Law of Education. In contrast, the logic behind the MSII program is to award positive behavior that is likely to break the intergenerational cycle of poverty and exclusion. This cycle is perpetuated when low educational achievement and poor health severely limit the labor market opportunities that are accessible to the next generation of children. Thus, the MSII program will have a greater chance of breaking the intergenerational cycle of poverty and exclusion through targeted cash transfers that address the multiple drivers of inequality. Housing The MSII program will include a housing benefit for families living in social housing in addition to the heating subsidy targeted services to low-income families living in their own dwellings. This housing benefit for beneficiaries living in social housing will cover the cost of their rent and a part of their heating-related costs. In this way, the MSII program will address the excessively high housing cost overburden rate and will prevent homelessness by reducing evictions. Social services The MSII program will cover a larger proportion of the poor population than its predecessors but will also do a better job of for vulnerable addressing the problems of vulnerable groups. The MSII will exempt some social benefits from its definition of household groups means such as the allowance for people with disabilities or the allowance for children in foster care. The implementation of the MSII program and of its poor parents with little education. In this way, poor children’s performance management system will be an opportunity access to and participation in national programs will no longer to coordinate and to reduce the administrative costs of the depend only on their parents’ knowledge and interest. existing social programs, including those financed from the Given the interrelated components of the MSII program, the European funds (see Box 10). For example, all children from implementation of the program will require strong inter- a MSII beneficiary family will be able to apply for the national ministerial coordination between the MLFSPE, the Ministry program of school supplies using a simple paper issued by of Education, the Ministry of Health, the Ministry of Regional their local Public Social Assistance Service (SPAS) instead of Development and Public Administration, and the Ministry of the current system, which often is too complex and costly for European Funds. Social Transfers | 91 BOX 8 Fund for European Aid to the Most Deprived (FEAD) The Fund for European Aid to the Most Deprived (FEAD) is part of the 2014-2020 EU programming period and supports actions to provide material assistance (food, clothing, and other essential items for personal use) to the “most deprived.” This term means “natural persons, whether individuals, families, households, or groups composed of such persons, whose need for assistance has been established according to the objective criteria set by the national competent authorities in consultation with relevant stakeholders, while avoiding conflicts of interest, or defined by the partner organizations and which are approved by those national competent authorities and which may include elements that allow the targeting of the most deprived persons in certain geographical areas” as defined by EU Regulation No 223/2014 of the European Parliament and of the Council, Article 2. The funding complements the financing provided by the European Social Fund (ESF) in the sense that FEAD addresses the basic needs of the most deprived in order to enable them to access training or employment as is also the case with the programs supported by the ESF. The total available resources for FEAD at the EU level come to €3,395,684,880 (at 2011 prices). The minimum allocation per member state is €3,500,000 (for the period 2014 to 2020), and this amount has already been allocated to Cyprus, Denmark, Luxembourg, Malta, the Netherlands, and the United Kingdom. Romania has a total allocation of €391,300,000, which is the third largest allocation at the EU level (in 2011 per capita prices). The Allocation of FEAD per Member State, 2014-2020 (EUR 2011 prices per capita) 25 20 15 10 5 0 Source: Authors’ computations using data from EU Regulation No 223/2014, Annex lll and population data (for 2014) from Eurostat database. In Romania, FEAD is funding the Operational Program for Aid to the Most Deprived, which supports the distribution of food and basic material such as school bags and equipment in order to increase school attendance of children of all ages. The school materials are targeted to children from families in which the net monthly per capita income is less than or equal to 50 percent of the gross national minimum wage. The program targets beneficiaries of the GMI or people whose total income is less than 45 percent of the gross national minimum wage. The detailed categories of beneficiaries of the program’s food aid are specified in GD 779/2014 and include beneficiaries of the Family Support Allowance, the unemployed, pensioners with incomes of less than 400 lei a month or beneficiaries of the Social Pension, people with medium or severe disabilities (adults and children), and war veterans. Implementing the program requires strong inter-ministerial coordination between the Ministry of European Funds, the MLFSPE, and the Ministry of Education (through its school inspectorates). The program shares a management authority with the Human Capital Operational Program. It was approved by the European Commission in November 2014 and began to be implemented in December 2014 (food aid component). 92 | PEOPLE-BASED POLICIES Poverty Reduction Impact of National Institute of Statistics as well as administrative data) to about 80 percent, with progressive coverage and larger the Increase in the MSII Budget benefit levels for the poorest. The proposed increase in the MSII budget is likely to have Simulations have shown that the increase in the program a significant impact in terms of reducing poverty and budget compared to the combined budgets of the current will significantly increase the chances that Romania will programs will have a major impact in reducing poverty meet its national poverty target before 2020. This policy under all economic scenarios (Table 22, row A). Assuming initiative will increase both the number of beneficiaries of moderate economic growth, relative poverty will decrease means-tested programs and the benefit levels that they by about 4.4 percent from 22.8 percent in 2014 to 18.1 receive. Compared to 2012, the budget is expected to go up percent in 2016. The simulations show the program having gradually from RON 1.1 billion in 2012 to RON 2.2 billion in a similar impact on absolute poverty (with the poverty 2016 and to RON 2.5 billion in 2017 and to be maintained line anchored in 2012 and indexed to the inflation rate). at this level in real terms afterwards. The new program is Given the additional financing envisaged for 2017 and the expected to be better targeted towards the poorest quintile economic parameters, the decrease in poverty due to the than the three existing programs (based on international program is likely to be even higher in 2017 at 5.8 percent experience, the targeting accuracy of the new program is (down from 17.2 percent in the absence of the program to expected to be around 80 percent). Moreover, given the 11.4 percent after the introduction of the MSII). This will increase in budget funds, the coverage of households in reduce poverty well beyond the assumed poverty target of the poorest quintile can be expected to increase from the 580,000 individuals by 2020. current level of 60 percent (according to HBS data from the TABLE 22: Likely Evolution of Relative Poverty after the Implementation of the MSII Program Implemented policy 2012 2013 2014 2015 2016 2017 2018 2019 2020 Status quo 22.6 23.1 22.8 22.5 22.4 22.6 22.5 22.8 22.8 A. Increase in budget 18.1 17.8 17.9 18.7 18.7 A+B1. Income exemption in MSII causing 7 percent of the NEETD to move into 17.0 16.6 17.1 17.8 17.9 jobs A+B2. Income exemption in MSII causing 17 percent of the NEETD to 15.7 15.3 16.1 16.4 16.6 move into jobs Source: World Bank estimations using data from the 2012 EU-SILC. Notes: NEETD = Not in employment, education, training, or disabled. Poverty Reduction Impact Moreover, it will be possible for beneficiaries to continue to receive some social assistance while they work, thus of the Introduction of the 50 raising their total income. Based on international literature, percent Earnings Disregard in it is expected that the change in benefit eligibility criteria will result in between 7 to 17 percent of the work-able poor the MSII Program who are currently not in employment, education, training, or disabled (NEETD) becoming employed. Therefore, the The MSII will have a benefit formula that will disregard 50 simulations in Table 22 assume that the beneficiaries who percent of wages and other labor earnings and 25 percent are activated and enter the labor market get an increment of of presumed agricultural profit. This means that for families half of the minimum income per month. They also assume with a formal income, the more they work, the higher their that most of the people who are activated come from the effective eligibility threshold and benefit levels will be. Social Transfers | 93 poorest quintile (70 percent) while the others come from the (different medical and functional criteria apply to pensioners other quintiles. and to beneficiaries of allowances), have different points of entry into the system, and separate staff. The level of We simulated an upper and a lower bound for the proportion duplication is high and increasing. As of 2012, about 30 of NEETD who benefit from the MSII are activated – 7 and percent of the disability allowance beneficiaries were also 17 percent (Table 22, rows A+B1, A+B2). The individuals receiving disability pensions, and at the household level, from the first quintile were selected using propensity the level of duplication was even greater. More than half of score matching (those with the highest chances of being the disability allowance recipients also receive some type of employed), while those from the second to fifth quintiles pension. were selected randomly. The simulations show poverty being reduced further in 2016 by an additional 1.1 to 2.4 Overall, the operation of two separate systems to certify an percentage points. applicant’s disability is inefficient for both beneficiaries and taxpayers. Because of different eligibility criteria, applicants 2.2.2. Providing face inequitable access to rehabilitation services, and if they need to apply for both kinds of benefit, then they Adequate Financial incur double the costs to do so. From the perspective of taxpayers, having two systems results in the inefficient use Support for the of scarce administrative resources, higher administrative costs, poor information management (which translates into Disabled at Risk of poor policymaking), and poorer compliance. In addition, it Poverty or Social does not provide all disabled people with the same set of rehabilitation services. Exclusion The government is already committed to correcting these institutional issues, to simplifying access to the disability Romania has a strong system for supporting people with support system, and to making the most efficient use disabilities. There are three main sources of support. First, of scarce administrative capacity. As part of its Social individuals who lost their ability to work while they were Assistance Reform Strategy, the government aims to: (i) in formal employment receive a disability pension (a cash harmonize the medical criteria in the disability assessments transfer) and rehabilitation services. These services are for the invalidity pension and the disability allowance financed by social security contributions and are provided and (ii) unify the institutional framework to create a single by the Pension House, which supports about 700,000 delivery channel to serve all people with disabilities. The people at an annual cost of about 1 percent of GDP. Second, new system will improve the lives of people with disabilities all individuals with severe, mild, or moderate disabilities in a number of other ways as well. It will include individual receive a cash transfer, free or subsidized provision of assessments of both types of beneficiaries (pensioners and equipment to ensure their social inclusion, and rehabilitation recipients of allowances) to find ways to improve how they services (including caregivers). The provision of these function in their social environments. It will also improve services is decentralized to the local authorities, and they the system for referring patients to rehabilitation services, benefit about 800,000 people. The cash transfer payments making it more equitable and accurate to ensure that only amount to 0.4 percent of GDP. These benefits are only the most deserving individuals will be included, thus financed by both national and local government revenues. increasing the overall efficiency and effectiveness of the Third, there is a system of institutionalized care, which system. supports about 17,000 people. This system is financed by The government’s second priority is to maintain the both state and local budgets. purchasing power of the cash allowances for people with The first priority for the government in this area is to unify disabilities. The majority of people with disabilities live in the institutional framework for beneficiaries of invalidity families that are faced with significant economic and social pensions and disability allowances, who are often the difficulties. Moreover, in the families of severely disabled same individuals. The operation of two separate sources people, the usual practice is that one of the parents leaves of support for the non-institutionalized disabled presents a his or her job and becomes a personal caregiver for the number of challenges. The two systems cater to the same disabled child. A 2010 study related to the quality of life beneficiary group, but they treat beneficiaries differently of children and youths with physical disabilities showed 94 | PEOPLE-BASED POLICIES that 89 percent of the personal caregivers for these people two demographic trends are rapidly changing the age are family members.49 Among these families, only 20 structure of Romanian society. This process is being further percent of the respondents said that their level of revenue accelerated by strong net emigration, particularly among is sufficient for a decent quality of life. These mono- the younger population. parental families are numerous, and their risk of poverty is often high, particularly when the families have two or Overview of the Aging of the more disabled children. The lack of indexation of the cash benefits for people with disabilities over the last four years Population in Romania has compounded their hardship. To address these issues, Over the next four decades, Romania will experience an the government has passed a law increasing the generosity unprecedented aging of its population. Falling fertility rates of disability allowances programs by 15 percent. Over the and increasing life expectancy will significantly increase 2016 to 2020 period, the government intends to index the proportion of elderly people in the population and the these benefits to inflation. share of age-related expenditures in GDP, especially for The government’s third priority is to improve the disability public pension programs and for health and long-term care assessment and remedial or support services.50 The services. government will work to improve the existing disability In Romania, average life spans have increased substantially assessment system to ensure that it takes account of in the last 60 years, with life expectancy at birth rising by the real needs of people with disabilities. This will mean about 14 years for females and 10 years for males (Figure designing a holistic system that takes into account both 13). At the same time, the total fertility rate dropped from personal and environmental factors and the individual’s life 2.9 children per woman in the late 1960s to 1.3 by the late habits and choices. 2000s (Figure 14). The aging of the population in Romania is being compounded by high rates of emigration, especially 2.2.3. Protecting over the last decade and particularly among younger age groups. Figure 14 shows the percentage reductions in age Elderly People at Risk cohorts between 2002 and 2011, which underscores the emigration trend among the under-30s. For example, only of Poverty or Social 82 percent of the population who were aged between 10 Exclusion and 19 in 2002 reappeared in the 2011 Population and Housing Census. Romania is facing an unprecedented demographic aging of its population brought about by steady increases in life expectancy and declining fertility rates.51 These 49 ASCHF-Romania (2010). 50 This topic is discussed extensively in the social services chapter. 51 According to Eurostat’s population projections, Romania’s working age population is projected to decline by 40 percent by the year 2060. Its old age dependency ratio, in other words, the ratio between the number of older people (aged 65 and over) and the number of working age people (aged between 15 and 64), is projected to double over the next four decades. Social Transfers | 95 FIGURE 12: Age Composition of the Romanian Population in 2013 and 2050 100 100 90 90 80 80 70 70 60 60 50 50 40 40 30 30 20 20 10 10 0 0 200 150 100 50 0 50 100 150 200 200 150 100 50 0 50 100 150 200 2013 2050 Male Female Male Female Source: World Bank calculation using PROST, 2013 input data provided by Ministry of Public Finance. FIGURE 13: Evolution of Life Expectancy in Romania 90 81.7 82.8 79.3 80.5 78.0 77.6 80 76.7 75.9 72.6 73.6 74.1 72.0 72.4 70.9 69.6 69.5 70 65.0 67.1 66.5 66.1 65.1 61.5 60 1955-60 1965-70 1975-80 1985-90 1995-00 2005-10 2015-20 2025-30 2035-40 2045-50 2055-60 Female Male Source: UN Population Prospects data. 96 | PEOPLE-BASED POLICIES FIGURE 14: Evolution of the Total Fertility Rate in Romania and the Reduction Effect on Cohort Sizes between 2002 and 2011 Evolution of Total Fertility Rate in Romania Reduction in Cohort Size between 2002 and 2012 (%) 4 3.0 30 27 2.9 3 2.6 2.6 2.5 2.2 2.3 25 2.0 20 18 2 1.5 1.3 1.3 1.3 15 13 13 10 7 7 8 1 5 0 0 0-9 10-19 20-29 30-39 40-49 50-59 60-69 Age in year 2002 Source: World Bank calculation using UN population data (graph on the left), Eurostat (graph to the right). FIGURE 15: Number of People in Different Age Brackets from 1960 to 2060 (thousands) 15000 12000 9000 6000 3000 0 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 200020052010 2015 20202025 20302035 20402045 20502055 2060 Under 20 20-64 Over 65 Source: UN Population Statistics; European Union Population Projections for 2014-2050. Social Transfers | 97 By 2030, it is expected that there will be more people over At the same time, the working age population (those the age of 65 than people under the age of 20 in Romania aged between 20 and 64) will decrease by more than 10 (see Figure 15). So far, the rise in population aged 65 and percent as a share of the total population (see Figure 16). above has been an outcome of increasing life expectancy As a result, Romania’s old age dependency rate – defined and larger cohorts of people reaching that age. The as the ratio of people older than 65 to the working age declining fertility rate is reflected in the reduced number population – will more than double over the next four of children since 1980 and the decline in the size of the decades, reaching 55 percent by 2050. During the period working age population since 2010. It is important to note covered by this background study, the old age dependency that population projections may not be extremely precise, rate will increase from about 22 percent in 2014 to 33 especially when the projection horizon spans decades. percent by 2020. The decline in the share of the population For example, migration has proven particularly difficult to contributing to economic output could result in lower growth estimate. Fertility rates may also change, although any in per capita income and might dampen prospects for changes would only start influencing outcomes in a few economic growth. decades time. The trend of lengthening life expectancy is The population dependency ratio – defined as the ratio of already well entrenched. people younger than 20 and older than 65 to the working Romania is projected to experience one of the sharpest age population (those aged between 20 and 64) – is set to drops in its working age population in the European Union, increase by more than 0.35 by 2050, up from a historically a trend that is likely to impose a heavy burden on the low rate of 0.60 in 2013. This rapid increase in the economy. The European Union’s population projections dependency rate will partly be driven by a sharp increase show that, by 2050, the numbers of people aged over 65 in the number of people over the age of 65 as a share of the are expected to increase dramatically and will account total population, as shown on Table 23. for close to 30 percent of the total population by 2050. FIGURE 16: Projected Changes in the Age Composition of Romanian Society (%) 70 63 58 58 60 55 50 45 42 52 40 32 28 30 21 21 20 16 10 0 65+/20-64 20-64/Total population 65+/Total population Source: UN Population Statistics; European Union Population Projections for 2014-2050. 98 | PEOPLE-BASED POLICIES The projected demographic transition is likely to increase shrinking working age population – Romania will need to fiscal pressure on public budgets as the increasing numbers find low-cost solutions to meeting the growing needs of an of elderly people will result in increased spending on expanding older population. In the absence of reform, the pensions and health and long-term care services. As growth demographic aging trend may lead to higher rates of poverty, and income tax revenues decline – a likely outcome of a social exclusion, and dependence among the elderly. TABLE 23: Trends in Population Dependency Rate and Share of the Population Aged 65 and Over 2015 2020 2025 2030 2050 Population Dependency Rate 61 66 71 72 94 Share of 65+ in Total Population 17 19 21 21 28 Source: European Union Population Projections for 2014-2050. Ethnic Dimensions of As the working age population in Romania is projected to fall, the share of Romania’s Roma minority is expected to Population Aging in Romania grow. Depending on which of the aforementioned estimates of the Roma population is used, between 6 percent and In contrast with these national demographic trends, one 20 percent of today’s youth are Roma. This minority group of the largest ethnic minorities of Romania, the Roma tends to be excluded from the labor market and if this population, is a comparatively young and dynamically continues, the employed population will shrink even faster growing group.52 About 613,000 Romanians, approximately than national demographic projections suggest. Therefore, 3.3 percent of the population, declared themselves to be of ensuring the inclusion of the Roma minority is critical for Roma ethnicity in the 2011 Population and Housing Census, the development of Romania. Increasing employment which makes them the second largest ethnic minority in rates and earnings among Roma has the potential to yield Romania after Hungarians. However, there are concerns considerable economic benefits ranging from €887 million that this estimate is inaccurate because of significant to €2.9 billion annually as well as additional fiscal benefits under-reporting. Experts estimate that the actual number ranging from €202 million to €675 million annually.54 of Roma is much higher. According to Council of Europe data, the Romanian Roma population in 2010 was between 1.2 million and 2.5 million or 6.5 to 13.5 percent of the total Regional Dimensions of population. Children and youths aged between 0 and 14 Population Aging in Romania years old - the next generation of labor market entrants - make up almost 40 percent of the total Roma population The aging of the population in Romania has a pronounced compared to 15 percent among the general population. regional dimension as evidenced by the uneven distribution Therefore, the demographic trend among Roma stands of the older population across the country (see the left in stark contrast with the fast-aging profile of Romania’s side of Annex Figure 4.2).55 This uneven pattern of aging general population (Annex Figure 4.1). Life expectancy does not necessarily translate into an equivalent regional among the Roma ethnic minority is considerably lower than reduction in the number of taxpayers or increased old age among the general population in Romania. Some estimates related spending. For example, the areas of high “pensioner point to a gap of six years, while others have found a 16 year density” shown in Annex Figure 4.2 (right side) are not difference in the average age of death of Roma and of the always where the share of population aged 65 and over general population in Romania.53 is the highest. While the two maps in Annex Figure 4.2 52 This section borrows from the World Bank (2014a). 53 World Bank (2014a). 54 World Bank (2014a). 55 This section borrows from the World Bank (2014a). Social Transfers | 99 show a concentration of the elderly and pensioners in the far right column represents the 10 percent of Romania’s Southern provinces, the West and Central Romania have population living in the smallest rural municipalities with considerably more pensioners than the numbers of elderly an average of 1,700 inhabitants. Figure 17 shows that 12 residents would suggest, while the reverse is true in the to 15 percent of the urban population is aged over 65, North-East. but this proportion is higher (23 percent) in the smallest rural communities. However, close to 25 percent of the Further analysis of the geographical distribution of the urban population are receiving a social insurance pension older population highlights stark divergences in the age compared with only 18 to 20 percent in rural areas. While composition of the population by the degree of urbanization. the latter statistic is biased lower due to the exclusion of To approximate the degree of urbanization, we grouped recipients of the farmer’s pension benefit, which has been the population of Romania into deciles by the size of closed to new beneficiaries since 2000, it represents the municipality in which they live (see Figure 17). The far left future trend of the pension system in the absence of a column represents the population of Bucharest, while the farmer’s scheme. FIGURE 17: Proportion of Older Population by the Degree of Urbanization in Population Deciles Average number of residents in locality (in thousands), and Degree of urbanization 40 30 20 pensioners 10 ages 75+ ages 65-74 0 ages 55-64 1,883 275 129 48 16 7.9 5.3 3.9 2.9 1.7 100% urban 100% urban 100% urban 100% urban 90% urban 36% urban 10% urban 2% urban 1% urban 0% urban Source: 2011 Population and Housing Census data. The uneven geographical distribution of the aging self-employed small-scale farmers often cannot afford to population and of social insurance coverage is likely to put pay pension system contributions, thus losing their right to many future elderly people in rural areas at an increased a contributory pension, which could insure them against the risk of old age poverty. As shown in Figure 18, social risk of old age poverty. insurance coverage among the over 65 urban population The magnitude of the challenge of providing medico-social exceeds 95 percent. On the other hand, pension coverage services to the rural older population is even larger when the is declining among the older rural population. While most geographical distribution of the very oldest people is taken rural elderly people who are not covered by the general into account. Despite the lower life expectancy in poorer social insurance scheme are eligible for the farmer’s rural areas, the highest proportion of the very old – those pension benefit, this is no longer true for those in younger aged 75 and over – still live in rural regions. Up to 11 percent rural age cohorts since the farmer’s scheme was closed to of the populations of the smallest municipalities are in this new entrants. Although the rural population can and should age bracket, and more than one-third of them live alone participate in the PAYG public pension system along with (Annex Figure 4.3). This population is extremely vulnerable the entire Romanian population, a large percentage of the to poverty, exclusion, and a lack of access to health services rural population is engaged in self-subsistence farming – and long-term care. typically operating outside the cash economy. As a result, 100 | PEOPLE-BASED POLICIES FIGURE 18: Social Insurance Coverage of the Older Population by Degree of Urbanization in Population Deciles Average number of residents in locality (in thousands), and Degree of urbanization 100% 45 - 54 55 - 64 65 - 74 75 and over 90% 80% 70% 60% 50% 40% 30% 1,883 275 129 48 16 7.9 5.3 3.9 2.9 1.7 100% urban 100% urban 100% urban 100% urban 90% urban 36% urban 10% urban 2% urban 1% urban 0% urban Source: 2011 Population and Housing Census data. Note: Recipients of the farmer’s pension benefit, which has taken on no new members since 2000 but continues to pay benefits to members who joined prior to 2000, are excluded from this analysis. The large differences in old age dependency rates years and over before the receipt of any transfers stood at between urban and rural communities (Annex Figure 4.4) 80.7 percent. However, income transfers from the pension are mostly caused by migration, a large part of which system lifted 61.9 percent of the elderly population out of consists of internal migration resulting from urbanization. poverty. Other social transfers further reduced the poverty It is important for policymakers to realize that migration, incidence rate by 2.6 percentage points. Similarly, for especially internal migration to urban areas, is a natural people aged between 50 and 64, pension transfers reduced product of development that mostly benefits urban areas. the pre-transfer poverty incidence rate of 48.4 percent by The phenomenon is often encouraged in the name of 32.8 percentage points, and other social transfers reduced increased productivity and employment opportunities of it by 2.1 percentage points. This analysis strongly suggests the young population and might be beneficial for other that substantial reductions in replacement rates and/or reasons. However, high old age dependency rates in rural declines in pension system coverage could significantly settings are often a cost of such economic development, the increase the old age poverty incidence rate in Romania.56 burden of which should be shared between urban and rural No significant increase of the PAYG pension system’s deficit communities. is expected in the future (Annex Figure 4.5). This is primarily In Romania, the pension system plays the most important because pension coverage is shrinking, especially in rural role in protecting against old age poverty. The poverty areas where the farmer’s pension scheme has been closed incidence rate among pensioners was relatively high during to new entrants, and because of declining replacement Romania’s transitional period of the 1990s. However, it rates. The average pension from Pillar I and Pillar II dropped significantly during the strong economic growth combined as a percentage of average wages is projected period between 2000 and 2008. The absolute poverty to decrease by more than 15 percentage points, settling at rate, which takes account of the minimum basic needs of a around 35 percent of the average wage by the end of the household based on World Bank methodology, has fallen simulation horizon. The decline is due to a less generous from 35.9 percent in 2000 to around 5 percent in 2008. pension indexation as foreseen in the law starting from 2021 In 2008, the poverty incidence rate for people aged 65 when the pension point value is to be increased annually by 56 International Labour Organization (2010) and World Bank (2015b). Social Transfers | 101 100 percent of the inflation rate plus 45 percent of the real poverty in Romania. As a result, any decline in coverage wage growth of the average gross earnings in the previous could seriously jeopardize Romania’s chances of reaching year. Over the next nine years, the percentage of real wage its EU 2020 target of lifting 580,000 people out of poverty. growth taken into account in the calculation of pension The developing situation in rural areas also raises the values will be gradually reduced by 5 percent per year until question of how the risk of old age poverty will be addressed 2030 when the pension point value will be increased only by policymakers in the medium to long run. The changes in line with any increases in the inflation rate. will especially affect women, 32 percent of whom currently depend on the farmer’s pension after reaching the age of The projected decline in pension coverage (see Table 24) 65 (only 13 percent of men in this age group are currently will mean that fewer elderly people in the future will have receiving the farmer’s pension). Universal old age pensions, access to a contributory old age pension, especially in re-established farmer’s pensions, or greatly expanded rural parts of the country. As discussed above, the pension social assistance programs for rural areas seem to be the system has had the single largest effect on reducing old age only viable options. TABLE 24: Projected Pension Coverage and Projected Replacement Rate, Pillars I and II (%) 2015 2020 2025 2030 2040 2050 2060 2070 2080 Projected coverage Age 65 female 85 82 78 73 68 67 67 of pension system Age 65 male 86 85 83 81 77 73 68 67 67 Total projected 49 44 41 37 34 33 33 33 34 replacement rate (Pillars I and II) Source: World Bank calculation using PROST, 2013 input data provided by Ministry of Public Finance. In the future, average real pension income is expected to questions about how to meet the growing needs of the continue rising but will slowly decline in relation to wages. elderly. At the same time, the projected decline in the The pension reform of 2000 has strengthened the link proportion of the population contributing to economic output between the contributions paid and pensions received, could result in lower growth in per capita income and could which has provided workers with some incentives to work dampen overall economic growth. In the absence of reform, longer. However, the reform also aimed to address projected the demographic aging of the population may therefore lead fiscal imbalances that were developing along with the to higher rates of poverty, social exclusion, and dependence rapidly rising population dependency rates. Policymakers among the elderly. should be credited for realizing early that demographic To mitigate the risks triggered by the aging of the developments require the accrual of fewer pension rights. population, we recommend that the government implement This, of course, means that replacement rates will decline policies to: unless contribution periods are significantly prolonged. Even with the projected gradual increase in retirement ages, the replacement rates are still expected to decrease over time, as shown in Table 24. It is likely that the people •  nsure longer, healthy life spans and careers for the E vulnerable working age population. Fiscal pressures are likely to lead to a low internal rate of return on affected by this change will prefer to work longer in order to pension contributions in the future, requiring even soften the relative decline in their pension incomes. longer contribution periods and higher contribution This demographic change will put increased fiscal pressure levels in order to achieve adequate pensions. on the public pension system, on healthcare services, and This may put a significant proportion of future on long-term care at the same time as labor tax revenues pensioners at risk of poverty. Women are especially will be increasing. The number of elderly people is projected vulnerable because they usually spend fewer years to increase both in absolute numbers and as a proportion in paid employment and earn lower wages (thus of the total population, resulting in an increased demand accumulating smaller pension entitlements). Also, for health and long-term care services. This raises difficult they often outlive their partners and end up living 102 | PEOPLE-BASED POLICIES alone and face higher living costs as a result and thus are at a higher risk of poverty and social exclusion. 2.2.4. Protecting In order to address this problem, we suggest that the government ensures that an adequate level of Poor and Vulnerable pension income is provided to those elderly people Consumers against Energy Shocks with short formal careers and low wage incomes as well as for elderly people living alone. In addition, it is vital to find ways to increase the length of working careers in the formal sector and to increase the Vulnerable consumers are those living in income poverty as employment and/or earning capacity of vulnerable well as select groups (such as single people and the elderly) groups. from the lower-middle-income part of the distribution. • The government has gradually increased electricity and R  eview social pension policy. Low coverage of the gas tariffs to align them with EU tariffs. This is increasing working age population by the pension system, the energy burden on consumers, especially poorer especially in rural areas, will eventually lead to a households. large segment of elderly people who are not eligible for contributory pensions and are thus at risk of Poor and lower-middle-income consumers will continue poverty. This will, in turn, put strong pressure on to receive social assistance benefits that will compensate social assistance programs. Therefore, there is a need them for a proportion of their heating costs during the cold to expand the coverage of the pension system and to season. These current mitigation measures include top- ensure an adequate level of income for elderly people ups in means-tested programs (the Guaranteed Minimum who have no rights to a contributory pension. To Income program and the Family Support Allowance) plus prepare for this risk, the government should consider seasonal support via the Heating Benefit program. The latter reviewing its policies regarding social pensions program was recently reformed to cover consumers whose for the elderly and identify financing sources for only option is to heat their houses with electricity in addition non-contributory pension liabilities, which can be to the existing coverage of users of wood, gas, and district expected to quickly grow in the future. heating. This program will be continued under the auspices of the forthcoming MSII program. •  eview legislation regarding anticipated pensions R and the future pension age. The problems involved in reducing the number of anticipated retirees and In addition to the heating subsidy targeted to low-income families living in their own dwellings, the new consolidated means-tested MSII program will include a housing raising the pension age are being further explored component for families living in social housing. This housing and properly documented at the national level. The benefit for beneficiaries living in social housing will cover the preconditions for these measures need to be carefully cost of their rent and a part of their heating-related costs, in put in place, and programs need to be developed and order to prevent homelessness by reducing evictions. adapted to prepare for this transition. Social Transfers | 103 2 PEOPLE-BASED POLICIES 2.3. Social Services “Our goal is to ensure the development of a national network of social services of good quality, adequately distributed in the territory and accessible to all potential beneficiaries at national level.” Government of Romania: The Strategy for Social Services 2006-2013, HG 1826/2005. Main Objectives Social Services 2.3.  106 2.3.1. Fostering the Participation of Beneficiaries in the Planning and Provision of Social Services 108 2.3.2. Improving Needs Assessments and the Management Information Systems and Ensuring They Align Local Decision-making Policies and Practices 109 2.3.3. Improving the Financing of Social Services 111 2.3.4. Strengthening and Enhancing Social Assistance at the Community Level 116 2.3.5. Developing the Integrated Intervention Community Teams 125 2.3.6. Developing Social Services for Vulnerable Groups 133 106 | PEOPLE-BASED POLICIES 2.3. Social Services Social services, according to Law 292/2011 on social assistance (Article 27/1), represent the activity or group of activities carried out in response to social needs as well • A  doption of regulation governing specific professions in the field (such as social workers and psychologists in 2004). • as to special, individual, family, or group needs aimed at overcoming difficult situations, preventing and fighting R  atification of the European Social Charter (1998), social exclusion, enhancing social inclusion, and raising the which stipulates the individual’s right to social quality of life.57 In this section, the focus is on social services services provided by qualified social workers. • within the social assistance system, given that the other types of services (such as employment, education, health, A  doption of legislation governing the social work justice, and housing) are discussed in other chapters. system (in 2001, 2006, and 2011), which provides strategic planning of social assistance measures as a The development of social services has been a strategic rapid response to economic, demographic, and social goal of the Government of Romania since 2006 and changes. will continue as such until 2020. Since 1990, the state, local authorities, NGOs, and commercial businesses An extensive, coordinated, and integrated network have developed a wide spectrum of social services for all of services is needed to address most of the most vulnerable groups throughout Romania, which nevertheless persistent social problems in Romania, such as children’s need to be further strengthened and enhanced. At present, precarious nutritional status, the neglect and abuse of the national social assistance system is a structured system children, early school leaving, and weak early childhood that completed the following key phases: educational programs. These problems also include • youth unemployment, insufficient primary and preventive  doption of legislation mandating local public A health services, underdeveloped social housing, and a authorities to organize, grant, and finance social lack of support services for a wide range of needs (such services as local public interest services.58 as disabilities, drug addiction and alcoholism, domestic • violence, homelessness, and ex-prisoners). Monetary A  doption of legislation providing for a diverse set of poverty further deepens the various vulnerabilities, but cash funding instruments including public funds through transfers alone cannot solve existing social problems. Social a direct but also competing (directed to the private benefits (both cash and in-kind) must provide recipients organizations) financing.59 with a secure income, and therefore any reforms of the • system will need to consolidate and optimize these kinds of A  shift in 1998 in the kind of programs funded by support. While income support (cash transfers) are crucial the MLFSPE from those setting-up or re-organizing given the high level of poverty and material deprivation in day care and residential services to those supporting Romania and the fact that families with young people and their running costs (in parallel with the setting up of children are most at risk, most vulnerable groups require new centers), especially salaries and the training of social services developed to cover their specific needs. specialists. Therefore, support packages for most vulnerable groups • should be developed that integrate cash benefits with social A  doption of a regulation setting up a quality services with the aim of promoting their full inclusion into assurance mechanism for social services.60 society. 57 This definition of social services is compatible with the most widely used definition in the EU, that of “personal social services” (Munday, 2007: 10). In Romania, social services are services of general interest and are organized in various forms/structures, according to the activities carried out and to the particular needs of each category of beneficiaries (Law 292/2011, Art. 27/2). These services are provided in a variety of locations and settings, such as individuals’ homes, day centers, and residential establishments, and they are staffed by personnel that include social assistants, social workers, care managers, home-helpers, therapists, and crèche staff. 58 Including a separate budgetary section for social services (1996) and child protection services (1998) in the local budgets; the first Local Budgets Law (after 1989); the setting up of social services as local public interest services (1996, 2001, through the Local Public Administration Law); the setting up of child protection services at the county council level as an optional (GD 1159/1996) and mandatory (GD 205/1997) responsibility. Recognition of social service providers as local public interest providers (2001). Increased accountability of local public authorities for setting up, organizing, and financing social services (2001, 2003). 59 The subsidy (1998), grant financing (2005), concession, procurement (2001, 2006, 2012) program. 60 Quality standards (2001, 2004, 2005, etc.), accreditation of service providers (2004), social inspection of service providers (2006). Social Services | 107 In the medium term, the demand for social services will and innovatively the knowledge of the individuals in most likely continue to grow, given the main demographic their communities and of the resources available in their evolutions. Eurostat data based on the 2011 Census environment to meet their socioeconomic needs. This show that Romania is among the top five European approach aims to maximize human potential and to foster states experiencing demographic decline caused both self-reliance and participation in decision-making. It also by negative natural population growth and migration. stresses services and support that are person-centered and Although almost half of the population lives in rural areas,61 family-centered and, at the same time, community-based only 24 percent of the social services are located in rural and integrated. In other words, the approach focuses on areas, and only 6 percent of the subsidies from the state the safety and needs of children, youth, adults and elderly budget for associations and foundations (Law no 34/1998) in vulnerable situations within the context of their families goes to centers located in rural localities. The aging of and communities, and it builds on the strengths of families the population in rural areas together with the optional in order to achieve optimal outcomes. In accordance with pension for farmers (2010), as well as youth and adult this approach, the current volume emphasizes the need migration for labor abroad, are expected to result into an for appropriate services for all, particularly the poor, the increase in demand for social services from elderly people vulnerable and those with special needs, it promotes and children left at home. In Romania, the tradition of integrated and community-based services to ensure families being responsible for providing care is still strongly the sustainability of interventions, and it recognizes that evident, although the massive numbers of the working age social workers, among other professions, play a key role in population migrating overseas for work has already left an enhancing the capacity of people to address the causes and increasing number of children and older people without consequences of their poverty and vulnerability. family support. Over the next few years, outmigration The development of social services must be framed within (particularly of women) is likely to have an even greater a coherent policy based on an inclusive approach designed impact on the need for and supply of social care service. to support individuals within families and communities, In the shorter term, a paradigm shift in the development especially in the context of regionalization and financial of social protection is envisaged. The government’s and administrative decentralization.62 To this end, the current emphasis on cash transfers has been criticized background study has identified six main objectives: (1) for creating dependency and for not being appropriate or increasing co-decision and participation of beneficiaries developmental. Most community development practices in the social services provision; (2) improving needs currently being used in Romania have been criticized for not assessments and information management system and being focused on empowerment or human development. ensuring their alignment with local decision-making policies Many social services have been criticized for not responding and practices; (3) improving financing for social services; to the real needs of their beneficiaries or for not being (4) strengthening and enhancing social assistance at the person-centered (with the client often being seen as community level; (5) developing integrated intervention merely a passive recipient). Therefore, there is a need to community teams, particularly in poor and marginalized shift to an approach that focuses on improving families’ communities; and (6) developing services for vulnerable living conditions, ensuring that families are involved in the groups, including children and people with disabilities decisions about their own cases, and engaging communities (mental health problems included), elderly people, and in supporting families. other vulnerable groups. These objectives are treated in the next sections. The new approach that needs to be fostered in the coming years is family- and person-centered, as well as sustainable and based on a holistic vision of development. The aim of this approach is to encourage beneficiaries to use creatively 61 According to the new NUTS classification (common classification of territorial units for statistics), Romania has two counties that are predominantly urban (with rural populations of less than 20 percent), 18 intermediary counties (with rural populations of between 20 percent and 50 percent), and 27 counties that are predominantly rural (with rural populations of more than 50 percent). 62 Social services are set up in a decentralized system (2003) and, therefore are not subject to decentralization process (2006). Thus an amendment to the Law no. 195/2006 on decentralization is needed. Strengthening government capacity to ensure access to quality public services is a general objective of the government’s Strategy for Public Administration 2014-2020 (General objective IV, Annex 1: 83-85,www.mdrap.ro/userfiles/consultari_publice/30_06_14/anexa1.doc). The Strategy recommends the development of quality and cost standards for all public services to make them more efficient and to improve their quality. It also proposes the creation of a minimum package of basic public services that each territorial-administrative unit will be mandated to provide as well as an optional package of services to be delivered by the more developed localities. The government is currently considering the budget allocations that will be necessary to achieve this objective. 108 | PEOPLE-BASED POLICIES 2.3.1. Fostering the •  nsuring its compliance with the Directive on services E in the internal market (2006) and the obligation to Participation of have a unique contact point (GEO 49/2009). Beneficiaries in the Planning and Provision •  aking into account analysis on different types of T public-private partnerships in the field of social services, in line with the Directive on public of Social Services procurement and the law on public-private partnerships (for instance, analysis of how the Romanian Social Development Fund chooses which The participatory involvement of beneficiaries is critical to groups from poor rural communities can initiate the success and sustainability of social services provided income-generating activities or small infrastructure within a community. It is also necessary to ensure that projects). • social assistance interventions have a positive impact and produce solid results. Romania does not yet have  implifying accreditation procedures for social S any clear guidelines for involving beneficiaries in the service providers (online registration with subsequent decision-making process for social services. Therefore, confirmation); organizing the registry by region so the government should develop specific measures in line that the future regional authorities could take it over with other forms of consumer rights protection to ensure when they will undertake the responsibilities from the that beneficiaries can have a say in decisions related to the central government. • planning, development, management, and evaluation of all types of social services. Social responsibility also involves I mproving the Nomenclature of Social Services the responsibilities and liabilities of social service providers (specified at NACE level 4, including a short towards their beneficiaries as well as the need to implement description of responsibilities, specifying the type mechanisms for handling and addressing complaints and of provider that is allowed to provide the services in petitions. question). The role played by private providers and NGOs in delivering and developing of social services needs to be increased at both the national and local levels. The existing public- • ncluding the obligation of recording the funding I contract in the land registration with the procedure applied for investments in daycare and residential private partnerships have evolved positively over the years centers, to ensure the sustainability of the in terms of both the number and size of their activities. The investments. government aims to provide greater support to NGOs that are delivering social services as well as to develop adequate contracting procedures, with the objective of increasing the number and improving the quality of social services •  bolishing the need for foreign non-profit entities to A obtain prior consent from the government to operate in Romania and formally recognizing the public utility available to communities as well as to a significant number of private social services providers (supplied by local of vulnerable and excluded people. and county councils or through intercommunity/ Moreover, in drawing up the secondary legislation for Law regional partnerships). no. 292/2011, the MLFSPE is: •  rafting the special regulations under which for- D profit providers are entitled to deliver social services (differentiating among them by type of contract rather than by type of enterprise. Social Services | 109 2.3.2. Improving Consequently, the monitoring and evaluation (M&E) of social services needs to be improved in order to make the Needs Assessments social service system more accountable, relevant, and efficient. The current database (national register) of service and the Management providers is limited and is not yet fully operational for a Information Systems range of functions that would support data collection and the documentation of public policies. and Ensuring They Investing in a complex e-social assistance system will Align Local Decision- be essential to ensure the effective planning, monitoring, and evaluation of social protection benefits and services. making Policies and This kind of e-system would make it possible to make automatic cross-checks of social assistance data across Practices all relevant databases. The e-social assistance system would include: (i) a public finances electronic database; (ii) an electronic agricultural registry; (iii) an employment and Needs assessments and information management systems pensions’ electronic registry; (iv) a civil electronic registry; in the social services sector are still deficient and are and (v) a national registry of providers of social services. rarely used to inform local decision-making policy and Implementing such a system at the local authority level practice.63 One of the main obstacles to the development would help beneficiaries to access information, benefits, and monitoring of social services is the dearth of data on and services, simplify procedures, avoid overlapping local social problems, particularly on the needs of poor and schemes, reduce administrative and beneficiary costs, and vulnerable groups, on what services are available, and on reduce or even prevent error, fraud, and corruption, while at referral patterns. The existing services are not regularly the same time respecting the client’s right to data protection evaluated, and as a result, there is no information to and privacy.64 guide policymakers or program managers in making any necessary adjustments. Social services are not provided The e-social assistance system would also meet in accordance with a transparent plan geared to local beneficiaries’ needs more effectively by facilitating and regional needs. There is no national methodology coordination between the social benefits and social for carrying out community needs assessments and services systems. These two components of the social local strategic planning of social services, and local assistance system need to become more complementary authorities do not have enough knowledge or capacity and coordinated in order to ensure the wellbeing and for these tasks, especially in rural and small urban areas. inclusion of all beneficiaries. By providing a clear picture As a consequence, over the past decade, social services of each recipient and all of the cash benefits that he or she (including prevention services) have mostly been managed receives, it would also enable social workers to develop by the county authorities (through the County Directorates a comprehensive planning system for support services, of Social Assistance and Child Protection or DGASPCs) to make informed referrals to specialized services (when instead of by the local communities themselves. needed), and to observe and evaluate the impact of any support measures. 63 Law no 292/2011 sets out the responsibilities of local public authorities to plan the contracting out of social services based on community needs, to conduct an inventory of existing social services and of their efficiency, to collaborate with public and private service providers in developing the criteria for providing evidence about the types of social services to be contracted out, to include the contracting program in their annual action plans on social services, and to include the necessary funding in the local budgets. 64 Ministry of European Funds (2014). 110 | PEOPLE-BASED POLICIES TABLE 25: Current Status of Necessary Development Actions, 2014 Development need Current status Gate-keeping mechanisms – macro level Available only in isolated cases despite being legally mandated (in the Law on social assistance Local needs assessments 292/2011) Available only in isolated cases. No methodology in place but this is a legislated obligation of local Mapping of needs authorities. Available only in isolated cases. No methodology in place but this is a legislated obligation of local Mapping of existing services authorities. Integrated information system at the Still deficient. A single database of accredited service providers is available. World Bank loan is in national level effect for the development of e-assistance. Gate-keeping mechanisms – micro level For people with disabilities that are very “medicalized.” The evaluation methodology is under revision Individual needs assessments with the support of a World Bank/ Japanese government grant. For other vulnerable groups, these are poorly developed. Poorly developed, especially in smaller communities. Better organized for children in public care but Case management approach needs development. Almost absent for adults with disabilities. This is a legislated obligation of local authorities. Referral systems for the most vulnerable groups are poorly developed or completely missing. SPAS social workers do not know what specialized services exist at the county level so cannot make informed referrals. The referral system for people with disabilities is outdated. With no mapping of Referral to services existing services, the referral commissions do not know what network of services is available at the local level. In addition, people with disabilities enter into a specific referral process in Romania once their disability has been certified. Generally, the commission members are not properly trained and receive no ongoing training. Licensing/accreditation procedures The licensing and accreditation process was changed in 2013. It is now in the process of being Licensing/accreditation procedures reformed again. Quality standards Outdated. Strong need for revision and modernization, especially for services for adults. Contracting and funding procedures for service providers Contracting (with national or local Not yet included clearly in the legislation. Strong advocacy effort ongoing at the national level for this authorities) procedure. A limited range of options, small budgets at the local and national levels, and no unit costs in place Funding procedures (all types of for the budgeting and development of new (and existing) services. The few existing unit costs are funding mechanisms included) obsolete and in need of revision, especially for services for adults. Monitoring and evaluation Monitoring No professionals in place for this process, despite a legal obligation to provide monitoring. No professionals in place for this process, despite a legal obligation to provide regular evaluation of Evaluation procedures services. Social Services | 111 2.3.3. Improving the whereas in-kind services have constantly received about 4 to 5 percent of Romania’s GDP compared with the EU-28 Financing of Social average of 8 to 10 percent (more than 10 percent in the EU- 15 with an increasing trend after 2008).67 Services The total allocation for social services (from all funding sources) has always been low. In absolute terms, the total This section is based on an analysis of the data available budget allocation for social services (in-kind benefits) in the European System of Integrated Social Protection increased from about 300 PPS68 to 573 PPS per inhabitant Statistics (abbreviated as ESSPROS).65 between 2003 and 2011. Even so, this allotment is starkly Romania’s social protection efforts are still the weakest low compared with the EU-28 average of almost 2,500 in the European Union despite the increasing availability PPS per inhabitant or over 2,800 PPS per inhabitant in the of funds. Social protection spending66 as a percentage of EU-15 countries. GDP is considerably lower in Romania than in developed Over 85 percent of total expenditure on in-kind benefits European countries on both cash and in-kind benefits in Romania relates to medical care (goods and services (goods and services) (see Figure 19). Expenditure on cash used in prevention, cure, or rehabilitation).69 Thus, in 2011, benefits in Romania has followed the European trend only about 0.6 percent of GDP was actually spent on in terms of increasing during the global financial crisis, social services other than medical care, including services FIGURE 19: Social Protection Spending by Type, 2000-2011 Romania EU-15 25 25 21.6 21.3 21.1 20 19.9 19.8 19.4 19.5 20 20 19 18.8 18.5 18.4 15 13.1 13.2 15 17.7 17.5 17.4 16.9 16.617 Social protection benefits, 10.9 12.2 of which 9.3 9.3 9.8 9.4 9.9 10 12.3 12.511.6 10 Cash benefits 10 Benefits in kind 8.2 8.5 8.8 8.5 9 5 5 2.8 2.8 2.7 (goods and services*) 2.3 2.3 2.4 2.5 2.5 2.5 1.1 0.8 1 0.9 0.9 0.9 0.8 0.70.6 0 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2003 2004 2005 2006 2007 2008 2009 2010 2011 Source: World Bank calculation using data from Eurostat, ESSPROS, extracted on August 29, 2014. Note: *Benefits in kind (goods and services) other than for medical care. 65 Data extracted on August 29, 2014. ESSPROS contains national administrative national data on social protection spending, both on cash transfers and in-kind benefits (goods and services) that are collected using a methodology that makes it possible to make coherent comparisons between European countries. 66 Social protection encompasses all interventions by public or private bodies intended to relieve households and individuals of the burden of a defined set of eight risks or needs, provided that there is neither a simultaneous reciprocal nor individual arrangement involved. The set of eight risks (or needs) include: (1) sickness, medical care; (2) disability; (3) old age; (4) loss of a family member; (5) children and families; (6) unemployment; (7) housing; and (8) social exclusion not classified in other categories, such as the rehabilitation of substance addicts. Cash benefits include cash payments to protected people and reimbursements of expenditure made by protected people. In-kind benefits refer to goods and services directly provided to protected people. (Eurostat, ESSPROS Manual, 2011: 9). 67 In-kind services are increasingly a favored tool of governments across the OECD. Over the past 20 years, total spending on social services has been steadily increasing, whereas spending on cash transfers has been stable. In the OECD countries, spending on social services is likely to continue to grow in the context of the ongoing global recession as the uptake of front-line social services increases. (Richardson and Patana, 2012: 3). 68 Purchasing power standard. 69 For comparison, the percentage of the sickness/healthcare function in total expenditure on in-kind benefits was 73 percent among EU-28 countries in 2011. Furthermore, between 2005 and 2011, this proportion increased in Romania from 77.3 percent to 86.7 percent, whereas in developed European countries (the EU-15) it has stayed constant at 73 to 74 percent. 112 | PEOPLE-BASED POLICIES intended to protect the population against risks or needs risks or needs of children and families and of persons with related to old age, children and families, housing, the loss disabilities. All other risks have constantly been severely of a family member, disability, unemployment, or social underfinanced. Figure 20 shows that, in Romania, the low exclusion (for example, the rehabilitation of alcohol and drug expenditures on in-kind benefits have resulted in a limited abusers). In Romania, social services other than medical spectrum of services. Considering the major demographic care receive a total allocation from all financing sources of trends that Romania will face in the coming years, the around 84 PPS per inhabitant (compared with an EU-28 government needs to pay more attention and allocate average of 664 PPS per inhabitant and an EU-15 average of higher budgets to risks and needs related to old age. In over 764 PPS per inhabitant in 2011). addition, social housing services receive disproportionately small budgets in Romania in comparison with other The highest spending on social services (other than medical European countries.70 care) is oriented towards protecting the population against FIGURE 20: Structure of Spending on Personal Social Services other than Medical Care, 2011 (%) 80 66 European Union (EU-28) Romania 60 40 32 21 22 23 18 20 6 3 6 2 0 0 0 Family and Disability Old age Housing Social exclusion Survivors Children n.e.c. Source: Eurostat, ESSPROS, Extracted on August 29, 2014 Note: Data refer to in-kind benefits in all schemes including residential care, home help, rehabilitation, child daycare, funeral expenses, social housing, and other in-kind benefits. Social exclusion n.e.c. (not elsewhere classified) includes services not categorized under the other functions. The financing for disability-related services (and goods) has severe curtailment and neglect of services. This has been declined in recent years, both as a proportion of GDP and in exacerbated by the global crisis. Social service practitioners terms of PPS per inhabitant. This has been particularly the have been forced to adopt a “make do” approach, mainly case for assistance in carrying out daily tasks (home help).71 dictated by resource limitations rather than by need or This trend is particularly worrying considering the national priority. Furthermore, while specialized social protection goal to deinstitutionalize people with disabilities and to services have remained underfinanced but mostly transition to a system of family-type care. functional, preventive social assistance services at the community level have continued to lag behind in terms of In conclusion, despite the government’s efforts to finance institutional development, capacity, and use. social protection at satisfactory levels, the crowding-out effect of the cash transfers budget has resulted in the At the moment, local authorities, DGASPCs and NGO 70 In 2011, social housing services were given a budget allocation of 2.66 PPS per inhabitant in Romania compared with an EU-28 average of over 145 PPS per inhabitant. 71 Between 2003 and 2011, the allocation for disability-related home help declined from 0.2 percent to 0.1 percent of GDP and from 15.3 PPS to less than 7 PPS per inhabitant. In contrast, spending on residential care for people with disabilities slightly increased from 5.8 to 8.6 PPS per inhabitant. Social Services | 113 providers do not receive sufficient funds from the state budget for the development of social services. As a result, Currently, in Romania, non-profit service providers local budgets tend to have to support the development have access to a limited range of public funds: • of social services at the local level, but these budgets have been severely curtailed by the decrease in tax  ubsidies from the national budget for certain S receipts during the recent period of austerity and fiscal types of expenditures incurred while providing consolidation. For example, the level of tax collection in an existing social service in line with Law no 34/1998, as subsequently amended. • rural areas in 2012 was only 30 percent of the usual level (according to the Association of Communes in Romania).  on-reimbursable funds from the county or N For this reason, local authorities need additional support local councils in line with Law 350/2005. from the central budget for developing social services. The DGASPCs, which are financed by the state budget and county councils,72 constitute the main providers of •  ublic funds used for the concession or P development of some of the services provided by public authorities in line with GEO specialized social services and, at the same time, the 68/2003 on social services.74 main purchasers of social services. In some counties, the Public authorities can contract with non-profit DGASPCs face financial difficulties, especially providing private providers through the procurement services for the disabled and the elderly, given the procedure regulated by GEO 34/2006 (updated). decline in extra-budgetary funding (such as donations However, most public authorities claim that terms of and sponsorships).73 The non-government providers of reference can only be produced for those services social services are also facing significant challenges as the for which minimum cost standards have been set at available funding for this category of providers is declining, the national level. These are usually services related non-sustainable, and unpredictable. The key funding to child protection, social assistance, and adoption mechanisms available to NGOs are subsidies (from the and some services for people with disabilities for central budget) and grants from local authority budgets. which quality and cost standards were developed between 2004 and 2014. Nevertheless, if the local need for services is pressing, BOX 9 county and local authorities may decide to procure additional services from private non-profit providers Access of social services even without these minimum cost standards. In these providers to public funds situations, the procedures used to draft the terms of reference and then to monitor the expenditure differ Most key stakeholders in Romania feel significantly from one county to another, as there that private non-profit providers of social services are no specific norms for the enforcement of the (non-government organizations and religious ordinance related to social services. entities) are not given sufficient access to public funds to help them to develop these services. They Local authorities still highlight the need to have clear also feel that this access is not properly regulated norms for the procurement of local services from at the national level. Because of the general private non-profit providers under GEO 34/2006, underfunding of the social services system and especially for those services for which there are still of the lack of any clear regulation ensuring the no national cost standards. consistent enforcement of GEO 34/2005 on public Currently, only a very small number of counties procurement in the social field, social services have procured services in this way (for example cannot be developed at the pace necessary to meet Alba and Arad), although the MLFSPE believes citizens’ needs. that this method should be used extensively. The 72 According to the law, DGASPC are financed 75 percent from the state budget and 25 percent from the county and local budgets (through the County Councils). In practice, the proportion of funds from the county budget varies widely among counties. 73 MLFSPE and SERA Romania (2012). 74 As the methodological norms for Law no 292/2011 (on social assistance) have yet to be developed this ordinance is still in force. 114 | PEOPLE-BASED POLICIES BOX 9 (continued) The financing framework also needs to be improved to main difficulties that county authorities tend to ensure the sustainability of financing for social services. The experience when procuring services in this way financing framework has a critical role to play in regulating are: (i) Preparing the terms of reference for the the supply of and demand for social services and is one of social services in question, especially if the services the key public policy tools for ensuring the availability, cost- to be procured have no national cost standards; effectiveness, and quality of social services. The qualitative (ii) Developing cost-quality assessment criteria research conducted for this report showed that local and to efficiently compare the bids received from county authorities are reluctant to develop social services various private providers; and (iii) Launching the even when funding is available, specifically because of procurement process in counties or areas where the the lack of a proper financing framework to protect them number of providers is limited so the legal conditions against potential charges of fraud in connection with any for an open competition cannot be met. inspections by the Romanian Court of Accounts. The procurement (and contracting out) of social services is not Most counties or municipalities are still reluctant yet properly regulated at the national level, nor are there to use this ordinance, especially because of the any effective monitoring and evaluation mechanisms. For different interpretations issued by the Court of this reason, the fiscal authorities often apply different legal Accounts on the contracts for the procurement of interpretations to the contracting out of social services social services. to not-for-profit providers. In many counties, as a result, As a result, various social services for which local authorities have become reluctant to contract these there are as yet no minimum cost standards at services out to private providers, despite their own limited the national level (and often no unitary quality capacity to provide all the services needed. standards) cannot be procured from public funds The financing framework should ensure that the limited under GEO 34/2006, although they are very much amount of available financing for social services is spent in demand and needed at the local level. where there is most need. It is necessary to prioritize among Romania’s obligation to comply with the new EU many demands to ensure that public funds are allocated to Directive on Public Procurement, from February those groups with the greatest need and to those services 26th 2014 (2014/24/EU) is an opportunity to adopt that produce the best outcomes. This prioritization (or a single consistent nationwide regulation on public rationing) requires staff with the technical knowledge procurement in the social services. The Directive and training to perform needs assessments and service has a distinct section on social services (Articles matching, as well as the assistance of social workers at 74-77), and member states are expected to enshrine the community level to identify potential beneficiaries these Articles in their national legislation by 2016. At and services. The framework should also set out service the end of 2014 and the beginning of 2015, several standards to ensure that all providers – whether public, large national non-profit provider networks in private, or NGO - supply services efficiently and of an Romania (including Dizabnet, SenoriNet, Federation adequate quality. of Children NGOs, and Federation of Social Services In order to achieve an improved financing framework, NGOs) asked to take part in discussions with developments in several areas are still needed: • representatives of the Ministry of Finance and the National Authority for the Regulation and Monitoring  unding mechanisms and procedures need to be F of Public Procurement (ANRMAP) with a view to fully developed, especially in the context of the developing these provisions for the social services decentralization. The main objective should be sector. to direct more resources to community-based Source: Opinions presented at the Social Services services targeted to families at risk and family-type Forum in Brasov (February 10-12th 2015), organized care alternatives. At the same time, the existing by Caritas Romania, Fundatia pentru Voi Timisoara, procedures for collecting and using donations from and Alaturi de Voi Iasi as part of the project Stronger and sponsorship by public institutions are rather NGOs Together. unwieldy and need to be simplified. Social Services | 115 •  oordination and harmonization between financing C mechanisms in different sectors (such as healthcare, education, housing, and employment) need to be BOX 10 Harghita county – partial funding increased in order to encourage and support the of private non-profit providers development of integrated services. from non-reimbursable local • I  mprovement, increased transparency and dissemination of the procedures for contracting out social services to non-government and private funds allocated and used in line with Law 350/2005 The County Council in Harghita has found a solution providers are highly needed. For those social services to this problem in terms of developing home care with a series of agreed performance indicators, services, a type of service for which, until now, there policymakers may wish to consider adopting an have been no national quality and cost standards. output-oriented contracting model with staged They have chosen to support these services from payments. The procedures for contracting out social non-reimbursable funds from the county council services should take into account the results of in line with Law 350/2005. Initially, the County local needs assessments and prioritization of social Council in Harghita used non-reimbursable funds: services. (i) to develop preventive services related to child • protection and (ii) to fund innovative activities in  mprovement of the costing methodology and I the county. For the past two years, the County procedures for social services is required. The Council has decided that all social programs funded Ministry of Labor, Family, Social Protection, and the from this mechanism should be transferred to and Elderly (MLFSPE), has developed standard costs for managed by the Harghita DGASPC. Currently, there social services (GD 23/2010). However, a 2012 study are five programs in Harghita county funded from showed that, while 94 percent of the DGASPCs apply non-reimbursable funds: these standard costs, 93 percent of them believe that they need to be revised and modified.75 Social service providers (especially NGOs, but not only) consider • T  he Community Assistance Program that was created after the DGASPC noticed that there are many communities where people have no that the current standard costs are not accurate and access to basic services such healthcare and realistic because they are determined as average transport. The program has built a network of costs that are highly influenced by the costs of community workers to help people with their large residential centers, with no direct reference to day-to-day tasks. The community workers care standards. For this reason, the development have vans that they use to travel from one of a methodology and improved procedures for settlement to another. They do shopping determining standard costs for social services is still for their clients, help them to pay bills and very much needed, especially for adults and the solve administrative issues, and sometimes transport people with limited mobility. • elderly.  he Home Care Program is a program T To ensure the full development of the sector, it will be vital targeted to people with more complex to secure adequate government funding in parallel with the caretaking needs. This program from Harghita funding received from various European bodies.76 is the only program in Romania that allows home care services to be developed in all settlements. The program grew out of the collaboration between the Caritas NGO and the County Council but was also as the result of the County Council convincing all 75 MLFSPE and SERA Romania (2012). 76 In 2011, Social Services Europe, a consortium of European non-profit providers of social services, recommended that the European Commission should prevent its member states from replacing their existing, sustainable financing of core services by funds from the European Social Fund (ESF), in order to ensure the continuity of service delivery and of the core activities of beneficiaries. 116 | PEOPLE-BASED POLICIES BOX 10 (continued) local councils to participate. Now in Harghita should be at least 10 percent), even though, most of the necessary funds for the program for social service providers, staff costs are provided by the local councils, with an represent the highest share of the budget for additional contribution from the County that service, usually 60 to 70 percent. • Council.  program for people with disabilities funds A and organizes cultural and sports events and •  he funding does not become fully available T until the middle of the year, meaning that it covers only six to seven months of the services for people with disabilities. provider’s operating costs. As a result, the • A  similar program for deprived elderly people is also funded from non-reimbursable funds. providers are required to make a significant financial commitment of their own. • A  program preventing children from entering the child protection system is run by the county DGASPC together with NGOs involved Under these circumstances, it is most efficient to use non-reimbursable funds as an additional funding source to other public and private funds. Although in the protection and promotion of children’s these funds cannot fully cover the operational rights. costs of social services, they are an important local mechanism for expanding services. In Harghita the funds for all of these programs are approved by the County Council after it approves Source: Interview with representatives of DGASPC the county budget. This funding is then subject to Harghita. a public debate for 30 calendar days, meaning that these funds only become available to the non-profit providers in the middle of the year (no earlier than 2.3.4. Strengthening June 1st). The methodology for submitting bids and evaluating the projects that use these funds is transparent, with notices published in the Official Gazette. Competitive bidding for all social services and Enhancing Social projects funded from non-reimbursable funds is open to all non-profit providers. The County Council Assistance at the President appoints a committee to evaluate the bids and then signs specific contracts with every non- Community Level profit organization that wins the bidding process. The World Bank carried out a survey of Public Social The county funds supplement those provided by Assistance Services (SPAS) in all cities and rural the local councils, as well as the service providers’ communities in Romania, in May 2014, as an input to the own funds and those from the state budget National Strategy on Social Inclusion and Poverty Reduction (subsidies). The main benefit of funding services 2015-2020. The aim of the survey was to account for all from non-reimbursable funds is that it is possible local authority staff with social work responsibilities. The to support innovative services or services that have questionnaire was filled in by 3,014 localities out of 3,180, a been requested directly by local citizens or their completion rate of 95 percent (see also Annex 5 Section II).77 representative organizations. Local authorities are required by law (292/2011) to This funding mechanism also has some limitations: • establish departments of Public Social Assistance Services,  he eligibility of some types of expenditures is T which are responsible for putting social assistance policies decided by the County Council. For instance, and strategies into operation and for delivering services at in Harghita the Council does not cover staff the community level. The SPAS identify community needs, costs (not even as own contributions, which provide appropriate services to vulnerable groups, and develop prevention and information services to enhance 77 Bucharest was not included. Due to partial non-responses, the (40) cities with 50,000 or more inhabitants were also excluded from the analysis. Thus, the analysis presented in this section covers 279 cities with fewer than 50,000 inhabitants and 2,861 communes, a total of 3,140 local authorities. Social Services | 117 118 | PEOPLE-BASED POLICIES FIGURE 21: Social Assistance Duties Listed in the Organizational Charts of Rural and Urban Localities by Population Size and Number of Posts 100 1 2 4 11 6 8 13 23 24 19 80 32 51 44 68 60 47 36 82 40 97 42 40 32 28 22 20 47 20 38 34 13 30 25 13 18 3 8 8 4 4 0 0 0/1.9k 2k/2.9k 3k/3.9k 4k/4.9k 5k+ Total 0/9.9k 10k/19k 20k/50k Total RURAL URBAN 0 post in the organizational chart 1 post 2 posts 3+ posts Source: World Bank "Social Assistance Services at the Community Level" Survey, May 2014. Notes: k = thousand inhabitants. See also Annex Table 5.1. public awareness about risks and social problems. The social to 18 percent of the large communes (those with 5,000 workers from SPAS, in cooperation with the professionals inhabitants or more). Virtually all local authorities in cities with from the DGASPC, are expected to play the role of more than 10,000 inhabitants have established a SPAS. gatekeeper for all children and adults in poverty or vulnerable The development of primary social services as mandated by situations in their communities. However, there is at present law has been hindered by a lack of financial resources at the no methodology that governs the collaboration between local level, by the hiring freeze and wage cut-off in the public the SPAS and the DGASPC, though one is currently being sector (as part of the austerity policies implemented in 2008 prepared by the government. to 2010), by the limited use of flexible forms of employment Many local authorities have yet to comply with the legal (such as part-time working) in the public sector, and by a requirement to establish SPAS, especially those in smaller lack of effective training for staff. As a result, local authorities rural municipalities. Although some progress has been made have limited capacity to employ specialized staff in social in recent years,78 in 2014 over one-third (34 percent) of assistance, especially in rural areas. local public administrations in rural areas and 8 percent in An additional constraint for local authorities in retaining and very small cities (those with fewer than 10,000 inhabitants) recruiting a specialized workforce in social assistance is had not set up an SPAS but instead had added these given by the very low wages of social workers. The average responsibilities to the job descriptions of existing staff (Figure monthly net wage in the health and social assistance sector 21).79 This overall proportion varies widely from 47 percent of is only 87 percent of the average wage across the economy small communes (those with fewer than 2,000 inhabitants) 78 Previous research showed that, in 2011, almost 45 percent of local public administrations in rural areas had not set up the relevant services. Furthermore, among SPAS, only 30 percent were accredited as social service providers, with 70 percent falling short of the standards needed for accreditation (MLFSPE and SERA Romania, 2012). 79 Actually, due to vacancies, the proportion of local authorities with no SPAS increases to 38 percent in rural areas (varying between 52 percent of small communes and 21 percent of large ones) and to 9 percent in very small cities. Social Services | 119 TABLE 26: Net Wage Earnings in the Health and Social Assistance Sectors in Romania 2008 2009 2010 2011 2012 Monthly net average wage earnings at national level (nominal, RON) 1,309 1,361 1,391 1,444 1,507 Health and social assistance nominal, RON 1,266 1,342 1,226 1,210 1,315 % monthly average wage at national level 97 99 88 84 87 Source: Tempo-Online, National Institute of Statistics. Note: Statistical research on labor costs in economic and social establishments from data collected in enterprises with three or more employees. (Table 26). Considering that wages in the health sector are Sweden (1 per 300), the United Kingdom (1 per 600), or almost double those in social assistance, social workers’ Italy (1 per 1,600).81 The ratio of inhabitants to each social wages are very low. worker is even higher when only the social workers of the Public Social Assistance Services (SPAS) are taken into The ratio of inhabitants per social worker is very high account (Figure 22). The World Bank’s census of SPAS in Romania, especially the ratio of inhabitants to each showed that this ratio varies between about 6,000 and over professionally trained social worker. There are nearly 6,000 13,000 inhabitants per professional in rural and small urban active social workers in Romania (almost 4,125 of whom are SPAS. When all personnel with social assistance duties registered with the National College of Social Workers)80 are taken into account, the average ratio declines to almost and a total population of 20.1 million people, which yields 2,500 in rural areas and approximately 3,000 inhabitants a ratio of 3,350 inhabitants per single social worker, much in small urban towns. higher than the ratio in other European countries such as FIGURE 22: Ratio of Inhabitants per Social Worker 16000 12000 8000 4000 0 0/1.9k 2k/2.9k 3k/3.9k 4k/4.9k 5k+ Total 0/9.9k 10k/19k 20k/50k Total RURAL URBAN Persons with social assistance duties in SPAS Professional social workers in SPAS Source: World Bank "Social Assistance Services at the Community Level" Survey, May 2014. Notes: k = thousand inhabitants. 80 /www.cnasr.ro/?modul=stiri&CID=14&pg=42&key= http:/ 81 Campanini et al (2010) in Preda (2013). 120 | PEOPLE-BASED POLICIES Public social assistance services are severely understaffed number of employees increases to 25 per SPAS. In fact, in in rural and small urban areas. Figure 23 shows that, in all large cities, the SPAS also include a spectrum of social most rural communities, there are only one or two staff services, such as social canteens, daycare centers, shelters members with social assistance duties (and very few for homeless people, and social housing. For example, out of professional social workers) to respond to the needs of a 149 social canteens reported by the MLFSPE in December population who are usually spread over several (between 2013, 137 belonged to urban SPAS, nearly all in medium or 2 and 40) villages, often located many kilometers away large cities (those with over 20,000 inhabitants). Rural and from each other.82 In small urban areas (those with fewer small urban areas lack the staff, resources, and capacity than 20,000 inhabitants), the SPAS usually includes one necessary to develop and implement social assistance professional social worker and an additional two to three activities. Therefore, despite the many people who people with social assistance duties. In larger cities, the have graduated with social work degrees from Romania SPAS tend to have more staff. In urban areas, including universities over the last 24 years, few are employed in large cities with over 50,000 inhabitants, the average rural and small urban areas. FIGURE 23: Social Assistance Staff at the SPAS Level 100 88 12 80 10 60 60 8 60 49 49 43 47 44 40 43 41 43 36 6 36 35 38 40 30 32 31 24 28 25 4 22 19 20 12 9 12 5 2 1 0 0 0 0/1.9k 2k/2.9k 3k/3.9k 4k/4.9k 5k+ Total 0/9.9k 10k/19k 20k/50k Total RURAL URBAN SPAS with at least one professional social worker SPAS without professional social worker but with a person full-time on social assistance SPAS without professional social worker and only with part-time workers in social assistance Average number of persons with social assistance duties (professionals or not, full-time or part-time) Source: World Bank "Social Assistance Services at the Community Level" Survey, May 2014. Notes: k = thousand inhabitants. See also Annex Figure 5.1. The World Bank’s census of SPAS indicates that the in rural communities (of whom more than half are needed deficit of human resources at the SPAS level in rural and in small communes) and another 700 in cities with fewer small urban localities is estimated to be between 2,300 than 50,000 inhabitants, thus a total of 2,300 people. The and 3,600 people.83 In Figure 24 the minimal scenario maximal scenario assumes a more favorable situation in assumes that at least one person is employed full-time which every local SPAS has at least one professional social on social assistance in every local SPAS, irrespective of worker. In this scenario, almost 3,600 personnel, mostly whether he or she is a professional social worker or not. In professional social workers, would have to be employed, of this scenario, at least 1,600 new employees are needed whom almost half would be in communes with fewer than 82 The 2,861 communes include over 13,000 villages. Most communes comprise two to eight villages. 83 In May 2014, the total number of SPAS staff dealing with social assistance in these localities was around 4,800. Social Services | 121 3,000 inhabitants. Given the poor transport connections communes with under 2,000 inhabitants to 23 percent that many of these communes have with urban areas in larger communes with populations of over 5,000) and as well as their poor living conditions, this scenario is 10 percent in urban areas with fewer than 50,000 people much less probable in practice as only a small number of hold several different responsibilities at the same time, professional workers is likely to accept a low-paid job in a such as agricultural registrar, archivist, registration clerk, remote, poor community. human resources specialist, librarian, tax consultant, and emergency manager. At present, most staff with social assistance duties in SPAS do not have clearly defined responsibilities and are often The insufficient professional training of social assistance expected to take on additional duties other than social work. staff at the local level constitutes another major problem. The World Bank census of SPAS reconfirmed this finding About 4,800 personnel cover social assistance activities from previous studies.84 Of all staff with social assistance in 3,140 rural and urban localities with fewer than 50,000 duties, 35 percent in rural areas (from 46 percent in small inhabitants. Around three-quarters of these are women FIGURE 24: Estimated Number of Staff Needed at the SPAS Level in Rural and Small Urban Localities, in Two Scenarios 3500 3134 3000 2500 2000 1604 1500 913 861 1000 598 676 417 409 327 424 456 500 273 181 341 155 152 192 133 329 171 0 0/1.9k 2k/2.9k 3k/3.9k 4k/4.9k 5k+ Total 0/9.9k 10k/19k 20k/50k Total RURAL URBAN Minimal scenario: Vacancies in SPAS with at least one professional social worker (PSW) or in SPAS without PSW but with at least a person full-time on social assistance PLUS One person full-time on social assistance in all other SPAS Maximal scenario: Vacancies in SPAS with at least one PSW PLUS One PSW in all SPAS without such an employee Source: World Bank "Social Assistance Services at the Community Level" Survey, May 2014. Notes: k = thousand inhabitants. aged between 35 and 54 years old (73 percent).85 Most developing ongoing training and supervision programs for have a university degree, but only one in every four SPAS personnel will be absolutely necessary to enhance is a professional social worker (Figure 25). Therefore, the effectiveness of primary service at the community level. 84 IRECSON (2011), MLFSPE and SERA Romania (2012), and Preda (2013). 85 The distribution by age groups is shown in Annex Table 5.2. 122 | PEOPLE-BASED POLICIES FIGURE 25: Distribution by Education of Social Assistance Staff at the SPAS Level (%) 100 80 46 47 48 47 48 47 50 56 60 56 60 40 22 26 25 28 26 28 26 22 24 4 23 4 3 5 3 4 20 4 4 3 28 1 23 22 22 23 24 19 18 17 15 0 0/1.9k 2k/2.9k 3k/3.9k 4k/4.9k 5k+ Total 0/9.9k 10k/19k 20k/50k Total RURAL URBAN Highschool Post-high school University - Social assistance or Sociology University - Others Source: World Bank "Social Assistance Services at the Community Level" Survey, May 2014. Notes: k = thousand inhabitants. At the local level, social work is almost exclusively rarely used, especially in rural and small urban areas. Local concerned with the processing of paperwork related to the prevention, information, and counseling services have very management of cash benefits (such as the Guaranteed little effect, mostly due to the shortage of social workers Minimum Income, the Winter Fuel Allowance, the Child and the insufficient professional training of existing ones. Allowance, and family benefits).86 Various qualitative There are no methodologies for evaluating or monitoring studies carried out by UNICEF have indicated that in the circumstances of different vulnerable groups in each rural communities about 85 percent of the work of social locality, nor are there any methodologies for the early assistance staff is office-based and bureaucratic. Often, any detection of at-risk cases. Social assistance is provided social work is limited to granting cash benefits, including not on the basis of clear plans and objectives but only making and checking files, handling monthly payment when cases turn up. Social workers rarely attempt any records, and making house calls (especially in large and outreach because they are overwhelmed with paperwork very large communities – those with a population of over related to the provision of social benefits. Referral systems 3,000) rather than carrying out prevention and counseling for most vulnerable groups are either poorly developed activities for people at social risk. For example, of all child or completely non-existent. SPAS social workers do not beneficiaries of SPAS in 2010, only 24 percent benefited know what specialized services exist at the county level from services while the remainder received only cash and cannot thus make informed referrals. In general, they benefits, although 21 percent of the recipients of cash refer children and families to services without ensuring that benefits were children at risk of being abandoned by their such services exist in the county. Prevailing social attitudes parents.87 and practices that foster discrimination and tolerance of negative behavior add more obstacles to the identification Case management88 is the main instrument in social and referral of at-risk children and adults. Under these assistance in Romania as in the rest of Europe, but it is 86 Magheru (2009), HHC Romania (2011), and UNICEF (2011). 87 FONPC (2012). 88 Case management is widely used in European countries. It focuses on the needs of individuals and their families and aims to mobilize all available resources to meet those needs, including those of the family as well as the community and wider society. Social Services | 123 conditions, it is even more important to ensure that staff would be useful if professionals (especially universities, receives professional training to improve the quality of service providers and the National College of Social services and increase the chances of them having a positive Workers in Romania) would develop family- and person- impact. centered tools and methodologies regarding the intake, assessment, planning, design, implementation, and M&E of In line with the current legislation and taking into services. These tools and methodologies should be taught consideration these deficiencies, this background study in the continuous training program for the personnel with recommends the development of a minimum intervention social assistance responsibilities at the local level. package89 to be mandatorily delivered in every rural and urban community. This minimum intervention package is aligned with the minimum package of social services set BOX 11 out in Law no. 292/2011 on social assistance and with the minimum package of public services delivered by local public administrations (GD 1/2013 and Strategy on The Package of Key Primary strengthening public administration 2014-2020, 2014). Services Currently Being Piloted This minimum intervention package should consist of: by UNICEF • O  utreach activities, which are crucial for identifying potential beneficiaries and for early intervention services. The Helping the Invisible Children project (HIC), which is being implemented between June 2011 and September 2015, is part of UNICEF’s Community-based Services Program in Romania. •  eeds assessments for communities, households, N and vulnerable people or those at social risk as well as the planning of needed services based on a The aim of this program is to develop a preventive approach within the social protection system, particularly in rural areas. The ultimate objective of HIC has been to increase the impact of social family- and person-centered approach. protection policies for poor and socially excluded • nformation and counseling services targeted to I vulnerable groups or those at social risk, individuals who have experienced domestic violence or neglect, (”invisible”) children aged from 0 to 17 years old and their families. The main specific objectives of HIC are to: (i) strengthen the effectiveness and efficiency of the national strategy for prevention services; (ii) problematic drug users/ex-prisoner members, and increase the national capacity for delivering basic single-parent low-income families as well as youth at services with an emphasis on identifying children risk (such as young offenders, school dropouts, and and families at risk and on strengthening monitoring children in low-income households). and assessment mechanisms; and (iii) in the long •  dministrative support (such as helping clients to fill A in forms to apply for all kinds of benefits), as well as social, medical, and legal assistance. run, extend access to essential services to 30,000 poor, excluded, and vulnerable children. In 2011, there were social workers employed in • 96 communes in eight counties (Bacău, Botoşani,  Referrals to specialized services. Buzău, Iaşi, Neamţ, Suceava, Vaslui, and Vrancea). • After a short period of training, these social workers M  onitoring of and home visits to all people in identified the “invisible” children within their vulnerable situations within the community. communities and mobilized community consultative Various other services (such as the provision of social structures (CCSs) under the supervision of the canteens and daycare centers) will preferably be added DGASPC as specified by Romanian legislation. to this minimum intervention package depending on The members of these consultative structures specific community needs and resources. For the effective included such local decision-makers as the mayor/ implementation of this minimum intervention package, it vice-mayor, the secretary of the mayoralty, social 89 Since 2011, UNICEF has developed and piloted a similar package of primary services as part of its First Priority: No Invisible Children project. 124 | PEOPLE-BASED POLICIES BOX 11 (continued) workers, doctors, policeman, school representatives, children and the field activities of social workers in and priests. Cojocaru (2008) showed that CCSs real time. In addition, it makes possible to aggregate were not properly functioning in most localities in data at various levels (such as the community, the country at the start of the project. county, or project levels) at any time, which supports evidence-based adjustments in the project In 2012, the project covered only 64 communes. in a timely manner. A basic package of community preventive social assistance services was piloted. The social workers In 2014, UNICEF built on the work of HIC by conducted outreach activities including needs supporting two parallel projects in Romania assessments, monitoring, information dissemination focused on developing the quality standards and and counseling, social, medical and legal support, costing standards required for the basic package of and referral to specialized services. They have also community social assistance services. delivered appropriate social assistance services to the worst-off children and families. In parallel with these services being implemented at the community level, another initiative was launched to increase The development and strengthening of local capacity to access to community-based medical care and refine provide social assistance services is essential for the entire the legal and regulatory frameworks for community social welfare system and would cover a wide range of nursing. In 2013, these two initiatives merged and needs. Given the serious budgetary and human resource the modeling project aimed at the development constraints faced by local public authorities in rural and of basic social services at community level was small urban areas, our background study recommends a given a new name: “First Priority: No More Invisible national program aimed at strengthening social assistance Children!” services at the community level at least for the period of 2015-2020, including the following actions: • Two formative evaluations of the project have been carried out, the first in 2012 and the second in 2013.  armarking a budget from the state budget for social E A third evaluation is planned for 2015, and an impact assistance services at the community level and evaluation is scheduled for 2017. developing mechanisms for monitoring the efficient The second evaluation (2013) showed that the use of this budget. This budget would support the project has been largely successful, and its general salary of a full-time employee in the field of social recommendation was to continue the intervention assistance (preferably a trained professional) in each and to enhance advocacy efforts to encourage the eligible/ selected locality, as well as the costs related adoption of the model of community service piloted to the national monitoring system. Thus, communities within HIC more widely at the national and county with a low level of development would benefit from levels. The project is very relevant and highly a specialized professional capable of and financially efficient but still needs to address some problems motivated to implement and develop social services related to its effectiveness and sustainability. In at the local level. • order to address these challenges, UNICEF has developed an online application (AURORA) to E  nsuring that local authorities should include in their provide guidance and support to the DGASPC organizational charts at least one full-time social supervisors and social workers (many of whom are assistance employee and that they publicly advertise not professionally trained). AURORA incorporates for this position in order to improve the recruitment of a methodology for making a complete diagnostic social workers, especially trained professionals. • of children’s vulnerabilities based on a grid of indicators to be applied unitary for all children/ ncluding consistent outreach tasks in the job I households and across all communities, as well as description of this full-time social assistance a methodology for developing an individual plan of employee (preferably a professional social worker) intervention based on this diagnostic. Also, AURORA and ensuring that he or she works one-to-one with allows its users to monitor both the vulnerable people in vulnerable situations and their families, according to a clear schedule. Cash benefits (and the Social Services | 125 corresponding files) should be administered by local (associated with parent alcohol abuse), poor parenting authority staff, thus leaving social workers free to practices, young or single parenthood, unstable marriages, perform their duties. poor health or disability, low school attendance or dropout, • poor or no housing, domestic violence, petty crime, and  andating the professional training of existing and M discrimination. There are also problems of low aspirations, newly hired social assistance staff and drafting low self-esteem, and learned helplessness. Therefore, methodologies, guidelines, and tools to strengthen families in extreme poverty represent a particular challenge, the implementation of case management in SPAS, not just in terms of skills and physical capital but also in especially in rural and small urban areas. terms of psychological issues. Research has documented very well the extreme poverty in Romania since the 1990s, By investing in social assistance services at the community and more recent studies have confirmed time and again level and more generally in community-based services that children, young people and Roma continue to face now, Romania can make long-term savings in other policy the highest risks (see also Section 1.1).90 Furthermore, areas. For example, quality services in the community will extreme poverty in Romania is not only an individual or lead to better health and education outcomes for individuals family phenomenon but is geographical in that it tends and to fewer children being separated from their families, to be concentrated in marginalized areas, both urban which in turn will reduce the use of specialized services and and rural, within which extreme poverty is transmitted the burden on the social protection and healthcare budgets. from a generation to another (see Section 3.2. Integrating Using EU funds to support the development of alternatives Marginalized Communities). to institutional care and to make mainstream services more accessible will give more people the chance to be included An integrated approach on social service delivery on the in society and to contribute to its social and economic supply side and social intermediation91 and facilitation growth. Moreover, investing in family-based care and programs on the demand side are needed to effectively community-based services as well as mainstream services reduce extreme poverty and social exclusion. Families in will not only improve the quality of life of those who use extreme poverty face multiple complex problems besides them but will also create more and better jobs in the social, the need for financial support. Thus, the provision of cash education and health sectors. This will help Romania to benefits - although necessary - is not in itself sufficient to achieve the Europe 2020 objectives on the sectors of social alleviate extreme poverty. A variety of social services in inclusion, education, and employment. education, employment, healthcare, social protection, and other public services need to be provided in addition to cash 2.3.5. Developing the benefits to help those poor to more effectively manage their lives and provide adequate care to their children. However, Integrated Intervention families in extreme poverty face multiple obstacles in using such services, starting with their lack of knowledge of their Community Teams existence, their inability to access the available welfare services, and discrimination. These constraints are even greater when the supply of services is insufficient and/ Romania still faces significant challenges in fighting or social service delivery is fragmented and complicated, extreme poverty and social exclusion. Despite the with multiple unconnected systems and different rules significant progress that has been made in reducing poverty and regulations that require a variety of documents and and improving human development indicators since 2000, certificates from applicants. Consequently, the system is extreme poverty has persisted. Extremely poor families difficult for poor families to navigate. On the institutional face multiple constraints in addition to monetary poverty, side, integrating the delivery of social protection, including long-term adult unemployment or joblessness, employment, education, healthcare, and other public poor child nutrition, a high risk of child neglect and/or abuse services - with real horizontal and vertical coordination 90 On “extreme poverty” and “poor zones” or “marginalized areas”: Chelcea (2000), Stănculescu and Berevoescu (coord., 2004), Constantinescu et al (2005), Berescu et al (2007), Preda (coord., 2009), Stănculescu et al (2010), Berescu (2010), Stănculescu and Marin (2012), Stănculescu et al (2012), Stănculescu et al (2013), and World Bank (Swinkels et al, 2014a). On Roma and Roma communities: Zamfir and Zamfir (coord., 1993), Rughiniş (2000), Zamfir and Preda (coord., 2002), Duminică and Preda (2003), Sandu (2005), Berescu et al (2006), Bădescu et al (2007), Fleck and Rughiniş (ed., 2008), Preoteasa et al (2009), ICCV (2010), Botonogu (2011), Daragiu and Daragiu (2012), Giurcă (coord., 2012), Tarnovschi (ed., 2012), FRA et al (2012), and World Bank (Anan et al, 2014). 91 Camacho et al (2014). 126 | PEOPLE-BASED POLICIES between agencies - is vital for providing appropriate BOX 12 support to families and children in extreme poverty. At the same time, social mediation or facilitation programs are UNICEF Pilot of Multi-disciplinary needed to help extremely poor families, especially those in Teams Integrating Social marginalized areas, to access welfare services in both rural and Medical Services at the and urban areas. Community Level In the medium term, the government should commit The concept of having multi-disciplinary teams to establishing multi-disciplinary teams of community of professionals at the community level is the workers at the local level and multi-agency cross-sectoral first stage towards the formal integration of the cooperation at all levels as a first step towards the full integrated provision of social and medical services. integration of service delivery in the long term. Research In this stage, staff from different professions work has shown that integrating social services has several as a team at the community level (for example, advantages over the silo approach,92 for addressing the social workers, community nurses, Roma mediators, diverse and complex problems related to social exclusion, and policemen). These teams are formed as a for facilitating better access to services, for helping to result of local initiatives rather than as part of a ensure the continuity and sustainability of service delivery, national program. Cooperation is based on personal for increasing the efficiency and effectiveness of service relationships rather than on common methodologies provision, for reducing overlap between different services, or formal procedures. Such initiatives have already and for avoiding unnecessary expenditure.93 been developed in some communities. The full integration of services would mean abandoning the Since 2014, a more formal model of multi- silo approach and the fragmented administration of national disciplinary teams including a social worker and and local services in favor of multi-agency teams at the community health nurse is being piloted by UNICEF national, regional and local level. These teams would work in 32 rural communities in the North-East region. under an integrated management structure, with shared The “First Priority: No More ‘Invisible’ Children!” budgets, programs, and objectives and a single key worker project aims to identify families at risk through (or case manager) with responsibility for coordinating outreach activities, implement coherent needs the various interventions from the different agencies assessment plans, implement a minimum package and professionals involved. Given the current regulatory of primary services effectively and efficiently, and framework in Romania as well as the deficit of human and enhance access to integrated social and medical financial resources in the social sectors, the full integration services for the most vulnerable groups in the of services is likely to have to remain a long-term objective. community, with an emphasis on children and their Nevertheless, in the short and medium term, is feasible families. The local teams do not necessarily include for policymakers to move Romania up the integration qualified social workers but are coordinated and ladder (Scheme 4) by adopting multi-disciplinary teams monitored by professionals from the DGASPCs and of professionals at the community level (Box 12) and by the County Directorates for Public Health (DSPs). initiating cooperation and coordination among the different Cooperation at the community level is based on sectoral agencies. Therefore, in the foreseeable future, the harmonized methodologies for needs assessments government’s aim is to integrated social work management and for personalized intervention plans that are at the community level while simultaneously setting up incorporated in an online application (AURORA), the framework for the full integration of social services after which provides guidance and support to teams in 2020. This integration of interventions at the community the communities and makes it possible for any key level should go hand in hand with the introduction of the stakeholder to monitor their activity in the field in Minimum Social Insertion Income (MSII) in order to ensure real time as well as to aggregate data at various that the program is able to meet the specific needs of levels (the community, county, or project levels) at vulnerable groups. any given time. The impact evaluation of this project and this model will only become available in 2017. 92 Each agency works solely within their confined area of responsibility. 93 European Committee for Social Cohesion (2006). Social Services | 127 The ladder progresses upwards from almost no attempt at integration at the bottom through various levels of SCHEME 4: The "Integration Ladder coordination, cooperation, and collaboration to integration at the top. The levels are not mutually exclusive as each level includes one or more of the components of the other levels. Integration of government Level 8 : Integration of central government ministries and policies: implementaion ministries and policies through all levels of society. Currently, ad hoc integration prevails in the social sectors in Romania. It emerges mostly out of necessity Whole system working Level 7 : Whole system working - not and external pressures. Cooperation between services necessary throughout the whole of a tends to be informal and based on personal contacts and country. relationships. Only in isolated cases do individuals or Multi-service agencies, Level 6 : Multi-service agencies with single groups of professionals from public services or NGOs take single location location for assessment and services. the initiative and cooperate in the interests of their clients. Agency or Service Level 5 : Agency or Service Partnership, with implications for structural changes and Strengthening the Capacity Partnership joint funding etc. of the Local Public Social Planned/sustained Level 4 : Planned and sustained service co-operation and co-ordination, often facilitated through formal networks or Assistance Services cooperation/coordination partnerships(both formal and informal). Integrated intervention community teams94 will be staffed Multi-disciplinary Level 3 : Multi-disciplinary teams of professional teams professionals. by local social workers, including social workers with full-time activities in social assistance, community health Level 2 : Ad hoc, limited, reactive Ad hoc, limited reactive mediators, Roma health mediators, school mediators, cooperation in response to crises or other cooperation pressure. school counselors, and Roma experts. Depending on the community’s needs and resources, the team might also Almost complete Level 1 : Almost complete separation and include a health assistant, a family doctor, school teachers, fragmentation/separation fragmentation of services. or the local policeman. If the community has few resources of its own, then local authorities could build integrated community intervention teams to cover several neighboring Source: Taylor (2014) based on Munday (2007). communes or towns, within the intercommunity development associations or local action groups (LAGs). Strengthening the local SPAS is a key objective, given staff, in terms both of numbers and of their professional that they will be the main promoter of integrated services training, is an important issue in all social sectors. There is by implementing social intermediation and outreach to also a dearth of all types of community workers (such as individuals and families in extreme poverty as well as in community nurses, Roma healthcare mediators, and school marginalized areas. Therefore, the national program for mediators), particularly in rural and small urban areas (see strengthening social assistance services at the community also Section 2.5.3 on Developing the Emerging National level will be essential for the development of the integrated Network of Community-based Healthcare Workers). intervention community teams (see the previous section 2.3.4). The main focus of the government’s 2014-2020 social policy agenda will be the transfer of public financing Investing in more and better-trained staff in the social to the community level and the creation of integrated sectors is absolutely necessary for developing integrated, community services, in which local stakeholders will play multi-disciplinary primary services at the community a decisive role. Thus, the introduction of the Minimum level. As shown in the previous subsections, the deficit of Social Insertion Income Program should go hand in hand 94 NGOs and some pro-active local authorities have piloted the integrated services approach in various localities in Romania. On a larger scale, UNICEF has developed and piloted the integration of social and medical services at the community level in several poor communes in the North-East region (in its First Priority: No Invisible Children project). In the future, the World Bank’s Social Inclusion and Integrated Basic Services Project will be implemented in selected marginalized communities in urban and rural areas across Romania between 2016 and 2020 under the auspices of the Ministry of Labor, Family, Social Protection, and the Elderly with the involvement of the Ministries of Health, Education, and Regional Development and the Romania Social Development Fund (RSDF). 128 | PEOPLE-BASED POLICIES with the development of integrated support services at the community level in order to ensure a tailored response to the specific needs of vulnerable groups. •  he Ministry of Health, together with its County T Directorates for Public Health (DSPs), is solely concerned with the healthcare system. At the local Also, the EU’s strategic healthcare directions for the level, community nurses and Roma healthcare forthcoming period imply a shift away from institutional mediators are hired either by the local authorities care to community-based care. In this general framework, or by local general practitioners (since 2012), are Romania has an opportunity to reshape its healthcare financed from the state budget from resources and social assistance systems with support from some of provided by the Ministry of Health, and have the forthcoming European funds with a view to increasing no formal reporting relationship with the local access to affordable, sustainable, and high-quality social administration. They are coordinated and monitored services, reducing inequalities between regions, and giving by the DSPs. There is no system for monitoring disadvantaged groups and marginalized communities better community nurses at the national level. • access to proper care. T  he Ministry of Labor, Family, Social Protection, and Increasing Horizontal and the Elderly (MLFSPE), along with the DGASPCs at the county level, are concerned with social assistance Vertical Coordination programs. Social workers as well as Roma mediators and Moving towards the and Roma experts are hired and financed by the local authorities to work in their Public Service of Integration of the Social Social Assistance (SPAS). The relation between Services the DGASPCs and SPAS is not yet regulated. The capacity of SPAS, particularly those in rural and small A new regulatory framework and a harmonization of urban areas, tends to be limited. There is no system financing mechanisms will be needed to enable agencies for monitoring SPAS social workers at the national in different social sectors to work together effectively. In level. • Romania, each locality provides decentralized primary and secondary education, primary healthcare, and social T  he Ministry of Regional Development and Public assistance services and benefits as well as of other public Administration regulates and finances social housing. services and social programs, generally with a wide degree However, local authorities decide on what buildings of coverage. However, there will have to be better use of are used as social housing, determine the eligibility existing resources at the local level in order to address the criteria for obtaining a social dwelling, and are root causes of extreme poverty and exclusion. At present, responsible for managing the existing social housing the existing services operate in organizational silos as stock. There is no system for monitoring social follows: housing at the national level. • T  he Ministry of Education, along with its County School Inspectorates (ISJ), is solely concerned with providing education. County Resources and The development of integrated services such as socio- medical services, complex rehabilitation services, or vocational and apprenticeship centers is hampered by these organizational silos. The rigid and fragmented Educational Assistance Centers (CJRAEs) are in regulation of services in different sectors, especially related charge of supporting the education of children with to funding, costing of services,95 staff allocation, internal special needs and the school mediators. School procedures and practice norms, and functioning standards, mediators are hired by schools, are financed by is preventing the creation of multi-disciplinary or mobile the state budget from resources provided by the teams (for example, to help isolated children with disabilities Ministry of Education, and have no formal reporting or the elderly with complex dependency needs, particularly relationship with the local administration. There is in rural communities). Thus, improving horizontal no system for monitoring school mediators at the coordination within and between ministries and the vertical national level. coordination of social service delivery, between the central, 95 Some services, if provided within the healthcare sector, cost twice as much as the same service delivered by a social assistance agency. Social Services | 129 county, and local levels is a must for promoting the effective twice as much as the same service delivered by a social development of any type of integrated services. assistance agency (see section on services for people with disabilities). Some services, if provided within the healthcare sector, cost BOX 13 Coordination in the Delivery of Social and informal mechanisms that are based Services based on Trust and Equality on a common interest and understanding. Partnerships are doomed to fail if partners As a way to integrate social service delivery, are forced to cooperate. In Europe, this kind coordination “represents a planned and deliberate of cooperation is often seen where integrated service harmonization of the activities of the separate agencies partnerships come together as a precondition for in a more systematic way. Coordination implies the accessing funding. The need for trust and balance of surrendering of a significant degree of autonomy by power does not mean that there is no role for a leader each of the agencies involved, with plans being fixed or coordinator who takes responsibility for the overall according to a protocol, or decision making being vested process and the overall objectives of the partnership. in a third party (for example a case manager) with Partnerships do not need to be institutions in their own responsibility for coordination.” (Kuzminskyi, 2013: 8) right, nor are major efforts needed to set them up or to True formal coordination, facilitated through formal run them. They just need to be able to find flexible and networks or partnerships, requires a level of mutual trust cooperative ways to ensure that the needs of the clients and cannot really function where there is competition for are met. influence and resources. This requires the partnership Source: Taylor (2014: 24-25). to be based on a balance of power and requires formal Estimating Accurate Costing identified three kinds of costs that are likely to be incurred in the integration process: (i) the costs of staff and support Needs and Allocating an systems; (ii) the ongoing costs of delivering services; and Adequate Budget (iii) start-up costs. Costs will be noticeably higher in the initial stages of implementation, but they will decrease It will be essential to estimate the accurate costs of setting with time. International experiences show that a return on up and running the integrated intervention community investment is not usually seen in the short to medium term. teams and then to allocate an adequate budget to Given the constraints on public expenditure in Romania, cover these costs. The government needs to develop a the model of integration proposed in this book focuses comprehensive financial strategy for integrating social work on the community level. However, sufficient funding will (including an earmarked budget), including all relevant be needed to procure a sufficient number of adequately budget lines from other sectors as well as resources from trained staff and IT resources. For the time being, there are European funds and any other types of external funding. no solid estimations of the real direct and indirect costs However, as Leutz (1999) has shown, “integration costs of establishing such services, including the costs of the before it pays” both in human and financial terms. Leutz has human, financial, and IT resources that will be needed. 130 | PEOPLE-BASED POLICIES BOX 14 Putting a Model of Integrated Basic Services Helping the Invisible Children (UNICEF), and into Practice others in the region and elsewhere, particularly the successful experiences of the Chile A model of integrated basic services will be piloted by Solidario and Colombia Red Unidos programs. the World Bank in Romania in 2016 to 2020. The Social It will be based on the concept of the social mediator or Inclusion and Integrated Basic Services Project will aim to social worker being the key figure in helping individuals break the intergenerational cycle of poverty and exclusion and families to overcome social exclusion and will have by increasing the ability of the social protection system strong social intermediation and family-counseling to reach out to poor communities and households and components. The project will also take a community- connect them to services. The project will: (i) strengthen led development approach by encouraging community the links between communities/households and services, members to identify problems, develop solutions, and and (ii) implement an integrated package of simultaneous participate in the project’s implementation and monitoring interventions for tackling a multitude of problems faced as facilitated by the local authorities. by the poor and marginalized in Romania. The program will be implemented in select marginalized It will aim to use different implementation methodologies communities in urban and rural areas across Romania suitable for different geographical areas (with a particular between 2016 and 2020, under the auspices of the focus on localities with low human development Ministry of Labor, Family, Social Protection, and the indicators, high unemployment, and low levels of service Elderly and with the involvement of the Ministries of access or use) and human development contexts and Health, Education, and Regional Development and the needs. It will build on the successful experiences of Romania Social Development Fund (RSDF). The aim is to programs such as A Good Start (Roma Education Fund), develop a model that will strengthen the social protection the Priority Intervention Program (Romania Social system as well as an integrated social inclusion Development Fund), A Place for Everyone (UNDP), intervention with the potential to be scaled up with An Integrated Approach with Interventions on the Demand and Supply Sides Community basic service infrastructure Health and Education: Facilitation, outreach, parenting programs (0-3) and identification child health (0-6) of needs (by social workers) preschool services (3-6) INCREASED KNOWLEDGE OF AND ACCESS TO SERVICES Quality control Earning Opportunities: and monitoring employment support (by counties and communes) and basic skills programs for Parents Citizen registration (ID cards, legalization of housing, land titles) Social Services | 131 BOX 14 (continued) To support this outcome, policymakers should consider taking the following actions: (i) provide appropriate training in the use of case management to all community workers, financing from the EU Structural Funds after 2020. including social workers, community nurses, Roma The proposed integrated service approach will put healthcare mediators, school mediators, and Roma experts; social workers at the center of the approach and (ii) clearly define the target groups and eligibility criteria empower them to develop solutions jointly with underpinned by laws or instructions from appropriate households and families in need. The focus of their government bodies; (iii) develop methodologies and tools work will shift to accurately identifying the needs for conducting a comprehensive needs assessment to offer of a poor or vulnerable household as a unit and constant guidance and support to community workers, meeting these needs mainly using locally generated especially as many community workers will not be qualified and locally implemented solutions. The backbone in case management at the outset; (iv) develop protocols of the approach will be intensive local facilitation to guiding teams of community workers in various sectors, and outreach via community workers (or social including clear outlines of responsibilities and rules for mediators). This intensive facilitation approach will reporting, transferring information, and documenting be complemented by the provision of an integrated activities); (v) establish functional relationships between package of services that will contain the following teams of community workers and higher levels of elements: management to ensure professional coordination, • B  asic Health and Education – investments in expanding and improving inclusive early childhood development (such as parenting supervision, and training/retraining; (vi) define functional relationships between teams of community workers and other service providers (such as GPs, GPs’ nurses, and programs), education (kindergartens), and NGOs); (vii) define protocols for joint case planning with basic health services (such as public health other service providers based the equality of all participants; information and promotion for children and (viii) develop procedures for referrals and protocols for mothers and recreational activities). interagency cooperation; (ix) develop procedures for •  arning Opportunities – programs to increase E the employment prospects of parents (such as literacy programs and labor market participation of beneficiaries in the social services provision; and (x) in the larger marginalized areas, develop multi- functional community centers to provide integrated primary counseling). and preventive services primarily (though not exclusively) • C  ommunity Infrastructure – investments in increasing the availability of basic services and improving their quality. to families in extreme poverty, including Roma. A national integrated evaluation system needs to be developed to measure the effectiveness and efficiency of the multi-disciplinary teams of community workers (integrated intervention community teams) and the outcomes for - and the satisfaction of - beneficiaries. The development of the e-social assistance system will be Developing Clear helpful in this respect but not, in itself, sufficient. Assessing Methodologies, Protocols, and the performance of the integrated intervention community teams will require a framework that will make it possible to Work Procedures measure outcomes for both children and adults on several fronts, such as education, health, skills, employment, The main role of social workers and other community income, and housing. Evaluating the satisfaction of workers working together as a multi-disciplinary team will beneficiaries will require a separate component. In addition, be to mobilize demand and to help extremely poor families the performance of staff in using the case management and those in marginalized areas to access available welfare approach will also need to be assessed. An evaluation services, in both rural and urban areas. In other words, should be built into every stage of service provided by them they will ensure the delivery of the minimum intervention as a way of gauging the effectiveness of all processes. package of key basic services as described in Section 2.3.4 Ideally, an online system for inputting and monitoring data and in doing so will be focused on the client rather than on in real time should be developed. the structural integration of the agencies that will actually deliver the various services. 132 | PEOPLE-BASED POLICIES BOX 15 Building on the Successful Experience of Chile families when they use services. The value Solidario of the transfer decreases every six months. All families who conclude the psychosocial In response to constraints that were hampering the support stage automatically enter a phase effectiveness of social programs, Latin American in which the Programa Puente monitors and tracks countries have been developing social intermediation their life conditions. Throughout this three-year period, programs that take a holistic, systemic, and family- families keep their guaranteed benefits and preferential based approach to supporting the poor. Social access to social programs, and the family cash transfer intermediation programs do not provide families with is replaced by an exit cash transfer for 36 months as a cash or in-kind benefits, but they help families to access “prize” for completing the first stage. other programs and thus improve their chances of graduating out of extreme poverty by addressing their The Psychosocial Support Service is delivered by specific needs. Therefore, to be successful, they must professionally trained family counselors. After families be well integrated into the social assistance system. have signed the required participation agreement, the family counselor visits them regularly in their home, Sistema Chile Solidario was the first such program in and also refers them to local social services. One family the region. Chile Solidario is not a distinct program or counselor works with between 60 and 100 families social benefit but a management model based on the simultaneously, some of them in the initial intensive creation of institutional and local networks for providing phase (weekly or biweekly) and others in the monitoring social protection to the poorest families. Chile Solidario and follow-up phase (monthly, bimonthly, or quarterly provides individuals and families living in extreme visits). Chile Solidario provides family counselors poverty and vulnerability (such as the homeless, elderly with regular training. Twice a year, these counselors people living alone, and children of detainees) with go through a binding performance evaluation process, guaranteed social protection coverage for five years, and only those who have achieved satisfactory scores with the objective of leading individuals and families can continue in the role. The performance evaluation to autonomously access and effectively use the social assesses the counselors on three criteria: (i) personal services network. ability; (ii) their ability to manage the supply of services; The Family Support component and the preparation of and (iii) productivity (coverage of beneficiaries, a family-specific development plan are the backbone the number of families graduating, and the social of Chile Solidario . The target group for the program is empowerment of families). Ninety-five percent of these the poorest 5 percent of families in Chile. Participation family counselors are university graduates. in the system is voluntary but the participants commit Chile Solidario began operating in 2002. By 2012, themselves to working towards the achievement of the effective cumulative coverage of the program measurable goals. Common and measurable objectives amounted to 482,558 families (or around 2 million for both the institutions and beneficiaries involved are people). Effective coverage includes those families who structured around 53 “minimum quality of life” conditions, completed both phases of the program and excludes organized in seven categories: identification, health, those who refused to participate (only 2.2 percent of education, family dynamics, housing, work, and income. those invited) and those who did not complete the The entry point to the system is a Psychosocial two phases (5.6 percent of those who signed the Support Service (Programa Puente) in which a family participation agreement). All these families entered counselor works with a family for two years through Chile Solidario through the Programa Puente. Since family visits, information dissemination, guidance, 2006, additional vulnerable target groups have been and referrals to social services and benefit programs. incorporated into the system, such as homeless The Psychosocial Support Service is complemented individuals, the elderly living alone, and dependent by a monthly family cash transfer (a fixed amount per children of adults in prison. In all three cases, the family), preferably delivered to a female family member, program’s support component was adapted to the which is intended to help to cover the costs incurred by specific needs of these populations. Social Services | 133 BOX 15 (continued) 2.3.6. Developing The range of programs and social services Social Services for sponsored and coordinated by Chile Solidario has been restructured over time. A few new programs Vulnerable Groups were also created to meet the needs of Chile Solidario beneficiaries, such as a subsidy to pay for Social services aim to maintain, restore, or develop the the issuing of ID cards, a school retention subsidy capacity of individuals and families to function in society. The paid directly to schools, an extra school meal County Directorates of Social Assistance and Child Protection per day, family dynamics workshops, a housing (DGASPCs), financed by the state budget and county program, and support for self-production. The councils, are both the main provider and, at the same time, Chilean government increased the overall program the main purchaser of specialized social services. budget significantly from US$3.6 million in 2002 to In the coming years all efforts will focus on reducing the US$182 million in 2012. Of this, around 14 percent fragmentation and lack of coordination in the specialized financed the psychosocial support component, 24 services sector. In 2011, the government passed a percent consisted of cash transfers, and 62 percent comprehensive law on social assistance (292/2011), but was transferred to other social programs in order to secondary legislation has yet to be developed. Combined fill gaps in coverage. Administrative costs seem to with an insufficient budget allocation (at both the national be relatively low. In 2009 (the latest year for which and local levels), this has led to fragmentation and a lack of information is available), they represented around 3 coordination in the specialized services sector, especially in percent of the total budget. rural areas and in the area of services for adults. Analysts differ with regard to their assessment of To achieve the objectives of the National Strategy on the impact of Chile Solidario depending on the Social Inclusion and Poverty Reduction 2015-2020, evaluation methodology and data used. All analysts it will be necessary to strengthen the role played by agree that social intermediation programs can be the DGASPCs in strategic planning, methodological powerful and cost-effective tools for supporting coordination, and supporting SPAS at the community poor and marginalized families. The innovative and level, as well as in monitoring and evaluating service intensive Chile Solidario has been able to help the providers within the county. At the same time, its role poor to access to cash benefits, to enhance their as the main provider of social services should gradually knowledge of the existence of social programs, come to an end. Consequently, the DGASPCs in most to improve their socio-emotional wellbeing, and counties will need to be fundamentally reorganized and to generate positive outcomes in the health and strengthened, by contracting out existing services to education (school attendance, literacy and job NGO or private providers and by increasing the number training) of the beneficiaries. Nevertheless, the of their professionals in strategic planning, monitoring program’s power to transform the lives of the and evaluation, as well as case management. At present, poorest families in terms of key long-term welfare only 60 percent of Directorates have drawn up strategies, outcomes - employment and housing - remains the plans, procedures, and methodologies, only 53 percent subject of some controversy. use the case management method or have developed Sources: Camacho et al (2014) and Carneiro et al case management procedures, and only 61 percent report (2014). having case managers. On average, one case manager oversees 74 cases, while a department for preventing social marginalization has been set up in just 61 percent of the Directorates and a quality management department for social services has been set up in only 65 percent. Finally, only 29 percent of DGASPCs have a department for coordinating and supporting SPAS.96 96 HHC Romania (2011), MLFSPE and SERA Romania (2012), and FONPC (2012). 134 | PEOPLE-BASED POLICIES The DGASPCs are going to need adequate sustainable of DGASPC specialized services have to bear excessive financial and human resources in order to develop a caseloads because of the shortage of professionals, national network of social services. The DGASPCs are especially since the budget cuts of 2009. Cuts were made large employers of specialized staff,97 but they face serious in both the DGASPCs’ own staff and foster carers (from difficulties in acquiring adequate staffing and skills to deliver 15,023 in 2008 to 12,201 in 2013) and placement center their services. The lack of performance indicators makes staff (from 16,534 in 2008 to 12,513 in 2013). At the end of it impossible to evaluate the professional performance 2012, research indicated a deficit of 11,000 social workers of DGASPC employees. The investment in the ongoing across the whole system of primary (SPAS) and specialized training of specialized staff98 is small and its added value (DGASPC) services. remains unmeasured. At the same time, the existing staff FIGURE 26: Distribution of DGASPC Staff by Type of Child Protection Service and Region, end December 2013 8000 6000 4000 2000 0 North-East South-East South- South-West West North-West Centre Bucharest Ilfov Muntenia Oltenia DGASPC Foster carers Plasement centres Other social services Source: National Agency for Protection of Children's Rights and Adoption. The government needs to develop an initial and a continuous With regard to the initial and a continuous training system training system for professionals working in social services, for professionals working in social services, policymakers including professionals dealing with the social services should consider taking the following actions: (i) establishing regulatory system. There is still no dedicated mechanism coordinated inter-ministerial bodies (for example, from for evaluating social services or for training of evaluators of the Ministries of Education, Health, Labor and Social social services. The inspectors who currently evaluate social Protection, and Youth and Sports) to manage the training of services are also in charge of controls and sanctions in the professionals involved in specialized services; (ii) managing sector, which often creates confusion and conflicts of interest. the accreditation of curricula and training for trainers; (iii) The capacity of Social Inspection to evaluate and control developing a comprehensive program of training at the social services also needs to be strengthened. national level (including blended learning and distance 97 As of December 31st, 2013, DGASPC staff consisted of over 32,000 people, of whom 77 percent were working either in placement centers or as foster carers and 9 percent were employed in other services according to the National Agency for Protection of Children’s Rights and Adoption (NAPCRA). 98 Only some 20 percent of DGASPC staff in 45 counties attended professional training courses in 2010 (HHC Romania, 2011). Social Services | 135 learning); (iv) developing an accreditation system for service should be further developed. Certain groups at risk professional social workers; (v) developing a system of of exclusion should have greater access to quality social continuous evaluation and re-calibration or re-training of services in Romania, such as children deprived of parental professional social workers; and (vi) developing specialized care or mistreated by their family, lone elderly, individuals training for social services evaluators. with disabilities and complex dependency needs, people suffering from addictions and chronic illness, people with Deinstitutionalization and the development of family-type rare medical conditions or victims of abuse, and homeless alternatives will continue to be among the government’s people. Specific types of services should be developed main objectives both for the child protection system and for to meet their specific needs, including early intervention, services for adults with disabilities. Worldwide experience long-term care, home or ambulatory care, social housing, indicates that institutionalized care is more expensive and a wide range of support services for inclusion/participation less beneficial per client than more inclusive approaches (in various areas such as education, employment, justice, designed to support individuals within their families. In fact, and healthcare), and integrated social and medical services. the unnecessary institutionalization of some of the most What is also needed are services that help people to vulnerable and/or marginalized groups (whether children, transition between different age cycles (from school to people with disabilities and mental health problems, or employment, from institutions to independent living, and dependent older people), in addition to violating their from employment to retirement, for example) and multi- human rights, also puts an excessive burden on social and disciplinary mobile teams. healthcare systems. The access of some vulnerable groups to specialized services needs to be increased while certain types of TABLE 27: The Main Development Needs in Human Resources in Social Services, 2014 Profession Current situation Formal training Social workers Mainly at the county level and in the urban SPAS. Not enough. Psychologists Mainly at the county level and in the urban SPAS. Not enough in the disability sector. Sociologists Rare in the disability sector Educators Not trained for inclusive education. Reduced number at the national level. Training curriculum is relatively old and is not adapted to the current needs Special educators of children and families. Few at the national level. Training curriculum is relatively old and is not adapted to the current needs of children Special teachers and families. Reduced number of special schools from 2008 on. The very few current professionals are trained by NGOs or international cooperation programs so they are not Educators-rehabilitators trained in the context of the Romanian system. Not familiar with disability in general with the exception of professionals in rehabilitation medicine and psychiatry. Medical doctors Strong need for overall training of family doctors and pediatricians. Hardly any outreach activities by GPs. Not familiar with disability in general with the exception of professionals in rehabilitation medicine and psychiatry. Nurses Strong need for overall training. Speech therapists Exist only at the county level and in large cities. Occupational therapists Rare in Romania. No official training for this profession. Strongly needed. Better coverage in urban areas, very scarce number in rural areas. Great need for practitioners located as close as Physiotherapists possible to people with disabilities. 136 | PEOPLE-BASED POLICIES TABLE 27 (continued) Better coverage in urban areas, very scarce in rural areas. Great need for practitioners located as close as possible Orthoprosthesists to people with disabilities. Better coverage in urban areas, very scarce number in rural areas. Great need for practitioners located as close as P&O technicians possible to people with disabilities. Art therapists Rare in Romania. No official training for this profession. Increasing demand. Crucial people within the support services system. The current low salaries do not encourage professionally Personal assistants trained assistants to enter the system, which leads to the hiring of family members for this position. Huge need for more professionally trained assistants at the local level and for more formal training (of around 40 hours). Not trained in disability-related issues. Hard to place children with disabilities in foster care or with adoptive Foster parents families Informal training According to the law, personal assistants for people with disabilities must have a mandatory number of training Personal assistants hours (40), but only the DGASPCs currently provide this type of training, which in practice is very rare. Coach, mediator for the Training provided only by NGOs or private training agencies. labor market Home carers Training provided only by NGOs or private training agencies. Sign language Training provided only by NGOs or private training agencies, plus one Masters degree program at Cluj University. interpreters Instructors for guide dogs Training provided only by one specialized NGO (Light into Europe). CBR workers (community-based These do not exist in Romania. They would be very useful in remote, rural, or isolated areas. rehabilitation) The following are the main development objectives and services according to identified needs; (iv) identifying actions related to specialized social services organized by the categories of children with parents working abroad vulnerable groups: who are at social risk and developing support services • for them and for the adults caring for them. •  eveloping and funding services for children deprived D of parental care in order to: (i) reducing the rate of  eveloping and financing services for people with D child abandonment in medical units, mainly by disabilities, which according to the National Strategy developing and strengthening the key preventive for People with Disabilities 2015-2020 should focus mechanisms at the community level; (ii) reducing on: (i) establishing a functional and coherent set of the number of children within the special protection99 evaluation methodologies related to disability and system, particularly by reconsidering the ways and invalidity; (ii) expanding the spectrum of services means (including cash benefits) of providing family for the disabled and making them better and more support in order to prevent child-family separation affordable; (iii) providing funding for and ensuring and by revising the existing child protection services the continuous development of support services for to enhance the quality of care provided while reducing youths with disabilities living within communities; (iv) the length of stays to the minimum necessary; speeding up and increasing the effectiveness of the (iii) reducing (and eventually eliminating) child transition from residential care to community-based homelessness, mainly by assessing and mapping services for adults with disabilities; (v) drastically the real situation of street children at the national reforming long-term care and rehabilitation services level and by developing preventive and specialized for people with mental health problems, based 99 According to the National Strategy for Protecting and Promoting Children’s Rights 2014-2020 (GD 1113/2014), younger children are a priority group for the next phase of the reform of the child protection system. Social Services | 137 on a plan to be agreed and developed jointly by often limited available information about the history and the MLFSPE and the Ministry of Health; and (vi) antecedents of children and their families and also because continuing the national plan to increase access to of the lack of capacity within the DGASPCs, most individual public spaces and the environment. protection plans are incomplete and are structured around • the availability of services rather than the specific needs of D  eveloping and financing a spectrum of tailored the child. services to meet the specific needs of the elderly with complex needs, with a special focus on in-home care A. Children Abandoned in services in accordance with the National Strategy on Medical Units Elderly People and Active Aging. • More children are being abandoned in hospital wards.  egulating, developing, and financing tailored social R While the number of children abandoned in medical units services for other vulnerable groups, including decreased by two-thirds during the last 10 years (from teenage mothers; adults deprived of liberty or on 4,614 in 2004 to 1,449 in 2014), the figures recorded a 12 probation; drug, alcohol, or substance addicts; percent increase between 2010 and 2012. During the last victims of human trafficking; and victims of violence. three years, they constantly remained at over 1,400, with These services should be developed jointly by a peak of 1,474 abandoned children recorded in 2013. The the MLFSPE with the MRDPA (which will prepare majority of these children were abandoned in maternity a draft National Housing Strategy), the National wards (56.94 percent in 2010 and 65.78 percent in 2011), Prisons Administration (responsible for the National with the next largest number being abandoned in pediatric Strategy for the Social Integration of People Deprived wards (31.86 percent in 2010 and 27.30 percent in 2011). of Liberty 2015-2019); the National Anti-Drug Poverty and a lack of identity papers are among the Agency (responsible for the National Anti-Drug underlying causes of child abandonment in medical wards. Strategy 2013-2020, GD 784/2013), the National Research in Romania has shown that a common reason Agency against Domestic Violence (responsible given by mothers for leaving their healthy children in for the National Strategy for the Prevention of and medical institutions is their lack of identity papers. This Fight Against Domestic Violence 2013-2017, GD prevents the child’s birth from being officially registered 1156/2012), and the National Agency Against and thereby affects his or her right to acquire a name and Trafficking in Human Beings (responsible for the citizenship.100 Poverty is associated with single parenting, National Strategy Against Trafficking in Human teenage pregnancy, out-of-wedlock pregnancies, child Beings 2012-2016, GD 1142/2012). disability, and the lack of access to adequate healthcare/ The next sections discuss in detail the needs of each monitoring and social-support services, all of which are vulnerable group for social services. among the main causes of child abandonment in medical care units. Services for Children Deprived Most new babies and very young children entering the of Parental Care child protection system have been abandoned in medical units. While it is encouraging to see that the number of Support for children and family welfare is one of the children returned to their biological and extended families cornerstones of Romania’s social protection strategy, has been constantly increasing during the last four years, grounded in a concern for both human rights and cost- it is still worrisome that the majority of children released effectiveness. To this end, it is crucial to develop and from hospital units were moved into the child protection harmonize cash benefits and social services for children and system (around 60 percent). Most of these went into foster families in a range of different circumstances. Once a child care (around 45 percent between 2010 and 2012, with a 3 is separated from his or her family, the childcare system percent drop in 2013) and some to residential care services provides protection based on an individual plan developed (placement centers and emergency reception centers), by a case manager within the DGASPC. Because of the where the highest number was recorded in 2013 (79 100 Stativă et al (2005). 138 | PEOPLE-BASED POLICIES children or 6.2 percent of the total number of abandoned Reducing the length of time spent by abandoned babies children entering the child protection system). in maternity wards will require the development of special response services such as foster families who can take Because of faults in the system, there are still children babies even in emergency situations. Adequate case who spend months in hospital units that are not adapted management and planning should reduce the length of time to their development needs. It is also worrying that, of the that children spend in the child protection system either by total number of children abandoned in hospital units, a reintegrating them into their biological or extended family or number remained in those units every year (236 in 2010, by finding adoptive families for them. 248 in 2011, 234 in 2012, and 175 in 2013). This means that children were kept in an institutional environment that was B. Children Living in Residential not geared to their development needs, which may have severely affected their physical, cognitive, and emotional Care or Alternative Family Care development (depending on the age of the children and the Reducing the number of children within the child protection length of their stay) given that young children are severely system remains a priority for the coming years. The affected by institutionalization. This is due mainly to the government has made significant progress over the last 15 lack of clear referral procedures between the healthcare and years in reducing the number of children in institutional care social protection institutions and to a lack of identity papers and by developing family-based alternatives. The number on the part of the parents, and also because of the lack of of children in residential care (public and private placement available foster care families prepared to care for children centers, including small group homes) has dropped from aged between 0 and 2 years old. a peak of 57,181 in December 2000 to 21,365 as of June Reducing the rate of child abandonment in medical units 30, 2014. Nevertheless, during 2011, for the first time in 15 will require the development and/or strengthening of key years, the number of institutionalized children increased101 preventive mechanisms at the community level. Some of as a consequence of an impoverished population and the these measures relate to the entire field of social welfare, limited budget for family-based services. However, the such as providing identity papers to all, strengthening rate has begun to decline once again over the last three social assistance services at the community level, and years. The total number of children placed in public care (in providing equal access to social benefits. Others will be either residential care or in family environments) dropped aimed at reducing the numbers of specific vulnerable significantly from around 98,000 children in 1997 to about groups - such as single mothers and adolescent/teenage 62,000 at the end of 2013 (and to almost 59,000 as of the parents through the provision of sex education and family end of June 2014). However, the total child population of planning services. These two kinds of measures will need to the country also declined and, for that reason, the rates of be coordinated and harmonized. For example, improving the children placed in public care have in fact been at a plateau health monitoring of all pregnancies clearly falls under the (1,776 in 2000 and 1,641 in 2011), which is indicative of responsibility of the healthcare services. However, this will the failure of the system to reduce the number of children need to include measures to enable the early identification entering the protection system (Figure 27). of pregnancies with a high risk of child abandonment and Research has shown that children entering public care to ensure their immediate referral to social services so that have multiple and complex vulnerabilities at the household counseling and support services may be provided as early level. As mentioned earlier, many of the children entering as possible. In this way, by the time of birth, a long-term the child protection system were abandoned in hospitals. plan will already have been developed, if it should such According to data collected by the National Agency for the be required. Also on the preventive side, when mothers Protection of Children’s Rights, the three main causes for (or parents) arrive at medical units with no identity papers, children being separated from their family and entering into they should be considered without exception as being public care are poverty (42 percent), abuse and neglect (25 high-risk for abandoning their baby. For these situations, percent), and disability (10 percent). However, policymakers policymakers need to develop procedures to enable medical should ensure that poverty is never the only justification for personnel to alert social services (child protection services) removing a child from parental care,102 and, in fact, evidence and the police (for identification purposes). 101 MLFSPE, DGPC (2011: 1). The number of institutionalized children was 23,240 in 2011 compared with 23,103 in 2010. 102 United Nations (2009) and European Commission (2013b). Social Services | 139 FIGURE 27: Share of children within the special protection system (1997-2013) 2 1.6 1.2 0.8 0.4 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Share of children in residential care in the total number of children Share of children protected in family environments in the total number of children Share of children within the special protection system in the total number of children Source: World Bank estimations using data on number of children in the special protection system from MLFSPE and TransMonEE database for the total number of children (aged 0-17 years old). suggests that separation is determined by multiple and are children who have not been identified by and registered complex vulnerabilities.103 In most cases, these complex with local authorities. Community Consultative Structures vulnerabilities consist of a varying mixture of extreme (CCSs) are legally constituted entities at the community poverty, parental unemployment, poor quality housing or level with members drawn from among local stakeholders homelessness, poor school attendance or dropout, poor (local authorities, social workers, doctors, police, and parenting, domestic violence, a high risk of neglect and teachers). This UNICEF study found that the number abuse of the child (associated with parental alcohol abuse), of “invisible” children is considerably smaller in those young or single parenthood, unstable marriages, low communes where Community Consultative Structures expectation and/or self-esteem, and learned helplessness. are functional, but as yet they have been set up in very few places across Romania. The system continues to be Reducing the number of children placed in care will in stasis, and local authorities do not seem to have taken require the development of community-based prevention over the responsibility for implementing services aimed at and support services. Children often end up in the child preventing the separation of children from their families. protection system because of a lack of services for identifying children at risk and of early intervention services Policymakers should review the current arrangements and referral systems at the community level. According to for placing children in family-based care with the aim official statistics, children at risk of separation from their of reducing total number of children considered to be families account for nearly 1.4 percent of children aged in protective care. Currently, over 60,000 children are between 0 and 17 years old. However, a 2012 UNICEF deprived of parental care in Romania.105 Out of those, 61.4 study estimated that the percentage would be higher – percent are in family-based care alternatives, with 30.8 almost 2 percent of children aged between 0 and 17 years percent in professional foster care and 30.6 percent having old – if “invisible” children are taken into account.104 These been placed with their own extended family (kinship care) 103 Stănculescu et al (2013). 104 Stănculescu and Marin (2012). “Invisible” children refer to children “disappearing from view within their families, communities, and societies, and to governments, donors, civil society, the media and even other children” according to UNICEF (2006). 105 61,749 according to NAPCRA data for December 2013. 140 | PEOPLE-BASED POLICIES or with other families. The proportion of children placed food allowance of less than €2 per day per child, whereas in family-based care alternatives has dropped from 65.3 a specialized foster parent receives a wage accompanied percent in 2007 to 61.4 percent in 2013. This has been by a package of in-kind benefits covering equipment, mainly due to budget cuts, which have led to a serious bedding, toys, hygiene materials, school supplies, and decrease in the number of professional foster carers,106 but living expenses for the placed child. This year, NAPCRA also to a 25 percent drop in the number of children placed has drafted new regulations aimed at encouraging and in kinship care. While the number of placements with supporting family placement by extending the coverage extended families or other families is quite impressive, the of these in-kind benefits to extended or other placement kinship care placement is often simply a way for children to families.107 remain with their families and is not in fact truly a protective Speeding up the closure of all the old residential care care arrangement. Yet because social workers must institutions for children must remain a priority, especially continue to manage these cases, this puts unnecessary for those with over ten residents.108 The government additional pressure on the already limited staff of the child has already recognized that institutionalized care is protection system. Therefore, policymakers should review more expensive and less beneficial than family-type the current kinship care placements and reclassify them alternatives. As of June 30, 2014, of the total number of as preventive rather than as protective measures, while children deprived of parental care, 21,365 (36.3 percent) making monitoring of these placements the responsibility of were in residential care. Most of these were in small group the local authorities under the direct supervision of DGASPC homes, but 9,937 were still in institutions (both classic and staff. This would reduce the workload of DGSACP case restructured/modulated). Of these, 8,679 were in public managers (which in turn should enhance the quality of case institutions and 1,258 were in institutions operated by management) and, while reducing costs, would improve NGOs or private service providers. After 2007, the process kinship care monitoring by devolving it to the community of closing these institutions began but at a very slow pace. level. Currently, 248 institutions are still functioning, of which A matter for concern is that kinship care/family placements 110 are classic institutions (25 of which are run by private are not regulated in a similar way to foster care. On the one service providers), and 138 are restructured/modulated hand, there are no criteria nor is any training of the family institutions (23 of which are run by private service required prior to placing a child with their extended family providers). As Map 1 shows, the classic institutions that or any other family, a situation that may be risky for the should be closed down are unevenly distributed throughout children in question. Therefore, it is important to establish the country. Out of the 41 counties in the country, 14 have minimum quality standards for family-based care and to finished closing their classic institutions,109 whereas three develop selection criteria and training requirements for counties are still operating eight to ten large residential units placement families. However, a placement family receives for children (namely Prahova, Sibiu, and Valcea). a monthly allowance of only RON 97 (about €22) and a 106 From 16,534 in 2008 to 12,513 in 2013. 107 As part of the same regulation, the food allowance will be doubled (to almost €4 per child per day) for all children in either residential care or family-type alternatives. Overall, the allowance per child placed with a family or in foster care will be increased to almost RON 600 (about €130) per month. 108 Even if the closing or restructuring of the classic residential units for children is the most urgent activity, efforts still need to be made to restructure some of the modulated residential services that contain large numbers of children. 109 These counties are: Alba, Arad, Braila, Calarasi, Dolj, Giurgiu, Hunedoara, Maramures, Mehedinti, Mures, Neamt, Satu Mare, Teleorman, and Vaslui. Of the six sectors of Bucharest, two sectors (2 and 4) have finalized the process. Social Services | 141 MAP 1: Residential Care Services for Children by County BUCHAREST Services for children in the special protection system 5 5 SATU MARE Region MARAMUREȘ BOTOȘ ANI SECTOR 1 2 SECTOR 6 County 4 SECTOR 2 2 SUCEAVA 1 2 SECTOR 3 1 32 units 1 SECTOR 5 BISTRIȚA-NĂSĂUD 5 SĂLAJ IAȘ I SECTOR 4 No. of classic (large) 2 1 0 2 4 6 km 3 residential units for children NEAMȚ BIHOR CLUJ 5 3 MUREȘ VASLUI HARGHITA BACĂU ARAD 8 ALBA 1 8 2 5 1 COVASNA SIBIU TIMIȘ HUNEDOARA BRAȘOV VRANCEA GALAȚI 5 6 7 9 10 2 1 CARAȘ -SEVERIN BUZAU DÂMBOVIȚA BRĂILA PRAHOVA TULCEA GORJ VÂLCEA 1 ARGEȘ 4 4 ILFOV IALOMIȚA Classic (large) BUCHAREST residential units for children 1 MEHEDINȚI Restructured (modulated) 3 CĂLĂRAȘ I residential services for children OLT Small group homes CONSTANȚA DOLJ (houses and apartments) GIURGIU TELEORMAN Emergency care for children Maternal centres 30 15 0 30 60 90 km Source: National Agency for Protection of Children’s Rights and Adoption. Note: Residential care units including public and private placement centers, small group houses, and apartments. Very young children should be the priority group for the out of all children placed in public care services, most are next stages of the reform of the child protection system. aged between 10 and 13 years old (29 percent), followed by Although efforts have been made to avoid institutionalizing those aged 14 to 17 years old (25 percent). Together, these children under the age of 3 years old (and there are laws two age groups make up more than half of the children placed against placing children under 2 years old in residential in residential care, and their total number and proportion have care),110 over 700 children under the age of 3 years old were been constantly increasing over the last four years, (from still in residential care as of the end of June 2014. The Child 12,379, or 53.6 percent, in 2010 to almost 12,500 children, Protection Strategy aims to integrate these children either or over 58 percent, at the end of June 2014). into their natural families or into foster families. However, 110 An extension of the ban on placing all children aged 0 to 3 years old in care is currently being legislated. 142 | PEOPLE-BASED POLICIES FIGURE 28: Distribution of Children in Protection Services by Age Group and Type of Service, June 2014 18000 16829 14666 15000 12000 9007 9000 7651 6724 6000 2926 3000 1111 0 < 1 year 1- 2 years 3-6 years 7-9 years 10-13 years 14-17 years 18-26 years Children in placement with extended or other families Children in foster care Children in residential care units Total children in public care Source: National Agency for Protection of Children's Rights and Adoption. Note: Residential care units including public and private placement centers, small group houses, and apartments. Enhancing the quality of care while also reducing the to the necessary minimum by adequate planning, length of time spent in care to the minimum necessary, is implementation, and review; (ii) revise and enforce case critical. Due to the economic crisis, the public care system is management standards to improve cross-sectoral and confronted with a chronic lack of staff. Since 2007, the total multidisciplinary communication and collaboration; and number of staff employed by the child protection system (iii) invest in the continuous training of all DGASPC staff has decreased by 27 percent. The staff of residential care (including foster parents). services has decreased by 18 percent over the same period. They also need to consider taking the following actions to With each case manager overseeing an average of 74 active improve quality control mechanisms in the child protection cases, each child’s case is reviewed only every six months system: (i) review existing legal requirements to increase instead of every three months as legally required, and the the frequency of quality controls and the enforcement of monitoring of placements is also generally suffering. Quality the minimum quality standards; (ii) introduce a regular control mechanisms are poor, with only one compulsory performance evaluation mechanism for staff working in the site visit by social inspection required every five years child protection system and a specific set of performance when the institution’s license is due for renewal, and a lack indicators to assess the professional performance of of child-appropriate complaint mechanisms. This situation DGASPC employees; (iii) introduce regular (annual) raises important concerns about the quality of care provided assessment mechanisms on the quality of services to children in protective care, which may be leaving children provided by the DGASPCs, including assessments provided exposed to potential abuse, neglect, and exploitation. by the end beneficiaries (both children and parents); and Because of this lack of capacity within the child protection (iv) introduce accessible and child-appropriate complaints system, even though care within the public system is meant mechanisms (developed with the direct contribution of to be temporary, the average stay for children in care is children themselves) to improve quality control and reduce around seven years. risk of abuse, neglect, and exploitation. Policymakers need consider taking the following steps to strengthen case management in the child protection system: (i) provide children entering the child protection system with adequate services tailored to their specific needs and reduce the length of their stay in the system Social Services | 143 C. Youths Leaving Residential Care learning process. Young people over 18 years old may remain in the child Policymakers should prepare now for the next contingents protection system up to the age of 26 if they are attending of children leaving institutional care by strengthening social a form of education. Therefore, as of as June 30, 2014, integration support services. Currently youths leaving more than 11 percent of all children in public care are aged care lack both family support and social and professional between 18 and 26 years old. integration skills. With an increasing number of youths leaving care each year (approximately 4,000 young people The main priority for the coming years is to increase as of 2014), this is reinforcing the need for services to the number of children and young people exiting child help them to establish an independent life, find a job, and protection services to sustainable living situations. Between obtain adequate housing. Although this problem has been July 1, 2013 and June 30, 2014, more than 8,500 children a government priority since the creation of the National left Romania’s child protection system. Leaving care means Strategy for the Social Inclusion of Young People Leaving one of the following: reintegration into the child’s biological Childcare 2006-2008 in 2006, the situation of the has or extended family (40 percent), social integration/ not improved. In order to facilitate the social integration independent living (40 percent), adoptions (11 percent), of young people leaving the care system, policymakers and other situations including transfer to the care system should consider providing them with support during their for adults (9 percent). Young people (those over 18 years transition from the care system to independent living, old) represent 43 percent of all of these exits, most of them including sheltered or social housing, counseling, and help being integrated into society (39 percent of all exits) with to find employment. fewer than 4 percent being reintegrated into their families. For younger children, the main exit route is reintegration D. Children and Youths into their biological or extended families (especially for those aged 7 to 17 years old) or adoption (especially for Living on the Streets those aged 1 to 6 years old). Child homelessness should be addressed as top priority, with the aim of eradicating this phenomenon completely. Helping children in protective care to developing the In order to achieve this objective, policymakers will need abilities needed to live independently is of vital importance to tackle the root causes that lead to children living on the for ensuring their full and sustainable inclusion in society. streets and to develop specialized services targeted to At the moment, social and professional integration services existing street children. and independent life-skill development services are underdeveloped in Romania, although specific quality The most urgent priority must be to conduct a thorough standards and guidelines were adopted some years ago. nationwide analysis of the issue of homeless children living For this very reason, young people leaving childcare on the streets. The DGASPCs reported that a total of 954 at the age of 18 are a vulnerable group at risk of social children were living on the streets at the end of 2013.111 Due exclusion. Therefore, what is needed is for the government to the weak monitoring mechanisms and the questionable to mandate the compulsory development and provision of reliability of the available data, little is known about the life skills training throughout the child protection system real situation of children and youths living on the streets.112 in accordance with quality standards requirements and However, previous research showed that street children and guidelines. While the main priority should be those aged youths are denied most of their rights and are profoundly between 14 and 17, children aged 10 to 13 years old should excluded from society. Living on the streets is associated also be included, and ways should be found of including with serious health problems, chronic malnutrition, school children regardless of age because life skills are a lifelong dropout and illiteracy (about 50 percent), physical abuse 111 These street children and youths were split into the following categories: (i) 383 who live on the streets separated from their families for long periods of time; (ii) 339 who live with their families but go onto the street or are taken onto the street every day to beg, to clean car windshields, and carry out other similar activities; and (iii) 232 children who live on the streets with their families. 112 Save the Children ran an estimate in 2009 in three major cities – Bucharest, Braşov, and Constanţa. The number of children thus identified was nearly 1,400 (the lowest number being 800 and 1,700 being the highest). Most of them live in the capital city (about 1,150). In the seaside city of Constanta, their number depends strongly on the season. More than half are children (aged between 0 and 17), the others being young people aged between 18 and 35 years old. Children living in the streets typically have a low level of education (most have no more than a completed primary school education), and their main source of income is begging, followed by daily occasional work and washing cars/ windscreens. They generally have little if any access to services. While in Bucharest the situation is slightly better, with more than half of the subjects (55.9 percent) receiving services at some point, in Brasov and Constanta very few have benefited from such services (Grigoraș, 2009). 144 | PEOPLE-BASED POLICIES (sometimes even from the police),113 (usually started at of residence.116 In reality, migrant parents very rarely (7 home and continued on the street), stigmatization and percent) inform local authorities about their intention to discrimination, limited access to social services (education, leave to work abroad. Other data sources117 also suggest healthcare and social assistance), the use of drugs or that there are more children with migrant parents than is solvents (including common glue or paint thinners), and reflected in the official DGASPC statistics. Furthermore, at even prostitution. the community level, more institutions collect data on these children including the SPAS (which report to the DGASPCs), What is urgently needed is a system to monitor street schools, and, sometimes, local authorities. However, there children as well as services designed to meet their needs is no unified methodology for collecting and sharing these and foster their inclusion into society and to prevent this data between institutions, which means that they are rarely problem in the future. Although there are national policies analyzed or used to inform policy decisions at either the to address the phenomenon of homelessness, both in national or local level. relation to children and adults, the current state initiatives are limited to providing social support, access to emergency Children with parents working abroad are a special healthcare, and emergency and temporary housing. NGOs, challenge for the social protection services, because their on the other hand, are providing medical care, education, development needs are primarily emotional rather than psychosocial support and, sometimes, housing and financial. Children with migrant parents are generally use outreach techniques and implement homelessness financially well-off. UNICEF research118 has shown that awareness campaigns. However, their efforts are limited the migration of parents results in some gains for the in terms of coverage and are highly dependent on the family in the short term, such as the improvement of living availability of funding, especially from international donors. standards, but it seems likely that children of migrant To address this issue, policymakers should consider taking parents are vulnerable to monetary poverty shocks due to the following essential actions: (i) revising the quality their strong dependence on remittances. While their access standards for street children’s services in order to provide to healthcare does not seem to be significantly different an integrated response (including psychosocial support, from that of children who live in complete families, the education, healthcare, and legal support); (ii) outsourcing main consequences for these children are emotional and or contracting out services to NGOs or other private service psychological suffering as reported by both parents and providers; (iii) designing and implementing some tailored children.119 Regarding the profile of children left behind, prevention mechanisms to address the root causes of this half of the children with both parents having migrated are problem as identified by research; and (iv) introducing early younger than 10 years old, and more than half of those identification, referral and response (multidisciplinary/ children are between 2 and 6 years old. In terms of time cross-sector) mechanisms for children in risky situations. spent without their parents, 16 percent of children with both parents abroad have spent more than one year without E. Children Whose Parents Migrate seeing their parents, and 3 percent spend more than four Abroad for Work years apart from their parents. A permanent and reliable system to monitor children with Despite the lack of accurate quantitative data, it can be migrant parents should be created. Official figures (which estimated that a significant proportion of children with have been collected by the DGASPCs since 2006) indicate migrant parents do not appear to be in need of support that 80,036 children had migrant parents as of December services. The most at-risk categories of children left 2013.114 However, this number seems to have decreased behind are those with both parents abroad, thus leaving since December 2010.115 However, the official statistics those children at risk of the psychological effects resulting are likely to underestimate the number of children who from the long-term separation from their parents. For the are in this situation as they only take account of those majority of children counted in the DGASPC records,120 the emigrants who intend to formally change their address person taking care of those children (the present parent or 113 Alexandrescu (2002). 114 Of these, 22,329 had both parents abroad, 47,394 had one migrant parent, and 10,313 were living in families where the parent as a sole provider was working abroad. 115 In December 2010, 84,084 children with migrant parents were registered. 116 Toth et al (2008). 117 Toth et al (2007) showed that some 170,000 5th to 8th graders had at least one parent working abroad, yet only 82,464 children were officially reported as such at the time. Another sociological study carried out in 2008 identified 350,000 Romanian children with migrant parents (Toth et al, 2008). Social Services | 145 BOX 16 Children with Migrant Parents in the 2011 The parents left to care for children are Population and Housing Census Data most often employees (35 percent), self- employed in agriculture (22 percent), or The total number of children in Romania aged between home carers (26 percent). The other parents, 0 and 17 years old recorded in the 2011 Census was up to 100 percent, hold various other activity statuses over 3.83 million. About 3 percent of all children (or such as employer (0.4 percent), self-employed in over 116,000 children) have experienced one (1.8 non-agricultural activities (2 percent), unemployed percent) or both (1.2 percent) parents migrating to work (5.2 percent), or students (1.2 percent). In comparison, abroad. More children are left behind by one or both in families with both parents at home, 56 percent of parents migrating abroad in rural areas than in urban parents are employees, 13 percent are self-employed areas (4.1 percent as opposed to 1.8 percent), and this in agriculture, and another 13 percent are home gap increases with the child’s age - from 2.6 percent of carers. Therefore, the welfare of families with children toddlers under 1 year old to 3 percent of 2 to 9 year olds, where one parent is living at home while the other is to 3.2 percent of children aged 10 to 14 year olds, and 3.1 working abroad depends heavily on remittances. As percent of adolescents aged 15 to 17 years old. for education (Annex Table 5.2), the 2011 Census data The Census data indicate that the predominant pattern show that children with both parents having left for work is that the mother stays at home and cares for the (either abroad or within the country) are most at risk of children, while the father migrates for work abroad not attending school. A lack of parental care is a source (and probably sends remittances home to provide for of great vulnerability for a child, while the presence of the family). Of all children with migrant parents, 43 a parent at home gives a child a sense of stability and percent live with their mother and 16 percent with their helps the child’s development. father, while the other 41 percent lack both parents. Children with One or Both Parents Having Migrated to Work Abroad (thousands) 50 46 AGE RESIDENCY 40 36 30 22 20 15 14 13 13 13 12 10 10 10 7 7 5 5 3 1 0 0 0-1 2-5 6-9 10-14 15-17 Bucharest Medium Cities Rural years old years old years old years old years old or large < 30k cities inhabitants Children with one parent migrant abroad Children with both parents migrants abroad Source: World Bank calculations using 2011 Population and Housing Census data. Note: Migrants abroad to work or to study who are absent from the household for less than 12 months. 146 | PEOPLE-BASED POLICIES a relative) has not received any specialized support. Of the F. Services for Children 80,036 children with migrant parents officially registered in 2013, around 3,700 required special protection measures,121 Deprived of Liberty but this number has dropped since 2010. At present, local The number of children deprived of liberty in Romania authorities lack the human and material resources needed is declining. In the third quarter of 2013, 2,400 children to address the phenomenon. Developing the capacity of committed criminal activities but were not imprisoned, local institutions in order to address the phenomenon is and other 1,700 children in detention were counted in the crucial as there are no signs that labor migration abroad statistics of the National Administration of Penitentiaries.123 will diminish any time soon and these migrants come home The official juvenile crime rate124 has remained fairly stable only rarely if at all. since 2003, with figures close to the 1,400 per 100,000 The government’s main objective must be to provide children level of 2011, and a slight decrease to 1,211 in 2012. adequate support services to at-risk categories of children The situation has improved in recent years on all with parents working abroad and to the adults caring for indicators.125 Boys account for 95 percent of arrested them. With this objective in mind, policymakers should children, 91 percent of convicted children, and 95 percent of consider taking the following steps: (i) strengthening detained children.126 social assistance services at the community level, which There has been an even more spectacular decrease in the is essential for the entire social welfare system and number of children in detention (in other words, the total would cover a wide range of needs; (ii) improving and number of children in a closed facility by reason of their strengthening monitoring and reporting mechanisms at actual or suspected participation in criminal activity). This the local (SPAS) level to enable the early identification of indicator dropped from 1,955 cases in 2000 to 444 in children who need support; (iii) equipping schools with 2012 according to the latest available data.127 It is difficult the capacity to compensate for the absence of the parents to make international comparisons as there are significant by providing counseling; and (iv) developing after-school differences between the juvenile systems that exist in the social-educational services. countries of Europe (Map 2). This development of support services for at-risk children No public data are available about re-offending or new with parents working abroad and for the adults caring for crime rates among children and young people released them could be geographically targeted to those areas with from detention, but experts estimate128 that almost 8 in the highest incidence of such children. The 2011 Census 10 children and young people leaving prison end up in data indicate that 71 percent of all children with one or both detention again. A comprehensive analysis is needed of the parents as migrants abroad come from rural areas and that socio-demographic profile of children deprived of liberty in over 40 percent live in seven counties, namely Maramures, Romania to inform future policy measures. Satu Mare, Suceava, Botosani, Iasi, Dambovita, and Bacau.122 Furthermore, 45 percent of all children with both Having an adequate policy response to juvenile parents abroad come from the same seven counties. delinquency is particularly relevant at both the national 118 Stănculescu et al (2012). 119 Toth (2008). 120 As of December 2013, 95 percent of children with one or both parents abroad and 88 percent of children with one parent working abroad. 121 More than half (53 percent) were in kinship placement, 14 percent were entrusted to foster parents, 8 percent were placed with other families, and 25 percent were placed in residential care units. 122 The number of children left behind by migrant parents as a percentage of the total number of children in the county was 8.4 percent in Maramures, 7.1 percent in Satu Mare, 6.1 percent in Suceava, 5.3 percent in Botosani, 5 percent in Iasi, 4.6 percent in Dambovita, and 4.5 percent in Bacau. 123 ANP (2014a) According to the National Administration of Penitentiaries, in Romania, there are four prisons for juveniles (Bacau, Craiova, Tichilesti, and Targu Mures) and three rehabilitation centers (Buzias, Gaiesti, and Targu Ocna). 124 The TransMonEE data only cover crimes committed by juvenile offenders between 14 and 17 years of age and do not take account of any other crimes in which juveniles were involved. All reported offences perpetrated by juveniles are included, irrespective of the year in which they were reported. 125 In absolute figures, the number of crimes committed by, or with the participation of children between 14 and 17 years old), declined by more than two times in 2012 (10,713) in comparison with 2000 (25,470). The number of arrested children declined from 790 in 2004 to 450 in 2011 but increased to 887 in 2012. The number of children charged with a crime also dropped from 16,510 in 2001 (0.32 percent of the 0 to 17 population) to 10,482 in 2012 (0,240 percent of the 0 to 17 population). In 2012, 444 children were arrested and imprisoned in closed institutions, less than one-fourth of the level in the 2000 to 2002 period. The number of juveniles convicted during the year 2012 was 3,026, once again around half of the 2000 to 2006 level (TransMonEE 2014 database). 126 TransMonEE 2014 database. 127 The rate (as a share of the total population of children) dropped from 0.03 percent to 0.01 percent. The child sentencing rate (per 100,000 average population aged 14 to 17) also decreased from 518 to 342 (TransMonEE 2014 Database). 128 These estimates are based on consultations in 2010 and 2011 by Save the Children experts with children and young people serving custodial educational sentences and measures, and with prison experts. These consultations were carried out under the auspices of the project JUST-Juvenile Justice. Social Services | 147 and the EU levels as it addresses a vulnerable group that have not been given any special training that would ensure is likely to be at high risk of social exclusion. In addition an adequate, coordinated practice in the field of juvenile to this, it develops activities to prevent “the adult crime justice.131 of tomorrow.”129 The European Council for Juvenile The legislation requires penitentiary institutions, Justice has selected three principles that will underlie its rehabilitation centers, and detention centers to organize and interventions in the period of 2015-2017: (i) facilitating provide educational, cultural, therapeutic, psychological, access to justice and procedural rights, which can be and social assistance activities during detention to difficult to implement when children are involved in the facilitate the social reintegration of inmates. Within projects justice system; (ii) promoting restorative justice, which developed in partnership with the MLFSPE or other it defines as “a system of justice that refuses a punitive partners, the National Administration of Penitentiaries approach in favor of a more participative role of victim, provides professional training courses, vocational guidance offender, and community, towards an educational aim,” and and counseling, and job placement assistance to juveniles (iii) ensuring that “unaccompanied minors, children on the in detention to help them to reintegrate into society after move, and victims of human trafficking” are not subjected their release.132 to “exploitation, discrimination, abuse, and violence.”130 However, the problem of juvenile delinquency has not The law also requires that psychosocial assistance must been addressed in the most recent relevant programming be provided for children involved in criminal acts, including documents in Romania – the Draft Strategy for the Judicial imprisoned children. Members of this group have often been System for 2015-2020 or the recently adopted National exposed to violent acts and antisocial influences in their Strategy for Protecting and Promoting Children’s Rights social environment and, during their detention in rehabilitation for 2014-2016. Also, little about juvenile delinquency is centers or penitentiary facilities, they are likely to deviate mentioned in the National Strategy for the Social Integration even further from normal development pathways. However, of People Deprived of Liberty 2014-2018 produced by the in Romania, the extent to which there is any collaboration National Administration of Penitentiaries. between magistrates and specialists working in psychosocial support services varies from one county to another, and there The Government of Romania has already taken some is a chronic lack of support services for child victims and steps towards creating a legal framework for restorative children in conflict with the law. 133 justice measures, but little has been done in terms of implementation. In the last two years, the majority of The prevention side of juvenile delinquency should be “minor” detainees (including those aged 18 to 21 years old) developed at the community level with the education and were released from prisons as a result of the government’s social assistance sectors being involved. In addition to adoption of a new Penal Code. The National Probation this, a restorative justice system will not be able to work Directorate has reported that, out of the 7,700 detainees unless cooperation between members of the judiciary and evaluated for probation in 2013, more than 5,000 were those working for the DGASPCs and SPAS is strengthened. minors (under 21 years old). In the same time, 20,446 ex- Studies have blamed the lack of available services for prisoners who had been released in 2013 and in previous children deprived of liberty as the main reason for the weak years were kept under surveillance of which 18,710 were cross-sectoral collaboration.134 minors. The new provisions of the Penal Code require that While rehabilitative activities are provided in detention non-custodial sentences should be given to children who facilities, when children and young people leave detention, have committed a penal offence. These sentences can they are confronted with many obstacles that increase include a civic training program, recording (consemnare) at the risk of recidivism on their part. The most common are the end of the week, and daily assistance. However, other a lack of support from and/or rejection by their family than the Court for Minors and Family in Brasov, there are (resulting in a lack of housing for the young person after hardly any designated courts for hearing cases involving leaving detention), difficulties in finding a job (because children, and members of the judiciary and court officials 129 International Juvenile Justice Observatory (2010). 130 European Council for Juvenile Justice, Roadmap 2015-2017. 131 Alternative Sociale (2010). 132 According to the legislation, young people aged 16 or over with a minimum of eight years of education can access a range of training courses. 133 Alternative Sociale (2010). 134 Alternative Sociale (2010). 148 | PEOPLE-BASED POLICIES MAP 2:  Breakdown of the Age of Criminal Responsibility and Percentages of Prisoners Less Than 18 Years in European Countries, in 2013 Source: Aebi and Delgrande (2014: 83). Note: This map should be used cautiously. Many figures presented in this map are partial, and cannot be compared among countries. Several countries did not provide the general data for the whole prison populations. Therefore, sometimes we used the available data (for example, only on sentenced prisoners). Moreover, some of the countries included in the map (for example, Italy) do not count young people held in institutions as juvenile offenders in their prison population. As a consequence, their percentage of inmates aged under 18 years old is close to zero. Social Services | 149 of inadequate professional training paired with a lack From the social services point of view, counseling for of required job-searching skills and knowledge), low at-risk groups will be necessary to reduce and prevent educational attainment, and a lack of minimum skills and teenage risky sexual behavior and teenage pregnancies. abilities for coping with life outside prison, such as self- Policymakers need to develop clear protocols for immediate sufficiency, social interaction, and using public transport. referral of all pregnant teenagers to social services so that they can receive counseling and support services as early The government’s main objectives for this category of as possible. These services will aim to keep the child with children must be to ensure their successful reintegration the family (where possible) or to find it a permanent home into their families and society and to prevent recidivism. as well as to help mothers to continue their education or The following actions should be considered in order to to find a job as appropriate.Services for teenage mothers achieve these objectives: (i) developing a network of and their children need to be developed across the whole services targeted to children in conflict with the law; (ii) country but particularly in rural areas. According to the 2011 improving the quality of custodial services for juveniles Census, 73 percent of children with teenage mothers and and young; (iii) improving the mechanisms for monitoring 72 percent of teenage mothers are located in rural areas, custodial services for juveniles and the young; (iii) with the majority of these being located in 10 counties - consolidating and strengthening capacity within SPAS Mures, Dolj, Bihor, Iasi, Dambovita, Brasov, Bacau, Arges, at the local level to provide support services; and (iv) Galati, and Constanta. improving and strengthening the specific monitoring and reporting mechanisms at the SPAS level to ensure the early identification of juveniles who need support and the Services for People with application of effective interventions. Disabilities Services for Teenage Mothers People with disabilities and invalidity represent almost 7 percent of the Romanian population, and this percentage Live births among teenage mothers under the age of 15 has been steadily increasing since 2006. People with have been increasing to a worrying extent in recent years. disabilities are estimated to constitute 3.5 percent of the According to NIS data, in 2011 2,898 live births were population, nearly all of whom live with their family or recorded among mothers under the age of 20, representing independently (over 98 percent of the total). 10.6 percent of the total number of live births recorded in The single system for assessing a person’s functional that year. While the rate of live births among all teenage limitations is currently being developed. In Romania, women has been declining (from 13.2 percent in 2006), it is over 1.4 million people have various degrees of functional worrying to note that in 2011 there were 748 mothers who limitations, either due to the loss of working capacity (partial were younger than 15 years old (3.6 percent of the total or total) for people of working age (called “invalidity”) or to a number of live births recorded among teenage women) up birth condition or disability. According to current Romanian from 551 births and 1.9 percent in 2006. legislation, individuals’ functional limitations are evaluated Preventive services, mainly those related to the education by two separate commissions, one for work accidents and and health sectors, are essential for reducing teenage the other for non-work disabilities. Currently, a World Bank pregnancies. For example, policymakers might consider: project is helping the government to merge the assessment (i) introducing educational policies (such as information criteria and instruments using in these two assessment campaigns) to prevent risky sexual behavior135 among systems. teenagers; (ii) improving the health monitoring of teenage The unification of the system for assessing functional women with the aim of identifying pregnancies early; and limitations is particularly necessary given that the (iii) increasing the access of teenagers to health counseling invalidity pension is far more generous than the disability and family planning services. allowance. This differential creates an incentive for potential 135 Risky sexual behavior among teenagers is directly linked to teenage pregnancy and motherhood. A recent study showed that, in Romania, 25 percent of teenagers over 14 years old and 1 percent of those under 14 years are sexually active (CURS, ISE, and UNICEF, 2013). On average, teenagers begin their sexual activity at the age of 15½ years old. At the time of the research, sexually active adolescents had an average of 2.3 partners, and 68 percent had a stable partner. Fewer than half (47 percent) of sexually active adolescents consistently used means of protection, mainly for preventing pregnancy and not for protecting themselves against sexually transmitted diseases. The survey from which these data came had a sample of 607 adolescents (aged 10 to 17 years old), with a margin of error of plus or minus 3.9 percent and a confidence level of 95 percent. 150 | PEOPLE-BASED POLICIES BOX 17 Teenage Mothers in 2011 Most Romanian girls aged 16 to 17 years old are unmarried, living with their parents and Population and Housing family, and attending fulltime education. By Census Data contrast, teenage mothers aged 16 to 17 years old tend to in rural areas, are in consensual unions or In 2011 Population and Housing Census data, 8,605 are married, and are living – along with their partner and cases of teenage mothers aged between 11 and 17 child - within an extended family, and 77 percent have years old were recorded across the country (with 8,422 dropped out of school, mostly becoming home carers. children in their households). Of these, 7,175 were aged Also, the Census data indicate that vulnerabilities linked 16 or 17 years old (with 7,246 children), meaning that the to teenage motherhood are perpetuated later in life. rate of teenage motherhood in this age group was 3.3 Thus, young women aged 18 to 24 years old who were percent. This rate is significantly higher in rural areas teenage mothers are at a disadvantage compared with than in urban areas (4.7 percent versus 1.8 percent), and those who had their first child after the age of 18 and it is extremely high for Roma girls (22.1 percent). even more so compared with young women with no children (Annex Figure 5.3). Comparison between Teenage Mothers and Other 16 to 17 Year Old Girls (%) Live with their child 81 Consensual union 2 58 Married 1 14 Never married 89 25 Home carers 3 51 Pupils/students 91 23 Roma 4 31 Hungarians 5 4 Romanians 81 58 Rural 52 74 0 20 40 60 80 100 Girls aged 16-17 years who never born a child Teenage mothers aged 16-17 years Source: World Bank calculations using 2011 Population and Housing Census data. Social Services | 151 beneficiaries to try to become eligible for the invalidity second is the new unified methodology for assessing the pension, especially given that the current legislation situation and needs of people with disabilities and suffering allows people to receive both benefits. As of 2010, about from invalidity, in accordance with the International 50 percent of disability allowance beneficiaries were also Classification of Functioning, Disability and Health. The receiving a pension, and 20 percent were in receipt of an recommendations put forward in this volume have also invalidity pension.136 However, this is mainly the result of the taken into account the opinions of families, professionals, limited opportunities that disabled people have of entering and people with disabilities in recent years as expressed the labor market during their working life because of the to various disability NGOs or during the consultations structural barriers discussed in the Employment Chapter. In related to the preparation of the National Strategy for Social addition, finding a job is often considered by the evaluation Inclusion of Persons with Disabilities (2015-2020).137 commission as grounds for cancelling or reducing a People with disabilities and those suffering from invalidity beneficiary’s eligibility for the disability allowance. This have both common and separate needs for various social creates a disincentive for them to enter the formal labor services. Those in both categories need accessibility market and an incentive for them to attempt to become measures as well as (re)habilitation and medical services,138 eligible for the invalidity pension. adapted transportation, respite care, daycare, long- The specific requirements in terms of access to services for term care or homecare, home adaptations, and lifelong people with disabilities or invalidity are being addressed in learning.139 However, early diagnosis and intervention, two important policy documents, currently being drafted by education, and early stages of vocational training are the MLFSPE. The first is the National Strategy for the Social specific to those with disabilities since in most cases their Inclusion of People with Disabilities 2015-2020, and the disabilities manifest before they reach working age. TABLE 28: Evolution of the Number of People with Disabilities or Invalidity (in thousands)   Dec 2011 Dec 2012 Dec 2013 Total number of people with disabilities in Romania (children + adults), of whom: 690 697 692 Children (total) 60 61 61 Adults (total) 629 636 631 Children with severe disabilities 30 31 32 Adults with severe disabilities 202 203 203 Children in residential institutions for adults with disabilities 0.026 0.015 0.012 Children in residential institutions for children with disabilities (public and private residential services together) 9 9 8 Adults in residential institutions 17 17 17 Total number of people receiving an invalidity pension 805 748 715 Source: MLFSPE (2013 Quarterly Statistic Bulletin). 136 World Bank (2014a). 137 Specific recommendations related to the consultations on the future strategy are available from the NGO Secretariat coordinated by the foundation, Fundatie Alpha Transilvana, Targu Mures, www.alphatransilvana.ro 138 The key priorities for improving the access of persons with disabilities to healthcare, which are presented in the next sections, are aligned to those recommended by UNICEF (e.g. Stanciu, 2013; UNICEF, 2013) and Handicap International (Chiriacescu, 2008). 139 In the context of the UN Convention on the Rights of Persons with Disabilities, habilitation and rehabilitation services include a wide range of activities aimed at enabling people with disabilities to achieve their maximum level of independence and participation in socioeconomic life. While habilitation refers mainly to those measures that enable people to achieve a functional level that they have never reached before (due usually to impairment from birth or from very early age), rehabilitation services focus on restoring (or compensating for) those abilities that have been lost due to an impairment or injury. The differentiation in terminology is due to the fact that these two situations often require different types of service and intervention. Here, the term “(re)habilitation services” is used when referring to both measures. 152 | PEOPLE-BASED POLICIES BOX 18 People with Complete Functional Limitations These people were women and men spread in the 2011 Population and Housing Census across the country, in rural areas, small Data urban areas, and large urban areas and in all counties. Most were aged 55 years old or over, The 2011 Census included a set of questions about 5 percent were children, 28 percent were aged between the existence of a medical condition that prevents 18 and 54 years old, 13 percent were 55 to 64 years old, individuals from carrying out their daily activities. 17 percent were aged between 65 and 74 years old, and About 906,000 people reported being limited in 37 percent were 75 or older. Most lived in households, their daily activities because of one or more health and (61 percent) had help and support from family problems related to vision, hearing, walking or stair members or other people. Nonetheless, 30 percent climbing, memory or concentration, personal care, or of people with complete limitations because of health communication. The most frequent reports were of problems face serious difficulties because they receive minor limitations related to sight problems. Complete no help from other people, even some of those who live limitation because of health problems was reported by with their family. 115,000 people (or 0.6 percent of the total population). Number of People with Limitations on Their Daily Activities by Health Problem 1000000 800000 600000 400000 200000 0 Sight Hearing Walking or stairs Memory or Personal care Communication climbing concentration Complete limitation Serious problem Small problem No problem Source: World Bank calculations using 2011 Population and Housing Census data. Note: N=906,500 people. Family Support for People with Complete Limitations because of Health Problems 60 54 40 25 20 8 9 5 0 Live with family and Live with family but Live alone but have Live alone with no Do not live in have help from other have no help help from other help from other households members persons persons Source: World Bank calculations using 2011 Population and Housing Census data. Social Services | 153 Early Detection and Early deficit hyperactivity disorder (ADHD), and some rare genetic diseases - that often go undiagnosed, even by specialized Intervention Services medical departments. While the medical diagnosis of motor-neuron and sensorial conditions is relatively A greater range of early detection and early intervention frequent, especially in pediatric hospitals or in the physical services is critical for ensuring that children with disabilities rehabilitation units of general hospitals, the diagnosis of receive proper care.140 Early diagnosis and intervention are developmental and learning difficulties and intellectual of major importance for children with disabilities. Depending disabilities is less frequent as the early detection and on the medical condition of the child, an impairment intervention of these conditions have only been emphasized or functional limitation can be successfully detected since 2001 or 2002. In addition, early intervention services immediately after birth (for example. various types of are usually located in the main city of a county, which agenesis or cerebral palsy) or in the first six months to three means they tend to be inaccessible to many families living years of life. This early detection increases the chances of in smaller towns or rural areas as appropriate transportation the child developing the skills that he or she needs to live as is often scarce or unaffordable. independently as possible. In this respect, this background study recommends that: The quality of Romania’s existing early detection and early • intervention services could be enhanced by following E  ach pediatric hospital should have an early proven best practices. • detection unit staffed by professionals who are trained to deal with the entire spectrum of conditions T  he number of professionals specializing in early that can lead to a potential disability.141 diagnostics is still very low, and most existing • practitioners were trained in - or acquired additional E  ach maternity ward and pediatric hospital should relevant qualifications in - Western European have a counseling unit to support families after a programs (such as pediatricians, neuropediatricians, diagnosis of a current or potential disability. This neurologists, speech therapists, psychologists, and family counseling should aim to offer guidance, physiotherapists). However, a program for training concrete support, practical solutions, and information professionals in the early detection of impairment during the early stages of the (re)habilitation process. and in early intervention is currently offered by • Cluj University, in the Faculty of Special Psycho-  ach city should have at least one early intervention E pedagogy. The Ministry of Education approved the unit or specific services for people with various curriculum in 2013.142 • types of functional limitations (physical, sensorial, intellectual, and behavioral). T  he way in which families are notified of their child’s disability in Romania is inappropriate. According to The network of early detection and early intervention various NGOs,143 parents have reported that medical services should cover the entire range of disabilities and professionals have often described their children’s the entire country. Currently, in Romania, early detection disability as an irreversible condition and as a burden of medical conditions that can lead to disability is done that will harm the life of the family. Despite some rare by family doctors or by specialist doctors in pediatric, positive examples and initiatives, the overall practice neuropediatric, or child neuropsychiatric units. However, is rather humiliating and disturbing for families. there are several types of disorders - such as autism Therefore, medical professionals need to receive spectrum disorder (ASD), behavioral disorders, attention training for addressing this problem. 140 Early detection is a screening and diagnostic process, designed to identify potential risks of impairments, developmental delays or functional limitation in infants and toddlers. Early intervention is a set of comprehensive and inter-disciplinary services that enhance the development of infants and toddlers with disabilities (0-3 years old) and minimize the risks of physical, developmental or psychological delays. 141 For example, Autism Spectrum Disorder (ASD), Downs’ syndrome, fragile X chromosome syndrome, cerebral palsy, various types of agenesis, Prader Willi syndrome, Coffins Siris syndrome, other rare genetic diseases, ADHD, learning difficulties, and speech-related delays. /www.monitoruljuridic.ro/act/anexa-din-18-ianuarie-2013-privind-continutul-educativ-pentru-interventie-timpurie-anteprescolara-destinat-copiilor-cu-deficiente-senzoriale- 142 http:/ multiple-surdocecitate-emitent-ministerul-educatiei-147553.html 143 Autism Romania, the European Center for Children’s Rights, and the Parents Association of Physically Disabled Children. 154 | PEOPLE-BASED POLICIES • I  n the last five years, significant progress has been made in the diagnosis of ASD, but families in small cities and rural areas rarely have access to medical • I n the last decade, several NGOs145 have started to develop early intervention and support services for children at risk and their families in cooperation professionals capable of assessing and diagnosing with local authorities and/or existing public services such cases. Between 2010 and 2013, the MLFSPE, (hospitals, kindergartens, and counseling services). in partnership with the Romanian Angel Appeal Maternity wards and pediatric hospitals in the pilot Foundation and the Romanian Association for municipalities have progressively incorporated a Cognitive-Behavioral Therapies, created 40 counseling program of early screening for children at risk. and support centers for the families of individuals with ASD.144 Similar support services are very much needed across the country, especially in smaller cities. TABLE 29: Early Diagnosis and Intervention Services in Romania Mainstream services* Specific services Support services Typology A. Family medicine A. Medical services A. Counseling for families,drafting Complex screening and diagnostic services for of individual habilitation plans for B. Maternity wards children with the potential for impairment or children, home adaptations, and C. Pediatric services functional limitation. These are mainly available in psychological support for parents pediatric hospitals, as well as in neuropsychiatric and extended families D. Neuropediatric units units for autism spectrum disorder (ASD). B. Self-support groups for families E. Neuropsychiatric units B. Multidisciplinary services D. Information and awareness, both Early intervention services are available in some of for families and professionals the major cities, focusing mainly on physiotherapy, speech therapy, behavioral and learning therapies (including specific therapies for ASD), sensorial stimulation (hearing and sight), and art therapy. These services are provided in medical rehabilitation units or by NGOs. C. Early education - described in the Education chapter Professionals who Family doctors Neuropediatricians Psychologists currently provide Neonatologists Orthopedists Speech therapists these services Pediatricians Child neuropsychiatrists Physiotherapists Neuropediatricians Psychologists Psycho-pedagogy professionals Orthopedists Educators Social workers Neuropsychiatrists Psycho-pedagogy professionals Speech therapists Physiotherapists Occupational therapists Note: * These services are intended to provide the family with a warning of a potential impairment or functional limitation. 144 A map of these services is presented at http://autism.raa.ro/servicii/centre-de-consiliere-si-asistenta. 145 Some examples include Alpha Transilvana in Targu Mures (for children with motor-neuron disabilities); Speranta in Timisoara (for children with developmental problems); The Center for Motoric Rehabilitation in Cluj; Thysia and Albin in Oradea; Sense International in Bucharest and Oradea, Timisoara, and Iasi (for deaf blind children); World Vision in Cluj, Craiova, and Bucharest; Help Autism in Bucharest; the Iulia Pantazi Center in Bucharest; and the Inocenti Foundation in Bistrita. Social Services | 155 Rehabilitation Services Services for People with The development of mobile multidisciplinary teams for Mental Health Problems early intervention is very much needed, especially for According to WHO, mental health is a state of wellbeing children with high dependency needs and complex medical in which an individual can realize his or her own potential, conditions and those in rural or isolated areas. The number cope with the normal stresses of life, work productively, and and composition of these teams should be adapted to local make a contribution to the community. Mental disorders (county) needs. However, best practice examples tend to comprise a broad range of problems that have different involve an average of three to four teams per county, each of symptoms. However, they are generally characterized which includes a physiotherapist, a psychologist, a speech by some combination of disturbed thoughts, emotions, therapist, a nurse, a social worker, and a psycho-pedagogist behavior, and relationships with others. Some examples of or educator. Currently, the use of this kind of mobile multi- mental health conditions are depression, anxiety, behavior disciplinary team for early intervention is rare in Romania. In disorders in children, bipolar disorder, and schizophrenia. 2011, the MLFSPE developed 20 mobile teams to support The key factors that prevent sufferers from accessing the families of children with disabilities based at home in 18 quality services are discrimination and marginalization, counties and two sectors in Bucharest.146 stigmatization, and a lack of coordination between sectors, More (re)habilitation centers and services are needed in which translates into poor collaboration between institutions small communities, including mobile teams that are able to at the central and local levels. provide integrated services in rural and remote areas and to People with mental health problems are at high risk of people with mobility difficulties. Habilitation/rehabilitation poverty and social exclusion. Mental health problems is obviously not limited to medical care. It relates to a much and poverty usually create a negative cycle. People wider range of activities including physical, psychosocial, living in poverty are more likely to develop mental health and occupational therapy, as well as a variety of support problems that are more severe, last longer, and have worse services for community living and daily life activities. outcomes than average.147 Conversely, with no targeted Although in the past medical rehabilitation was mostly social and financial protection or assistance, people with provided in institutional settings, these services are mental problems are very likely to fall into poverty or not increasingly being provided at the community level be able to rise out of it.148 In order to break the cycle of managed by local authorities or accredited NGOs (Annex poverty and discrimination, it will be necessary to introduce 5, Section III). The Ministry of Health is supporting more income-generating and community empowerment this positive trend for the foreseeable future. However, programs for people with mental health problems. policymakers need to encourage the development of more Stigmatization is a significant constraint to accessing medical rehabilitation services for adults, which lag behind proper care for people with mental health problems. Many those for children, especially in terms of accessibility and people fear being “labeled” with a mental health problem, affordability. Similarly, during the qualitative research, which is why they delay or avoid seeking treatment. This NGOs mentioned the need for more free or subsidized self-stigmatization combined with previous negative medical equipment, medical consumables, and medicines experiences with the health care system (for example, for those with disabilities. Also, service providers drew discriminatory behavior from medical personnel, high costs, attention to the need for incentives to attract and retain staff and a lack of health literacy skills on the part of the patient) working with individuals with complex disabilities or high often cause the person with mental issues to postpone dependency needs given the high levels of outmigration seeking professional help.149 In this context, many mental among this category of professionals, who are in high problems remain under-diagnosed and untreated. It is demand in Western Europe. important for medical and social specialists working with 146 Arad, Argeş, Bihor, Bistriţa Năsăud, Brăila, Braşov, Dâmboviţa, Dolj, Galaţi, Giurgiu, Gorj, Mehedinţi, Mureş, Neamţ, Olt, Sălaj, Satu Mare, Vaslui, and Bucharest (Sectors 4 and 6). Each /www.mmuncii.ro/j33/ mobile team consisted of a speech therapist, physiotherapist, psychologist, social worker, pediatrician, occupational therapist, and a special educator. http:/ index.php/ro/transparenta/comunicare/comunicate-de-presa/2009-rezultatele-implementarii-proiectului-cresterea-capacitatii-autoritatilor-publice-locale-din-romania-in-vederea- sprijinirii-copiilor-cu-dizabilitati-in-cadrul-propriilor-familii. 147 Lunda et al (2010). 148 WHO (2012a). 149 Wahlbeck and Huber (2009). 156 | PEOPLE-BASED POLICIES people with mental health problems to provide accessible and Child Protection (DGASPCs) and the county councils. information on symptoms and treatments and to ensure that Therefore, for the benefit of the patient, there needs to be patients understand their rights. Educational and advocacy more collaboration between institutions and sectors. At programs are needed to promote mental health and to the moment, some services provided by mental health challenge the myths surrounding mental problems among hospitals and the psychiatric departments of general both the general population and medical specialists. hospitals overlap with the services provided by the NRRCs. In 2002, the Government of Romania passed the Law on Although mental health hospitals and NRRCs should Mental Health Promotion and Protection of Persons with be providing complementary services for mental health Psychiatric Disorders. This became operational only in patients, in practice they often offer similar services but 2006 when the National Strategy for Mental Health was with different specialists, different funding sources, and launched. Since 2007 the Romanian Ministry of Health different standard per capita costs (Box 19). The institutional has had a National Program for Mental Health in place, gaps have allowed the creation of informal functional which aims to ensure the accessibility, continuity, and mechanisms. In many mental health hospitals, even in the quality of services for people with mental health problems. psychiatric departments of general hospitals, most patients In 2009 the government created the National Center for are residents for years, in some cases more than 15 years. Mental Health and the Fight against Drugs and began This situation is the result of a vicious cycle in which few the process of reforming the mental health care system. institutions are available to accommodate mental health The National Health Strategy 2014-2020 - Health for patients who have been released from hospital (mostly Prosperity reinforces the need to improve the mental a small number of NRRCs) and families and/or local health status of the population by assuring equal access authorities do not have the capacity to provide them with to adequate and efficient medical services. The rights of the necessary specialized care. In most cases, the mental children with mental problems to treatment, dignity, and health hospitals and the psychiatric departments cover the active community participation are specified in the National institutional gap by providing these patients with residential Strategy for Mental Health for Children and Teenagers, and specialized medical treatment as a response to a social which has recently been approved despite having been problem (see interview excerpt in Box 19). under discussion since 2007. These factors increase the pressure felt by the families There is a strong need for both horizontal and vertical of people with mental health problems. To address this, collaboration between institutions in order to provide policymakers should consider funding psychosocial appropriate medical and social services for people with counseling and support for families and other caregivers of mental problems. Theoretically, a chronic patient may people with mental health issues. be hospitalized for maximum 44 days (114 days for long- The NRRCs were designed to be a viable alternative to term chronic patients) in a mental health hospital and then mental health hospitals for patients with chronic mental should be referred to a residential specialized institution health problems. They were intended to be institutions such as the Neuropsychiatric Recovery and Rehabilitation where people with neuropsychiatric disabilities live in a Centers (NRRC), which in principle are supposed to offer family-type environment and where their individual needs residential, specialized, recovery, rehabilitation care and, are met through activities focused on ensuring their recovery, when possible, social and professional reintegration for rehabilitation, and reintegration into society. However, few people with mental health problems. However, in practice, have been established as yet. According to MLFSPE reports, this varies across the country as there are no clear referral as of March 31, 2014, only 53 NRRC had been authorized mechanisms or collaboration protocols between institutions. and were functioning in Romania serving 5,310 beneficiaries. There are at least two ministries that need to coordinate The process of restructuring or closing down large residential their policies and strategies - the Ministry of Health and institutions that do not meet minimum quality standards the Ministry of Labor, Family, Social Protection, and the started in 2002 and was reinforced in 2006 in the National Elderly (MLFSPE) - and two local structures – the mental Strategy. The aim was to reduce the size of the institutions health hospitals and the NRRCs, which may or may not be caring for people with neuropsychiatric disabilities, with the directly run by the MLFSPE. NRRCs receive financing from optimum number of beneficiaries expected to be no more the MLFSPE and the county councils, at the national level than 60 people. However, 16 of the NRRCs that have been they are overseen by the National Authority for People with approved so far have over 100 places and an additional 17 Disabilities, and at the county level they are a subordinate are already home to more than 100 beneficiaries each. Thus, structure of the General Directorates of Social Assistance Social Services | 157 BOX 19 A Comparison between Mental Health Hospitals and the Neuropsychiatric Recovery and Rehabilitation Centers MENTAL HEALTH HOSPITALS NEUROPSYCHIATRIC RECOVERY AND REHABILITATION CENTERS (NRRC) Coordinated by the Ministry of Health Financed by the Ministry of Health and partially by the Coordinated by the DGASPC County Councils Financed by the MLFSPE and the county councils Presents the traditional option for non-institutionalized Presents the modern option mostly for former institutionalized people who visit the specialist on their own initiative, or children who have reached adulthood. Usually, they are referred are brought by their family, SMURD, or other parties by the SPAS or DGASPC to the NRRC, depending on available Care for patients who are either acute or chronic placements. Approximately 50 percent are long-term patients Care for patients that have chronic conditions Are closed and isolated establishments, usually in 100 percent of their patients are long-term parks and/or forests Are open and connected establishments with a high degree of Benefit from the services of at least one psychiatric integration between the community and the beneficiaries doctor Benefit from the services of a family doctor, medical assistants, When in crisis, the patients receives on-the-spot and nurses specialized medical treatment or is transferred to the When in crisis, the patient is transferred to the ER of the nearest ER of the nearest psychiatric hospital with an acute ward psychiatric hospital. Most do not offer social services (such as ergotherapy) In the majority of cases they offer social services (i.e. ergo therapy). SERVICE ACCESS A person diagnosed with a mental disorder most probably… … Does not have housing or an income … Is alone The ratio of beneficiaries to … Is a former institutionalized child The ratio of beneficiaries to NRRC hospital employees is not known … Has a family that no longer supports him. employees is 1.45. The cost per patient per day is The cost per patient per day is approximately 120 RON. approximately 72 RON. COSTS Opinions of an Administrator of a Mental longer?” And it is normal, because the entire Health Hospital responsibility for treatment falls into their hands once the patient arrives at home. Many ”In our hospital, the majority of patients, more than do not understand this… so they don’t pay 70 percent, are social cases. Theoretically, the attention to the treatment and the patient’s condition hospitalization period for chronic cases is 44 days. worsens… Here… everybody is happy, everybody feels Normally, after 44 days we should discharge them from well. If you discuss with the patients, you will see, many the hospital, but we cannot do so because we do not of them do not want to go home, do not want to return to have anywhere to send them. We discuss these cases their families. What would you make of this? What kind with the municipalities… [but] the municipalities cannot of treatment is a mental health patient likely to receive receive them, although every mayoralty should have from his family? I tell you, they are at the margins of the special or protected homes for people like that. But we society.” know that this involves high costs. […] Those who have families should be reintegrated with their families. But Source: World Bank qualitative study carried out in you know, families also need to be educated. They say July-August 2014 for preparing this background study. “Can you just keep him or her hospitalized a little bit 158 | PEOPLE-BASED POLICIES in 2014, 33 out of the 53 existing NRRCs are significantly The long-term success of mental health service will depend overpopulated. With respect to the availability of places in the on coordination between the health services and the 53 NRRCs, 13 are at full capacity, 13 have between one and services provided by other sectors, in particular the social ten available places, 16 have more than 10 available places, sector. The challenges faced by the mental health sector eight have exceeded their capacity by between one and ten are related to the paradigm shift in the treatment of mentally people, and three have exceeded their capacity by more ill people. In the past, the policy was to segregate them from than 10 people. At the national level, in the 53 NRRCs, there society whereas the aim is now to reintegrate them into are more than 400 available places yet 97 beneficiaries are society wherever possible. living in NRRCs that have exceeded their approved capacity. This has involved the evolution of a hospital-based model NRRC places are reserved for people who have been of care into a community-based integrated model of care.152 diagnosed with a mental, psychological, or associated In order for this approach to succeed, it will be necessary disorder or handicap. In 2014, about 80 percent of the to provide multi-disciplinary support services at the beneficiaries had mental or psychological problems. Among community level to ensure that people with mental health the remaining 20 percent, 9 percent have associated problems are accepted by their communities and to protect disorders and 11 percent have other types of handicap, and their right to live an independent life. these people could be defined as social cases rather than neuropsychiatric patients. Psycho-social and Psychiatric Although the NRRCs are meant to be a step towards Habilitation and Rehabilitation reintegrating patients into the community, most patients consider them to be long-term, even lifelong, institutions. As Services a result, many chronic patients prefer hospitals because they The number of psycho-social and psychiatric habilitation expect to be released at the end of a finite stay. As a NRRC and rehabilitation services should also be increased and director in Arad County explained, “[They] probably have in their geographical distribution should reflect the distribution mind that coming here is like forever, a decision for life. And in of need across the country. Currently, this type of (re) this context they rather not take a definitive position… at least habilitation is provided in the following ways: (i) general theoretically, when you take the patients to the hospital, at services are provided for children in a small number some point you have to take them back home.”150 of mainstream schools and kindergartens, public and An ANPIS 2013 Evaluation Report151 revealed that many private after-school programs; and public and private (re) NRRC patients do not benefit from any recovery therapy habilitation centers and (ii) specific services for people with or social inclusion programs because no such programs disabilities are provided in residential settings for children are available (because of the lack of personnel, adequate and adults with disabilities, public and private daycare number of places, or materials), because they are centers for people with disabilities, and public and private inappropriate for the needs of the beneficiaries, or patients rehabilitation centers specifically for people with disabilities are not encouraged to participate. However, compared to or people with mental health conditions. Psycho-social and psychiatric hospitals, the NRRCs are more connected to psychiatric (re)habilitation is governed by quality standards the community, in that the beneficiaries can go outside the set jointly by the MLFSPE, the Ministry of Health, and the center, work in the community, and participate in social Ministry of Education and is provided by psychologists, events (such as community days and church events). special educators, psychiatrists, and occupational therapists. It is very probable that, once occupational Although the NRRCs were designed to accommodate therapy becomes sufficiently developed in Romania, chronic mental health patients released from hospitals psycho-social rehabilitation and occupational therapy will and to reintegrate them into the community, most of their merge. It will be critical to develop system for the constant current residents are formerly institutionalized children. The training of professionals at both the county and national NRRCs are being used to solve the problem of what to do levels since these professionals often work alone with no with institutionalized children once they reach the age of 18. 150 World Bank qualitative study carried out for this background study. 151 ANPIS (2013) - National Authority for Payments and Social Inspection. 152 Caldas de Almeida (2011). Social Services | 159 BOX 20 Best Practices - Community Involvement generosity of the medical personnel involved Increases the Chances of Rehabilitating who volunteered their services free of charge. People with Mental Health Problems At the same time, the patient was included in a local social assistance program that provided The success of interventions to help a person suffering her with meals at a social canteen and that helped her to from mental health problems is often due to close apply for and receive an invalidity pension and heating collaboration between the community and social workers. benefits. She receives weekly visits from the community This collaboration proved to be very effective in the case of medical nurse who checks her status. This is an example a schizophrenic woman from Arad who received help after of how an integrated intervention provided jointly by the the social assistance services (SPAS) had been alerted community, social workers, and medical specialists can by the owners’ association in the apartment block where provide effective, timely support to people with mental she lived. The woman lived alone with limited financial health issues in a non-institutionalized setting. The most resources (some money that she received after her mother important conclusion is that the intervention was triggered died) with no health insurance or diagnosis. The Owners’ by the community Association proactively assumed responsibility for their neighbor’s recovery by providing her with the necessary Source: Interview with a representative of the support (especially with regard to the costs of housing Department of Development and Community Assistance and utilities). The challenge for the SPAS was to diagnose Arad, World Bank qualitative study carried out in July- her and to give her access to treatment without incurring August 2014 for preparing this background study. enormous costs for her. This was possible only due to the professional network or peer support. Additionally, training development of the service, a mobile team of occupational could be provided for psychiatrists on the different kinds of therapists could be developed per county, as was done in disability and on the provisions of the UN Convention on the the program managed by the MLFSPE in 2011.154 In the long Rights of Disabled Persons. term, each rehabilitation unit (in the areas of medical, social, or mental health) should employ at least one occupational Occupational Therapy Services therapist. Professionals in the field are currently trained in Bacau (a bachelor’s degree course at Vasile Alecsandri The government needs to develop comprehensive University), Timisoara (West University), and Oradea,155 regulations for occupational therapy.153 These regulations in cooperation with a European professional network of should cover funding and evaluation methodologies and occupational therapists (ENOTHE). The funding for the the inclusion of newly trained professionals in all public occupational therapy service could come jointly from the and private services that deal with people with disabilities. Ministry of Health and the MLFSPE. The development of occupational therapy in Romania is in the very early stages. It represents a new departure for (re)habilitation-related practice. As a first step in the 153 Occupational therapy is the use of treatment to develop, recover, or maintain the daily living and work skills of people with a physical, mental, or developmental condition. Occupational therapy focuses on adapting the environment, modifying the task, teaching the skill, and educating the people with disabilities (and/or their families) in order to increase their participation in and performance of their daily activities, particularly those that are meaningful to the person in question. Occupational therapy often involves physical therapies related to preventing diseases, improving the daily quality of life, and improving physical functionality. However, it also includes: (i) activities aimed at building skills of children and youths to enable them to participate in meaningful occupations and addressing their psychosocial needs to enable them to participate in meaningful life events; (ii) mental health services such as routine building, coping skills, medication management, employment, education, community access and participation, social skills development, leisure pursuits, money management, and childcare; (iii) services for the elderly disabled to help them to maintain their independence and daily routines and to adapt their homesaccordingly; and (iv) training in the use of assistive devices. 154 http://www.mmuncii.ro/j33/index.php/ro/transparenta/comunicare/comunicate-de-presa/2009-rezultatele-implementarii-proiectului-cresterea-capacitatii-autoritatilor-publice- locale-din-romania-in-vederea-sprijinirii-copiilor-cu-dizabilitati-in-cadrul-propriilor-familii 155 These faculties prepare professionals for the following services: (i) health services – general hospitals, rehabilitation centers, spas, plastic surgery, neurology units, pediatric departments, internal medicine, cardiology units, and respiratory units; (ii) Centers for Assistance and Care (CIA) - residential rehabilitation centers for disabled people and centers for occupational therapy (CITO) under the coordination of the DGASPC; (iii) both public and private placement centers for children; (iv) both public and private services for the elderly; and (v) probation services. 160 | PEOPLE-BASED POLICIES Support Services within to afford the basic costs of community living (such as the rent for an apartment and the costs of utilities and Communities transport) after a long period of institutionalization. Support services for people with disabilities to help them This should be considered in the context of a reform to benefit from independent or supported living are crucial that increases the efficiency of the entire set of cash for their full inclusion in society. This is the area in which benefits for the disabled. support services play the most important role (see Annex 5, Section IV). Most people with disabilities in Romania live with their families and are not able to access affordable •  trengthening and developing social assistance S services at the community level to provide professional and peer support to families and carers housing or support services for independent living. Adapting houses to take account of a person’s disability is of people with disabilities, including counseling, expensive since state subsidies cover only the interest on self-support groups, and help with administrative a bank loan for such purposes. Many families of those with procedures and with applying for relevant benefits or disabilities do not have high enough incomes to qualify services. Of particular importance is helping carers to for a bank loan, which makes the subsidized interest obtain a disability certificate for children in need as a irrelevant. Furthermore, the qualitative research indicated first step towards accessing a series of entitlements that local authorities do not always give priority to families (cash benefits and services). In practice, families in of people suffering from disabilities for social housing, as rural areas or deprived communities are often not is stipulated in Law 448/2006. Various group homes and keen to require a disability certificate. According to supported living arrangements are emerging, mostly for UNICEF and several NGOs,157 there is a significant children and adults with intellectual disabilities. In-home number of undeclared disabled children in these support, legal assistance, and accessible leisure, culture, areas for three main reasons: (i) a lack of information and sports programs are all very limited at the national level about the application procedure; (ii) the stigma that is but are gradually increasing. To accelerate this process, often attached to disability in these communities; and policymakers could consider: (iii) the costs involved, including the transportation costs from the person’s city of residence to the • D  eveloping a national program of independent and county commission or the DGASPC office. supported living for people with disabilities that covers the total or partial cost of home adaptations • I ncreasing control over the implementation of legislation, mainly because numerous families of • R  evising the regulation system and the cost and quality standards for housing services to take account of the needs of people with disabilities.156 people with disabilities have drawn attention to abuse and irregularities. An example is provided in Box 21. There is a particular need for support services for young • adults with disabilities living in their communities. The ncreasing the number of respite centers for children I needs of adults with disabilities have often been treated and adults with disabilities. These centers offer the same as those of elderly people. However, while some a break for families who are providing 24/7 care support services might serve both categories (such as in- for people with complex dependency needs and home support for people with complex dependency needs by doing so they make it possible for people with and help with daily home activities and personal care), complex dependency needs to remain with their there is a wide range of needs specific to younger adults families. Respite centers are not yet fully regulated with disabilities that do not usually apply to the elderly. at the national level, for example, in terms of quality These include: (i) the need to find and keep accessible standards and unit costs. housing, live independently, and, in some cases, manage • financial and personal assets; (ii) the need for habilitation  esting a personalized budget for independent living, T and rehabilitation services adapted to the specific needs a mechanism that would allow people with disabilities of adults with disabilities and provided in the context of 156 For example, a person who was institutionalized for many years might need stronger support in the first year after deinstitutionalization, but this need for support will progressively decrease over the years. 157 Salvati Copiii, World Vision, and Alpha Transilvana. Social Services | 161 BOX 21 Remuneration of the Personal Assistants of and 2011 or were made redundant (collectively) People with Severe Disabilities by the local City Halls, with their salaries being replaced automatically by carer indemnities. Between 2009 and 2013, people with severe Personal assistants lost their working contracts disabilities reported numerous abuses and delays in and therefore their health and social coverage. The the remuneration of their personal assistants (usually number of court actions initiated by personal assistants family members). In some cases, the personal assistant’s against local public authorities increased significantly in salary was paid a smaller indemnity for carers. These two 2011 and 2012. different types of benefits works as follows. The legislation has been amended to revert to the 2006 Law 448/2006, for the protection and promotion of the situation, but local authorities maintain the practice. Many rights of people with disabilities, refers to the personal families currently report strong pressure from town halls, assistant as follows: “Art. 42 para 4: The parents or the especially in rural areas, to accept an indemnity instead of legal representatives of children with severe disabilities, or a personal assistant’s salary (and thus a working contract adults with severe disabilities or their legal representatives, for this assistant). excepting the ones with severe visual disability, can choose between a personal assistant and a monthly Many family members in Romania have no choice other indemnity.” The monthly indemnity is lower than the than to become personal assistants for their severely personal assistant’s salary and is equivalent to the net disabled children. The lack of support services and the salary of of an entry-level social worker with a secondary low income of these assistants do not give these families degree in the public system. many options. Under these circumstances, removing this option of being a remunerated (and contracted/insured) In September 2010, the government issued Ordinance personal assistant within the family means that many of no. 84/2010, which allowed local authorities to ignore these families risk becoming impoverished and threatens the choices of parents or people with disabilities and to the wellbeing of this vulnerable group. automatically swap the salary of the personal assistant for a “carer indemnity” (indemnizatia de insotitor) paid /legeaz.net/legea-448-2006/art-42- Sources: http:/ directly to the disabled person. This switch was justified / asistentul-personal-servicii-si-prestatii-sociale; http:/ by the inability of local authorities to afford to cover the www.dsclex.ro/legislatie/2010/septembrie2010/ salaries of personal assistants, as well as by the freezing mo2010_654.htm#oug84; http:/ /www.mmuncii.ro/pub/ of public positions in the public system. As a result of this imagemanager/images/file/Legislatie/LEGI/L%20136- regulation, a large majority of personal assistants did not 2012.pdf receive their salaries for more than six months in 2010 162 | PEOPLE-BASED POLICIES independent living; (iii) the need for vocational preparation, care practices have not improved significantly, and the training, job coaching, and employment support (tailored percentage of real and effective (re)habilitation services for people at various ages and at various stages of the has remained very low in these institutions. Recent reports employment cycle); (iv) the need to access to other by the Center for Juridical Resources have raised serious community services (such as healthcare, legal services, concerns about the quality of services in large-scale (re) outdoor activities, cultural activities, and leisure facilities); habilitation centers and in neuropsychiatric units. and (v) the need for a balanced family life (requiring, for The speed and effectiveness of the deinstitutionalization example, family counseling and sex education). For these process for adults with disabilities need to be increased. reasons, services for independent living are a very specific To this end, policymakers should consider the following and important category that needs to be developed over the actions: (i) developing and implementing a national plan coming years. for the progressive transfer of adults with disabilities from The continuation of the national plan to make public spaces residential centers to small group homes for up to 50 more accessible should be an important priority for the residents (either houses or apartments that are rented in disability sector. This plan was initiated in 2006 and aimed the community or small-scale residential units for people to make services such as transportation and the built with high dependency needs or with medical conditions that environment more accessible to people with disabilities. require permanent medical or rehabilitation care services); The implementation status of this plan needs to e evaluated (ii) developing a permanent monitoring mechanism for all as do any plans for it to be continued. Renewing and forms of abuse and neglect of individuals with disabilities extending this plan is especially relevant to Romania given in residential services; (iii) ceasing all new investments in that compliance with Article 9 of the UN Convention on the infrastructure of the current residential centers, except the Rights of Persons with Disabilities (Accessibility) is a where the safety and/or lives of the current beneficiaries general ex-ante condition for receiving financing from the are endangered by the lack of such investment; and (iv) European Structural and Investment Funds (ESI).158 strengthening social assistance services at the community level accompanied by investment in community-based Transition from Residential services such as daycare and other support services for independent or supported living (such as transportation, Care to Community-Based personal assistants, assistive devices, and interpreters). Services Services for the Elderly The transition from residential care to community-based The elderly population as a proportion of the entire services for adults with disabilities remains a priority and population is set to grow considerably and, consequently, is included in the National Strategy for Social Inclusion of the demand for healthcare and long-term care services People with Disabilities (2015-2020). Deinstitutionalizing will constantly increase. According to the 2011 census, adults with disabilities has been a very slow process. During 16.1 percent of the population of Romania was then 65 or the communist regime, (re)habilitation and care services older (about 3.24 million people). According to the EU, this for people with disabilities in Romania were provided in percentage is projected to grow rapidly in the near future very large residential and segregated institutions. The and to reach almost 30 percent by 2050. As of 2011, more unacceptable living conditions for disabled people in these than 1.45 million people were aged 75 or over (7.2 percent institutions have been widely publicized by numerous of the Romanian population). This particular age group international organizations, disability activists, and the requires particular attention from social policymakers media. Over the last decade, there has been a growing because of the higher need for long-term care services number of call for calls for action the government to close among the elderly population. Elderly people with no family these institutions and rapidly develop community-based support face a higher risk of poverty and social inclusion. services instead. Although the old large-scale residential As previously shown, elderly people in Romania have institutions have mostly been transformed into rehabilitation a relatively low risk of poverty compared with other age centers159 and have to some extent modernized, overall 158 European Commission (2014a: 349). 159 Methodological coordination is currently provided by the Department for the Protection of Persons with Disability (in the MLFSPE), while administratively and financially they depend on the DGASPCs. Social Services | 163 groups, particularly children and young people, but the people find it face difficult to afford the cost of medicines, risks that they do face relate to the low value of pensions food, and utilities. For this reason, many elderly people (pensions from agriculture, health-related pensions, or would prefer to receive long-term care in a residential survivor’s pensions) and to their higher incidence of health institution. However, the number of these services remains problems.160 The elderly with no family support face a completely inadequate. Only 393 residential centers considerably higher risk of poverty, especially elderly currently exist in Romania, of which 67 are not accredited, women (see the poverty profiles in the Poor and Vulnerable and their overall capacity does not exceed 17,000 places.162 Groups chapter). The number of elderly with no family The priorities of policymakers must be to develop a wide support is expected to grow in the future, especially given network of affordable and person-centered homecare the mass overseas migration of the working age population. services in both urban and rural areas, to enhance the ICT infrastructure and new technologies that could support The government took a first step towards systematically the needs of elderly people at home, and to diversify the defining the social and healthcare needs of older people provision of care to include nursing care, tele-assistance, in 2000 by introducing the National Grid for Needs day centers, integrated services, and more. In the long term, Assessment of Older People. This includes all items these actions would significantly reduce the pressure on necessary to assess an older person’s social and economic institutional care. status, his/her health conditions, and related care needs in order to determine three levels of care needs as well as the Services for People in Other types of social and healthcare services required. The grid takes into account the preferences of the beneficiary and of Vulnerable Situations his/her informal caregiver and also the availability of local Besides the large vulnerable groups of children, people services. Currently, legal reforms are being prepared to with disabilities, and the elderly, the government should unify the assessment procedures used for disabled people also aim to regulate, develop, and finance social services and for elderly people. tailored to the needs of other vulnerable groups, including Regulating, developing, and financing a spectrum of adults deprived of liberty or on probation; drug, alcohol, services tailored to meet the specific needs of the elderly is or substance addicts; victims of human trafficking; and becoming increasingly important. More and better services victims of violence. These services should be developed for the elderly must be made available within rural and jointly by the MLFSPE and the National Administration urban communities, especially for those without family of Penitentiaries (which is responsible for the National support and/or with complex dependency needs. At present Strategy for the Social Integration of People Deprived of in Romania, the range of care services (including homecare Liberty 2015-2019, GD 389/2015), the National Anti-Drug and long-term care) is insufficient, as is the number of staff Agency (which is responsible for the National Anti-Drug for these services. There is a need for more of every kind Strategy 2013-2020, GD 784/2013), the National Agency of care service, including nursing homes, respite centers, against Domestic Violence (which is responsible for the daycare centers, and home-based social services for National Strategy for the Prevention of and Fight Against dependent people. Domestic Violence 2013-2017, GD 1156/2012), and the National Agency against Trafficking in Human Beings A network of integrated social, medical and homecare (which is responsible for the National Strategy Against services must be developed jointly by the MLFSPE and Trafficking in Human Beings 2012-2016, GD 1142/2012). the Ministry of Health. As 2011 Census data indicate, about 6 to 7 percent of the elderly population in Romania need A. Services for Adults Deprived of homecare services, but only 0.23 percent benefit from these services at present. The number of requests for Liberty and on Probation long-term care, either at home or in residential centers, is There is no effective system for supporting the social constantly increasing, and 81 percent of Romanian service inclusion of detainees after their release. Inappropriate providers report a constant increase in requests for services reintegration policies can negatively affect the employment coming from the elderly.161 In many households, older prospects of these people as well as their access to housing, 160 See also CNPV (2013) - National Council of Elderly People. 161 /www.seniorinet.ro/ According to the SeniorNet project of the Caritas Confederation - http:/ 162 /www.seniorinet.ro/ http:/ 164 | PEOPLE-BASED POLICIES BOX 22 Elderly People in Vulnerable Situations in the vision, hearing, walking or stair-climbing, 2011 Population and Housing Census Data memory or concentration, personal care, or communication. Over 242,000 elderly people Of all Romanians aged 65 years and over, fewer than reported having serious limitations, of whom 1 percent live in institutions while the majority live about 5,000 lived in residential facilities and 237,000 in households. More than 26 percent live alone, 28 lived in households. In addition, more than 62,000 percent live in households with other elderly people elderly people reported having complete limitations (most of these households consist of pensioner couples), due to health problems, of whom about 4,000 live in and 45 percent live in extended families. People aged institutions and 58,000 in households. Nearly 212,000 65 to 74 years represent 55 percent of the elderly, elderly (or 6.5 percent of all people aged 65 or older) and women represent almost 60 percent. Most elderly have serious or complete limitations but do not receive people are located in rural areas (55 percent). any help within the family and so need support for In the 2011 Census, 14 percent of these elderly carrying out daily activities. Of these people, 68,200 people reported being limited in their daily activities live alone, 127,000 are aged 75 years or over, and due to one or more health problems related to 47,300 are 75 years old or over and living alone. Family Support for Elderly People with Complete or Serious Limitations due to Health Problems by Age Category 160 Live with family and have help from 120 other members 80 Live with family but have no help 40 Live alone but have help from other 44 persons 20 0 1 3 Complete Serious Complete Serious Live alone with no help from other limitation limitation limitation limitation persons Elderly 65-74 years old Elderly 75 years or over Source: World Bank calculations using 2011 Population and Housing Census data. Note: Complete or serious limitations in any of the following medical categories: vision, hearing, walking or stair climbing, memory or concentration, personal care, and communication. Social Services | 165 identity documents, social benefits, and mental health According to European estimates, 3-5 percent of the services. As a result, the risk of social exclusion for former inmate population has the required level of education to detainees is high, and, as a perceived necessity, many of attend higher education.167 Furthermore, prisoners have them revert to criminal activities. The National Administration negative perceptions on education as a result of negative of Penitentiaries estimates that 60 to 80 percent of all school experiences and do not see long-term usefulness of current prisoners in Romania will end up back in prison. The social-educational programmes.168 For certain subgroups actual level of repeated offences is already high, with 45% of of prisoners, access to education during imprisonment is prisoners being repeated offenders, in 2013. even more difficult than for the majority. Minors, women and foreign citizens in prisons require special attention. During 2010-2013,163 the prison and probation system faced great pressure in the context of an increasing number of The prison and the probation system face a lack of social- prisoners and individuals on probation. The inmate population educational and psychosocial personnel that helps to increased from 28,244 (2010) to 33,434 individuals (2013). prepare the social reinsertion of prisoners and reduce the Out of them, over 10,000 were released on probation in re-offending risk. According to European standards, it is 2013 (compared to about 8,000 in 2010) and 659 were recommended that a psychologist/social worker cover 200 released on parole. As in most EU-27 states, prisons are prisoners and an educator about 100 prisoners. However, overpopulated, exceeding 100 percent occupancy.164 in 2013, according to ANP data,169 prisons had 659 social- educational specialists for over 33,000 prisoners. Moreover, A series of factors expose the inmate population to a high social workers - staff that can play an important role in risk of social exclusion.165 Most prisoners are male (over supporting the social rehabilitation of prisoners - are not 90 percent) with a low level of education. A significant part allowed (as per internal rules) to visit the home of the inmate of them have only primary education, while only about to see his/her living conditions. In 2013, the probation a quarter are graduates of vocational education. Before system had less than 400 positions for approximately imprisonment, half of them were unemployed or were 10,000 individuals on probation.170 In addition, there is working on the black market. Nevertheless, most inmates no annual continuous specific training provided to each tend to have a positive attitude toward labor and vocational personnel category in the prison or probation system.171 training. Although efforts were made to increase integration In the same time, there are no adequate spaces and chances on the labor market of prisoners after release, sufficient materials to effectively organize educational and they continue to face a lack of viable job opportunities both psychosocial activities. during imprisonment and after release, all the more so since the onset of the economic crisis. Providing prisoners’ access to universal medical services and to specialized services (e.g. methadone substitute A general low level of education and training is one of treatment programs for drug users, testing for HIV, hepatitis the main factors for the social exclusion of prisoners. B or hepatitis C) as well as the availability of medical European statistics show that maximum 25 percent of services within the community have not proven sufficient the adult population in prisons in EU Member States to ensure adequate physical and mental health conditions (Romania included) accesses any type of education during among prisoners, both during imprisonment and after imprisonment.166 163 ANP (2013) - National Administration of Penitentiaries. 164 In Romania, there are 36 prisons (out of which four for minors and young people, one for women and six departments for women in co-ed prisons), six hospital prisons and two correctional centers.Of the prisons, 16 are open and half-open and 17 are closed and with maximum security. 165 IRECSON (2012). Survey on the inmate population (5,000 respondents), representative at the national level. 166 GHK Consulting (2013). 167 According to the Romanian legislation in force, prisoners of all ages have the right to general education during imprisonment, vocational training, as well as non-formal education. Starting with 2011, a credit system was implemented through which inmates attending and completing education programmes or other activities (e.g. labour) receive points. Cumulating these points would bring inmates additional benefits, such as more family visits, parole etc. In certain circumstances, completing general education programmes or qualification programmes could also reduce the sentence by a certain number of days. Inmates attending university education or qualification courses may also receive, during education, a monthly stipend in the amount of the minimum guaranteed income. 168 Dâmboeanu (2011). 169 ANP (2013) - National Administration of Penitentiaries. 170 The probation system is coordinated by the National Directorate of Probation, under the Ministry of Justice. There are probation services in each county seat and in Bucharest, as a result of the restructuring of probation services attached to tribunals. The maximum number of positions for territorial offices has been: 370 in 2013, 663 positions in 2014, 945 positions in 2015 and 1,177 positions in 2016. The probation office personnel consists of a head of office and probation officers, people with higher education, licensed in social assistance, psychology, pedagogy, law, and sociology. 171 ANP 2013 data show that over 3,000 ANP employees attended continuous training for acquiring prevention and control measures in prisons, but there was no training for the social- educational personnel. 166 | PEOPLE-BASED POLICIES release.172 First of all, the imprisonment culture fosters the Between 2007 and 2011, the number of people serving non- persistence of conditions and practices that jeopardize the custodial sentences ordered by the court being handled by the physical and mental health of the prisoners (poor hygiene probation services gradually increased from 7,673 to 12,857 conditions, overcrowding, tattoos, drug use, mostly injection cases. By the time the new criminal code becomes effective drugs, alcohol abuse, violence and psychological abuse in 2014, it is estimated that the number of cases handled by among prisoners etc.). Secondly, upon returning to the the probation services will have reached 34,000 and will community, prisoners may face situations that limit access to jump to 48,400 in the following year. As national figures rise medical and recovery services, especially to major specialized and alternatives to detention are being encouraged by the interventions (such as surgery, anti-TB treatment, psychiatric European Union, the efficient management of the probation treatment), including: stigmatization, lack of medical process for each registered offender is going to require insurance, lack of identity documents or of a stable residence, substantial resources.175 Currently, there is no public sectoral lack of financial resources to purchase medical care. strategy for the probation system. Regulating, developing, and financing of post-detention In this context, partnerships between the probation services, support services at the community level are essential local and/or central governments, and civil society at large can to ensuring the effective inclusion of ex-prisoners. Once become a part of the solution. In many European countries, they leave prison, ex-prisoners tend to become socially EU structural funds are continually used for the social marginalized because of the lack of essential post-detention reintegration of offenders. For now, the cooperation between services at a time when they have little social and economic prisons and the probation system, on the one hand, and capital and they are often stigmatized by the community.173 community institutions, on the other hand, is rather weak. For The National Strategy for the Social Integration of Persons example, according to the legislation in force (Law 275/2006 Deprived of Liberty 2015-2019 envisions the reintegration on enforcement of sentences), prisoners may attend primary, process as a continuum, starting in prison and continuing after lower secondary or upper secondary education levels during release. Existing data suggest that there is a need to target imprisonment. However, the system most often meets the work integration measures to prisoners both while in detention demand for primary education, but for the lower secondary and after their release. Because post-detention services are level, it often stumbles over the refusal of teachers in the currently very scarce, many prisoners who received support community to teach in prisons or over the arguments provided while in detention are deprived of this support once they are by the school inspectorates in the lack of resources to released. There is still no relevant legislation for organizing organize these courses. A study176 from 2011 shows that there post-detention support services. Existing services need to be are local cooperation problems between prisons and a series scaled-up and integrated (for example, those aimed at harm of institutions: probation services (with insufficient human reduction and social rehabilitation) on a continuum that links resources to provide individualized assistance for each inmate the life of the prisoner in detention with his or her subsequent released on probation), Directorates of Social Assistance life in the community. These measures should focus on and Child Protection (that are often reticent to take children reducing the risk of re-offending, on increasing the integration to visit their parents in prisons), Pension Agencies and even of ex-prisoners into the labor market, and reducing the social with NGOs (whose mission may not overlap with the social and institutional stigma associated with the prisoner’s status. insertion needs of the prisoners). Therefore, strengthening the cooperation between prisons, probation offices and local The probation system is responsible for managing the and central institutions which can play a part in the social social reintegration of convicted people with a non-custodial reintegration of prisoners is critical for achieving the targets on sentence by serving as a liaison between the judicial system social inclusion in Romania. (while the sentence is being served) and the community.174 172 ANP (2014b). According to the Social Assistance Law (2011), prisoners could receive, during imprisonment, free educational, social and psychological counseling services and medical care within prisons. These services should be provided in an integrated system with educational, psychological, social assistance, school training and vocational training services, which are delivered the Ministry of Education, the Ministry of Health, the Ministry of Labor, Family and Social Protection or NGOs in partnership with the National Administration of Penitentiaries. During imprisonment, prisoners may also receive counseling on social services available in the community where they will reside after release. The same type of counseling is also available within probation services. In addition, prisons provide harm reduction services (health education sessions, testing for HIV, hepatitis B, hepatitis C, methadone substitute treatment for prisoners with drug addictions), as well as specific measures for social reintegration of prisoners recovering from drug addictions (three therapy communities in Jilava, Rahova and Targsor Prisons). 173 ANP (2014b) - National Administration of Penitentiaries. 174 The probation system operates as part of the judicial system, but it is strongly connected with public, private, and non-profit institutions and organizations that provide social services. The probation system is funded by public sources, but its institutional development has been greatly supported by projects funded from external sources. 175 Probation services provide the following services for individuals on probation: psychological counseling, assistance and mediation employment, further education, access to healthcare and other community support services. 176 Dâmboeanu (2011). Social Services | 167 BOX 23 Labor Market Integration Services for attempt at social reintegration. This is the result Former Detainees in Arad County of understaffing. Only six probation specialists are available in Arad to work with 500 The qualitative research carried out for this background beneficiaries in various categories, with different study confirmed the finding of existing reports and ranges of interventions being involved for each client. documents that few services exist to support former The number of beneficiaries has increased lately and is detainees, either in terms of training and labor market expected to get even higher as a result of the wider range integration services or services aimed at promoting of categories that are now subject to probation according their social inclusion. However, local initiatives in Arad with the new Penal Code and the new Penal Procedure County do exist that aim to meet the needs of this code. The concomitant administrative reform (Law 252 vulnerable social category. /2013) shifted the financing of the system from the local Two main public entities are involved in promoting court houses to the National Probation Directorate within labor market services for former detainees in Arad - the the Ministry of Justice, which led to an additional burden Probation Service (Serviciul de Probațiune), which is being put on existing staff. Now probation staff members primarily responsible for the social inclusion of indicted are expected to handle procedures like budgetary people who are not currently in custody, and the County planning, accounting, or public procurement with no Directorate for Social Assistance and Child Protection proper training. (DGASPC) through a project financed by the Sectoral Nonetheless, the Probation Service in Arad attempts to Operational Program Human Resources Development use a personalized, case-by-case, approach with former 2007-2013 (SOP HRD). In addition, the interviews with detainees in promoting their employment prospects. The the Probation Service representatives carried out as Probation Service has entered into a partnership with part of this background study qualitative research effort the County School Inspectorate whereby beneficiaries indicated that the Arad penitentiary occasionally provides with an incomplete education can access to schools informal limited education and psychosocial support to that deliver Second Chance education programs. Under some former detainees. The County Employment Agency this arrangement, the Inspectorate monitors their (AJOFM) does not specifically deal with this group, and school attendance and results. Occasional support in its role is confined to providing lists with vacant jobs to the the form of clothes, hygiene articles, and subsidies Probation Service or the DGASPC. for transportation costs is also awarded as a result of The Probation Service in Arad was set up as a pilot a partnership with a local NGO. A similar relationship project by the central government in 1997. According with the AJOFM ensures that probationers can access to the 2014 legislation, the Probation Service deals weekly updated job listings. If a probationer is interested with several types of adult clients: (i) indicted people in a particular job, his or her probation officer contacts for whom the judge has requested an evaluation the employer and arranges an interview. The Probation report; (ii) adults whose sentence was suspended; Service also helps beneficiaries to write their CVs and (iii) adults whose sentence was postponed; (iv) adults gives them guidance on how to be interviewed for a job. who were sentenced to educational measures with no Ex-prisoners face several substantial obstacles to custodial sentence; (v) adults who were released from finding employment. There are not enough adequate prison on parole; (vi) detainees or ex-detainees who training courses for ex-prisoners. This is exacerbated request support from the Probation Service; and (vii) by the overwhelming stigma associated with ex- victims of violent offenses. The type of interventions detainees, which means that few employers are and the frequency of the service’s interaction with the prepared to consider them as potential employees. beneficiaries vary according to the category of the Several successful cases were mentioned during the sentence and execution regime. qualitative interviews, but these were considered to be One of the main challenges for probation specialists is exceptions rather than the rule as most beneficiaries do the limited time that have available to work directly with not succeed in finding a job. each beneficiary, which is considered essential to any 168 | PEOPLE-BASED POLICIES BOX 23 (continued) alcohol dependence affects 2 percent of the men and 0.6 The DGASPC in Arad has a specialized department percent of the women.179 There are no other recent survey for promoting the employment of those from data documenting the needs and profile of groups prone vulnerable groups. This department was set up to alcohol abuse. Also, there is no national system of data within the SOP HRD project “Equal Opportunity on gathering and analysis that to allow a periodical estimate the Labor Market” (Șanse egale pe piaţa muncii), of the number of individuals that abuse alcohol (including which aims to increase employment opportunities dependence). Therefore, it is crucial to find ways to identify for individuals with disabilities. The financing these individuals so that preventive measures can be ended in 2012, but the project has a three-year designed and effectively targeted to those most at risk. sustainability period. During this phase, the project At the community level, the prevention actions that has opened up eligibility to all socially vulnerable currently exist tend to be passive, while activities among groups, including ex-detainees. The representatives the school population mostly consist of active interventions. of the DGASPC reported facing difficulties similar to The main measures at the community level are: imposing those encountered by the Probation Service in terms a minimum legal age for alcohol consumption (18 years); of trying to find real employment opportunities for zero tolerance of drunk driving; requiring the media to add ex-prisoners. warnings about the risks associated to excessive alcohol Source: World Bank qualitative study carried out consumption after alcohol advertisements; and banning in July-August 2014 for preparing this background advertising for alcoholic beverages near schools and in the study. media between 6am and 10pm.180 The interventions that are conducted in schools are optional health education courses for those in grades 1 to 12 and the national competition on anti-drug projects “Together” that for more than 10 years has been supporting students in the 9th and 10th grades B. Services for People with to implement their own ideas for drug prevention in high Alcohol Problems schools.181 There is no national system of data collection and analysis Besides the insufficient supply of services, access to that would make it possible to make periodic estimates of existing services is hindered by a variety of factors including the number of individuals who abuse alcohol (including a lack of specialized human resources, lack of information, those who are dependent). The only available estimations and stigma. Over 80 percent of individuals with alcohol of alcohol abuse in Romania come from the World Health problems did not use the services that are currently Organization.177 According to the most recent available data, available because they did not know that they existed. 3.8 percent of men aged 15 years and older and 1.1 percent Those who use these services are usually in an advanced of women in the same age group abuse alcohol,178 while state of alcohol abuse, and most of them are dependent.182 177 WHO (2014a). 178 Alcohol abuse refers to a chronic use that is having medical-psychological-social effects on the individual, as well as to alcohol addiction (WHO, 2014a: 232). 179 In addition, Romania is one of the European countries with the highest number of deaths caused by liver cirrhosis or cancer caused by alcohol consumption (70 to 102 deaths per 100,000 inhabitants in 2013). In 2012, the total amount of fees reimbursed by the National Health Insurance House for patients hospitalized due to health problems related to the harmful use of alcohol was RON 107,487,375.50 – about €25 million. The same year, 1,396 road traffic accidents were reported in which one of the drivers was under the influence of alcohol (WHO, 2013b). 180 In addition, information, assessment, and referral services are also provided by: (i) the Drug Prevention, Assessment, and Counseling Centers (CPECA) of the National Anti-Drug Agency in each county; (ii) the four Infocenters opened by ALIAT in Bucharest, Campulung Moldovenesc, Miercurea Ciuc, and Craiova in partnership with local hospitals; and (iii) the only online health platform for preventing and treating alcohol abuse (www.alcohep.ro) also administered by ALIAT. Between 2010 and 2013, ALIAT implemented its only active prevention measure – Alcoohelp Caravan, a mobile campaign that organizes events in urban and rural communities known for their high alcohol consumption levels. 181 Other than the initiatives of the Ministry of Health, several other public institutions (such as the Drug Prevention, Assessment, and Counseling Centers of the National Anti-Drug Agency) and NGOs implement annual prevention actions aimed at students (such as information sessions in school, competitions, camps, sport events, and cultural events). 182 General physicians usually are not able to make early diagnoses of disorders related to alcohol consumption but only when the disease is quite advanced. Thus, 55 percent of the patients with alcohol-related problems received information on alcohol abuse from their general physician and 44 percent were referred to a specialized service compared with only 2 percent and 3 percent of non-patients (ALIAT, 2011). Social Services | 169 However, the main barrier to accessing these services is in the early identification of alcohol abuse and behavioral the stigma associated with being identified as having an change therapies has been provided mainly by NGOs.186 alcohol problem. 70 percent of specialist doctors, over 50 Intervention is very necessary since, according to the WHO, percent of the beneficiaries of treatment, and 80 percent of for every person who has problems with alcohol, seven the individuals with alcohol consumption problems who did other people are affected (family, relatives, and friends) not use specialized services identified stigma as the main barrier to accessing the services.183 No assessment has been conducted of the efficiency and impact of Romania’s prevention, recovery, and social BOX 24 reintegration measures related to alcohol consumption and abuse. For the school population, the only tool that is Best Practice - Treatment and gathering data on the impact of prevention measures is Social Reintegration Centers for the European School Survey Project on Alcohol and other Alcohol Drugs (ESPAD), to which Romania has contributed since Two treatment and social reintegration 2004.184 However, there are no studies that have measured centers were established in 2011 in Bucharest and the impact of passive or active measures to prevent alcohol Targoviste under the coordination of ALIAT, an NGO, consumption and abuse among adults.185 with co-financing from the European Social Fund. Currently there is no national strategic document for the These centers provide case selection and assessment prevention, recovery, and social reintegration of individuals services (psychiatric evaluations, assessments of with alcohol abuse problems. In principle, reducing demand the patients’ level of consumption, and personalized for alcohol is one of the goals of the National Anti-Drug intervention plans), personalized treatment Strategy, and it has also been, over time, a component of (psychological counseling for patients to increase various national programs implemented by the Ministry of motivation and to prevent relapses and for families Health (including a health promotion program and a mental and children affected by alcohol abuse), and social health program). Nevertheless, there is no institution that assistance (legal counseling, vocational counseling, effectively coordinates all actions related to prevention, assessment of professional competences, access to treatment, and care in this sector. Furthermore, except vocational training, and mediation for employment). for the documents developed by the National Anti-Drug The centers are included in a cross-cutting service Agency (the National Anti-Drug Strategy 2013-2020 and provision mechanism that involves psychiatrists, the National Standards for the Medical, Psychological, psychologists, psychotherapists, social workers, and Social Assistance of Drug Users), there are no educational psychologists, legal advisers, vocational guidelines or protocols governing the integrated treatment counselors, and professional training providers. During of alcohol abuse. The survey performed by the Alliance 2011 to 2014, the two centers helped 1,220 alcohol to Fight Against Alcoholism and Drug Addiction (ALIAT), dependents (of whom 400 also received professional in 2011 indicated that, of all psychiatrists in dependence training) and 440 family members, including children. treatment units, only half had attended training on alcohol ALIAT also wants to train 750 general physicians in dependence in the previous three years, and about one- Bucharest-Ilfov and South-Muntenia to recognize the third had never attended any such training. The percentage early signs of alcohol dependence and to apply short- is even higher among general practitioners and those with term interventions that could reduce the patient’s level other medical specialties who can play an important role of dependence. in referring individuals with alcohol abuse problems to the specialized services, with 65 percent never having had any training on this topic. Up until now, training for specialists 183 ALIAT (2011). 184 Hibell et all (2012). 185 Although the implementation of the National Anti-Drug Strategy 2005-2012 (ANA, 2005a) had a final assessment in 2012, it focused on assessing measures to reduce demand for and supply of illegal drugs and did not include alcohol. 186 For example, in 2013, ALIAT implemented two training programs for specialists in the medical and psychosocial areas working with individuals with alcohol abuse. Over 130 general practitioners participated in a residential training session on the early identification of and short interventions in disorders related to excessive alcohol consumption, and 24 specialists were trained in the use of art therapy and cognitive-behavioral therapy techniques (ALIAT, 2013). 170 | PEOPLE-BASED POLICIES on average. Furthermore, recent UNICEF studies187 have Among high-risk drug users, injection drug users (IDU) are shown that child nutrition, child neglect and/or abuse, and highly vulnerable from a social point of view.191 Injection drug child separation from the family are strongly associated use makes individuals prone to blood-borne infections (such with parents’ alcohol abuse. as HIV, hepatitis B, and hepatitis C), to tuberculosis, to living in poor conditions, and to unemployment. The available This background study recommends that the government data indicate that there was an increase in 2012 of the draft a multi-sectoral integrated strategy for the prevention prevalence of hepatitis B, hepatitis C, and HIV among IDUs, and counteraction of alcohol abuse both among adults and with the last two exceeding the European averages.192 minors. This national plan should be accompanied by a clear methodology for monitoring and assessing the outputs and outcomes of prevention, assistance and recovery BOX 25 measures for people with alcohol abuse issues. Profile of Injection C. Services for Drug Users Drug Users While there are data on the prevalence of lifetime illegal In 2012, the average heroin user had drug use in the general population, there is no clear the following characteristics: male, aged evidence to indicate how many high-risk drug users (or between 30 and 39 years old, with a low level of problem users) there are at the national level. According education. Most had asked for help on their own to the latest available data for 2010 provided by the initiative. Most had a stable home, living with their National Anti-Drug Agency,188 show that 4.3 percent of the parents or family and, in general, had no income as Romanian population aged 15 to 64 years report having they were unemployed. Most started using drugs used illegal drugs at least once (including psychoactive between 15 and 19 years of age and had been substances sold under the label of “ethnobotanical plants,” using for a long time (at least six years) and had which were legal at the time of the survey) and about previously requested treatment for psychoactive another 4 percent reported having used medication without substance use. They tended to inject heroin daily a doctor’s recommendation (tranquilizers, sedatives, and (with most having injected in the 30 days prior to antidepressants). The most commonly used drugs were their admission to treatment), and most only used “ethnobotanicals” and cannabis, followed by ecstasy, heroin (in other words, there was no polydrug or heroin, and cocaine - in decreasing order of frequency.189 secondary drug use). Problem drug users or high-risk drug users are the main The average new psychoactive substances (NPS) targets of government policies designed to reduce drug- user has the following characteristics: male, aged related vulnerabilities. High-risk drug use was defined under 40 years old, with a low level of education, by the European Monitoring Center for Drugs and Drug user of emergency medical care, lives with the Abuse in 2012 as “recurrent drug use that is causing parents/ family in stable homes, most probably actual harms (negative consequences) to the person without an income or a pupil/student. About one (including addiction, but also other psychological or health out of every three NPS users started using before problems) or is placing the person at a high probability/ reaching the age of 19. Most of them have been risk of suffering such harms.”190 According to the Romanian using NPS for a maximum of two years, most often legislation (Law 143/2000 as revised), high-risk controlled by injection, and have experimented with polydrug substances include opiates, cocaine, fentanyl, derivatives, use (also using alcohol, opiates, or cannabis). and “ethnobotanicals.” Substances such as cannabis and barbiturates are in a different category - “risk substances.” Source: ANA and EMCDDA (2013). 187 Such as Klingemann (2001), Stănculescu et al (2012). 188 ANA and EMCDDA (2013). The latest survey to gather data on prevalence was carried out by the National Anti-Drug Agency in 2014, but these data are not yet available. 189 Drugs are associated with different social-demographic profiles. For example, medication without a prescription and solvents are most often used by adult women between 45 and 64 years old. Heroin and cocaine are most common in the Bucharest-Ilfov, West, and Center regions, while solvents/inhalants are mostly used in the West, South-West, Bucharest, North- East, and North-West. There are also drugs that are used in almost all regions – ethnobotanicals, cannabis, and ecstasy. 190 EMCDDA (2012). 191 Iliescu and Georgescu (2013). 192 Abel-Ollo et al (2014). Social Services | 171 Measures for the social reintegration of high-risk drug users BOX 26 have a two-fold aim: (i) to reduce the physical and mental health harm associated with injection drug use (including Integrated Care HIV, hepatitis B or hepatitis C infections, overdoses, for Addiction abscesses on injection sites, and neuro-cognitive harm) and (ii) to support and encourage users to give up drugs As of 2013, the following addiction care and recover their lives. Most of these initiatives in Romania services were available in Bucharest and Ilfov: • have been projects implemented by NGOs and/or state organizations.193 The number of these services decreased F  ive medical units of the Ministry of Health, significantly in 2010 when the programs financed by the of which three provide rehab services and Global Fund to Fight AIDS, Tuberculosis, and Malaria and medical and psychological care and two by the United Nations Office on Drugs and Crime (UNODC) provide outpatient care including medical, ended. Specialists estimate that this reduction in services is psychological, and social assistance and among the main factors leading to the HIV outbreak among substitute treatment with methadone, suboxone, or naltrexone for opiate addiction • users during 2010 to 2013.194 In order to provide a coherent policy response, there is a  hree centers of the National Anti-Drug T need to further develop integrated addiction care services Agency providing medical, psychological, and social care for outpatients and integrated care (medical, psychological, and social assistance) at the for addictions, including substitute treatment national level.195 At present, only Bucharest and Ilfov with methadone, suboxone, and naltrexone have a wide range of services, including harm reduction for opiate addiction measures available both within the community and during imprisonment.196 Although service providers and academics active in the field have drawn the government’s attention • T  hree centers/private practices in Bucharest (run by the National Association for Drug Addiction Intervention, PSYMOTION, and to the need for specialized harm reduction and social D&C Medical) providing integrated care for reintegration services for minors with drug use problems, no addictions including substitute treatment for measures have been taken so far in this regard. opiate addiction for outpatients To ensure the social integration of problem drug users (PDUs), the health services should be integrated with or strongly linked to social rehabilitation services.197 •  wo centers in Bucharest called Arena and T Titan managed by ARAS, an NGO, and providing integrated care for addictions Psychological counseling/ psychotherapy and social (including substitute treatment for opiate addiction) for outpatients • support should be provided to PDUs before and after they undergo specific drug treatments, especially to those PDUs  wo centers of the National Administration of T with neuro-cognitive impairment caused by chronic drug Penitentiaries located in Jilava and Rahova use. Currently, there are not enough services available to prisons providing integrated care for addicted PDUs living in the community or for those in prison. prisoners (including substitute treatment for opiate addiction). Preventive services, mainly in the education and health sectors, are vital for reducing the use of drugs as well as the harmful consumption of tobacco and alcohol among teenagers. Policymakers should consider: (i) introducing adequate educational policies aimed at preventing risky behavior among teenagers and (ii) increasing the provision of health counseling and family planning services to teenagers. 193 For example, during 2010-2013, ARAS (Romanian Association against Aids), an NGO, implemented a project that helped ex-injection drug users to be reintegrated into the labor market by means of qualification training, professional counseling and guidance, and mediation for employment. However, these activities came to an end once the project closed. 194 Institutul Național de Boli Infecțioase ”Prof. dr. Matei Balș” (2013), ANA and EMCDDA (2014), and Andrus et al (2014). 195 The principles underlying the organization and provision of services for drug users in Romania are presented in Annex 5, Section V. 196 ANA and EMCDDA (2014) and Andrus et al (2014). 197 EMCDDA (2003), ECDC and EMCDDA (2011), EMCDDA (2012). 172 | PEOPLE-BASED POLICIES D. Services to Reduce the Risk trafficked (77 percent), as were individuals with low levels of education (47 percent with a lower secondary education of Becoming a Victim of Human at most), and minors (48 percent).200 However, there is Trafficking insufficient systematic information on the characteristics of trafficking in human beings. Except for statistics gathered Available evidence suggests that women and individuals and provided by the public authorities, there have been with a low social and economic status are highly vulnerable few recent studies (in the past five years) that describe to the phenomenon of human trafficking in Romania.198 The the profile and needs of the groups most vulnerable to highest numbers of cases are registered in counties in the trafficking or of the individuals who become victims. North-West, South-West, West, and Center regions. The recent statistical analysis of the identified victims of The 2014 report199 of the National Agency against human trafficking during the period January 1 to June Trafficking in Human Beings (ANITP) showed that there was 30, 2014 issued by ANITP201 confirms that the social and a general decrease in the number of victims of trafficking demographic trends presented above were continuing in in human beings in 2013 compared to previous years, as 2014. well as a decrease in the ratio of victims from rural areas. As in previous years, in 2013 women were more likely to be TABLE 30: Number of the Identified Victims of Human Trafficking Identified victims* Trend Traffic victims Trend (number) (previous year) (number) (previous year) 2013 896 -14% 419 -24% 2012 1,041 -1% 554 -9% 2011 1,048 -9% 606 -3% 2010 1,154 +32.5% 626 +94.5% 2009 780 -37% 322 +0.4% 2008 1,240 -30% 321 Source: ANITP (2014a). Note: *Victims identified in 2013 = victims of traffic and identified in 2013 + victims of traffic of previous years, but identified in 2013. Romania’s system for dealing with victims of human exploited children, those facing labor exploitation risks, child trafficking should be built around the inter-institutional victims of human trafficking, migrant Romanian children, National Identification and Referral Mechanism, which is a and victims of other types of violence in the territory of other cross-cutting and inter-institutional tool for keeping track of states.202 The National Agency against Trafficking in Human 198 Trafficking in human beings (Article 165 in the Romanian Criminal Code) refers to recruiting, transporting, transferring, sheltering, or receiving an individual for commercial or non- commercial sexual exploitation, through forced labor or services, in slavery or slavery-related circumstances, for using them in armed conflicts or in criminal activities, for using organs or tissue for transplants, perpetrated by means of: threats of using physical or psychological violence not dangerous for the life or health of the individual, including kidnapping, confiscation of documents or servitude, with the purpose of paying a debt of an unreasonable amount; deceit; abuse of vulnerability or abuse of power, giving or receiving payments or benefits to obtain the consent of an individual holding control over another individual, using dangerous violence for the life, physical or mental health of the individual; by using torture, inhuman or degrading treatment in order to subdue the individual or by rape, physical dependence, weapons, threats of disclosing confidential information to the victim’s family or to other individuals, as well as by other means. 199 ANITP (2014a). 200 The highest number of victims of human trafficking was found in Mures county (with over 40 victims) and in Iasi, Dolj, Olt, Brasov, Bihor, and Timiş counties (with between 21 and 40 victims). At the other extreme, no cases were reported in 2013 in Maramures, Harghita, and Vrancea counties. For more details, see Map3. In general, women victims of trafficking in human beings are subject to sexual exploitation and men become victims of forced labor in agriculture and construction. The available data do not include the number of foreign citizens identified as victims of human trafficking in the Romanian territory. 201 ANITP (2014b). 202 Described in GD 49/2011. Social Services | 173 Beings (ANITP) within the Ministry of Internal Affairs203 centers, minor victims are sent to general child care services is the central institution that coordinates, monitors, and (within the DGASPC), which are not qualified to provide assesses policies on human trafficking.204 Currently this specialized assistance to victims of human trafficking.207 system functions poorly in terms both of identifying victims On the demand side, the existing services are accessed by and of referring them to protection and assistance services. a very low number of victims, partly also because some Therefore, a review is necessary to determine to what extent services for victims limit their rights. The US Embassy’s the decrease in the number of identified victims is due to 2014 report pointed out that, although there are assistance an actual decline of the phenomenon or to shortcomings in centers and protection services in each county, only one the functioning of the National Identification and Referral in every three registered victims in 2013 (291 people) Mechanism. benefitted from specialized protection, assistance, and The available services designed to prevent and counteract reintegration services. According to the legislation, victims human trafficking and to protect and socially reintegrate are accepted in residential reception centers at their own victims have very little capacity to carry out their request. Nevertheless, victims complain that their freedom of mandates.205 The various prevention efforts developed by the movement is restricted while they are being accommodated public authorities and NGOs are not coordinated or long-term in these centers. In addition, there are cases when, although and do not have national coverage. The only permanent beneficiaries are entitled to free medical care, their access to intervention is the Helpline set up by ANITP, a free number specialized medical care is restricted if they do not have any where anyone can call to ask for information about the rights insurance or identity documents. of victims of human trafficking and about what services are To sum up, reducing the risk of becoming a victim of human available in the country. A 2012 report by the Ministry of trafficking requires integrated and multi-sector initiatives Internal Affairs206 showed that the capacity to monitor and since the risk is dependent on a variety of factors – gender, evaluate prevention measures in human trafficking and the age, the family environment, living conditions, personal support given to victims is quite low. This finding points up values, and the level of economic development in the area the lack of up-to-date and complete data to enable analysts where the victim lives.208 Because of limited available to come to an accurate estimate of the phenomenon and of resources and institutional capacity, the initiatives that the need for services for victims as well as the lack of any are currently being implemented in the country are not impartial assessments of the impact of national policies in sufficiently integrated, lack continuity, and have only limited this field. Currently, the main report assessing the results of coverage. Efforts to increase public awareness of the risks national policies in this field is the one drafted annually by the and forms of human trafficking need to be continued. Human US Embassy in Romania. trafficking prevention initiatives must be scaled up and further The US Embassy’s latest report for 2014 shows that the developed at both the national and local levels through number of psychologists working in existing services is awareness campaigns, hotlines, school programs, and the low compared to the need, even though psychological distribution of modern and interactive information materials. assistance is one of the main ways of supporting victims of human trafficking. There are only six transit centers for E. Services for Reducing the Risk of unaccompanied minors or victims of human trafficking in Becoming a Victim of Violence the country, although children account for almost a half (48 percent) of the victims. None of these transit centers There is a strong need to gather more evidence on the size for minors are in Bucharest, even though a large share of and characteristics of domestic violence209 in Romania. As the victims are repatriated by plane and arrive at Bucharest is the case in other countries, the official statistics on this international airport. When not referred to one of the six transit phenomenon are contradictory between institutions with 203 In 2012, this ministry was the Ministry of Administration and Interior. 204 ANITP has 15 regional centers in counties with Courts of Appeal: Oradea, Cluj, Suceava, Iasi, Bacau, Mures, Alba, Timiş, Craiova, Arges, Brasov, Galati, Prahova (Ploiesti), Constanta, and Bucharest. The main responsibilities of the regional centers are to diagnose and monitor the phenomenon (including gathering data on each identified victim), to refer the victims to protection, assistance, and social reintegration services, and to coordinate the activities of public and non-governmental actors active in this field in the region. Victims who ask that their identity be protected or who refuse support are registered as anonymous cases for statistical purposes. 205 The organization and types of services for victims of human trafficking in Romania are presented in Annex 5 Section VI. 206 Ministry of Internal Affairs (2012). 207 United States Embassy in Romania (2014). 208 Preda (coord., 2009). 209 According to the Romanian legislation (Law No. 271/2003), domestic violence offences cover a broad spectrum from family abandonment, deprivation of freedom, threat to commit serious injuries, murder, and attempted murder. 174 | PEOPLE-BASED POLICIES MAP 3: Counties of Origin of Victims of Human Trafficking, 2014 Source: ANITP (2014b). Social Services | 175 different roles (prevention, assistance, and regulatory).210 victims of domestic violence and attackers; (iv) developing A comprehensive methodology for registering the number psychotherapeutic and behavioral change measures for of individuals (victims and attackers) to compare with the children with behavioral disorders (involving violence, number of offences or number of cases brought to court school dropout, and delinquency); (v) training teachers, by victims still needs to be developed. Currently, the main medical personnel, and social staff on the procedures for available statistics are those on the number of victims of identifying and referring cases of domestic violence to domestic violence who access social services (managed specialized services; and (vi) carrying out public awareness by the MLFSPE)211 and those on the number of offences campaigns to publicize the prevalence and effects of involving domestic violence (under the responsibility of the domestic violence along with campaigns to change General Inspectorate of the Romanian Police). Moreover, attitudes and behavior based on the changing social norms there are also data belonging to the Ministry of Justice on in Romania with respect to domestic violence. the number of files related to incidents of domestic violence, Few NGOs and public-private partnerships are providing including files in which victims filed for a restraining services aimed at preventing and counteracting domestic order against the attacker. Nevertheless, due to the high violence. Of all available social services215 for victims of tolerance toward domestic violence among both the general domestic violence and attackers most are organized by population and the authorities, there are also numerous public institutions (65 percent), about one-third by private “invisible” cases that are not reported or included in actors (such as NGOs or for-profit organizations), and only statistics.212 3 percent are public-private partnerships according to There are no national continuous measures to prevent213 MLFSPE data for 2012. domestic violence (including emotional abuse and The capacity of social services for victims of domestic child abandonment) and to reduce risk factors, such as violence is low compared to the EU standards, both in addiction, disability, mental health problems, and economic terms of service availability and specialized personnel. EU dependence. According to the European network Women standards recommend that there should be one place in a Against Violence (WAVE),214 Romania is one of the nine specialized shelter per every 10,000 inhabitants. Given the member states within the EU-28 that do not have a national current size of the population of Romania, this would mean Helpline for identifying cases of domestic violence against there is a need for 2,000 shelter places. However, the total women and referring the victims to specialized services. number of available shelter places is much lower, with 14 International experience has shown the efficiency of out of the 41 counties of the country having no residential enacting integrated initiatives combining the prevention of services specialized in victim protection. In 2012, only 689 domestic violence with measures to reduce it. Thus, this women and 1,136 children were offered a place in a shelter, document recommends that the government consider which amounted to only about one-quarter of the potential implementing the following measures between 2014 and demand (the 7,530 women, children, and men who are on 2020: (i) developing psychotherapeutic and behavioral the records of specialized services).216 Furthermore, only change interventions for families affected by alcohol or some of the victims who were placed in residential units in substance abuse; (ii) creating more initiatives like “School 2012 were offered any services such as: psychological and for the Parents” (which informs and trains parents on legal counseling (595 people), assistance in and counseling topics regarding raising, caring for, and educating children for finding a job (478 people), counseling and assistance focusing on adopting positive practices); (iii) developing for increasing their personal safety after leaving the center psychotherapeutic and behavioral change measures for (445 people), or support at court hearings (82 people). 210 In 2013, 4,619 domestic offences were registered in the criminal files. Most offences (2,900 cases) consisted of family abandonment, but it is just as worrisome that almost one in every five offences fell under “beating or other types of violence” (864 cases) and injuries (57 cases), while 4.7 percent of total offences consisted of murder (115 cases), death inflicted by beating or injuries (20 cases), and attempted murder (73 cases). These statistics do not show, however, the number of individuals involved (victims and attackers) as the same file may involve one victim and several attackers, several victims and one attacker, one victim, or one attacker and several offences (General Inspectorate of the Romanian Police, 2014). The number and profile of victims and attackers also are not recorded in the data on the number of cases brought to court by victims in order to receive a restraining order (2,453 files in approximately 14 months during 2012 and 2013). MLFSPE (2012) and Transcena (2013b). 211 According to MLFSPE data, in 2012, the number of victims of domestic violence registered with social services was 7,000 individuals, of whom 2,575 were women, 4,955 were children, and 898 were men. 212 For example, Stănculescu and Marin (2012). 213 We define this as measures that prevent violence or generate circumstances that reduce the possibility that an individual will become a victim or an attacker. 214 Lesur et al (2014). 215 The organization and types of services for victims of domestic violence in Romania are presented in Annex 5, Section VII. 216 The shelter deficit is also mentioned in the WAVE 2013 report (Lesur et al, 2014), which estimates that 2,012 shelter places were needed for women victims in Romania in 2013 but only 590 were available. 176 | PEOPLE-BASED POLICIES Not only are there few services available, but victims of psychological fatigue that is naturally involved with working domestic violence face an additional hurdle in trying to with victims of violence. access them. Romanian law requires that victims need On the policy side, there is much room for improvement in to have a forensic medical certificate both to obtain a terms of turning the restraining order into an efficient and restraining order against their attackers and to qualify for a effective tool for protecting victims of domestic violence. place in a residential shelter.217 This certificate costs around The key problems relate to: (i) access to information; 40 lei and thus is unaffordable for many victims. There (ii) the timeframe for issuing a restraining order; and (iii) have been a few initiatives aimed at making it easier for the type of restrictions included in the restraining order. victims to obtain a forensic medical certificate, but these Victims often do not have sufficient information on how initiatives have been local and short-term and have covered to obtain a restraining order or its consequences.223 only a limited number of cases.218 Thus, the measures Moreover, the restraining orders take too long to be issued recommended by this book for 2014 to 2020 include: (i) (on average between 20 and 60 days).224 Furthermore, ensuring that all victims of domestic violence can access even if a restraining order is issued, it may be insufficient specific services, including those designed to support (for example, requiring the attacker to stay only 1.5 addicts, people with disabilities, and people with contagious meters – or about 5 feet – away from the victim) or may illnesses or behavioral disorders, either by adapting existing include contradictory restrictions (for example, requiring services to meet the needs of these groups or by developing the attacker to stay 50 meters or 160 feet away from new services; (ii) ensuring that all victims of domestic the victim but not requiring either the attacker or the violence have access to a forensic medical examination by victim to move out of their joint home). This suggests a providing them with information on and covering the costs lack of a coherent understanding by the courts of the of the examination; and (iii) conducting studies of the factors role that should be played by this tool in preventing and that influence victims’ access to specialized services. counteracting domestic violence. The current way in which In terms of specialized personnel, services provided to courts are applying the legislation regarding the issuing victims of violence rely heavily on volunteers. A recent restraining orders is having a negative impact on the efforts study219 by an NGO showed that about a quarter of to prevent and counteract domestic violence.225 Making individuals working in services for victims of violence are the restraining order a more effective tool for protecting volunteers, most of whom are working as administrative victims of domestic violence, our background study staff, social workers, and psychologists.220 As a result, there recommends the following priority actions: (i) developing are significant differences between similar services in terms nationwide interventions (such as awareness campaigns of the number and qualifications of their available staff. and information services) aimed at providing victims of There are residential centers that have only two employees domestic violence with information on their rights and way (a psychologist and a social worker), while others have 11 of using and applying restraining orders; (ii) increasing the employees.221 Participation of staff in continuous training is competences of using it of the staff members who have also low.222 In addition, there is no professional supervision a role in issuing it, by training, by amending/improving system for staff working with victims of domestic violence. methodological guidelines for implementing Law 25/2012 Staff members need feedback on the quality of their on amending and by completing Law no. 217/2003 on interventions as well as support to help them overcome the preventing and counteracting domestic violence; and (iii) 217 Law 25/2012 requires a forensic medical certificate to be issued before a victim of domestic abuse can file for a restraining order against her or his attacker. 218 For example, based on a cooperation protocol between an NGO and the Institute for Forensic Medicine in Bucharest, about 100 women victims received free forensic medical examinations during 2012 and 2013. Also, certain public services cover the costs incurred by victims of obtaining these certificates from their own budgets. 219 Transcena (2013a). 220 The fewest numbers of volunteers are social workers, counselors, and doctors. These services are also staffed by nurses, teachers, and legal advisors (Transcena, 2013a). 221 Most residential centers have between four and eight employees (Transcena, 2013a). 222 Participation in continuous training is most frequent among counselors (64 percent of them attended training in 2011 to 2013) and psychologists (about a half of them attended training in 2012) both in residential and non-residential services. Furthermore, only 11 percent of the employees of residential centers attended training between 2011 and 2013 (Transcena, 2013a). 223 A recent study shows that about a half of the requests submitted by victims are accepted by judges, the rest being either rejected (predominantly) or withdrawn. The main reason that judges give for rejecting a restraining order is that the request has been inaccurately or only partially filled in (Transcena, 2013b). 224 The victim must first be medically examined by an emergency unit, then she must get a forensic medical certificate attesting that the physical aggression occurred, and then she must file the request in court. Apart from the forensic medical certificate, the victim must also gather other types of evidence, such as evidence of a complaint filed previously. For non-urgent cases, restraining orders can even take more than 60 days to be issued (Transcena, 2013b). 225 For example, the same Transcena studies (2013a and 2013b) showed that victims may withdraw their request for protection or may refuse to access specialized services because they fear their attacker or do not want to be stigmatized as a victim. The staff in services that assist victims of domestic violence feel at risk of being themselves subject to the violence of the attackers against whom they have no protection. In addition, the police often find it difficult and sometimes impossible to enforce a restraining order with contradictory provisions. Social Services | 177 reducing the social stigma that often becomes attached to how services in shelters or in recovery centers contribute to victims of domestic violence by introducing information and improving the quality of life of the beneficiaries, or the cost- awareness campaigns and education programs in schools. effectiveness of services for women, children, and attackers. The government’s monitoring and evaluation capacity at Law 292/2011 requires that social services for victims of the central level needs to be enhanced. The key policy domestic violence should be delivered in an integrated measures aimed at preventing and counteracting domestic system that takes into account all aspects of the issue violence in Romania are included in the National Strategy medical, psychological, social, and legal. An integrated for the Prevention of and Fight Against Domestic Violence approach should also be taken in developing cost standards 2013-2017, GD 1156/2012.226 This strategy is designed for these services, but this is not currently the case. For as a cross-cutting effort under the coordination of the example, the costing for residential centers does not include MLFSPE in partnership with the Ministry of the Internal the costs of acquiring forensic medical certificates or of Affaires, the Ministry of Health, and the Ministry of Justice. providing hygiene and health products for beneficiaries.227 However, there are no studies that assess the results and Also, similar services can have different standard costs. For impact of the measures that are being implemented as example, recovery centers have higher costs per beneficiary part of the strategy. There is no mechanism for assessing than emergency reception centers, although both types of the impact and outcomes of services and campaigns units provide similar services.228 Thus, the standard costing aimed at preventing and counteracting domestic violence. of services for victims of domestic violence needs to be Specifically, the government has no feedback to inform its revised in order to improve the quality and increase the future programming on such important topics as the impact affordability of services as well as their efficiency. of prevention campaigns on target groups, whether and 226 MLFSPE (2012). This Strategy has the following priorities: (i) providing a coherent and functional legal framework; (ii) promoting harmonized work practices among social services provided to victims of violence; (iii) developing services by increasing their coverage and the number and qualification of their specialists; and (iv) promoting a non-violent culture. 227 Transcena (2013a). 228 MLFSPE and SERA Romania (2012). 2 PEOPLE-BASED POLICIES 2.4. Education The government should focus on ensuring equality of opportunity to quality education for all children. Special attention should be paid to the quality of education and training and to their relevance to the needs of both the labor market and of individuals. Main Objectives 2.4. Education 180 2.4.1. Improving the Early Childhood Education and Care System 182 2.4.2. Increasing Participation and Improving Outcomes in Primary and Secondary Education for All Children 186 2.4.3. Promoting Broader Access to Tertiary Education by Under-represented Groups 197 2.4.4. Increasing Access to Lifelong Learning and Training for Disadvantaged Youths and the Working Age Population 197 2.4.5. Increasing Access to Quality Education for Children from Vulnerable Groups 198 2.4.6. Enhancing the Effectiveness of Welfare Programs in Education 216 180 | PEOPLE-BASED POLICIES 2.4. Education The discussion in this chapter is organized by education ESL Strategic Framework.) The OECD report presented level with a special focus on increasing the access of worldwide evidence that supporting disadvantaged students children in vulnerable situations to high quality education. and schools strengthens the capacity of both individuals and The contents of this chapter are in line with a 2012 OECD society to respond to recession and contributes to economic report229 on Equity and Quality in Education and with the growth and social wellbeing. The World Bank’s ESL Strategic World Bank’s Draft Strategic Framework to Reduce Early Framework set out the main strategic directions for achieving School Leaving (ESL) in Romania.230 (The Draft Strategic the European Union’s Europe 2020 target of reducing the Framework to Reduce Early School Leaving (ESL) in rate of early school leaving231 from 17.3 percent in 2013 to 11.3 Romania will be referred to hereafter in this chapter as the percent by 2020. BOX 27 Improving Equity and Quality The OECD report made five in Education recommendations for preventing failure and promoting completion of upper secondary In 2012, the OECD produced a report titled Equity education: (1) eliminate grade repetition; (2) and Quality in Education, which demonstrated that avoid early tracking and defer student selection until improving equity and reducing school failure rates the upper secondary level; (3) manage school choice can pay dividends because education is an engine to avoid segregation and increased inequities; (4) of economic growth. One of the most efficient make funding strategies responsive to students’ and educational strategies available to governments is schools’ needs related to inclusiveness; and (5) design to invest in all levels of education from pre-school to alternative and equivalent education pathways at the upper secondary to ensure that all students to have upper secondary level to ensure completion. access to quality education throughout the cycle, that they stay in the system until at least the end of upper The report made an additional five recommendations secondary education, and that they acquire the skills related to helping disadvantaged schools (those with and knowledge needed to participate in society and higher proportions of disadvantaged students) to in the labor market. Governments can prevent school improve. These were to: (6) strengthen and support failure and reduce dropouts by taking two parallel school leadership; (7) stimulate a supportive school approaches: eliminating system-level practices that climate and environment for learning; (8) attract, hinder equity and targeting support to low-performing support, and retain high quality teachers; (9) ensure disadvantaged schools. Students from poor families the use of effective classroom learning strategies; and are perhaps the most disadvantaged. PISA 2012 (10) link schools with parents and local communities. results in both reading and mathematics showed In addition, education policies need to be aligned with about a 100-point difference in scores between the other government policies, such as those on housing top and bottom 20 percent of 15 year olds based on or welfare, to ensure student success. their socioeconomic status, which is equivalent to an academic gap of about 2.5 years. Source: OECD (2012a: 9-12). 229 OECD (2012a). 230 World Bank (2014b). 231 Early school leaving (ESL) is defined in Romania as the percentage of 18 to 24 year olds who have completed at most lower secondary education (equivalent to grade 8) and are no longer in education/training. Those who have completed compulsory education, which is equivalent to completing grade 10 according to Romanian law, are not included in the ESL definition even though they have not completed upper secondary education (grade 12). Education | 181 The key issues concerning the education sector232 in Romania are related to the quality of education and training and • C  hildren and young people aged between 11 and 17 years old. • their relevance to the needs of both the labor market and of individuals. The challenges that need to be addressed relate C  hildren and young people from families with low to: (i) school enrollment and attendance in early education; socioeconomic status. • (ii) participation in tertiary education; and (iii) participation in lifelong learning.233 Policymakers in the education and  Children and young people from rural areas. • training sector should aim for smart and inclusive growth in order to prevent and reduce early school-leaving and to R  oma and other marginalized and under-represented ensure greater participation in the tertiary sector and in lifelong groups. learning. The ESL Strategic Framework emphasizes the need The ESL Strategic Framework proposes four pillars and six to prioritize support for those groups at risk of leaving school flagship programs aimed at reducing early school leaving in early. In the absence of this support, the primary objective of Romania during the 2014-2020 period as seen in Table 31. the ESL Strategic Framework is likely to fail or at least to be compromised. The Framework defines the following groups in Romania as being at risk of leaving school early and, thus, as the intended targets of the proposed interventions: Summary of Pillars, Flagship Programs, and Thematic Areas within the ESL Strategic TABLE 31:  Framework Thematic Area Pillar 1: Ensure That All Children Go To School And Receive A Quality Education Flagship Program 1.1: Increase Access To Early Childhood Education And Care P Flagship Program 1.2: Provide Access To Quality Primary And Lower Secondary Education For All PI Pillar 2: Ensure That All Children Complete Compulsory Education Flagship Program 2.1: Develop Early Warning Systems And Consolidate Remedial And Support Programs For PI Students At Risk In Compulsory Education Flagship Program 2.2: Increase The Attractiveness, Inclusiveness, Quality, And Relevance Of Vocational Education I And Training (Vet) Pillar 3: Bring Early School Leavers Back To School Flagship Program 3.1: Provide An Adequate Supply Of Quality Second-Chance Education Programs C Pillar 4: Developing Appropriate Institutional Support Flagship Program 4.1: Strengthen The Capacity Of The Government To Implement And Monitor And Evaluate The P Early School Leaving Reduction Strategy Source: World Bank (2014B: 9). Note: *P = Prevention, I = Intervention, C = Compensation. 232 Education in Romania is compulsory for 11 years, starting at primary education, and covering lower secondary education and the first two years of upper secondary education (grades 9-10). The Romanian pre-university education system covers: (i) early childhood education (0-6 years); (ii) primary education (grades 0-4); (iii) lower secondary education/gymnasium (grades 5-8); and (iv) upper secondary education (grades 9-12 or 9-14, depending on the stream:theoretical, vocational, and technological). The entire upper secondary education cycle (provided in high schools) is expected to become compulsory by 2020. Tertiary education includes university and non-university education. The student assessment and evaluation system includes two milestones that determine transitions into upper levels: a national grade 8 exit exam, and the Baccalaureate at the completion of upper secondary education/ gymnasium, which is mandatory for entrance into universities, but not mandatory for graduation from upper secondary education or entrance into non-university tertiary education. 233 Ministry of European Funds (2013). Each of the three challenges was supposed to be developed and programmed within several separate strategies: the Strategy for the Reduction of Early School Dropouts, the Strategy for Tertiary Education, the Strategy for Lifelong Learning, and the Strategy for the Development of Educational Infrastructure. 182 | PEOPLE-BASED POLICIES In line with this approach focusing on the groups of children and slightly decreasing to 85.5 percent in 2012.237 and youths most at risk and on disadvantaged schools, this Discrepancies between rural and urban areas have chapter provides additional information that will be useful continued, though they have decreased every year.238 in designing effective policies to ensure that each child Romania has been performing better than some of its will remain in education and training until at least 16 years southern and eastern neighbors, but its enrollment rates of age and will complete at least grade 10.234 The chapter are still lower than the EU-28 average and they have is organized by education levels with a special focus on little prospect of achieving the EU target of 95 percent. In increasing access to quality education for children in designing policies to increase equitable access to ECEC, vulnerable situations. policymakers will need to take into account two key facts: address (i) the 15 percent of preschool-aged children (4-6 2.4.1. Improving years old) deprived of early childhood education, and (ii) the inequalities in the quality of early childhood education for the Early Childhood those who have access to it. On the supply side, the reduction in the number of Education and Care kindergartens, as part of the government’s cost- System rationalization of the education sector, has affected children in rural and urban settlements unequally. As smaller kindergartens were moved to the centers of communes Early childhood education helps children to reach their in order to reduce costs, smaller villages and hamlets full potential and is a key factor in determining their with fewer preschool-aged children were left without any later performance in school and in the labor market. It preschool establishments. This situation has prevented has become commonplace in educational literature to many children living in these settlements from attending emphasize the importance of good quality early childhood early childhood education not only because of the costs education and care (ECEC) for a child’s ability to adjust to involved but also because of the long travel distances the school environment, to acquire skills, and to perform involved. The ESL Strategic Framework emphasizes the well in rewarding occupational positions. Evidence also importance of increasing access to ECEC services. The shows that access to good quality ECEC increases measures proposed in that report aimed to consolidate educational achievement and reduces the risk of early the steps taken by the Government of Romania in two key school leaving. According to the latest PISA survey, “Across areas: (i) expanding the institutional framework to cover OECD countries, students who reported that they had children between 0 and 6 years of age and (ii) training attended pre-primary school for more than one year scored teachers and inspectors to execute the new curriculum 53 points higher in mathematics – the equivalent of more and inclusive teaching methodologies in ECEC Moreover, than one year of schooling – than students who had not the ESL Strategic Framework proposes the creation of a attended pre-primary education.”235 According to a recent flagship program to introduce a mix of mobility schemes study,236 increasing participation in pre-primary schooling and financial incentives to encourage new teachers from 0 to 100 percent could result in a 6.6 percent increase to volunteer for preschool posts in remote, rural, and in GDP. disadvantaged areas. After a steep positive trend in early childhood education On the demand side, actual attendance rates in rates up to 2008 in Romania, participation rates started to kindergartens in disadvantaged areas seem to be decline. There has been an expansion of early childhood lower than those given by the official records. Although education and care provision for children between the ages Romania’s participation rate in early childhood education of 4 and 6 in the last decade, with the gross enrollment is encouraging in comparison with those of other EU rate significantly increasing from 2001-2002 to 2008, countries, anecdotal evidence from interviews with experts 234 In Romania, completing compulsory education is defined as the completion of Grade 10. 235 OECD (2013b: 14). 236 Checchi et al (2014). 237 At the same time, center-based care for children between the ages of 0 and 3 years old is relatively rare, with only 2 percent of such children being enrolled in nurseries. Increasing the availability of safe and reliable day care centers would increase the extent to which many children would benefit from ECEC, especially those with working mothers who have no family members to serve as caregivers. 238 Arnhold et al (2013). Education | 183 FIGURE 29: Percentage of the Age Group between 4 Years Old and the Starting Age of Compulsory Education 100 93 93 94 92 92 89 91 87 88 87 87 88 90 89 88 87 86 86 80 85 82 83 83 70 75 72 69 60 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Romania EU (28 countries) Source: Eurostat. in the field239 indicates that the actual attendance rate financial support to parents in vulnerable groups in the in kindergartens, especially in rural and marginalized form of nursery tickets as well as existing social protection areas, is significantly lower than is shown in the official programs such as complementary family allowance, records. This means that children from the most vulnerable guaranteed minimum income benefits for poor families, categories – rural, Roma, disabled, and those from free croissants and milk in schools, and free supplies for marginalized communities – are less prepared for and vulnerable students. Kindergartens have incentives to enroll able to adjust to the requirements involved in attending these children, but they do not have any way to enforce primary school. Parents in low-income and marginalized their attendance. households usually have little education themselves so Although public kindergartens should be free by virtue of cannot give their children any effective help with their being fully subsidized, access to early childhood education homework. They may not even consider education as at the preschool level is hindered by the fees that such a relevant asset in life, and thus may pay little attention institutions charge parents in order to function. These to their children’s participation in educational activities. fees are often a burden that prevents poor and vulnerable This is in addition to the fact that they have little money families from enrolling their children in early childhood to invest in their children’s education. One other measure education. This, in turn, constrains the ability of those proposed in the ESL Strategic Framework will support children to adjust to the requirements of primary education the current efforts of the Government of Romania by: (i) and sets them up for an increased risk of educational failure developing support schemes for parents in vulnerable in the future. groups and disadvantaged communities; (ii) implementing awareness campaigns on the importance of early childhood The practice of some kindergartens to select the “best education; (iii) enriching and expanding parental education children” is another cause of inequality of access to early (through mentoring and the provision of learning material) childhood education. Although a systematic analysis for vulnerable groups including Roma, and (iv) providing of this phenomenon has not been carried out so far, 239 The interviews with representatives of the Ministry of Education and with school directors and teachers from Botoșani and Arad counties were conducted in April-August 2014, under this background study. 184 | PEOPLE-BASED POLICIES anecdotal evidence indicates that some kindergartens managers refuse admission to children from poor and vulnerable families by charging additional fees or by •  ystematically training teachers and care providers S in providing ECEC to children from poor and vulnerable families and implementing strong anti- arbitrarily manipulating the number of available places. discriminatory policies at the preschool level. • This phenomenon seems to occur most often in large urban settlements where there is an apparent shortage of places E  xtending the operation of school minibuses (or in kindergartens every year. This combination of restricted the value of the transport allowance) to cover the options for parents and selection by the institution is prone transportation of preschool children to kindergartens. to producing socially segregated kindergartens. Several projects have been implemented in Romania in the BOX 28 area of inclusive early education, efforts which need to be strengthened and continued. Two highly visible examples are as follows: The Efficiency and Equity of Investing Early in Education Since 2007, the Ministry of Education has being implementing the Inclusive Early Education program240 This figure shows the different rates of financed by the World Bank (€6.1 million) and the return to a constant investment through Romanian Government (€1.7 million) under the Social all of the different educational levels. Investing in Inclusion Program I. This program has targeted children early childhood education and care yields high aged 3 to 6 years old from Roma and other disadvantaged returns, particularly in the case of disadvantaged groups. In 2013, the program covered 5,000 children with children, while investing in training and lifelong an allocation of RON 4 million. learning yields positive but lower returns than for the previous educational stages. Disadvantaged The project Inclusive Kindergartens was implemented by students benefit more from early educational the Association RENINCO Romania (The National Network investments, while well-off children benefit more for Information and Cooperation to Support Community from later investments. Integration) with UNICEF’s support during 2009 and 2011, mainly targeting children with disabilities.241 The priorities for education policymakers in the foreseeable Rate of future are improving the quality of the ECEC system and return Disadvantaged children developing an equality-focused approach to achieving universal participation. To achieve these objectives, they might consider taking the following actions: • I ntroducing means-tested vouchers for disadvantaged families. Each voucher should cover the average fee of kindergarten on a monthly or Well-off children yearly basis. These vouchers should be nominal and non-transferable. Recipients should be children living in families that are recipients of the Minimum Income Early Schools Higher Training & Allowance. The use of the vouchers should be childhood Age education LLL strictly conditional on the children actually attending preschool. • F  inding ways to accurately assess the attendance rate in kindergartens and devising measures to increase the number of days/hours spent by children Sources: OECD (2012a: 27) based on Cunha and Heckman (2007 and 2008) for the U.S. and on Woessmann (2008) for Europe. in these institutions. 240 /proiecte.pmu.ro/web/guest/peti http:/ 241 Vrășmaș and Vrășmaș (coord., 2012). Education | 185 BOX 29 Using Food Coupons to Encourage locality, with a high risk of tuberculosis and of Disadvantaged Children to Attend under-5 mortality. The incentive is a RON 50 Kindergarten (approx €11) monthly social coupon awarded to the family of every participating child. The main The Every Child in Preschool program (Fiecare Copil condition attached to the benefit is the requirement for în Grădiniță), managed by the OvidiuRo Association the child to maintain an almost 100 percent kindergarten (OvidiuRo), provides food coupons to disadvantaged attendance rate, with only an official certificate from children in selected rural localities conditional on their the family physician being accepted for any absences. regular kindergarten attendance. This program is financed During any months when this condition is not fulfilled, the by a combination of major private investors and the family’s benefit is suspended. The benefit is awarded on European Economic Area Grants scheme (2009-2014), an individual basis, which means that children do not lose while the local authorities in the targeted localities are their benefit if their siblings lose theirs for not attending required to provide a modest amount to fund clothes and kindergarten. In this respect, this program differs from the footwear for pupils. Local authorities may apply to the design of public conditional cash transfers such as the program either for the entire commune or for one or more Family Support Allowance). The program also requires of the component villages. To qualify for support, the local that parents participate in the Parents’ Day (a monthly authority must: (i) quantify the number of disadvantaged special activity with children and parents) and in regular children who are not attending kindergarten; (ii) prove kindergarten activities as a teacher’s assistant five times that the local capacity and willingness to implement the per year. program exist (the key stakeholders are considered to be the mayor and the school principal, but the presence of Besides social coupons, the program awards other types supportive school mediators, social workers, professors, of financial support every year. OvidiuRo allocates €15 health mediators, and County School Inspectors per child for school materials, while the local council is is considered relevant as well), and (iii) commit to required to allocate €35 for every child in the form of conducting a thorough door-to-door recruitment process. clothes and footwear. A series of connected activities The final decision to select a locality to benefit from the facilitates the implementation of the program. Training program is taken after the OvidiuRo team has performed is provided onsite for the implementation teams and for a site visit. A local action group or taskforce is then formed teachers, and summer-school programs are organized in the selected commune or village to implement the for the targeted children and also for primary and lower- program, and the school mediator and the social worker secondary students. carry out an initial census of households to determine As of 2012, a healthcare component has been built into the true extent of local needs and to establish a tentative the program, comprising preventive activities such as list of beneficiaries. The OvidiuRo team then carries out a vaccinations, complex medical tests, healthy food (fruit) second site visit to establish the final list of beneficiaries. and vitamin-intake support, hygiene lessons and aid, Children and families qualify for the program based on: and help with accessing health services (for example, (i) the level of household income per family member (to covering the costs of medication, transportation to qualify this must be below RON 150 or approximately healthcare facilities, and even treatment for sick children). €35); (ii) sub-standard housing conditions (as defined by The FGC program has expanded significantly during the provisions of the Social Assistance Law with reference recent years. In 2014, it covered four times as many to Housing Law 114/1996); and (iii) the parents’ low villages as it did in 2010 (84 villages in 43 localities). education level. According to OvidiuRo representatives, Around 2,400 children in 89 kindergartens are being the overwhelming majority of beneficiaries live in covered by the program in 2014/2015. Furthermore, the situations characterized by extreme intergenerational retention rate has improved. While six out of the 21 target poverty, inadequate housing conditions, and villages dropped out of the program after the first year of overcrowded extended households. They lack access implementation, in 2014 only one village dropped out. to clean water or toilet facilities and live in houses with The adjustments in the program’s design are constantly improvised heating, often situated on the outskirts of the aimed at achieving better outcomes. 186 | PEOPLE-BASED POLICIES BOX 29 (continued) The social coupon system is quite widespread nowadays different types of social programs (such as food aid for the in the Romanian commercial environment. OvidiuRo poor and help for the elderly). representatives report that there are usually several The supervision of the program by the local and central shops within their locality where beneficiaries can spend OvidiuRo appears to be essential to the successful their coupons. The program’s managers recall only one functioning of the program. If the program is ever to be single occasion throughout the history of the program’s scaled up, tighter, more standardized rules might need implementation when beneficiaries from one village to be developed and external onsite quality supervision had to travel to the neighboring locality in order to use might be needed. their allowance. Even small commercial entrepreneurs who did not join the system are reported to accept the An impact evaluation of a very similar intervention coupons because they can use them to acquire supplies is currently being carried on in Bulgaria with the from the major wholesale providers. However, there is an participation of OvidiuRo, the World Bank, the Bulgarian implementation issue that is affecting the sustainability of Ministry of Education, the Trust for Social Achievement the program related to the lack of any current legislation Bulgaria, and various academic institutions. This to regulate the entitlement of public authorities to use evaluation is investigating the impact of incentives and coupons. The local public ownership of the program conditions associated with kindergarten attendance on varies from one county to another. For example, in Cluj, the efficient development of early education skills. The the county council agreed to take over the management randomized control group will include approximately 200 of the program, and social coupons are currently used, rural communities and 2,000 children, and the findings of whereas other local public authorities use them for the evaluation are expected to become available in 2016. 2.4.2. Increasing the economic crisis turned the tide, and in 2010 and 2011, dropout rates rose once again to 6 percent at the primary Participation and level and 8.9 percent at the secondary level. Improving Outcomes in Nearly 69,800 children aged 7 to 14 years were recorded as being out of school in the 2011 Census, of whom 48,400 Primary and Secondary were illiterate (defined as having had no formal education). Almost 99 percent of these lived within families, while Education for All only 1 percent lived either in institutions or on the street. Children However, the rate of out-of-school children of primary school age (7 to 9 years) was 6 percent for children in families and over 16 percent for children in placement or The rates of participation in primary and lower secondary living on the street.243 The equivalent rates of out-of-school education have remained low in Romania compared with adolescents of lower secondary school age (10 to 14 years) the European average despite the improvements achieved were 3 percent and 11 percent.244 For children living within in recent years. In 2012, the primary and lower secondary families, the out-of-school rate was slightly higher in rural participation rate fell to 90.6 percent from a high of over areas (4.3 percent) than in urban areas (3.7 percent), 100 percent242 in 2005-2006, with a persistent disparity whereas for children living without their families, the risk of in enrollment rates between rural and urban areas. After being out of school is almost five times higher in urban areas a short period during which dropout rates were falling, than in rural areas, particularly in medium and large cities. 242 “In the 2003/ 2004 school year, gross school enrollment rate in primary and middle education has increased considerably, at above 100%, due to application of the provisions where is stipulated the start of school at six years (thus was determined concomitant entry of 6 and 7 years children, in first grade, in this school year). Subsequently this indicator decreased gradually from year to year.” (Ministry of Education, 2014: 49). 243 The UNESCO Institute of Statistics reported that 6.3 percent of children of primary school age (7 to 10 years old) were out of school in 2009 (http:/ /data.uis.unesco.org). 244 The UNESCO Institute of Statistics reported that 6.9 percent of children of lower secondary school age (11 to 14 years) were out of school in 2009 (http:/ /data.uis.unesco.org). Education | 187 FIGURE 30: Cumulative Dropout Rate to the Highest Grade of Primary and Secondary Education (%) 14.0 11.5 12.0 9.8 9.5 8.9 9.9 8.9 10.0 8.4 8.5 7.7 6.7 7.2 8.0 6.2 6.3 6.5 6.0 6.0 4.8 4.8 5.1 5.2 4.2 2.9 4.0 2.0 0.0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Primary education Lower secondary general education Source: UNESCO Institute of Statistics, http://data.uis.unesco.org. Note: Definition = proportion of pupils from a cohort enrolled in a given grade at a given school year who are no longer enrolled in the following school year. FIGURE 31: Number of Out-of-school Children aged 7 to 14 Years Old Living in Families (thousands) 40.0 37.3 35.0 30.0 25.0 20.0 16.4 15.0 10.2 10.0 4.8 5.0 0.0 Children out-of-school Children out-of-school Children out-of-school Children out-of-school 7-9 years old 10-14 years old 10-14 years old 10-14 years old who have never been who completed who completed enrolled in education primary education secondary education Source: World Bank calculations using data from 2011 Population and Housing Census. Note: Definition = children in the official primary school age ranged who are not enrolled in either primary or secondary schools. 188 | PEOPLE-BASED POLICIES Among children aged between 7 and 14 years old who are is held constant. The gap between Roma and living with families, those with disabilities, Roma children, non-Roma children is significant even if the level of and poor children face a disproportionately high risk of education of the parents is the same and they come being out of school. The categories of children most at from the same geographical area. • risk of not participating in or not completing compulsory education are:245  hildren with numerous siblings in households with C • three or more children (6.8 percent). • C  hildren with at least one totally disabling incapacity (55.4 percent) and those with at least one significant  hildren deprived of parental care, in other words, C incapacity (20.4 percent). with no parent at home (5.4 percent). •  hildren with mothers with no formal education (22.7 C percent) or who completed only primary education (10.6 percent). School dropouts and out-of-school children tend to be concentrated in particular areas, especially rural areas or urban marginalized communities that sometimes include a large proportion of Roma. Not only does early school •  oma children (18.7 percent). Although the mother’s R level of education is a relevant predictor for school participation, the difference between Roma and non- leaving or a lack of schooling disproportionately affect disadvantaged groups in terms of the lifelong opportunities available to them, but, because of segregation, early school leaving, or a lack of schooling, they tend to be concentrated Roma is large even if the mothers’ level of education FIGURE 32: Rates of Out-of-school Roma and Non-Roma Children aged 7 to 14 by Area of Residence and Mother’s Level of Education 0 5 10 15 20 25 30 35 3 Mothers with long upper secondary education 2 12 13 3 Mothers with short upper secondary education 2 (vocational, apprenticeship) 11 9 3 Mothers with lower secondary education 3 (5-8 grades) 12 11 7 Mothers with primary education 7 19 17 14 Mothers without formal education 14 31 27 Non-Roma - Urban Non-Roma - Rural Roma - Urban Roma - Rural Source: World Bank calculations using data from 2011 Population and Housing Census. Note: Only children living within families are considered. 245 The overall rate of out-of-school children aged 7 to 14 years living with their families was 4 percent. Education | 189 in specific areas and consequently in specific schools, often showed that 10 percent of primary school students and 37 in rural areas with a high concentration of Roma. In Bihor percent of lower secondary students qualify as dropouts. and Caras Severin counties, 50 percent of all dropouts from Statistically, this means that only about 50 percent of the gymnasium (grades 1 to 8) have been recorded in just 5 students enrolled in Grade 1 in those schools with a large percent of schools.246 proportion of disadvantaged children actually complete eight grades. A similar worrying situation was signaled A recent study carried out in several schools247 with a high by the Atlas of Urban Marginalized Areas in Romania249 concentration of disadvantaged students found a very high (see more in Section 3.2). In urban marginalized areas, the incidence of academic failure and dropout at the primary proportion of children enrolled in education is lower than in level (more than 25 percent), and an even higher incidence other areas, particularly for those who are 14 or older and for at the lower secondary level (almost 50 percent).248 Roma (Table 32). Based on an analysis of school records, the same study School Enrollment of Children in Marginalized Urban Areas in Romania (%) TABLE 32:  Urban Romania Urban Marginalized Areas Age group Total Roma Total Roma Population (% total 0-5 years 6 13.2 11.1 15.4 population/Roma) 6-10 years 4.6 10.8 8.9 12.5 11-14 years 3.7 7.9 6.8 8.9 15-19 years 4.8 8.5 7.2 8.7 Enrolled in education 6-10 years 78.1 68.9 75.9 69.2 (% age group) 11-14 years 97.7 77.3 90.8 77.4 15-19 years 86.7 46.3 67.1 43.3 Source: World Bank (Swinkels et al, 2014a: 18) using data from the 2011 Population and Housing Census. Free compulsory education for all children is provided by worth noting that significantly less money is spent on law, but law enforcement mechanisms are ineffective in education by households with unemployed people, informal terms of enforcing either aspect. Despite the existing legal workers, Roma informal workers, and/or two or more provisions, various research on children has shown that children. They also spend less per child. For instance, the free compulsory education has hidden costs, including fees monthly average amount allocated by the households of such as school and classroom funds, which are sanctioned Roma informal workers is less than €3 per child. At the by law.250 Most households with children allocate a monthly opposite extreme, households of formal workers pay, on average amount of €30251 per child for school-related average, €56 per month per child. Precisely because of expenses, including school supplies, books/notebooks, the high costs related to education, parents in poor and uniform and sports equipment, school fund/classroom vulnerable households often report facing major difficulties funds, organized events, transport to/from school, home in ensuring the enrollment, continuation, and/or completion tutoring, and other contributions paid to the school. It is of their children’s education. 246 Hatos, 2011. The concentration is more likely to be observed at locality or at a lower level (villages or small marginalized areas) than at county level. According to the 2011 Population and Housing Census data, out-of-school children aged 7 to 14 years old are spread across all counties, with rates varying from a minimum of 1 percent in Giurgiu and a maximum of 7.1 percent in Mures (and a national average of 4 percent). In seven counties, the rates of out-of-school children aged 7-14 years exceed 5 percent, namely Arad, Bihor, Brasov, Cluj, Ialomita, Mures and Timis. However, these seven counties account for only 27 percent of all out-of-school children aged 7 to 14 years old overall, which means that the concentration of the phenomenon within certain counties is limited. 247 The so-called Educational Priority Areas, identified within the framework of a project implemented by UNICEF and the Institute for Educational Sciences. 248 Jigău et al (2012). 249 World Bank (Swinkels et al, 2014a). 250 Gradinaru et al (2010) and Stănculescu and Marin (2011). 251 This is about 125 lei per month, which makes an annual average amount of 1,500 lei. 190 | PEOPLE-BASED POLICIES Consequently, although education is compulsory, the reduce the influence of background socioeconomic factors problem of out-of-school children has remained persistent. as much as possible to reduce inequality and minimize the Nevertheless, it has not yet been addressed by any risk of failure and exclusion. Any streaming based on ability program or institution. The qualitative research carried out should not be introduced until late in the education cycle for our background study has highlighted that, even when (in other words, until students enter higher education) and a some teaching staff and/or community workers take the strong emphasis should be put on ensuring the availability initiative and identify out-of-school children of school age of extensive and well-developed vocational education at the within the community, they have no way of forcing them upper secondary and post-secondary levels. to enroll or attend school. For the effective implementation In Romania, compulsory education is defined as the of a child’s right to education as set forth in the Convention completion of grade 10. However, upper-secondary on the Rights of the Child (Article 28), a national program education covers grades 9 to 12254 and used to comprise focused on out-of-school children of compulsory education four streams. Three of these are regarded as “high school”: age needs to be designed and implemented for the benefit (i) theoretical (which subdivides further into humanities and of all children in Romania. science); (ii) vocational (education, arts, sports, military, The quality of education at both the primary and the and theology); and (iii) technological (agriculture and secondary level in Romania needs to be improved in services). The fourth stream was vocational education and order to promote social inclusion. Education of a high training (VET) in the Schools of Arts and Trades. In 2009 enough quality to produce a skilled workforce benefits when the government closed the Schools of Arts and both individuals and society as a whole. Recent evidence Trades, the children who may have entered the VET (școli on the measurement of competencies in Romania has profesionale) system became part of the technological yielded inconsistent results. Romania’s PISA scores have track. Consequently, while the gross enrollment rate in high shown definite improvements during the last three rounds school rose from 72 percent in 2008-2009 to 92.7 percent of measurements, but Romania remains among the worst in 2012-2013, gross enrollment rates in VET decreased performers in the EU. In 2012, 41 percent of Romanian sharply from 25.3 percent to 3 percent over the same students were found to be functionally innumerate and period Figure 33). The distribution of students by gender is 37 percent were functionally illiterate. Meanwhile, the balanced at all levels, except in VET, which is much more TIMMS and PIRLS scores in mathematics for 8th-graders popular among boys who made up 76 percent of all VET have shown a negative trend. The scores of Romanian students in 2012-2013.255 students in science during five rounds of measurements The evidence shows that there is a sharp decline in school stayed largely unchanged as did their scores in reading participation between the end of lower secondary school during three rounds of measurements.252 Variations in the and the beginning of upper secondary school (in other socioeconomic status of the students can explain part of the words, between grades 8 and 9), especially for those in the differences in the test results.253 Segregated school systems poorest decile. There is an even more significant decline in – particularly the more exclusive ones, in which students participation in upper secondary once school attendance is of similar socioeconomic backgrounds are gathered in the no longer compulsory (in other words, between grades 10 and same schools or classrooms – perform poorly compared 11) among those from the poorest four deciles (Figure 34).256 with the more inclusive ones. Consequently, national education policymakers need to 252 All TIMMS and PIRLS data retrieved from http:/ /timssandpirls.bc.edu/ on August 26, 2014. 253 For example, 19.3 percent of the variance among Romanian students in their mathematics performance in the PISA test is explained by the socioeconomic status of the student, which is more than the OECD average of 14.8 percent but still not a significant degree. 254 After 12th grade, students take a baccalaureate examination that can be repeated if necessary. 255 NIS (2013a). 256 The average dropout rate in Romanian high schools increased from 2.2 percent to 3.8 percent between 2009 and 2011, with even higher rates prevailing in technological high schools (5.3 percent in 2011) as well as in high schools located in rural areas (around 7 percent in grade 11 in 2012). Education | 191 FIGURE 33: Gross Enrollment Rates in High School and VET (%) 100 85 90.8 94.6 92.7 80 72 66.4 60.5 54.7 60 40 27.6 26.8 25.8 25.3 15.8 20 7.8 1.8 3 0 2005/2006 2006/2007 2007/2008 2008/2009 2009/2010 2010/2011 2011/2012 2012/2013 High-school education Professional education Source: World Bank (2014b). FIGURE 34: School Enrollment Rates for Children from the Poorest Four Deciles in Romania 100 90 The poorest (1st) decile 80 2nd-3rd deciles 70 4th-5th deciles 60 6th-10th deciles 50 7 8 9 10 11 12 13 14 15 16 17 18 Age Source: World Bank calculations using data from the 2012-2013 HBS. Note: Quintiles of total income per adult equivalent (using the modified OECD equivalence scale). 192 | PEOPLE-BASED POLICIES There are various reasons257 why Romanian students grades of education have a 25 percent chance of dropping drop out of high school, but the lack of financial resources out compare with only 2 percent for students with mothers is particularly important, particularly for children in rural who have completed high school or have a higher level areas. The reasons for dropping out of high school fall into of education. A multiple regression analysis (Annex Table three broad categories: (i) pedagogical, (ii) financial, and (iii) 6.1) indicates that area of residence, income, and mother’s personal. Pedagogical reasons relate to the low quality of education level are all significant factors in early school education provided by high schools because of which they leaving, yet the level of education achieved by the mother are not teaching students satisfactorily, thus leading them is the most influential determinant of the participation of to fail and to drop out of school. Some other pedagogical children in upper secondary education. In other words, if reasons are parents’ low expectations regarding the a child completes compulsory education, then it is much returns from education and the higher opportunity costs more a matter of his or her mother’s education (because of of participation. Financial causes refer to the high non-fee the support given and the value assigned to education) than costs of participation, including the cost of books, supplies, of money or geography. and transportation. A 2014 study258 has shown that 47.3 There is a rich supply of empirical evidence that the percent of parents of students who live in rural areas cited acquisition of skills is beneficial to the individual and the lack of financial resources as the most important reason accounts for many desirable outcomes throughout the why their children do not continue into upper secondary individual’s lifecycle. For example, the OECD’s Survey of education. This finding is consistent with a 2011 study on Adult Skills has shown that highly skilled adults are twice access and equality in higher education,259 which found as likely to be employed and almost three times more that 38.3 percent of students who had dropped out of likely to earn an above median salary than are low-skilled school stated that financial constraints on attending high adults.260 In particular it has been found that skills inequality schools were their main reason for dropping out. Personal is reduced by the existence of a strong vocational sector, reasons include a lack of motivation among students to especially at the upper secondary level.261 This happens continue studying, real life events such as the migration because those at the bottom of the skills distribution of their parents, early pregnancy, or marriage, bullying or perform better in these systems. In other words, vocational prejudice within the school environment, and/or students’ education has the ability to foster inclusion. On the other myopic preferences (for example, preferring to enjoy leisure hand, it has been found that early ability tracking or or consumption now rather than deferring them till later in streaming leads to greater skills inequality without actually order to acquire more skills). delivering the benefit of being educationally effective.262 The nationwide proportion of teenagers aged 15 to 18 years The dropout rate in vocational schooling has been of not enrolled in school or training reached 11 percent for particular concern to Romanian policymakers and has the period 2009-2012, with a substantial gap between prompted some policy changes. In 2009-2010, the urban (6 percent) and rural areas (17 percent). Besides government’s decided to abolish the Schools of Arts and area of residence, factors such as income and the mother’s Trades in the vocational system, primarily because of their education have a significant influence on the rate of early poor quality and design. This had a significant impact in school leaving (Figure 35). For example, for adolescent girls the following academic year with the dropout rate among in rural areas with mothers who have received a primary VET students almost doubling from 8.6 percent in 2009- education at most, the rate of leaving school early is 57 2010 to 19.8 percent in 2010-2011. This impact may have percent for those from the poorest households, more than extended to students in lower secondary who had little twice as high as those in households with above average prospect of succeeding in the theoretical/academic streams incomes (25 percent). On the other hand, if students’ and who may no longer have felt that they had any reason financial status is held constant, then the mother’s to remain in school until the end of lower secondary once education has a stark impact on the child’s risk of early the VET alternative was no longer available. In December school leaving. Students with mothers with at most four 257 An analysis of the factors driving early school leaving, in the supply and demand framework, is presented in the World Bank study on early school leaving, 2014: 26-28. 258 Badescu et al (2014: 27). 259 Pricopie et al (2011). 260 OECD (2013a). 261 Checchi et al (2014). 262 Checchi et al (2014). Education | 193 FIGURE 35: Proportion of Adolescents aged 15 to 18 Not Enrolled in Education or Training by Gender, Area of Residence, Mother’s Level of Education, and Income Decile (%) 100 Boys 80 67 55 53 60 44 37 34 40 40 26 24 30 19 18 16 22 20 8 12 8 3 13 11 73 11 5 731 5 62 4 2 0 1st decile 2nd decile 3-4th 5-10th 1st decile 2nd decile 3-4th 5-10th deciles deciles deciles deciles Rural Urban 60 57 Girls Mothers with no more than primary education 44 42 Mothers with lower secondary education (5-8 grades) 40 34 Mothers with short upper secondary education: 27 30 vocational, apprenticeship 25 22 18 17 15 20 13 13 11 8 6 9 8 7 5 3 2 41 3 52 31 52 1 0 1st decile 2nd decile 3-4th 5-10th 1st decile 2nd decile 3-4th 5-10th deciles deciles deciles deciles Rural Urban Source: World Bank calculations using data from the 2009-2012 HBS (pooled data). Note: The first decile indicates the 10 percent of people with the lowest income in the country.The 5th to 10th deciles indicate the half of the population with medium to high incomes. 2013, the government changed the VET system by requirements of the baccalaureate examination and the ordinance and opened up opportunities for students to absence of any revisions of the income threshold for enroll in vocational programs (entering what are called scoli the Money for High school Scholarship. As a result, an profesionale) right after grade 8 when they had completed increasing number of 8th grade graduates have chosen to the gymnasium level. Under the new rules, students would enroll in vocational school instead, particularly those from no longer have to enter upper secondary before being poor and disadvantaged backgrounds because vocational granted access to the VET system.263 education enables students to acquire skills quickly and to make a faster transition into the labor market. Participation in Initial Vocational Education and Training (IVET - ISCED 3c levels of education) is still very low, Increasing the attractiveness of IVET would lead more although increasing. On the one hand, the Professional students to enroll. Lower secondary students from Scholarship Program has been created with the aim of disadvantaged socioeconomic backgrounds are often not increasing demand in IVET. The program provides RON properly informed about the economic opportunities open 200 monthly to any student who enrolls in vocational to graduates of vocational schools and the various available school. On the other hand, several disincentives exist that schools and their respective specialties. This partially prevent students from enrolling in the academic tracks explains why, notwithstanding the relatively limited supply of upper secondary education, including the increased of vocational and professional training, the demand is 263 World Bank (2014b: 26). 194 | PEOPLE-BASED POLICIES still weak. In order to increase the demand for IVET, the for those graduating from grades 8 and 9 from 20,000 measures proposed in the ESL Strategic Framework include in 2012 to 26,000 in 2013 and to 51,000 for 2014-2015. career counseling services in schools and more vigorous (The number of internships was also increased to 5,000 for promotion of IVET within and outside schools (by teachers, 2014-2015. Currently, when schools are setting up IVET school counselors, school mediators or media), focusing on courses, they need to produce a signed agreement between career opportunities and further education flexibility. the students and their families, the school, and one or more company that will offer internships to the students. Without Alongside these actions to increase demand, policymakers this agreement, the Ministry of Education will not grant also need to take steps to increase the supply and official approval to the school to create the course. For this relevance of IVET. Many of the existing vocational schools reason, the supply and quality of IVET courses depends provide qualifications and skills that do not match the strongly on the companies’ interest in and commitment to needs of the labor market. This is another reason why 8th training VET students. grade graduates from disadvantaged groups are choosing not to follow the vocational stream in upper secondary Some useful actions that policymakers should consider in school. For example, rural agricultural schools still focus this area include: • on farming organization and technologies that are suited to large enterprises even though the average farm in Romania Setting up apprenticeships within IVET courses. • is now relatively small. This happens because of historical dependencies (path dependencies) as well as material  edesigning the IVET curricula to focus on several R constraints that mean that the schools cannot afford to key industrial sectors in each region. • modernize their infrastructure or diversify their offerings. However, there has been some progress in terms of  eveloping national sponsorship programs with large D increasing supply in recent years. Government orders have companies and fostering partnerships with local increased the number of places available in VET schools private companies. BOX 30 Best Practice - Kronstadt Vocational School related to the school are undertaken under a partnership agreement, which covers the The qualitative research carried out as background to the selection and training of teaching staff, the development of the National Strategy on Social Inclusion examination process, the development of and Poverty Reduction 2015-2020 has revealed two the curricula, and the teaching of both theoretical and contradictory findings. On the one hand, there is a practical courses. At the admissions stage, the students pressing need for qualified workers in all counties and are required to choose the type of qualification that they localities where the interviews were conducted. On the are interested in as well as their prospective employer. other hand, the technical and vocational schools in those areas use outdated curricula, and the work experience The Kronstadt School is operating on the site of the old courses with employers are insufficient and partly professional school (Grup Scolar Industrial) affiliated with irrelevant, since the students do not acquire the actual Rulmentul Brasov’s factory until 1997, when the latter skills related to the qualification in question. was declared bankrupt. Many of the former employees of Rulmentul were hired, starting in 2005, by the newly In this context, the Kronstadt Vocational School in established Schaeffler enterprise, thus meeting in part Romania is a worthy example of a vocational program the international company’s demand for a skilled labor that can successfully train top-level professionals force. However, the existing personnel needed to be and improve their employment prospects. The school retrained in modern production techniques, although boasts an almost 100 percent employment rate many of them were approaching retirement age, and the following graduation. The school’s management board fresh graduates emerging under the existing educational is comprised of representatives of 12 large entrepreneurs system were not being equipped with relevant skills. active in the local market (most of the employers A local study prepared for Schaeffler’s management, are operating in the Brasov area). The main activities Education | 195 BOX 30 (continued) prior to the vocational school project, identified that the concentration, coordination, and dexterity). curricula did not reflect modern production techniques The students are trained in two-year programs (starting in and that the laboratory practice was insufficient. To 10th grade) or three-year programs (starting in 9th grade), compensate for the shortage of trained employees, the with the option of several specialties such as computer Kronstadt School was established. Schaeffler employs numerical control operator (the most widespread profile), around half of the school’s graduates, although it is not electromechanical machine tools operator and industrial the largest of the companies involved. facilities operator, mould toolmaker, or leather-sewing technician. Occasionally, the school offers six-month The school began operating in 2012 when the new adult training courses, and the prospect of preferential building was constructed by the city hall and the employment is reported to attract higher education companies equipped the classrooms. Currently, the local graduates as well. council is renovating the school’s workshop, while the participating firms will ensure the provision of technical Every student attending the Kronstadt School must sign equipment. The major features of the Kronstadt School a contract, which, among other obligatory conditions, include: (i) high pedagogical and technical standards requires a 95 percent attendance rate. The learning of education and practice; (ii) careful practical training curricula are closely adapted to the standards and carried out both by employers’ instructors and by school requirements of the economic environment, reflecting the staff at the employer’s site and using high-tech devices; technological characteristics of the production process. (iii) a qualification certificate that is internationally Professional practice is coordinated by the employers, recognized; (iv) transportation to the work sites, together with a ratio of one tutor and one teacher to 12 students. with meals and a boarding regime for those children The proportion of practical training in the curriculum coming from other areas supported by the employers; increases gradually and eventually overtakes theoretical (v) an allowance of RON 200 per month paid by the teaching in the students’ senior years. For example, employers during the student’s studies in addition to the practical work accounts for 25 percent of instruction time RON 200 professional allowance received from public in the 9th grade, progressing to 75 percent in the 11th funds; and (vi) an almost 100 percent employment grade over the three-year path. The contract provisions rate after graduation as shown by the 93.7 percent do not oblige graduates to accept a job within their employment rate of the first generation of graduates in originally selected enterprises, but the high salary levels 2014. and the incentive packages in general tend to ensure that they do. There were no dropouts among the first To ensure a broad admissions base, the employers generation of Kronstadt’s students, though six students carry out active promotion and recruitment activities in switched to other schools. In an agreement between the gymnasiums and via public advertisement campaigns. school and a private health network, the network provides The school organizes a promotional road-show in the healthcare, hygiene, and family planning activities, as counties where the employers have their headquarters. well as psychological and professional training. Many students learn about the school via word-of- mouth, with the former workers of Rulmentul and current In the case of the Kronstadt School, the involvement of Schaeffler employees, who were originally residents major investors was a great help in pushing forward the of the Northeast and other distant parts of Romania, institutional arrangements and providing constant financial spreading the information. The school’s promising and technical support. At the same time, the city hall of educational and employment prospects attract a high Brasov, one of the most economically developed localities number of applicants annually - six times more than the in the country, provided RON 10 billion of the RON 16 375 places allocated in 2014-15 - with 60 percent of the billion worth of initial investment. In order to establish students being from counties outside Brasov, such as Iasi, similar schools in other urban and rural areas that are less Maramures, Buzau, and Vaslui. The admission test is a developed, it will be necessary to have the support of local combination of general knowledge in certain fields (such authorities and to devise a strong strategy for recruiting as logics and mathematics) and skills considered relevant entrepreneurs, along with clear strategies relating to both to the technical/practical aspects of the job (such as the educational system and labor market services. 196 | PEOPLE-BASED POLICIES Improving the quality of IVET is a key priority for making it more inclusive. The dropout rate in IVET is the highest •  edesigning IVET programs take into account those R students most at risk of dropping out. • of all the levels of education. The recently introduced Vocational Scholarship is expected to cover part of M  onitoring the school attendance and performance of the direct and indirect costs to poor students and their students at risk. families of participating in vocational education, but it is A reform of Romania’s vocational education and training unlikely to cover enough of those costs to significantly (VET) system is currently underway but it needs further reduce dropouts, especially among students who have review and support. As the ESL Strategic Framework264 completed the 10 years of compulsory education. Moreover, states, the VET reforms face two main challenges: (i) VET the substantial dropout rate from vocational schools is does not provide the high-quality technical skills that would an indicator of students’ lack of engagement with the help students to enter the labor market and (ii) it fails to courses, which in turn indicates problems with the quality provide an adequate level of generic skills that would give of teaching, with the degree of academic and social students a sound starting point for further learning. In other adaptation, and with students’ expectations. The absence of countries, VET has become an effective way to reduce early vocational programs tailored to the needs of youths who are school leaving and has become an excellent pathway to already active in the labor market (such as evening classes lifelong learning (LLL). Some projects and programs have and apprenticeship programs) is another reason why been implemented in Romania265 and have demonstrated participation is so low. some encouraging results. However, most of these projects Some actions that policymakers should consider taking to have been small-scale pilot interventions, and a more improve the quality of IVET include: comprehensive approach will be required to ensure the full implementation of these reforms. FIGURE 36: Number of Students Enrolled in Second Chance Education Programs (2007/2008-2012/2013), (thousands) 5 4 Primary - Rural 3 Lower secondary - Rural 2 Primary - Urban 1 Lower secondary - Urban 0 2007/2008 2008/2009 2009/2010 2010/2011 2011/2012 2012/2013 Source: World Bank (2014b) using data from the Ministry of Education. 264 World Bank (2014b: 60). The ESL Strategic Framework includes two measures aiming at increasing the attractiveness and relevance of VET. These are: (i) redesigning VET pathways to increase its flexibility and permeability and reforming the curriculum and (ii) providing teacher and management staff training. 265 In various areas: teacher training, curriculum development, linking VET with market needs, opening schools to the community and business environment, and the development and monitoring of School Action Plans. For example, see http:/ /www.tvet.ro/index. /www.tvet.ro/index.php/ro/proiecte-de-dezvoltare-a-invamantului-profesional-si-tehnic/88.html or http:/ php/ro/proiecte-de-dezvoltare-a-invamantului-profesional-si-tehnic/191.html. Education | 197 Second Chance education is the main reform that has only 5 percent (as of 2009). While the situation improved been implemented by the Ministry of Education.266 Figure somewhat between 2002 and 2009, students from poorer 36 shows that the largest enrollments in Second Chance (and rural) households continue to lag substantially behind courses are in urban areas, with the highest numbers being their more well-off peers in terms of tertiary attainment. at the lower secondary level. Other measures include the Some priority actions for policymakers to consider include: introduction of evening classes for secondary education and low frequency classes for primary and secondary education. Given the number of children under 18 years of age who are not currently in school, it is essential to find alternatives • D  eveloping clear progression routes from vocational and other secondary education streams into tertiary education. • for those who are unable to attend Second Chance classes beyond lower secondary. Second Chance VET is the only R  eplacing merit-based fee waivers with a more second chance program available beyond lower secondary. limited set of need-based grants. • Low enrollments, however, indicate that a large number of out-of-school children under 20 years old are not being  Launching a student loan program as swiftly served. Of a total enrollment in Second Chance VET of as possible. • 8,143 students in 2012-2013,267 two-thirds (5,372) were at least 20 years old. E  ncouraging tertiary institutions to reach out to students from under-represented groups and to non- traditional learners, including adults. 2.4.3. Promoting Broader Access to • ncreasing the transparency of information on I educational opportunities and outcomes and Tertiary Education by providing appropriate guidance to students to inform their study choices and reduce dropout rates. Under-represented Groups 2.4.4. Increasing The main challenges that policymakers face in the area Access to Lifelong of tertiary education consist of enhancing access to, Learning and Training supporting participation in, improving the quality of, and increasing the relevance of the subsector. Enrollment in for Disadvantaged tertiary education has decreased by 35 percent, from 716,464 (in 2005/06) to 464,592 (in 2012/13). According Youths and the Working to the NIS, the enrollment rate in tertiary education for young students aged 18 years old (in other words, the Age Population tertiary education entrance age) decreased by 50 percent The participation of disadvantaged groups in lifelong from 2005/06 to 2012/13. In addition, as is the case learning (LLL) is particularly low. The goal for Romania, as worldwide, in Romania there is a strong correlation between set out in the European Union’s Europe 2020 targets, is socioeconomic status and those who enroll in and graduate to increase the participation rate of adults (those between from tertiary education. As of 2009, more than 50 percent 25 and 64) in LLL to 10 percent by 2020. Between 2007 of the 25 to 29 age group in Romania’s richest quintile and 2013, Romania did not make any significant progress held a tertiary degree, whereas in the poorest quintile in this regard, with the rate barely increasing from 1.3 the rate of tertiary completion among this age group was percent to only 2 percent. The rate in 2012 (1.4 percent) 266 Second Chance education was piloted by the Ministry of Education as early as 2001 with a focus on those between the ages of 14 to 24 years old to help them to complete lower secondary education. This approach was eventually extended to other educational areas. A new curriculum for Second Chance education for primary and secondary education has been developed and implemented. Second Chance education aimed specifically at at-risk groups, especially the Roma population, has also been piloted. 267 With an allocation of RON 18,326 million in 2013. 198 | PEOPLE-BASED POLICIES was significantly below the EU-27 average of 8.9 percent. Romania has one of the lowest average increases in that Children with Special respect in the EU and is failing to make the minimum Educational Needs and progress required by the European Commission. A lack of financial resources hampers participation in LLL programs, Children with Disabilities particularly for disadvantaged groups. In a 2014 survey Disabled people in Romania are trapped in a vicious carried out by the World Bank, 22.8 percent of the almost circle of limited access to education, discrimination, 400 stakeholders involved in lifelong learning in Romania low employment, and poverty.269 Several assessments stated that the cost of education and training is a barrier to published in recent years have shown that the various increasing participation.268 This is a peculiarly important programs funded by the government and/or the EU factor for social inclusion policy because LLL is essential for aimed at increasing the participation of disabled people in empowering those at risk of exclusion. education and the labor market have produced very few improvements in their situation.270 This has been because The Strategic Framework for Lifelong Learning in Romania a lack of support from teachers, parents, and employers, as (2014) includes initiatives and specific measures aimed well as a lack of enthusiasm for decisive action on the part at increasing participation in LLL. The Framework of local and state authorities. recommends enhancing counseling services on education and training for students in upper secondary and tertiary A standardized methodology for annual statistics and a education, adults who have left the formal education dedicated permanent and reliable monitoring mechanism system, job seekers, and underrepresented groups. It is needed to document access that children with special also recommends providing vouchers and grants to the education needs (SEN) and/or disabilities have to unemployed to enable them to continue their education. education.271 Official statistics are fragmented among The combination of grants and vouchers and intensive many different departments and ministries and are only counseling to help prospective trainees make sound choices systematically collected and reported by the Department should expand demand for LLL services. for Protection of Persons with Disabilities (DPH) and by the National Authority for the Protection of Child’s Rights 2.4.5. Increasing and Adoption (NAPCRA), both under the Ministry of Labor, Family, Social Protection, and the Elderly (MLFSPE). Access to Quality However, these two sets of statistics are not comparable as NAPCRA also includes children in residential settings, Education for Children while the DPH has no access to these data. Thus, at the end of 2013, the DPH reported that the number of children from Vulnerable with disabilities in Romania was 60,993 whereas NAPCRA Groups reported the number as being 70,647.272 NACPRA’s data on the participation in education by children with disabilities come from the County Directorates for Social Assistance This section focuses on children with special educational and Child Protection (DGASPCs). Occasionally, the Ministry needs, children with disabilities, Roma children, and of Education also releases data on the number of children children living in rural remote areas. with disabilities in schools as it did, for example, within the Response of the Government of Romania to the UN’s Office of the High Commissioner for Human Rights’ (OHCHR) questionnaire on the right of people with disabilities to receive an education273 issued in December 2013). Again, 268 World Bank (2014c). 269 Guttman (2011). 270 Preda (coord., 2009), Szekely (2012), and Tudorache et al (2013). 271 See, for example, European Agency for Development in Special Needs Education (2009). 272 In December 2013, the DPH reported 60,993 children with disabilities, of which 31,740 children had severe disabilities, 11,922 had marked disabilities, 16,494 had medium disabilities, and 837 had mild disabilities (MLFSPE (2013 Statistical Bulletin Persons with Disabilities). For the same period, NAPCRA reported 70,647 children with disabilities, of which 34,905 children had severe disabilities, 13,861 had marked disabilities, 20,121 had medium disabilities and 1,760 had mild disabilities (MLFSPE, 2013 Quarterly Bulletin on Children with Disabilities). /www.crj.ro/userfiles/editor/files/Response%20by%20the%20Government%20of%20Romania.doc 273 http:/ Education | 199 there were differences between the official data provided child protection sector, the Complex Evaluation Service by the NAPCRA and those released by the Ministry of under the DGASPC confirms the diagnosis of disabled Education. In addition, various studies have given yet another children every year and issues proposals for including different set of statistics.274 With regard to children with them in the education system with a particular recovery special educational needs (SEN), no monitoring system plan. Regarding the schooling of children with disabilities, is in place, and no government agency issues any regular the CJRAEs and the DGASPCs cooperate within educational reports on their circumstances. Some children with SEN also orientation commissions, which are organized in different have disabilities, but most are prodigies or, more commonly, ways from one county to another. This commission decides have behavioral disorders or have developmental delays the educational pathways for each disabled and SEN child associated with being from extremely poor families. The in preschool, primary school, and secondary education and reverse is also true, in that some children with disabilities issues a certificate recommending the type of school for each have also special educational needs, but not all of them (in school cycle of four years (the primary, lower secondary, and other words, most of these children have a physical disability upper secondary cycles), as well as recommendations for an but no mental or intellectual disability). Due to the lack of individual services plan for each child. consistent data, it is not possible to analyze the relationship According to national legislation, children and young people between these two categories of children (with SEN and/ with disabilities can receive their education in mainstream or disabilities) or to quantify their actual participation in schools, in special schools, or in special classes integrated education. The proportion of people with disabilities within into mainstream schools. In theory, the option that is best the total Romania population is estimated to be about 3.5 for each child is decided by their families in consultation percent. Of these, fewer than 10 percent are children, with with their county’s educational orientation commission. the result that the incidence of disability among children Consistent with Romanian legislation, the degree and in Romania appears to be much lower than the worldwide type of a child’s disability should determine which level of about 10 percent. This is likely to be because of the educational path is chosen. However, during the qualitative problems faced by the Romanian authorities in trying to study carried out for this project, various problems were identify all cases of disability.275 These problems are largely highlighted by professionals in education, special education, caused by a lack of effort from the government compounded and child protection, by NGOs, and by families with children by the stigma associated with disability, which makes with SEN and/or disabilities: individuals unwilling to admit to being disabled.276 As is often highlighted in the literature on disability, the underreporting of the incidence of disability and special educational needs indicates that many children in need are not being provided •  he Complex Evaluation Service of the DGASPC T informs children with disabilities and their families about the educational orientation commission, but it with appropriate care and education. is left to the family to decide whether or not to present In order to increase the participation of children with themselves to this commission. At the same time, disabilities in education, the evaluation of special there is no formal mechanism by which the full list educational needs should be improved and better of children with disabilities can be shared between coordinated with the annual evaluation and confirmation the Complex Evaluation Service and the educational of children’s disabilities by the DGASPCs. In the education orientation commissions, which would facilitate the sector, the County Resources and Educational Assistance monitoring of these children and their participation Centers (CJRAEs) are in charge of the integration in in education. This means that decisions about how education of children with special needs. The CJRAE are a child with disabilities participates in school are also required to provide schools, parents, and teachers left solely to the parents without any assistance or with support and professional assistance to ensure that guidance. As a result, a large number of children with education is inclusive (Law 1/2011, Article 99 (6)). In the disabilities remain out of school. 274 Vrășmaș et al (2010). 275 Preda (coord., 2009) and Hatos (2010). 276 UNICEF (2007). 200 | PEOPLE-BASED POLICIES •  ven if the parents go to the orientation E commissions, the commissions often do not consider the opinions expressed by children with Some teachers, especially from top schools and •  top classes, who may be excessively focused on academic performance, tend to refer to the disabilities and their families but tend to direct educational orientation commission any child from them to special schools. Nonetheless, the law a low-income or troubled family who happens to be on education states that children with disabilities assigned to their classes, often with the support of should primarily be educated in mainstream schools the other pupils’ families. (Law 1/2011, Chapter 2, Article 50). Some teachers refer some of their low-achieving •  • pupils in their classes to the educational A  ccording to the legislation, a child does not need to orientation commission specifically because hold a disability certificate in order to be assessed teachers can receive annual performance bonuses for specific support in schools (either mainstream by identifying children with SEN and integrating or special).The identification of children with SEN is them into their classes. done by a specific evaluation service that functions Teachers tend to refer adolescent pupils with poor •  within the CJRAE. The inclusion of children with school performance to the educational orientation SEN in mainstream or special schools is decided by commission, particularly those from challenged the educational orientation commissions. A request family environments or those with behavioral for a child to be evaluated by the CJRAE is made disorders, mainly because they themselves are by parents, educators (in crèches or kindergartens), not trained to deal with these difficult cases and teachers, school psychologists, and/or other the schools have no counselors or psychologists to professionals who may work with the child at a given effectively support these children. stage of his or her development. The evaluation and orientation of children with SEN (especially those without disabilities) is distorted because of the following practices: • T  he task of monitoring a child’s situation throughout his or her entire education should be clearly assigned to one or more specific agency such as the CJRAEs, Often, parents are “ashamed” that their child might •  the schools, or the School Inspectorates. The have special educational needs so they do not situation must be constantly (re)assessed, and any approach the educational orientation commission support measures must be periodically adapted to even when the signs are evident.277 the child’s changing needs. • Parents with little education may not know how to •  recognize the signs of SEN and prefer to say that  any children with complex disabilities finish M their child “doesn’t like school” and are too willing compulsory education but cannot pass the to allow him or her to drop out of school rather than examinations required to attend upper secondary looking for an alternative solution that is in his or her school or the baccalaureate, mainly because of a best interest. lack of support services (such as counselors), and of •  Sometimes parents from extremely poor a failure to adapt the curriculum and their individual households discover that various in-kind benefits intervention plans to reflect their needs. Thus, and support services (such as food, clothes, one of the most difficult problems for people with and school supplies) that are not available in disabilities is the passage from one education cycle to mainstream schools are made available for pupils another. During these stages, additional coordination in special schools. In an effort to obtain these is needed between the various bodies involved, benefits, they approach the educational orientation including the Complex Evaluation Service and the commission. In many cases, their children are educational orientation commission. Similarly, the accepted because they have a two-year lag in educational orientation commission needs to work development as a result of living in extreme poverty in tandem with vocational training programs or the without proper support and care in a challenging courses offered by professional schools. and non-stimulating environment. 277 UNICEF (2012: 42). Education | 201 The development of an inclusive culture in schools and communities is essential for increasing the participation of children with disabilities in education and for fostering their • ncluding the topic of tolerance of disabled people I and diversity in the educational curriculum in order to reduce the stigma and rejection associated with integration in mainstream schools. Various research, reports, disability and SEN. and interviews with families of children with disabilities Collaboration between teachers and families needs to have illustrated the key problems that families encounter be strengthened. At present there is no framework for when their disabled children enter the education system.278 a real and constructive partnership between teachers It has not proved to be easy to educate disabled children in and the parents of their students, which means that mainstream schools, mainly because many teachers and expectations on both sides are often unrealistic and biased families of non-disabled children are not in favor of their by misconceptions and prejudices. It would be advisable presence in schools. There is no culture of inclusiveness for policymakers to consider mandating the creation of in schools, nor is there any respect for differences or for some consistent institutional arrangements within schools maximizing individual potential. A focus on competition and (such as parent/teacher associations) that would facilitate knowledge in the Romanian education system compounded the building of trust, cooperation, and dialogue between by the marking system creates significant pressure on teachers and parents. students, teachers, and families. The parents of disabled children have frequently identified this attitude as the major The government should create and pass a specific all- obstacle to accessing education for their children. This has inclusive education law as recommended by the Office of meant that they often prefer to send their children to special the High Commissioner for Human Rights of the United schools as long as they can find an adequate educational Nations (Box 31). The legislative framework that regulates pathway for their child in this special sector. In order to access to education for people with disabilities is extensive promote a more inclusive culture in schools, policymakers and covers all aspects of education from preschool to should consider taking the following actions: tertiary education and vocational training (see Annex 6, • Section II. Romania ratified the UN Convention on the C  reating further programs to train parents, tutors, and Rights of Persons with Disabilities (UNCRPD) in December teaching staff in interacting with and helping children 2010 but has not yet provided the UN Committee on the with SEN and/or disabilities, possibly using Human Rights of Persons with Disabilities with an official national Capital Operational Program (POCU) funds. report on the implementation of the Convention (as it should have done in 2013). BOX 31 An Opportunity to Introduce Inclusive with measurable goals. States should put in Education Legislation place training programs for teachers, create reasonable accommodation funds, provide In 2013, the Office of the High Commissioner for Human for accessible materials, promote inclusive Rights within the United Nations produced a Thematic environments, improve testing methods, promote the Study on the Rights of Persons with Disabilities to transfer from special schools to mainstream schools, Education. This following quote is from the conclusions promote monitoring through indicators on inclusive and recommendations section of that report. education, provide adequate support to students, and “Through inclusive education laws, States should use appropriate communication means and formats. establish an inclusive education system under the aegis Schools need to be properly funded, while at the same of their respective ministries of education that prohibits time availability of resources should not be a basis for rejection from mainstream schools on the basis of denying access to the right to education for a student with disability and provides for reasonable accommodation. disability.” A transformation plan should provide the framework for Source: UNHCR (2013). the implementation of an inclusive education system 278 For example, Horga and Jigău (2010), Ghergut (2011), Toth (2013), European Centre for Disabled Children’s Rights (2013), and Chiriacescu (2014). 202 | PEOPLE-BASED POLICIES The rights of people with disabilities to be educated in Children with special educational needs (SEN) and children mainstream schools is included in Article 24, paragraph with disabilities are among the groups most likely to be 2(a) of the UNCRPD, which states that no student can be out of school, especially in rural areas. As the 2011 Census rejected from general education on the basis of disability. As indicated, one in every three children aged 7 to 14 years old an anti-discrimination measure, this “no-rejection clause” with a disabling incapacity (total or partial) has either never has immediate effect. Policymakers should ensure that been enrolled in or has dropped out of school. According to a new dedicated education law is passed that explicitly official data, the total proportion of children with disabilities includes a “no-rejection clause” that makes it illegal to deny not attending any kind of school (either mainstream admission to mainstream schools to disabled students and or special) varies between 24 percent and 40 percent that guarantees continuity in their education. The current depending on the source of data.279 Also, 5,191 children do impairment-based assessments for assigning students not benefit from educational support services, although they to schools should be discontinued, and instead disabled were identified as having SEN by the CJRAE’s evaluation students should be evaluated to ascertain their support service. In addition, various studies have shown that most needs to participate effectively in mainstream schools. The children with disabilities who are not attending school come Ministry of Labor, Family, Social Protection, and the Elderly from rural areas (see Table 33).280 From these data, it is is currently developing a Strategy on the Social Inclusion of clear that a large number of children with disabilities are Persons with Disabilities (2015-2020). falling through the “net” of education in Romania. Numbers of Romanian Children with Disabilities who are Not in School by Degree of Disability, TABLE 33:  Age group, and Area of Residence, 2011 Degree of disability 3-6 years old 7-10 years old 11-14 years old Rural Urban Total Mild handicap 364 23 33 236 184 420 Medium handicap 1,490 364 393 1,081 1,166 2,247 Marked handicap 1,211 479 521 1,266 945 2,211 Severe handicap 3,805 2,454 2,369 4,867 3,761 8,628 Total 6,870 3,320 3,316 7,450 6,056 13,506 Source: UNICEF (2012: 25). Note: The total number of children with disabilities at that time was 60,269 according to DPH official statistics. Families and NGOs are raising the alarm about the • Children with severe intellectual disabilities. • inappropriate ways in which many schools (mainstream and special) currently accommodate:281 C  hildren with complex disabilities (such as associated • impairments or functional limitations and complex Children with autistic spectrum disorders. dependency needs). • Children with behavioral problems. Increasing the number of vocational training programs for adolescents with disabilities in accordance with their • Children with ADHD. capabilities and with available labor market opportunities has become a necessity. A research study conducted • Children with HIV/AIDS and with rare diseases. in 2009282 showed that the percentage of people with disabilities aged 18 to 55 years old with no formal education 279 These data were provided by the Ministry of Education within the Response of the Government of Romania to the OHCHR’s questionnaire on the right of persons with disabilities to education, December 2013. 280 UNICEF (2012). 281 European Centre for Disabled Children’s Rights (2013). 282 Motivation Foundation and the Academic Society of Romania (2009). Education | 203 was seven times higher than among the general population who actually manage to obtain a qualification encounter and the dropout rate after primary school was twice as high. significant challenges in finding employment. In conclusion, The study also found that only 17.5 percent of disabled policymakers should consider designing and implementing people in this age group finished high school, and only 8.3 new vocational streams at the upper secondary level, percent had attended tertiary education institutions. The possibly funded by the EU, to teach qualifications that same study argued that making professional and special are appropriate for people with disabilities and that are in vocational education more accessible to disabled people demand by social economy projects.283 would increase their employment opportunities since many Increasing the genuine inclusion of people with disabilities of them are currently following this path of education. in the labor market will require increasing their participation However, in practice, employment rates are no higher for in education, enlarging the spectrum of lifelong learning disabled graduates of professional schools, mainly because programs, and making qualification systems more professional education has not been adapted to take into flexible. Currently the opportunities for lifelong learning account either people’s capabilities or market demands. and continuous education for people with disabilities are The current vocational training system for disabled people extremely scarce. Only 1.5 percent of adults with disabilities qualifies them for professions or activities that are no were involved in a continuous training process in 2008, a longer needed in the labor market or for occupations that proportion equal to that of the general population in Romania, individuals with disabilities cannot properly perform. As but much lower than the EU-28 average of 9.3 percent. a consequence, most of the few youths with disabilities BOX 32 The Current Education Network Available for Step, and Waldorf) following the Children and Young People with Disabilities existing curricula accredited for these in Romania alternative education methods in Romania. A National Commission for Currently the following education institutions are Alternative Education regulates these alternative available to children and young people with disabilities: schools. •  ainstream kindergartens, schools, high schools, M post-high-school education (with or without • • V  ocational schools.  pecial vocational schools. S • support or mobile teachers). • S  pecial kindergartens, schools, high schools, post-high-school education. •  Technological special high schools. Inclusive education centers.  • •  Daycare centers (with an educational component). ntegrated special education consisting of: I (i) Special classrooms integrated into the For more specific needs, mainstream or special education can be provided for people with disabilities either in their mainstream kindergartens, schools, and high homes or in groups or classrooms that are organized schools or (ii) Children with SEN being integrated in hospitals and rehabilitation centers (for children with individually in mainstream classrooms. • chronic illnesses or children who need a rehabilitation/  lternative schools developed by NGOs or public A hospitalization period of no longer than four weeks). institutions (for example, Freinet, Montessori, Source: Law of Education, no.1/2011 and Order pedagogia curativă, Planul Jena, Step by 3283/2012 of the Ministry of Education. 283 See, for example, European Agency for Development in Special Needs Education (2006). 204 | PEOPLE-BASED POLICIES FIGURE 37: The Number of Children with Specific Educational Needs in Schools in Romania, 1999-2013 60 53.4 No of students in special schools 48.2 No of students with disabilities in mainstream schools 37.9 40 29.4 27.6 27.9 28.9 27.4 25.9 20 16.3 17.4 12.8 14.2 14.2 10.8 11.5 5.7 1.1 0 '99/'00 '00/'01 '01/'02 '02/'03 '03/'04 '04/'05 '05/'06 '06/'07 … 'Dec '13 Source: Vrășmaș et al (2010: 70) adapted for December 2013 with data provided by the Ministry of Education within the Response of the Government of Romania to the OHCHR’s questionnaire on the rights of persons with disabilities to education. The transition of children with SEN and/or disabilities from Investing in the County Resources and Educational special schools into mainstream schools has progressed Assistance Centers (CJRAEs) to enable them to become and should continue in the coming years. Since 1998, real resource centers for inclusive education would several laudable measures have been taken to transfer constitute a major breakthrough for the education of more disabled students into regular classes. A major children with disabilities. The CJRAEs, if properly financed policy reform in 2000 gave the Ministry of Education the and staffed with highly professional staff and equipped role of ensuring the inclusion of children with SEN into with support services available for all schools and families mainstream schools. Four years later the Ministry issued in the county, would contribute greatly to the promotion an order encouraging schools to enroll children with SEN and development of inclusive education. For example, the (Order no. 5379/Nov. 25, 2004). As a result, the number of CJRAEs already provide speech therapy centers (centre SEN students in special schools has been reduced by half logopedice interscolare) as well as centers for psycho- (from 53,000 in 2000 to less than 26,000 in 2013), while pedagogic assistance that provide counseling services the number of SEN students enrolled in regular schools for teachers, students, and families. In 2013, the budget reached over 17,000 by the end of 2013 (Figure 37). The allocation to CJRAEs was RON 460,372 million for the current legal provisions (Law 1/2011, Chapter 2, Article 50) support of 16,609 children with SEN. recommend that most children with disabilities should be The government should support the transformation of educated in mainstream schools. In addition, according to special schools into inclusion resource centers to provide the official data, there are 5,191 students who have been pedagogical assistance to mainstream schools should be certified as needing special education support who are resumed and supported. This would use the expertise of not receiving this individualized educational assistance teachers from special schools to support the education (probably because of the insufficient number of support of children with disabilities within mainstream schools teachers) and 1,137 students who are being educated at rather than as a way to maintain segregation. Although the home. It is important to highlight that the closure of Schools reform initiated in 2000 aimed to modernize the special of Arts and Trades decreased the number of SEN students education sector, the process was never completed, and enrolled in the special vocational education system these special schools currently have fewer resources, staff, (învățământ profesional special) from 12,468 in 2000 to and opportunities for modernization than in the early years 2,094 in 2012, with a further drop to 1,628 in 2012-2013. of the reform. The years of economic austerity (2008- Education | 205 2013), along with the freezing of public positions, contributed when their classrooms or laboratories are not on the ground significantly to this difficult situation. The number of special floor, and the building is not provided with elevators or schools has also been gradually reduced from 180 schools mobile electric platforms. in 2006 to 167 schools in 2013. These schools are mostly It will also be necessary to adapt the information technology located in the main cities of each county and have residential used in existing schools in order to integrate children facilities to accommodate children from neighboring with SEN and/or disabilities. Easy-to-read information, localities. Considering the large number of children with pictograms, and specific learning areas for children with severe and marked disabilities (almost 44,000 children complex educational needs are rare in mainstream schools. living in families as of the end of 2013), it is evident that these Moreover, there are no assistive devices or technologies,284 special schools are completely insufficient, and therefore a except in those schools that already integrate children large number of children with complex disabilities are falling with sensorial disabilities. In addition, no interpreters for through the education net at the present time. sign language are assigned to mainstream schools, and Extending and adapting the available transport systems therefore it is very difficult for children with hearing or for children with disabilities is absolutely necessary. associated sensorial disabilities to function in a mainstream Adapted transportation is not available at national level, school environment. A national program for assistive and therefore many children with neuromotor or associated technologies in schools would be of great benefit for disabilities cannot attend school, except in cases where children with SEN and/or disabilities. their parents or an NGO finds suitable transportation to and The provision of social, health, or rehabilitation services is from the school. In smaller cities (such as Roman in Neamt common in special schools but is almost non-existent in county), where public transportation is not even available mainstream schools. This is a major barrier to integrating for local inhabitants, people with physical disabilities are children with disabilities into mainstream schools. Children practically isolated in their homes. In rural areas, school enrolled in special schools benefit from physiotherapy and transportation is uneven distributed. The initial school speech therapy within the school, because special schools buses provided by the Ministry of Education are currently are entitled to hire these professionals directly. However, the responsibility of local councils and therefore their children in mainstream schools who need rehabilitation maintenance is inconsistent. In winter, a large number services such as speech therapy, physiotherapy, intensive of children in rural or remote areas, even those with no medical treatment, and cognitive or behavioral therapies any disabilities, are isolated at home, because of a lack of are forced to adjust their daily program in order to include transportation options. these services after (or before) school hours when they are A program of investment in essential infrastructure is enrolled in mainstream schools. These services are rarely needed to ensure that students can access all public available in locations close to the student’s home, which educational institutions at all levels. This investment means that families have to make extra efforts to try to find could potentially come from the Structural and Cohesion the most practical solution for these daily arrangements. Funds. National and local policymakers could help by In order to keep these schedules flexible, the families are imposing regulations that require all educational and care forced to use private sector therapists (instead of services institutions to be made fully accessible for the physically covered by health insurance or by public institutions), which disabled. Access to schools and instructional materials, creates an additional financial burden for families. both mainstream and special, remains unevenly distributed. Currently there is little pedagogical support available While special schools started investing in accessibility to mainstream schoolteachers who have students with infrastructure from 2004-2005 onwards, mainstream disabilities in their classrooms, despite the existence schools are usually inaccessible for wheelchair users of some continuous training projects initiated by the and for people with sensorial or associated disabilities. CJRAEs in several counties. There is little cooperation Additional challenges are encountered by children with between mainstream and special schools, and therefore no mobility difficulties, especially in secondary education, 284 Assistive devices include any device that disabled children (or adults) might use to help them to learn and function more effectively. They include wheelchairs, hearing aids and amplification devices that improve hearing, glare-reduction screens, screen magnifiers, Braille note-taking devices, and voice-recognition software and technologies that enable severely disabled students to control their computers simply by following letters and commands on the computer screen with their eyes. In Romania, the development of such assistive devices is not very advanced. Producers are reluctant to enter the market because a large majority of devices are still not covered by the National Health Insurance, which means that most potential users cannot afford to buy these devices. 206 | PEOPLE-BASED POLICIES dialogue and exchange of practices between teachers on workload of a mobile teacher for home-schooled children pedagogical methodologies and instruments for teaching with severe or marked disabilities is 16 hours per week, children with disabilities. Nationwide, the number of school divided between four to six children. Actually, in practice, counselors and school-community mediators is very small the same professional may have to work in several different - 2,184 and 232 respectively as of the end of 2013. There schools or may spend some of his or her time as a support is an average of one school psychologist for at least every teacher in a mainstream school and the remainder as a 800 students. Under these circumstances, the inclusion mobile teacher for a small number of children, sometimes of children with disabilities often depends on a motivated situated in different locales. Thus, the quality of the service or charismatic teacher or schoolmaster rather than on is affected by these high workloads. The families of the legislation, human rights, or existing professional norms. students served by these teachers have complained that these hours are completely insufficient, especially when the Children in rural or remote areas are particularly children being supported by a given teacher are not located negatively affected by the lack of support services. Mobile in the same school or classroom. Parents and mainstream (interdisciplinary) teams are almost nonexistent in many schoolteachers believe that, in order to provide effective counties. These children are often diagnosed later, or not support to a child either in a classroom or at home, a support at all, and often they fall completely through the net of teacher cannot work with more than one (maximum two) education and social security. children with disabilities per week. The Ministry of Education has piloted a variety of prevention The evidence of the last 20 years has proved that the and remedial programs such as School-After-School, which existing resources in the education system cannot provides after-school remedial support and extracurricular guarantee a quality for children with challenging behavior activities to students needing extra help. This program was and complex dependency needs who are being educated piloted at the beginning of the 2012-2013 school year, with at home. There were 1,137 such home-schooled students in 5,500 beneficiaries and a budget of RON 61.395 million Romania as of December 2013 as reported by the Ministry in 2013. Having had some success, this program will be of Education. The assigned mobile teacher spends several progressively scaled up and will include a grant scheme hours per week with the child, and the entire social network to promote innovation at the school level. However, so of the child is compromised as a result of his/her isolation at far, financing for these preventive measures has been home. While home education might be a good solution over insufficient and ad hoc in nature. The ministry has also short-term periods (for example, after complex surgery or fostered the introduction of counseling services, school during periods of intense medical rehabilitation), it is not a mediators, and support/mobile teachers (see below). recommended solution for the long term. The development of inclusive education will not be possible There is a strong need for extensive and continuing training without proper selection and training, of and funding of teachers in this sector, in both mainstream and special for an extensive network of support or mobile teachers schools, along with the modernization of pedagogical for mainstream schools and remote or isolated areas. interventions, instruments, and methodologies. There is Educational services are delivered to children with SEN a significant lack of information and knowledge among and/or disabilities, both home-schooled and in mainstream teachers (in both mainstream and special schools) regarding education, by support or mobile teachers (cadru didactic the education of children with SEN, including those with very de sprijin or cadru didactic itinerant). The number of complex needs. Many teachers in mainstream schools find support teachers is very small, and no new support it difficult to adapt the curriculum to the needs of disabled teachers have been hired in recent years on any significant children because they are not familiar or at ease with them. scale - only 1,310 for the entire country relative to about Even more experienced teachers have difficulties in adjusting 20,000 children who are home-schooled or integrated in their practices to the needs of children with autistic spectrum mainstream education (as of December 2013). disorders, behavioral problems, ADHD, complex dependency The regulations relating to the weekly workload of support needs, HIV/AIDS, rare diseases, severe intellectual or mobile teachers need to be revised in order to ensure that disabilities, and other conditions that are considered each child receives high quality support. The current norm obstacles to learning. Several CJRAEs (for example, in is that a support teacher in a mainstream school will provide Botosani, Cluj, Neamt, and Valcea) have using local or EU 16 hours of direct support per week for either eight children funds to initiate courses or projects with the aim of expanding with mild or moderate disabilities or four to six children the skills and knowledge of teachers and counselors in the with marked, severe, or associated disabilities. The weekly area of inclusive education. However, there are still very Education | 207 few of these initiatives. In the future, initial training could The financing mechanism for mainstream schools that be provided at the level of Departments for Preschool and have integrated children with SEN and/or disabilities Primary Education (within the Faculties of Educational needs to be adjusted, and an adequate budget should be Sciences) as well as in universities. Subsequent training allocated for the promotion and development of inclusive could be provided at the level of Casa Corpului Didactic or at education. The government provides specific cash and the level of the CJRAE. Additionally, all practicing teachers in-kind benefits, such as food allowance and grants for at all levels should take a mandatory module (of a minimum school materials (Government Resolution no. 1251/2005), of five working days on average) covering the principles and to children with disabilities who attend mainstream or practices involved in inclusive education. special schools. At the school level, special schools receive extra funding in addition to their per capita financing, and The current poor training of teachers is reflected in the lack they offer their students a series of in-kind benefits and of adaptation and differentiation of the curriculum. Children services, such as hot meals, school supplies, and personal enrolled in special schools benefit from a specialized hygiene facilities (adapted toilets). However, this is not the curriculum at all levels of education, and they are also case with mainstream schools that integrate children with entitled to exceed the maximum age of school attendance SEN and/or disabilities. The costing methodology for per by two years on average. In special schools for sensorial capita financing includes correction factors both for children disabilities (hearing and visual impairments), children with SEN and children with disabilities. However, the extra follow the mainstream curriculum, adapted only in terms funding resulting from the application of correction factors of the communication methodologies and manuals used. is granted only if the school develops special programs Children with disabilities enrolled in mainstream schools for these children. These programs must have been are supposed to be taught according to a curriculum that incorporated into the school curriculum after being approved is adapted to their needs and challenges in accordance by the School Board and subsequently by the local council, with the recommendations included in their individual the county council, the Ministry of Education, the ministry plan of intervention.285 These adaptations are theoretically responsible for public administration (currently the Ministry made by teachers with the support of counselors or of Regional Development and Public Administration or support teachers. However, adapting and differentiating MRDPA), and the Ministry of Public Finance. Because the curriculum is not a simple process, and the majority of this long and complicated process for applying for of teachers are not familiar or at ease with the process, supplementary funding, most mainstream schools that nor are they capable of adapting it in the best interest of have integrated children with SEN and/or disabilities the disabled child. Moreover, the younger generation of receive only the basic per capita financing. The interviews preschool and primary school educators, who have been conducted under the current study highlighted this fact obliged to graduate from a specialized three-year university as a source of frustration for these schools, especially program since 2011, have usually received only a very because the per capita financing formula seems to conflict small number of hours of training on the subject of inclusive with the regulations governing the number of children education and of special psycho-pedagogy. As a result, assigned per class, according to which one pupil with SEN they have no real understanding of the specific needs and is counted as two regular pupils. So, while the formula for requirements of children with disabilities when they start assigning the number of children per class promotes smaller work in the professional field. classrooms, thus making it easier to adapt the curriculum Teachers are not trained in the use of specially adapted and to give special attention to students with SEN, the per evaluation methods. As a result, the assessment of capita financing system pushes schools to maximize the disabled children’s school progress is not always adapted size of their classrooms in order to secure the most funding to the unique abilities and needs of the child, despite the possible. Therefore, the financing mechanism diminishes legislative requirements. Children with complex disabilities the quality of education for children with SEN and/or often find it difficult to take annual examinations. Many disabilities, which has already been undermined by the of them finish compulsory education but cannot pass the underdevelopment of the support services discussed above. examinations required to attend upper secondary school or In addition, public funding should be made available to the baccalaureate. support any educational centers provided by public-private 285 The Ministry of Education’s regulations specify how the school curriculum can be “adapted to” or “differentiated in relation to” the needs of each child (HG 1251/2005). 208 | PEOPLE-BASED POLICIES partnerships or by NGOs (including specialized centers) that education in smaller communities close to children’s homes. have been accredited by the Ministry of Education. Support A good example of such initiative is provided in Box 33. should particularly be provided to those centers that provide BOX 33 Good Practice - The Only Private Special to improve the quality of life for the elderly in School Accredited by the Ministry of Education need, and to organize educational camps. for the Primary and Secondary Education of RCE Hope for Children runs the Sun Ray Children with Severe Disabilities School, an educational center that works to integrate The Christian foundation RCE Hope for Children in Arad children with disabilities into the education system. The county is a non-governmental non-profit organization school consists of six classes, each with six to seven created from the merger of two non-governmental children between the ages of 3 and 14 years old who live organizations, the Association of Christian RCE Arad either with families or in placement centers in Arad and (created in 1992) and Hope Children’s Christian surrounding localities. Each class has a teacher and an Association (created in 1994) Arad, both of which had assistant. the same sponsor - Romanian Christian Enterprises Each student benefits from an educational plan designed USA. Although initially focused on supporting micro to meet his or her specific needs including reading, enterprises through training and the provision of interest- mathematics, writing, language, and socialization. free loans, the foundation’s vision has been adapted to take into account local needs and priorities. The In addition to special education, students benefit from foundation’s programs have been redesigned to reduce physiotherapy, speech therapy, and counseling provided dependence on the state and to address basic human by qualified staff. The school’s social networking needs, especially the needs of vulnerable children. Thus programs are delivered two times a week and include RCE Hope for Children is a private body authorized and going to a puppet theater, going on trips, going to the accredited as a legal entity, with no religious and political park, riding the tram, or visiting the farm, the baker’s, conditionalities, carrying out child protection, assistance, or the transport company. During the school year, and support programs for various categories of vulnerable celebrations are prepared for various events such as people. Christmas, the 8th of March, Easter, and the end of school. The purpose of the organization is to facilitate the placement or adoption of abandoned children in The educational center has 29 employees of whom 21 Romania, to support abandoned children in orphanages are teachers. In 2009 the Ministry of Education approved and care centers and street children, to help those in the extension of the school’s education services to need who cannot help themselves (children, youths, include a special school gymnasium and kindergarten. In the elderly, people with mental or physical disabilities, 2014, 60 children were enrolled and six children were on orphans, and others with special needs), to support and the waiting list. The center’s budget for is 11,000 lei per train entrepreneurs in developing and expanding their month plus donations (for example, for supplies, food, and organizations by hiring young people with disabilities, clothes). and to support education in schools and care centers for Extracurricular activities include a chorus of bells, sewing children and the elderly. tapestry, teaching computers, music, and movement, The organization’s mission is professional service of swimming, and going shopping. Children are transported abandoned children in institutions, families and the to and from school and are provided with two meals and a elderly in need. The objectives of the organization are snack daily from Monday through Friday. to ensure social inclusion and rehabilitation services for /www.rcesperantacopiilorarad.org Source: http:/ abandoned children and children with special needs, Education | 209 Roma Children The participation rates of Roma children in compulsory education are low. The results of the survey of Roma in In Romania, the Roma population faces the most Central and Southeast Europe undertaken by UNDP, the widespread and severe forms of deprivation, among which World Bank, and the European Commission in 2011 showed the lack of access to education is of the utmost relevance that the compulsory education enrollment is significantly and gravity. The recent World Bank study286 on increasing lower for Roma than for non-Roma (78 percent versus 95 the social inclusion of Roma in Romania drew attention to percent, see Figure 38). The same survey indicates that some alarming facts concerning the participation of Roma the main reasons that parents of Roma children for their children in education. The participation rates for Roma children not going to school “costs are too high,” they feel children in all levels of education are significantly lower their children are already “sufficiently educated” or they than for non-Roma children, with this inequality increasing “need to work for income.”290 Increasing the participation sharply in upper secondary education.287 of Roma children in compulsory education will require policymakers to take actions such as: Few Roma children have access to quality preschool education. Only 37 percent of Roma children between 3 and 6 years of age are enrolled in preschool as opposed to 63 percent of their non-Roma neighbors (Figure 38). •  eveloping an early warning system to identify D students at risk of dropping out would enable schools to take effective measures before the students This low preschool enrollment undermines the school become alienated from school, play truant, or even readiness of Roma children and their chances of attaining drop out. The Ministry of Education could commission higher educational levels and acquiring employment Romanian or international experts to identify the skills later in life. International evidence demonstrates that most reliable and effective instruments for identifying early intellectual stimulation in the home and in preschool disadvantaged children at risk from both Roma and develops the foundations of cognitive and socio-emotional non-Roma backgrounds. skills, improving a child’s chances of socioeconomic success later in life, especially for vulnerable groups.288 For example, while only 5 percent of Roma children aged 4 to 6 who do not attend preschool can identify at least 10 letters • E  xpanding and enhancing mentoring and tutoring activities in order to help individual pupils to overcome particular academic, social, or personal of the alphabet, the percentage in the same age group goes difficulties. Either in one-to-one approaches up to 40 percent if they attend preschool.289 The same (mentoring) or in small groups (tutoring), pupils would study states that the costs of preschool contribute to the low receive targeted assistance from educational staff, preschool enrollment rates of Roma children. Roma parents community members, or their peers. with children in preschool have reported spending €7.50 per month on preschool, approximately 4 percent of their household income, with children bringing lunch from home in more than three-fifths of all cases. Although this may • O  ther policies could include: (i) making schools more inclusive, relevant, and welcoming to Roma children; (ii) facilitating parental involvement in education; and seem a comparatively low amount, costs are nonetheless (iii) investing in the transportation of Roma children commonly cited by Roma parents as a constraint to sending who live far away from schools. their children to preschool. The small number of available places in local preschools and the generally low quality of Education and employment policies should focus on the early education available to Roma communities further increasing the skills and employability of Roma children in limit the access of Roma children. a coordinated manner. Roma have low rates of secondary 286 de Laat (coord., 2012) based on the regional UNDP/World Bank/EC regional Roma survey (2011). 287 The data on Roma have to be considered cautiously - each of the data sources having its own pitfalls (the survey on Roma communities not estimating right the situation of the dispersed Roma, while the Census underestimating the number of Roma and capturing most probably only the most deprived Roma – the other ones not having declared their ethnicity). 288 Kendall et al (2008). 289 de Laat (coord., 2012: 35). 290 FRA, UNDP and European Commission (2012). 210 | PEOPLE-BASED POLICIES FIGURE 38: The Gap in Education Outcomes between the Roma and Non-Roma Enrollment rates Roma Non-Roma Highest completed education (25 -64) 95 Non-Roma 2 9 32 52 5 100 90 83 78 80 70 63 60 Roma 31 31 28 10 0 50 37 40 30 23 0% 50% 100% 20 No formal education 10 0 Primary education - ISCED 1 Pre-school Gross enrolment Gross enrolment Lower secondary education - ISCED 2 enrolment rate rate in compulsory rate in upper- (3-6)** education (7-15) secondary Upper secondary education - ISCED 3 education (16-19) Post-secondary education - ISCED 4+ Source: World Bank estimations based on UNDP/WB/EC Regional survey 2011.291 . school completion. Secondary education in Romania lasts four years: grades 9 and 10 (lower secondary) are • I ntroducing second chance education and traineeships, including adult literacy programs. • compulsory, while grades 11 and 12 (upper secondary) are not. According to the UNDP/WB/EC survey, 90 percent of  reating traineeships, internships, and placement C the Roma aged 25 to 64 have completed lower secondary programs in administrative positions at the central, education or less, while the percent is only 42 in the case regional, and local levels, especially for young of their non-Roma neighbors (Figure 38). The gap between Roma women. Roma and non-Roma enrollment is especially wide among Enhancing the capacity of teaching staff is crucial for the young people aged 16 to 19 - only 23 percent of Roma effective delivery of inclusive education to Roma children. youths are in upper secondary education, compared with The following actions could be considered: 83 percent of non-Roma; completion rates are particularly low among Roma women – only 18 percent of Roma women aged 16 to 19 are still in school, while the percent of Roma men is 29.292 Other indicators point in the same • D  eveloping and introducing cultural competency modules within the mandatory curriculum for initial and in-service training of public officials. • direction. Rates of computer literacy and participation in vocational training are about half as high among Roma  xpanding the teacher training university curriculum E as among their non-Roma neighbors. As a result of these with courses focusing on teaching children from significant gaps in early child development and education, disadvantaged groups (including Roma). • Roma have access to fewer job opportunities in adulthood than the non-Roma. Actions that policymakers could P  ractical training with classes in disadvantaged consider in order to close this gap include: schools, to accompany the above measures. • S  caling up and increasing the effectiveness of the Roma school mediator program. To achieve comprehensive inclusion of the Roma population, combating negative stereotyping is crucial. 291 /www.eurasia.undp.org/content/dam/rbec/docs/Roma_survey_data___Romania_2011.xls http:/ 292 World Bank (Anan et al, 2014). Education | 211 Roma children often experience exclusion on the basis For the effective inclusion of Roma population, it will be of their ethnicity in school. A UNICEF study presented essential to rigorously pursue anti-segregation policies evidence that the risk of school dropout as well as the risk and to continue the desegregation of Roma schools. of early school leaving is negatively correlated with parents’ Discrimination and prejudice lead to segregation, level of education, household income, and household segregated classrooms, and even segregated schools. expenses related to school.293 However, they are also As a recent research report showed, ethnic prejudice positively correlated with ethnicity (for example, being among teachers is one of the major obstacles preventing Roma), with rural location, with having a higher number of desegregation.297 Consequently, the opportunities for children in the household, and with birth order.294 Within Roma children to develop skills are further hindered by households with many children, the younger children have the high level of segregation of Roma pupils in classrooms. a significantly higher risk of leaving school early than their Nearly a quarter of Roma children currently attending older siblings. However, ethnicity was the only significant basic education are in classes where most of the children determinant in multiple regression models295 of risk of are Roma.298 This is worrying, given the evidence that school dropout or early school leaving. Consequently, being school segregation has strong negative implications for identified as Roma by a teacher significantly increases a the quality of education and skills development of Roma student’s chance of only completing eight grades at most, students. Findings from international studies suggest that all other things being equal or constant. This reflects the students in integrated schools, both Roma and non-Roma, existence of discrimination against Roma children within perform better on standardized reading comprehension schools, a finding which confirms existing evidence about tests and in the development of non-cognitive skills and highly persistent anti-Roma attitudes among parents, attitudes of tolerance.299 The ESL Strategic Framework members of local authorities, teachers, school managers, recommends that the government should help communities and even non-Roma children. Research conducted in and schools to achieve a representative population balance some of the largest Roma communities has shown that in classrooms.300 The Framework suggests a set of activities Roma frequently face discriminatory remarks at school.296 that would expose families, communities, and schools to As shown in Section 2.7 on social participation, Roma Roma and other cultural minority groups. This initiative still experience discrimination and prejudice in Romania would be complemented by targeted community events because of their ethnicity, despite the continued efforts of to disseminate information on social inclusion to dispel the Romanian authorities, civil society, and international donors myths that are often developed about ethnic minorities. It to fight the problem. Some measures to tackle this social also proposes appointing more mediators to help school problem are suggested in the same chapter, to which the principals to ensure an ethnic balance in the classrooms following recommendations may be added: and to facilitate dialogue with parents. • I ntroducing a third-party ombudsperson to monitor the observance of non-discrimination principles by public service providers (for example, in health care, Investing in school mediators would be beneficial for the Roma, as these mediators appear to play a positive role in enhancing the participation of Roma children in compulsory education. The number of school mediators is low and has social assistance programs, and schools). been declining in recent years. A recent study by ‘Împreună’ •  nforcing the law against discrimination more E effectively and consistently by amending the law and the institutional framework of the National Council for NGO showed that over half (55 percent) of the surveyed schools lack a school mediator, including schools with over 50 percent Roma children. Between 2003 and 2013, through various programs, a total number of 1,001 school Combating Discrimination. mediators were trained in Romania, but only 232 were reported be to actively employed as school mediators at the 293 Stănculescu et al (2012: 63). 294 Within households with many children, the younger children have a significantly higher risk of leaving school early than their older siblings. 295 All other things being equal, being Roma increases significantly the probability of a child dropping out or leaving school early irrespective of the child’s age, gender, and health status, the mother’s level of education, the number of children within household, the number of parents at home, the location of the household, and household spending related to education (or household income). 296 ERRC (2013: 10). 297 Fox (2012: 2). 298 World Bank (Anan et al, 2014: 37) based on the regional UNDP/World Bank/EC regional Roma survey (2011); See also Surdu (2008). 299 Kezdi and Suranyi (2009). 300 World Bank (2014b). 212 | PEOPLE-BASED POLICIES national level by the Ministry of Education as at December There are few qualified full-time teachers in rural areas, 2013. Some local mayors have diverted resources from the so the schools have had to employ a large number of Roma mediator program to other areas, while in other cases, part-time, poorly qualified teachers who commute from a the Roma mediators themselves have opted out because distance. Consequently, there is high turnover of personnel of the low salaries being paid. In future, it will be vital to at rural schools. improve the regulation of the role of Roma mediators. For The limited amount of quality infrastructure and of example, at present, mediators are required by principals school directors and teachers is noticeable in rural areas to do administrative work or even cleaning. In other cases, at all levels of education but especially in vocational they are assigned to teach Roma children while the and technical education and training. The increasing teachers themselves only teach the non-Roma students.301 professionalization of farming is making it necessary to provide rural students with relevant programs of basic and Children from Rural and Urban technical education. The ESL Strategic Framework includes Marginalized Areas recommendations that mirror the priorities set by the National Strategy for Strengthening the Agri-Food Sector.303 Further investment in rural schools will be needed to ensure Investment in the transport infrastructure and related equal access to quality education for children in deprived projects is essential for ensuring access to quality rural areas. Rural areas are at a disadvantage compared education for children in remote and poorly connected rural with urban areas (see the chapter on rural marginalized communities. There are two programs available to support communities), as are rural schools in comparison with most pupils commuting to and from school, namely free urban ones, in terms of available funding, human resources, school buses and transportation reimbursement. During infrastructure, and accessibility. the 2012/2013 school year, 2,238 school buses were Although the costing methodology for per capita financing available nationwide, and the Ministry of Education reported uses a correction factor in favor of rural schools, in many cases that a total of between 150,000 and 170,000 students it does not succeed in compensating these schools for the received transportation reimbursements. While use of the low number of students per class. Consequently, schools with school bus program has increased sharply in 2013 and a smaller number of students receive an insufficient budget 2014, the transportation reimbursement was delayed and and are regularly subjected to the budgetary re-equilibration downsized in terms of both the total budget and method of mechanism to cover salaries and taxes. Their available budget assessment, so that the average amount reimbursed to a for “material expenses”302 is also small and does not allow child for the same distance has been almost halved.304 The them to develop or fully equip themselves. The standard cost number of rural children whose transportation to and from per student for the acquisition of goods and services is RON school is not reimbursed is still significant.305 This problem 296 in rural areas compared with RON 347 in urban areas. particularly affects preschool children and primary and secondary school students living in remote areas that do Despite continued investment, many rural schools, not have functioning roads. Many rural households that particularly smaller ones in remote villages, still have poor are dependent on subsistence agriculture cannot afford infrastructure and are ill-equipped with teaching materials the travel expenses associated with sending their children and modern equipment, such as ICT and connections to to school. It is also educationally ineffective for students the Internet. Many of them have not been granted sanitary to live a long distance from the school. This is especially certification because of a lack of proper toilets and sewage the case with several large vocational schools that provide systems. Moreover, many rural schools lack safe and training and education for many rural teenagers, for whom effective heating systems. 301 World Bank (Anan et al, 2014: 19). 302 This covers all costs related to the maintenance and operation of the educational unit, including the purchase of goods, repairs, books and publications purchased for the library, expenses incurred in conducting training sessions, and other expenses authorized by statutory provisions. 303 World Bank (2014b). These recommendations include measures to: (i) “accelerate the structural transition towards professional commercial farming, while aligning with demographic trends and ensuring an equitable phasing out of surplus farm labor” and (ii) “reinstate Romania as a net agri-food exporter, in accordance with its sector production potential and in response to strong global food demand agricultural development.” 304 According to a monitoring report of the Ministry of Education in 2013, the six-month delay and the downsizing of the program were the result of the high, unforeseen costs of the passes (supposed to be reimbursed). The value of the passes greatly varied from one locality to another, the most costly being 10 times higher than the lowest value pass for a journey of the same distance. 305 A public report indicated that there are no school buses or other sustainable solution for transporting local children to and from school is available in several counties - Argeș, Mehedinţi, Vaslui, and Suceava (Avocatul Poporului, 2013). With regard to the transportation reimbursement, the actual numbers of students commuting to school in other counties is higher than the number of applicants for reimbursements because some of the students use the services of private transportation providers that do not always issue transportation passes. Education | 213 the transportation reimbursement program has been vital, leave to work elsewhere as soon as an alternative presents especially those from low-income backgrounds. Therefore, itself. This has a negative effect on children since younger this very popular program needs to be restored to its former teachers have limited knowledge of working with vulnerable level of support as a matter of priority. Policymakers may children (and their families). A high staff turnover means that wish to consider several other actions, including: continuity in care and nurturing for needy students is lost, • and the bonds and the trust relationships between teachers E  xtending the school bus service to cover the on the one hand, and students and their families on the transportation of preschool children (and, where other become more tenuous (Coleman, 1988). The status longer distances are involved, their parents) in and prestige of these schools is also low, and consequently rural areas where other means of transport are not better-off parents tend to bypass them. available. The School Infrastructure Rehabilitation program,306 which •  evising the school bus program so as to include R clear and explicit criteria, such as the number of children with special needs attending non-residential began in 2004 and will end on December 31, 2015, aims to rehabilitate, upgrade, and furnish primary and secondary school buildings. The program is managed by the Ministry of Education and is financed by a loan from the European schools who need transporting to and from school. Investment Bank and the Council of Europe Development • P  roviding adequate financial support to the localities where buses are available to ensure the sustainability of the program. At present, fuel and Bank. Its main objective is the rehabilitation, upgrading, and furnishing of the 1,336 Romanian primary and secondary schools and 16 dormitories to restore the safety of school drivers’ salaries are usually funded by a combination buildings and improve their sanitation and comfort. In 2013, of direct payments from the county governments and the program was operating in 320 locations throughout payments from the school budget. Romania, with an allocation of RON 250 million. However, • more investment is needed in this area. D  esigning a means-tested scheme for children from poor and vulnerable households to fully cover Making Funding Mechanisms their transportation costs in cases when the actual transportation scheme does not do so. Responsive to Students’ and Schools’ Needs • Investing in boarding facilities for schools.  Greater investment is also needed in disadvantaged Above all, improving the quality and equity in education in Romania will require an increase in overall financing for schools in urban marginalized areas. In urban areas, there education. In Romania, the level of funding for education are also some schools with a large proportion of children is among the lowest in Europe and is decreasing. Total from vulnerable groups, including children with special education spending as a share of GDP has declined educational needs, children with disabilities, Roma children, substantially from 4.25 percent in 2007 to 3.1 percent in or children from low-income or extremely poor families. 2011 (Figure 39). The amount that a government spends Some of these urban schools are also segregated, either in a given social sector depends partly on its overall fiscal geographically or in ethnic terms or both, particularly those constraints and partly on the priority given to that particular that concentrate children from marginalized areas. Most sector in its public resource allocations.307 Therefore, the urban disadvantaged schools have equivalent infrastructure country’s fiscal context308 is the main driver of the relatively to regular schools, but some (particularly the segregated low spending on education as Romania has an overall ones) may lack sanitary facilities and proper heating. government spending level of 39.4 percent of GDP (in 2011) However, most of these schools lack educational materials as against an EU-27 average of 47.9 percent. However, and modern equipment and are subject to high staff government education spending accounts for only 7.8 turnover because young inexperienced teachers usually percent of total government expenditure (decreasing from 306 /www.schoolrehabilitation.ro/ http:/ 307 This relationship was demonstrated for health care by Kutzin and Jakab (2010). 308 The fiscal context refers to the current and expected spending capacity of a government. More affluent countries tend to be more effective at mobilizing tax revenues and thus have higher levels of public spending as a share of GDP, whereas when a country has more limited fiscal space, this usually results in low government spending, including on education and health care. 214 | PEOPLE-BASED POLICIES 11.1 percent in 2007) compared with a constant EU value of from 0.5 percent of GDP in 2007 to 0.11 percent of GDP in 10.8 percent, meaning that the central government gives a 2011, which was almost seven times lower than the then fairly low priority to the education sector. In addition, private EU-27 average of 0.74 percent. expenditure on education has also decreased in Romania FIGURE 39: Relationship between Education Spending, Fiscal Context, and the Priority Given to the Education Sector in Romania and in the EU-27 in 2011 (%) 12 10.9 11.0 10.9 10.8 10.8 10.8 10.9 10.9 10.8 10.8 10.8 10.7 10 11.1 11.1 10.0 10.3 10.3 10.3 10.3 % of Total Public Expenditure - EU-27 9.8 8 9.0 9.0 8.8 7.6 % of GDP - EU-27 6 5.0 5.0 5.0 5.4 5.4 5.3 4.9 5.0 5.0 4.9 4.9 4.9 % of Total Public Expenditure - Romania 4 4.3 4.3 4.2 % of GDP - Romania 3.3 3.5 3.5 3.3 3.5 3.5 3.5 2 2.9 3.1 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Source: Eurostat. BOX 34 Improving Equity and Quality in Education use funding strategies, such as weighted funding formula, that take into consideration The 2012 OECD report Equity and Quality in Education that the instructional costs of disadvantaged spelled out the funding strategies required to improve students may be higher. In addition it is equity and quality in education as follows: “Available important to balance decentralization/local autonomy resources and the way they are spent influence students’ with resource accountability to ensure support to the learning opportunities. To ensure equity and quality most disadvantaged students and schools.” across education systems, funding strategies should: guarantee access to quality early childhood education Source: OECD (2012a: 10-11). and care (ECEC), especially for disadvantaged families; Education | 215 The per capita financing of Romanian schools is based on a weighted funding formula that takes into consideration the fact that the instruction costs of disadvantaged •  chools, usually in rural areas, that have lost their S official status because they had fewer students than the legal minimum, thus becoming part of one larger students may be higher than average.309 These per capita institution whose management transfers only the costs apply only to basic funding. The costs associated minimum amount to the original school. • with educating poor and vulnerable children come under the complementary funding or supplementary funding L  arge prestigious schools with highly qualified staff in sections of the budget. Complementary funding consists urban areas (with high staff salaries). • of expenditure on canteens, boarding schools, school allowances, and national support programs (for example, V  ocational schools where the teaching process those covering the costs of school supplies and high school involves one-to-one activities. • scholarships), which comes from the budgets of the local authorities from the amounts that they deduct from VAT. A  pprenticeship schools where practical learning Supplementary funding finances programs encouraging activities require expensive materials. ethnic minorities to enroll in school, school dropout Thus, many rural schools are facing serious financial prevention programs, and support for students with social difficulties that are negatively affecting the quality of the problems or disabilities. Supplementary funding comes education that they provide. This is the case even though from both the central and local budgets. Despite these the financing formula is weighted in favor of rural schools various sources of funding, most school managers report in order to compensate for their lower numbers of students that their budgets are barely sufficient to cover their basic per class. The stated intention of the Ministry of Education expenses (mainly salaries).310 to close financially unsustainable schools in remote The per capita based funding of Romanian schools seems to areas goes against the need to ensure that all children be inadequate to meet the actual needs of schools located can access education. A more equitable financing system in or serving disadvantaged communities, particularly that incorporates social criteria in calculation of per capita in rural areas. Within the basic funding, per student unit funding might allow some of these schools to become costs311 take into account schools’ characteristics including sustainable and remain open. their location (in urban or rural areas), their utility needs (for In addition, supplementary funding, which is currently those with high winter utility bills), the level of education based on a weighted funding formula for children in (preschool, primary, or secondary), what educational vulnerable situations, needs to be reviewed, but should also streams they offer (in other words, theoretical, vocational, be properly delivered to all mainstream schools where such and so on), their teaching profile (full-time, part-time, or children are enrolled. The base funding includes various distance learning), and type (public or private). School correction factors to cover the additional costs to schools of financing is decentralized to the local authorities, though teaching children in minority languages, but all other groups the state sets the formula per student to ensure that schools are covered by correction factors to the supplementary do not lack funds, irrespective of how limited local revenue- funding as can be seen in Table 34. However, as already generating possibilities may be. However, a recent UNICEF explained above in the section on children with SEN and/ study312 showed that many schools have a systematic or disabilities, supplementary funding is usually received budget deficit, particularly these categories of schools: only by special schools and often does not reach those •  chools in small villages with dwindling numbers of S students, which are usually unable to attract children from neighboring localities in order to enhance their mainstream schools that have students from vulnerable situations. This supplementary funding is only available to mainstream schools if they develop special programs for those children. As shown before, these programs must number of pupils. have been incorporated into the school curriculum after 309 The new financing system was introduced in the 2011 National Education Law and implemented later with government decisions spelling out the costing and allocation methodology (GD 1274/2011 and GD 1165/2013) and the actual standard costs. A subsequent legislative provision (GD344/2013) allows a redistribution of budgetary funds to schools in cases where the per capita allocation does not entirely cover expenditure. 310 Fartușnic et al (2014). 311 The reference unit cost is decided every year by Government Ordinance and is estimated for a gymnasium student in an urban area by dividing the value of the average teacher salary by the average number of students per teacher. 312 Fartușnic et al (2014). 216 | PEOPLE-BASED POLICIES Correction Factors for Supplementary Funding TABLE 34:  Categories of Correction factors Observations vulnerable students Roma pupils 3.07% Applied only if specific programs are directed toward these students within the school. Pupils with disabilities 2.59% Applied if there are children with disabilities within the school. Pupils from 6.31% Applied only if specific programs are directed toward these students within the school. disadvantaged groups Pupils with SEN 0.68% Applied only if there are approved specific programs for these children. high risk area - 0.65% Pupils with special Depends on the area in which the school is located, with the degree of risk determined medium risk area - 0.43% social needs by the County Directorate for Statistics. small risk area - 0.21% Source: www.isj.dj.edu.ro. Note: The correction factors are applied to the standard unit cost. being approved through a long and complicated process for eligible children such as hot meals, after-school programs, applying. Consequently, these schools, although they have special support programs, and incentives to attract teachers higher than average proportions of disadvantaged students, to work with children from disadvantaged groups. have limited resources and are usually unable to implement 2.4.6. Enhancing any activities that support students who are at risk of repeating grades, absenteeism, or dropping out. Policymakers might consider providing supplementary funding counting all children from very poor families given the Effectiveness of their high risk of dropping out of school or early school Welfare Programs in leaving (Figure 35). The UNICEF study cited above313 evaluated several alternative measures for improving Education equality within the Romanian education system and concluded that the simplest and most accurate measure The Romanian Government and local authorities operate would be to ensure that the families of these students a plethora of cash and in-kind schemes to help poor and receive the GMI (soon to be called the Minimum Social vulnerable families to overcome the financial barriers to Insertion Income or MSII). The advantages of using this educating their children. A summary of these schemes measure include: (i) it is a nationally provided benefit is presented in Table 35. However, even with all these that uses standard criteria; (ii) it is effective in identifying financial programs in place, students still cite financial families with the highest risk of social exclusion; and barriers as the main reason for not participating in upper (iii) the necessary social enquiries are made by the secondary school. High school dropout rates are rising, social assistance department of the local authority. This and fewer people are applying for most of the schemes. supplementary income could be used by the school only Individually and collectively, the schemes have not been within the school and only to cover the cost of services for successful in reversing the sharp decline in participation in upper secondary schooling in Romania. 313 Fartușnic et al (2014). Education | 217 Summary of Cash and In-kind Schemes Aimed at Facilitating Access to Education for TABLE 35:  Disadvantaged Pupils National Level – The Money for High School program provides a large cash grant (180 lei or US$51) every month to high school pupils with Cash Grants  incomes per family member under 150 RON The Professional Scholarship program provides an even larger cash grant (200 lei or US$57) every month to students in the professional stream, regardless of income, in both public and private schools. The Transport Reimbursement program reimburses the actual cash value of transportation (up to 50 kilometers) for pupils who travel beyond their locality to attend school. A Government Decision enforced a 26 RON threshold for the 3 km distance, with 2 RON added for every additional km. National Level – The School Supplies program provides a fixed package of goods of very low value (25 to 30 lei or US$7 to US$8.5) once In-kind Support  per year to students from the poorest decile in grades 1 to 8 for students in families with earnings less than one-half of the minimum wage per household member. The Euro200 program provides a one-time voucher to families in the poorest decile to purchase a computer. School buses have been purchased to ease transportation barriers, especially in rural areas. The milk, breadstick, and apple program provides basic food to all pupils in grades 0 to 8 and kindergartens.314 Local Level  A range of local bursaries exist, notably for excellence and performance (high grades), study (good grades by students whose families earn less than the national minimum wage per capita), and social bursaries (for students whose families earn less than half the national wage per capita, are suffering from certain medical conditions, are orphans, or cannot attend a school near their home). The amounts awarded, the eligibility criteria, and the actual distribution of these bursaries are highly discretionary. The theory behind social assistance benefits says that, registries), this can reduce the amount of administrative where markets exist, a cash transfer is usually the best work required for each application, while also providing kind of benefit to provide because it allows families to controls against fraudulent applications. Harmonizing the optimize their consumption choices, and the evidence bears eligibility requirements and application forms for multiple this out. Giving the cash transfer to the mother of a family benefits and/or allowing automatic entry if an applicant has increases the chances that the money will be spent on the already qualified for another scheme can reduce the private children and for productive purposes. In places where there costs to individual applicants. is a thriving financial market, delivering a family’s cash The following observations can be made about the current transfer to a bank account or savings card can promote welfare system as it pertains to poor and vulnerable students: financial inclusion and encourage savings. Benefit levels should be set high enough to prevent extreme hardship but low enough not to create any disincentives to work. Adding conditions to the receipt of these cash transfers •  hree schemes (the School Supplies program, the T Money for High School program, and Euro200) use an extremely low eligibility threshold of 150 (specifically in this case requiring the family to ensure that lei (US$43 or approximately US$1.5 per day) per their children stay in school) works best where there is a adult income. This is well within the income level of supply of services available that are not being used because households in the poorest decile (who earn between of financial constraints on potential users. 0 and 187 lei per adult equivalent income). This In countries where multiple social assistance schemes threshold has not changed in 10 years, except when exist, the costs to families of submitting applications are the Money for High School program increased the often high, and the administrative costs of these multiple threshold for one year in 2008 to 200 lei, which schemes can also be high. When these programs have temporarily reversed the decline in enrollment in the management information systems that are linked to other scheme, which increased by 10 percent in that year. databases (such as tax records, land registries, or civil 314 A comparative analysis of the school fruit schemes across the European countries, including Romania, is available in AFC Management Consulting AG and CO CONCEPT Marketing Consulting (2012). For an analysis of the milk and breadstick program, see Arpinte et al (2009). 218 | PEOPLE-BASED POLICIES •  ach scheme requires applicants to produce a E significant amount of notarized paperwork and to go to the town hall to get their documents verified. In the case by students from poor and vulnerable families. However, we have been unable to find any evidence that any of the schemes have been evaluated for their impact or cost- of the School Supplies program, the cost of application effectiveness, nor does there appear to have been any is thought to equal or exceed the value of the goods strategic overview within the Ministry of Education of the provided, and in the case of the Euro200 scheme, compatibility and consistency between national and local the pupil still has to pay any cost of purchasing the schemes or between the programs provided by the various computer over and above the voucher amount. ministries at the national level. •  amilies with multiple children have to apply for each F scheme separately and for each child separately each year, thus multiplying their private costs. Furthermore, the Ministry of Labor, Family, Social Policy, and the Elderly (MLFSPE) administers a range of cash social assistance schemes, including the Family Allowance (soon to become part of the Insertion Minimum Income •  he Money for High School program requires a T minimum amount of school attendance by the child (85 percent), with no possibility of re-entering the that is also conditional on children staying in school. The eligibility threshold of the Family Allowance has been increased twice in recent years and is now at 530 lei. This is three and a half times higher than the 150 lei threshold scheme if this threshold is not met, even though for the Money for High School program, but the benefit in rural areas children of high school age are often level is four and a half times lower at 40 lei (soon to rise expected to participate in agricultural activities for to 74 lei) compared with the 180 lei benefit paid by the several weeks or months. Money for High School program. There are considerable •  he Transport Reimbursement scheme suffered T a setback when transport companies raised their prices, knowing that the full amount would be overlaps between schemes in terms of their objectives, and the School Inspectorates are required to issue separate attendance lists to the Ministry of Education for reimbursed, leading to a six-month delay in sending the Money for High School scheme and to the Ministry of payments to pupils. Some private transport providers Labor, Family, Social Policy, and the Elderly for the Family do not even issue invoices. Allowance program. • There are several recommendations that stem from these I n the Money for High School program, applicants observations that range from very minor to ambitious: • apply through and receive cash from the school, thus creating potential for petty fraud by school V  ery minor technical changes that might be administrators. It also risks stigmatizing students who considered include: (i) merging the School Supplies are seen applying for and receiving cash from the and Money for High School programs into a single Principal’s office every month. cash grant for all pupils, increasing eligibility • thresholds for the cash schemes; (ii) limiting the  nder the Money for High School program, the amount U Professional Scholarship program grant to students provided to the student in cash exceeds the per adult from poorer backgrounds; (iii) and/or reducing the income for their household, thus raising questions application requirements for some or all schemes. • about whether the funds are used optimally. Further, the amount does not increase when school stops A  moderately ambitious action might be to harmonize being compulsory (in 11th and 12th grades) when other the application requirements and eligibility thresholds supplies are no longer provided free. for all programs, resulting in a one-stop application A few more general observations can be made about process, with automatic enrollment for students the administration of these schemes. Those involved in throughout school years (unless they have been administering the schemes (including school principals, suspended due to absences) and with the onus on the staff of the School Inspectorates, and Ministry staff) the applicant to advise administrators of a positive believe that the schemes foster high school participation change in their household circumstances. Education | 219 •  ore ambitious still would be to revamp the whole M series of cash programs, acknowledge that they are in reality social assistance, and merge the national to be increased.315 The Ministry of Education has just implemented a complex new system for collecting data about kindergartens and schools (with information on, for example, cash programs into the MLFSPE’s Family Allowance the number of children enrolled by grade, the characteristics (soon to be the IMI) program, which has low of schools, and the number and qualifications of teachers). application costs and considerable monitoring and Continuously updating the information from such a system oversight capacity. will not only improve the design, monitoring, and adjustment of policies but will also yield the evidence necessary to inform For education policymakers to make the best decisions thorough and reliable impact assessments of the various for children at risk of social exclusion, capacity in the programs and measures for fighting exclusion from education area of monitoring and statistical data collection needs and employment. BOX 35 Meals for Vulnerable Children in separation from their family or school dropouts Disadvantaged Schools in Arad and (ii) to support children in achieving the best possible school results. Three target groups Two hundred vulnerable children from six have been set: (i) children at risk of separation disadvantaged schools in Arad benefit from a local from their parents; (ii) children reintegrated into their program delivering hot meals. These beneficiaries are families after leaving the special protection system; and children from destitute families (with an income below (iii) children at risk of dropping out of school. RON 470 per family member), exposed to extreme social risk (at risk of separation from their families or of The cost of the hot meal, subsidized by the local dropping out of school), and who are attending primary authorities, is RON 8 per child, and covers only the education in targeted local schools. financing of the meals provided by the social canteen. The cost of the program targeted to vulnerable children The social assistance office in Arad, namely the from disadvantaged schools is comparable to the costs Department for Community Development and covered by parents in the after-school programs in Assistance (Direcția de Dezvoltare și Asistență better-off schools, which are reported to range from Comunitară – DDAC) finances, coordinates, and RON 6 to RON 12 (with the menu being at the discretion monitors the program. The social canteen, owned and of the parents). operated by the DDAC, provides the catering, which is delivered after classes on the premises of the selected The institutional arrangement for the program is schools. The DDAC program is supplemented by a formalized in a cooperation protocol entered into daycare center, Curcubeu, where children from the between the DDAC and the County School Inspectorate poorest school in the city (School No. 2), which is (Inspectoratul Scolar Judetean - ISJ). The Local Council located near the daycare center, attend after-school Decision establishes, among other aspects, the RON 470 activities and receive a broad spectrum of services, eligibility threshold per family member, a threshold that including food support. This daycare center serves is much higher than the value set by the outdated Social 127 poor children in total, most of whom are from Canteen Law 208/1997 (which uses the Guaranteed School No. 2. Minimum Income threshold for a single person). The declared objectives of the food support program are: The DDAC submitted a formal petition to the ISJ, which (i) to ensure the upkeep, remediation, and development selected the most disadvantaged schools. However, it of the capacities of such children and their parents is not clear what selection criteria were used as there to withstand the critical conditions that may cause is no system in place (at either the national or county 315 An extended analysis and recommendations can be found in World Bank (2014b: 72-83). Chapter 5 covers monitoring and evaluation (M&E) mechanisms, including their rationale, proposed indicators, processes for tracking change, the frequency of M&E activities, and the assignment of responsibilities. 220 | PEOPLE-BASED POLICIES BOX 35 (continued) level) for establishing which are the most disadvantaged one school administration representative. The program schools. Within these schools, the class masters is particularly relevant in the context of the ongoing establish an initial list of children, relying on their public debate about whether to change the targeting of knowledge of the economic and social situation of the the program and whether to provide hot meals instead individual pupils and their families. The DDAC performs of the current milk, breadstick, and fruit package. Other a social inquiry and compiles an application file for than its intrinsic benefit in providing a healthy and each pupil, which includes the application form, identity nutritional meal, the program appears to be, in the eyes documentation, and other civil status documents, as of the stakeholders, an important incentive for securing well as papers certifying the family’s income sources school attendance and preventing school dropouts. It is (salaries, pensions, and social allowances). Around 10 not clear, however, if it improves students’ performance percent of the schools’ proposals are rejected following in school given that the complementary educational the DDAC’s social inquiry. and social support activities have been temporarily abandoned. The critical points of the program appear to be: (i) securing the cooperation of parents in the application In the context of the debate about introducing a national process; (ii) the condition that the food be delivered food support program, the implementers of the Arad in individually wrapped cutlery in accordance with program suggest a range of available solutions in order hygiene standards in those schools without a canteen not to restrict the access of better-off children. One or dedicated refectory (which slightly raises the total simple idea would be to distribute meals according to costs); and (iii) the unclear targeting mechanisms for the the income thresholds of families, in other words, free selection of schools and children. of charge for the poorest children and with progressive costs charged for income-earning families if they are In general, satisfaction with the program is reported interested in participating. Keeping the program open to be high both among managers (the DDAC, the ISJ, to all children could prove to be an important feature, and the schools) and beneficiaries. The complete especially considering that more than one in five hot meal (three courses) is regarded as an excellent families in Romania cannot afford a meal with meat, intervention given that “it might be the only cooked chicken, fish or a vegetarian equivalent every second food that these children have for the day” according to day, according to Eurostat data for 2013. Education | 221 2 PEOPLE-BASED POLICIES 2.5. Health “We want to see better health and well-being for all as an equal human right. Money does not buy better health. Good policies that promote equity have a better chance. We must tackle the root causes (of ill health and inequalities) through a social determinants approach that engages the whole of government and the whole of society.” (Margaret Chan, WHO Director-General) Main Objectives Health 2.5.  224 2.5.1. Improving Health Equity and Financial Protection 225 2.5.2. Improving Healthcare Provision in Specific Areas Relevant to Poor and Vulnerable Groups 230 2.5.3. Increasing the Access of Vulnerable Groups to Quality Healthcare 240 224 | PEOPLE-BASED POLICIES 2.5. Health Health and poverty are strongly interrelated. Poverty is a improving the health of the poor. The theory of the social direct contributor to ill health, while poor health, in turn, can determinants of health (Scheme 6), which was developed be a major contributor to poverty, reducing a person’s ability some decades ago, is the foundation of all strategies and to work and leading to high costs in treatment and care. For interventions aimed at reducing the health gap between example, at the EU level, there are significant differences the poor and the general population around the world. As between various income groups in terms of how healthy shown in Scheme 6, access to health services is just one they are, in the extent to which their personal activities of the determinants of good health so increasing access, are restricted because of illness and disability, and in their while essential, can only make a limited contribution life expectancy at birth, with the gaps between the lowest to improving health outcomes among the poor. Only and highest socioeconomic groups being up to 10 years an integrated approach that includes not only greater for men and six years for women.316 Romania’s healthy access to social and healthcare services (with a focus on life expectancy - the average number of years spent in prevention) but also improving education, nutrition, and good health - is far below the EU-15 average of more than housing conditions, including water and sanitation, will 70 years as is also the case in most other South-Eastern lead to a significant improvement in the health outcomes of European countries.317 Also, evidence shows that Roma the poor. This is what the WHO Regional Office for Europe are particularly affected. High poverty, limited education, report Health 2020: a European Policy Framework319 and low employment rates among the Roma population all has recommended as an essential approach for achieving contribute to poor health, resulting in a life expectancy that the strategic objectives of improving health for all and is, on average, six years lower than that of the non-Roma reducing health inequalities. With this aim, the member population.318 states of the European Union have called for inclusive and sustainable cross-sectoral policies aimed at reducing the Poor and vulnerable people become ill sooner and die health gap between the poor and the general population. In earlier than the general population. Poverty creates ill addition, the European Platform against Poverty and Social health through inadequate living conditions (lack of decent Exclusion, one of seven EU flagship initiatives supporting houses, of clean water and/or of adequate sanitation). It the social objectives of Europe 2020, highlights the urgent leads to poor nutrition and an unhealthy diet, making the need for national health policies to increase efficiency poor vulnerable to disease. Poverty also creates illiteracy, while simultaneously ensuring universal access to quality leaving people poorly informed about health-promoting healthcare. behavior or health risks. Last but certainly not least, poverty makes it difficult for people to access health care As acknowledged by the European Commission in June and medicines when needed. There is strong evidence 2014,320 Romania has made some progress321 in pursuing that health gets progressively better as the socioeconomic health sector reforms aimed at increasing efficiency and status of people and communities improve (this is called the accessibility and improving quality in accordance with the social gradient of health). Consequently, preventing illness 2013 country-specific recommendations of the European and providing access to effective and affordable healthcare Council. The Commission praised Romania’s National are important ways to combat poverty. Health Strategy 2014-2020322 for pursuing more equitable access to quality health services, but it considered the Cross-sectoral policies that take into account the social prevalence of informal payments323 as a significant determinants of health are the most effective way of 316 European Commission (2010b). 317 The most recent World Health Organization estimates of the disability-adjusted life expectancy (DALE) indicated a healthy life expectancy of 65 years for Romanians in 2007. (http:/ / data.euro.who.int/hfadb/, data downloaded November 20, 2014). 318 World Bank (Anan et al, 2014). 319 WHO (2012c). 320 European Commission (2014b). 321 According to the standardized categories used by the EC to assess progress in implementing the 2013 country-specific recommendations (CSR): “Some progress means that the Member State has announced or adopted measures to address the CSR. These measures are promising, but not all of them have been implemented yet and implementation is not certain in all cases.” 322 Ministry of Health (2014). 323 Informal payments are defined as a monetary or in-kind transaction between a patient and a staff member for health services that are officially free of charge in the public sector. Health | 225 SCHEME 6: Social Determinants of Health GENERAL SOCIO-ECONOMIC, CULTURAL AND ENVIRONMENTAL CONDITIONS LIVING AND WORKING CONDITIONS Work Unemployment environment SOCIAL AND COMMUNITY NETWORKS Water and sanitation Education INDIVIDUAL LIFESTYLE FACTORS Health care service Agricultural and food production AGE, SEX AND CONSTITUTIONAL FACTORS Housing Source: Dahlgren and Whitehead (2007: 20). barrier to accessibility, especially for the most vulnerable. Therefore, reforming the health sector remains one of the 2.5.1. Improving Health Commission’s eight country-specific recommendations for Romania as follows: “Step up reforms in the health Equity and Financial sector to increase its efficiency, quality, and accessibility, including for disadvantaged people and remote and isolated Protection communities. Increase efforts to curb informal payments, The government has initiated strategies and policies aimed including through proper management and control at increasing health equity, and this process needs to be systems.”324 accelerated in the future. Key measures have included the program compensating pensioners earning less than 700 lei per month for 90 percent of their medicine expenses, which has more than 1,000,000 beneficiaries,325 and the increase of around 34 percent in the health insurance budget allocated for homecare services in 2014 compared with the previous year. The main challenge is to put the promised reforms into practice in the relatively near future. These promised health reforms consist of: 324 European Commission (2014b: 7). 325 National Reform Program 2014, Government of Romania, April 2014 (cumulative data starting 2011, OPSNAJ Health Insurance Fund are not included). 226 | PEOPLE-BASED POLICIES (i) an improved minimum healthcare package, aimed at Therefore, the country’s fiscal context328 is the main driver providing prevention services (assessment of health risks) of the government’s relatively low spending on health since and treatment to the uninsured population in addition Romania has an overall government spending level of 35.2 to emergency services and the care to which they are percent of GDP (in 2012) compared with an EU-27 average currently entitled; (ii) a revised basic healthcare package of 48 percent. However, public health spending accounts covered by social health insurance that will allocate more for only 14.5 percent of total government expenditure (which resources to primary and secondary preventive care; (iii) a has decreased from 16.3 percent in 2005) compared with a revision of the existing national health programs to focus constant EU average of about 20 percent, meaning that the more on prevention and targeted interventions; (iv) a shift central government gives a fairly low priority329 to the health in health service delivery from hospitals to ambulatory sector. As a result, Romania’s total health expenditure per and primary healthcare providers; and (v) a revision of capita is nearly four times lower330 than the EU-27 average the list of reimbursable medicines. In November 2014, - US$873 PPP compared with US$3,346.331 These data the government approved the National Health Strategy are consistent with the OECD and European Commission’s 2014-2020 that set out the strategy for reducing health recent report “Health at a Glance: Europe 2014,” which inequalities, but no consistent interventions yet exist to found that Romania has the lowest health expenditure per put this strategy into practice. For example, simple but capita (€753 PPP) among the member states, three times cost-effective regulations need to be devised to encourage lower than the EU-28 average. Between 2009 and 2012, doctors’ to prescribe generic drugs, to exclude drugs with expenditure on health in real terms (adjusted for inflation) limited evidence of effectiveness, to confine the use of some decreased on average by 0.6 percent (due to cuts in health drugs to very specific conditions, and to exclude the use workforce and salaries, reductions in fees paid to health of no cost benefit drugs or those with an available generic providers, lower pharmaceutical prices, and increased equivalent. patient co-payments), while in Romania the annual average growth rate in per capita health expenditure in real terms Making Funding Responsive was 0.4 percent (2009-2012), compared to 9.1 percent in the previous years (2000-2009).332 Despite these overall to the Specific Needs of figures, Romania constantly increased its expenditure on Vulnerable Groups public health, and this spending will continue to increase. The budgetary allocations to primary healthcare need Above all, improving the quality and equity of health care to be increased, and better monitoring is needed of the in Romania will require an increase in overall financing for services provided by general practitioners. Although all the sector. Spending on health is not merely a cost but is European governments have declared primary healthcare a also an investment with a long-term impact on a country’s priority, it has always had low budget allocations. In 2008, socioeconomic development.326 In Romania, the level of the Ministry of Health initiated a costly but questionable total health spending is among the lowest in Europe and population screening exercise, which was the cause of is decreasing. Total health spending as a share of GDP has a sudden increase in the primary healthcare budget, declined from about 6 percent in 2010 to 5.1 percent in which dropped back down in subsequent years (Table 2012 (Figure 40), but the official figures do not take into 36). Various international organizations have encouraged account the widespread use of informal payments within Romania to increase its primary healthcare budget by at the health system. The amount that any government least 10 percent of the National Health Insurance Fund spends in a given social sector depends partly on its overall budget. Increasing the availability of primary healthcare is fiscal constraints and partly on the priority that it gives to undoubtedly the best way to increasing the access of poor that particular sector in its public resource allocations.327 326 European Commission (2007). 327 Kutzin and Jakab (2010). 328 The fiscal context refers to a government’s current and expected spending capacity. More affluent countries tend to be more effective at mobilizing tax revenues and thus have higher levels of public spending as a share of GDP, whereas when a country has more limited fiscal space, this usually results in low government spending, including on education and health care. 329 However, the priority given by both the Romanian government and the EU to the health sector has been consistently higher than that accorded to the education sector. 330 Nevertheless, with respect to total health expenditure in PPP$ per capita, the gap between Romania and EU-27 has continuously narrowed, from more than eightfold in the late 1990s to less than fourfold in 2012. 331 WHO estimates for 2012, http:/ /data.euro.who.int/hfadb/ 332 OECD (2014). Health | 227 FIGURE 40: Total Public Expenditure on Health as a Percentage of GDP/Total Public Expenditure in Romania and in the EU-27 19.1 19.4 19.7 19.8 19.9 19.9 19.9 19.9 20 20 18.1 18.2 18.5 16 16.2 16.3 14.4 14.8 14.3 16 13.7 13.8 13.7 13.1 12.1 11.3 12 9.9 9.8 9.6 8.5 8.8 8.8 9 8.9 8.9 9.2 8 8.2 8 5.3 5.4 5.5 5.4 5.6 6 4.6 5.1 5.2 5.6 4.3 4.4 4 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 % of GDP - EU-27 % of Total Public Expenditure - EU-27 % of GDP - Romania % of Total Public Expenditure - Romania Source: World Bank calculations using data from the European HFA Database, WHO/Europe, November 2014. and vulnerable groups to quality healthcare, particularly Measures aimed at improving the health of the poor and by means of health promotion and education and disease vulnerable population should receive adequate funding. A prevention. The budget of a family doctor contracted with good example is family planning. While one out of every the Health Insurance Fund consists of a combination of ten live births is registered to a teenage mother, the state a capitation fee (50 percent) and a fee for service (50 allocates no more than RON 20 per person per year for percent), but GPs also charge their patients a consulting family planning and a maximum of two reimbursed visits fee even though this ought to be covered by the capitation per year to a family doctor or GP for counseling about fee. The primary healthcare services that they provide contraceptive methods. Over a year, GPs earn more money should only carry a fee for service if they are aligned with by releasing a death certificate than by providing family public health priorities333 or, as in other countries, if GPs planning services to an uninsured woman. If that doctor is reach a certain target related to a public health priority (for a senior GP, then the death certificate has almost the same example, reaching a 90 percent vaccination rate for all financial value as the post-natal care delivered by a regular eligible children in a given catchment area such as a village, GP to an uninsured woman (RON 33 versus RON 37).334 regardless of whether eligible children are included on the GP’s capitation list or not). 333 The list of Romania’s strategic areas of intervention together with their corresponding general objectives can be found in Ministry of Health (2014: 26). 334 The framework contract and its application in the 2014-2015 service delivery within the National Health Insurance System (Gov. Decision 400/2014; Ministry of Health-Health Insurance House Ordinance 619-360, May 2014). 228 | PEOPLE-BASED POLICIES TABLE 36:  Primary Healthcare Budget 2005-2014 2014 2005 2006 2007 2008 2009 2010 2011 2012 2013 (approved) Health Insurance 9.3 10.1 12.9 16.6 15.3 17.5 17.8 19.5 23.1 22.6 Budget (RON million) Primary Healthcare 0.5 0.5 0.7 1.5 1.1 1.1 1.1 1.2 1.3 1.5 Budget (RON million) Primary healthcare expenditure as 4.9 4.6 5.8 8.8 7.2 6.3 6.2 6.2 5.7 6.6 % of total health insurance budget Source: Data aggregated from National Health Insurance reports (www.cnas.ro). Ensuring the Financial is higher among higher-income groups, it is obvious that the middle classes and upper-income groups benefit the most Protection of Poor and from subsidized health services. Vulnerable Groups The government needs to design, implement, and budget for a clear policy on informal payments in the public Out-of-pocket and informal payments are a barrier to healthcare system nationwide. Statistics on out-of-pocket accessing to healthcare services for poor and vulnerable payments probably underestimate the phenomenon people who cannot afford to pay. Patients’ co-payments as patients also pay informally for healthcare services for publicly insured services represent a relatively small (whether voluntarily or not). Several studies of informal component of total health expenditure, but out-of-pocket payments for healthcare in Romania have shown that payments335 are significant and increasing. Estimates these are widespread in both ambulatory and hospital from WHO show that households’ private out-of-pocket care and are almost universal for operations, childbirth, payments on health as a share of total health expenditure and life-threatening procedures. A study conducted by have continuously increased since 2007 from 17 percent the Romanian Institute of Evaluation and Strategy in 2011 to almost 22 percent in 2012. This compares with a showed that, out of all of the informal payments for public constant 16 to 17 percent EU-27 average during the same services reported by the population (11 percent at the period.336 This prevents many people with lower incomes national level), those for healthcare are the most common from accessing health care and thus has a negative effect (5 percent for doctors and 2.5 percent in hospitals).338 on their health outcomes. According to the World Bank’s However, most of the reported informal payments were Functional Review of the Health Sector,337 62 percent of the given in gratitude for healthcare, as only 1.2 percent patients poor in Romania pay for medicine, and almost 60 percent declared that the staff had solicited the payments. A of people admitted to hospital said that they had made national representative survey carried out in 2012 indicated informal payments in 2008, up from about 30 percent in that gifts (such as coffee, chocolate, meat, flowers, and 2001. Furthermore, 63 percent of households in the poorest cigarettes) accounted for 88 percent of informal payments quintile pay out of pocket compared with 88 percent of the in Romania, while informal cash payments represented richest. Many of the poor who are in need of healthcare approximately 37 percent. Most gifts were given at the services do not seek care. Because the average rate of end of treatment while most cash payments were given reimbursement for the poor is the same as for all other before or during treatment.339 Usually, the amount that income groups and because the use of healthcare services patients pay informally for care reflects the seriousness of 335 Defined by WHO as including non-reimbursable cost sharing, deductibles, co-payments, and fee-for-service but excludes payments made by enterprises that deliver medical and paramedical benefits, mandated by law or not, to their employees. It also excludes payments for overseas treatment. 336 WHO/Europe, European HFA Database. 337 World Bank (2011a). 338 IRES (2011). 339 Spridon (2011). Health | 229 the illness. Thus, a survey done in 2013 in the capital city with the previous year, Romania is still one of the top three Bucharest showed that the informal payment for a GP was EU member states in terms of unmet healthcare needs for around 34 lei (about €8), while in hospitals for a problem households at all income levels. that did not require surgery, it increased to approximately In this area, the government should consider: 360 lei (or €80)340 and reached 1,130 lei (or €250)341 in cases involving surgery.342 Wealthier, better educated, and younger patients tend to pay more often as a way of obtaining better quality treatment. A recent literature review •  inding ways to make prescribed generic drugs, F medical consumables, and assistive technologies affordable to the most vulnerable and to rural and that covered eight South-Eastern European countries343 remote communities. concluded: “After 1990, informal payments had become more frequent, explicit, increasingly in cash, and less affordable. Informal payments stem from patients desiring better treatment, the low wages of staff, acute funding •  lanning and implementing consumer awareness P campaigns regarding the cost savings, safety, and quality of generic medicines. shortages, and tradition. Attitudes to informal payments range from strongly negative (if solicited) to tolerant Ensuring appropriate healthcare coverage for all social (if patient-initiated), depending on the circumstances. groups is the key to reducing health inequities. There are However, generally speaking tolerant attitudes towards still major inequalities in healthcare coverage in Romania. such practices are prevalent both among patients and A large share of self-employed workers in agriculture medical staff.” and of the rural Roma population is not covered by health insurance. The percentage of people enrolled with a family Informal payments may be associated with cultural and physician as part of the Healthcare Insurance System historical factors, but they have mainly arisen because the increased significantly from 87.8 percent in 2008 to 95.9 public healthcare system is unable to provide adequate percent in 2010 and then declined to 85.3 percent in access to basic services. So the actions recommended 2012. All throughout this period, there was a considerable in the next sections relate mainly to strengthening and and constant difference between urban and rural health improving the quality of primary healthcare and developing coverage, with coverage being up to 20 percent higher in the community-based healthcare network. In addition, urban areas as of 2012 - 94.1 percent coverage in urban the government should implement regular information areas as opposed to only 74.6 percent in rural areas.344 campaigns on the benefits of the changes targeted both to Except in rare circumstances, the uninsured are not healthcare system stakeholders and the public. entitled to any ambulatory examinations or to medicines Lack of resources also makes it difficult for the national recommended or prescribed by their family doctor, even healthcare system to supply proper treatment and though the health insurance budget for ambulatory medication. One of the EU health indicators relevant for paraclinical examinations and services was doubled in social inclusion is the self-reported percentage of unmet 2014. Apart from emergencies, pregnancies, and certain need for medical examinations. The Eurostat data show infectious diseases, the uninsured are obliged to pay for that 9.6 percent of the Romanian population declared in their own medical care. This leads to aggravated health 2012 that they could not afford medical care or considered conditions and/or to an overuse of emergency pre- it to be too expensive (compared with 0.1 percent in United hospital and hospital care (ambulance service, the Mobile Kingdom and Finland, 0.2 percent in the Netherlands, and Emergency Service for Resuscitation and Extrication, and 5.9 percent in Bulgaria). There were significant differences hospital emergency departments) where treatment and based on socioeconomic status from 13.3 percent for those examinations are provided free of charge. The combination in the lowest income quintile (the poorest 20 percent of of poverty, illiteracy, and the healthcare system’s lack of the population) to 3.5 percent for those in the highest capacity to provide preventive services or access to basic income quintile (the richest 20 percent of the population). care leads to high rates of ill health among the poor as well Although these percentages had decreased compared as to the high costs involved in treating the poor with severe 340 On average, 76 percent went to doctors and 24 percent to nurses. 341 On average, 60 percent went to surgeons, 24 percent to anesthetists, and 16 percent to nurses. 342 Stoica (2013). 343 Stănculescu and Neculau (2014: 48). The countries were Bulgaria, Croatia, Kosovo, the FYR Macedonia, the Republic of Moldova, Montenegro, Romania, and Serbia. 344 National Social Health Insurance House (2013: 113). 230 | PEOPLE-BASED POLICIES or life-threatening medical conditions in inpatient facilities. Although communicable diseases have a low prevalence The government should issue legislation on private health due to the constantly improving surveillance system insurance for those who can afford this option to decrease and increasing immunization coverage, Romania has the pressure on the public budgets, which could then be highest tuberculosis (TB) incidence within the European reallocated in ways that will improve and increase the Union, and the number of multiple drug-resistant TB cases services included in the minimum benefit package and/or is increasing. Also, sexually transmitted infections (STIs), targeted evidence-based programs addressing the needs of including HIV/AIDS, still represent a challenge.349 Within the most vulnerable. the European Union, moderate to high prevalence rates of viral hepatitis B, C, and D are found only in Romania and 2.5.2. Improving three other countries.350 Tuberculosis is strongly correlated with poverty,351 while socially conditioned diseases352 have Healthcare Provision in the greatest negative impact on life quality and duration and are among the main causes of poverty, discrimination, Specific Areas Relevant and marginalization.353 Consequently, infectious diseases should constitute another area of intervention relevant to to Poor and Vulnerable increasing health inclusion in 2014-2020. Groups Scheme 7 shows the specific areas of intervention relevant to poor and vulnerable groups. They are set within the strategic framework that needs to be used for the health Within the sphere of healthcare reform in Romania, certain sector, which is aligned with the integrated approach to areas of intervention are particularly relevant for poor and social services that is used in Romania. This involves vulnerable groups (Scheme 7). In terms of health outcomes, multi-disciplinary teams of community workers at the Romania has the highest under-5 mortality rate of all of the local level and multi-agency cooperation and coordination EU-27 countries and a risk of maternal mortality at birth five between the social sectors at the national level (see times higher than the EU-27 average.345 The country also Section 2.3 on Social Services). The primary healthcare has the highest child poverty rate of all of the 35 countries and community-based healthcare network undoubtedly covered in the analysis of child poverty carried out by constitutes the best framework for implementing our UNICEF in 2012.346 Therefore, mother-and-child health and recommended interventions on an adequate scale. These reproductive health should be priority areas for interventions recommendations will be presented in the final section of aimed at increasing health inclusion in the 2014 to 2020 this chapter. period. At the same time, Romania has a life expectancy at birth that is considerably lower than the EU average and an The specific areas of intervention relevant to poor and age-standardized death rate for males that is almost twice vulnerable groups are discussed in the next sections with a that of the lowest EU countries - over 1,200 per 100,000 focus on preventive services, early detection, and outreach compared with an EU average of 866.347 The two main services as well as on the monitoring and evaluation of causes of death are cardiovascular disease (Romania having interventions. In all areas, the Ministry of Health needs to one of the highest rates in the WHO European Region) and change the paradigm of public health policy by: • cancer, with both trends on the increase. For this reason, the government should focus on reducing chronic diseases I ncreasing its allocations to evidence-based through health promotion and disease prevention as a way preventive services while at the same time building to improve the health of the poor and vulnerable, especially programmatic capacity at all levels of the health as current evidence unequivocally demonstrates that system non-communicable diseases are largely preventable.348 345 WHO/Europe, European HFA Database. 346 UNICEF Innocenti Research Centre (2012). 347 OECD (2012b). 348 WHO (2011). 349 Institutul Național de Boli Infecțioase ”Prof. dr. Matei Balș” (2013). 350 Bulgaria, Latvia, and Turkey (Rechel et al, 2011). 351 WHO and ECDC (2014). 352 Socially conditioned diseases are those that cannot be explained exclusively by heredity but are influenced by a person’s lifestyle and socioeconomic environment. 353 United Nations (2008). Health | 231 SCHEME 7: Specific Areas of Intervention Relevant to Increasing the Inclusion and Improving the Health of Poor and Vulnerable Groups HEALTH EQUITY AND FINANCIAL PROTECTION SPECIFIC AREAS BETTER HEALTH OF INTERVENTION OUTCOMES Actors Types of activities Health promotion Reproductive health Primary healthcare (population services to reduce prevalence of risk Mother and child care and nutrition factors) Chronic diseases, longstanding IMPROVED HEALTH Primary prevention Community health conditions and preventable deaths INDICATORS (individual services workers AND SOCIAL INCLUSION to control risk factors) Infectious diseases ( tuberculosis, STI’s including HIV/AIDS) Community health Secondary prevention workers (personal services Specific heatl needs of to delay progressions vulnerable groups and complications) Source: Dahlgren and Whitehead (2007: 20). • mplementing effective mechanisms for needs I analysis, service planning, the coordination, monitoring, and evaluation of interventions, and the 44. Early motherhood, especially when the pregnancy is unwanted, can lead to child abandonment, school dropout, and even social exclusion. Therefore, it is important to control of service providers. reduce the rate of unwanted pregnancies. There is evidence that current family planning services are ineffective, Improving Reproductive especially in the case of poor and vulnerable women. This is evident in the still high number of unwanted pregnancies Healthcare Services resulting in abortion, particularly among girls younger than 19, and the increasing number of newborns abandoned in The percentage of unwanted pregnancies in Romania is maternity units in the last few years (918 children in 2012 over 50 percent among girls aged 19 or younger, while up from 762 children in 2010). The increased percentage of one in ten live births is registered to a teenage mother births out of wedlock, from 15 percent of all births in 1992 (aged between 15 and 19 years old). According to the most to almost 28 percent in 2010, and 31 percent in 2012, is a reliable latest data from the 2004 Reproductive Health demographic phenomenon with significant socioeconomic Survey (carried out jointly by the Ministry of Health, USAID, and health consequences. The percentage is higher in UNFPA, UNICEF, and the World Bank), the percentage rural areas (34 percent), where traditional attitudes to of unwanted pregnancies was 50.4 percent among teens reproduction seem no longer to apply.354 aged 15 to 19 and 48.7 percent among women aged 15 to 354 NIS 2012 and 2013b. 232 | PEOPLE-BASED POLICIES Preventing early motherhood and unwanted pregnancies will require all women of reproductive age (in particular girls and young women) to be able to access affordable and •  xpand the network of GPs who are willing to deliver E free contraceptives and ensure fair geographical coverage. • high-quality sexual and reproductive health services.355 The number of Ministry of Health reproductive health  rain and retrain community healthcare providers T interventions targeting the vulnerable population has (family doctors, community nurses, and Roma gradually decreased since 2008, as have the related health mediators) in delivering quality sexual and budgets. The regulations, methodologies, and tools reproductive health services. • of the Ministry of Health’s National Program have not been updated, including the criteria for the vulnerable E  stablish partnerships with specialized and groups eligible for free reproductive health services, the grassroots NGOs to deliver reproductive health management information system governing contraceptives services and interventions. • and their distribution, and the list of free contraceptives. The network of family physicians’ offices providing reproductive  lan, implement, monitor, and evaluate information- P health services has become unstructured, due to a lack of education-communication (IEC) campaigns and incentives, training, and budgets and a lack of interest in this outreach interventions in the field of reproductive program on the part of decision-makers at the national and health, tailored to the particular needs, beliefs, and county levels. There are no sustained medical education traditions of the most vulnerable communities. programs for family physicians on reproductive health. The Ministry of Health’s National Program interventions Only some family physicians - far fewer than are needed in the field of reproductive health and family planning nationwide - have agreed to distribute free contraceptives, must be revised and updated. There are no disaggregated and the effectiveness of this free contraception program data or recent studies to draw on to design cost-effective also suffers from a low budget and a high degree of reproductive health interventions, nor has a coherent and inconsistency in procurement and distribution. There is a systematic approach been developed to govern the required lack of accurate data on the activities of community health policies and actions. Until 2007, with the support of UN workers (community nurses and health mediators for Roma organizations, the World Bank, and bilateral agencies (such communities) in the area of reproductive health, and since as USAID), reproductive health was one of the priority these personnel no longer benefit from training programs areas of health system reform in Romania, which was or any guidelines or educational materials, it is quite likely a direct contributor to the subsequent improvements in that their services are infrequent and/or of poor quality. The infant mortality and maternal mortality. The interventions decentralization of responsibility for healthcare services from that were put in place were based on coherent strategies the central government to local authorities, which was poorly resulting from needs analyses and impact studies that used coordinated and insufficiently regulated, coupled with the internationally validated methodologies. The Reproductive recent economic crisis have led to the current situation. Health Survey (RHS) was fielded in 1994, 1999, and 2004 The priority actions that we recommend that the on a sample of more than 10,000 women of fertile age. The government take over the next few years are: resulting studies demonstrated how certain effective and • sustainable interventions had positively influenced health Revise the criteria for the free distribution  indicators and recommended that these interventions of contraceptives. should primarily be targeted to the rural population, the • poor, and certain vulnerable groups. According to the RHS S  pecify priority beneficiaries (such as rural areas, poor data, between 1990 and 2007, with international support and deprived communities, and specific age groups). and technical assistance (from UN organizations and • bilateral agencies like USAID), the government designed and  nsure continuity of access to a range of free E implemented consecutive reproductive health strategies, contraceptives for vulnerable women of the Ministry of Health mother-and-child healthcare program reproductive age. (which included all reproductive health and safe motherhood 355 A comprehensive definition of reproductive healthcare includes other priority public health areas such as: (i) family planning; (ii) sexual health; (iii) safe motherhood; (iv) unsafe abortion and STIs, including HIV; and (v) cervical cancer. This section focuses particularly on family planning and sexual health, while the other areas are covered in the next sections. Health | 233 interventions), and community healthcare and health contract with NGOs to implement the interventions included mediation activities for Roma communities. The government in the national public health programs. also developed and strengthened the family planning The government should increase the budgetary allocations network, distributed free contraceptives to poor women for preventive services in the field of reproductive health and/or women at risk based on objective criteria, and put in and should implement effective mechanisms for monitoring place a highly functional logistics management system that and evaluation and for the control of service providers. ensured the continuity of contraceptive supplies. The current strategic documents governing the Ministry In order to revise and update the Ministry of Health’s of Health provide an adequate general framework for National Program on reproductive health and family conducting reproductive health interventions that target planning, we recommend that policymakers consider taking vulnerable people. According to the 2014-2020 National the following actions: Health Strategy, developed by the Ministry of Health at • the end of 2013 (and approved by the government in Nov C  arrying out a round of the Reproductive Health 2014): “The success of the family planning intervention Survey every five years to gather sound data for depends a great deal on strengthening the capacity for baseline indicators and to measure the outcomes program management at the central level, on continuing the and impact of interventions, taking advantage of training of primary healthcare physicians and nurses, on the expertise of the organizations that implemented the access to free-of-charge contraceptives for vulnerable the previous rounds (the National Institute of people, and on a better targeting of this category of the Statistics, public institutions, and NGOs). We population with the help of the emerging community recommend fielding the survey both before and after healthcare network in Romania.” However, these strategic implementing the Strategy on social inclusion and documents need to be translated into effective and poverty reduction 2015-2020. evidence-based interventions. For instance, although the • government planned to review or amend the national health S  etting up a sound logistics management information programs in 2014, this has not yet happened. This year, system built on proven best practices. the national mother-and-child healthcare program (which • includes all reproductive health interventions) has been  esigning interventions targeted to the poor and the D allocated a budget of RON 10,330,000, which is less than most vulnerable based on evidence from periodic half of the 2013 budget (RON 24,336,000) and is five times assessments of the achieved outcomes. less than, for example, the national organ, tissue, and cell • transplantation program (RON 52,123,000). In fact, ever D  esigning and developing sound monitoring and since preventive and curative programs were combined into evaluation mechanisms for all programs, including “public health national programs” funded from the state those targeted to the poor and vulnerable groups. budget, the programs that included a significant prevention Partnering with NGOs in providing community-based component started having progressively lower budgets, services is essential, both now and in the future, particularly while the budgets for curative programs increased. since NGOs can be a catalyst for the development of a coherent national approach to reproductive health Improving Healthcare Services interventions. In the absence of sustainable funding, many NGOs active in the area of reproductive health for Mother and Child Health - former partners of the Ministry of Health and of and Nutrition international organizations - have had to scale down or stop providing services to beneficiaries, most often the Although the Government of Romania has developed poorest communities or vulnerable groups, such as Roma a National Mother and Child Healthcare Program and communities. Currently, most of them implement projects a National Immunization Program, health outcomes based on the priorities decided by the existing funding for Romanian mothers and children are showing some sources rather than on the needs of their beneficiaries. alarming trends. Many NGO interventions that were once seen as best Children from poor and Roma households face significant practices (between 1992 and 2007) ended because public disadvantages in terms of their health and wellbeing, institutions failed to take over ownership. Also, the Ministry disadvantages that may occur in the very earliest stages of of Health lacks the mechanisms and regulations required to childhood. 234 | PEOPLE-BASED POLICIES A recent UNICEF study356 indicated that households than half of all neonatal deaths. Most premature and/ with total income per person below the national poverty or underweight babies are born to teenage mothers and/ threshold, single-parent families, and families with a large or to mothers in the lowest socioeconomic groups and/or number of children living in poor conditions and relying on of Roma ethnicity, those with low levels of education, and social benefits are the categories with the highest long-term those living in rural areas. Mothers in these groups either child health and development risks. do not use prenatal care services or use them inadequately, and 40 percent of women who give birth prematurely do not In Romania, 11 percent of all live births are premature, and receive systematic or regular prenatal visits.357 prematurity and its complications are responsible for more BOX 36 Testimony of Family Physicians about their there, who knows? And at this first visit, I give Respond-Only-If-Asked Approach Related to her a referral to the laboratory, one to the Prenatal Care Services in Rural Areas ultrasound scanner, and one for a consultation with a gynecologist. With all these three “Minor mothers are registered by the family doctor referrals she has to travel. The nearest hospital, the and are supervised during pregnancy, their babies are Botosani Maternity, is 70 to 80 kilometers away. She also registered. Supervision means that she receives doesn’t have the money to travel so she will not go. services but only if and when she comes to the Moreover, she will not come to me the second time, physician... The family doctor is not supposed to go to because all I do is giving her unrealistic tasks and not her home and to say: come on, please. So, although real solutions to her problem.” insured because of being a minor, many of them do not receive the services precisely because they do Source: Group discussion with the Family Doctors’ not come to a family physician’s office. And then, she College, the Family Doctors’ Association, and the comes when she is already nine months pregnant and Family Doctors’ Employers Association, County she is close to giving birth to the child. Why she hasn’t Botoșani, World Bank qualitative study carried out in come so far? Lack of information, shame, poverty, she July-August 2014 for preparing this background study. doesn’t have clothes to wear, she has no way to get Although infant mortality is in a declining trend, it is still counties continue to exist, with the highest rates reaching too high, especially in rural areas and among the most 13 to 15 infant deaths per 1,000 live births.359 The under-5 vulnerable groups. A significant share of the deaths under mortality rate has also significantly dropped yet remains the age of 1 occur at home, while most newborns die without considerably higher that the EU-27 average - 12.2 versus having benefited from any healthcare to address the 4.8 per 1,000 live births in 2012.360 The risk of a child dying disease that led to their death.358 While the infant mortality before reaching 5 years old provides a robust measure of rate has declined from 18.4 in 2001 to 8.5 per 1,000 live the health of children and is a sensitive indicator of poverty births in 2013, it remains the highest in the EU (with an and social exclusion. Children in Romania are at greater risk EU-28 average of 3.8 per 1,000 live births in 2012). Also of dying before the age of 5 if they are born in rural areas, to in 2013, the infant mortality rate was higher in rural areas poor households, or to a mother denied a basic education. than in urban areas (10.4 per 1,000 live births and 939 More than half of the deaths of children under the age of 5 deaths of children under 1 year in rural areas compared with are due to diseases that are preventable and treatable by 6.8 per 1,000 live births and 741 deaths of children under simple and affordable interventions.361 1 year old in urban areas). Significant differences between 356 Stănculescu et al (2012). 357 Stativă and Stoicescu (2011). 358 Ministry of Health (2013). 359 National Institute of Statistics, Tempo Online database. 360 WHO/Europe, European HFA Database. 361 WHO (2013a). Health | 235 Romania has a serious problem of child nutritional their advice to justify their respond-only-if-asked approach. deficiency because of limited access to food and of child There has been an alarming decrease in national diseases. This problem requires an urgent response. Child immunization coverage. Coverage of the DTP364 vaccination nutritional deficiency is measured by the prevalence of has decreased from 99 percent in 2001 to 89 percent in a low weight-to-waist ratio, and in Romania it exceeds 2013. Rubella and measles outbreaks occurred in Romania UNICEF’s international standard of 10 percent. The at the end of 2011 and 2012. Due to the high numbers of prevalence of a low weight-to-waist ratio (a predictor of young adults who were contracting rubella, this outbreak under-5 mortality) has significantly increased in recent infected large numbers of pregnant women with this virus, years from 4.4 percent in 2004 to 10.4 percent in 2010, which led to a large number of infants who were born with with considerably higher rates in rural areas than in urban congenital rubella syndrome. According to WHO experts, areas as shown in a recent study.362 This study, which coverage of the measles vaccination among children is not assessed the effectiveness of the Ministry of Health’s sufficiently high to stop the transmission of measles. In national programs on the nutritional status of children under general, the lack of disaggregated data (except by age, sex, the age of 2, showed that children with nutritional deficiency and geographical location) makes it impossible to identify who have not benefitted from early breastfeeding, exclusive susceptible groups and therefore to target interventions. breastfeeding until the age of 6 months, or a minimum While GPs and other specialists claim that the public has diversified diet363 are more likely to have teenage and/or a low level of acceptance of vaccination, the Ministry of less educated mothers. Also, the exclusive breastfeeding Health and its technical bodies should work to ensure a rate is clearly lower among children raised in poor or higher level of routine vaccination coverage and should extremely poor households. The same research has initiate public awareness campaigns aimed at increasing pointed out the significant positive correlation between the public’s confidence in the long-term benefits and providing prenatal breastfeeding counseling to mothers acceptance of immunization. and the duration of any breastfeeding. In this respect, only one in two mothers had discussed breastfeeding with Although maternal mortality is declining, it is still high their ob/gyn. Adolescent mothers (those aged between and occurs mainly among socially disadvantaged groups. 15 and 19 years old), less educated mothers, and women Romania’s maternal mortality rate remains much higher in rural areas are the groups with the fewest mothers than the EU-27 average - 11.44 as opposed to 5.05 who had received counseling during their pregnancies. maternal deaths per 100,000 live births as of 2012.365 It is The proportion of Roma mothers who benefitted from worrying that the number of deaths resulting from abortion breastfeeding training during pregnancy was almost twice has doubled and that maternal mortality increased as as low as the proportions of the other ethnic populations. a result of direct obstetrical risk in 2013 compared with With regard to the post-partum training provided in 2012. These statistics indicate that pregnant women are maternity hospitals and units, only 33 percent of mothers not being monitored and registered in due time to allow for claimed to have been trained in exclusive breastfeeding, early detection of obstetrical risk and to prevent abortions. and there were no significant differences between rural and A recent analysis of 2011-2012 maternal mortality in urban areas. Finally, the high prevalence of anemia among Romania366 showed that most of the women who die from children under 2 years old (40 percent in 2010) confirms direct obstetrical causes are poorly educated (86 percent that Romania has a child nutritional deficiency problem. of the sample were illiterate and graduates of only primary Children in rural areas eat up to 15 percent fewer iron- or secondary education), unemployed (74 percent), and/or based foods (meat, eggs, or milk) than those in urban areas. single mothers (40 percent). The maternal mortality rate is Family physicians who participated in the study admitted slightly higher in rural areas than in urban areas, and more that patients rarely asked them about diet issues and than 65 percent of the women who died in 2011-2012 were expressed their belief that it is the mother’s duty to ask for not provided with prenatal services.367 362 Ministry of Health et al (2011). 363 At a minimum, an improper diversified diet does not include sufficient meat, eggs, or vegetables and that some types of fruits are preferred over others (for example, bananas over apples). 364 Diphtheria, tetanus, and pertussis vaccine (WHO-UNICEF estimates for Romania, available at http:/ /apps.who.int/immunization_monitoring/globalsummary/timeseries/ tswucoveragedtp3.html) 365 WHO/Europe, European HFA Database. 366 Stativă (2013). 367 More than 125 children became motherless as a result of the 53 maternal deaths, 23 of which occurred as result of direct obstetrical risk (11 during pregnancy, six during delivery, and six post-partum). 236 | PEOPLE-BASED POLICIES These disquieting facts indicate that improving nutrition for monitoring and control. For improving the delivery of and health outcomes for all women and children should prenatal and postnatal care and childcare, we recommend be a priority for the government over the next few years. the following priority actions: • The Ministry of Health’s current mother-and-child healthcare interventions are discontinuous, inadequately D  eveloping clinical protocols, guidelines, and funded, poorly coordinated and monitored, and have not standards of practice and requiring physicians to been particularly effective. Therefore, the Ministry of submit to clinical audits by their peers. • Health should evaluate its current national public health programs on mother-and-child care and retain only  eveloping and implementing specific immunization D those that are cost-effective while introducing new ones coverage for vulnerable children left out of the based on evidence of best practices and of the real needs national immunization campaigns. • of vulnerable groups. The government should provide adequate funding for preventive interventions, including ncreasing the coverage of basic healthcare service I those designed to provide mothers and their families with providers (family doctors, community nurses, and education and information on prenatal care and healthy Roma mediators) at the local level countrywide. • lifestyles. Parenting education should be included in these interventions and should be focused on improving children’s  raining or retraining community healthcare providers T health, especially the health of children from disadvantaged (family doctors, community nurses, and Roma health populations.368 mediators) in the delivering of quality prenatal and postnatal care and childcare. • In order to deliver prenatal and postnatal care and childcare at a consistent standard of quality countrywide,  onitoring, evaluating, and controlling the delivery M policymakers will need to increase access to and enhance and quality of care. the quality of the existing mother-and-child healthcare services. Access to mother-and-child healthcare services is limited, sometimes because services are too far away from Reduce the Number of their target populations or because the pregnant woman Chronic Diseases, cannot afford to pay for transportation into town for tests (simple ultrasounds or lab tests) or, indeed, for the tests Longstanding Conditions, themselves. Although by law these tests should be provided and Avoidable Deaths free of charge, this is often not the case in practice because the health system budget is insufficient to cover these A serious challenge for Romania’s health sector is the costs. Another factor that limits access is that many rural limited access of the poor to healthcare services for communities lack family physicians or even community chronic diseases. The minimum healthcare package that nurses. This is partly because few family physicians seem is designed to meet the needs of the uninsured does not interested in practicing in those communities but also partly cover these services (see Annex Table 7.1).There is also the because the authorities fail to oversee and control their possibility that the poor are unaware of their need for care. activities other than on paper. There are no mechanisms In surveys, almost half of poor respondents who state that for evaluating the quality of the services provided by family they need healthcare do not actually seek care. The gap physicians, for example, assessing their compliance with between the poor and the better-off is particularly evident in practical guidelines and protocols on pre- and postnatal the treatment of chronic disease with 42 percent of the poor care or on infant care. not receiving this kind of care compared with 17 percent of those who are better-off. Simulations by the World Bank Therefore, research is needed to determine what factors that assumed that the need for chronic care is similar for the prevent pregnant women, nursing mothers, and infants from poor and for the better-off showed that 85 percent of the accessing health services and to suggest ways to remove poor who need chronic care do not receive it.369 The cost of the barriers through legal regulations or coherent measures medicines and the widespread practice of making informal 368 Especially given that most deaths in children under the age of 1 that have occurred at home are correlated with “the parents’ inability to recognize the disease in time or to correctly assess its severity.” (Anghelescu and Stativă, 2005). 369 World Bank (2011a). Health | 237 payments to health professionals have both been reported due to premature death in Romania, cirrhosis of the liver as being barriers to accessing care for chronic diseases. was among the highest ranking causes in 2010.374 Segregation and discriminatory practices at all levels of the Thus, we recommend that the government consider healthcare system are additional obstacles faced by the developing local, regional, and national plans for reducing Roma population in trying to access healthcare services. the incidence of unhealthy behavior and for preventing Innovative interventions tailored to the dominant risk factors chronic diseases. Also, within the national public health faced by poor and vulnerable groups are needed to reduce programs, the Ministry of Health should design and the rate of chronic disease among these populations. implement evidence-based health promotion interventions. These interventions need to be designed, implemented, These should focus on: (i) reducing harmful alcohol monitored and evaluated within each national public health consumption, especially in rural areas, with a focus on program for chronic diseases. Currently, the Ministry of those who are less educated; (ii) developing smoking Health’s national public health programs do not focus prevention programs in urban areas, including among the sufficiently either on the prevention and early detection of better educated; and (iii) initiating outreach interventions major diseases or on the main determinants of the burden of in specific communities identified as being the most disease. Since June 2014, GPs have been required to carry vulnerable. out a health risk assessment for each insured person on In the forthcoming years, the efficacy of the national their capitation list, but no such assessment is envisaged for screening program for the early detection of cervical cancer uninsured people either under health insurance or through must be evaluated. Romanian women still have the highest the Ministry of Health’s national public health programs. mortality rate from cervical cancer in the EU despite the fact Therefore, there is a strong need for effective information that this disease is easily preventable or curable by early campaigns, the provision of culturally sensitive health detection. The most common cancers in women are breast, services,370 and preventive programs for the most relevant colorectal, and cervical cancers, while lung, colorectal, and diseases and risk factors. Non-communicable diseases prostate cancers are the most common among males. In are very prevalent in Romania and account for 91 percent 2012, the Ministry of Health initiated a population-based of all deaths. Among the non-communicable diseases, cervical cancer screening program, which is still ongoing but cancer-related deaths rank second only to cardiovascular needs a specific component targeted to the most vulnerable disease. The three risk factors that have accounted for the women. The program targets women between the ages greatest disease burden in Romania are dietary risks, high of 25 and 64 years old and tests them every five years. blood pressure, and tobacco smoking. In 2010, the leading Family physicians provide the program with lists of their risk factors for children under the age of 5 and adults aged female patients in the target age group who are then sent between 15 and 49 years were household air pollution an invitation to participate in the screening. However, this from solid fuels and alcohol use respectively.371 Smoking means that uninsured women are unlikely to be included, is a real health issue for males and females, especially for even though this is a national public health program. A younger age groups. There is an inverse socioeconomic number of health professionals have claimed that not gradient prevalent among males but not among females.372 all women who are diagnosed with cervical cancer after Smoking is the main risk factor related to cancer. The being screened receive follow-up treatment, particularly prevalence of smoking is higher among males than females the poor and women in rural and remote locations, (37.4 percent versus 16.7 percent), but female smoking has because of the costs of transportation, treatment, and care increased very significantly in the last decade. Romania and the lack of appropriate health infrastructure and a ranks first among all EU countries in terms of alcohol specialized healthcare workforce for treatment and care consumption, with a rate that is 130 percent higher than the (mainly the oncological services). Also, in the Ministry of EU average.373 The mortality rate due to cirrhosis and other Health’s Activity Report 2013,375 the staff of the program’s effects of alcohol consumption has increased substantially implementation unit identified many bottlenecks in the in recent years. In terms of the number of years of life lost 370 One example of a culturally sensitive health service is approaching specific Roma communities with reproductive health services. 371 IHME (2013). 372 Irimie (2012). 373 Alcohol consumption among adults aged 15 years and over was 16.2 liters of pure alcohol per person per year in 2008, compared with the EU average of 12.45 liters (WHO, 2012b: 115). 374 WHO (2012b). 375 Ministry of Health (2013). 238 | PEOPLE-BASED POLICIES program’s design and implementation and suggested simple but effective ways to improve cervical cancer Improving Healthcare Services screening and the continuity of the cycle of early detection, for Infectious Diseases treatment, and care. Clearly, better planning, monitoring, The control and treatment of infectious diseases, especially and overall management of the cervical cancer screening tuberculosis (TB) and HIV/AIDS, should remain high on the program is needed. policy agenda as they are particularly prevalent among The government should also initiate and fund a vulnerable groups, including Roma. TB remains a critical mammography screening program for breast cancer focused problem in Romania, mostly affecting adults in the second on poor and vulnerable women and those in rural areas. The half of life. The geographical distribution of TB by counties program should target women aged 50 to 69 years old and is inversely correlated with income and education level.377 should include culturally appropriate interventions for the Although HIV/AIDS patients have free access to drugs and poor and the vulnerable, including Roma. the survival rate is around 30 times higher than it was in 1990, the problem is still of major concern, because no Investing in palliative and long-term care in the near public budgets or services are available for prevention, future is a must, given the aging population and the high especially for vulnerable groups such as injection drug and increasing cancer mortality rate. Palliative and long- users (IDUs).378 term care and rehabilitation services are not sufficiently developed within the national healthcare system, and this TB is a disease of poverty, so tuberculosis control remains is a challenge that has not yet been consistently addressed a critical public health priority in Romania. The links in Romania. Most long-term care is provided by the between poverty and the disease burden of TB have been patient’s family, and there are few resources available to documented for many years. The incidence and prevalence support informal carers. What little professional long-term of the disease in Romania has been declining continuously care and home care exists is mainly funded by donations over the past decade, but WHO still lists Romania as among and other third-party contributions (charities or NGOs the 18 high-priority countries in the WHO European region funded by private donations or membership fees; some due to its high number of multidrug resistant cases of countries receive funding from the EU).376 The availability TB (MDR-TB). of palliative care services is still very limited. Palliative care There are many challenges facing Romanian TB patients. professionals say that currently only about 5 to 10 percent Generally, GPs have no particular interest in TB prevention of people in need of palliative treatment actually receive or care. There is also a waiting time for seeing a GP, and it. According to the 2010 data provided by the Romanian therefore patients often prefer to seek emergency medical National Association of Palliative Care and Hospice (Casa care in hospital. Late diagnosis and excessively long Sperantei), specialized palliative care is available only in 16 hospitalization by international standards are the norm, counties. There are a total of 46 palliative care units, but the and there is limited availability and often discontinuity of distribution is uneven (12 of them being located in Bucharest prescribed drugs. Many patients do not receive supervised and another 12 in Brasov). Most patients in the advanced treatment or any of the psychological support that they stages of cancer are treated at home and remain in the need to continue their treatment outside hospital. Social care of general practitioners, who usually lack training and support is restricted to 100 percent of the patient’s salary practice in this field. The health insurance reimbursement for one year of medical leave but only for those patients for palliative care is insufficient (up to 90 days of care per who were employed prior to the start of their treatment. No patient), and palliative care facilities claim that in practice public funds are available to support the unemployed, the health insurance funding covers only 20 to 50 percent of self-employed, people working in agriculture, or vulnerable the real costs. groups such as the homeless. Local authorities lack the necessary knowledge of and thus the commitment to support TB control interventions. 376 Genet et al (2012). 377 World Bank (2011a). 378 Institutul Național de Boli Infecțioase ”Prof. dr. Matei Balș” (2013). Health | 239 Although Romania has made remarkable progress in Our recommendations for redesigning the National Plan to detecting and treating tuberculosis over the last few years, Prevent and Control M/XDR-TB 2012-2015 are as follows: • the TB notification rate remains the highest of all of the EU member states. Data from the National TB Control Program  rovide adequate funding and include specific P (NTP) within the Ministry of Health379 show that there are measures are included that target the most significant disparities among counties varying from a low of vulnerable groups and communities. • 26 per 100,000 inhabitants to a high of 114 cases as of 2013. TB notification rate is, however, up to seven times higher I  nclude social support and interventions targeted among prisoners (479 cases per 100,000 in 2013 compared to the poor, such as vouchers for transportation to with 74 cases per 100,000 among the general population). medical facilities and subsidies to MDR-TB patients Furthermore, the TB prevalence among homeless people for appropriate nutritional or psychological counseling. is fifty times higher than that in the general population Also, develop (and allocate adequate budgets (6,700 cases per 100,000 in 2011), while in some Roma from national and international funds for) specific communities from rural areas it may reach a high of over two interventions for vulnerable groups such as IDUs, street hundred times higher than that of the general population children, the homeless, prisoners, and Roma. A large (27,000 cases per 100,000 in 2012). Furthermore, the range of interventions aimed at reducing TB among the use of Direct Observed Treatment (DOT), one of the most most vulnerable populations have been tested around effective ways to control the spread of the disease in its early the world and are strongly recommended by WHO and phases, has declined in Romania in recent years.380 There its technical bodies (Stop TB Partnership). • are few options available for receiving DOT ambulatory treatment. TB treatment during the continuation phase is  einforce the Direct Observed Treatment Strategy R provided by family physicians who tend to be unmotivated to (DOTS) through regulatory measures and county- provide DOT for TB and MDR-TB patients in the absence of based mapping of resources. Use GPs and available any financial incentives from the Ministry of Health. Patients community healthcare workers (especially in rural have to travel to county TB dispensaries to be treated, areas) to rigorously apply DOTS. Develop cycles or on weekends when the dispensaries are closed, they of planning, implementation, monitoring, and usually have to self-administer the treatment. Alternative evaluation, ensure appropriate funding, develop DOT providers, such as community nurses, Roma health guidelines and procedures for implementing DOTS, mediators, and family members, are rarely used, and there is and ensure that NTP coordinators provide appropriate still no patient-centered approach in place. guidance, supervision, and control. Most importantly, periodically train and/or retrain DOT providers. • The goal of the government in this area should be to increase access to TB care and prevention by means of mprove the identification of people with TB through I an integrated, patient–centered approach that takes into health communication interventions. Engage and train account the high burden of disease in Romania and its direct health care providers (TB county managers network correlation with poverty and vulnerability. To achieve this GPs, community nurses) and DOTS supporters. aim, the government should reform its national TB efforts Inform and train community stakeholders to identify to bring them in line with the recommendations issued by TB cases. Design, periodically update, and distribute WHO and the European Center for Disease Prevention IEC materials to providers and patients. Contract and Control (ECDC) in 2014. The Prime Minister officially with NGOs to reach the most remote communities launched a National Plan to Prevent and Control M/XDR- countrywide. Raise awareness within communities and TB381 2012-2015 on October 2, 2012 during the visit to local authorities of TB and the availability of treatment Romania of the WHO Regional Director and the European services. Plan, monitor, and evaluate outreach Commissioner for Health and Consumer Policy. However, interventions to educate vulnerable groups, patients, its implementation has been delayed by the lack of financial and communities about TB. Run IEC campaigns resources despite joint WHO-ECDC follow-up missions to targeted to poor households, rural populations, Roma, put pressure on the government. and other vulnerable groups at higher risk of TB. 379 National TB Control Program, “Marius Nasta” Pneumology Institute, 2014 data. 380 DOT means that a trained health care worker or other designated individual (other than a family member) provides the prescribed TB drugs and watches the patient swallow every dose. 381 M/XDR-TB means multi-drug and extensive drug-resistant TB. 240 | PEOPLE-BASED POLICIES •  eview the NTP information system and collect R disaggregated data at both the county and the national level. Develop sound criteria for defining • D  evelop procedures and guidelines for HIV/ TB detection and care based on international recommendations and protocols. Invest in HIV/AIDS the poor and most vulnerable patients among both prevention focusing on specific vulnerable groups. suspected and confirmed cases. Conduct a periodic analysis of the data collected by the revised NTP health information system. Document all targeted interventions in each round of the NTP. BOX 37 International Support for Romania to Control having endorsed and budgeted for its National Infectious Diseases Plan to Prevent and Control M/XDR-TB for 2014 to 2020. Thanks to the Global Fund’s The Global Fund to Fight AIDS, Tuberculosis, and long-term support, there is a network of NGOs Malaria has been supporting Romania’s efforts to in Romania that are active and knowledgeable in the TB combat TB since 2004. The Global Fund for Romania control field. approved four grants totaling US$68.8 million for fighting TB and HIV/AIDS between 2004 and 2014. The Norway Financial Mechanism supports the Ministry The Global Fund for Romania on HIV/AIDS ended in of Health’s public health initiatives, including TB control, 2009. Romania is still eligible for support on TB due through the program called Public Health Initiatives, to the country’s high burden of disease. The current which focuses on MDR-TB, HIV/AIDS, and hepatitis Global Fund grant was awarded to help the government B and C. The program has a budget of €5.3 million to scale up the provision of high-quality MDR-TB and prioritizes increasing the access of vulnerable treatment and care. Other grant-aided activities include groups such as Roma to primary care and community the training of healthcare providers and targeted care services. A second TB project proposal of about education and adherence programs for the poor, €5 million was approved by the Norway Financial homeless, prisoners, Roma, and rural communities. Mechanism in the summer of 2014. Both programs will In 2015-2016, Romania may receive up to US$12.8 have been implemented by the end of April, 2016. million for TB control, conditional upon the government 2.5.3. Increasing the communities (both rural and urban). We recommend that all of these stakeholders become part of multi-disciplinary Access of Vulnerable teams at the local level that will implement the integrated approach to delivering social services over the next few Groups to Quality years (see Section 2.3.5. Developing the Integrated Healthcare Intervention Community Teams). Strengthening and Enhancing This section focuses on the primary healthcare and community-based healthcare network in Romania, the Quality of Primary which constitutes the best framework for the effective Healthcare Delivery implementation of the recommendations made in the At present, the primary healthcare network in Romania is previous sections. Family physicians, GPs, and their ineffective in providing healthcare to the poor. There are nurses together with community nurses, social workers, two broad reasons for this: (i) a lack of human resources, school mediators, and Roma health mediators are the key incentives, and appropriate budgets, especially in rural stakeholders for ensuring access to health services for areas and (ii) the behavior of family doctors who operate poor and vulnerable groups and in poor or marginalized with little monitoring of their daily activity. Health | 241 The primary healthcare network must be extended and strengthened. The family doctor profession was introduced as part of the overall primary healthcare reform in mid- •  eveloping, as a matter of priority, community- D based healthcare services in those villages with no permanent family doctor’s practice (See Section 2.3: nineties. It entails four additional years of postgraduate Social Services). • studies than is necessary to become a GP, which requires only graduate studies. This reform also eliminated the E  xploring innovative alternative solutions such as difference between primary healthcare providers for telemedicine for reaching remote communities and adults and those for children. Family doctors have become for overcoming the uneven distribution of healthcare independent service providers under contract with the resources and professionals. As a prerequisite, putting National Social Health Insurance Fund (NHIS). Each year, legislation in place to enable such an approach. they negotiate and sign contracts with the Fund for the On the supply side, there is still no effective health provision of a “basic package of services” to the insured workforce strategy, particularly for attracting staff to rural (eligible beneficiaries registered on their own practice list) areas and keeping them there. The availability of all types and non-insured populations (who are entitled to receive a of medical professionals in Romania is well below the “minimum package of health services”). Although primary European average, particularly in rural areas (Table 37). A healthcare is associated with physicians, a very important large number of doctors and nurses have left medicine and role is played by the nurses employed by the family even the country in search of better pay, working conditions, physicians from their own medical practice budget. and/or social recognition. Between 2000 and 2005, about In order to tailor the provision of primary healthcare services 10 percent (5,180) of the total number of medical doctors to the needs of the most disadvantaged, we recommend that and 5 percent (4,440) of nurses trained in Romania worked the government consider taking the following priority actions: in OECD countries.382 The EU expansion in 2007 and the • economic downturn in 2009-2010 considerably increased  eveloping and piloting new models of primary D these existing migration flows towards the western EU healthcare delivery such as diversified services and countries.383 Given that family medicine is one of the most health providers’ networks (primary healthcare, demanded specialties in some EU countries, it is most likely ambulatory care, hospitals, long-term care, home care, that existing inequalities in access to primary care services and palliative care) in certain areas and increase the will increase even further if the emigration of family doctors role of primary healthcare providers in patients’ case- and nurses continues and/or increases. management especially for the chronic diseases and with a focus on primary and secondary prevention. Resources in Healthcare Services in 2011 (number) TABLE 37:  Different resources per 100,000 inhabitants Active Specialist medical GPs Pharmacists Nurses Hospital beds physicians practitioners Romania 68 239 70 68 551 611 EU-28 79 346 92 * 836 540 Source: WHO/Europe, European HFA Database, November 2014. Note: *Data not available. 382 Simoens and Hurst, (2006). These percentages were higher for Romanians than for citizens of any other former communist country. For instance, the equivalent percentages for Bulgarians were 6.2 percent of medical doctors and 2.6 percent of nurses. 383 Galan et al (2011). Around 3 percent of all practicing medical doctors in Romania (1,421 doctors) left in 2007 alone. In 2009-2010, a freeze on hiring and a 25 percent cut in public sector salaries (as part of the government’s “austerity policies”) contributed to higher outflow numbers. According to the National College of Physicians, from 2007 to December 2014, more than 16.000 certificates of recognition of medical diploma in the EU space were issued to Romanian medical doctors by the competent authority. 242 | PEOPLE-BASED POLICIES To reduce socioeconomic inequalities effectively, the government needs to develop a national plan for healthcare services, followed by prudent investment in infrastructure • I nvesting in health infrastructure and technology in a cost-effective way in accordance with the requirements of the national plan of health services and human resources. The lack of sufficient healthcare and based on documented evidence. professionals and their uneven distribution together In addition, the government should consider allowing local with geographical inequities in the distribution of health authorities to hire GPs in special circumstances, with funds infrastructure have contributed to inequalities in access from the National Health Insurance Fund. In a recent case in to healthcare. Most medical infrastructure is located in a commune of fewer than 800 inhabitants in the North-East urban areas,384 while rural areas account for only 8 percent region, the family physician died, and his/her heirs put the of hospitals, 8 percent of specialized medical clinics/ medical practice on the open market. The local authority offices, and 24 percent of the total number of pharmacies. was unable to provide the commune’s inhabitants with any This is the case even though about a half of the national kind of healthcare because the current regulations in force population lives in rural areas. For this reason, Romania do not allow the opening of a second medical practice (or has the longest travel times to a major hospital in Europe workstation/facility) in a location with so few inhabitants. after Northern Norway, Northern Scotland, Southern Italy, the Greek Islands, and Eastern Poland.385 Consequently, To reach the goal of ensuring access to quality healthcare primary healthcare providers and community nurses (see for all, the government will need to implement measures to Section 2.3 on Social Services) hold the key to ensuring ensure continuity of care at all system’s levels and to set access to health services in most rural or poor communities. up a reliable referral system from primary care doctors to Nevertheless, the nationwide density of family physicians specialists and back. At present, insured patients can only and GPs is only 0.5 per 1,000 inhabitants in rural areas access specialist and inpatient services by referral from compared with 0.73 per 1,000 inhabitants in urban areas.386 their family doctors or GPs. By international standards, the So, in most rural areas, the departure of even a few health rate of referral to specialized healthcare structures is high in specialists can substantially reduce service provision. Romania - 9 percent in rural areas and 12 percent in urban The migration of health professionals has been a major areas. However, this may partly be due to the rules imposed matter of concern for policymakers, particularly because on family physicians by the National Health Insurance the most economically deprived North-East region and the Fund that prevent them from providing certain tests and rural areas with the lowest coverage of medical doctors treatments themselves. Therefore, the government should have had some of the highest emigration rates of medical consider: • doctors and nurses.387 A recent study showed that, in rural areas, primary healthcare services are unevenly distributed  eveloping methodologies and standards of care D geographically, the widest gaps being identified in the aimed at integrating community-based services, GP North-Eastern, Southern, and South-Eastern regions.388 delivery of healthcare services, and specialized care. Thus, in the coming years, we recommend that the government should consider: • I ncluding in the health sector’s Unique Information System a module aimed at monitoring continuity • R  eviewing and revising the existing financial and non-financial incentives designed to attract and retain physicians in rural and remote areas. • of care. A  nalyzing results of the monitoring activity at county and national levels and using them as input into local, • S  etting up local, county, and regional healthcare service plans to be consolidated into a national plan of health services and to be followed by prudent county, and national plans for healthcare services. The quality of primary healthcare services must be considerably improved and systematically monitored and investments in infrastructure and human resources. controlled, particularly in relation to the services provided to the poor and vulnerable population. A range of different 384 NIS (2013c). 385 Bertolini et al (2008). 386 NIS (2013c). 387 Galan et al (2011). 388 Schaapveld et al (2011). Health | 243 local and central stakeholders have expressed a general regular consultation, with a fee per service without actually dissatisfaction with the performance of family physicians providing any patient consultations per se. Nonetheless, and GPs.389 A significant number of family physicians are the family physicians themselves tend to complain that exclusively business-oriented and lack empathy with their they provide more consultations per day than they are patients and their communities, especially the poor (Box reimbursed for, as their NHIF service provider contracts pay 38). They have a family physicians’ association, which for only a limited number of consultations in addition to the is similar to a trade union, and frequently threaten to go capitation fee. Finally, there is virtually no monitoring of on strike if their current rights, contracts, or payments are or control over the activities of family physicians. Both the affected. They also threaten to strike when they are given Ministry of Health’s county-level offices and the County additional duties with no financial compensation, even Health Insurance Houses have limited capacity and though their current (official) incomes are comparable operate under unclear regulations that prevent them from to those of hospital physicians, if not higher. Also, many controlling primary healthcare providers. As a result, there family physicians refuse to participate in preventive health have been cases of family physicians who signed contracts programs financed by the Ministry of Health unless they to provide services in more than one location but who rarely are paid extra for such work, despite the fact that the visited their second and third contracted locations, which beneficiaries of these programs are likely to be insured are often poor, isolated communities with just a few hundred individuals for whom the doctor already receives per capita inhabitants. funding from the NHIF. A good example is the cervical Therefore, we recommend that the government consider cancer screening program, for which family doctors are taking the following actions as a matter of priority: given extra payments by the Ministry of Health from funds allocated to the program, even though most of the women who are screened are already enrolled in the doctors’ per capita lists of beneficiaries. As a high-level decision-maker •  arrying out a clinical audit391 of primary healthcare C providers. declared during an interview for a recent study, “Many general practitioners are like boutique salesmen. They open at 9am and close at 5pm, have no time or interest for •  etting up national mechanisms and clear S responsibilities for the regularly monitoring and evaluation of primary healthcare services. • prevention activities, and know nothing about the patient other than what is in the medical record.”390 In addition,  eveloping a system of collecting data about patients D the interviewed specialists tend to believe that family and implementing a system of disaggregated data physicians spend most of their days writing prescriptions for collection and analysis on primary healthcare delivery. subsidized drugs, for which they are paid the same as for a BOX 38 Opinions of Family Physicians about Providing and start to complain and say: what should Healthcare Services to the Poor I do? I will die! So what, I respond, there are plenty of priests, leave me alone. I cannot take The qualitative research conducted for this report it anymore, people are simply too demanding, in June 2014 highlighted the opinions of family with no respect or consideration for us. They mistake physicians about providing healthcare services to the us, family doctors with a university education, with poor and vulnerable population, as expressed by the community-based healthcare. They mix apples with representatives of their professional associations: nuts. To be clear, at the present time, the Insurance “People come to us, but they are not informed, and House forces me only to take care of the insured usually they delay. Nevertheless, they ask for attention patients because this is how I get paid. And to be frank, 389 Stănculescu and Neculau (2014) and qualitative research conducted for this background study. 390 Stănculescu and Neculau (2014: 88). 391 A clinical audit is a quality improvement process that seeks to improve patient care and outcomes through a systematic review of care and the implementation of change. 244 | PEOPLE-BASED POLICIES BOX 38 (continued) I do not have the time, given the low pay, to treat the Then, of course, I would treat the gypsy community uninsured... the vulnerable ones. From time to time, I do in my area, but not otherwise... the provider must be some charity work because people know me and I don’t given an incentive.” (From a group discussion with want to get my face spat on or to have stones thrown at representatives of the Family Doctors’ College, the my car. But, they, the community, do not think that our Family Doctors’ Association, and the Family Doctors’ relationship should be a kind of yin and yang... In the Employers Association, County Botoșani.) case of the insured patients I am paid by the Insurance “If the patient can make a choice between family House, and in the case of the vulnerable, of course, I can doctors, in the same way, I can also say: I don’t want to deliver services but only if and when the community register him or her on my list. If, moreover, this person asks for them and pays a certain amount, let’s say, is not insured, you cannot register him. Earlier it was enough for hiring an additional nurse or even a second possible, but nowadays the Insurance House simply medical doctor.... Of course, family doctors would treat cuts them from the list, and I get no pay.” (Interview with vulnerable people or the uninsured ones if we were a representative of the Family Doctors’ College, County given an incentive. Let’s say, the senior colleague who Arad.) has only blond patients with blue eyes, give him 2 RON per point, but pay him 100 RON per point for a gypsy. Source: World Bank qualitative study carried out in July-August 2014 for preparing this background study. On the demand side, the Ministry of Health should traditions of the most vulnerable, while also ensuring that increase the usage rates of primary healthcare services these interventions are monitored and evaluated. by developing health education and disease prevention At the same time, demand could be increased by tailoring services. The use of primary healthcare services by the the provision of primary healthcare to the needs of the population is low. Data from the 2012 pilot of European poor and vulnerable groups. The Ministry of Health has Community Health Indicators Monitoring (ECHIM) showed defined a new basic package of healthcare services to be that Romania has one of the lowest mean number of self- provided to the insured population as of mid-2014. It has reported visits to GPs per capita per year in the EU - 2.7 also revised the minimum package of healthcare services among people aged 15 and over as opposed to 4.8 in the for the uninsured population, but the implementation of this EU. The contrast is even more striking for those aged 15 entered into force only starting January 2015. Although to 64 years old - 1.9 consultations per person per year the Ministry of Health finalized the minimum package at versus the EU average of 4.1 consultations per person per the same time as the basic package of healthcare services, year. The fact that the many among the general population only the insured are benefitting from these improved do not understand their right to healthcare as enshrined services, including prevention programs. This is the case in the Constitution contributes to healthcare inequalities even though the budgets for both primary healthcare and and to the low usage of primary healthcare. The most ambulatory specialized care were increased in 2014 by over disadvantaged categories are the poor and vulnerable 11 percent and 10 percent respectively. The basic package people – who are more likely to be uninsured - who cannot of services explicitly includes disease prevention for the afford to visit a family physician from whom they receive no first time with a health risk assessment being standardized encouragement to use his or her services. and included in the primary healthcare services to be Increasing the use of primary healthcare will require the provided to the insured population. The revised minimum introduction of health education and disease prevention package also includes additional primary care preventive measures aimed at reducing the health gap between the services addressing specific chronic diseases and long- poor and vulnerable population and their more advantaged standing conditions (as well as pre-natal and post-natal neighbors. In all specific areas of intervention relevant care and family planning counseling provided in ambulatory to poor and vulnerable groups, the Ministry of Health specialized care), but these services for the uninsured will should plan and implement IEC campaigns and outreach only come into effect in 2015. Meanwhile, the budget for interventions tailored to the particular needs, beliefs, and ambulatory oral healthcare increased by 450 percent in Health | 245 2014 compared with 2013 but not for the uninsured. They are only entitled to oral healthcare services in emergencies and have to pay for any additional required examinations • D  eveloping, implementing, and monitoring practice guidelines, clinical protocols, and management procedures on the interventions and services delivered (including x-rays or drugs) out of their own pockets, to the poor by the primary healthcare network. while a yearly visit by an insured adult to the dentist (as a preventive measure) is reimbursed to the tune of RON 80. Developing the Emerging As in the past, in 2014 an uninsured person can register with any GP on a separate list and benefit from a limited National Network of range of healthcare services (Annex Table 7.1). Community-based Healthcare In order to tailor the provision of primary healthcare services Workers to the needs of the most disadvantaged, the government should consider the following priority actions: Despite the government’s efforts to develop primary care, • certain parts of the population still find it difficult to access R  eviewing and diversifying the interventions included adequate health care, especially poor and vulnerable in the minimum and basic benefits packages households, residents of rural areas and small towns, delivered by family doctors and increasing the share and the Roma population. The barriers faced by rural of services that proved to be effective (evidence- residents, especially those from remote villages, are mainly based services) delivered to the poor, with a focus on geographical barriers, but they are also less likely to be health prevention, early detection (such as cancer covered by health insurance and are usually poorer and screening), and home visits. less educated and informed than the urban population. • Roma suffer from worse health than the non-Roma  eriodically assessing the effectiveness and cost- P population, with a higher burden of infectious and chronic efficiency of those interventions. disease. Roma children also have a lower vaccination rate, • which is largely attributable to a lack of information and  eveloping and implementing continuous medical D education as well as of the absence of identification papers. education programs for family doctors and their In Romania, 42 percent of Roma do not seek healthcare nurses, tailored to the health needs of the most when they actually need it, and over 80 percent of those disadvantaged. who do not seek needed care say it is because of financial constraints or the lack of health insurance.392 BOX 39 Community-based Healthcare Workers in disabilities, the elderly, marginalized people Romania - Definitions and Activities including Roma, and rural communities with no family physicians or general practitioners). Community Health Nurses (CHNs) are trained nurses who operate in the field, providing mainly health The activities of the CHNs as defined by current promotion and education, disease prevention, and regulations are to: home-based care and counseling. In fact, the CHNs are a revival of the community nurses that used to exist prior to 1989. Today, they continue •  rovide community health education and P interventions related to environmental health and to health and social counseling. to provide health and social services and/or to facilitate access to primary healthcare services for disadvantaged •  rovide health education regarding health risk P behavior and a healthy lifestyle. • groups (such as people with physical or mental Provide secondary and tertiary prevention.  392 World Bank (Anan et al, 2014). 246 | PEOPLE-BASED POLICIES BOX 39 (continued) • P  rovide reproductive health and family planning education and counseling. These health mediators are mainly Roma women with • a medium (or low) level of education, who have been P  rovide home-based healthcare services for recommended by local communities and who have pregnant and postpartum women, newborns, and successfully completed a brief training course. children. • The activities of the RHMs as defined by current  rovide homecare services for chronically ill P regulations are to: patients, people with mental disabilities, and the elderly. The Roma Health Mediators (RHMs) program was • • Provide health education.   erve as a liaison between Roma communities S and healthcare practitioners. • designed to improve the health status of Roma and increase their access to healthcare services. The RHM Help Roma to access healthcare.  program was initiated by the Ministry of Health based on a good practice model set by an NGO (Romani Criss). •  upport public health interventions in Roma S communities. In 2002 the government set up a national network of decentralization created confusion on all sides, with most community health nurses (CHNs) and Roma health local authorities failing to understand the role of community mediators (RHMs) in an attempt to increase the access of health workers. Some of them refused to take on the poor and vulnerable groups to basic health services. This community nurses and Roma health mediators in their own was initiated after the failure of primary healthcare reform to facilities, despite the fact that their salaries continued to be increase access to reproductive health services and mother- paid by the Ministry of Health although the Ministry did not and-child care for the most vulnerable populations. cover the other operational costs related to their work.393 Consequently, the number of CHNs dropped considerably The community-based nursing system must be extended (from 1,228 to 780 at the national level). The number of and strengthened as it represents the most powerful RHMs has stayed more or less stable as they are better “equalizer” in the health system. Currently, the community- organized than the CHNs. As of 2013, the community based healthcare system is largely underused (Figure 41). nursing system had started to recover, yet it was functioning Between 2002 when the system was set up and 2008, with less than half of the workers needed to cover the whole the number of community-based healthcare workers, both country according to the current legislation (Government CHNs and RHMs, gradually increased. In 2009, during the Decision 459/5 of May 2010). A major cause of this economic downturn, the government began decentralizing situation, besides the lack of trained specialists and the responsibility for healthcare to local governments, which small wages, is that, even today, the secondary legislation meant that community-based healthcare workers became regarding community healthcare workers is not sufficiently employees of the local authorities though they continued clear or precise (see Box 40). to be financed by the Ministry of Health. In the beginning, 393 Even in the census of the Public Social Assistance Service (SPAS) carried out for this report in May 2014, only about a quarter of the Roma health mediators were declared as SPAS employees of local authorities in rural areas and small towns (of less than 50,000 inhabitants). Health | 247 FIGURE 41: The Number of Community-based Healthcare Workers in Romania 2500 2032 2000 1500 1228 979 1000 908 780 463 462 474 447 500 304 282 160 174 94 0 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 '13 Necessary in 2013, based on RHM- Roma Health Mediators GD 459/5 May 2010 CHN - Community Health Nurses Source: Ministry of Health. Notes: Data for 2009 at the time of the decentralization of healthcare on June 30. Data for 2013 are for February 1. The number of necessary community-based healthcare workers was estimated according to the current regulations. BOX 40 The Need to Improve Regulations Regarding amount of time to devote to community Community-based Healthcare Workers nursing and often have to give up home visits and outreach activities. All of these factors The qualitative research conducted for this report diminish the effectiveness of the network of highlighted that the existing regulations governing community health workers. community healthcare nurses (CHNs) represent a major barrier for the development both of the profession and of “Community health nurses are trained medical a national network. On the one hand, CHNs are hired by assistants. They have completed special training local authorities and as employees of the mayoralties sessions so they know what they are supposed to do. they have to carry out the activities decided on by the We still have many localities with community health mayor or vice mayor. On the other hand, their wages nurses, but some of them do not perform the work they are paid by the Ministry of Health and, consequently, were trained and know to do. Instead they do paperwork the County Directorates for Public Health monitor and for some cash benefits or various other office tasks coordinate their methodology. Sometimes the local given to them by the mayors. So many ill people who authority and the County Directorate come into conflict, are unable to move and have no one to help them do not with the CHN caught in the middle. Furthermore, benefit from care services precisely because of the lack often the family doctor or the GP of the community of coordination between the social and health services asks the CHN to complete various tasks related to and of the unclear status of the community nurses.” healthcare delivery, which are not included among the Source: County Directorate for Public Health, Botoșani, CHN’s duties as defined by the local authority. Under World Bank qualitative study carried out in July-August these circumstances, many CHNs have only a limited 2014 for preparing this background study. 248 | PEOPLE-BASED POLICIES Improving the quality of the basic health services available necessary equipment for the work of community to poor and vulnerable groups will require significant nurses and Roma healthcare mediators, including investments aimed at strengthening the capacity of basic medical kits, IEC materials, vehicles and community-based health workers to deliver the needed transportation and vouchers, and an IT infrastructure. • services. There is a lack of any organized workflow, activity planning, or periodic results assessment for community- I mplementing integrated community-based social, based health workers. The duties of CHNs are vaguely health, and educational services and promoting defined in the legislation. In general, local authorities partnerships with specialized or grass-roots NGOs, have a limited grasp of the concepts of health promotion while building the capacity of local authorities to plan and primary and secondary preventive services. The and manage these integrated community-based capacity of the Ministry of Health and its decentralized services. directorates to control, evaluate, and coordinate CHNs’ The government should ensure adequate funding for the activity decreased dramatically when responsibility for development of the community-based healthcare services the CHNs was transferred to the local authorities and as a and should clarify the provisions governing operational result of the frequent changes in the Ministry of Health’s expenses and ancillary costs related to their delivery. structure and staffing at both the local and national levels. There are advantages and disadvantages to the present The County Directorates for Public Health fail to conduct financial flow arrangements (Scheme 8). In terms of any activity in the community healthcare area, not even the advantages, community workers being employees of the half-yearly orientation meetings that the regulations require local authorities means that they are close to their direct them to hold, except for handling the monthly transfer from beneficiaries, and the Ministry of Health being in charge the Ministry of Health to the local authorities of the salary of the salary budget is the safest option. However, the budgets for CHNs and RHMs. Except for various NGOs disadvantages are that shared responsibility means that that have been providing community workers with training neither party takes direct responsibility for the community sessions under several different projects, there has been no health workers, and neither the local authorities nor the initial or continuous medical training system for CHNs for Ministry of Health bodies at the county level consider over five years since decentralization. themselves to be in charge of the planning coordination, We recommend that the government consider taking the monitoring, and evaluation of community-based healthcare following priority actions to improve the quality of the basic services. The local authorities have neither the knowledge health services delivered by the community healthcare nor the capacity to do this, and the County Directorates for workers (CHNs and RHMs): Public Health do not have enough staff for this purpose. • As a result, for the time being at least, the community R  evising, updating, and endorsing the tasks and healthcare network is in a vacuum, with no adequate job descriptions of community health workers, professional guidance, methodological support or control, implementing a standardized system for planning, and no legal provisions to ensure the sustainability of reporting, monitoring, and supervising the community funding for its operational expenses, other than salaries. health workers’ quality of work, and periodically Because of an error that has not been remedied over assessing results vis-a-vis the planned targets. the past five years, no legal document specifies who is • responsible for funding community healthcare activities or  eriodically training and retraining community health P from what source, and local authorities find it impossible workers, carrying out regular assessments of training to cover the related expenses of the network (such as needs, and developing short and practice-oriented medical kits, travel expenses to villages, and attendance by training sessions. community health workers at training meetings organized • by the County Directorates for Public Health in the county E  nhancing the role and the capacity of the County capitals). At present, there are cases in which the family Directorates for Public Health to provide professional physician (formally or informally) hires the community support and supervision to community health nurse to make house calls or to work in the physician’s workers. medical office. Thus, the state ends up paying twice for • the same service, once by paying the CHN’s salary and D  eveloping a standardized process of planning and twice by reimbursing the family physician for the services of periodic assessment and renewal of the basic provided, in fact, by the same community nurse. This is a Health | 249 SCHEME 8: Financial Flow of Community Healthcare Services (Community Nurses and Roma Health Mediators) TRANSFERS State Budget MoH Budget TRANSFERS TRANSFERS County Public Health Local Budget Directorare Budget Unspecified source Budget for community Salaries for community nurses health related activities and Roma health mediators simple example of the lack of coherence and control within mediators have generally been successful in increasing the health system. the knowledge of health care providers about Roma and in changing their negative attitudes. The mediators reported The cost-effectiveness of the national network of seeing less discriminatory behavior and less use of abusive community healthcare workers should be analyzed to language by the doctors with whom they worked. As a identify the most appropriate ways to respond to the needs result, the mediators felt that this had led to more effective of poor and vulnerable groups and to determine how much interactions between physicians and their Roma patients financing will be needed to integrate (primary) social and thus to better medical care. A later World Bank report services at the community level. For now, it is impossible to entitled Diagnostics and Policy Advice for Supporting tell whether community healthcare work is cost-effective Roma Inclusion in Romania395 emphasized that local health or not since there is no analysis or available data on its mediators can help to change the social norms that have interventions and outcomes. Anecdotally, its beneficiaries discouraged the uptake of health services by reducing generally declare that the CHNs and RHMs are a great the social stigma associated with accessing counseling help to them and their communities. A 2011 regional services, reproductive health services, and tests for sexually qualitative review of Roma health mediators394 showed that transmitted infections. 394 Open Society Foundation (2011). 395 World Bank (Anan et al, 2014). 250 | PEOPLE-BASED POLICIES BOX 41 The Positive Impact of the Community Nurses When the family doctor considers that it is Network in Botosani County a problem that needs a specialist, he or she sends the woman to the gynecologist. The “The impact [of the community nurses network] is community nurse facilitates the process and highly visible in the steep decrease in infant mortality. offers continued support to the pregnant woman in This is one of these indicators with a positive trend this situation, and this is how we had a drop in infant precisely because of the work of the community nurses. mortality... Also, cases of teenage mothers abandoning They manage the register of pregnant women, they go their children have dropped considerably from 33 to them and explain to them the importance of going to abandoned children in 2009 to only two cases in 2013.” hospital and of regular consultations, and therefore the pregnant women are constantly monitored and informed Source: Interview with Inspector in the Department for about the possible risks. Sometimes the pregnancy Medical Care for Disadvantaged Communities, County itself is at risk and therefore needs more intense Directorate for Public Health Botosani, Qualitative study monitoring by the family doctor and the gynecologist. under this background study, July 2014. The Relation between Infant Mortality, the Birth Rate , and the Network of Community Nurses 25 20 Infant mortality (per 1,000 live 15 births) 10 Birth rate (per 1,000 inhabitants) 5 0 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 120 100 Number of 80 Community Health Nurses (CHNs) 60 Number of 40 localities with 20 CHNs 0 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Source: Data on CHNs reported by the County Directorate for Public Health, Botosani. Rates of births and infant mortality from the National Institute of Statistic, Tempo Online database. Note: The birth rate is the number of births per 1,000 individuals per year. Health | 251 The qualitative research conducted for our background (almost 5 percent of all localities) are “white spots” in study in July 2014 yielded some additional evidence of the terms of the absence of community-based and primary positive effects of community healthcare workers. Botosani healthcare services, while the others have only a pharmacy. county is one of the few counties that had an adequate The “white spots” are all rural localities and are spread supply of community nurses before decentralization that throughout the country (with the exception of four counties, has succeeded in maintaining this network since 2009. namely Arges, Braila, Dolj, and Gorj), with a higher Especially in the rural areas of the county, community prevalence in Buzau, Ialomita, Caras-Severin, Vrancea, nurses have had a substantial positive impact on the decline and Hunedoara. Most “white spots” are small communes of infant mortality from about 25 infant deaths per 1,000 with fewer than 2,000 inhabitants (which are also likely to live births in 2002 to fewer than 14 per 1,000 live births in lack social workers, see Section 2.3), with a generally low 2013. The MoH recently announced an initiative to extend level of human development,398 in a municipality with low the community healthcare and health mediation network, fiscal capacity,399 and with a relatively low number of (self- but it is difficult to know whether this will be enough to identified) Roma. Map 4 indicates that the “white spots” achieve the ministry’s declared goal of increasing the are more likely to be found near the borders of counties. access of poor or vulnerable people to health services in the The explanation for this may be that it is not the distance to absence of other measures to address the other problems any city that influences the availability of health services faced by the network. at local level but the closeness to the administrative center of the counties. Health professionals may be more inclined At the national level, an insufficient number of localities to search for jobs in localities close to their county centers benefit from the services of a community health nurse. for both economic (in general, incomes are higher in such According to Ministry of Health data, at the beginning of cities) and career development reasons. However, both 2014 there were almost 1,000 CHNs nationwide,396 of in rural and urban localities, most communities tend to whom only 18 were employed by the local authorities. have one or more family physicians along with one or In the previous year, these CHNs provided community more pharmacies. About 10 percent of all localities may health services to nearly 1 million people, including about be considered “champions” because they have family 250,000 children. With regard to the health mediators physicians, pharmacies, and community healthcare for Roma communities, Ministry of Health data indicate workers. These “champions” are located in all counties, that, in 2013, the 447 RHMs facilitated access to health particularly in cities400 but also in larger communes where services for approximately 200,000 Roma. However, there is a generally high level of human development there is no systematic data collection process to monitor (according to the Local Human Development Index), where the community health workers network, and therefore the municipality has relatively high fiscal capacity and no reliable data are available to be analyzed regarding where there are higher numbers of (self-identified) Roma. the types of services offered, the characteristics of the They also tend to have a Public Social Assistance Service beneficiaries, or medical outcomes. with more staff and financial resources. In conclusion, there Nevertheless, it was possible to do a mapping exercise is a polarization in terms of service delivery between small using official data collected from the websites of the and poor rural communities, which lack all types of social National and County Health Insurance Houses regarding services, and larger and better developed rural communities the availability of family doctors, GPs, pharmacies, and cities, which have succeeded in developing more and community health nurses, and/or Roma health mediators more diversified services at the local level. Consequently, within each locality between September and November the extension of the national network of community health of 2014.397 The exercise showed that over 6 percent of workers should start as a matter of priority in the “white all localities have no family physicians, no community spots” and in those communes with no permanent family nurses, and no Roma health mediators. Most of them doctor’s practice. 396 The total yearly salary costs to the Ministry of Health of these activities can be roughly estimated at around RON 20 million as the average annual salary of a community health worker is approximately RON 20,000. 397 Data for four counties - Calarasi, Giurgiu, Mehedinti, and Timis - became available too late to be included in this analysis. Ministry of Health data collected in July 2014 regarding the Roma health mediators who were contracted in 2013 overlapped with data from the census of the Public Social Assistance Services carried by the World Bank in 2014. 398 Estimated against the Local Human Development Index (LHDI), which measures the total capital of rural and urban administrative units in Romania, looking at four criteria: human capital, health capital, vital capital, and material capital (Ionescu-Heroiu et al, 2013a). Human capital is measured based on the indicator of education stock at local level (for population aged 10 and over). Health capital is measured as life expectancy at birth at local level. Vital capital is measured using the indicator of mean age of the adult population (those aged 18 or over). Finally, material capital is assessed as a factor score of three specific indicators that focus on living standards: dwelling space, private cars to 1,000 residents, and distribution of gas for household consumption in the particular territorial unit. The aggregation of the four measures of the dimensions of community capital is achieved by another factor score. 399 First quartile of the variable: share of own revenues in total revenues at the local budget, average annual value for 2009-2012. 400 The rate of “champions” is 36 percent among urban municipalities and only 6 percent among the rural ones. 252 | PEOPLE-BASED POLICIES MAP 4: Coverage of Community-based and Primary Healthcare Services Primary and Community-Based Healthcare Services Legend State border Development region County Administrative-territorial base unit Missing data White spots: lack any healthcare services Partially endowed: but lack both GP and CHN/RHM Partially endowed: but have either GP or CHN/RHM Dominant pattern: GP and pharmacy 30 15 0 30 60 90 km Champions: fully endowed Health | 253 2 PEOPLE-BASED POLICIES 2.6. Housing The government should aim to increase access to housing services, particularly for the homeless and other people who cannot afford accommodation. Main Objectives Housing 2.6.  256 2.6.1. Increasing the Affordability and Improving the Quality of Housing, Especially for the Vulnerable Population 256 2.6.2. Developing Social Housing Services 262 2.6.3. Ensuring Efficient Emergency Support for the Homeless while Building Capacity for Social Reintegration and Early Prevention 267 256 | PEOPLE-BASED POLICIES 2.6. Housing Housing deprivation and homelessness are extreme forms occupancy) and to the market. In time, the housing sector of poverty and social exclusion in today’s society. Access disappeared from ministerial names as well as from the to adequate and affordable housing is a fundamental right, organizational charts of ministries. Data on housing from the and it represents the cornerstone upon which safe, healthy, censuses had never been coherently or deeply analyzed403 and productive lives can be planned. For people in extreme and were almost never used for the justification and/or poverty, food and housing represent their most basic needs, design of housing policies. which consume an inordinate proportion of their financial As a result, the programs addressing various housing resources to the detriment of other aspects of their lives related problems were not very coherent or integrated. In such as health or access to education. The incapacity to addition, responsibility for social housing was decentralized procure or to sustain decent housing leads, in itself, to other to local authorities as social housing has always been vulnerabilities, cutting the destitute off from the normal considered a local interest and responsibility, even though cycle of development. it was known that the housing stock still in municipal At the European level, the recent economic crisis has hands was either insufficient or/and in a bad state. Given heightened concerns about housing affordability, especially that many cities and the majority of rural settlements had for the worst-off social groups. According to the European shrinking or collapsing economies, local budgets have been Commission (2010b), increasing access to housing is totally insufficient to support any housing investments. As a key to achieving the Europe 2020 strategy of decreasing result, sizeable discrepancies in the condition of the housing the number of people in - or at risk of - poverty or social stock emerged between the different regions of the country, exclusion. Actually, since 2007, social housing has been especially between urban and rural areas but also between recognized as a social service of general interest,401 suitable municipalities of the same size and/or type. for state aid, which broadens the scope of opportunities for 2.6.1. Increasing the policymakers. In Romania, guaranteeing the right to affordable accommodation still represents a significant challenge. Appropriate policy responses and budgetary allocations Affordability and in the area of social housing are very limited, while Improving the Quality many vulnerable groups in extreme poverty, such as the homeless and people living in illegal settlements, in of Housing, Especially marginalized areas, or in inadequate dwelling conditions, are insufficiently covered by the existing housing support for the Vulnerable programs. Population The main evolutions402 in the housing field after 1990 have largely been outside the control of the government. At the national level, a legal and institutional framework404 Thus, most development has been left to private initiatives for the housing sector exists, but the government has never (based, among others, on the argument in favor of owner- developed either a policy or a strategy for the sector. Also, 401 Huber et al (2007). 402 During the 1990 to 1999 period, there was only limited housing construction, mainly in certain (more wealthy) rural areas. In the same period, the de-industrialization of the economy led, in the housing area, to the decay or abandon of “bachelor hostels/blocks of one-room flats” (camine de nefamilisti / blocuri de garsoniere). Also, the increasing rates of migration for work abroad seriously affected the construction sector as many professionals and skilled workers left Romania. The period of economic growth (2000 to 2008) was the golden period of larger housing schemes, particularly in large cities, as well as expansions and sprawl generated by green field housing developments in nearly all cities. This was also the pre-EU- accession period of SAPARD programs for increasing water and sewage access in small towns and rural areas, including the rehabilitation of distribution networks. The post-accession period, after 2007 and up to 2009 (the beginning of the global crisis), was marked by an increase in housing construction and improvements, fueled particularly by the remittances sent home by the migrants working abroad. After 2009, many construction projects were put on hold with some real estate investors disappearing before the completion of the work, a slow- down in construction, and decreases in housing high prices. 403 Except for describing general housing conditions in the otherwise meritorious studies done by various research institutes. 404 For example, Law 50/1991 allowing leases on municipal land for housing construction, the massive privatization of the state-owned housing stock between 1991 and 1993, Law 10/2001 related to real estate, particularly housing, nationalized between 1945 and 1989 (involving many evictions with unhappy consequences), the Housing Act (Law 114/1996), the creation of the National Housing Agency (with only a limited effect on housing conditions), and Law 190/2013 on Regional and Urban Planning (which had a few moderately successful outcomes). Housing | 257 as shown in section 2.3, Romania’s public spending on funds devoted to housing construction dropped steeply in social housing has constantly been very low compared the early 1990s and have remained at extremely low levels with other European countries.405 More generally, public ever since (Figure 42). FIGURE 42: Total Public Expenditure on Health as a Percentage of GDP/Total Public Expenditure in Romania and in the EU-27 70000 61171 60000 50000 42820 41547 40000 26744 30000 20000 5779 10000 1520 2040 0 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 Dwellings finished during the current year - Total Public Funds Dwellings finished during the current year - Total Private Funds Source: World Bank calculations using data from the European HFA Database, WHO/Europe, November 2014 Romania ranks first among EU countries in terms of private living with their parents. According to Eurostat, almost two- ownership of housing stock - 97 percent compared with thirds of young people (aged 18 to 34) and 45 percent of an EU-28 average of 70.4 percent in 2012 (Annex Table youths in full-time employment still live with their parents 8.1). This appears to be a comparative advantage in terms (Annex Table 8.2). The lack of housing may be one of the of dwelling security,406 but it also has some drawbacks. factors influencing young people to postpone major family For example, owners often struggle to afford to maintain decisions such as getting married or giving birth. The their properties, there is little accommodation available difficulties faced by the young in establishing their own for those seeking new employment opportunities in a households coupled with the economic and/or physical new area, and there is only a limited supply of affordable dependency of some of the elderly has led to many large housing to rent or buy for the younger generation. The overcrowded households in Romania. More than half of the combination of a lack of affordable housing, the scarcity of population lives in overcrowded dwellings,408 which is the economic opportunities to enable young people to be able highest percentage among all of the European countries to afford independent housing, and a Romanian culture and is three times higher than the EU-28 average (16.8 that encourages young people to continue to live with their percent). Overcrowding is even more acute among the parents407 has resulted in a high share of young people poor population. The 2012 Household Budget Survey (NIS) 405 In 2011, social housing services were allocated 2.66 PPS per inhabitant in Romania compared with an EU-28 average of over 145 PPS per inhabitant. 406 According to the 2011/2012 European Quality of Life Survey, a total of 90.8 percent of Romanians stated that it was very unlikely that they would consider leaving their accommodation in the next six months as a result of it becoming unaffordable compared with 81.5 percent of Europeans on average. 407 Particularly in rural areas, this is aimed at keeping multiple generations of a family within the same house to maximize the household’s agricultural production and to take advantage of intergeneration support for bringing up children and carrying out domestic work. 408 Defined as those that do not meet the following standards: at least one room for each single person aged 18 or for a pair of single people of the same gender between 12 and 17 years of age and/or one room per pair of children under 12 years of age. 258 | PEOPLE-BASED POLICIES data indicate that the number of people per room varies results in a high share of indebtedness among the low- from 0.73 in households in the highest income decile to income population of those areas. Furthermore, the housing 1.44 among those in the lowest income decile, as shown in cost overburden rate is substantially higher among people Annex Table 8.3.409 In the same time, the available space at risk of poverty (41.4 percent compared with the national in the dwelling decreases from an average of 29.4 square rate of 16.5 percent). The 2012 Household Budget Survey meters per person for better-off households to less than 15 (NIS) data show that the situation is critical, especially for for the poorest (Annex Table 8.4). poor people in urban areas (see Figure 44). Thus, the costs of utilities (electricity, thermal energy, gas, firewood/coal/ The quality of housing stock is rather weak. Besides petroleum, water, and sanitation) account on average for overcrowding, severe housing deprivation affects 23 more than 52 percent of the total monthly expenditures percent of the Romanian population, four times more than of households in the lowest income decile in urban areas the EU-27 average (Figure 43). Although the situation compared with 20 percent of the expenditures of better- improved after 2007 (Annex Table 8.5), severe housing off urban residents.411 Specifically, Eurostat figures for deprivation has remained consistently acute for the poor 2012 show that more than one-quarter of Romania’s total (49 percent) and for households containing children (37 population and one-third of households with children were percent of children). in arrears with their utility payments for the previous year Given the high share of the population living in rural areas, compared with an EU-28 average of about 10 percent.412 the most severe deprivation is apparent in the area of The Roma population is generally excluded from the housing sanitary facilities with 35 percent of people living without market, as was documented in a recent World Bank study:413 an indoor bath or shower and 37 percent living without an indoor flushing toilet for the sole use of that household (Annex Table 8.6). According to the 2011 Census, out of the 8.72 million dwellings in Romania, 3.96 million are • M  ost Romanian Roma live in segregated communities. The Regional Roma Survey (RRS) found that 56 percent of Roma households live in located in rural areas and 4.76 million in urban settlements. settlements where the dominant ethnicity is Roma, In rural areas, most dwellings are individual houses (3.81 indicating a high level of spatial segregation. Spatial million) consisting of two to three rooms that were built segregation is highly correlated with lower health before 1970 of poor quality materials (abode or framework) status, early school-leaving, low labor market and that lack hot running water, indoor baths or showers, attachment, and costly access to other services (such and a connection to the sewage system. In urban areas, as public transport and health facilities). most dwellings are apartments in blocks (3.22 million) or individual houses consisting of two to three that were built between 1960 and 1990 with reinforced concrete or were prefabricated units and that are connected to utilities. Thus, • A  significant proportion of Roma live in poor quality houses with inadequate infrastructure, overcrowding, and a lack of secure tenure. The housing conditions of the housing stock is obsolete, and only one in four houses Roma households are consistently worse than those complies with current seismic standards. of non-Roma households. The RRS data show that Housing affordability is also problematic, although almost 30 percent of Roma households live in a dilapidated the entire population lives in owner-occupied dwellings house or slum compared with only 4 percent of non- with no loan or mortgage. In 2012, Romania was one of Roma households living nearby. Only about half of the countries in Europe with the highest housing cost the Roma households in urban areas have access overburden rate (the percentage of the population living to housing of relatively good quality such as newly in households where total housing costs represent more constructed housing, dwellings made of traditional than 40 percent of disposable income).410 Utilities costs are materials in older settlements, or social housing considerably higher in some localities than in others, which provided by the local authorities. 409 Income deciles based on the total monthly household per capita cash income (without self-consumption). 410 This measure is crucial for keeping track of the risk of homelessness. According to Eurostat, the proportion of the population living in households where housing costs exceeding 40 percent of their disposable income was the highest in Greece (33.1 percent), followed by Denmark (18.2 percent), Germany (16.6 percent), Romania (16.5 percent), and Bulgaria (14.5 percent). For comparison, the EU-28 average was 11.2 percent, while much lower values were found in Malta (2.6 percent), Cyprus (3.3 percent), Finland (4.5 percent), Luxembourg (4.9 percent), and France and Slovenia (both 5.2 percent). 411 However, in absolute values, the poor households (D1) from urban areas spend a monthly average of 225 lei on their utility bills, while the better-off households (D10) pay about 500 lei. 412 Other types of arrears, such as rent and mortgages, are less common among Romanians. 413 World Bank (Anan et al, 2014) using data from the Regional Roma Survey undertaken in Europe by UNDP, the World Bank, and the European Commission in 2011. Housing | 259 FIGURE 43: Severe Housing Deprivation by Poverty Risk and Age (Children), 2012 (%) 70 64 60 49 50 40 37 30 23 18 20 13 8 10 5 0 Romania EU-27 Romania EU-27 Romania EU-27 Romania EU-27 Total population Population at risk Children Children at risk of poverty of poverty Source: Eurostat. Note: The poverty threshold is set at 60 percent of disposable income per equivalent adult. FIGURE 44: Costs of Utilities as Percent of Total Household Monthly Expenditures by Income Deciles, 2012 (%) 60 50 40 Total 30 Urban 20 Rural 10 0 D1 D2 D3 D4 D5 D6 D7 D8 D9 D10 Income deciles Source: World Bank calculations using data from 2012 HBS. Notes: Utilities refer to electricity, thermal energy, gas, firewood/coal/petroleum, water, and sanitation. Income deciles are based on total monthly household per capita cash income (without self-consumption). The figure shows the average values per decile. 260 | PEOPLE-BASED POLICIES The remaining 40 to 45 percent live in low-quality years after the privatization process. The restructuring multi-story blocks or slums or in temporary camps of the economy after 1990, which mainly involved de- with poor-quality structures and inadequate industrialization, widened the income gaps between flat- infrastructure, while only 20 percent of the owners. In many cases, families that had recently arrived neighboring non-Roma live in such poor conditions. In in town decided to move back to their rural municipalities, rural areas, about one-third of Roma households live but often they decided to retain their urban apartment. The in poor quality housing. new laws regulating businesses made it possible for them • to convert their urban flats into business premises. Not only  large number of Roma households lack access A did this lead to co-management problems in the buildings to water and sanitation. Only about 17 percent of themselves, but it also diminished the size of housing stock Roma households have indoor sanitation (a toilet, a and put upward pressure on prices (as firms were more bathroom, and a sewage connection), while about willing to pay higher rents than families in need of housing). 44 percent of nearby non-Roma families have One of the consequences of the low costs involved in these amenities. Similarly, only about 17 percent buying apartments in collective housing was that some of Roma households have access to drinking water new owners tended to be careless about the maintenance indoors compared with 34 percent of their non-Roma of their recently acquired property, either because of the neighbors. About 36 percent of Roma households small amount they paid for it414 or because they simply report that there is no or only collection of waste in lacked the resources to do so. Somehow pre-1989 attitudes their area compared with 18 percent of their non- were perpetuated, with the new owners continuing to invest Roma neighbors. only in the interior of their flats - upgrading, remodeling, • changing fixtures (such as windows and sanitary fixtures),  any Roma still lack identity documents, which M and general maintenance - but neglecting to maintain the has further restricted their access to services and communal spaces (such as staircases or elevators) and the credit. One major hurdle has been the need to show exteriors of buildings.415 There was (and still is) a chronic proof of residence, which many Roma lack because lack of interest from owners in the state and quality of of their informal housing situations. Other barriers hidden fixtures such as water and sewage distribution pipes include their lack of literacy as well as discriminatory within the building, which has caused this infrastructure to attitudes among the personnel in charge of issuing deteriorate. Although analysts have issued warnings about the documents. the gravity of these problems, policymakers have yet to The massive privatization of the housing stock between come up with any coherent policies or programs to address 1991 and 1993 was probably the most important action them.416 affecting housing and the housing market. Justified by A number of housing programs have been developed and policymakers as politically and socially necessary, the implemented with the aim of increasing the affordability and privatization was achieved by offering previously public improving the quality of housing. However, most of them housing for sale at very low prices, allowing virtually are concentrated in urban areas where housing demand all occupants (who had previously been renting their is higher and severe social problems have emerged in the apartments from the state) to buy their homes. The last few decades. In rural areas, the persistent housing overwhelming majority of privatized housing stock deprivation and severe material deprivation (energy consisted of apartments in collective housing units of all poverty) have not yet been addressed by specific policies. types and quality, and the new owners bought one part of The most important program in terms of the number of the collective housing building, with the rest of the property public sector housing units has been the Youth Housing becoming part of the private domain of the local public Program administered by the National Housing Agency property. The regulations concerning the co-ownership (NHA). The program constructs rental housing for youths of collective housing (condominiums) were adopted only 414 The gap between the “appetite for the status of owner” and the “responsibilities generated by this status” has been characterized as a kind of “divorce.” The ownership of the dwelling (flat or house) became, after this massive privatization, a must-have “social norm” (Voicu and Noica, 1999). 415 The negligent attitude of property owners towards leaking roof terraces is typical. They are seen as only a problem for those on the upper floors. This will be the case at least until clear regulations have been established governing co-ownership of buildings. 416 It was recently reported in the media that “inner building piping improvements” might become eligible for co-financing from EU money in the 2014-2020 period, together with thermo- insulation works, which are already eligible. Housing | 261 and young professionals. Since its inception in 2001, the units for resident doctors who cannot afford to rent or to program has built 31,244 dwellings in about 195 cities privately own a house (even under the Youth Housing across the country. The program targets young people Program) has so far built 534 units in Bucharest, Cluj who cannot otherwise afford to buy an apartment or to Napoca, Iasi, Sibiu, Falticeni, Timisoara, and Radauti. The rent a privately owned housing unit. If the local authority program Rebirth of the Romanian Village (GD 151/2010) has evidence of demand for accommodation from people aims to build service housing units for young specialists in displaced by restitution (from nationalized houses), 20 communes.419 Also, 70 urban municipalities have a total percent of the units built under the Youth Housing Program of about 800 service housing units available for young may be assigned as social housing. This is relatively good specialists. Another program aims to provide temporary quality housing and is considered to be much better than leases of necessity housing units (similar to social housing) the average housing stock in Romania. The rents are to people and families whose dwellings have become typically a small fraction of the market rent, which may be unusable.420 However, necessity dwellings are very incrementally increased to a maximum of 70 percent of the rare in rural areas,421 while in urban areas only 46 local market price for tenants older than 35 years old. Thus, in municipalities have a total stock of approximately 1,000 terms of subsidies, the Youth Housing Program resembles such units. Law 15/2003 regulates the awarding of land the social housing program but with very different targeting. plots422 from territorial-administrative units done by local According to Law 152/2011, the Youth Housing units authorities to young people aged between 18 and 35 years may now be sold417 to the holders of those contracts with old to construct houses. However, data on these land an average income per family member that does not plots allocations are available only for urban areas. Out of exceed the national average upon their request and after a all urban municipalities, 152 allocated more than 11,500 minimum of one year of continuous rental, notwithstanding land plots to young people. In an attempt to use housing the applicant’s age. Local authorities appear inclined to sell to reduce social marginalization, Law 116/2002 stipulates these houses, mainly because the rents are too low to cover that county councils may raise funds in order to facilitate the maintenance costs. Nevertheless, at the national level, access to housing for young people aged up to 35 who fewer than 3 percent (about 900 units) have been sold so cannot afford to buy a dwelling on their own. The specific far. This is because some tenants have incomes higher than access criteria can be set by the county councils, but their the national average (so are not eligible to buy the units), priority must clearly be young people from placement while other tenants cannot afford even the subsidized centers and orphanages, individuals aged under 35 years sale price. Also, the very low rents for these units and the old with children, individuals aged under 35 years old with absence of any cap on the total number of years during no children, and all other individuals under 35 years old. which they can be rented means that many prospering No data are available on the amounts that county budgets tenants prefer not to move out, even though their units could currently allocate to this program. Also, no evaluations of be allocated to a lower-income or younger tenant. any these housing programs are yet available. Other government housing programs are small or very The government has also introduced some housing finance small-scale. The government-supported mortgage- initiatives (for example, Prima Casa program and subsidies financed housing units are designed for Romanian citizens for savings products) and various programs for housing who can take out a mortgage from a bank to pay for the and related infrastructure, such as heating subsidies, tax construction of his or her housing unit, while the National incentives, mass thermal insulation of collective housing Housing Agency is responsible for acquiring serviced land units (GEO 18/2009), the Green House program, and from local authorities for free.418 A program of housing seismic retrofitting (GO 20/1994). 417 The selling value of the unit is established by the local public administration authorities (or the central authorities in the case of young specialists in education and health) according to GO 2401/2013. 418 Between 2000 and 2014, 3,200 housing units were completed in 16 counties and in Bucharest. Almost half of the units (1,589) were built in Bucharest. 419 This is funded from the state budget and is targeted to public sector employees working in rural areas, including teachers, doctors, nurses, and police officers. These are two or three room houses, not exceeding 100 square meters and 120 square meters respectively, on land plots of 500 square meters. A maximum of 10 to 15 houses can be built per commune. Priority is given to applicants who are under 35 years old. Public workers can rent the units only during the duration of their job contract in the respective locality. 420 Necessity housing units are financed and built under the same conditions as the social housing. The necessity housing units can be used as social housing units if they are free, or the social housing units can be used as necessity housing in cases of emergency. 421 In 2005, a special program managed by the NHA was made available to people affected by floods. Under this program 1,617 houses have been rebuilt and 16,076 households have been provided with building materials to renovate their own dwellings. 422 The size range of the land plot varies by location: 150 to 300 square meters in the cities and districts of Bucharest, 250 to 400 square meters in cities, and 250 to 1,000 square meters in communes and villages. 262 | PEOPLE-BASED POLICIES These programs are analyzed in Inputs for the National for the homeless. Under the same law, the social housing Housing Strategy recently prepared by the World Bank construction program (administered by the MRDPA) began for the Ministry of Regional Development and Public in 1997 and is funded from both the state and local budgets. Administration.423 Under this program, local authorities are responsible for building new dwellings or refurbishing old buildings to use As a conclusion, all existing programs that aim to as social housing. rehabilitate and modernize the housing and utility stock should be redesigned to be targeted more to the poor and The social housing sector is severely underfinanced in vulnerable. In addition, all programs designed to increase Romania compared with other EU member states (see energy efficiency need to be targeted to low-income Section 2.3.1 on financing social services). The social households and to protect vulnerable consumers (should housing stock is under the control and responsibility of the compensate low-income households for a share of the costs local councils located in the territorial-administrative units. of making their homes energy-efficient in proportion to their According to the 2011 census, at the national level, only financial constraints and energy needs). 122,538 dwellings are state-owned (or 1.4 percent of the total housing stock), out of which only a small proportion is 2.6.2. Developing used as social housing. Of these, 26,156 (21.3 percent) are in rural areas and 96,382 in urban areas. The construction Social Housing Services of new social housing units has also been very slow. In 2012 and 2013, only around 200 social houses were completed for people displaced by restitution from nationalized houses A European Parliament resolution of June 11, 2013 on social (GD 74/2007) in 26 localities (in 2012) and 23 localities (in housing in the European Union (2012/2293(INI)) ”reminds 2013). During the same period, the number of social houses the Commission, the Member States, and local and regional available for other types of eligible beneficiaries (according authorities that spending on social and affordable housing to Law 114/1996) has also fluctuated around 200 units per is in keeping with fundamental rights, enables urgent social year, much lower than the 2,000 units per year that built on needs to be met, and, as a strategic social investment, average in the period between 1998 and 2007. helps in a sustainable way to provide local jobs that cannot be off-shored, stabilize the economy by reducing the risk The scarcity of available social housing has constantly been of property bubbles and household over-indebtedness, a general problem after 1990.425 Local public authorities promote labor mobility, counter climate change, combat own and manage housing stock to be rented to the poorest energy poverty, and alleviate health problems stemming population, but this fund is not “social housing” as it does from overcrowding and poor living conditions; insists, not comply with the legal requirements. Most often this therefore, that social housing should not be considered a stock includes nationalized or low-quality houses that have cost to be cut but an investment that pays off in the long been neglected in the past few years and are located in term through better health and social wellbeing, access unattractive, difficult to access, and poorly endowed urban to the labor market, and the empowerment of people, areas, with a low market price. especially the aged, to live independent lives.” In October 2014 as part of the preparation of this There is a lack of a commonly accepted definition of social background study, the World Bank in collaboration housing at the European level. In Romania, social housing with the Ministry of Regional Development and Public is defined under the Housing Law 114/1996424 as a dwelling Administration (MRDPA) conducted a Situation of Social that is allocated by a public authority for a small rent Housing (SSH)426 survey in all urban municipalities.427 The (subvention) to individuals or families who cannot otherwise SSH showed that about 28,000 to 29,000 state-owned afford to buy or rent a house from the free housing market. dwellings are officially registered as social housing units, This definition of social housing does not include housing of which 19,000 to 20,000 are in apartment blocks and services for vulnerable groups such as shelters or refuges 8,000 to 9,000 are in other types of buildings. These units are not evenly distributed among cities - 131 have no social 423 World Bank (2015a). 424 Currently, the MRDPA in collaboration with the MLFSPE is drafting amendments to this law. 425 Constantinescu and Dan (2005). 426 The SSH survey was also part of the preparation of the National Housing Strategy (World Bank, 2015a). 427 Out of all 319 urban municipalities and six sectors of Bucharest, 19 urban municipalities and three sectors did not respond to the survey. See more details in Annex 8 Section II. Housing | 263 housing units at all,428 while the others have anything from these standards do not apply to older buildings. The one to 2,500 units (Annex Figure 8. 1). What is clear is Situation of Social Housing (SSH) survey confirms that, that the supply of social housing is much lower than the in 2014, most social housing units consist of apartments demand. The number of applications received by urban of one or two rooms covering 10 to 37 square meters and mayoralties exceeds 67,000, while the local authorities are lived in by numerous families (Annex Figure 8.4). estimate that the need amounts to 55,000 to 60,000 Common spaces tend to be obsolete, damaged, and/or units (Annex Figure 8.2) Local authorities have a manifest dirty, and services such as electricity, sewerage, and water interest in expanding the existing stock of social housing supply are either missing or have been disconnected due to in response to mounting local demand, but the resources payment arrears. Massive overcrowding leads to a serious available to do so are minimal, both financially and in terms pressure on the apartment blocks, which are not technically of vacant lands and buildings. designed to support such a large number of users. As most infrastructure is old and broken, the basements of these To qualify for social housing, households must have earned blocks are usually flooded with water and dirt. As a result, an average net monthly income per person in the previous the walls and roof are eroded and full of damp, which puts 12 months that was less than €380 (the national average the residents’ health at risk. Some of these areas of social monthly net income).429 As this national average monthly housing are at risk of becoming - or have already turned into net income tends to be about the 90th percentile of the - pockets of poverty (especially ghettos), with inadequate total population, most households in Romania are income- housing conditions and general unemployment. Local eligible for social housing. In addition, the eligibility criteria authorities typically act simply as the financial managers include other broad categories of the population, including of the buildings, and existing social housing programs are people evicted from restituted nationalized houses, married not designed to include any incentives to encourage or people under 35 years of age, youths leaving the child require tenants to participate in the active labor market or in protection system, disabled people, war veterans and education or to access other social services. widowers, and victims of the communist regime and the revolution, according to the laws regulating their rights The financial management of the social houses is (118/1990 and 341/2004). Under these conditions, many complicated by these units often have high levels of local authorities grant priority access to social housing to accumulated arrears on rent and especially public utility families with a small number of children and with sufficient payments. The latter often leads to whole buildings income to pay the utilities (Annex Figure 8.3). The result is being disconnected when they do not have individual that the poorest families and those with a large number of consumption meters for each unit. The rent charged by children (especially Roma) are often excluded from social the local authority cannot exceed 10 percent of the income housing. Actually, the SSH shows that considering all of the occupants, with the difference up to the nominal types of social housing the total occupancy rate is about 97 value of the rent being subsidized from the local budget. percent, of which only 57 percent are rented to low-income Since the residents are typically poor, this level of rent families while the other 40 percent are let to other people. may not even cover the maintenance costs, which makes Nonetheless, local public authorities allocate social housing social housing a major drain on local finances. In the case units according to a list of criteria that they set annually.430 of social housing, the local authority’s accounting system The qualitative study carried out for this background study attributes arrears in rent to the unit rather than to the renter, analyzed several local council decisions and found that which means that any overdue debt is passed to the next poor families with children are in fact given priority access tenant. The system of cancelling overdue debts that could to dwellings with a subsidized rent but less to those that not be recuperated is administratively difficult (as it would comply to social housing standards. require the local council to create a regulation, which means that many new social housing tenants are considered The low quality of the social housing stock is another major liable for the arrears associated with their new home. problem. Although Law 114/1996 stipulates minimum For more detail, see Box 42. technical standards for newly built social housing units, 428 Nonetheless, 34 of these cities have state-owned dwellings rented to low-income households that are not officially registered as social housing units. 429 If the average net monthly income per household surpasses the specified level by 20 percent for two consecutive fiscal years, the contract is terminated (Article 42 of Law 114/1996). 430 Each local authority sets its own criteria for allocating the social housing units under its management (Article 43 of Law 114/1996). Service housing and necessity housing are allocated according to the same criteria as social housing. The criteria cover: household composition, income level, current dwelling tenure, ratio of square meters per person in the current dwelling, length of application, special social or dwelling situations, and education levels. There are also requirements for eligibility established at the national level, for example, the family must not have ever owned another home. 264 | PEOPLE-BASED POLICIES BOX 42 Distorted System of Overdue Debts for Rent The Termination of Fiscal Obligations through in Social Housing Voluntary Payments: Order Rules For social housing beneficiaries from disadvantaged Some general rules apply to the termination communities, paying even a low monthly rent of 20 to of fiscal obligations through voluntary payments. 104 lei (about €4 to €23) can be too heavy a burden. When the debtor owes several types of taxes or other Historic debts are accruing fast, while the low levels fiscal obligations with different due dates and when the of residents’ monthly earnings are insufficient to cover amount actually paid does not cover all of the fiscal the basic necessities of daily life, not to mention to pay obligations due, the paid amount is distributed by off their own arrears and those of the previous tenants the fiscal authorities to terminate existing obligations of their housing unit. The local authority rules requiring according to the order established by law and presented old arrears to be carried forward to the existing tenants as follows in a simplified form: are causing severe hardship to already disadvantages residents of social housing. Under current Romanian legislation, interest and •  irst, all fiscal debts (principal, interest, and F penalties) included in the fiscal payment facility plan, as approved by the fiscal authorities penalties are calculated by the fiscal authorities for and due when the payment is performed, are any unpaid taxes owed to the state or local authorities. terminated. All other fiscal obligations whose The applicable rates are established by government payment is required as a precondition for ordinance or decision. The generic term “taxes” is used the continuation of the payment facility are terminated. • here to include other budget revenues, including rents payable for social housing facilities.  econd, all principal fiscal debts are terminated in S chronological order. • Late Payment Interest T  hird, interest and penalties are terminated in Interest is added to any unpaid tax owed to the state or chronological order as well. local authority from the next day that the payment of tax is due to the date of the actual payment. Late payment interest rates are currently set by government ordinance •  ourth, future fiscal obligations are included in the F payment facility plan. However, few members of disadvantaged communities but used to be regulated by government decision in the past. Currently, the interest rate for failing to pay a tax that are entitled to social housing services have the is 0.04 percent per day. The interest is assessed on the benefit of an approved fiscal payment facility plan. One unpaid amount of tax. of the reasons is that collateral is required by fiscal authorities in order to approve a payment facility plan, Penalty for Failure to Pay and beneficiaries of social housing services generally The late payment penalty applies to any portion of the cannot produce such collateral. tax owed to the state or local authority that is unpaid as Thus, most of the disadvantaged community members of the payment due date. Starting with the next day that find themselves in the second and third stages of rent the tax payment is due to the state, the central fiscal payment, namely they have accumulated unpaid authorities impose a failure-to-pay penalty of 0.02 rents or sometimes even inherited them from previous percent per day calculated on the unpaid amount of tax. tenants, and these historic debts have accrued late As an exception from the general rule that applies to payment interest and penalties. state budget taxes, the late payment penalty rate for The Unbreakable Debt Spiral overdue local taxes is 2 percent per month, which amounts to 0.06 percent per day or 0.07 percent per The debts spiral is unbreakable in such situations. The day depending on the number of days in each month. following hypothetic example illustrates the mechanism Late penalties are owed for every month or fraction of more clearly. A family from a disadvantaged community the month until the complete payment is made and are living in a social house rented from the mayoralty assessed on the unpaid amount of tax. consists of four members: two adults and two children. Housing | 265 BOX 42 (continued) The family’s total net average earnings (including all The total amount of debt accrued at the payment date types of available allowances) come to 600 lei per (January 26, 2013) is 943 lei, out of which: month. Their earnings are cashed in on the 25th of each month. •  80 lei represent unpaid rent for the last 12 7 months plus the current month rent The rent due for their social house is 60 lei per month and the rent due date is on the 10th of each month. Despite the fact that the family moved in only at the • •  62 lei represent accrued interest 101 lei represent accrued penalties.  beginning of the year (January 1st, 2013), they inherited The family’s current month’s earnings will barely cover from the previous tenants historic debts representing the interest accrued to date but, under the current the unpaid rent for the entire year of 2012 amounting to regulations will, in fact, be used to cover the rent due 12 863 lei, out of which: • months ago (January 10, 2012). No part of the current  20 lei represent unpaid rent for the previous 12 7 month’s rent, interest, and penalties are going to be months covered. The rest of the historic rent and the current • •  54 lei represent interest  89 lei represent penalties. month’s rent will continue to generate interest and penalties, and this mechanism will perpetuate the indebtedness spiral although the family will continue to First of all, the family has to pay the rent on the 10th and pay the rent due each month. only receive their social allowances on the 25th of each Possible Solutions month. They do not receive enough income to make any (a) The creation of more flexible fiscal arrangements for savings, so the family cannot pay the current month’s the most disadvantaged families, including reducing rent from their previous month earnings. Thus, from the the collateral requirements related to social housing 10th until the 26th (the day when they are able to make services a payment one day after their earnings are cashed in), namely for 16 days, interest and penalties accumulate both (b) The urgent settlement of the historic debts related on the historic debt and on the rent that is currently due. to social housing services and the abolition of the imposition of existing rent debts on new tenants. Paying utilities charges can be a considerable challenge that are taken back at the beginning of the spring. Baia Mare for the poor residents of social housing. Some local is also cited as best practice area because it has a very authorities have managed to develop systems that prove large complex that includes social services, an elementary to be sustainable while still helping people to cover their school, and a high school, thus facilitating access to monthly utility costs. For example, the Cuprom facility in education for all the children in the area. Baia Mare is fully endowed with utilities, which is very much Evicting tenants is the final step in the case of unsettled appreciated by its inhabitants (463 people in 135 families). arrears. According to the law, the term of the rental is five In this system, the residents receive their utilities for free in years, with the possibility of extension. However, cases their first three months of residency. In the following three have been reported where local authorities decide to months, they are required to pay make small payments (20 lease the social housing units for much shorter terms (as lei, respectively 30 lei, depending on the number of rented little as three months) to make it easier for them to evict rooms). Then, their bills are gradually raised every three renters who do not pay their rents or utility bills. To prevent months up to a limit of 100 lei per month for a one-room renters from building up overdue debts for social housing apartment and 120 lei per month for a two-room apartment, costs, some municipalities evacuate people to make them of which 50 lei represents the rent and 70 lei accounts for “responsible and accountable.” Thus, while the housing the running costs. Overdue debts are low, and nobody has department of mayoralty is just applying the law in evicting been evicted. In order to ensure heating during the winter, people with arrears, the public social assistance service the mayoralty provides the residents with portable radiators either is not being informed or does not intervene. It is 266 | PEOPLE-BASED POLICIES not clear where the evicted end up, and these vulnerable due to overdue rent or utilities, this volume proposes the people, including their children, live through a traumatic life introduction of the Minimum Social Insertion Income (MSII) event with no protection at all. In their cases, human and program, including a housing component targeted to the children’s rights are definitely not being observed by state most vulnerable people (especially families with children) institutions. Specifically to address the problem of evictions living in social housing. BOX 43 Main Problems Identified by the Local Public Authorities in Managing Social Housing • T  he poor quality of existing social housing stock. However, social housing units that respect the standards The public local authorities present at the Stakeholders’ imposed by the law imply high utility Meeting organized by the World Bank within the project costs that cannot be covered by the beneficiaries; Regulatory Impact Assessment (RIA) Framework in Romania, held in Bucharest on February 12, 2015 •  he problem of identity papers in the locality of T residence where the social housing is located; • identified the following problems in managing and developing the housing stock: L  ack of available land lots for the construction of • new social housing units; D  ecentralization of responsibilities, but not of financing; •  he need for clarifications of the definition and T • eligibility criteria for social housing. Special  he low income of tenants leads to (a) huge T attention to the criteria regarding previous overdue debts and (b) evictions, which both create ownership over a dwelling should be given for significant problems to local authorities; • special cases; T  he fact that social housing is not accompanied by other social assistance; • T  he definition of family to cover also consensual • unions.  he insufficient available housing stock T compared to the demand; With regard to the Roma population, the government because of the associated stigma and the risk of further operates a social housing program (GD 1237/2008) social excluding the Roma residents. that aims to build 301 housing units431 in line with the Various qualitative studies have highlighted the popular government’s strategy for improving conditions of the Roma resistance to extending social housing on the grounds that people.432 The government has assigned 10 million lei for its occupants are likely to be the less desirable elements of this project, but no housing unit has yet been completed. society, in particular the Roma who suffer prejudice in many As shown in the recent World Bank report Inputs for the different ways.434 Therefore, there are multiple political and National Housing Strategy,433 this is likely to be because financial disincentives that are preventing the government it has not been mandated by law and because no local and local authorities from building new social housing. The authority will willingly co-finance social housing specifically government should assess the need for social housing for the Roma when the demand for social housing for the for all vulnerable groups (including the homeless, post- general population is so high. In fact, it might not be a good institutionalized youths, ex-prisoners, victims of domestic idea to build social housing exclusively for the Roma, given violence, people evicted from restituted houses, and people the evidence of the poor maintenance of such buildings 431 The housing must meet the minimum standards stipulated in the Housing Law. The number of units/ rooms for each location has to be determined according to the number of applicants and the structure and size of their families. 432 The program targets 11 localities in the following counties: Arad (49 dwellings), Bihor (28 dwellings), Bistrita-Nasaud (21 dwellings), Brasov (21 dwellings), Constanta (49 dwellings), Iasi (49 dwellings), Mehedinti (28 dwellings), Olt (28 dwellings), and Sibiu (28 dwellings). 433 World Bank (2015). 434 World Bank (Anan et al, 2014). Housing | 267 with drug dependencies). It should then establish a clear national strategic framework for its housing policy involving • P  eople facing eviction as a result of rent and utility arrears. • inter-sectoral coordination and cooperation between the central and local authorities. The range of social housing  eople leaving hospitals and mental health and P instruments should be enhanced, and the government disability facilities. • should consider awarding housing allowances to those most in need. To this aim, financing for social housing  People leaving penitentiaries. • services should be increased. Victims of domestic violence. 2.6.3. Ensuring • Elderly people who are victims of property scams. Efficient Emergency • People with severe drug dependency. Support for the Homeless while •  he remaining occupants of formerly nationalized T houses returned to their former owners - special legal provisions437 have been created in order to facilitate Building Capacity for the allocation of social housing to this category of people, but the city halls lack the required housing Social Reintegration stock. and Early Prevention • Victims of human trafficking. No reliable recent assessment of the scope of homelessness in Romania has been done, even though some data are •  eople in illegal settlements and in improvised P houses. available from the 2011 Census and from previous studies.435 The capacity of shelters for the homeless seems to be The profile of the homeless that can be derived from the growing. Of all of the urban municipalities that participated Census is generally consistent with the findings of earlier in the Situation of Social Housing survey,438 63 reported research.436 The vast majority of homeless people are located having one to 10 shelters. In total, as of September 1, in urban areas (95 percent), 88 percent of them being 2014, 104 shelters for homeless people existed in urban concentrated in county towns and the capital city (one- areas, with a total of 2,525 places available. However, the third living in Bucharest). More than three-quarters of the qualitative research conducted for our background study homeless are men and active-age adults (three-quarters are suggests that they do not yet fully meet the existing needs. aged between 25 and 64 years old). Worryingly, more than Specialized shelters have become available in some areas, one in ten homeless people are children. for instance, for victims of domestic violence. Although Several groups of the population are at extreme risk shelters should be regarded as a transitional solution, many of homelessness or precarious housing unless early of them tend to become long-term accommodation for intervention housing measures are taken: their current residents, mainly because of the lack of social housing or alternative accommodation. As result, the “new” •  ouths leaving residential institutions – more social Y apartments and houses are being made available for these young people but the capacity at the local level homeless people have to rely on other types of low-value accommodation, such as privately managed, improvised, or insalubrious houses and hostels, or shared rent in extremely is still insufficient. low-value areas and marginalized communities. 435 Only 1,542 people were counted as homeless in the Census, whereas even the most optimistic previous estimates were at least three times higher (Ministry of Regional Development estimates based on figures reported by local authorities in 2008). Some estimates went as far as to suggest that there were as many as 10 times more homeless people living in Romania than the number recorded in the Census. 436 For example, Samusocial (2010), Paraschiv (2013). 437 Government Decision 74/2007. 438 World Bank and Ministry of Regional Development and Public Administration, October 2014. 268 | PEOPLE-BASED POLICIES In the years to come, the capacity for emergency and controlling illegal and improper settlements should interventions to house people living in the streets has to be developed and followed up with special programs increase in the following ways: (i) outreach services for the that help their residents to access to physical and social homeless have to improve in order to meet their basic needs infrastructure. Illegal evictions and evictions in the absence for food, water, and medical assistance; (ii) as the incomplete of any alternative accommodation should no longer be picture of the territorial distribution of homelessness seems carried out. to indicate, more shelters are needed in the county towns As an urgent matter of principle, child homelessness must and other large urban localities; (iii) there is a need to pilot be drastically reduced and then eradicated. In order to do programs that provide integrated packages of social services so, child protection services need to be more proactive for the homeless, including housing; and (iv) the problem of in their outreach efforts with the support of local service this “invisible population” should be brought to the attention providers and the SPAS as referral entities. Support should of the general public to build support for these interventions be provided to enable children to attend school without and at the same time advocate for the abandonment of the need for complex documentation requirements, and harmful practices (such as begging). free transportation and other necessary material should be However, merely improving the institutional set-up will provided for them. not alleviate chronic homelessness and extreme poverty. The size of the homeless population at the national level In order to gradually shift the policy emphasis towards and in all major cities has to be quantified on the basis of prevention, social housing services should be delivered more reliable data. In order to create a system for the timely within an integrated package of social services for people recording and monitoring of homelessness, collaboration leaving prisons, childcare institutions, asylums, and will be needed between all relevant public institutions, hospitals, the victims of domestic violence, and the drug NGOs, and statistical and research institutions. dependent. An improved strategy for keeping track of BOX 44 The Priority Intervention Program – Providing dropouts (70 percent) or a total lack of access Integrated Services in an Urban Marginalized to school (unregistered children), and limited Roma Community access to utilities. A community development project being implemented The project has two key components: (i) in the extremely poor Roma neighborhood called Bora infrastructure – the building of a multifunctional social on the outskirts of Slobozia, Ialomita county, has an centre built on land made available by the Town Hall international reputation as a good practice example and (ii) community-based social services – including of improving the living conditions of marginalized educational, school, and after-school activities, leisure communities. The project is one of 133 projects of the and traditional cultural activities, social and legal wider Priority Intervention Program, which is being counseling for adults, and health-related education implemented throughout the country by the Romanian and information. The project involves a complex Social Development Fund (RSDF) under a broader participatory process, with 30 representatives of the Social Inclusion Project (SIP). The key characteristic of community belonging to an initiative group that is in the Priority Intervention Program is its focus on Roma charge of identifying problems, designing solutions, communities. Its projects tackle various aspects of and facilitating dialogue. The project’s implementation Roma social exclusion, such as low access to education, is monitored by a special monitoring unit, community health, social protection, and different types of facilitators and project supervisors from the RSDF, and infrastructure (such as a lack of road construction within representatives of the Town Hall. their communities). The project has had several successful outcomes. The 214 beneficiaries of the Bora project – 129 of whom For example, 50 Roma children benefit from school children – are among the poorest of the approximately and after-school activities, including the provision 1,700 Roma living in the neighborhood. Bora is of free meals, and 214 Roma parents are involved in characterized by multiple deprivations, including networking and counseling activities in support of the general poverty, widespread unemployment, school children’s participation in school. As a result, school Housing | 269 BOX 44 (continued) absenteeism and abandonment have decreased by 20 similar communities elsewhere, the development percent. of cooperative relationships between different communities, providing beneficiaries with help to A key strength of the project has been the involvement access other kinds of support, and carrying out constant of the community from the very earliest design monitoring and evaluation on the ground with the stage. Some of its most effective participation community’s involvement. approaches could be replicated in projects in other disadvantaged communities such as those living in Source: World Bank qualitative study carried out in social housing, including the use facilitators throughout Slobozia as part of this background study. the project cycle, knowledge exchanges with other Failing to address the problem of homelessness in the future the street by ensuring that the basic need for food, water, will result in further costs to society. Several crucial measures and medical assistance of those in need are met as well; need to be taken in the near future: (i) eradicate child (v) adopt regeneration programs to tackle the problem of homelessness by requiring child protection services to be illegal settlements; (vi) cease all illegal evictions; and (vii) more proactive in their outreach efforts and by encouraging adopt prevention policies to protect people at risk of ending local service providers and SPAS social workers to be more up in the streets including people leaving prisons, childcare systematic in referring at-risk people to the specific services institutions, residential centers, and hospitals, victims of they need; (ii) assess the size of the homeless population domestic violence, drug addicts, and vulnerable, lonely, and in all major cities; (iii) increase the capacity of shelters; (iv) elderly people. increase capacity for making emergency interventions in 2 PEOPLE-BASED POLICIES 2.7. Social Participation To guarantee that they are full members of the democratic system, individuals need to be informed and active citizens, to have opportunities to join the ranks of others, and to work together to achieve common goals. Social participation is not only beneficial itself but also has multiplicative effects: it improves the welfare of vulnerable groups as well as local governance and, in general, makes society more cohesive. The government should encourage both volunteering activities through which the general population can help vulnerable groups as well as other types of social participation through which the voices of the deprived and marginalized can be directly and immediately heard. Main Objectives 2.7. Social Participation 272 2.7.1. Improving the Social Climate and Increasing Trust in Institutions 272 2.7.2. Increasing Tolerance and Decreasing Discrimination 274 2.7.3. Increasing Participation in Volunteering Activities with and for Vulnerable Groups 276 2.7.4. Empowering Poor and Marginalized Communities through Active Social Participation 276 2.7.5. Increasing Access to Information and Knowledge through Social Innovation 280 272 | PEOPLE-BASED POLICIES 2.7. Social Participation Social participation includes a wide range of dimensions perspective, the empowerment of the poor may improve such as volunteering, voting, and participating in political different aspects of their lives, for example, increasing activities. The current volume focuses on two key forms of their access to basic services, improving local and national social participation that directly affect the socially excluded: governance, promoting economy-wide reform and pro-poor (i) volunteering activities through which the non-vulnerable market development, and increasing their access to justice.445 can help vulnerable groups (social participation for the In conclusion, the social participation of and for vulnerable deprived) and (ii) other types of social participation through groups can be fostered by creating a positive social climate, which the voices of the deprived and marginalized can be increasing institutional trust, and increasing tolerance directly and immediately heard. and reducing discrimination. It is equally important to Participation rates in different types of voluntary create the institutional mechanisms through which poor or organizations439 are much lower in Romania than in most marginalized groups can be empowered to participate more other countries in Europe, while participation in voluntary in their communities and through which social innovations activities for vulnerable groups is almost non-existent. On can be developed that will foster participation. average, 26 percent of Europeans participate in voluntary 2.7.1. Improving the and charitable activities (activities outside of their paid work) either regularly or occasionally,440 whereas only 15 percent of Romanians do voluntary work (only four other countries have fewer volunteers – Greece, Bulgaria, Portugal, and Social Climate and Poland). Only 3 percent of Romanians have declared in surveys that they do voluntary work in a human rights, Increasing Trust in environmental, or charitable organization (this percentage includes those doing such activities only occasionally). The Institutions percentage is as low as 1 percent for those involved only in The social climate creates the environment within which charitable activities. people act. It can be cohesive and conducive to social The social participation of vulnerable groups is often a participation or it can be fragmented, thus fostering stated aim of development projects that are designed isolation, marginalization, and even social conflict. People to empower vulnerable groups by, among other ways, may or may not be satisfied with how things are going, increasing their access to information. In this sense, with their own lives, with institutions or with other public participation is defined as a “process through which stakeholders. Dissatisfaction often results in the inhibition stakeholders influence and share control over the of people’s personal development skills and community development initiatives and the decisions and resources involvement, as well as with self-isolation and a refusal to which affect them.”441 Within this conceptual framework, take part in social life. analysts often present the empowerment442 of marginalized The social climate in Romania is much less cohesive groups as one of the ways in which poverty can be than in the other EU member states, and it deteriorated sustainably reduced in deprived communities.443 Moreover, immediately after the crisis against a backdrop of economic empowerment is not only a means of reducing monetary recession, austerity measures, and political crisis. The poverty but is also a goal in itself, the lack of power being results of the five Eurobarometer446 surveys aimed at one of the aspects of poverty.444 From the same theoretical 439 The range of voluntary organizations is large including religious organizations, professional organizations, trade unions, cultural associations, sports clubs, and political parties. 440 Moreover, only 2 percent of Romanians are involved in these activities on a regular basis instead of only occasionally (Romania is situated at the lowest end of the distribution together with Bulgaria and Poland). 441 World Bank (1996: XI). 442 Empowerment represents the “capability of poor people and other excluded groups to participate in, negotiate with, change, and hold accountable institutions that affect their wellbeing” (Klugman, ed., 2002: 2). 443 Narayan (2000), Pozzoni (2005), and Eberlei (2007). 444 Klugman (ed., 2002: 2) and Pozzoni (2005: 14). 445 World Bank (2002: vii). 446 Eurobarometers were conducted in Romania by TNS Opinion & Social at the request of the Directorate-General of Employment, Social Affairs, and Inclusion. Social Participation | 273 FIGURE 45: The Social Climate in Romania, 2009-2012 2009 2010 2011 2012 1 0 OVERALL SOCIAL CLIMATE INDEX -1 -2 Satisfaction with personal situation -3 -4 Satisfaction with aspects of social protection and inclusion -5 Perception of the national -6 economic indicators -7 Source: EC, 2005-2012 Eurobarometer. Notes: The graph presents the average values determined on 15 scores varying from -10 (“not at all satisfied”/”very bad”) to +10 (“very satisfied”/”very good”). Satisfaction with one’s personal situation is the average value of four scores that rate the respondent’s satisfaction with his or her life: (i) life in general; (ii) area of residence; (iii) personal job situation; and (iv) household financial situation. Perception of the national economy consists of an average of six scores in the following areas: (i) the cost of living; (ii) the affordability of energy; (iii) the affordability of housing; (iv) the efficiency of public administration; (v) the overall situation of the economy; and (vi) the employment situation nationally. Satisfaction with aspects of social protection and inclusion is the average score in five areas: (i) healthcare provision; (ii) the provision of pensions; (iii) unemployment benefits; (iv) relations between people from different cultural or religious backgrounds or nationalities; and (v) the way in which inequality and poverty are addressed by the government. The overall social climate index is the average of all these 15 scores. monitoring the crisis impact (2009 to 2010) and the public - starting with the crisis - poverty has become more special Eurobarometers on social climate (2011 and 2012) widespread, people’s financial resources have decreased highlighted a disturbing reality. Among the EU member considerably, and it has become increasingly difficult to states, Romania and Greece ranked at the bottom in the cover household, utility, and medical bills. The situation three main dimensions that were being measured: (i) the has been aggravated by the fact that public administration respondents’ satisfaction with their personal situation; and healthcare services are perceived as functioning in (ii) their satisfaction with aspects of social protection and an unsatisfactory manner, and protection from poverty inclusion; and (iii) their perception of national economic and inequality is considered inadequate. In fact, a recent indicators.447 Romanians’ perceptions of the state of survey among the younger population clearly showed that the national economy are overall quite bleak, with most corruption, poverty, and unemployment represent the major people being close to the bottom end of the satisfaction problems that need to be addressed in Romania.448 scale (not at all satisfied). The indicator significantly The social climate can be changed by a sustainable decreased immediately after 2009 and registered a slight improvement of the economy that has a direct impact on positive trend after 2011. Moreover, in the minds of the 447 The only countries with similar scores were Hungary, Bulgaria, and Portugal, but they were in better shape at least in some respects. 448 Sandu et al (2014). 274 | PEOPLE-BASED POLICIES the population’s welfare, by a decrease in perceived levels examples of “successful” interactions between citizens of corruption and in the inefficiency of public administration, and institutions (both in Romania and globally) need to be and by the provision of services and key social protection widely disseminated to demonstrate how similar problems benefits. In the absence of these elements, all other efforts have been solved and thus encourage social participation in to directly increase participation are likely to have only a the long term. limited impact. Institutional trust is also a prerequisite for successfully fostering social participation. The main reason why people 2.7.2. Increasing have to have at least some trust (some authors refer to this as having cautious trust) in the institutions of state is that most Tolerance and social participation involves interactions with central, regional, Decreasing or local institutions. If people do not trust these institutions, then they have no desire to interact with them, and the result Discrimination is a civil society that is separated from the state and in a relationship of conflict rather than cooperation. Tolerance is one of the main prerequisites for social participation. While social participation can also occur in Trust in institutions is also low and has been declining since contexts characterized by intolerance, this type of social 2009.449 Various surveys have shown decreasing levels participation is of a kind that does not attempt to create of trust in institutions after 2009. This reached a point in bridges from one group to another. Nor does it attempt 2012 (according to the World Value Survey) where only to understand and accept the “other’” regardless of how about 30 percent of people had trust in the government, this is defined. Social participation in intolerant contexts and just 20 percent had trust in the Parliament (both with is social participation within one’s defining group, it is large year-to-year variations) and in the Presidency (the social participation behind closed doors, and it is social previous five years having shown a significant drop from participation that eliminates any potential for additional, the levels recorded in the 2000s). The fact that, at most, more developed engagement, which eventually ends up one-third of the respondents have trust in institutions fragmenting society or the community. Participation in suggests that citizens do not have any reason to believe contexts characterized by high levels of tolerance, however, that the political system is going to be responsive to their is of the type that opens the doors for the possibility of more demands or to their social participation. If this is true, engagement. The “other” is accepted as a valid interlocutor, then people are going to have little incentive to use social as an acceptable (if not valued or trusted) partner. participation as a tool to achieve their goals and might opt Moreover, this type of participation brings together people to use other strategies that they expect to be more effective from different groups, and by putting them into contact, it under these circumstances, such as corruption or extreme increases inter-group tolerance and the chances of future litigiousness.450 cooperation among groups. To increase the level of institutional trust, public institutions Tolerance towards vulnerable groups has grown with responsibilities in specific social domains (such as significantly in Romania in recent years, but discrimination employment, higher education, and child protection) continues to put these groups at risk of social exclusion.451 are (or should be) open to everyone. If the public has a Table 38 indicates that discriminatory kinds of behavior negative perception of how these institutions carry out are still likely to be adopted in everyday interactions given their responsibilities, then they have little incentive to the great number of people with negative attitudes towards interact with them. The solution to this problem is twofold. vulnerable people motivated purely by these people First, state institutions should improve the ways in which belonging to a certain group. According to the European they respond to people who interact with them and make Values Survey in 2008, the adult Romanian population had demands of them – in other words, their clients. Second, the least tolerance for three groups that could be seen as 449 The level of institutional trust in Romania is highly dependent on the particular moment of the electoral cycle when the measurement was taken (for example, see Tufiș, 2012). 450 For more details, see Sztompka (1999). 451 While there is no single, generally accepted measure of tolerance, most of the experts in this area use one of three measures (for more details, see Gibson, 2013). The results we present here are based on one of these three measures. The higher the number of people that comprise a group, the higher the level of intolerance within the population towards that particular group tends to be. Social Participation | 275 possible threats: heavy drinkers, drug addicts, and people Roma reported that they had faced discrimination in the with a criminal record.452 This type of intolerance, however, process of job search based on their etnic background.457 An can be explained. All three groups are comprised of people alarming 49 percent indicated that employers had openly that seem to have a higher propensity to engage in violent said that they were treating them differently because they (or at least disturbing) acts, acts that can be interpreted as a were Roma, and a further 5 percent had heard the same personal threat, and all previous literature has identified the from labor offices. perception of threat as one of the most important predictors Education is a good indicator of the level of tolerance of intolerance.453 What is worrying is that high shares of towards and trust in others. There is a strong relationship Romanians were still intolerant of some vulnerable groups between the level of intolerance and education for all such as people with HIV/AIDS or homosexual. groups except heavy drinkers and drug addicts. Data on Roma continue to be on the receiving end of discrimination high school students in Romania presented in Annex Table because of their ethnicity. The European Values Survey 9.2 show three important patterns. First of all, high school data showed a high level of intolerance towards Roma students are significantly more intolerant than the general that is based on prejudice. It showed that 40 percent of population with respect to any considered group. The the adult population of Romania would not like to have difference can be explained by a combination of factors Roma neighbors, double the percentage of people who including the tempering effect of education on intolerance, would reject a neighbor with other characteristics including the tendency of teenagers to exaggerate their beliefs, and being Muslim (23 percent), of a different race (21 percent), teenagers’ lower compliance with the common standards immigrant (21 percent), or Jewish (19 percent). of political correctness. Second, the higher the educational stock of the family, the lower the intolerance levels. Third, Roma are excluded on the basis of their ethnicity from both this relationship between education and intolerance is service provision and in markets. Focus group discussions completely reversed in the case of Roma in that the more with Roma communities carried out by the World Bank educated a family is, the higher the chances that they will in 2014 showed that the discriminatory attitudes of be intolerant towards Roma. service providers are the main barrier preventing Roma from accessing services.454 For example, with respect to Advocacy is needed to raise awareness and increase education, a UNICEF study showed that a student being tolerance of diversity (including various categories of (hetero-) identified as Roma by a teacher considerably marginalized or discriminated groups) and to create a social increases the chances that the teacher expects that student and institutional environment that facilitates the social to complete only eight grades of education at most, all integration of vulnerable groups. This advocacy should other things being equal or kept constant.455 In the area be targeted not only to the general population but also to of health, discriminatory practices toward Roma patients decision-makers and employers. Including representatives are manifested in “avoiding physical contact with patients; of vulnerable groups on local decision-making committees non-involvement of patients and of their family in choosing and bodies (both formal and informal) would help to the treatment; omission of explanations concerning the establish their role and position within their communities. risks of administering a certain type of treatment; using Education is also key to increasing acceptance of aggressive procedures.”456 Roma also report experiencing marginalized groups. Reducing early school leaving in discriminatory practices in the labor market. In a survey of general and increasing the number of people with tertiary 402 Roma in Romania, Bulgaria, the Slovak Republic, the degrees has the potential to reduce the level of intolerance Czech Republic, and Hungary, 64 percent of working age in the medium to long term. 452 The level of intolerance was measured by the percentage of the total population who had expressed antipathy to having the listed groups as neighbors. 453 Gibson (2006). 454 World Bank, 2014. 455 Stănculescu et al (2012). Ethnicity is the only significant determinant in multiple regression models of the risks of both school dropout and early school leaving. Ceteris paribus, being a Roma child significantly increases the probability of school dropout/early school leaving irrespective of the child’s age, gender, and health status, the mother’s level of education, the number of children within household, the number of parents at home, the residential area, or the level of household school-related expenditures (or household income). 456 Wamseidel et al (2012). 457 ERRC (2007). 276 | PEOPLE-BASED POLICIES TABLE 38:  The Percentage of the Total Population Who Have Expressed Antipathy to Having the Listed Groups as Neighbors Population aged 18 years or over High school students 1993 1999 2008 2011 Large families 22% 14% 16% - People of different race - - 21% 27% People with HIV/AIDS 66% 47% 39% 65% Roma 72% 52% 40% 71% Emotionally unstable people 64% 53% 45% - Homosexuals - - 55% 74% People with a criminal record 67% 69% 56% - Drug addicts 76% 74% 61% - Heavy drinkers, alcoholics 79% 77% 63% - Sources: European Values Survey for 1993, 1999, and 2008 and Open Society Foundation (2011). 458 2.7.3. Increasing value of participation. However, companies have the most to contribute to promoting volunteering. Until now, few Participation in companies have supported volunteering activities and have at most encouraged their employees to volunteer after Volunteering Activities working hours and on weekends. In future, companies could with and for Vulnerable give their employees of all ages and levels of seniority time off to volunteer. In addition, they could also ensure that their Groups pre-retirement programs and counseling routinely include information about volunteering opportunities and benefits. The current legislative framework governing volunteering does not encourage social participation. The Law on 2.7.4. Empowering Volunteering (No. 95/2001) was passed in 2001, modified in 2006, and revised again in 2014 (Law no. 78/2014). Poor and Marginalized However, the current legal framework presents some obstacles to the development of social participation for Communities several reasons. The requirement to sign a contract deters short-term and spontaneous volunteering. Also, the through Active Social provision of health and accident insurance pertaining to Participation any risks involved in the voluntary activity does not appear to be mandatory for voluntary organizations, and there The community driven development (CDD) approach is are no provisions to induce employers to encourage their a popular financing mechanism at the community level employees to volunteer.459 that aims to empower the poor. CDD gives control over To increase participation, the mass media have a role to planning decisions and investment resources for local play in fostering awareness of best practices and of the development projects to community groups. Its promoters claim that CDD ensures an optimal allocation of resources, 458 /www.fundatia.ro/romanii-devin-mai-toleranti-religios. Survey on Religion and Religious Behavior carried out in June 2011 on a sample of 1,204 persons aged 18 years or over, http:/ Calculations done by Claudiu Tufiș. 459 World Bank (2014a). These changes would not only encourage the employees to participate but might also help young people to build skills and gain work experience while volunteering. Social Participation | 277 increases the efficiency and efficacy of small investments, framework (which will impact the norms/rules that and makes these investments more sustainable. In addition, govern the functioning of an institution). These effects they claim that not only are resources used more efficiently remain under the direct control of the actors who are but the poverty level decreases and services and facilities using the resources, and, because of this, they are are better targeted towards the poor (in a progressive considered outputs (direct results) of the projects. • distribution of resources). In addition to the economic effects, development through communities is designed to increase f resources are used appropriately and the desired I the transparency of the decision-making process, to increase results are obtained, the expected outcome will be the capacity of the authorities, and to make those authorities an increase in the influence of communities, with more accountable. In theory, all of these positive goals can community members having greater control over be accomplished by increasing the amount of information the way in which decisions are made and public available to individuals and their participation (particularly of resources are distributed. • the poor) and by increasing their social capital.460 B  ecause of the increased empowerment of The CDD approach perceives the poor as a resource, not as communities and of the increased accountability of a social problem that needs to be solved. CDD is the type authorities, the long-term impact of a CDD project can of development that aims to give “control of decisions and be expected to be a major improvement in the lives of resources to community groups.”461 In other types of project, the poor and the start of a sustainable development the poor are considered as a social problem that needs to process for these households. be solved by experts with competencies and resources, but the theory of development through community emphasizes While the picture painted by the advocates of such an that the poor are a key resource for their own development. approach is appealing, the impact around the world of Therefore, the promoters of CDD state that the poor have CDD projects has been mixed, including those of the Rural the necessary capacity to “effectively organize to provide Development Project (RDP) implemented by the World goods and services that meet their immediate priorities… Bank in Romania in 2002 to 2006 (see Box 45). Several given clear rules of the game, access to information, and lessons can be learned from the accumulated evidence: • appropriate support.”462 T  he participatory mechanisms for targeting resources The CDD approach is based on an explicit logical model of seem to be useful only when the projects aim to reach inputs, activities, and outputs that must be followed when out to poor communities rather than to dispersed implementing such a project in order to get the desired poor households. In other words, geographical outcomes: targeting may be progressive, but this is only rarely •  he inputs consist of the resources needed to T implement the project and the efforts that must be made to change the legal and policymaking the case with the targeting of poor households in general.463 Moreover, some studies have pointed out that the effectiveness of geographical targeting is also dependent on the inclusion of the poor in the environment at the local level. What is significant participatory spaces created by CDD interventions so if here is that the manner in which resources are the inclusion of the poor is not consistent, the targeting distributed and used is decided within the community of such programs will fail.464 Another study has shown and in accordance with the community’s needs. shows that the poor can only be reached effectively •  he effect of this use of these resources is T expected, on the one hand, to be an improvement in infrastructure (which will improve quality of life by a participatory mechanism if the financing agencies carry out their work at an adequate pace, with efficient monitoring and means of evaluation. If the financers have “little experience in participatory approaches” or even increase incomes in the long term), and on and “the pressing need for quick and visible results”, the other, to change the policymaking and legal the results can be disastrous.465 460 Klugman (ed., 2002) and Mansuri and Rao (2013). 461 Klugman (ed., 2002: 303). 462 Klugman (ed., 2002: 303). 463 Wassenich and Whiteside (2004: 82). 464 Mansuri and Rao (2004: 17) and World Bank (2005: 23). 465 Platteau (2002: 10). 278 | PEOPLE-BASED POLICIES SCHEME 9: The Results Chain in a Bank-supported CDD Intervention OUTPUT OUTCOME Increased access by communities to basic infrastructure, services, and income-generating Empowered communities activities. Community control and management Favorable policymaking and legal environment, of decision and resource together with strong local government institutions INPUT IMPACT Resources for financing capacity building at commu- nity level for preparing and implementing develop- Sustained development and positive ment plans according to community priorities. impact on the lives of the poor Support for strenghtening the legal and policymaking environment, along with local government institutions Source: World Bank (2005: 57). • T  he evidence concerning increases in empowerment through such projects is also not convincing. What works in theory does not always do so in practice, systems): and (iv) when there is an organization at the community level that can administer and oversee the investment projects (for example, collecting money for because progress depends on local authorities being repairs or for individual consumption and penalizing motivated to encourage the CDD approach (see the households when they do not pay or meet their evidence from the evaluation of the Romania RDP in responsibilities).467 Box 45).466 In conclusion, poor and other vulnerable groups should •  he often praised sustainability of the CDD approach T seems also to be highly dependent on how it is implemented. The sustainability of investment is be empowered by increasing their access to information and their participation in decision-making processes. Three key measures are needed to make sure that this becomes reality: (i) whenever small infrastructure highest in the following circumstances: (i) in those projects are implemented at the local level, a participatory communities where households choose the type approach should be built in by default with an emphasis of investment and its location; (ii) when NGOs and on the inclusion of the poor and vulnerable; (ii) the individuals are involved in the project who are in government should provide the relevant local authorities a position to increase the level of communication and the target population with technical assistance on within communities and to increase the access of the operation and management of such projects; and deprived people to information and to decision-making (ii) local authorities should be trained to understand the processes; (iii) when both authorities and citizens relevance of the including poor and vulnerable groups in are trained in how to adequately use, maintain, and the decision-making processes (including in the design and operate the infrastructure (such as water/sewage implementation of small investment projects). 466 Poteete (2003). 467 Sara and Katz (2000) and Mansuri and Rao (2004). Social Participation | 279 BOX 45 Evaluation of the Rural Development Project, mainly by the local authorities. Moreover, 2002-2006 about one-fifth of them said they were involved in the decision-making process Project description: The Rural Development Project regarding these investments. However, there (RDP), implemented between 2002 and 2006, were wide variations in terms of how well-informed the was designed to build government capacity for rural respondents were. In those villages with infrastructure development in five counties (Sălaj, Dolj, Botoșani, subprojects, information was more widespread than in Tulcea, and Călărași) and in 100 communes within these villages without any kind of investments. Furthermore, counties and to provide funds for investment grants the poor and the elderly were less likely to be informed (water supply and roads). These grants were designed than the general population. In general, people with to “facilitate learning-by-doing, while improving living lower levels of education were less likely to have standards for rural inhabitants.” Local governments participated in the decision-making process. – both counties and communes – were expected to “establish investment priorities and strategies, choose Empowerment and participation at public meetings: from a list of infrastructure types and technologies, The RDP seems to have had a direct positive impact and coordinate the implementation, operation, and both on participation (at public meetings) and on maintenance of investments.” The final objectives empowerment. Moreover, the project seems to have were to: “(i) increase the efficiency of local government had indirect effects on trust and information, even decision-making and management; (ii) improve after holding constant individual characteristics government accountability to citizens and community (such as gender, income, and education), community groups and increase their involvement in decisions; and characteristics, and the initial level of the aspects (iii) increase the effectiveness of local government in being studied (participation, empowerment, trust, delivering investment benefits to beneficiaries.” and information). In addition, when looking at the mechanisms explaining changes, it can be seen that Evaluation design: In order to evaluate the project, an the increase in participation seems to be due to a elaborate design was followed with a baseline survey change in behavior on the part of the authorities (they in 2002 and a follow-up in 2006 of both the project were more likely to invite villagers to public meetings), localities and some control communes (with a similar while empowerment seems to have been influenced likelihood of participating in the program), and research by participation in the decision-making process related instruments designed to collect data at the commune, to the RDP and even by being well-informed about the village, and household/individual levels. way in which RDP decisions were made. Targeting performance: Within the RDP communes, Investment sustainability: In theory, one of the villages where road infrastructure sub-projects had advantages of the CDD approach is manifested in the been implemented were often administrative centers sustainability of the investment because citizens are that already had better roads and greater access to more inclined to maintain them and to carry out public institutions than other villages. There are several works. However, the impact evaluation came up with no possible explanations for this. For example, the clear results in this respect. While the public authorities populations of these villages may have been better do seem to be more willing to involve communities in represented at the local administrative level, and/ such activities, the participation rate did not significantly or they may have had larger populations. However, increase in the project communities. another reason may have been that these roads benefit not only the populations of the administrative centers Welfare impact: Given the short period of time during themselves but those who dwell in various other which the RDP was implemented and the small amount villages. of money invested in infrastructure, the evaluation did not show any major impact on the welfare of the Information about and participation in RDP activities: beneficiaries (except for the water connection rate). The current data show that about half of all survey respondents had been informed about the project, Source: Grigoraș (2015). 280 | PEOPLE-BASED POLICIES 2.7.5. Increasing Access know how to read or because they need the information to be presented in a particular format such as braille, to Information and large print, sign language, or closed captioning, none of which are prevalent in Romania. Therefore, policymakers Knowledge through should consider taking the following actions: (i) providing Social Innovation accessible information in all areas related to public policies, services, and goods and developing technologies that will eliminate the barriers to communication for all vulnerable Under the EU’s Common Strategic Framework,468 actions groups and (ii) developing accessible information points for that fit into the thematic objective of social inclusion should people with disabilities as close as possible to their living be aligned with actions listed under the thematic objectives environment, for example, by increasing the number (and of developing ICT, enhancing the competitiveness of small training) of sign language interpreters and providing access and medium-sized enterprises (SMEs), and investing in to easy-to-read Braille material and more audio materials. education, skills, and lifelong learning. The European Particularly for people with disabilities, it will be necessary Social Fund469 promotes social innovation in all sectors to ensure a barrier-free environment. People with disabilities under its area of responsibility, and member states are are critically affected by the lack of accessibility of, for invited to identify social innovation initiatives that meet a example, housing and communication, especially in rural demonstrated need. Social innovation involves developing areas or deprived urban areas. This restricts the movement and applying new ideas (products, services, and models) of individuals with disabilities as well as their access to to addressing social challenges in various fields, such as information, with the consequence that they often miss out social inclusion. Social innovations related to social media on a wide range of opportunities and services. have the potential to strengthen citizens’ autonomy, to ensure access for vulnerable groups to information and The Digital Agenda for Europe presents technology-based social services and to the job market, and to enhance options for increasing the participation of vulnerable the participation of these groups in mainstream society. groups in society. In addition to the forms of participation Consequently, ensuring nationwide Internet connectivity discussed up to this point, the technological developments and supporting digital skills development are key of the last 20 years have opened the way for new forms empowering factors for social innovation. of participation, forms that either occur entirely online or combine an online presence with on-street activities. New technologies, ICT, and innovative services are almost While these new forms of participation have the potential non-existent in the social sector. Between 1995 and 2005, to expand the number of active citizens and to encourage the use of these technologies spread rapidly throughout participation, especially in situations where this was Romania in many sectors, but there was a massive previously difficult to achieve, they can also involve access decrease thereafter because of legislative inconsistencies, costs that may be too high for some vulnerable groups. gaps in funding, and a decrease in the number of professionals working in the system due. This has all First, in order to be able to access the Internet and participate contributed to a “subsistence” attitude to research rather online, the physical infrastructure must be available. This is than to innovation and outside-the-box thinking, particularly not really a barrier in Romania except, perhaps, in the most in the social sectors. remote areas because as of the end of 2013, fixed broadband covered 90 percent of homes in Romania (compare with Investment is needed to increase the access of all an EU average of 97 percent). Even in rural areas, fixed vulnerable groups to information and knowledge in a wide broadband was available in 78 percent of homes.470 range of formats. In some form or another, all forms of participation involve costs, and accessing information is Second, there is an individual monetary cost. In order to be no exception. People need time and/or money to access able to access the Internet and participate online, people information sources. Some people may have reduced need to have a computer and an Internet connection, both of access to information sources because they do not which cost money. This may prove to be a prohibitive cost 468 European Commission SWD(2012) 61 final, Part II, Brussels, 14 March 2012. 469 ESF regulation proposal, COM (2011) 607 final. 470 /ec.europa.eu/digital-agenda/en/country/romania https:/ Social Participation | 281 to many Romanians, given that half of those who are at risk few digital skills, and disadvantaged groups have even of poverty and social exclusion cannot afford a computer fewer, which means that computers and the Internet are an and 42 percent cannot afford an Internet connection. The inefficient way of ensuring their inclusion and participation. Digital Agenda data show that 56 percent of Romanian Moreover, most users in Romania access the Internet only households had a broadband subscription at the end of to get information or to socialize, whereas very few use it 2013, which is still considerably lower than the EU average for economic, social, cultural, or political participation (for (76 percent) but higher than at the end of 2012. example, through e-commerce, e-sales, looking for jobs, e-learning, e-health, or e-governance). This behavior pattern Finally, there is an educational cost. Even if a person has is not only a reflection of people’s preferences and skills but access to a computer and an Internet connection, he or also of the underdevelopment of e-governance services. she still needs to be computer-literate in order to be able Very few public services are currently available online, and to access the Internet and participate online. This is not their level of sophistication is relatively low.471 The national necessarily a problem for the younger generation, but it e-governance strategy (eRomania) has bold objectives might be an insurmountable obstacle for at least some of (promoting transparency, increasing administrative efficiency the elderly population in rural areas, especially if they have by cutting costs and bureaucracy, ensuring broad and never used a computer. In 2013, 45 percent of Romanians permanent access to information and public services, and reported using the Internet at least weekly (regular users), preventing corruption through digital tools), but it is still being well below the EU average of 72 percent. As many as 42 implemented at the desk level. All of this underscores the fact percent of the population had still never used the Internet that the Government of Romania is not making enough effort - lower than in 2012 but still significantly higher than the to connect people to the knowledge-based economy and to EU average of 20 percent. The general population has very prepare the way for social innovation. BOX 46 Community Development through Social years old and youths between 16 and 24 Innovation – A Good Practice Example years old. Irrespective of factors such as family economic status, ethnicity (Roma The Knowledge Economy Project, which was are statistically overrepresented in these implemented between 2006 and 2012 by the Ministry communities), educational attainment, parents’ of Communications and Information Society and employment status, or household amenities, children financed by the World Bank, proved to be a positive and young people from these communities use link between ICT development and social inclusion. computers and the Internet on a regular basis at a The project targeted 255 communes and small towns rate comparable with the European average (70 to 80 selected on the basis of their knowledge deprivation. percent). These young people have better digital skills The project increased rates of possession, access, than the rest of the population, and they are greatly and use of digital skills by citizens, companies, and involved in various community actions. In addition, local public services. The communities involved in the young people have developed a preference for online project changed from being disadvantaged to having means of information and interactions with public knowledge indicators equal to or higher than national authorities. The main determinant of this behavior averages. In these communities, local public services has been the schools with their ICT equipment and (including social ones) have become more developed, considerable increases in computer-assisted classes. local online services have multiplied (with their use rates Therefore, the Knowledge Economy Project is a model being significantly higher than at the national level), of social innovation using ICT to foster social inclusion and the social infrastructure has been substantially and ensure equal opportunities for vulnerable groups, extended and modernized. Currently, many of in particular to children and youths, women, Roma, and these communities are top consumers of European people with disabilities. development funds. Source: Stănculescu and Aprahamian (2013). With regard to vulnerable groups, the most visible impact has been on children aged between 3 and 15 471 Therefore, in 2013, only 5 percent of the population aged between 16 and 74 years old used e-governance services (as opposed to versus 41 percent in the EU-27). Th is p age inte ntio nal ly l eft bla nk 3. AREA-BASED POLICIES 3 AREA-BASED POLICIES 3.1. Geographical Dimension of Poverty The government should aim to reduce geographical inequalities by improving the definition of urban and rural areas and by developing institutional solutions for the administration of functional urban areas that would enable dynamic cities to grow demographically and economically. The quality of life in rural communities should be improved by increasing the access of rural residents to quality basic infrastructure and services, while exploring the possibility of an administrative reform of rural localities. Finally, a program offering more resources and assistance for the recently declared small towns and for very small cities needs to be developed. Main Objectives Geographical Dimension of Poverty 3.1.  286 3.1.1. Reducing Geographical Inequalities 286 3.1.2. Improving the Quality of Life in Rural Communities 291 3.1.3. Improving the Quality of Life in Small Urban Communities 302 286 | AREA-BASED POLICIES Geographical Dimension of Poverty 3.1.  Poverty has a stark geographical dimension in Romania, so less developed. To some extent, the lack of development one of the government’s main objectives should be ensure in these areas can be attributed to the limited trade that that resources are allocated according to the geographical Romania has with countries like the Ukraine, Moldova, distribution of need within the country at the regional, or Bulgaria and to their distance from the Western border county, and local levels. To this end, this section discusses through which 70 percent of Romanian exports are sent. how poverty is distributed within the country and examines As discussed in the draft National Territorial Development possible ways of reducing these geographical inequalities. Strategy, the Carpathian Mountains also prevent localities in the East and South from accessing Western markets. 3.1.1. Reducing Another geographical pattern that emerges from Map 5 is the importance of cities in triggering development. Geographical Usually the closer a locality is to a developed city, the more developed it tends to be itself. As such, it is critical to Inequalities increase access to dynamic urban centers as this is one of the most efficient ways of enabling more people to take In the European Union’s 2014 to 2020 multi-annual advantage of the opportunities that these cities offer (such financial framework, €1 trillion have been budgeted to as jobs, education, healthcare, culture, and entertainment). support growth and jobs and to reduce poverty and social The poverty maps473 for Romania produced by the World exclusion. Success depends on developing the right policies Bank in 2013 confirmed existing knowledge about poverty and programs and targeting them effectively. Poverty maps in Romania but also revealed new insights. For example, can provide more detailed information on intra-country previous surveys have shown that the Northeast region has variations in poverty than was previously available and thus the highest rates of poverty, and the county-level poverty have the potential to improve resource allocation. The maps map ( Map 6 ) confirmed that all six counties in that region may also induce policymakers to give greater consideration have an elevated risk of poverty. In contrast, the South to how best to allocate resources in ways that will raise region is heterogeneous, comprising some counties with living standards – whether by targeting poor areas or poor very high poverty rates such as Călărași and Teleorman people. While the right combination of approaches will vary but also other counties with relatively low poverty rates by country, the maps provide important information to help such as Prahova. Similarly, Cluj county has the second- policymakers to arrive at the best solution. lowest poverty rate in Romania (after Bucharest), but its The Local Human Development Index (LHDI),472 which was neighboring counties in the Northwest region (Bistrița- devised to measure the overall level of development of each Năsăud, Maramureș, Sălaj, and Satu Mare) have poverty locality within a given county, also shows that community levels that are higher than the Romanian average. Knowing poverty in Romania has a strong geographical dimension. which counties have higher poverty rates can help As Map 5 shows, localities in the East and South of the policymakers to target resources for development and country, particularly those closer to the borders, tend to be poverty reduction more efficiently. 472 The LHDI measures the total capital of rural and urban administrative units in Romania on four dimensions: (i) human capital; (ii) health capital; (iii) vital capital; and (iv) material capital. Human capital is measured by education stock at the local level (for the population aged 10 years old and over). Health capital is measured as life expectancy at birth at the local level. Vital capital is measured by the mean age of the adult population (those aged 18 years old and over). Finally, material capital is assessed as a factor score of three specific indicators that focus on living standards: (i) the size of the dwelling space; (ii) the number of private cars for every 1,000 residents; and (iii) the distribution of the use of gas for household consumption in the particular geographical unit. The four measures of the dimensions of community capital are aggregated by calculating another factor score. (Ionescu-Heroiu et al, 2013a). 473 For details about the methodology of creating poverty maps at community level by combining survey and census data see Elbers et al (2003) and Elbers et al (2004). Geographical Dimension of Poverty | 287 MAP 5: The Local Human Development Index for 2011 Regions Local Human Development Index in 2011 Very poor Poor Lower-middle developed Middle developed Upper-middle developed Developed Upper developed Source: National Agency for Protection of Children’s Rights and Adoption. Note: Residential care units including public and private placement centers, small group houses, and apartments. 288 | AREA-BASED POLICIES MAP 6: Risk-of-Poverty Rates and Number of People below the Poverty Threshold by County, 2012 (thousands) Poverty rates vary widely and are highest in the Northeast region and along the Southern border. The largest number of poor people is in the Northeast region, but some areas with low rates also have many poor residents. Source: World Bank estimates using 2011 Population and Housing Census and 2012 EU-SILC. Note: The risk of poverty is defined using the EU standard of 60 percent of median national equivalized income after social transfers. Geographical Dimension of Poverty | 289 Targeting poor areas is only likely to be effective if priority have always been considerably higher among children is given to areas that not only have high poverty rates but in rural areas than those in urban areas.476 There has also contain large numbers of poor people. Policymakers always been less infrastructure available in rural areas and are interested both in those areas where poverty is high and of lower quality. Access to upper secondary education, in those areas that have the largest number of poor people. healthcare, and social services has been much more limited These two are not the same. Areas that are very poor may in rural areas. Rural households are located, on average, also be sparsely populated, whereas large cities tend to much further from a high school or major hospital than have low poverty rates but large numbers of poor people urban residents (see the Health and Education chapters). because of their large populations. For example, despite Therefore, the next sections of this chapter analyze the its lower poverty rate, Cluj county has more people at risk quality of life in rural and small urban areas, as well as the of poverty than Sălaj. Also, Bucharest has more people at availability of European funds to fund future community risk of poverty than 14 counties. The poverty maps suggest development. yet another approach to allocating resources for poverty The current administrative definition of rural and urban reduction that takes into account the fact that many of the areas needs to be improved by taking account of emerging poor live in relatively rich areas. Both maps clearly illustrate suburban or peri-urban areas that continue to be defined that the Northeast - especially Botoșani, Iași and Suceava as rural areas. In the World Development Report 2009: - have both high poverty rates and large numbers of poor Reshaping Economic Geography,477 the World Bank people and thus should be given a high priority according to proposed a unified methodology for measuring urbanization either criterion. (the agglomeration index). By this measure, Romania The Northeast and South regions of the country have been is around 65 percent urban and 35 percent rural when fare worse than other areas on nearly all socioeconomic these suburban or peri-urban areas (otherwise known as indicators, especially in rural areas. As a general rule in “functional urban zones”) are defined as urban. In fact, Romania, the larger the proportion of the rural population, the World Bank’s 2014 report478 on Competitive Cities: the more severe the poverty is in that region or county.474 Reshaping the Economic Geography of Romania showed So, inter-regional disparities are mainly the result of that, although the population of the country including the the large discrepancies between urban and rural areas. population of most large urban centers decreased between Actually, a recent study by the European Commission 1990 and 2010, some localities grew in population and, as clearly showed that the rural-urban gap has been more the map below illustrates, the most pronounced population marked in Romania than in the Western European growth happened in the peri-urban areas of large and countries.475 After 1989, as structural changes began to be dynamic cities (Map 7). In order to serve as engines of made in Romania, the urban–rural gap widened, with rural growth, cities, especially the most dynamic ones, need to areas being clearly at a growing disadvantage. Rural areas be defined as functional urban areas. Failing to do so can have been constantly characterized by a higher incidence undermine even the best local strategies and can ultimately of income poverty than urban areas (see Section 1.1.1 on lead to suboptimal development outcomes. Regional Disparities). Infant and under-5 mortality rates 474 Sandu (1999 and 2011), Sandu et al (2009). 475 Bertolini et al (2008). 476 For example, in 2013, the infant mortality rate was 10.4 live births to every 1,000 inhabitants in rural areas compared with 6.8 in urban areas (National Institute of Statistics, Tempo Online, https:/ /statistici.insse.ro/shop/). 477 World Bank (2009). 478 Ionescu-Heroiu et al (2013a). 290 | AREA-BASED POLICIES MAP 7: Growing Functional Urban Zones The 2011 census results have prompted many to talk about policy measures aimed at tackling the urban-to- rural migration that seems to be taking place in Romania. A look at the data shows, however, that most of this urban- rural migration is in fact the result of people moving to the suburbs of București, Cluj-Napoca, Timișoara, Constanța, Iași, and Ploiești, with most of these suburbs still being wrongly defined as rural areas. Source: World Bank (Ionescu-Heroiu et al, 2013a: 22). Geographical Dimension of Poverty | 291 Policymakers must also identify and implement adequate services. Each of these aspects of the problem will require institutional arrangements for the management of functional tailored policy responses. urban areas to enable dynamic cities (or growth poles) to enlarge their demographic and economic mass. A World A. The Physical Availability of Basic Bank study479 proposed the creation of Metropolitan Infrastructure and Services in Development Agencies, which would be similar to Romania’s Regional Development Agencies, in that they Rural Areas would plan and manage functional urban areas and There is a pronounced urban-rural divide in Romania in implement projects at the metropolitan level. Policymakers terms of the physical availability of basic infrastructure should help dynamic functional urban areas to grow in order and services, with rural communities being heavily to act as economic engines for the regions in which they disadvantaged. However, there are variations by type are located. It is also important for policymakers to enable of infrastructure or service. The current rural-urban gap a larger number of people to access the opportunities that provides policymakers with a strong justification for rapidly these cities offer (such as jobs, education, healthcare, increasing the supply of basic services and infrastructures culture, and entertainment). Because these growth in rural areas. This will require “hard” measures such as poles have already attracted a significant amount of new area-targeted investment projects funded primarily through investment, it will be vital to expand metropolitan public the National Rural Development Program (NRDP), the transport systems (ideally to areas with high population Regional Operational Program (ROP), and, to some extent, densities and with strong commuter flows), to develop new through the Large Infrastructure Operational Program connective infrastructure, and to upgrade and properly (LIOP). The main areas where these investments should be maintain existing infrastructure.480 made are as follows: Road network: In 2012, total road network in Romania 3.1.2. Improving the covered 81,185 kilometers. The network of county and municipal roads totaled 67,298 kilometers, of which Quality of Life in Rural municipal roads represented 47 percent. The density of Communities rural roads was 15 kilometers per 100 square kilometers of territory, which is less than half of the national average (35.1). These are among the lowest densities in the entire Nearly half of the population lives in rural administrative European Union. areas (46 percent according to the 2011 Census). Both Basic utilities: Rural areas lag significantly behind urban the aging of the rural population and the migration of areas in terms of the availability of basic utilities such as many rural dwellers in search of work abroad – notably water supply, the sewerage network, and natural gas, with of young people and women – are deepening the general the notable exception of electricity, which is available to impoverishment of rural areas. virtually all rural dwellers. In 2012, only 13 percent (2,011) of rural municipalities were connected to a public drinking Access to Quality Basic water supply, in contrast with 99 percent of cities. Only 4 Infrastructure and Services in percent (616) of rural localities were connected to a public sewerage network compared with 97 percent of urban Rural Areas districts. In addition, only 4 percent (650) of communes and villages could tap into the natural gas supply as opposed to The availability of reliable basic services and infrastructure 95 percent of urban dwellings. is a vital prerequisite for ensuring a good quality of life and social inclusion in rural areas. In this section, we analyze: (i) Preschool facilities: Rural areas are even more severely the physical availability of basic infrastructure and services; affected as far as preschool facilities and vocational/career (ii) financial and physical access to basic infrastructure schools are concerned and are facing a major infrastructural and services; and (iii) the quality of basic infrastructure and deficit. Kindergartens accounted for only 7.4 percent of the 479 World Bank (Ionescu-Heroiu et al, 2013b). 480 These investments should be prioritized based on careful analysis of local and regional trends and according to a set of clear criteria (for example, the availability of resources to maintain and operate the new or upgraded infrastructure). 292 | AREA-BASED POLICIES total number of such facilities registered at the national level percent). More details on the urban-rural divide regarding in the 2012/13 school year. Similarly, in 2011, only 1 percent healthcare resources are provided in section 2.5.3. of Romania’s 295 nurseries were located in rural areas. Information and communication technology: The uptake of The lack of these preschool facilities in rural areas prevents ICT in Romania remains very low by European standards. parents from returning to full employment while their children In 2012, only half of all Romanian households had at least are of preschool age, thus limiting household income. one computer and access to the Internet. Rural households Schools: The total number of public schools has dropped are much further behind, with only 32 percent owning a significantly in both rural and urban areas, though it has computer and only 28 percent being connected to the declined much more significantly in rural areas. Between Internet. This constitutes a major infrastructure gap that 1996 and 2012, the number of urban schools fell by needs to be closed. 55 percent while the number of rural schools fell by 85 percent. In contrast, the number of students fell by only B. The Gap between Rural and 20 percent in both rural and urban areas during the same Urban Areas in terms of Access to period. Indeed, while the population of Romania has been on a general downward trend, neither the urban nor the Basic Infrastructure and Services rural population has dropped by more than 10 percent People in rural areas also face more physical and financial since 1990, but the decline in the number of educational barriers to accessing basic infrastructure and services. The facilities has been much more precipitous. There are challenges identified in this subsection are best addressed notable differences in these dynamics by education level. by ”soft” programs targeted to the most vulnerable groups. While the number of primary and secondary education Along with social programs, the NRDP together with the facilities halved in urban areas, in rural areas was they Competitiveness Operational Program (COP) can help to declined by 75 percent. In the case of secondary schools, boost rural incomes by creating jobs and supporting income there was a slight increase in total numbers in both urban diversification in ways that particularly benefit low-income and rural areas. Furthermore, it has been estimated that people of working age (such as the rural unemployed or over 90 percent of primary and middle schools - 70 percent small farmers). of which are located in rural areas - require modernizing.481 Nevertheless, while the number of schools decreased, Road network: Only half of all communes have direct the number of teachers more or less followed the trend access to the national road network, meaning that the in student enrollment numbers in that they dropped by a current road network only serves three-fifths of the total similar percentage. On balance, student-to-teacher ratios rural population. This is an important access gap that needs are good, and there are no major disparities between urban to be filled. and rural areas, at least in pre-university education. Basic utilities: In terms of economic access to basic utilities Upper secondary education: The number of agricultural such as water supply, the sewerage network, electricity, high schools has decreased by over 80 percent in the last and natural gas, available statistics do not indicate, at face 15 years, and only 34 were still operating in rural areas as value, any major differences between urban and rural of 2011. The lack of specialized agricultural education in households. In fact, 66.3 percent of urban households rural areas leads to suboptimal management of agricultural – compared with only 33.6 percent of rural households holdings and reduces income-generating opportunities for – faced difficulties and delays in paying their utility bills vocational groups who are already dealing with reduced in 2012. However, the numbers are not fully analogous incomes and poverty. so this comparison may be misleading. The much lower availability of these services in rural areas also translates Healthcare: As was the case with schools, the number into a proportionally lower incidence of utility bills, which of medical clinics in Romania has been on a significant might be the main explanation for the difference (Map 8). downward trend as has the number of healthcare Once the availability of these services is similar in rural and professionals. The decline in the number of medical clinics urban areas, the balance might shift back in favor of urban in rural areas (down by 38.9 percent since 2005) has been households, given their higher incomes. much more rapid than at the national level (down by 17 481 Ministry of Regional Development and Tourism (2012). Geographical Dimension of Poverty | 293 MAP 8: Share of Population with Access to Piped Water (up) and Sewage (down), 2011 Access to Piped Water in 2011 75.1% - 100% 50.1% - 75% 35.1% - 50% 0% - 35% Generally, cities have better access to basic services, as they benefit from economies of scale. Developed cities also enable neighboring communities to share the prosperity that they enjoy. Access to Sewage in 2011 This fact should be taken 75.1% - 100% into consideration when 50.1% - 75% attempting to prioritize 35.1% - 50% investments in the extension of basic infrastructure and 0% - 35% services. Source: World Bank (Ionescu-Heroiu et al, 2013a: 152). 294 | AREA-BASED POLICIES Education: In 2011, only 45.5 percent of rural children under in conjunction with expanding the network of healthcare 4 years old were enrolled in nurseries. Furthermore, the facilities in rural areas. 256,856 rural children enrolled in kindergartens equaled Information and communication technology: The low only 80 percent of the corresponding urban enrollment. incomes of most rural households are the main reason Nationwide primary educational attainment (grades 1 to 4) for the low penetration and use of broadband Internet in is satisfactory (over 90 percent), with no major urban-rural rural areas. In addition, digital literacy remains low in rural disparities. However, gaps start developing in the secondary areas, although these areas are quickly catching up with education cycle (grades 5 to 8) where attainment levels as the rest of the country. Approximately 60 percent of the of 2012 were 66 percent in rural areas and 85 percent in rural population aged between 16 and 74 has never used urban areas, and this gap widened even further after high a computer or the Internet, in contrast with 30 percent of school. In 2013, three-quarters of all urban employees had the urban population (as of 2013). Yet the number of rural completed high school or had a higher education degree, inhabitants who have used the Internet increased by 3.5 while 42 percent of rural employees had only primary or times between 2007 and 2013, a much faster rate than secondary education or none at all. among urban dwellers. Employment: The urban-rural education gaps are reflected in the employment structure, which has direct implications C. The Quality of Basic for income levels and job opportunities. In 2013, one- Infrastructure and Services in quarter of the rural employed consisted of non-salaried family workers, while another third were self-employed. In Rural Areas contrast, in urban areas, over 90 percent of the workforce The quality of basic infrastructure and services in rural comprises salaried employees. areas is as important as their availability and accessibility Healthcare: Apart from deficient infrastructure and an and should not be overlooked, although it is harder to insufficient number of healthcare professionals, particularly substantiate with statistical data. Specific performance in rural areas, financial constraints also limit access to indicators (such as educational or health outcomes in healthcare services. In this regard, there are no major urban versus rural areas) can provide some insights, differences between urban and rural dwellers, with 75.8 although multiple factors are involved in determining these percent and 74.2 percent respectively claiming that they outcomes. Nevertheless, the government needs to make cannot afford healthcare. However, there is a notable intensive efforts to monitor the quality of basic infrastructure difference between urban and rural areas in terms of and services and improve it wherever necessary. These physical access, defined as living an excessive distance efforts should primarily consist of programs financing the from health services or as a lack of public transportation to development of rural infrastructure (such as rural roads and access them – 5 percent as opposed to 8.2 percent. There utilities), as well as the monitoring of the quality of rural is a clear need to improve the rural transport infrastructure services by the responsible line ministries (such as the Ministry of Health or the Ministry of Education). TABLE 39:  Breakdown of Public Roads by Type and Degree of Modernization in 2012 National County Municipal Modernized 93% 27% 8% Light asphalt pavement 6% 45% 16% Stone 2% 22% 47% Dirt 0% 6% 28% Source: National Institute of Statistics. Geographical Dimension of Poverty | 295 Road network: In the case of rural roads, poor quality is an unified transport network, 60 percent are in need of repair. even more significant constraint than physical availability Therefore, a significant proportion of the rural labor force or access. Rural roads are in much worse condition than is hampered from moving to urban areas in search of national and county roads (Map 9). Only 8 percent of employment. Map 9 below indicates the counties with the rural roads are modernized (compared with 93 percent of highest shares of county and communal roads in need of national roads), and 75 percent of them are stone or dirt modernization. Overall, according to the cost standards roads. In cases of major rainfall or snowfalls, many of these of the Ministry of Regional Development and Public roads become impassable, cutting off people’s access Administration, modernizing all of the earth and gravel to vital supplies and services and disrupting economic county roads in Romania would require around €3.4 billion, activities. Of the 23,000 kilometers of county roads that while the modernization of earth and gravel county roads connect with the TEN-T network, the European Union’s would require around €4.7 billion. MAP 9: Counties with Highest Shares of County and Community Roads Requiring Modernization, 2011 County and Communal Roads Botosani % Earthen and Stone, in 2012 0% - 35% Maramures Suceava Satu Mare 35.1% - 50% Iasi Salaj Bistrita-Nasaud 50.1% - 65% Neamt Bihor Cluj Vaslui Mures Harghita Bacau Arad Alba Covasna Galati Sibiu Vrancea Brasov Timis Hunedoara Buzau Braila Tulcea Prahova Caras-Severin Valcea Arges Gorj Dambovita Ialomita Ilfov Mehedinti Bucuresti Calarasi Olt Constanta Giurgiu Dolj Teleorman Source: National Institute of Statistics. 296 | AREA-BASED POLICIES Basic utilities: The extremely low physical availability of undergo an external evaluation every five years. A set basic utilities such as water supply, the sewerage network, of 24 performance indicators – laid out in Government electricity, and natural gas limits the extent to which it is Decision no. 21 of 2007 – constitutes the basis for both the possible to discuss their quality. However, it is evident that accreditation and evaluation of schools. Based on these the most of the existing physical infrastructure is in great indicators, a combined score is calculated for each school. need of repair or reconstruction. The quality and reliability The evaluation report concluded that rural students have of Romania’s water supply and wastewater services are access to lower quality education than their urban peers generally poor, especially in rural areas where the quality of and that government efforts aimed at closing the quality water does not always meet minimum hygiene standards. gap needed to be intensified. Romania’s regional water master plans indicate that the Healthcare: No clear evidence exists with regard to quality investment needed in these two sectors is somewhere standards in the Romanian healthcare system. Quality around €30 billion. Map 10 below shows those regions assurance in this field is still in its early stages (see the where the need is highest. Romania National Health Strategy 2014-2020,482 with Education: The quality of rural pre-university education the notable exception of laboratories. Quality standards, is worse than that of urban pre-university education. A procedures, and protocols for healthcare units are being study commissioned by the Ministry of Education in 2012 developed but, so far, anecdotal evidence suggests that indicated that rural schools fall 10 percent behind their very often not even minimum standards are met, even if urban counterparts in scores based on standard quality such standards already exist. indicators. By law, the Romanian education system must MAP 10: Water and Wastewater Investment Needs by Water Region, 2007-2018 (in €1,000) Source: Regional water master plans. 482 Ministry of Health (2014: 36). Geographical Dimension of Poverty | 297 Information and communication technology: Overall, fewer than 200 inhabitants, of which about a half (1,610 Romania ranks high in terms of the quality of its broadband villages) are very small (with fewer than 100 inhabitants). Internet service. According to a recent report by a major About 3.4 percent of the total rural population (nearly global Internet content manager, Romania ranked 18th in 312,000 people) lives in small villages, of whom fewer than the world with an average connection speed of 9.3 Mbps as 1 percent live in the very small villages. Most of these small of the first quarter of 2014.483 According to the same report, villages are peripheral within their communes (sometimes the speed of adoption of the internet in Romania is also situated many kilometers away from the central village) high, with the country ranking sixth globally in terms of its and have elderly populations (Annex Table 10.4and quarterly increases in broadband connectivity (of greater than Annex Table 10.7). Over 41 percent of the populations of 4 Megabytes per second). While no breakdown of the quality villages with fewer than 200 inhabitants and 45 percent of Internet services exists between urban and rural areas, it is of the populations of very small villages are aged 55 or safe to assume that the quality of ICT services is not the main older.486 Small and very small villages are spread all over constraint for potential rural users. Instead, the government the country but appear to be concentrated in the West needs to focus on ensuring the availability of these services and Center regions (Annex Table 10.2 and Annex Table and increasing access to them, mainly by increasing rural 10.3). Also, villages with an elderly population are more income opportunities and rural digital literacy. likely to be found in the Western regions of the country (North-West, West, and South-West) (Annex Table 10.8). Small and Remote Rural In terms of basic infrastructure, small and very small villages have similar development needs to those of the Communities larger communities (Annex Table 10.5 and Annex Table 10.9).487 However, due to their population composition, Rural areas are highly heterogeneous. Rural areas in small and very small villages have specific needs mainly Romania are organized into 2,861 communes (administrative related to the development of social services, specifically units) that include 12,373 villages.484 Villages are categorized assistance in carrying out daily tasks (home help) for the by geography, population size, distance to a city, and elderly and better access to quality education (particularly administrative type (central or peripheral). Some 88 percent early childhood education and primary school for younger of communes have one central village and one or more children). This is because in many of these villages schools peripheral villages. Central villages tend to concentrate the have been closed down or are severely underfinanced administrative and institutional resources of the commune because of the small number of pupils (Annex Table 10.6). (the mayoralty, health unit, school, library, post office, and police station). Public infrastructure, which is in need of Among rural municipalities, the small communes with fewer modernization in most rural areas, is significantly poorer than 2,000 inhabitants are the most disadvantaged in terms in peripheral villages. The most affluent villages are those of human and social development. In Romania, the size of located close to a city and/or to a European road.485 In fact, the commune populations varies widely from a low of 119 to a many of these developed villages are part of suburban or high of almost 23,000 inhabitants.488 The small communes peri-urban localities. (those with fewer than 2,000 inhabitants) represent 26 percent of all communes (or 751) and are inhabited by Small and very small villages are the most disadvantaged, over 1.1 million people (see Annex Table 10.10). These particularly those with an elderly population and/or those communes are spread throughout the country but tend that are located in remote areas (see Annex Table 10.1). to be concentrated in the West, Center, and South-West The 2011 Census counted a total of 3,172 villages with 483 Akamai (2014). 484 As at January 2015, the Nomenclature of Territorial-Administrative Units (NIS) reported 13,755 villages (SIRUTA units) nationwide, which were grouped in 3,181 administrative units (communes and cities). However, 129 villages have been ‘fictive’ (have zero inhabitants) and have no corresponding data in the 2011 Population and Housing Census (114 from rural and 15 from urban). As most of the analysis presented in the following sections is based on the 2011 census data, we will refer only to those villages that are ‘valid’, 13,626 SIRUTA units, of which 12,373 in rural areas and 1,253 in urban areas. 485 Sandu (2000) and Stănculescu (2005). 486 At the same time, children aged between 0 and 17 years old represent only 18 percent and 16 percent respectively of the total population of villages with fewer than 200 inhabitants and of very small villages. For comparison, in villages with more than 200 inhabitants, children represent 22 percent of the total population, while people aged 55 or older constitute 31 percent. 487 The villages with a high proportion of elderly inhabitants appear to have lower percentages of dwellings connected to utilities such as cooking gas, piped water, or the sewerage network, but usually the demand for these services is also lower (some elderly are too poor to afford gas and water tariffs, while others have no desire to invest in such facilities as they are used to getting their drinking water from wells or fountains). 488 Brebu Nou (Weidenthal) is the smallest commune in the country (with 119 inhabitants according to the 2011 Population and Housing Census). It is a former Saxon commune that includes two villages and is located in the Semenic Mountains in Caraş-Severin County in western Romania. The largest commune is Floresti, which is a peri-urban suburb of Cluj- Napoca city in Cluj County in the Center region. 298 | AREA-BASED POLICIES regions, a pattern rather similar to that of small villages and fewer than 2,000 inhabitants) and, on the other hand, small villages with a high proportion of elderly inhabitants (Annex communes are generally less connected to their nearest Table 10.11). With regard to the availability, affordability, cities than larger communes (in other words, they are more and quality of basic infrastructure, small communes have likely to be remote). Although infrastructure development a similar proportion of dwellings connected to utilities and in the small communes increased between 2002 and 2011 of households that report difficulties and delays in paying and these communes attracted a larger volume of European their utility bills (such as heating, electricity, and gas) as funds per inhabitant than the larger communes between other communes (Annex Table 10.12 and Annex Table 2009 and 2012, they have not succeeded in closing the 10.13). However, the Local Human Development Index development gap. Furthermore, as shown in the previous (LHDI) indicates that small communes were and still are sections on social services, education, and health, small significantly less developed than the larger communes, communes are clearly at a disadvantage in that they have even the remote ones (Table 40). In fact, Table 40 shows few community workers (social workers, community health that, on the one hand, remote communes (those that have nurses, Roma health mediators, and qualified teaching little connection to any city) are likely to be disadvantaged staff), their local institutions have little capacity, and they only when they are small (in other words, when they have have very few primary and community-based services. TABLE 40:  Human and Economic Development of Small Communes and Remote Communes Other communes Small communes Remote communes (neither small nor Urban areas (<2,000 inhabitants) 2,000+ inhabitants remote) Number of communes 751 375 1,735 320 Average population size (number of people) 1,474 3,558 3,932 34,000 Urban Connectivity Index (IURCON) 1.4 1.0 1.7 1.4 Share of remote communes (%) 23 100 0 - Local Human Development Index 2002 (LHDI 2002) 29.8 32.7 33.5 44.3 Local Human Development Index 2011 (LHDI 2011) 33.5 36.7 37.7 47.2 Evolution of LHDI (2011 as % of 2002) 112 112 112 106 Total volume of expenditures on European funded 174 153 112 61 projects, in the period 2009-2012 (Euro per capita) Share of self-generated revenues in total revenues in the 12.9 16.0 17.4 38.6 local budget, in 2007 (%) Share of self-generated revenues in total revenues in the 19.1 20.8 22.8 41.6 local budget, in 2012 (%) Evolution of self-generated revenues (2012 as % of 2007) 148 130 131 108 Share of capital investments in total expenditures in the 26.0 22.6 25.4 19.4 local budget, in 2007 (%) Share of capital investments in total expenditures in the 20.7 18.4 20.4 16.5 local budget, in 2012 (%) Evolution of capital investments (2012 as % of 2007) 80 81 80 85 Source: World Bank calculations using the 2011 Population and Housing Census; World Bank (Ionescu-Heroiu et al, 2013a) for LHDI 2002 and 2011; and local budget execution data posted by the Ministry of Administration and Interior.489 Notes: IURCON provides an estimation of urban connectivity based on a set of distances between a commune and its neighboring small, medium, large, and very large cities. The higher the IURCON value, the better connected to cities is that commune. Remote communes are those localities in the lowest quintile of IURCON. 489 At present, the local budget execution data are reported by the Ministry of Finance. The Ministry of Administration and Interior is the Ministry of Internal Affairs. Geographical Dimension of Poverty | 299 At the same time, local budget indicators show that small legislation to enable rural communes to merge and create communes are also disadvantaged in terms of economic fewer but larger communities that are better connected to development (Table 40). The extent to which local urban areas (especially to the growth poles). This will help communities depend on support from the state budget is a to reduce the existing inequalities between rural and urban relevant indicator of the potential for local economic growth. areas as well as within rural communities. If a locality’s budget contains few central budget transfers in conjunction with a high proportion of self-generated The European Funds as an revenues (from local tax collection), then this is a sign that it is experiencing healthy economic development and that it Instrument for Developing has a large base of taxpayers (citizens and firms). Ministry Basic Infrastructure and of Finance data from the end of 2012 show that the average share of self-generated revenues (or independence from Services in Rural Areas state budget transfers) of Romanian localities was only 24 Romania is receiving funding from various European percent. Within this average, rates differed significantly Union funds to improve health outcomes, social services, between urban areas (42 percent), communes (22 percent), the physical environment, and economic infrastructure and small communes (19 percent). Only a small number of in Romania’s less developed regions. These funds are localities managed to achieve an independence threshold the European Regional Development Fund (ERDF), the of over 50 percent in 2012, namely 84 cities (or 26 percent European Social Fund (ESF), and the European Agricultural of all cities apart from Bucharest) and 135 communes (of Fund for Rural Development. The government is expected which 109 are neither small nor remote). Consequently, to allocate about €3.5 billion (10 percent) of these funds capital investments are low and have even decreased in to meet the EU’s Thematic Objective 9 to promote social recent years in all localities. inclusion and combat poverty and discrimination.490 This indicates that policymakers should explore the To be as effective as possible, these funds will need to be possibility of reforming the local government administrative carefully spent. In Table 41, we lay out the areas where structure as a realistic and efficient way to enable rural investment is needed in basic infrastructure and services in development. At the moment, it is too expensive for most rural areas and prioritize them according to the urgency of localities to invest in developing any basic infrastructure or the need. service. Therefore, policymakers need to devise adequate TABLE 41:  Priorities for Investments in Basic Infrastructure and Services in Rural Areas Financial and Physical availability Quality physical access Roads Medium Medium High Basic utilities: - Drinking water High High High - Sewerage High High High - Electricity Low Low Low - Natural gas High Low High Education Medium* Low Medium Healthcare High High Unknown** ICT Medium Medium Low Notes: *High only for pre-school education and vocational/career schools. **No quality assessment available. 490 The tentative breakdown of EU funding in support of Thematic Objective 9 in Romania is as follows: the ERDF (€0.5 billion), the ESF (€1.1 billion), and the EAFRD (€1.8 billion). 300 | AREA-BASED POLICIES Given the priorities set out in Table 41, the European funding needs to be used to: •  reate programs aimed at diversifying rural incomes C and creating additional job opportunities in rural • areas (using funds from the EAFRD, the ERDF,  xpand and modernize the physical infrastructure E and the ESF), and increasing labor mobility and in rural areas, specifically roads and basic utilities skills acquisition (using funds from the EAFRD and (mainly water, sewerage systems, and natural gas). the ESF) to overcome the income constraints that • may prevent sections of the rural population from E  xpand and modernize education and healthcare accessing to infrastructure and services. • facilities in rural areas and design incentives to encourage service providers (such as teachers and  mpower local communities to take charge of their E physicians) to work in these areas. own development and prioritize their investment • needs through LEADER,491 a local development  xpand the ICT network in rural areas and develop E method developed by the European Network for policies to increase digital literacy in those areas. Rural Development (ENRD) that allows local people • to develop an area by using its inherent potential. C  reate programs targeted to vulnerable groups (in This will help to direct funds to where they are both urban and rural areas) to increase their access to needed the most. education and healthcare. • In Table 42, we present a summary of these policy actions  evelop, monitor, and enforce quality standards for D and the main source of funding for each of them. human development services (such as education and healthcare) in both urban and rural areas. Key Policies to Enhance the Provision of Basic Infrastructure and Services in Rural Areas TABLE 42:  with Main Sources of Financing Investments to facilitate Investments to improve Investments to increase physical availability financial and physical access quality*** Roads Local roads (EAFRD/NRDP), county roads (ERDF/ROP), TEN-T Same as for physical n.a. (ERDF and CF/LIOP) availability Basic utilities: Drinking water Municipalities between 2,000 and 10,000 inhabitant equivalent Same as for physical n.a. and sewerage * (EAFRD/NRDP), above (ERDF and CF/LIOP) availability Electricity n.a. n.a. n.a. Natural gas n.a. TBD** n.a. Education Kindergartens, nurseries, and afterschool units in rural areas, Same as for physical and agricultural high schools (EAFRD/NRDP), other education TBD** availability facilities (ERDF/ROP) Healthcare Rural clinics and community care centers (EAFRD/NRDP), Same as for physical regional and county hospitals, primary care and integrated TBD** availability community care centers (ERDF/ROP) ICT Small-scale ICT infrastructure in rural areas (EAFRD/NRDP), Same as for physical TBD** other ICT infrastructure (EFRD/Competitiveness OP) availability Notes: *Municipalities with fewer than 2,000 inhabitants are put on hold at least until 2018, by which time the larger municipalities must meet specific EU standards. **“Soft” measures are people-based to be determined. ***Complementary measures (including adequate monitoring and enforcement) are not yet included in this table. 491 Liaison Entre Actions de Développement de l’Économie Rurale or Links between the Rural Economy and Development Actions). Geographical Dimension of Poverty | 301 The EAFRD is providing about 50 percent of the resources  he ERDF, through the EU’s Regional Operational T delivered to Romania by the EU funds to pursue social Program, is providing only about 14 percent of the inclusion and poverty alleviation objectives. These funds will resources to help Romania to increase social inclusion and finance the following actions:492 reduce poverty. However, the ROP provides Romania with • additional funds that have had significant positive effects T  he creation, expansion, and improvement of the on the quality of life in rural areas. The ERDF funds will network of local roads in rural areas. Connectivity to finance the following actions: • the main road network is an important principle guiding the EAFRD’s investments.  he development of a network of regional hospitals, T • the equipping of county hospitals with adequate T  he creation, expansion, and improvement of the technology, the development of a primary care public water supply and sewerage networks (M07, system, and the setting up of integrated community sub-measure 7.2). These investment projects are care centers. A provisional budget of €400 million complementary to those undertaken under the Large (EU contribution) is earmarked for this component. Infrastructure Operational Program. They will be carried However, neither a breakdown by subcomponent nor out only in rural localities with between 2,000 and targets are available for the time being. Integrated 10,000 inhabitant equivalents (I.E.)493 subject to being community care centers are of particular relevance part of the regional master plans. Localities with fewer for closing the rural healthcare access gap. By than 2,000 I.E. will be allowed to finance investments providing both medical and social services in the in water infrastructure after 2018 if Romania meets its same location and by covering more geographical commitments to the EU in accordance with Directive areas, they will be closer and more accessible to the 91/271/EEC. EU guidelines indicate that water ultimate beneficiaries. • infrastructure investments be carried out in localities with at least 50 people, while wastewater investments I nvestment in educational infrastructure, which will should be made in communities with at least 2,000 support the modernization of education facilities inhabitant equivalents. from pre-school through middle schools, as well • as specialized high schools and universities. T  he creation, upgrading, or expansion of the Provisionally, €340 million (EU contribution) is education/care infrastructure (M07, sub-measure 7.2): earmarked for this component. These investments (i) the creation and upgrading (including the furnishing) are rooted in the National Strategy for Education of kindergartens, nurseries, and after-school units and Vocational Training 2014-2020. While the and (ii) the expansion and upgrading of secondary strategy acknowledges that rural areas are facing agricultural schools. greater challenges, it does not set specific targets for • modernizing rural education facilities. • T  he creation and/or upgrading of rural medical clinics and of community care centers (M07, sub- I nvestment in road infrastructure. The ROP earmarks measure 7.2). €900 million (EU contribution) for modernizing the  ommunes will be eligible to receive funding for these four C county roads that enable TEN-T connectivity and for measures, while NGOs may also be supported in upgrading the development or repair of adjacent ring roads. education facilities (kindergartens) and social infrastructure The LEADER approach can be used to increase access (after-school units). A total of 1,151 operations are expected to small-scale ICT infrastructure to improve basic to be completed by 2023. In addition, the NRDP is investing infrastructure and services. Support is granted to local action in the maintenance, preservation, and renovation of local groups operating in rural areas and in small towns of under cultural heritage in rural areas (M07, measure 7.6), including 20,000 inhabitants. monastic settlements, and this is expected to have a positive In addition, the Large Infrastructure Operating Program (LIOP) impact on local tourism and to stimulate the development of – combining resources from ERDF and the Cohesion Fund local business. (CF) in the respective amounts of €2.5 billion and €6.9 billion – will contribute to the development of the TEN-T network 492 As of July 1, 2014, no detailed financial breakdown was available by measure. 493 I.E. is the ratio of the sum of the pollution load produced during 24 hours by industrial facilities and services to the individual pollution load in household sewage produced by one person in the same time period. 302 | AREA-BASED POLICIES and to the modernization of large water and sewerage household type, and age since the rate in thinly (rural) areas infrastructure. While these investment projects will not focus is 4.5 times higher than in densely populated areas (medium specifically on rural areas, they will yield indirect benefits for and large cities). the rural population. Most urban centers in Romania are small towns with fewer In order to make the best use of EU funds in terms of than 20,000 inhabitants, that is 225 out of a total of 320 alleviating poverty and social exclusion in rural areas, the cities (Figure 46). However, the 2011 Census data indicate government needs to provide more assistance to local that most of the urban population (43.1 percent of the 10,859 authorities and local stakeholders in micro-regions (clusters million inhabitants) lives in medium-sized cities, 37.6 percent of communes/LAGs) or rural communities to help them in large cities, and only 19.3 percent in these small towns to develop basic social and integrated services. They can (See Annex Table 10.14). do this by: (i) assessing the need for social and integrated services (including homecare and long-term care services, Investments are needed in the infrastructure of villages day centers, and leisure services); (ii) providing training incorporated within cities in order to improve the quality of and facilitation for the LEADER approach and for the LAG life of the population in small towns and to close the gap (local action group) framework; and (iii) increasing use of ICT between disadvantaged small cities and other urban areas. infrastructure in community-based services, including new In Romania, only 81 cities (out of 320) do not include any technologies that would meet the needs of rural residents. villages (defined as compact settlements of houses with a rural aspect usually located a few kilometers away from the city nucleus). By contrast, 88 percent of recently designated 3.1.3. Improving the (between 2002 and 2006) small towns, 80 percent of other Quality of Life in Small small towns, and 62 percent of medium-sized cities include between 1 and 21 villages, as shown in Figure 47. There are, Urban Communities for example, small towns that cover a mountain area where villages are spread at distances of more than 10 kilometers from the city center. In fact, many small towns are thinly Urban areas are substantially more developed than rural populated areas and appear on the map as clusters of distant ones, but considerable discrepancies exist among different settlements with poor road links. In contrast, the medium types of urban areas according to their population size. cities are densely populated areas, and their growth has The 2013 Regional Yearbook (Eurostat) shows that the mainly been the result of the suburbanization process. In at-risk-of-poverty or social exclusion rate (AROPE) has a their expansion, some medium cities have reached the limits strong geographical dimension, in other words, a location of some villages and have thus naturally incorporated those effect, across Europe. However, the widest gaps by degree within their boundaries. Therefore, the existence of villages of urbanization were recorded in Bulgaria and Romania, in within a small town is usually a reflection of the town’s effort terms of the risk of poverty and social exclusion (AROPE), to meet the administrative population threshold to obtain the the risk of (monetary) poverty (AROP), and severe multiple status of an urban administrative unit, whereas the presence deprivation. Romania recorded the second widest range of villages within medium cities is more likely to be related to of AROPE in Europe among three different degrees of the actual enlargement of their functional area. urbanization - a difference of 19 percentage points between thinly and densely populated areas. Furthermore, Romania’s The number of village-neighborhoods is significantly at-risk-of-poverty rate (AROP)494 - one of the highest correlated495 with the city’s local level of human among the European member states - varies widely from development; the larger the number of villages about 7 percent in densely populated areas to 19 percent included within a city, the higher its probability of being in intermediate density (small urban) areas and over 31 underdeveloped (measured against the LHDI).496 Since the percent in thinly populated (rural) areas. Therefore, the recently designated small towns and very small towns with differences (by degree of urbanization) suggest that the at- fewer than 7,500 inhabitants have, on average, a larger risk-of-poverty rate does not exclusively depend on personal number of villages (more than five), they have a much characteristics such as education, employment status, more accentuated rural character and are more likely to be underdeveloped than other urban areas. 494 The at-risk-of-poverty rate is not adjusted for differences in the cost of living between the different types of area, and therefore the gap between different areas may be overestimated. 495 The Pearson correlation coefficient between the number of incorporated villages and LHDI2002 is -0.18 (p=.001) and it is -0.23 (p=.000) for LHDI2011. 496 See the definition of the LHDI in footnote 470 at the beginning of this chapter. Geographical Dimension of Poverty | 303 FIGURE 46: The Regional Distribution of Romanian Cities by Population Size (number) 40 38 33 34 31 31 30 30 24 20 18 14 14 12 9 10 10 5 4 4 1 2 1 1 1 1 1 1 0 North East South East South South West West North West Center Bucharest Muntenia 1,641-20,000 inhabitans 20,000-200,000 inhabitants 200,000 or more inhabitants Source: World Bank calculations using the 2011 Population and Housing Census. Note: Only nine cities have more than 200,000 inhabitants (including the capital Bucharest with over 1.88 million people). FIGURE 47: Romanian Cities by Population Size and Number of Incorporated Villages (number) 35 30 25 20 15 10 5 0 No 1 2 3 4 5 6 7 8 9 10 12 13 14 16 18 21 villages Number of villages incorporated within the city The 51 new small towns (designated in 2002-2006) Very small towns <7,500 inh. (set up before 2002) 7,500 <20,000 inh. 20,000 <200,000 inh. Source: World Bank calculations using data from the National Institute of Statistics (SIRUTA database). Note: “No villages” refers to cities including those urban centers with no incorporated villages. 304 | AREA-BASED POLICIES The Recent Small Towns 2006). The total population of all of these recent small towns is about 385,000 people with an average population The category of small towns is highly heterogeneous, size of approximately 7,500 people (see Annex Table representing a mix of agricultural cities, former (mono) 10.15). The typical city in Romania is small, incorporates industrial cities, and tourism areas. Some small towns have villages, has or used to have an industrial aspect,498 has no a long history and tradition (especially in the Transylvania- tourism or historical aspects,499 and is somewhat socially Center region), while others were formed during the underdeveloped. communist regime, as part of the industrialization process The most disadvantaged small towns are the 51 that were (particularly around a former large enterprise in heavy recently designated. These are in reality rural settlements industry), and others were designated as cities in recent with severely underdeveloped urban infrastructure, years (as a result of pressure to increase the proportion of facilities, functionality, and appearance. The LHDI shows urban population within the country). Out of the 225 small that they were and have remained considerably less towns (with fewer than 20,000 inhabitants) in Romania, 79 developed than other urban areas (Figure 48). Furthermore, came into being before 1950, 90 were developed during 57 percent of these recent small towns are among the least the communist era (1950-1989), 5 were officially included developed urban areas in Romania (the lowest quintile of among urban settlements between 1990 and 2000, and LHDI2011). In addition, a large number (41 percent) of the 51 were designated as cities497 in recent years (2002- FIGURE 48: The Average Level of Local Human Development (LHDI) in Romanian Urban Areas by Type and Population Size, 2002 and 2011 60 53 56 49 52 46 47 46 48 42 42 44 44 43 44 41 38 40 20 0 The 51 new Small towns 5,000 <7,500 7,500 10,000 15,000 20,000 200,000+ inh. small towns <5,000 inh. inh. <10,000 inh. <15,000 inh. <20,000 inh. <200,000 inh. (designated in 2002-2006) LHDIg2002 Local Human Development Index, 2002 LHDIg2011 Local Human Development Index, 2011 Source: World Bank calculations using 2011 Population and Housing Census and World Bank (Ionescu-Heroiu et al, 2013a) for LHDI 2002 and 2011. 497 For example, Law no. 83/2004 through which 35 settlements were designated as urban - http:/ /www.lege-online.ro/lr-LEGE-83%20-2004-(51035).html. 498 The dominant economic profile of small towns is post-industrial. A knowledge typology developed within a previous World Bank study (Stănculescu, 2005) showed that about 180 small towns (out of 225 in total) used to have an industrial element. The number, size, and economic sector of local enterprises varied, but in most small towns the former enterprises were closed down after 1990 and only small businesses were developed, mainly in the commerce and service sectors. 499 The historical dimension refers to the existence within the city of a historical center or area, which before the communist era was inhabited by Jews (in the Eastern regions) or by Germans (in the Central and Western regions of the country). Later, the houses in these areas were nationalized. After 1990, some were returned to their former owners, while others remained under the jurisdiction of the municipality that had used them as social housing. At present, in many cases, these areas accommodate poor, marginalized groups of population. However, as a rule, these areas are in prominent locations within cities and have a high value on the real estate market. Tourism is not necessarily associated with the historical dimension. Most often, tourism is associated with the existence of cultural, sports, or leisure facilities within the city. In small towns dominated by tourism, houses predominate, and because of their tourism-related uses, (for example, as hotels, restaurants, or tourist-oriented shops) they tend to be larger, more modernized, better maintained, and thus more expensive than in other small towns. Geographical Dimension of Poverty | 305 very small cities (those with fewer than 7,500 inhabitants) Basic utilities: There are far fewer basic services in small are among the least developed urban areas in the country. towns, particularly in the recently designated ones, than in larger cities, but considerably more than in rural localities. The recently designated small urban areas, although more This is the case with respect to all of the following services: developed than rural areas of comparable size, are the most piped water from a public network; hot water from a public disadvantaged urban settlements in many dimensions: network; sewage disposal system connected to a public Local budget: Our analysis of local budget execution data500 sewage disposal plant; electric lighting; and cooking gas from indicates that (i) the per capita self-generated revenues501 of public network. For example, the percentage of dwellings small towns are two to three times higher than those of rural connected to a public sewage system varies from 4 percent communities - even when population size and county are kept in rural communities to 22 percent in the recently designated constant - but are much lower than those of larger cities; (ii) small towns and up to 64 percent in small towns declared among urban settlements, the recently designated small towns before 2002. These data are presented in Annex Table 10.18. have the lowest economic potential; and (iii) expenditures Education: The education level of the working age population incurred in European-funded projects502 are higher in rural is substantially lower in the recently designated small towns communities than in small towns, especially for the very small than in the other small towns (and especially with larger cities) localities with fewer than 5,000 inhabitants. These data are but is higher than in rural areas (Annex Table 10.1). presented in Figure 49 and in Annex Table 10.18. FIGURE 49: A Comparison of Local Budget Indicators between Small Towns, Larger Cities, and Rural Communes 250 225 200 164 150 133 Rural communes 107 100 72 Small towns - recently designated 58 51 57 Small towns designated before 2002 50 Larger cities (20,000+ inhabitants) 0 Self-generated revenues of localities Total volume of expenditure on (annual average per inhabitant, in 2009 European funded projects, in the 2009- constant RON) 2012 period (Euro per capita) Source: World Bank calculations using local budget execution data from the Ministry of Administration and Interior.503 500 /www.dpfbl.mai.gov.ro/sit_ven_si_chelt_uat.html (date of accession: January 10, 2014) as well as Data posted by the Ministry of Administration and Interior, available at: http:/ population data from 2011 Population and Housing Census (National Institute of Statistics). At present, the local budget execution data are reported by the Ministry of Finance. The Ministry of Administration and Interior is the Ministry of Internal Affairs. 501 Self-generated revenues reflect the municipality’s fiscal autonomy and local economic potential. In our analysis, they did not include the portions deducted from PIT (personal income tax) for equalization purposes, so that we could focus on those revenues over which the municipality holds a greater degree of control. The per capita formula makes it possible to make vertical comparisons (between localities of different sizes or between urban and rural areas) and horizontal comparisons (between localities of the same status but in different counties). They were computed as an annual average for the period 2009-2012 using local budget execution data. Revenues were computed in 2009 constant value using the index of inflation from the National Institute of Statistics. 502 Expenditures on projects financed from external sources include European-funded programs (structural funds, the National Rural Development Plan, and the Fisheries Operational Program) as well as other programs such as those financed by foreign embassies. However, it can be assumed that at a national level they mostly consist of the European-funded programs and, in the case of communes, expenditures financed by the National Rural Development Plan. We computed them as a proxy variable for the total volume of absorbed European funds in the period of 2009-2012, as the sum of all expenditures incurred in European-funded projects (in Euros per inhabitant), with the data transformed into Euro based on the annual exchange rate from the National Bank of Romania and using population data from the 2011 Population and Housing Census (National Institute of Statistics). Data on this type of expenditure was not available for the period of 2007-2008 in the administrative data from the Ministry of Administration and Interior. 503 At present, the local budget execution data are reported by the Ministry of Finance. The Ministry of Administration and Interior is the Ministry of Internal Affairs. 306 | AREA-BASED POLICIES Employment: The employment rate in non-agricultural sectors 10.20 show that the share of employees in the working age is considerably higher in small urban areas than in rural areas population increases from 28 percent in small communes but is lower than in larger cities, while in rural communities, to 42 percent in the recently designated small towns and 51 employment in agriculture is substantial (see Annex Table percent in the other small towns, and reaches as high as 57 10.19). Correspondingly, Annex Table 10.19 and Annex Table percent in larger cities with more than 20,000 inhabitants. FIGURE 50: Share of Employees Among the Working Age Population (15-64 years) by Locality Size, 2011 (%) 70 64 57 56 58 58 60 54 48 49 46 50 45 45 40 40 35 30 30 20 10 0 0-4.9k 5k-7.4k 7.5k-9.9k 10k-14.9k 15k-19.9k 0-4.9k 5k-7.4k 7.5k-9.9k 10k-14.9k 0-4.9k 5k-7.4k 7.5k-9.9k 10k-14.9k 20k+ inhab. inhab. inhab. inhab. inhab. inhab. inhab. inhab. inhab. inhab. inhab. inhab. inhab. inhab. Small towns designated before 2002 Recently designated small towns Communes Larger cities Source: World Bank calculations using 2011 Population and Housing Census. In conclusion, the 51 recently designated small towns we do not consider these sources in this section. Three key (those with fewer than 20,000 inhabitants) and the 61 very questions are addressed: • small cities (those with fewer than 7,500 inhabitants) must receive more support and assistance to help them to catch F  or which European funded programs are local public up with other urban areas in every area of development. authorities eligible? The European Funds as an Instrument of Community • A  re there any eligibility criteria that vary between local public authorities? Development The local public authorities of Romanian small towns and •  hat are the main investment objectives financed by W European Union and by the state budget? Local public authorities (LPA) are eligible to receive communes have several different sources of revenue, financing from almost all European funds. Except for two the most significant of which are the state budget and operational programs (Transport and Technical Assistance), the European Union. In this section, we focus on extra- all other European programs (including the National Rural budgetary investment expenditures financed from various Development Plan and the Operational Program for Fisheries) European funds and compare them with programs financed include local public authorities as eligible beneficiaries. by the state budget. Local public authorities can also be Annex 5 presents in detail each key intervention area (or funded by their own revenues, equalization funds, transfers measure) within which LPAs can apply for funding. However, from the government’s Reserve Fund, and bank loans, but the eligibility criteria differ between programs in terms of: (i) Geographical Dimension of Poverty | 307 urban versus rural areas (ii) the size of the local population; capita) strongly oriented towards medium or large-scale and (iii) the form of partnership involved. agglomerations.”508 Furthermore, the number of inhabitants is also a strong predictor of an administrative unit’s fiscal The European funds have different eligibility criteria for urban capacity, which is in turn important for ensuring co- and rural areas. The definition of urban and rural areas is financing from European funds or bank loans and, thus, the based on Romanian legislation (which is different from OECD flow of funds to the project. standards), which puts communes and villages in the rural category and towns/cities and administered villages in the The development of partnerships by local authorities is urban category. A clear demarcation between urban and key to attracting investment from European funds. These rural areas is included in the Regional Operational Program funds are open to applications from two main types of (ROP), the Sectoral Operational Program Environment for the partnerships - intercommunity development associations Environment, and the National Rural Development Program and local action groups (LAGs or FLAGS) - as well as (NRDP). The ROP is directed mainly to local public authorities partnerships between local authorities and other eligible in urban areas (county councils and urban municipalities), partners. Both IDAs and LAGs/ FLAGS were devised as while the NRDP is targeted to rural areas. Nevertheless, both ways to enhance the administrative capacity of local include indirect beneficiaries in the opposite areas (county authorities. Partnerships increase a rural municipality’s roads in the case of the ROP and urban municipalities as chances of being able to use EU funds effectively.509 A part of the local action groups in the case of the NRDP). This partner with either well-developed administrative capacity creates further inequalities in terms of access to funding. In (including specialized human resources) or considerable contrast with all other operational programs, the beneficiaries fiscal capacity (to cover the costs of consultancy firms or of the NRDP (mostly in rural areas) can also benefit from feasibility studies) can help all members of the partnership the Romanian Rural Credit Guarantee Fund, which provides to attract extra-budgetary revenues from European funds. credit for much more favorable conditions than those offered Moreover, increasing the size of the population covered by financial institutions (such as banks). This fund provides by the partnership can satisfy the fund’s cost-efficiency funding opportunities for even the poorest communes in conditions for large-scale investments. At the same time, Romania,504 but it is not available to local authorities in urban these intercommunity development associations and areas. One solution to this problem is to develop different LAG/ FLAGS partnerships have the potential to further the forms of urban-rural partnerships, as described below. integrated development of both urban and rural areas in partnership with other private stakeholders. Even those The eligibility criteria of the European funds vary also by local public authorities that are not explicitly eligible for the size of the population within the jurisdiction of the local particular European funds can build partnerships with authority. The Regional Operational Program (Priority other (eligible) beneficiaries to apply to those funds. For Axis 1, Key Area of Intervention 1.1),505 the LEADER Axis example, the Sectoral Operational Program for Human under the National Rural Development Programme 506 Capital includes the member institutions and organizations and the Operational Program for Fisheries (Priority Axis of the Regional and Local Partnerships for Employment 4)507 all have three population thresholds as eligibility and Social Inclusion as eligible beneficiaries. Another type criteria for urban localities - 10,000, 20,000, and 100,000 of partnership with potential benefits for a large number of inhabitants. Even in those programs that do not specifically communes and small towns consists of associations of local mention population size as an eligibility requirement, it authorities such as the Romanian Association of Communes plays a crucial role in funding investment projects. For and the Romanian Association of Cities. Both of these have example, in the case of water and wastewater systems, carried out large-scale European-funded projects510 that the Sectoral Operational Program for the Environment have had an impact in numerous localities. specifies that it is “for cost-efficiency reasons (output per 504 Marin (2015). Poverty defined in terms of fiscal capacity (own revenues as a proportion of total revenues in the local budget). 505 Only towns with populations of over 10,000 inhabitants are eligible. 506 Both rural and small urban (under 20,000 inhabitants) areas are eligible but only as members of a local partnership (LAG) that might include one or more towns (only in exceptional cases). However, these small towns cannot have in total more than 20,000 inhabitants or over 25 percent of the total number of inhabitants living in the LAG (MARD, 2013: 396). 507 Both rural and urban (under 100,000 inhabitants) areas are eligible as members of a local partnership (the Fisheries Local Action Group or FLAG), but the overall population covered by FLAG has to be between 10,000 and 150,000 inhabitants (MARD, 2014: 86). 508 Sectoral Operational Program for the Environment February 2012: 68. 509 Marin (2015). 510 Details of the implemented projects can be found on www.acor.ro or www.aor.ro. 308 | AREA-BASED POLICIES BOX 47 Local Action Groups in Romania to 18 to 26 percent in the other regions. The participation in LAGs by rural communes The Progress Report on the National Rural Development declines from nearly 80 percent in the Center Program for 2013 (MARD, 2014: 105-109) presents the region to 69 percent in the North-East, 62 most recent data on the authorized local action groups to 65 percent in the West and North-West, 57 to 60 (LAGs) approved for financing under the LEADER percent in the South-East and South, and less than component. 48 percent in the South-West, respectively 13% in At the end of 2013, 163 LAGs with local development Bucharest-Ilfov. plans were selected for financing, over twice as many The larger the city and the higher its capacity, the as in 2011 (81 LAGs). These 163 LAGS covered a total more likely it will be able to access European funds on surface of 142,267 square kilometers, or 78.3 percent its own, instead of in partnership with the neighboring of the provisioned target area and a total population of rural communities. The small towns most likely to over 6.77 million inhabitants compared with the target participate in LAGs in order to access European funds of 9.36 million. A total of 1,781 communes and 77 small are the recently designated ones, those with 5,000 to towns were involved in these partnerships, as well 7,500 inhabitants, those with a relatively low level of as 5,103 private partners and NGOs. The LAGs had community development, and those with a low level of received financial assistance to implement a total of economic potential (small self-generated revenues at 2,040 local projects compared with the target of 9,502. local budget). Because population size is one criterion, Most projects, and the largest grants, went to LAGs from the rate of participation in LAGs is 52 percent for towns three regions: North-East (nearly €16 million for 518 with 5,000 to 7,500 inhabitants, 37 to 39 percent for projects), South (over €15.1 million for 354 projects), and very small towns with fewer than 5,000 inhabitants Center (more than €12.1 million for 301 projects). and those with 7,500 to 10,000 inhabitants, and 22 Romanian LAGs Selected for Funding, end of 2013 percent of towns with 10,000 to15,000 inhabitants, while only one town with more than 15,000 inhabitants participates in a LAG. Among the recently designated small towns the rate of participation in LAGs is 43 percent compared with 32 percent of cities officially designated before 2002. These towns access European funds as partners in LAGs not only due to the eligibility criterion related to population size but also due to their limited capacity to co-finance and manage large projects. In fact, among small towns with fewer than 20,000 inhabitants, the rate of participation in LAGs declines from 46 percent of the least developed towns (those in the lowest quintile of LHDI2011) to 25 percent of the most developed ones. Communes of all types participate in LAGs. However, it appears that communes with the lowest self-generated revenues in their local budgets and most extensive Source: Ministry of Agricultural and Rural Development, poverty are more likely to be partners in LAGs. At the /www.pndr.ro/content.aspx?item=2243&lang=RO. http:/ same time, small remote communes (with fewer than The map shows that the municipalities that are 2,000 inhabitants) find it difficult to take part in local members in LAGs are spread all over the country but partnerships. Thus, the rate of participation is 54 percent are much more common in the North-East and Center among the small and remote communes compared with regions. The proportion of localities participating in LAGs 63 percent of small non-remote communes, 69 percent declines among small towns from 35 percent in the of remote communes with more than 2,000 inhabitants, North-East region and 32 percent in the Center region and 62 percent of the other communes. Geographical Dimension of Poverty | 309 Small towns appear to have fewer sources of extra- investments in rural areas, the total value of which was budgetary funds than communes, so their access to around 14 billion RON, with around 50 percent of this European funding strongly depends on their capacity to funding going to communal and county roads and around build and participate in partnerships, particularly IDAs 50 percent to water and wastewater projects. or LAGs (Box 47). A partnership enlarges the number In recent years, the significance of European funds in of potential beneficiaries and thus makes small towns funding local authorities has increased because the volume eligible for funding from these extra-budgetary sources. An of investment resources available from the government analysis is needed at both the municipality and program budget has diminished with the exception of the PNDL.512 levels of the volume of funds available to small towns The Romanian Association of Communes has concluded as well as of their capacity to absorb these funds. The that: “most arrears at the level of communes are caused investment projects covered by European funds largely by the lack of predictability by the government and correspond with the development needs of communes ministries in funding development projects through national and small towns. A good example is the NRDP’s Measure investment programs. The dominant practice of these 322, which is by far the most popular program (in terms of national programs is to approve thousands of investments volume of funds requested in applications). Measure 322 projects but to transfer only small amounts for their supports investments in road, water, and social and cultural implementation, without a clear timeframe for allocation of infrastructure, but most of the funds are spent on improving funds until the completion of the project.”513 In this context, road and water infrastructure in rural areas. In urban areas, the large amount of financing available through European more or less the same types of investment are financed funds can be a better financing solution for local authorities, by the Regional Operational Program and the Sectoral especially given the low level of self-generated revenues Operational Program for the Environment. The state that poor communes and small towns can access. However, budget also finances capital expenditures in these areas. In as a general rule, local authorities are concerned about the 2013, the various water and wastewater system programs lack of predictability of European funds and the growing funded by the government budget511 were brought under complexity involved in dealing with them in terms of one umbrella - the National Local Development Program required documentation, related legislation, and number of (PNDL). The PNDL has a large portfolio of infrastructure control institutions.514 511 Mainly managed by the Ministry of Regional Development and Tourism, which is currently known as the Ministry of Regional Development and Public Administration. 512 ExpertForum (2014). 513 Romanian Association of Communes (2012: 5). 514 Marin (2015). 3 AREA-BASED POLICIES 3.2. Integrating Marginalized Communities The government should address economic and financial inequalities among different geographic areas by implementing integrated community- based social, health, and educational services and promoting partnerships with specialist or grassroots NGOs. Main Objectives Integrating Marginalized Communities 3.2.  312 3.2.1. Integrating Rural Marginalized Communities 314 3.2.2. Integrating Urban Marginalized Communities 317 3.2.3. Integrating Roma Communities 322 3.2.4. An Integrated, Cross-sectoral, Area-based Approach to Marginalized Areas 327 312 | AREA-BASED POLICIES Integrating Marginalized Communities 3.2.  Segregation is again at the top of the European agenda as housing and urban planning policies promoted during the it affects almost all European cities, prosperous, growing, communist period and the first post-communist decade. and shrinking cities alike. Residential segregation refers There is currently little measuring and monitoring of to how people are separated in terms of where they segregation in European cities. However, some local live, but segregation can also occur in terms of schools, authorities in Germany and the Netherlands have jobs, or public services and can affect people in all social developed sophisticated early warning systems to monitor and demographic dimensions, including age, ethnicity, segregation (for example, in Berlin in 1998), and a multitude religion, income, or social class (the rich in one place, of studies has examined these efforts.517 A useful guide the poor in another) or in combination. In the context of to monitoring urban development was produced by the urban development, residential segregation is the main German Federal Ministry of Transport, Construction, and frame of reference. Segregation is closely related to Urban Development in 2009 as an input into integrated concentration, which implies that there is a statistical over- local development plans. The guide includes a variety representation of one group and an under-representation of indicators related to the physical environment (for of one or more other groups in a certain space. It is also example, the age, tenure, and quality of the housing stock), related to the fragmentation of urban spaces into areas social context and demographic data (such as population with visible differences. “If these fragments become age groups, ethnicity, and dependents), and quality of inaccessible, then we encounter segregation into ghettoes, life and existence of social opportunities (for example, gated communities, and other manifestations of hyper- income, employment, educational attainment levels, and segregation. The most extreme examples of segregation health status). However, the interpretation of such data is might take the form of polarization, in which different parts critical and sensitive since such analysis often designates of the city fight against each other.”515 some areas as “problematic,” and this interpretation is Segregation can be a deliberate choice, such as when then used to inform policy. Given the importance of local better-off groups choose to self-segregate into gentrified context, qualitative research is an important complement areas or gated communities, or can be a separation forced to statistical analysis for developing a well-rounded on people by outside factors, such as when marginalized understanding of any area. However, while a solid populations are concentrated in poor areas. A ghetto is knowledge base is key for informing policymakers, it cannot the most extreme form of forced segregation. “There are replace political will to implement change. no universal rules to determine what is ‘still acceptable’ Typically, the policies that are in place at the EU level and at and what is ‘an extreme’ level of segregation, but it is the national and local levels in Romania encourage area- clear that both extreme forms of self-segregation by the based interventions in areas that policymakers consider rich and coerced forms of segregation of the poor are part to be “problematic.” Area-based interventions are usually of the problem of an unequal society and ‘unjust’ urban divided into “hard” and “soft” measures518 as follows: development.”516 The most common type of segregation in Romania is related to economic and financial inequalities. This aspect has received little attention in the segregation literature • H  ard interventions often consist of physical restructuring programs in which buildings are demolished and new infrastructure and housing compared with the racial-ethnic dimension. The factors developments are built or the housing stock is that have led to Romania’s segregation issues include the refurbished, new public facilities are created (such structural changes involved in the country’s transition to as social or cultural facilities and parks), and public a market economy, unemployment, growing economic transport is improved. precariousness, and weaker welfare systems as well as the 515 Colini et al (2013: 10). 516 Colini et al (2013: 11). 517 RegGov (2011). 518 Colini et al (2013: 29). Integrating Marginalized Communitie | 313 • S  oft interventions strengthen networks and which areas are in need of these interventions. • interactions between people in the area (for example, through work integration and training programs  orizontal policy integration means coordinating H in specific areas, field work to find solutions for all policies that are relevant for the development the immediate problems of the homeless or other of an area. Other than physical interventions, key types of people in extreme situations, and local sectoral policy areas are housing, public transport, festivals where the community can gather) and education, employment, culture, and the provision of help individuals to access the labor market through social services. Horizontal policy integration requires training, work experience, and job placement. adapting existing services and organizations to the specific needs of the area and increasing coordination However, these initiatives often do not address the driving between the different service providers. To strengthen forces behind segregation such as the deregulation of horizontal integration, URBACT, an EU program housing markets or the shrinking welfare state. Instead, promoting sustainable urban development, has neighborhood regeneration projects tend to focus on suggested, “…the creation of multi-purpose amenities buildings and infrastructure rather than people and do not and collaborative projects with different partners as challenge the rising land values and house prices that force a way of creating a concrete action around which the relocation of less affluent inhabitants. Regeneration partners at the horizontal level could collaborate.”519 projects, at least in theory, have yet to find a balance between social inclusion and economic competitiveness At the European level, the segregation and integration and need to be supported by a broad range of public of marginalized or deprived neighborhoods has so far and private actors (public agencies, landlords, residents, mainly been discussed, analyzed, and acted on in relation and businesses) to be effective. While politicians often to urban areas in the context of urban regeneration and favor quick and visible interventions that have immediate development policies. However, in Romania a large share visible results, neighborhood change takes time and of the population lives in rural areas. Out of the 3,181 often softer, incremental measures would be more administrative units within the country, only 320 are urban effective in the long term. Also, at least in Romania, many settlements, while 2,861 are rural communes. Segregated marginalized communities and deprived neighborhoods and marginalized communities are emerging, especially have a bad reputation with the general population, so local in urban areas, consisting of concentrations of people administrators and politicians who attempt to regenerate who have fallen into extreme poverty as a result of the them can often lose political support. structural changes associated with Romania’s transition to a market economy that resulted in unemployment, growing Both area-based and people-based interventions are crucial precariousness, and weaker welfare systems. Nevertheless, for fighting segregation in marginalized areas. Both sectoral marginalized communities can also be found in rural areas, (people-based) and spatial (area-based) interventions must although to a lesser extent than in cities. be integrated within the strategy. The relevant policies and programs should be coordinated among all levels of In the Romanian context, the “problematic” marginalized governance (vertical policy integration) and across sectors communities can be defined as areas characterized by low (horizontal policy integration): human capital, limited formal employment, and inadequate • housing. This definition applies to both for rural and urban  ertical policy integration can be initiated in many V areas, but we devised two identification methodologies ways. One way is for national policymakers to based on different indicators in order to reflect the specific make strong national policies, selecting the areas circumstances of each type of area (see Annex Table of intervention and requiring the cooperation of the 10.21). We used the Atlas of Urban Marginalized Areas520 to regional and local authorities. This model prevails in identify urban marginalized areas, and we identified rural England, France, the Netherlands, and Sweden. In marginalized areas by means of a methodology developed other countries such as Hungary or Spain, the rules as part of this background study that will be further and conditions for deprived areas are selected at the developed as an Atlas of Rural Marginalized Areas under national or regional level, but local authorities decide the Flagship Initiative #6. 519 URBACT (2011: 54) in Colini et al (2013: 33). 520 World Bank (Swinkels et al, 2014a). 314 | AREA-BASED POLICIES BOX 48 Examples of Good Practice in Interventions legal requirements. In urban areas, every to Tackle Segregation in Europe municipality is required to achieve a minimum of 20 percent of social housing in its housing There are several good practice examples in from stock by 2020. (For more information, see different European countries of both area-based and www.aurg.org/sru/sru.htm.) people-based interventions. Germany: Soziale Stadt (Socially Integrative City) AREA-BASED INTERVENTIONS This program is targeted to “neighborhoods with special England: New Deal for Communities development needs.” It was launched by the federal The New Deal for Communities Programme was government in 1999 as a legacy of the first URBAN initiated by the Blair government to help some of Community Initiative. It is part of a scheme jointly financed England’s most deprived neighborhoods. It ran from by the federal government and the states (Länder), which 1999 to 2008. The goal was to “close the gap” between covers cities all over Germany. By 2012 more than 500 39 deprived urban areas and the rest of the country neighborhoods had participated in the scheme. through investments of an average of €50 million in The Soziale Stadt program focuses on upgrading and each area over 10 years. The method was to achieve stabilizing critical urban areas and preventing the holistic change in relation to three area-based outcomes downward spiral of social exclusion and segregation by – crime, community, and housing and the physical inviting the neighborhood’s inhabitants to participate in environment – and three people-based outcomes – the development, prioritization, and implementation of education, health, and joblessness. Local partnerships locally based bottom-up actions. were established in each regeneration area to ensure that the change was community-led. Soziale Stadt in North Rhein-Westphalia was one of the first area-based initiatives and was part of the urban SECTORAL (PEOPLE-BASED) INTERVENTIONS development funding started in that Land in 1993. Its France: Social mix and urban regeneration approach is one of the most comprehensive examples of integrated urban regeneration at the neighborhood level In 2000 a law called Solidarité et Renouvellement in Europe. Eighty city neighborhoods in North Rhein- Urbains (urban solidarity and renewal) came into force Westphalia have created and implemented local action in France. The main goal of the program, which is still plans under this program. in operation, is to tackle urban segregation and to strengthen solidarity among citizens in urban areas. Source: Colini et al (2013: 28-30). It promotes a housing tenure mix through the use of In the case of both methodologies, we used 2011 Census data, and our analyses were done at the census sector 3.2.1. Integrating level (see Annex Table 10.22) using three broad sets of indicators: (i) human capital; (ii) formal employment; and Rural Marginalized (iii) housing conditions. By definition, marginalized areas (census sectors) were those that had disadvantages in all Communities three respects. In Romania, the majority of people at risk of poverty In the next three sections we discuss the marginalized or social exclusion live in rural areas (see Chapter 2). communities in rural and urban areas including both Roma However, rural poverty is diverse, from the poverty of small and non-Roma communities. The final section presents villages and those with aging populations to marginalized the multi-sectoral integrated area-based approach that is communities characterized by low human capital, low the most appropriate for ensuring the reintegration of these formal employment, and inadequate housing. marginalized communities and discusses lessons learned At the national level, 6.2 percent of the rural population, 5.3 from previous interventions that have been piloted by percent of all households, and 5.2 percent of all dwellings various local authorities or NGOs. are located in rural marginalized areas. Integrating Marginalized Communitie | 315 These rural areas are severely deprived census sectors In 42 percent of the rural marginalized sectors, high in which most of the population have completed only proportions of residents belong to the Roma ethnic minority. lower secondary education at most, make a living in Self-identified Roma people represent, on average, 27 the informal sector (especially agriculture), and live percent of all residents, which appears to indicate an in housing conditions that are precarious even by the estimated521 proportion of Roma identified by the authorities usual low standard for rural areas that generally have (or hetero-identified) of about 42 percent. Qualitative little basic infrastructure or utilities (in other words, they research522 has shown that rural marginalized communities live in overcrowded houses and/or have no access to include two broad types of communities, namely Roma running water or electricity). These marginalized areas are hamlets and communities of venetici (in-migrants). Roma considered to be “problematic” specifically because they hamlets are popularly called tiganie and are usually located are characterized by low-income households, populations at the periphery of villages. The venetici communities were with low levels of education and skills relevant to the labor formed by in-migrants who came before 1989 and settled market, a preponderance of single mothers, large numbers in a village because cities were near. The state provided of children, and a high rate of petty crime. Even more than them with an apartment in the block areas built in the the other rural communities, the marginalized areas have 1980s or in former state-owned farms or workers’ colonies, dirt streets and bad housing, are exposed to environmental and they worked either in the village agricultural enterprise hazard (such as floods and landslides), and have poor or in a state-owned industrial enterprise in a nearby town. quality or no public services. Table 43 and Figure 51 After 1990, many of them were made redundant. Being compare the profile of rural marginalized areas with that of in-migrants, they were not granted any reinstated land non-marginalized areas. although they remained in the village. Accordingly, large numbers of these households fell into poverty. FIGURE 51: Rural Marginalized Areas by Key Indicators, 2011 90 80 83 80 72 70 Human capital 54 56 60 45 47 Employment 50 36 38 40 Housing - electricity 29 30 Housing - overcrowding 20 13 14 10 5 Housing - piped water 1 1 0 Non-Marginalized Areas Marginalized Areas Total Rural 521 According to the National Survey on Roma conducted by the Research Institute for Quality of Life in 1998 in the rural areas of Romania (Zamfir and Preda, coord., 2002), out of every 100 individuals identified by the authorities as being Roma, 64 people self-identify as Roma. 522 See, for example, Stănculescu and Berevoescu, (coord., 2004); Sandu (2005); Berescu et al (2007); and Stănculescu et al (2010). More recent research on the topic is not available. As part of the planned Atlas of Rural Marginalized Areas, a qualitative study was developed in May-June 2015 to identify the main subtypes and characteristics of rural marginalized communities. 316 | AREA-BASED POLICIES Rural Marginalized Areas by Key Indicators, 2011 TABLE 43:  Rural Rural Criteria/ Total Key indicators Non-marginalized Marginalized Dimension Rural Areas Areas Proportion of people aged 15-64 years old who Human capital 45 80 47 completed 8 grades or less Proportion of people aged 15-64 years old who are Employment neither in education nor have ever been in formal 54 83 56 employment (employees, employers, or pensioners) Proportion of dwellings not connected to electricity 1 5 1 Housing Proportion of overcrowded dwellings 13 29 14 Proportion of dwellings not connected to piped water 36 72 38 Source: World Bank calculations using the 2011 Population and Housing Census. Overall, in Romanian communes, 2,244 census sectors523 15 and 19 years old living in rural marginalized areas meet the criteria for being rural marginalized areas, and compared to those in non-marginalized ones (51 percent as over 564,000 people live in those sectors. Children opposed to a 23 percent in non-marginalized areas). The (between 0 and 17 years old) represent more than one-third proportion of people neither working as employees nor in (34 percent) of the total population in rural marginalized education among people aged between 20 and 64 years areas, while the elderly account for only 13 percent (for old is almost 64 percent in rural non-marginalized areas, comparison, the average shares for rural non-marginalized but this increases to 88 percent in rural marginalized areas; areas are 22 percent for children and 19 percent for people the indicator is highest for Roma women living in rural aged 65 or older). One in every four households in rural marginalized areas (95 percent). marginalized areas has five members or more compared Rural marginalized communities are spread across 992 with only 15 percent in non-marginalized areas, while communes (or 35 percent of all communes in the country), 16 percent of households have three children or more with significant regional differences (see Annex Table compared with only 5 in non-marginalized areas. The 10.26). The marginalized census sectors are located in proportion of teenage mothers is more than three times 1,605 villages (14 percent of all villages) in all counties and higher in rural marginalized communities than in non- regions of the country. The proportion of the population marginalized ones (4.6 percent of girls aged between 13 living in rural marginalized areas (census sectors) is over and 17 years old compared with 1.3 percent). Rates of twice as high as the national rural average in the North East marginalization for the key groups in rural areas are shown region (6.2%). While most villages have no marginalized in Annex Table 10.23.. areas, in 663 villages more than half of their populations While as much as 80 percent of the adult residents of live in such areas.524 As regards the communes, in 157 the rural marginalized communities have completed communes (representing 5.5 percent of the total number of less than eight years of school, of whom 35 percent communes),525 more than one-third of the populations live have only a primary education, in the non-marginalized in marginalized communities.526 communities the proportions drop to 45 percent and 8 percent respectively (Annex Table 10.24). The percentage of people neither working as employees nor in education or training is twice as high among youths aged between 523 Out of all 46,547 census sectors in rural areas at the time of the 2011 census. A number of 2,523 census sectors were not included in the analysis either because they have fewer than 50 inhabitants (2,473) or because they were not sectors of households. 524 In 197 villages 40 to 49 percent of the population live in marginalized areas, and in 209 villages 30 to 39 percent live in such areas. 525 The five communes with the highest shares of marginalized populations are: Bărbulești (Ialomița county), Lipovu (Dolj county), Ibănești (Vaslui county), Voinești (Vaslui county), and Joraști (Galați county). 526 In 298 communes (10.4 percent) 10 to 19 percent of the population lives in marginalized areas, and in 155 communes (5.4 percent) 20 to 29 percent live in such areas. Integrating Marginalized Communitie | 317 3.2.2. Integrating in “problematic” areas can become an additional burden for already marginalized groups because of geographical Urban Marginalized stigma, leaving them with few opportunities to acquire a proper education, find a good job, or move upward in Communities socioeconomically. As a rule, these areas tend to be underrepresented on local political decision-making bodies. In recent decades, geographically concentrations of Urban marginalized areas are often seen as discriminated extreme poverty have emerged in Romania’s urban against from a human rights perspective, particularly as areas.527 Pockets of poverty have developed within cities Roma constitute significant percentages of the population where residents fail to benefit from all types of basic in about 46 percent of these marginalized areas. However, services. In comparative terms, poverty is distributed more according to the National Survey on Roma conducted in evenly in rural areas. Where there are small and remote 1998, self-identified Roma people represented, on average, rural localities and those with aging populations that are 20.7 percent of total residents of the marginalized urban equally in need of social inclusion policies. Nevertheless, in areas of Romania, which indicates that the actual proportion rural areas, the proportion of children and vulnerable groups of Roma may be twice as high at about 40 percent.529 Thus, affected rarely reaches the same level as in these urban 60 to 80 percent of the residents of marginalized urban pockets of extreme poverty. areas belong to other ethnic groups than Roma (most being At the national level, 3.2 percent of the population, 2.6 ethnic Romanians). percent of households, and 2.5 percent of dwellings are Overall, 1,139 of the 50,299 urban census sectors in the located in urban marginalized areas. These are severely 2011 Census met the criteria for being marginalized areas, deprived areas that combine low human capital (little and nearly 342,000 people live in those areas. These education, poor health, and/or a high number of children) were located in 264 cities in all counties and in the capital with low formal employment and inadequate housing city, Bucharest (see Map 11). The census data show that conditions.528 On the one hand, urban marginalized 342,933 people lived in marginalized urban areas as of areas often consist of socially isolated poor areas within 2011. Children (aged between 0 and 17 years old) represent cities and towns in Romania and, as such, are not always almost one-third (31.3 percent) of the total population in well reflected in aggregated poverty statistics at the marginalized urban areas, while the elderly account for only local or county level. On the other hand, they represent 4.1 percent. One in every five households in marginalized “problematic” areas as described in various studies and urban areas has five members or more, and 11.9 percent thus are targeted by urban regeneration programs and of households have three children or more. Almost half policies against segregation. These marginalized areas are (48.9 percent) of all adult residents of urban marginalized deemed to be “problematic” as a result of a combination areas have completed fewer than eight years of school. of bad housing, dirty and decrepit streets, a concentration The percentage of people who are neither in employment of low-income households, low levels of education and nor in education or training (NEET) is almost three times skills relevant to the labor market, overall poor health, higher among youths aged between 15 and 19 years a preponderance of single mothers, large numbers of living in marginalized areas than the urban average (28 children, poor quality and/or segregated schools, and a high percent versus 10 percent). The proportion of people aged rate of petty crime. In addition, such areas are physically between 20 and 64 years old who are employed is almost inaccessible and are exposed to environmental degradation, 63 percent at the national urban level, but this decreases with only low-quality or no public services. Thus, the to about 48 percent in marginalized areas and drops market value of the land and dwellings in these areas is further to 35 percent among women. For Roma, less than much lower than in other areas of the same city. Living 31 percent who live in such areas are employed, and this 527 Stănculescu and Berevoescu (coord., 2004); Sandu (2005); Berescu et al (2006); Berescu et al (2007); Preda (coord., 2009); Stănculescu et al (2010); Botonogu (2011); and World Bank (Swinkels et al, 2014a). 528 The methodology for identifying urban marginalized areas was developed in a World Bank study (Swinkels et al, 2014a) using 2011 Population and Housing Census data. It identifies three broad criteria: (i) human capital; (ii) formal employment; and (iii) housing conditions. The analysis was done at the level of the census sectors. Marginalized areas (or census sectors) were defined as those that were disadvantaged in all three respects. In addition, the study identified three other types of urban areas that were disadvantaged on terms of one or two of the three criteria. The majority of the total urban population (67.8 percent) lives in non-disadvantaged areas, while 11.7 percent live in areas disadvantaged in terms of human capital, 9.9 percent live in areas affected by unemployment, 5.2 percent live in areas disadvantaged in terms of housing, and 2.3 percent live in other urban areas. 529 According to the National Survey on Roma conducted by the Research Institute for Quality of Life in 1998 (Zamfir and Preda, coord., 2002), the hetero-identification/self-identification ratio, in the case of the Roma, is as follows: for every 100 individuals hetero-identified by the authorities as Roma, 56 people in urban areas and 64 people in rural areas self-identify as Roma. 318 | AREA-BASED POLICIES drops down to only 14 percent among Roma women. Rates towns (those with less than 20,000 inhabitants) contain the of marginalization for these key groups in urban areas are largest number of residents of urban marginalized areas, shown in Annex Table 10.23. with almost 153,000 people living in these cities. While 56 cities have no marginalized areas, in five cities530 more Urban marginalized communities are found in most cities than one-third of the population (up to 47 percent) live in of the country but with significant regional differences such areas. There are also regional discrepancies. The (see Annex Table 10.26). The marginalized urban census percentages of the population living in marginalized areas sectors are located in 264 cities in all counties and in the are 4.3 percent in the North-East and Central regions, 4.2 capital city, Bucharest (see Map 11). The proportion of the percent in the South-East, and 3.7 percent in the West, population living in marginalized urban census sectors is while the other regions have rates equal to or smaller than over ten times higher in very small cities (with fewer than the national average of 3.2 percent. 10,000 inhabitants) than in Bucharest. Furthermore, small Proportion of the Urban Population Living in Each Type of Disadvantaged Area or in MAP 11:  Marginalized Areas in Each of the 42 Counties BOTOȘ ANI Typology of urban areas SATU MARE MARAMUREȘ SUCEAVA BISTRIȚA-NĂSĂUD IAȘ I SĂLAJ BIHOR NEAMȚ CLUJ MUREȘ HARGHITA VASLUI BACĂU ARAD ALBA COVASNA SIBIU TIMIȘ VRANCEA GALAȚI HUNEDOARA BRA?OV BUZĂU CARAȘ -SEVERIN ARGEȘ VÂLCEA PRAHOVA BRĂILA TULCEA GORJ DÂMBOVIȚA ILFOV MEHEDINȚI IALOMIȚA Region BUCHAREST County CĂLĂRAȘ I OLT CONSTANȚA DOLJ TELEORMAN GIURGIU Resident population % population in non-disadvantaged areas % population in areas disadvantaged on housing % population in areas disadvantaged on employment % population in areas disadvantaged on human capital Data source: NIS, Population and Housing Census 2011 Cartography: ESRI, ArcGIS 10.1 % population in marginalized area 50 25 0 50 100 150 km % population in areas with institutions or with less than 50 persons Source: World Bank (Swinkels et al, 2014a: 14). 530 These cities are: Aninoasa (Hunedoara county), Podu Ilioaiei (Iași county), Budești (Călărași county), Băneasa (Constanța county), and Ștefănești (Botoșani county). Integrating Marginalized Communitie | 319 The recently published Atlas of Urban Marginalized Areas Ghetto communities are fragmented between owners and used qualitative research methods to identify four broad tenants, between the “bad” and the “well-behaved” (cuminti), subtypes of marginalized urban areas that partially overlap and between the “self-declared leaders” and the “weak” with each other:531 ones characterized by low self-esteem, a lack of confidence in other people, and a lack of trust in institutions (public (1) Ghetto areas of low-quality apartment or private). These communities are also characterized by blocks or former workers colonies.532 helplessness, which is accentuated by the constant shame of living in a disreputable area and is associated with a strong feeling of being belittled and discriminated against by most of society. In fact, many residents of ghetto areas hide their address in order to try to maintain their respectability. (2) Slum areas of houses and/ or improvised shelters.533 These marginalized areas consist of low-quality housing facilities built before 1990 for workers employed by large enterprises during the socialist regime. Most often, these are small to medium-sized buildings (housing 150 to These areas comprise old neighborhoods on the outskirts 500 residents) concentrated in one or more low-quality of cities with very poor populations that include both Roma apartment blocks with a desolate appearance. The main and non-Roma. Most have expanded in size since 1990. problems include massive overcrowding, which puts serious In addition to low-quality houses made of adobe, many pressure on the block’s utilities (electricity, water, sewerage, additional improvised shelters have been put together and garbage collection). over time, either within the courtyards of old houses or in In addition to very poor living conditions, ghetto residents public areas. These shelters are often made of plastic and face three major problems: (i) being unable to pay for cardboard with some wooden frames. utilities; (ii) fear of being evicted because of overdue debts In these slums, the community tends to be spread over a (for tenants of social housing); and (iii) weak support large area, which makes their problems much more difficult networks and low social capital because of the negative to tackle. In some slums, there is virtually no infrastructure reputation of the area. Paying for utilities is a challenge for or, for example, only one tap that supplies water for the a large part of the Romanian population, but it is especially entire area. In other areas, the infrastructure is developed difficult for ghetto residents. In most ghettos, the majority along the main street but is not available in the rest of the of the population has some overdue debt related to utility area (not even electricity). As a result, many of these areas payments, some of which was built up by previous tenants are insanitary and are greatly exposed to natural hazards of their apartments. In order to avoid attaching overdue such as heavy rain or floods. debt to the rent in social housing, some municipalities evict tenants when they cannot pay their utility bills. 531 World Bank (Swinkels et al, 2014a). Note that these subtypes cannot be distinguished in the census data. 532 Photo: World Bank (Swinkels et al, 2014a). Aleea Romanilor, Călan, Hunedoara county. 533 Photo: Berescu (2010). Pata Rat, Cluj, Cluj county. 320 | AREA-BASED POLICIES The main problem for the people in these areas, in addition (3) Modernized social housing.535 to extreme poverty and miserable housing conditions, is the lack of identity papers and property documents, even in places where the local authorities have declared this issue to have been resolved. This problem is common to all slum areas. Even more difficult is the situation of those who live in plastic and cardboard shelters situated on public land. Current legislation does not allow municipalities to make them legal owners of this land or give them legal rights of possession. This problem can only be solved through national legislation. In some areas, especially those that contain improvised shelters, the actual number of inhabitants is unknown, and the census enumerators were only able to obtain data Modernized social housing in urban areas was often from part of the population. Therefore, the inhabitants of developed as part of integrated projects that combined these areas are at least partly invisible in the official figures substantial investment in new buildings with a series of except for those residents who apply for social benefits. social interventions. These areas are well-served with Consequently, residents claim that they are highly exposed infrastructure and utility services (sometimes better served to the discretionary actions of the powerful leaders of than the rest of the urban area), but they are often not competing gangs that are active in the area. While some affordable. Also, they are often located on the outskirts of slums can be peaceful and quiet, particularly the older the city from where the residents have been relocated from neighborhoods, others are unsafe. slums or other marginalized urban areas. Thus, paying for utilities still represents a major problem for the residents of The main issues in the slums will require significant social housing who tend to be poor people in difficult social investments in infrastructure and urban planning and/ situations. This often results in the rapid deterioration of or a change in legislation (in the case of slums on public their dwellings and can lead to forced evictions. land). Low school attendance and high school dropout rates need to be addressed by local authorities, schools, In the case of many areas of modernized social housing, Roma leaders, Roma experts, education experts, and civil the designers of the modernization did not pay enough society organizations. Addressing the situation in these attention to: (i) the geographical location of the social often-expanding communities will require the development housing complex within the city; (ii) holding an information of a national framework for well-coordinated actions in and consultation process before any relocation; and (iii) the the medium and long terms along with considerable ethnic composition of the relocated population. If an area investment. The European Commission has recommended is torn out of the context of the city and offers only housing that a land-use and housing strategy should cover an with no other services, is inhabited by a single group defined entire functional urban area - the de facto city - to prevent in ethnic, social, economic, or cultural terms (for example, segregation.534 Roma or the poor), has little development potential, and is dependent on public transportation for accessing basic services such as schools, then that area is segregated regardless of how modern the housing conditions are. This problem is exacerbated when an imposed relocation was carried out in a very short time and without adequate notice to the residents involved. Consequently, some areas of modernized social housing have deepened segregation instead of promoting integration. Furthermore, local authorities in various cities are planning to demolish the pockets of poverty that have grown within the city 534 European Commission (2011b). 535 Photo: World Bank (Swinkels et al, 2014a). Drochia area, Dorohoi, Botosani County. Integrating Marginalized Communitie | 321 and to relocate the residents, mostly the poor and Roma Except for the fact of being located in city centers, the communities, to “nicer” and well-serviced compact living conditions of these communities to a large extent complexes of buildings outside the city, for example, ”on resemble those that prevail in slum areas. Because the a hill” or “next to a forest.” These plans, however well- location of such houses is extremely attractive to investors, meaning, are also likely to exacerbate segregation. these buildings have a potentially high market value, which means that the former owners of these houses (or their (4) Social housing buildings in historical areas inheritors) have made great efforts to repossess them. In in the city center.536 accordance with Law 10 passed in 2001, the rights of the former owners (or their successors) were reinstated, and the tenants were given five years to find new housing. A number of people were allowed to stay in some ruined buildings but were not given any identity papers as tenants living at that address, given that the building had been administratively registered as “destroyed.” As a result, many people who have lived in an area for 10 to 15 years or even longer often have only provisional identity papers that state that they are “without dwelling.” This means that the person in question cannot get a job, has no right to medical care or social benefits, and may suffer other deprivations. Marginalized areas of social housing buildings in “historical All over Europe, the argument that concentrations of city centers” or “historical urban areas” are effectively poor people tend to lead to crime in a given area has been areas of individual houses - often in an advanced state of dangerously misused to justify dispersing communities with dilapidation - that were nationalized during the communist no proper resettlement of the displaced people.537 International period and, after 1990, used as social housing. Local evidence shows that policies of dispersal often have significant authorities assigned most of these houses to poor families, human costs. When demolition is also involved, it represents either before 1989 or in the early 1990s. Some, especially a policy failure with enormous cost implications, and there those in a very poor condition, were illegally occupied by are many examples of such interventions that have had homeless people. These are old neighborhoods where controversial outcomes (see Box 49). people have often lived for 30 years or more. BOX 49 Displacement Interventions in Romania the destruction of the few goods that the occupants own. This kind of action reinforces The most worrying interventions that local authorities social exclusion and denies children who have taken in marginalized urban areas in Romania already live and grow up in misery any are those involving the wholesale displacement chance of escaping poverty and marginalization. of the inhabitants. In most marginalized areas, the Unfortunately, very few local authorities have so far buildings are decrepit (some on the verge of collapse), chosen to react to the problems of urban marginalized sanitation is appalling (due to a lack of running water areas by cooperating with institutions or NGOs in the and of a sewerage system), and various forms of fields of health, education, culture, or religion or with the violence and small crime are widespread (aggravated residents themselves to come up with better solutions. by overcrowding). In response, local authorities have often decided to take a radical approach and have Sources: Stănculescu and Berevoescu (coord., 2004), evicted the inhabitants from the area, making no effort Berescu (2010), and World Bank (Swinkels et al, to resettle them elsewhere. These evictions have 2014a). usually been hasty and forceful and have often involved 536 Photo: World Bank (Swinkels et al, 2014a). Historical center Uranus, Bucharest. 537 Colini et al (2013: 29). 322 | AREA-BASED POLICIES 3.2.3. Integrating Roma Târgu Mureş, and Sibiu) and in the southwest between Craiova and Drobeta-Turnu Severin close to the border with Communities Bulgaria and Serbia. Poverty maps estimated using data from the 2011 Census indicate that the population at risk of poverty or social exclusion tends to be clustered in the East The Roma population does not always overlap with the and South of the country in areas that contain a relatively poorest regions in Romania, as a recent World Bank low concentration of Roma. Consequently, policymakers study has shown.538 According to the 2011 Population and should keep in mind that measures aimed at addressing Housing Census, the self-identified Roma population is the challenges faced by poor and marginalized groups in mainly located in clusters around the western border of general may not have a direct impact on large segments of Romania, in the heart of Transylvania (usually around large the Roma minority because these two populations do not urban centers like Timişoara, Arad, Oradea, Cluj-Napoca, overlap geographically. The Correlation between Local Human Development (LHDI) and the Presence of Roma MAP 12:  Source: World Bank (Ionescu-Heroiu et al, 2013a: 169). 538 World Bank (Ionescu-Heroiu et al, 2013a: 167). Integrating Marginalized Communitie | 323 Nonetheless, there seems to be a large number of poor in need (including Roma). However, the question is localities to the South and East of Bucharest that also whether this instrument captures the specific problems of happen to contain a relatively high concentration of Roma. communities with high proportions of Roma residents and This key insight, which appeared in the same study,539 whether it excludes parts of the Roma population living in emerged from comparing the LHDI540 with the presence difficult situations. The current background study conducted of Roma communities (see Map 12). The fact that these for preparing the National Strategy on Social Inclusion and rural communities are so close to the country’s capital city Poverty Reduction 2015-2020 indicated the following: and premier economic engine but still fail to benefit from (1) When the methodology for identifying marginalized spillover effects once again underscores the need to target communities was applied to the 2011 Census data, this measures specifically to Roma communities. confirmed that the population who self-identified as Evidence indicates that most Romanian Roma live in Roma542 was very much territorially concentrated (Annex segregated communities. The recent World Bank study Table 10.23). In rural areas, nearly 39 percent of all self- on Roma integration541 found that 56 percent of Roma identified Roma live in marginalized communities (which households live in settlements where the dominant are characterized by a combination of low human capital, ethnicity is Roma, indicating a high level of al segregation. low formal employment, and poor housing conditions) as Segregation is highly correlated with lower health status, opposed to less than 5 percent of non-Roma. In urban early school leaving, low labor market attachment, and areas, almost 31 percent of the self-identified Roma live in costly access to other services (such as public transport marginalized areas, while the share of non-Roma is only or healthcare facilities). About half (51 percent) of Roma 2.6 percent. Furthermore, the Atlas of Urban Marginalized households living in segregated communities live in Areas543 showed that an additional 40 percent of self- dilapidated houses or slum conditions. identified Roma live in areas disadvantaged in terms of human capital,544 which by definition differ from the A key issue with direct policy implications for designing marginalized areas only with regard to housing conditions. targeted interventions is whether Roma communities and This does not mean that Roma who live in areas with low the marginalized communities discussed in the previous human capital have good housing conditions, but they are sections overlap or not. The methodology for identifying not as bad as the dwellings in marginalized areas. This marginalized communities (in both rural and urban areas) difference can be seen in the following photographs. can be used to identify and target resources to people A Roma dwelling in an urban area with low human capital A Roma dwelling in an urban marginalized area Photo: World Bank (Swinkels et al, 2014a). Photo: World Bank (Swinkels et al, 2014a). Valea Rece, A typical villas area, Targu Mures, Mures county. Poligon area, Aiud, Alba county. 539 World Bank (Ionescu-Heroiu et al, 2013a). 540 See the definition of the LHDI in footnote 472, at the beginning of chapter 3.1. 541 World Bank (Anan et al, 2014). Based on data from the 2011 UNDP/World Bank/EC Regional Roma Survey. 542 In the 2011 Population and Housing Census, 621,573 people self-declared as Roma in the entire country, of whom 230,670 were in urban areas. 543 World Bank (Swinkels et al, 2014a). 544 The proportion of self-identified Roma living in non-disadvantaged areas is extremely low, at only 16.1 percent. For comparison, the majority (67.8 percent) of the total urban population lives in non-disadvantaged areas, while only 11.7 percent live in areas disadvantaged in terms of human capital and 3.2 percent in marginalized areas. 324 | AREA-BASED POLICIES (2) The larger the share of Roma residents in a community, percent Roma, and only 25 percent have no Roma at all (in the higher the probability of that community being comparison only 1.8 percent of all census tracks have more marginalized (Figure 52). In urban areas, while only 1 than 20 percent self-declared Roma). Similarly, in rural percent of communities with no self-declared Roma areas, the probability of being marginalized increases from are marginalized, 47 percent of communities with large 4 percent of communities with no self-declared Roma to 53 shares of Roma are disadvantaged in all three dimensions percent of communities with large shares of Roma. Also, out (human capital, employment and housing). Of the 1,139 of the 2,244 Census sectors identified as marginalized, 29 census sectors identified as marginalized in the Atlas of percent have more than 20 percent Roma compared to only Urban Marginalized Areas, 29 percent have more than 20 5 percent of all rural census tracks. FIGURE 52: Distribution of Census Sectors in Marginalized and Non-marginalized, by the Share of Roma in the Total Population in Urban and Rural Areas in Romania, 2011 100% 290 521 1310 276 164 162 80% 188 494 60% 37,156 11,432 33,151 7,262 40% 937 383 20% 166 434 0% 0 0.1-19.9 20-39.9 40-100 0 0.1-19.9 20-39.9 40-100 Urban Rural Share of Roma in total population of census sectors Non-marginalized Source: World Bank calculations using 2011 Population and Housing Census data. Marginalized Note: The total number of census sectors was 50,298 in urban areas and 44,028 in rural areas. (3) Within the same types of communities (rural or urban, and decreases to 52 percent for non-Roma. In urban marginalized or not marginalized) with similar percentages marginalized communities with less than 20 percent Roma of Roma within the community, Roma are much more population, 68 percent of Roma of working age who are not often socially excluded from education and employment in school are not working or retired, while the percentage as can be seen in Figure 53 and Figure 54. For example, in is only 39 for non-Roma who are not in school living in the rural marginalized communities with a large concentration same communities. As a rule, the gap between Roma and of Roma, the proportion of young people aged between non-Roma is more accentuated in urban areas, especially 16 and 24 years old who completed no more than the in non-marginalized communities and in areas with lower gymnasium level of education is 83 percent among Roma shares of Roma. Integrating Marginalized Communitie | 325 FIGURE 53: Proportions of Youths Aged 16-24 Years Old with a Lower Secondary Education at Most and Not in School by Ethnicity, Type of Area, and Different Percentages of Roma (%) 90 84 83 80 79 79 Share of 75 78 7576 75 70 Roma in total 61 6256 60 52 population of 60 43 the census 38 35 34 31 31 33 31 sectors 2728 30 0 6 9 0 0 0 0 0 (0.1-19.9) Roma Non-Roma Roma Non-Roma Roma Non-Roma Roma Non-Roma (20-39.9) Marginalized areas Non-marginalized areas Marginalized areas Non-marginalized areas (40-100) RURAL URBAN Source: World Bank calculations using 2011 Population and Housing Census data. FIGURE 54: People Not Retired or Employees among Not-in-School 15-64 Year-Olds by Ethnicity, Type of Area, and Different Percentages of Roma (%) 120 Share of 92 94 93 84 84 90 8278 85 Roma in total 82 73 6971 7272 population of 68 60 57 5455 the census 60 50 47 45 44 sectors 3939 40 30 19 21 0 0 0 0 0 (0.1-19.9) 0 Roma Non-Roma Roma Non-Roma Roma Non-Roma Roma Non-Roma (20-39.9) Marginalized areas Non-marginalized areas Marginalized areas Non-marginalized areas (40-100) RURAL URBAN Source: World Bank calculations using 2011 Population and Housing Census data. 326 | AREA-BASED POLICIES (4) The exclusion of Roma from decent housing is specific non-Roma, especially if they live in urban areas either to urban areas, while in rural areas limited access to in communities with a high concentration of Roma or in utilities tends to be common to all residents. Annex Table marginalized areas. 10.27 shows the substantial gap between urban and (5) In general, the higher the share of Roma in a rural dwellings in terms of basic utilities. The dwellings in marginalized community, the worse the values of all social marginalized areas are less endowed with utilities than exclusion indicators are. Although in all marginalized those from non-marginalized communities, but the gap communities the situation is by far worse than in other is considerably wider in urban areas. For example, the areas, the share of Roma continues to be a good predictor share of people living in dwellings with no piped water of the severity of the problems for everyone in these areas. varies in urban areas from 8 percent in non-marginalized If, for example, in marginalized areas with no self-declared communities to 34 percent in the marginalized ones, while Roma, 31 percent of youths aged between 16 and 24 years in rural areas the share is 66 percent in non-marginalized old are not in school and have attained a lower secondary areas and 86 percent in marginalized communities. In education at most, whereas in marginalized communities rural areas, the gap is much narrower with respect to other with more than 40 percent of the population being Roma, services than in urban areas given that 99 percent of the the equivalent figure is 65 percent (Figure 55). The share rural population live in dwellings with no hot water from a of Roma is a good predictor of the severity of exclusion public network, 94 percent with no connection to a sewage within non-marginalized areas as well. For instance, disposal system, and 90 percent with no gas for cooking. the same indicator (the proportion of young people who Similarly, there is little variation according to the share of have completed gymnasium at most) varies between Roma in total population in rural areas,545 whereas in urban only 6 percent in urban non-marginalized areas with no areas it is significant, particularly in the non-marginalized self-declared Roma and 63 percent in non-marginalized communities (see Annex Table 10.28). Therefore, with communities with high concentrations of Roma (which is a regard to housing, Roma are more disadvantaged than value close to that in urban marginalized areas). FIGURE 55: Differences in Terms of Education and Employment between Areas with Different Shares of Roma for Both Marginalized and Non-marginalized Communities in Urban and Rural Areas (%) Proportion of 16 -24 year olds not in school Proportion of people not retired and with lower secondary or employees in population of not -in-school education at most 15 -64 year olds 90 86 90 83 81 81 76 RURAL 65 69 64 66 65 63 62 Marginalized areas 61 60 61 60 60 55 RURAL 51 49 49 47 45 48 Non-marginalized areas 46 41 31 35 URBAN 31 27 Marginalized areas 30 30 23 19 12 URBAN 6 Non-marginalized areas 0 0 0 (0.1-19.9) (20-39.9) (40-100) 0 (0.1-19.9) (20-39.9) (40-100) Source: World Bank calculations using 2011 Population and Housing Census data. 545 With the exception of electricity connection. Integrating Marginalized Communitie | 327 (6) Most importantly, with regard to human capital, The lack of capacity within local communities to design formal employment, and even to access to utilities (in and implement projects compounded by inadequate urban areas), living in a marginalized or non-marginalized central-level support is undermining the ability of many urban area makes little or no difference to the situation of disadvantaged communities to benefit from EU funds.547 In Roma; what matters is the proportion of Roma in the total particular, the EU Structural Funds, the Cohesion Fund, and population of the area. Regardless of whether they live the European Agricultural Fund for Rural Development are in a marginalized or non-marginalized urban area, Roma not reaching enough marginalized Roma communities. The have significantly lower scores on all human capital and overall absorption rate of EU Structural and Cohesion Funds employment indicators than other ethnic groups. The gap during the 2007 to 2013 period was also low in Romania. between Roma living in marginalized areas and those living This is due to a number of key factors: (i) a lack of alignment in non-marginalized areas is much narrower than the gap between the legislation regulating the implementation of between non-Roma in these two types of areas. In all types structural instruments and other relevant national laws; (ii) of areas (marginalized or not), the larger the proportion the complexity of administrative procedures; (iii) a lack of of (self-identified) Roma, the lower the human capital administrative capacity both within management authorities and formal employment of its Roma residents (but not and among beneficiaries; (iv) the absence of adequate necessarily of the non-Roma ones). With regard to housing accountability mechanisms requiring local authorities to indicators, no matter whether Roma live in marginalized address issues faced by Roma and other disadvantaged areas or in communities with high concentration of Roma, communities; (v) a lack of co-financing capability on the they are likely to have limited access to potable water and part of local authorities; and (vi) the unclear distribution connections to sewage disposal systems or electricity. of tasks among ministries and other public entities at the national level. In conclusion, interventions that target marginalized areas do not benefit all Roma. Measures are needed that are specifically targeted to Roma communities, particularly those with higher proportions of Roma, based on the EU’s “explicit, 3.2.4. An Integrated, but not exclusive” principle on Roma inclusion546 and that strongly focus on human capital (education, skills and Cross-sectoral, Area- healthcare), formal employment, and access to basic utilities based Approach to (water, sewage, and electricity). At the moment, Roma are often not explicitly targeted by social inclusion programs. Marginalized Areas Also, specific social policies, programs, and investment projects often target disadvantaged population groups but Integrated, cross-sectoral regeneration projects that without specific methodologies for measuring the extent balance social inclusion with economic competitiveness of their disadvantage. While there is not always a need to are the best way to reduce geographically concentrated target Roma exclusively, the absence of specific criteria for poverty in marginalized urban areas, in Roma communities, identifying target groups and the lack of a clear methodology and in certain remote rural areas. These interventions by which to measure these criteria makes it difficult to need to be supported by a broad range of public and target social programs at the local level. Targeting Roma private players (public agencies, landlords, residents, communities is hampered by a lack of data on ethnicity, and businesses) in order to be effective. Policies against which are not collected systematically. Collecting these segregation can relate to a particular geographical area data on a regular basis would make it possible to track social (area-based interventions) or to specific policy sectors outcomes for Roma and non-Roma communities and to carry (people-based policies). “Problematic” areas need high- out much deeper analysis of the determinants of poverty. quality, accessible services – affordable housing, education, employment, childcare, healthcare services, and public 546 The European Union’s 10 Common Basic Principles on Roma Inclusion recommend “explicit but not exclusive” targeting of measures, “focusing on Roma people as a target group but not to the exclusion of other people who share similar socio-economic circumstances” (Principle No. 3). “Policies and projects should be geared towards ‘vulnerable groups’, ‘groups at the margins of the labor market’, ‘disadvantaged groups’, or ‘groups living in deprived areas’with a clear mention that these groups include the Roma” (Principle No. 2). http://www.coe. int/t/dg4/youth/Source/Resources/Documents/2011_10_Common_Basic_Principles_Roma_Inclusion.pdf. 547 A study was conducted by the World Bank (Anan et al, 2014) in the context of the Assessment of the Communication and Collaboration between the Managing Authority and Intermediate Bodies of the Regional Operational Programs and Facilitation of Proactive and Direct Support for Beneficiaries. It indicated that, while many local communities are capable of submitting funding proposals, they often lack the capacity to design and implement projects. The report identified several capacity gaps including the inability to define or verify the technical specifications of investment projects and to undertake procurement procedures in line with the regulations on EU funds. 328 | AREA-BASED POLICIES transport – in order to achieve levels of integration on a par and poverty in marginalized areas. Similar to the role with other parts of the same city. To this end, policymakers played by LEADER in rural areas, CLLD is expected to be should consider adopting sectoral or people-based policies an effective method for reducing the segregation of the that are tailored to improving the circumstances of individuals urban poor and marginalized areas. LEADER and the EMFF or households with low incomes and specific needs in these will provide Romania with CLLD funds for rural areas and “problematic” areas. very small cities, and the ERDF and the ESF will provide funds for urban areas. This support will increase the total These policies might include: budget available for local development and will enable local • A  land use and housing strategy that applies to the whole functional urban area in order to prevent extreme segregation. authorities to consider a broader range of interventions. Nonetheless, programs that are financed from several different sources are complex to design and implement and require experience in the area of urban development, while •  pecific efforts to provide public services in S “problematic” areas. the relevant local partners need to have already established working relationships with each other. They “could prove • difficult to implement for groups experimenting with local E  ducation and school policies that aim to improve the development for the first time. It will therefore be crucial quality of education across the board and to achieve to analyze the capacity of LAGs [local action groups] and an ethnic and socioeconomic mix of students in all to choose an appropriate division of tasks between the schools. LAGs and the authorities responsible for the design and • implementation of the program... Solid preparation and  conomic interventions to increase employment, E capacity-building actions should be organized to enhance support start-ups, and enhance training opportunities. their administrative capacity.”548 • Local and central capacity to develop and implement  social housing policy that makes affordable A integrated projects is vital for improving the living housing available in all parts of a given city. conditions of Roma and of marginalized communities. • To date, Romanian policymakers have had no incentives  lanning regulations that prevent the development of P to tackle urban decline and target funding to segregated gated communities. neighborhoods, and the general provisions associated with •  mobility policy that guarantees equal opportunity A of access to job centers and major facilities by public transport from all parts of the city. EU funding have offered very limited opportunities to do so. Also, there has been no attempt to take an integrated approach to the design of interventions. Although several different approaches to reducing the segregation of Area-based and people-based interventions must be disadvantaged communities have been tried in Romania, integrated in a framework of participative community no comprehensive review has been done of the success or development in order to fight segregation effectively. For failure of these approaches. As a result, there is only limited the 2014 to 2020 programming period, the European Union data on how the limited number of integration policies and has proposed an approach called community-led local programs in Romania have actually performed in the field, development (CLLD) in which local people are invited to what practices seem particularly successful and why, form local partnerships to design and implement integrated and what ways exist to circumvent the often overly rigid multi-sectoral area-based strategies to tackle segregation government systems in order to ensure that integration programs are delivered responsively and effectively. 548 European Commission (2013a: 29). Integrating Marginalized Communitie | 329 BOX 50 Lessons Learned From Previous Integration 4. In order to make the community Interventions in Romania accountable, the intervention must have clear, predictable, and transparent rules and Various lessons have emerged from previous integration procedures that are publicly debated, agreed interventions that have been implemented in Romania. on by all stakeholders, and put into action. For example, 1. There is a need for a national legislative framework to an explicit and widely disseminated local policy to govern policies related to marginalized communities. regulate social housing would improve the relationship This framework should provide regulations related to: between tenants and the local authority. A clear set of • penalties and rewards should be formulated so that A  national housing policy (which has yet to be desirable behavior by tenants is acknowledged and thus developed). • rewarded, while undesirable behavior is discouraged. It  Regulations related to properties in slum areas. would be useful to provide information on both positive • and negative examples to tenants to ensure that they T  he enforcement of Law 15/2003 (according to understand what is expected of them. which mayoralties may lease public land to local people for construction purposes with proposals 5. Interventions in marginalized areas need to be selected on the basis of a set of criteria). medium-term or long-term, with a preparatory phase of • one to two years during which both the local authority nvestment in buildings owned partly by the I and the marginalized community learn to communicate, municipality and partly by the residents. • build an equal partnership, and create a participatory C  hanges in the fiscal rules for calculating the environment with a well-defined, predictable, and interest and penalties for unpaid taxes owed to transparent set of rules. state or local budgets by social tenants. • 6. Interventions in marginalized areas should include T  he settlement of historical debts related to social components targeted to neighboring non-marginalized housing services. areas to foster social integration and increase the odds of the project being acceptable to all citizens. In addition, at the city level, land use and housing regulations need to be developed that apply to entire 7. Interventions should be designed to take into account functional urban areas in order not to perpetuate differences in: extreme segregation (European Commission, 2011b). 2. Interventions in marginalized areas should be • nfrastructure (apartment blocks as opposed to I slum areas as opposed to social housing). integrated in order to combine investment projects in housing and infrastructure with projects related to employment, the education of children and adults, •  roperty (owners as opposed to tenants of social P housing as opposed to people living in improvised shelters). • sanitation services, parental education courses, family planning, the provision of hot meals for children, life C  ommunity participation (communities skills development (for teenagers), the fight against concentrated in apartment blocks as opposed to discrimination, community empowerment, and other communities spread over large areas). social, medical, or cultural activities. A national scheme of vocational training needs to be developed for adults who have little or no formal education (eight grades of •  eadership (communities with strong informal L leaders as opposed to communities with no strong leaders). • schooling at most) and who live in marginalized areas. 3. Policymakers must search for innovative solutions  he history of the area (old-traditional T to the problems of marginalized areas that are neighborhoods as opposed to new affordable for the poor but that also aim to raise family neighborhoods). incomes within the community. Only in this way can 8. Interventions targeted to children are likely to have an intervention be sustainable and the quality of life positive spillovers at the community level and thus enhanced. to increase support from residents who do not benefit directly from the project. Source: World Bank (Swinkels et al, 2014b: 32). 330 | AREA-BASED POLICIES Limited consultation between central policymakers and interventions promote integration and prevent the isolation local communities can limit the relevance and sustainability and exclusion of marginalized communities. of policies and initiatives aimed at increasing the social Having well-coordinated institutional mechanisms is a inclusion of Roma and marginalized communities by failing prerequisite for developing effective policies, implementing to take account of local needs and opportunities. Moreover, priority interventions, and reducing service delivery gaps. the discriminatory attitudes of some officials toward We recommend that the government of Romania clarify Roma can deter them from participating in the design and the responsibilities of the various institutions involved in the implementation of inclusion programs. effort to reduce geographically concentrated poverty. This Therefore, local communities should be involved in the can be done through both legislation and the establishment design and delivery of interventions. To support this, local of cooperative working arrangements at the local level. authorities could offer training to community members in The government should enact a framework law that sets areas such as participatory decision-making, accounting, out the functional relationships between various bodies and basic financial literacy. In addition, involving local as well as their budgetary sources. It should also support populations in efforts to upgrade local infrastructure could the building of capacity at the local authority level, which increase their sense of ownership, while providing them will be essential to make the most effective use of EU opportunities to work and develop skills. It is important to funds. Policymakers should also formulate a methodology ensure that these improvements to local infrastructure and for gathering stakeholder feedback, encouraging local housing will not lead to increased concentration or further participation in the design and operation of interventions, physical isolation and segregation of marginalized groups. and developing partnerships with Roma and marginalized This non-segregation principle is reflected in Article 7 of the communities. Finally, simplifying the procedures for local European Regional Development Fund (ERDF) Regulation, communities to apply for EU funds is likely to increase which was amended in May 2010 to encourage the use demand and foster local initiatives. of ERDF funds for housing interventions as long as these Integrating Marginalized Communitie | 331 Th is p age inte ntio nal ly l eft bla nk 4. STRENGTHENING INSTITUTIONAL CAPACITY TO REDUCE POVERTY AND PROMOTE SOCIAL INCLUSION 4 STRENGTHENING INSTITUTIONAL CAPACITY TO REDUCE POVERTY AND PROMOTE SOCIAL INCLUSION Strengthening Institutional Capacity To Reduce Poverty And Promote Social Inclusion The government should aim to enhance the capacity of the public system at all levels to enable all parties to work together in order to develop and implement policies to combat poverty and social exclusion. The main priorities should be: (i) upgrading the current IT system to implement a strong e-social assistance system; (ii) strengthening coordination mechanisms and developing an integrated monitoring and evaluation system; and (iii) developing a modern payment system. Each chapter dedicated to people-based (sectoral) policies presented in detail the priority measures recommended to increase and strengthen Romania’s institutional capacity to reduce poverty and promote social inclusion. Specifically, each chapter included a sectoral analysis of development needs in the areas of human, legal, financial resources and monitoring and evaluation mechanisms and went on to describe the best practice solutions to meet these needs. This chapter presents the main recommendations in each of these areas. Main Objectives Enhancing Capacity for Policy Formulation and Management at all Levels 4.1.  336 Developing an Integrated Approach in the Field of Social Policy Development 4.2.  340 Developing an Integrated Approach in the Field of Social Policy Development 4.3.  341 Improving Service Delivery with Information and Communication Technologies 4.4.  342 Modernizing Payment Systems 4.5.  344 336 | STRENGTHENING INSTITUTIONAL CAPACITY TO REDUCE POVERTY AND PROMOTE SOCIAL INCLUSION  nhancing Capacity for Policy Formulation 4.1. E and Management at all Levels Planning and management activities still represent a and targets and to prioritize and standardize management challenge at all system levels and in all sectors. Policies, and implementation procedures. programs, and services still fail to take into account Building capacity for policy formulation, planning, and existing research and rarely benefit from special needs managing services is a prerequisite at all levels and in all assessments, and because of this their efficiency can relevant sectors for developing anti-poverty and social be only partially estimated. Furthermore, there are few inclusion policies. Legislation is required to establish mechanisms for monitoring and evaluating their outcomes. the key elements and procedures involved in designing, The lack of systematic, evidence-based planning in managing, and implementing social programs. Romania hinders interventions at all stages of their implementation, making it difficult to set clear objectives A summary of the changes needed in the current legal provisions is presented in Table 44 below. Changes in the Current Legal Provisions by Sector TABLE 44:  Employment Create labor market regulations and promote social dialogue to support the ability of workers to negotiate for wages commensurate with their productivity. Social Protection Enact a new legislative and regulatory framework to consolidate the three current means-tested programs (the GMI, the FSA, and the HB) into a single program - the Minimum Social Insertion Income (MSII) program, soon to become the key anti-poverty program in Romania. Ensure longer contribution periods and higher contribution levels in order to achieve adequate pensions in the future. Review social pension policy to address the low coverage of the pension system of the working age population, especially in rural areas. Review legislation regarding anticipated pensions and the future pension age to address the problems involved in reducing the number of anticipated retirees and raising the pension age. Develop secondary legislation to enforce the government’s comprehensive law on social assistance (292/2011). Unify the medical criteria for assessing the degree of disability for people with disabilities and create a single delivery channel to serve all people with disabilities (currently two separate systems exist to certify an applicant’s disability, one for pensions and one for allowances). Develop comprehensive regulations for occupational therapy covering funding and evaluation methodologies and the inclusion of newly trained professionals in all public and private services that deal with people with disabilities. Education Ensure effective law enforcement mechanisms for ensuring free compulsory education for all children. Draft and pass a specific all-inclusive education law in accordance with the recommendations of the Office of the High Commissioner for Human Rights of the United Nations. Ensure enforcement mechanisms in accordance with the national legislation to ensure that children and young people with disabilities can receive their education in mainstream schools, in special schools, or in special classes integrated into mainstream schools. Develop a coherent framework for a real and constructive partnership between teachers and the parents of their students with special educational needs. Redesign current IVET programs by setting up apprenticeships, redesigning the curricula, developing national sponsorship programs with large companies, and focusing on students most at risk of dropping out. Enhancing Capacity for Policy Formulation and Management at all Levels | 337 Health Change the paradigm of public health policy by increased budget allocations to evidence-based preventive and health promotion services, while building programmatic capacity at all levels. Review all national health programs as of 2014 including the national mother-and-child healthcare program. Develop a national plan for healthcare services, followed by prudent investments in infrastructure and human resources. Consider developing local, regional, and national plans for reducing the incidence of unhealthy kinds of behavior and for preventing chronic diseases. Consider changing legislative provisions in order to allow local authorities to hire GPs with funds from the National Health Insurance Fund. Revise, update, and endorse the tasks and job descriptions of community health workers. Review and diversify the interventions included in the minimum and basic benefits packages delivered by family doctors and increase the share of services that proved to be effective (evidence-based services) in reaching the poor. Redesign the National Plan to Prevent and Control M/XDR-TB 2012-2015. Reinforce, through regulatory measures and county-based mapping of resources, the Direct Observed Treatment Strategy and develop procedures and guidelines for HIV/TB detection and care based on international recommendations and protocols. Issue legislation on private health insurance for those who can afford this option. Housing Elaborate a housing policy and a housing strategy to address the excessively high housing cost rate on the poor and to prevent homelessness, especially due to evictions. Ensure the pro-poor focus of the large infrastructure programs aimed at rehabilitating and modernizing the housing and utility stock. Ensure that improvements to local infrastructure and housing will not lead to increased concentration or to the further physical isolation and segregation of marginalized groups. Increase the capacity of shelters, strengthen the capacity for carrying out emergency interventions in the street, adopt regeneration programs to tackle the problem of illegal settlements, cease illegal evictions, and adopt prevention policies for people at risk of ending up in the streets. Social Participation Change the current legislative framework governing volunteering in order to encourage social participation. In terms of human resources, more and better trained staff are greatly needed in all social sectors. Thus, the previous chapters highlighted the following list of main development • I ncrease the number of professionals in strategic planning and monitoring and evaluation, as well as case management within the County Directorates for needs: Social Assistance and Child Protection (DGASPCs) • to strengthen strategic planning, methodological I ncrease the management and operational staff of the coordination, and support for the local-level SPAS as National Employment Agency devoted to developing well as in monitoring and evaluating service providers specialized local employment services (ALOFM) within the county. • and create local partnerships for the implementation of ALPMs and the sub-contracting of some of its D  evelop a continuous training system for services. professionals working in social services, including • professionals dealing with the social services D  evelop a national program to strengthen social regulatory system. There is still no dedicated assistance services at the community level for the mechanism for evaluating social services or for 2015 to 2020 period, accompanied by investment training evaluators of social services. • in community-based services such as daycare and other support services for independent or supported  trengthen the capacity of Social Inspection to S living (such as transportation, personal assistants, evaluate and control social services as well as cash assistive devices, and interpreters). transfer programs. 338 | STRENGTHENING INSTITUTIONAL CAPACITY TO REDUCE POVERTY AND PROMOTE SOCIAL INCLUSION • I nvest in and increase the number of professionals available within the County Resources and Educational Assistance Centers (CJRAEs) to enable •  rain or retrain community healthcare providers T (family doctors, community nurses, and Roma health mediators) in how to deliver quality pre- and them to become real resource centers for inclusive postnatal care and childcare. • education. • nvest in continuous medical education programs, I P  rovide systematic training for teachers and care tailored to the health needs of the most providers in how to pro vide ECEC to children from disadvantaged for family doctors and their nurses. • poor and vulnerable families. •  xtend the number of professionals specializing in E E  nhance the capacity of teaching staff to ensure the the early diagnosis of children with disabilities. • effective delivery of inclusive education to Roma children.  reate traineeships, internships, and placement C • programs in administrative positions at the central, ntroduce a national program for young specialists in I regional, and local levels, especially for young Roma agriculture. women. •  nhance the role and the capacity of the County E Directorates for Public Health to provide professional support and supervision to community health • D  evelop training for community members in areas such as participatory decision-making, accounting, and basic financial literacy. • workers (both CHNS and RHMs). •  rain community representatives in the use of the T D  evelop an effective health workforce strategy, LEADER program and the LAG (local action group) particularly for attracting and retaining staff in rural framework. areas. Besides legal changes and human resources, adequate • E  xtend and strengthen the community-based nursing system as the most powerful equalizer in the health system. Develop community-based healthcare government funding should be secured, in parallel with the funding received from various European bodies, for the reduction of poverty and promotion of social inclusion. As shown in the previous chapters, increased overall financing services in villages with no permanent family doctor’s together with improved financial management is required in practice. all social sectors. The main aspects of the issue of funding, as discussed in previous chapters, are presented in Table 45. TABLE 45:  Changes in the Current Legal Provisions by Sector Employment Increase resource allocations to - and improve the management of – labor market institutions and activation policies for socially vulnerable groups and the in-work poor. Social Protection Increase the budget of means-tested programs and their share in the overall social assistance budget. Increase the budget of the forthcoming MSII compared to the combined budgets of the current programs to ensure that social assistance funds cover most of the poor. Earmark a budget within the state budget for social assistance services at the community level and develop mechanisms for monitoring the efficient use of this budget by supporting the salary of a full-time employee as well as the costs related to the national monitoring system. Increase the budget allocated to the development of social services for vulnerable groups. Improve the financing framework to ensure the sustainability of financing for social services by developing funding mechanisms and procedures, promoting coordination and harmonization between financing mechanisms in different sectors (such as healthcare, education, housing, and employment), increasing transparency and the dissemination information on the procedures for contracting out social services, and improving costing methodology and procedures for social services. Enhancing Capacity for Policy Formulation and Management at all Levels | 339 Education Increase overall financing for the education sector. Continue the program of investment in essential infrastructure in order to ensure that students can access all public educational institutions at all levels. This investment might come from the Structural and Cohesion Funds. Increase investments in disadvantaged schools in marginalized urban and rural areas. Review the system of Supplementary Funding, which is currently based on a weighted funding formula for children in vulnerable situations, and ensure that it is properly delivered to all mainstream schools where such children are enrolled. Revamp the whole series of cash programs implemented through schools, acknowledging that they are in reality social assistance, and merging the national cash programs into the MLFSPE’s Family Allowance (soon to be the MSII) program, which has low application costs and considerable monitoring and oversight capacity. Health Increase overall financing for the health sector, especially the budgetary allocations to primary healthcare and ensure adequate funding for the development of community-based healthcare services. Review and revise the existing financial and non-financial incentives designed to attract and retain physicians in rural and remote areas. Design, implement, and budget for a clear policy on informal payments in the public healthcare system nationwide. Ensure adequate funding for targeted measures addressing the health of the poor and vulnerable population and for social support and interventions targeted to the poor, such as vouchers for transportation to medical facilities and subsidies to MDR-TB patients or adequate budgets for specific interventions for vulnerable groups such as IDUs, street children, the homeless, prisoners, and Roma. Increase budgetary allocations for preventive services in the field of reproductive health. Provide adequate funding for redesigning the National Plan to Prevent and Control M/XDR-TB 2012-2015. Invest in health infrastructure and technology in a cost-effective way in accordance with the requirements of the national plan for health services and based on documented evidence. Housing Increase the budgetary allocations for social housing. Invest in the infrastructure of villages incorporated within cities in order to improve the quality of life of the population in small towns. Social participation Increase the access of all vulnerable groups to information and knowledge in a wide range of formats. Marginalized Finance a package of integrated interventions in marginalized communities (in rural development, regional development communities and human capital) from the national budget, EU funds or loans to significantly reduce or eradicate the incidence of deep, concentrated, and persistent poverty in Romania by 2020. Institutional reforms should be carefully planned and experienced staff, which could negatively affect the service assessed, given that they could result in the loss of delivery capacity of the institutions. 340 | STRENGTHENING INSTITUTIONAL CAPACITY TO REDUCE POVERTY AND PROMOTE SOCIAL INCLUSION  eveloping an Integrated Approach in the 4.2. D Field of Social Policy Development Adopting an integrated approach in policy development, dependency needs and complex medical conditions and service provision, and the use of local resources can be those in rural or isolated areas, as a first step towards expected to improve the way in which national and local the full integration of service delivery in the long term; authorities plan and use existing resources for reducing (v) encourage vulnerable groups to be more active in poverty and social exclusion. Interventions based on an decision-making at all levels from local service provision integrated approach would be the product of cross-sectoral to national policymaking; (vi) enhance local and central cooperation and would take into account all aspects of the capacity to develop and implement integrated projects as wellbeing of the targeted groups. a key factor for improving the living conditions of Roma and of marginalized communities; (vii) improve horizontal Several conditions will be key to making this integrated coordination within and between ministries and the vertical approach happen. It is recommended that the government: coordination of social service delivery between the central, (i) set up an inter-sectoral Social Inclusion Commission with county, and local levels; and (viii) make a proper budget a technical secretariat to be in charge of the implementation allocation available from local and national sources for all of of the Social Inclusion and Poverty Reduction Action these activities. Plan for 2015-2020 and a social inclusion monitoring and evaluation system; (ii) develop specific legislation, Area-based and people-based interventions are crucial quality standards, and a comprehensive regulatory system for fighting segregation in marginalized areas. Relevant for vulnerable groups; (iii) train social service workers, policies and programs should be coordinated among all education professionals, community mediators, and levels of governance (vertical policy integration) and across other relevant professionals in the integrated approach to sectors (horizontal policy integration). Integrated, cross- service provision; (iv) establish multi-disciplinary teams of sectoral regeneration projects that balance social inclusion community workers (integrated intervention community with economic competitiveness are the best way to reduce teams) at the local level and multi-agency cross-sectoral geographically concentrated poverty in marginalized urban cooperation at all levels, especially for children with high areas, in Roma communities, and in certain remote rural areas. Developing an Integrated Approach in the Field of Social Policy Development | 341 Developing an Integrated Approach in the 4.3.  Field of Social Policy Development The government needs to develop a national social assessments, process and impact evaluations, and cost- inclusion monitoring and evaluation (M&E) system and benefit analyses); and (iv) strengthening cooperation and establish specific indicators of poverty and social inclusion coordination between different institutions in carrying out to track progress towards the goals set out in the National activities in the areas of poverty reduction and social inclusion. Strategy on Social Inclusion and Poverty Reduction 2015- To track the results of the flagship initiatives in reducing 2020. The system is needed to ensure that the results of poverty, the government is advised to strengthen the the interventions included in this National Strategy can be monitoring capabilities of the EU-SILC survey for Romania measured and monitored during the 2015 to 2020 period by: (i) adding an additional module to the questionnaire and to ensure that the key elements of poverty reduction, to track some of these initiatives and (ii) expanding the social inclusion and participation, and an integrated survey’s representative subsamples of beneficiaries of these approach to social services are reflected in national and initiatives. These improvements in the survey’s design would local policies. enable the government to track: (i) the level of poverty among Developing such a system would also increase the beneficiaries of the MSII program and their labor market accountability and efficiency in the allocation of public attachment; (ii) the use of ALMPs and training activities by resources and thus more effectively meet the real needs the MSII and Youth Guarantee beneficiaries; and (iii) the level of poor and vulnerable people. In order to adequately plan of poverty in marginalized communities. the development of the social inclusion M&E system, the Several evaluations will be needed to inform the policy government with input from the World Bank should prepare reforms in the coming period: (i) an impact evaluation of the an M&E plan that will set out the logical sequence of various elements of the Minimum Social Insertion Income implementing and monitoring interventions. program;549 (ii) impact evaluations of active labor market In the context of limited resources and numerous needs programs for the poor and vulnerable (including the Youth (which need to be prioritized and dealt with in the most Guarantee program), (iii) a process and impact evaluation effective way possible), the government should continue to of the EU-funded social economy projects; (iv) an impact invest in strengthening its M&E capacity by: (i) improving evaluation and cost-benefit analyses of integrated social mechanisms for collecting both administrative and survey services at the community level; (v) impact evaluations data on a regular basis; (ii) building the capacity of staff of means-tested benefits aimed at increasing school at different levels (central, county, and local) to analyze attendance and improving the academic performance of quantitative and qualitative data in the areas of poverty and disadvantaged children; (vi) process evaluations of social social exclusion; (iii) increasing the skills of the line ministries’ services prioritizing child protection social services; and staff responsible for implementing the National Strategy (vii) needs assessments of specialized social services at the on Social Inclusion and Poverty Reduction 2015-2020 in local, regional, and national levels. carrying out different types of evaluations (such as needs 549 The elements of the design of the MSII that should be evaluated are the impact of the size of the labor earnings of the families that are exempt from the income test on the activation of working age poor and the success or failure of the conditionalities related to school attendance and performance and to health interventions. 342 | STRENGTHENING INSTITUTIONAL CAPACITY TO REDUCE POVERTY AND PROMOTE SOCIAL INCLUSION Improving Service Delivery with 4.4.  Information and Communication Technologies The use of information and communication technologies and processing rules involve a range of private, (ICT) varies in various ministries and agencies responsible public, and compliance costs, all of which contribute for employment, social protection, health, and education to making the system cumbersome and inefficient. policies. In general, they operate in silos, with few This weakness is exacerbated by the lack of ICT opportunities to share and exchange information about technology support within most local authorities. At their beneficiaries. Most management information systems the county level – which is where the local authorities (MISs) were developed seven to ten years ago, and both their send the benefit applications – the County Agencies hardware and software is becoming technically obsolete. for Payments and Social Inspection use a central MIS system (SAFIR) to administer the majority of While there is a need to update or upgrade most of the benefits. However, the SAFIR system is outdated and sectoral MISs, in relation with the National Strategy on inflexible, has limited functionality, and does not have Social Inclusion and Poverty Reduction 2015-2020, adequate ex-ante data verification capacity. Overall, expanding the coverage and functionality of the social SAFIR is not capable of sustaining the future system assistance MIS is absolutely necessary. This MIS is requirements as recommended in the National expected to play – when the MSII program implemented Strategy on Social Inclusion and Poverty Reduction – the important role of a registry and a targeting tool for 2015-2020. programs for the poor. The goal is to develop an MIS that will: (i) enable local social assistance workers to devote more time and resources to social work activities; (ii) enable the tracking, monitoring, and case management of the • T  he prime responsibility for the governance of the present social assistance system rests with the National Agency for Payments and Social poor and vulnerable, leading to better policymaking and Inspection (ANPIS). However, ANPIS has extremely improved targeting of resources; and (iii) strengthen the limited internal resources and capacity to manage referral function of the local social workers to specialized or develop ICT systems, and at present it relies services (such as employment, health, education, disability, on another governmental institution – the Special child protection, and long-term care). Telecommunications Service – and a private sector The present processing system for social assistance contractor to operate and maintain the SAFIR benefits encompasses means-tested, categorical, and system. This governance gap poses a serious risk universal benefits. In most cases the local authority is the to the implementation of the recommendations institution to which potential beneficiaries must submit of the National Strategy on Social Inclusion and their benefit applications. This has the advantage of being Poverty Reduction 2015-2020 in the field of social close to the applicant, of providing them with locally based assistance, while also negatively affecting the assistance in completing the forms, and finding any local ongoing operation of the SAFIR system. information that the applicant needs for the means-test We recommend that the government should respond process. However, in some cases the local authority is these issues by simplifying benefit eligibility conditions, burdened with handling applications that could instead be streamlining the processing system, rationalizing the submitted directly (via a web portal) by the applicant, and number of decision-making centers, strengthening the the new MIS will offer this facility. inspection system, and developing a new social assistance The current social assistance system is unnecessary MIS to automate processing and to carry out validations complex and inefficient and suffers from significant (both ex-ante and ex-post). This new MIS should include governance problems related to the ICT system: automated payment processing and auditing as well • as case management and prioritization tools to support T  he social assistance processing system relies service staff in local authorities, in the county Agencies for heavily on paper documents, and various eligibility Payments and Social Inspection (AJPIS), and in partner Improving Service Delivery with Information and Communication Technologie | 343 institutions. services systems, which will make both systems more effective in meeting the needs of their clients. By providing We recommend that the social assistance MIS strategy a clear picture of each recipient and all of the cash benefits focus on four main areas: (i) ICT governance; (ii) a business that he or she receives, it will also enable social workers operations model; (iii) MIS development; and (iv) the reform to develop a comprehensive planning system for support of payment services. This will require significant institutional services, to make informed referrals to specialized services strengthening, the centralizing of decision-making, and the (when needed), and to observe and evaluate a client’s reforming of business processes. It will also involve a major progress and the impact of all of the different kinds of ICT development program over a five-year timeframe. At the support provided to him or her. local authority level, we recommend further development of local customer relationship management solutions to We recommend that the social assistance MIS be enable local authorities to maximize the automation of all implemented in three stages. Between 2015 and 2017, the local social assistance processes so that they can link all government will: (i) develop additional ICT support for the local databases with the social assistance MIS. new unified MSII benefit; (ii) move the current MIS to the Oracle 12 database version; (iii) deliver ICT support to local The core of the new MIS will be: (i) the electronic transfer of authorities; and (iv) reform the governance of the entire data on means-tested programs from local authorities; (ii) social assistance system, especially at the central level. government-to-citizens web interfaces (G2C) for universal Between 2016 and 2018, it will be necessary to: (i) develop and categorical programs; (iii) a centralized data processing the new social assistance business operations model and center within the National Agency for Payments and Social (ii) start modernizing the payments system. From 2018 Inspection (ANPIS); (iv) the electronic transfer of data to 2020, the government will: (i) develop and implement between the MIS and other government organizations; the social assistance MIS and (ii) finish modernizing the (v) a centralized payments system for all types of social payments system. assistance benefits – means-tested, categorical, and universal; (vi) the centralized management of social The new MIS will significantly automate benefit processing. assistance service providers; (vii) government-to-business This will free up staff at the grassroots to focus on the web interfaces (G2B) enabling the social assistance MIS most vulnerable clients and, using the case management to be accessed by authorized social assistance service approach, target interventions and priority actions to those providers; (viii) an accounting (general ledger) interface; and clients. Other key benefits that will flow from the new MIS (ix) advance reporting and analytics, including risk profiling will include: (i) the reduced costs of the application and to prevent and detect possible errors or cases of fraud. qualification process and the payments system; (ii) greater accuracy of decision-making; (iii) less fiscal leakage as a The proposed e-social assistance system will also facilitate result of reduced levels of error and fraud; and (iv) improved better coordination between the social benefits and social targeting of key interventions and support services. 344 | STRENGTHENING INSTITUTIONAL CAPACITY TO REDUCE POVERTY AND PROMOTE SOCIAL INCLUSION Modernizing Payment Systems 4.5.  The current payment system for social assistance benefits The overall objectives of the program will be to: (i) rationalize involves a complex set of (mostly manual) procedures and and automate the funds transfer function between ANPIS and fails to take advantage of modern technologies. Most social the Treasury; (ii) phase out insecure cash-in-hand payments; assistance benefits are calculated by the SAFIR MIS system. (iii) ensure that beneficiaries receive their payments However, all subsequent tasks – from obtaining the funds conveniently, safely, and securely; (iv) use the most cost- from the Treasury to making payments to the beneficiaries effective, secure, reliable, and sustainable technologies to – are undertaken outside the SAFIR platform. The existing make benefit payments; and (v) make all benefits payable system by which authorities at different levels request, obtain, directly to the beneficiary (including the Heating Benefit and and distribute the funds needed to make benefit payments the Disability Benefit). is inefficient, fragmented, and overly complex. The existing The strategic advantages to be gained by adopting this payment modalities are outdated, are not secure, and involve new system are: (i) a significant reduction in administration moving large amounts of cash to post offices to be distributed complexity and workload; (ii) the freeing up of scarce to beneficiaries. In addition, the audit and reconciliation resources to be reallocated to other critical support services; functions are inadequate. (iii) the elimination of costs associated with printing and To remedy the inefficiencies and weaknesses in the current distributing payment receipts; (iv) reduced scope for fiscal system, we recommend that the government implement leakage by minimizing cash-only transactions; (v) an a payments modernization program as a result of which increase in the beneficiaries’ options for making purchases payment of benefits will be automated using the electronic and payments; (vi) the automatic audit and reconciliation of transfer of funds. The new central funds distribution and payments; (vii) a reduction in security costs associated with payment processing system will be managed at the central transporting large volumes of cash to and from post offices; level rather than by the 42 county-level AJPIS offices. and (viii) less financial exclusion for vulnerable groups. The payments modernization program will have two main We recommend that the transition to electronic payments pillars: (i) reforming the system of requesting and distributing should take place in stages over a period of five years and funds to pay social assistance benefits by replacing the should involve specific groups of beneficiaries at each stage. present fragmented and multi-layered system with a Many beneficiaries will require support to move from cash- single centralized funds transfer and distribution system in-hand payments to e-payments, and special measures, and (ii) reforming the methods used to pay beneficiaries such as help with opening bank accounts, will have to be put by strategically moving to an electronic benefit payments in place. 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Qualitative research: • Segmentation of NEETD for the target group of • means-tested benefits (EU-SILC) • Case studies in Arad and Botoșani counties (over 150 interviews) Profiles of vulnerable groups – teenage mothers, • children with parents left abroad, persons with Interviews with representatives of central disabilities, lonely elderly, rural, children out of governmental bodies (over 20 interviews) school, homeless (2011 Population and Housing • Interviews with recipients /eligible potential Census) beneficiaries of means-tested benefits and with social workers. • Diagnosis of the housing problems for the overall population (2011 Population and Housing Census) 2. Quantitative data collection and analysis: • Census of the urban mayoralties on social housing • Diagnosis of the problems in small/recently declared urban localities (2011 Population and Housing Census • and administrative data) • Census of the SPAS social workers (more than 3,100 questionnaires from local authorities) Identification of poor villages (2011 Population and • Housing Census) • Consolidated database of physicians, representatives of the pharmacies, community nurses/health Identification of rural marginalized communities (2011 mediators Population and Housing Census) • Administrative dataset on social services for the elderly • Analysis of the overlap between Roma communities and urban/rural marginalized communities • Administrative dataset on social services for people with disabilities • Analysis of the conditions and types of social participation. • Administrative dataset on child protection services 3. Other analyses (case studies, focused desk research, and background notes): • Identification of the “source communities” (rural/ urban) for children in special protection services • Functional analysis of the role of the National Agency for Employment in reducing poverty and social based on administrative data from the Child Monitoring and Tracking Informational System exclusion (CMTIS) managed by the National Authority for the Protection of Child’s Rights and Adoption (NAPCRA) • Analysis of the microcredit sector and of the shelter workshops for persons with disabilities • Research in cooperation with UNICEF and NAPCRA on the children in the special protection services and • Analysis of special education for children with disabilities • the source-communities • Analysis of the nutrition-related programs in schools • Analysis of poverty and material deprivation for vulnerable groups – 2008/2012 (EU-SILC) Analysis of the means-tested programs in schools • (school supplies, High School Money, and social Prognosis of poverty dynamics in 2013/2020 (EU- scholarships administered at the local level) • SILC) • Stock taking of the European funds for small urban Simulation of the impact of different policies on localities. poverty (EU-SILC) Annexes | 367 Annex 2: Poor and Vulnerable Groups I. Statistical Data Percentage of the Population and Relative Poverty Rates by Age and Area, 2012 ANNEX TABLE 2.1:    Population structure Relative poverty rate   Rural* Urban** Rural* Urban** 0-15 year olds 16.6 13.8 52.1 16.5 16-64 year olds 62.5 70.9 39.2 11.2 65+ year olds 21.0 15.3 23.5 6.3 Total 100 100 38.1 11.2 Source: World Bank calculations using data from the 2012 EU-SILC. Note: *Rural = thinly populated areas. **Urban = densely populated areas and intermediate areas. Percentage of the Population and Relative Poverty Rates by ANNEX TABLE 2.2:  Occupational Status and Area, 2012   Population structure Relative poverty rate   Rural* Urban** Rural* Urban** Total <16 year olds 16.9 14.0 52.1 16.5 33.3 Employees 18.2 39.0 11.6 3.5 5.6 Self-employed (including family workers) with employees 0.1 0.4 0.0 6.6 5.5 Self-employed without employees, skilled or unskilled workers in agriculture, forestry or fishery 15.8 2.3 57.4 54.0 56.8 Self-employed without employees, other occupations 5.6 2.4 49.7 22.7 39.8 Unemployed 2.0 2.4 62.9 45.6 52.1 Pupil, student, further training, unpaid work experience 5.8 8.8 44.1 15.8 25.1 In retirement 24.6 24.3 20.7 5.1 11.8 Permanently disabled or/and unfit to work 1.0 0.6 49.3 38.6 44.7 Fulfilling domestic tasks and care responsibilities 9.4 5.0 55.7 29.8 44.8 Other inactive person 0.6 1.0 63.9 23.6 36.3 Source: World Bank calculations using data from the 2012 EU-SILC. Note: *Rural = thinly populated areas. **Urban = densely populated areas and intermediate areas. 368 | ANNEXES Poverty Rates for Children (0-17) and Youths (18-24) by Area of Residence, 2012 ANNEX TABLE 2.3:  Children Youth Urban* 17.0 18.4 Rural** 52.6 47.1 Total 34.0 31.4 Source: World Bank calculations using data from the 2012 EU-SILC. Note: *Urban = densely populated areas and intermediate areas. **Rural = thinly populated areas. Poverty Rate for Households with Different Numbers of Children, 2012 (%) ANNEX TABLE 2.4:  Households with… Total Urban* Rural** 0 children 16.5 8.2 29.0 1 child 22.6 12.3 41.8 2 children 33.8 16.1 52.0 3+ children 56.6 39.2 65.2 Source: World Bank calculations using data from the 2012 EU-SILC. Note: *Rural = thinly populated areas. **Urban = densely populated areas and intermediate areas. The Percentage of Children Living in Households with ANNEX TABLE 2.5:  Different Numbers of Children, 2012 Households with… Total Urban** Rural* 0 children 0 0 0 1 child 36 24 13 2 children 45 23 22 3+ children 19 6 13 Total 100 52 48 Source: World Bank calculations using data from 2012 EU-SILC. Note: * Urban = densely populated areas and intermediate areas. ** Rural = thinly populated areas. ANNEX TABLE 2.6:  Average Real Pension Indices of State Social Insurance Pensioners, including Pensions from Ministry of Defense, Ministry of Internal Affairs, and Romanian Information Service (base year 2000) 2000 2001 2002 2003 2004 2005 2006 100 105.9 109.5 117.4 131.2 141.8 154.8 2007 2008 2009 2010 2011 2012 2013 190.1 255.1 285.8 278.9 265.7 265.9 266 Source: Tempo Online, the National Institute of Statistics. Annexes | 369 Relative Poverty Rate by Gender, 2012 (%) ANNEX TABLE 2.7:  Age Females Males 0-17 34.9 33.1 18-24 30.4 32.4 25-49 22.3 21.2 50-64 15.1 17.6 65-79 16.6 7.8 80+ 26.5 14 65+ 19.3 9.2 Total 23.1 21.9 Source: World Bank calculations using data from the 2012 EU-SILC. Relative Poverty Rate by Gender, 2012 (%) ANNEX TABLE 2.8:    % of elderly (aged 65+) % of poor elderly (aged 65+) Lone elderly (65+), of whom… 22 33 Men 6 5 Women 16 28 Couple of elderly (both 65+ and married) 23 8 Other types of HHs with elderly 34 26 Households without elderly 0 0 Total 100 100 Source: World Bank calculations using data from the 2012 EU-SILC. Relative Poverty Rate by Gender, 2012 (%) ANNEX TABLE 2.9:    2008 2009 2010 2011 2012 Primary education 42.1 37.4 36.4 35.1 35.3 Lower secondary education 33.6 30.2 31.7 34.5 34.4 Upper secondary education 14.8 11.9 13.3 15.2 15.2 Post-secondary non-tertiary education 3.3 2.1 4.6 5.1 5.6 First stage of tertiary education 0.7 1.2 1.1 2 3.1 Age<=16 32.4 31.4 31.3 32.4 34 Total 23.4 20.8 21.1 22.2 22.6 Source: World Bank calculations using data from the 2012 EU-SILC. 370 | ANNEXES Relative Poverty Rates for the Working Age Population (between 15 and 64) ANNEX TABLE 2.10:  by Occupational Status and Area, 2012   Relative poverty rate % of population   Rural* Urban** Total Employees 11.6 3.5 5.6 44.2 Self-employed (including family workers) with employees 0.0 6.7 5.6 0.4 Self-employed without employees, skilled or unskilled workers in 61.8 54.5 60.6 10.4 agriculture, forestry or fishery Self-employed without employees, other occupations 52.7 21.9 41.0 5.2 Unemployed 62.9 45.6 52.1 3.2 Pupil, student, further training, unpaid work experience 46.7 16.0 27.0 12.9 In retirement 15.0 5.3 8.4 12.3 Permanently disabled or/and unfit to work 48.6 34.5 42.5 1.0 Fulfilling domestic tasks and care responsibilities 56.7 30.9 45.9 9.4 Other inactive person 63.8 24.6 37.0 1.2 Total 39.6 11.3 22.5 100.0 Source: World Bank calculations using data from the 2012 EU-SILC. Notes: *Rural = thinly populated areas. ** Urban = densely populated areas and intermediate areas. ANNEX TABLE 2.11:  Relative Poverty Rates for the Working Age Population (between 15 and 64) by Occupational Status, 2008-2012   2008 2009 2010 2011 2012 Employees 5.5 5.1 5.0 5.9 5.6 Self-employed (including family workers) with employees 3.5 2.2 0.0 2.1 5.6 Self-employed without employees, skilled or unskilled workers in agriculture, forestry or fishery 62.0 66.0 58.7 63.0 60.6 Self-employed without employees, other occupations 34.5 39.0 35.8 41.3 41.0 Unemployed 41.5 40.4 42.0 45.3 52.1 Pupil, student, further training, unpaid work experience 23.6 21.8 20.6 23.5 27.0 In retirement 12.5 10.7 8.5 9.3 8.4 Permanently disabled or/and unfit to work 39.0 35.8 33.2 35.5 42.5 Fulfilling domestic tasks and care responsibilities 43.4 40.4 41.7 45.8 45.9 Other inactive person 33.2 44.2 39.0 36.1 37.0 Total 21.2 20.9 20.2 22.0 22.5 Source: World Bank calculations using data from the 2008-2012 EU-SILC. Annexes | 371 Poverty Rate by Ethnicity and Residential Area, 2013 (%) ANNEX TABLE 2.12:    Non-Roma Roma Rural 5.6 37.0 Urban 1.6 28.0 Source: World Bank calculations using data from the 2013 HBS. Percentage of People under 60 years old Living in Households with Very Low Work ANNEX TABLE 2.13:  Intensity in Different Kinds of Geographical Areas, 2012   2012 Densely populated areas 5.5 Intermediate areas 7.4 Thinly populated areas 9.0 Total 7.4 Source: World Bank calculations using data from the 2008-2012 EU-SILC. Percentage of People Aged 16 to 59 Living in Households with Very Low Work ANNEX TABLE 2.14:  Intensity by Education, 2008-2012   2008 2009 2010 2011 2012 Primary education 20.0 21.7 18.9 17.8 18.0 Lower secondary education 11.0 9.8 9.2 9.8 9.6 Upper secondary education 7.1 6.4 5.8 5.5 6.6 Post-secondary non-tertiary education 8.6 8.6 8.1 9.0 9.2 Tertiary education 2.0 2.2 2.2 2.1 3.8 Age<=16 5.6 6.7 3.7 3.0 4.6 Total 8.2 7.6 6.8 6.6 7.3 Source: World Bank calculations using data from the 2008-2012 EU-SILC. Percentage of People Suffering from Severe Material Deprivation, 2008-2012 ANNEX TABLE 2.15:   Cannot afford to ... 2008 2009 2010 2011 2012 ... go on holiday 75.7 75.6 77.1 76.1 75.2 ... run a car 48.8 46.6 43.6 41.3 39.6 ... eat meat or other protein regularly 19.5 23.7 21.4 21.9 23.7 ... face unexpected expenses 41.9 41.8 44.7 50.5 53.2 ... pay their rent, mortgage, or utility bills 0.4 0.6 0.4 0.6 0.6 ... keep their home adequately warm 13.9 14.9 16.1 17.3 18.1 ... purchase a washing machine 20.2 17.8 15.5 13.7 12.9 ... have a telephone 12.4 9.4 7.2 6.6 5.8 ... purchase a color television set 2.6 2.2 1.8 1.4 1.5 Source: World Bank calculations using data from the 2008-2012 EU-SILC. 372 | ANNEXES Percentage of People Suffering from Severe Material Deprivation ANNEX TABLE 2.16:  by Residential Area, 2012 Densely populated Cannot afford to ... Thinly populated areas areas/intermediate areas ... go on holiday 86.2 67.1 ... run a car 46.8 34.3 ... eat meat or other protein regularly 29.1 19.8 ... face unexpected expenses 59.5 48.6 ... pay their rent, mortgage, or utility bills 0.2 0.8 ... keep their home adequately warm 17.5 18.6 ... purchase a washing machine 22.4 5.9 ... have a telephone 9.8 2.9 ... purchase a color television set 2.7 0.6 Source: World Bank calculations using data from the 2012 EU-SILC. ANNEX TABLE 2.17:  Percentage of People Suffering from Severe Multiple Deprivation by Education Level, 2008-2012   2008 2009 2010 2011 2012 Primary education 52.9 50.9 51.0 47.2 46.9 Lower secondary education 43.2 41.4 40.7 38.9 38.0 Upper secondary education 25.7 25.5 24.9 24.3 25.3 Post-secondary non-tertiary education 15.9 15.0 13.1 11.1 11.7 First stage of tertiary education 6.6 8.1 9.0 9.0 8.8 Age<=16 39.3 40.1 36.7 36.0 38.6 Total 32.9 32.2 31.0 29.4 29.9 Source: World Bank calculations using data from the 2008-2012 EU-SILC. ANNEX TABLE 2.18: Percentage of Population at Risk of Poverty or Social Exclusion, 2008-2013   2008 2009 2010 2011 2012 2013 People at risk of poverty or social exclusion (AROPE) 44.2 43.1 41.4 40.3 41.7 40.4 People at risk of relative poverty after social transfers (AROP) 23.4  22.4  21.1  22.2  22.6  22.4  People severely materially deprived 32.9 32.2 31 29.4 29.9 28.5 People living in households with very low work intensity (population aged 0 to 59 years) 8.3 7.7 6.9 6.7 7.4 6.4 Source: Eurostat. Annexes | 373 Projected Relative and Anchored Poverty Rates, 2012-2020 ANNEX TABLE 2.19:    Relative poverty rate Anchored poverty rate (poverty line anchored in 2012) Low Growth Moderate Growth High Growth Low Growth Moderate Growth High Growth 2012 22.5 22.5 22.5 22.5 22.5 22.5 2013 23.1 23.1 22.8 21 21 21 2014 22.9 22.8 22.3 20.3 19.9 19.6 2015 22.9 22.4 22.5 19.4 18.7 18.7 2016 22.7 22.3 22.3 18.8 18.1 17.6 2017 22.9 22.5 22.2 18.2 17.1 16.3 2018 22.9 22.5 22.1 17.4 15.5 14.5 2019 23 22.7 22.2 16.7 14.4 13 2020 23.1 22.7 21.6 15.9 13.4 11.2 Source: World Bank estimations using data from the EU-SILC in three main scenarios. Reduction in the Number of Poor in the Best Case Scenario, 2012-2020 ANNEX TABLE 2.20:  Diff 2012 2013 2014 2015 2016 2017 2018 2019 2020 2020- 2012 Predicted population 2012-2020 20,071 20,020 19,988 19,964 19,935 19,904 19,873 19842 19,810 (thousands) Projected 22.5 23 22 23 22.3 22.2 22.1 22.2 21.6 poverty rate Projected number of poor if population 4,516 4,576 4,476 4,516 4,476 4,456 4,436 4,456 4,335 -181 size does not change (thousands) Projected number of poor if population 4,516 4,565 4,457 4,492 4,445 4,419 4,392 4,405 4,279 -237 size changes (thousands) Source: World Bank estimations using data from the EU-SILC in three main scenarios. 374 | ANNEXES II. Assumptions of the Poverty Forecasting Model Our poverty forecasting model relies on a macro- is expected to increase gradually from 3 percent in demographic labor force-micro model to quantify the 2014 to 5 percent in the period 2018 to 2020. • likely reduction in relative income poverty between 2014 and 2020. The model was used to assess under what Corresponding to each economic growth scenario, conditions Romania will achieve the poverty target and there are three employment growth scenarios what combination of economic growth, employment (Annex Table 2.21, first panel). Under the low and wage growth, and policies designed to increase the scenario, the share of employed people in the earnings and transfer income of the poor would ensure the cohort of those aged between 20 and 64 years old achievement of the target. The model uses 2012 EU-SILC is expected to grow from 63.8 percent in 2012 to data to simulate the 2014-2020 at-risk-of-poverty (AROP) 64.9 percent by 2020 or by 1 percentage point over indicator and anchored poverty indicators. the period. This forecast is consistent with the weak employment growth achieved during the previous The poverty forecasting model relies on a set of decade. Under the base scenario, employment macroeconomic, labor force, and demographic is expected to grow by 3.6 percentage points. assumptions: Under the high (rather optimistic) growth scenario, • Three possible economic growth scenarios were modeled - a low, base, and a high economic growth the employment rate is expected to increase gradually to reach 70 percent by 2020, which is the Romania’s EU 2020 employment target (an scenario (Annex Table 2.21, middle panel). The increase of 6.2 percentage points over eight years). forecasts used in the scenarios were those of the IMF, the World Bank, and the EU as of September 2014. Under the low economic growth scenario, Romania’s GDP per capita is expected to growth by 2.2 to 2.5 • Labor productivity was assumed to follow the same path in all cases, while education trends were derived on the assumption that Romania will meet its EU percent per annum over the forecasting period. Under 2020 national education targets by 2020. the high economic growth scenario, per capita GDP ANNEX TABLE 2.21: Growth Scenarios for Romania Labor % of 18-24 with Tertiary Employment rate productivity at most lower educational   GDP Growth rate (20-64 years old) (growth rate, secondary attainment in per hour) education 30-34 age group Low Base High Low Base High 2012 63.8 63.8 63.8 2013 63.6 64.1 64.5 3.5 3.5 3.5 1.5 14.8 20.2 2014 64.0 64.6 65.2 2.5 2.7 3.0 1.7 14.3 21.3 2015 64.4 65.1 65.9 2.6 3.1 3.5 2.0 13.8 22.1 2016 64.6 65.6 66.7 2.5 3.7 4.0 2.4 13.3 23.0 2017 64.7 66.1 67.4 2.5 3.9 4.5 2.7 12.8 24.0 2018 64.8 66.5 68.1 2.5 4.0 5.0 2.7 12.3 25.0 2019 64.8 66.8 68.9 2.2 4.1 5.0 2.7 11.8 26.0 2020 64.9 67.4 70.0 2.2 4.1 5.0 2.7 11.3 26.7 Annexes | 375 The assumed changes in economic growth, employment, Annex Table 2.22). The total population is expected to fall by labor productivity and education achievement that are 177,000 people. This change will be distributed differently presented in Annex Table 2.21 were then incorporated into a across age groups. While the old age cohort (people aged microeconomic model based on data from Romania’s 2012 65 years old and older) is expected to increase by 436,000 EU-SILC survey, the same survey that was used to track people, the working age population (those aged 20 to 64 progress toward the relative income poverty target (AROP) inclusive) will shrink by 557,000 people, and the number and the anchored poverty rate.550 of children (up to 20 years old) by 56,000. Over time, the working age population will fall while the elderly population The model was also calibrated with the predicted change in will increase, putting further strains on government revenues demographics and labor market participation.551 Between derived from income taxes and increasing demand for 2012 and 2020, Romania is likely to experience a significant pensions, healthcare, and elder care. change in the level and structure of its population (see ANNEX TABLE 2.22: Main Demographic Changes, 2014-2020 (in thousand people) Year Change 2014- Age groups  2014 2015 2016 2017 2018 2019 2020 2020 0-14 3,133 3,127 3,117 3,116 3,117 3,113 3,110 -24 15-19 1,093 1,088 1,092 1,090 1,081 1,071 1,061 -32 20-64 12,464 12,368 12,270 12,174 12,083 12,002 11,907 -557 65+ 3,297 3,381 3,457 3,524 3,592 3,656 3,733 436 Total 19,987 19,964 19,935 19,904 19,873 19,842 19,810 -177 Source: World Bank’s PROST model for Romania. In the micro model, the employed population was derived and its real value as forecasted by the PROST model. The from the predicted working age population (Annex Table ratio of the average pension to the average wage, however, 2.22) and the low, base, and high employment rates is predicted to fall by about 10 percent between 2014 and (Annex Table 2.21). Further assumptions about the rate 2020 as a result of the Swiss indexation formula used in the of unemployment were used to estimate the number of first pillar of the pension system in Romania. This change unemployed over the forecasting period. The sum of the was incorporated into the model. employed and the unemployed represents the total active Changes in the size of different population groups and of population of each year. the employed and the unemployed were introduced into Finally, the model incorporated the predicted changes in the micro model by altering the weights of the respective the coverage of the old age pension (assumed to be stable) categories. 550 For each of the forecast years, the income of the households in the survey sample was changed using the assumed changes in education distribution, employment, labor productivity, and expected GDP growth. The model adjusted education distribution in such a way that it mimics the supposed education distribution in that particular year; this adjustment affected only individuals in the 20 to 34 age group. Employment was also adjusted to take account of the employment rates of the 20 to 64 age group in each year. The unemployed/inactive individuals with the highest probability of being employment were “switched” to employed status until the total number of the employed reached the assumed employment level of that year. These individuals who are predicted to move from inactivity to employment were imputed earnings based on their level of education, sector of activity, work experience, and other variables known from the survey. All individuals who were employed (or were predicted to move from inactivity to employment) received a flat increase in their earnings equal with the assumed increase in labor productivity. The social protection transfers to households were assumed to remain at the same level in real terms (in other words, they increased only with the expected inflation rate). The incomes of the households were changed according to these assumptions, and the model generated a new, simulated income distribution for each year of the forecast period. 551 The demographic forecast was taken from the National Institute for Statistics.Other demographic changes, such as changes in formal employment, informal employment, the number of pensioners, and the real value of their pension, were simulated using the World Bank’s PROST model. 376 | ANNEXES Annex 3: Employment I. Statistical Data Key Characteristics of the NEETD Groups from the Bottom Quintile ANNEX TABLE 3.1:  High Kids<15 Kids<16 Group Size Short description Males (%) Urban (%) Modal Age School or Single (%) (Average) (Average) More (%) Educated urban 1 24 75 74 35-44 65 39 0.53 0.15 unemployed men Married middle-aged 2 18 12 31 35-44 62 0 0.81 0.27 rural women Uneducated idle 3 17 28 67 15-24 25 49 0.1 0.0 youths Young rural women 4 11 4 6 25-34 9 0 2.45 0.74 with families 5 10 Single Roma youths 38 35 15-24 0 70 1.26 0.19 Educated rural 6 8 67 1 25-34 91 71 0.15 0.15 unemployed Urban Roma women 7 7 0 100 25-34 0 0 2.84 1.78 with families 8 5 Young urban couples 47 97 25-34 52 0 2.28 0.85 Source: Bachas (2013).  ctivation Policies ANNEX TABLE 3.2: A Vulnerable Group Activation Policies Educated urban unemployed Job counseling and assistance Additional barrier might be low local demand Educated rural unemployed ->information and job search assistance Increasing barriers Educated inactive women Provide opportunity to work by developing child care facilities Second chance education, targeted retraining linked to new Young and middle-aged urban couples employment Build human capital early on (through CCTs), vocational Young unemployed early school leavers education Inactive women with little work experience and many children Address barriers to employment Source: Bachas (2013). Annexes | 377 II. Profiling of Job Seekers In Romania, there is no nationwide systematic model of would be to allow job seekers to complete a “profiling” tool job seeker profiling to distinguish different types of job either online or using pen and paper for those who have no seekers as is practiced in some countries such as Australia, access to ICT. This would make it possible to categorize Germany, Ireland, Denmark, France, and Serbia. self-registered clients and to prioritize interviews with those most in need. The clients whose self-assessment One benefit of such profiling systems is that they can indicates that they do not need an in-depth interview can reduce the costs involved in making clients job-ready be encouraged to use the self-service approach to pursuing and thus enable employment services to allocate more jobs and registering themselves for vocational training resources to serving disadvantaged groups who are hard to courses or internships online. activate. An extension of the current self-service approach Profiling in the Serbian Public Employment System ANNEX TABLE 3.3:  Profiling Levels Service Provided 1st Level Information and job-matching Clients who are easily employable on the open labor market and are Job fairs offered basic mediation services by PES. 2nd Level Information and job-matching Clients who are employable on the open labor market but who need to CV preparation and interview techniques – active job search be supported with active job-search PES services. Job clubs 3 Level rd “Self-efficiency” training Clients who need intensive support from the PES Pre-job-club workshops to help this category of clients to participate in the job club Employment subsidies Public works Programs of additional education 4 Level th Intensive individual counseling Clients for whom short-term mediation is not possible without Assessment of working ability intensive support for their reintegration into the labor market “Self-efficiency” training Social and professional rehabilitation Source: Communication from Serbian Public Employment Service, 2010. Profiling is currently one of the key areas of experimentation ones who do need help. This approach supports the concept and study in Europe (there is already a strong history of of a dual internal pricing system as is used by some PES using profiling in the US). Profiling is basically a way of in EU and OECD countries so that more financial resources identifying those clients most in need when they register can be allocated to clients who need extensive support and with the PES so that PES resources are properly and are hard to place in jobs. cost-effectively targeted (see the Serbian model described There are a number of approaches that can be used to carry above). The idea is that there is less need to engage with out profiling, with the econometric approach generating the clients who can help themselves than to concentrate on the most interest among professionals at present. 378 | ANNEXES The characteristics of each approach can be described becoming long-term unemployed on the basis of a number as follows: of individual characteristics. Based on their JSCI results, • job seekers are referred to Job Services Australia to receive Assessment by Counselor whatever level of assistance best suits their needs. Where In this approach, which is currently used in the Romania the JSCI indicates that a client may need the most intensive NEA, the clients’ risk of long-term unemployment is assistance from Job Services Australia or the support assessed by employment service staff solely on the basis provided by the Disability Employment Services (DES), the of interviews. The risk assessment can be either more or job seeker will undertake an additional comprehensive Job less formal in terms of using questionnaires and checklists. Capacity Assessment (JCA) before being referred to the The main advantage of this approach is that it captures risk most suitable specialized service. factors specific to the individual and thus makes it easy to The JSCI computes the risk of becoming long-term prepare a needs assessment. As to the disadvantages, the unemployed on the basis of 14 individual characteristics as approach is costly, and the accuracy of the assessment follows: • can vary substantially between individual employment mediators. Age • Group Screening • Gender In this approach, a client’s risk of long-term unemployment • Language and literacy • is determined on the basis of whether he or she belongs to one or more at-risk target groups, which is typically Disability or medical condition ascertained by employment service staff using statistical analysis. The main advantages of this approach are its low • Recent work experience or lack thereof costs and its objectivity as the assessment does not require • Stability of residence • the input of counselors. The disadvantage of the approach is that it does not take into account characteristics and risk Educational attainment • factors specific to each individual as the assessment is based on group characteristics only. Disclosed ex-offender • Econometric (Statistical) Model • Personal characteristics requiring professional or specialist judgment • In the econometric approach, the characteristics of individual clients are fed into a mathematical model Indigenous/Australian born/South Sea Islander based on statistical indicators and knowledge of causal status • relationships. The model then calculates a risk measure for each client. The main advantages of this method include Country of birth its low costs, its objectivity, and its combination of theory and empirical data. The disadvantages of the model include • Geographic location its inflexibility, the complexity of building the model, and • Vocational qualifications • the need for statistical data on job seekers’ characteristics and outcomes that must be regularly updated. Adopting Family status/living arrangements the econometric approach is more time-consuming than other methods because it must be preceded by research to establish the econometric factors to be used in profiling. • Contactability (access to a telephone) Only job seekers at high risk are counseled immediately The time needed to introduce the econometric model is by their case managers, whereas low-risk job seekers are approximately two years. eligible for job search training only after a few months. Considering the extensive datasets now available to The Australian Job Seeker Classification Instrument (JSCI) the National Employment Agency in Romania, it is is based on the econometric model and computes the risk of recommended that this approach be considered. Annexes | 379 III. Evaluation of the Outcomes of ALMPs A sustainable system for measuring the outcomes of government’s net financial balance, because the (B + tW) active labor market programs (ALMPs) is presented in the criterion means that programs are selected when the benefit OECD Employment Outlook for 2005.552 This system savings and increased tax receipts that they generate depends on having inter-connected databases such as exceed their cost.” those that are or will be available to the NEA. The authors How benefit savings, the tax rate, and wage savings can of the OECD report proposed that the PES should track be calculated can be seen by applying this system to the off-benefit, employment, and earnings outcomes for measurement of the outcomes of Job Clubs in Ireland. program participants for up to five years in order to assess The current cost of an immediate job club placement553 in which programs have had a genuinely beneficial long-term Ireland is €800 when all job club capital and staff costs are impact. They suggested that a robust measure of long- taken into account. The employment taxation rate for that term outcomes can be assessed in terms of a “B + tW” one person over the first six months of employment (€600 formula, where B is the benefit payments saved, t is the to €1000 in total depending on the job) can exceed the cost tax rate, and W is total participant earnings (the product of the job club intervention. The saving on unemployment of the employment rate and the wage rate). They go on to benefit (say €720 per month multiplied by six) is additional say that “when impacts are measured over long periods, to the tax gain. If the placed job seeker is tracked over the earnings component in this formula can be relatively a long period, the saving to the government is in many large. Effective performance management with outcomes cases even more substantial using the B+ tW formula. It is, valued according to the (B + tW) formula would not only therefore, clear that the Job Clubs’ simple active job search reduce total unemployment but also increase the delivery interventions in a normal labor market can be one of the of substantive employment services which improve long- most cost-effective and efficient proactive employment term employment and earnings outcomes. It would improve measures available to governments. IV. Youth Guarantee Program in Romania, 2014–2015 Twenty-two Youth Guarantee Centers will be established provision for young people is delivered in the future. in Romania over the next year, and 10 have recently The services planned for delivery through the Youth begun operating. They will operate as joint information Guarantee Initiative in 2014 and 2015 include: and employment centers using many of the existing NEA tools and services. They are designed to provide a more 1. Early intervention and activation measures: comprehensive overall package of services than the range of services provided by local employment agencies, • An integrated database of youth unemployment  including educational and training opportunities as well as • Information campaigns in schools  • employment mediation. Part of the logic of establishing such centers is the perceived reluctance of many young  caling up self-service systems and implementing S job seekers to use the existing PES services beyond them at the local level, especially in rural areas • meeting the conditionalities associated with any monetary benefits that they may be receiving. Having a service that C  ontinuation of the programs “Second Chance for operates in parallel with yet connected to the NEA may a Primary and Lower Secondary Education” and have implications for how the management of labor market “High-school Money.” 552 OECD (2005). 553 The placement rate averages 70 percent for job-ready clients. 380 | ANNEXES 2. Labor market integration measures: •  rofessional training P •  ctivation measures for self-employment and A •  obility allowances M • entrepreneurship • Incentive payments for employers  •  Professional counseling and guidance Pilot youth guarantee schemes.  V. A Staff Training Initiative to Professionalize the Work of NEA Advisers and Mediators The approach envisaged is for the NEA to enter into client case reviews, reflections on good practice, and an agreement with a university (either the psychology applied guidance skills. Workshop themes might include: • department or the adult education/counseling department) in order to jointly deliver a two-level training program Adult Development and the Guidance Process for employment advisers and mediators and other front- line employment staff. The first level (part-time over six • Models of Adult Guidance months) would be delivered to all the relevant staff and • Applied Guidance Skills • would consist of an introduction to professional vocational guidance in the PES. The second level (see Annex Box 3.1. Support Systems, Contracts, and Boundaries below) would initially be delivered to a selected number of graduates from the first level, with the second level taking • Change, Transition, and Loss two years to complete on a part-time basis. Ultimately the • Understanding Aggression and Conflict • aim would be to have most front-line staff who wish to take part trained at the second level. The courses described in Developing a Quality of Work Life • Annex Box 3.1. were developed in Ireland by the National University of Ireland, Maynooth,554 and any such initiatives Endings and Evaluation. in Romania would need to be developed from scratch taking into account local conditions and a training needs analysis. Assessment procedures might include on-the-job skills Given the right conditions, the first level of training could applications and case presentations, learning journals, be put in place quickly. In Ireland it is delivered in an and interviews by the trainer. The training would teach open learning format incorporating home-based learning the skills and strategies used in advising, informing, and materials and workshops. The methodology of the guidance, assessing information and contacts in the labor workshops would be based on an experiential approach, market context, working effectively with others in teams which encourages people to engage in a critically reflective and networks, managing relationships and boundaries with process of learning. The course would explore the models clients, and defining roles in different situations and settings. and approaches to guidance and counseling as well as 554 This model is based on the Certificate in Guidance and Counseling course developed by the Adult Education Department of the National University of Ireland-Maynooth in conjunction with the Irish PES (FAS). Annexes | 381 ANNEX BOX 3.1 Second-level professional adult guidance Unit III Theory and application of programme for employment advisers/ psychometric testing mediators 4. Group work The course aims to develop the critical awareness of Unit I Group facilitation: skills and styles participants about their professional role by: Unit II  Experiential approaches to group dynamics Developing participants’ knowledge on adult guidance and process and counselling; Unit III Theoretical perspectives on group work Facilitating the exploration of issues of marginalisation 5. Theory and Practice of guidance and counselling and exclusion as they relate to employment and Unit I Applied guidance skills unemployment; Unit II Applied counselling skills Enabling participants to develop the key skills and Unit III Theoretical perspectives on counselling competencies involved in working with clients. 6. Research and evaluation methodologies The Diploma would extend over two academic years Unit I Quantitative approaches to research on a part-time basis and would be delivered in an open Unit II Qualitative approaches to research learning format, incorporating e-learning materials, and Unit III Applied research techniques workshops. 7. Psychology of work and working life Course hours include 212 hours of home-based learning and 216 hours of workshop (total 428 hours) Unit I Organization systems and dynamics Unit II Human resource management The workshops are to be provided over 2 x 3 day Unit III Occupational psychology and 6 x 2 day sessions each year and one week- long psychometric testing workshop in the first year. 8. Professional issues in adult guidance and counseling Participants are expected to attend on average one Unit I Working with difference workshop per month. Unit II Working with disability Introductory module Skills Application: twice a year, participants are required Unit I: Course guide to submit a taped interview together with a written Unit II Study skills for adults returning to learning commentary. This would be completed in the light of Unit III Learning as a way of being both the theoretical and practical aspects of the course. The case studies will assess participants’ capacity to 1. Psychology of human development demonstrate a competent use of skills. Unit I Transition to adulthood A portfolio of home based learning activities is to be Unit II Developmental stages in adulthood completed by each participant and assessed to gauge Unit III Development and change in the context of the understanding of the material. social exclusion Essay/Research: Participants are required to submit 2. Sociological perspectives on work, employment and two essays throughout the course. One of the essay everyday life must be completed from the module Theory and Unit I Work, employment and everyday life Practice of Guidance and Counselling. Participants Unit II Work and unemployment will also complete a research project integrating Unit III Historical overview perspectives from various modules. 3. Vocational Guidance Self- and Peer Assessment: Twice during the course participants will submit a learning statement on their Unit I Career information and Information Technology personal development and learning progress Unit II Theory and practice of career development and behavior 382 | ANNEXES Annex 4: Social Transfers ANNEX FIGURE 4.1: Contrasting Population Pyramids: Roma and Non-Roma Population in Romania Roma Non - Roma 80+ 80+ 75-79 75-79 70-74 70-74 65-69 65-69 60-64 60-64 55-59 55-59 50-54 50-54 45-49 45-49 40-44 40-44 35-39 35-39 30-34 30-34 25-29 25-29 20-24 20-24 15-19 15-19 10-14 10-14 5-9 5-9 0-4 0-4 15 10 5 0 5 10 15 15 10 5 0 5 10 15 Female Male Female Male Source: Based on the 2011 UNDP/World Bank/EC regional Roma survey and United Nations (2013). Annexes | 383 ANNEX FIGURE 4.2: Share of the Population Aged 65 and Over in the Total Population (left side) and Share of Pensioners in the Total Population (right side) Share of the population aged 65 and over in total ptopulation 2.8 - 15.0 % 15.1 - 18.0 % 18.1 - 21.0 % 21.1 - 25.3 % 25.4 - 55.0 % Region County Share of pensioners in total population 2.9 - 15.0 % 15.1 - 18.3 % 18.4 - 20.9 % 21.0 - 24.6 % 24.7 - 57.1 % Region County 50 25 0 50 100 150 km The intervals represent quintiles calculated at locality level. Data source: NIS, Population and Housing Census 2011 Source: 2011 Population and Housing Census data. Cartography: ESRI, ArcGIS 10.1 384 | ANNEXES ANNEX FIGURE 4.3: Proportion of Population Aged Over 75 and Living Alone by the Degree of Urbanization in Population Deciles 12 11.0 9.7 8.9 8.0 8 6.9 6.8 5.6 5.2 5.6 4.7 4.0 3.0 3.3 4 2.6 2.5 1.9 1.8 1.5 1.6 2.0 0 1,883 275 129 48 16 7.9 5.3 3.9 2.9 1.7 100% urban 100% urban 100% urban 100% urban 90% urban 36% urban 10% urban 2% urban 1% urban 0% urban Average number of residents in locality (in thousands), and Degree of urbanization aged 75 and over aged 75 and over and live alone Source: 2011 Population and Housing Census data. ANNEX FIGURE 4.4: Old Age Dependency Rates by the Degree of Urbanization in Population Deciles 160 138 122 120 105 93 75 80 66 53 56 58 57 36 41 29 32 40 20 18 18 17 20 24 0 1,883 275 129 48 16 7.9 5.3 3.9 2.9 1.7 100% urban 100% urban 100% urban 100% urban 90% urban 36% urban 10% urban 2% urban 1% urban 0% urban Average number of residents in locality (in thousands), and Degree of urbanization Age dependency rate (65+/18-64) System dependency rate (pensioners/employed) Source: 2011 Population and Housing Census data. ANNEX FIGURE 4.5: Projected PAYG Pension System Deficit as a Percentage of GDP -2 2014 2019 2024 2029 2034 2039 2044 2049 2054 2059 2064 2069 2074 2079 -2.5 -3 -3.5 Source: World Bank calculation using PROST, 2013 input data provided by Ministry of Public Finance. Annexes | 385 Annex 5: Social Services I. Statistical Data Administrative Organization of the SPAS at the Community Level (%) ANNEX TABLE 5.1:  No specialized Number of Direction Service Compartment Office Total   structure localities Rural 0-1,999 inh, 4 46 3 47 100 751 2,000-2,999 6 54 3 38 100 782 3,000-3,999 10 57 4 29 100 603 4,000-4,999 13 60 3 24 100 326 5,000+ inh, 11 66 5 18 100 399 Total 8 55 3 34 100 2,861 Urban <10,000 inh, 2 33 48 9 8 100 134 10,000 & <20,000 7 46 41 7 0 100 91 20,000 & <50,000 inh, 29 63 6 2 0 100 54 Total 8 43 38 7 4 100 279 Source: World Bank “Social Assistance Services at the Community Level” Survey, May 2014. ANNEX FIGURE 5.1: Human Resources at the SPAS Level 10 9.7 8 6 4.4 4.5 4 2.6 1.8 2.2 1.1 1.2 1.3 1.5 1.3 1.1 2 0.5 0.7 1.0 0.2 0.3 0.4 0.4 0.3 0.0 0.0 0 0/1.9k 2k/2.9k 3k/3.9k 4k/4.9k 5k+ Total 0/9.9k 10k/19k 20k/50k Total RURAL URBAN Average number of professional social workers in SPAS per locality Average number of all persons with social assistance duties in SPAS per locality Source: World Bank “Social Assistance Services at the Community Level” Survey, May 2014. Note: k = thousand inhabitants. 386 | ANNEXES ANNEX FIGURE 5.2: Distribution by Age Group of Staff with Social Assistance Responsibilities at the SPAS Level (%) 25 23 22.0 22 21.8 20 16 16 17 16.2 17 17 17 15 13 13.0 12 9 9.5 10 8 8.5 5 5.2 4 5 3 2 2.7 1 1.2 0 0 20-24 years 25/29 30/34 35/39 40/44 45/49 50/54 55/59 60+ years Rural Urban <50k Total Source: World Bank, “Social Assistance Services at the Community Level” Survey, May 2014. Note: Urban localities = those with fewer than 50,000 inhabitants Participation in Education of Children with Migrant Parents (%) ANNEX TABLE 5.2:  % of 6-9 % of 10-14 % of 15-17   year-olds in education year-olds in education year-olds in education Children with both parents at home 75.5 97.3 92.8 Children with one parent at home and the other having migrated 77.1 97.9 91.3 abroad Children with both parents having migrated abroad 60.3 87.0 73.3 Children with one parent at home and the other having migrated 77.2 97.5 92.1 within the country Children with both parents having migrated within the country 65.3 89.4 86.8 Children with one parent having migrated abroad and one parent 67.1 93.8 89.9 having migrated within the country Source: Authors’ calculations using 2011 Population and Housing Census data. Note: Migrant parents are those who have migrated abroad or within the country for work or studies who are absent from the household for less than 12 months. Annexes | 387 ANNEX FIGURE 5.3: Comparisons between Young Women (18-24) Who Were Teenage Mothers, Who Had their First Child after the Age of 18, and Who have No Children (%) 0% 20% 40% 60% 80% 100% Group A - former teenage mothers 27 73 Group B - mother after 18 years 35 65 Group C - never mothers 61 39 Urban Rural 0% 20% 40% 60% 80% 100% Group A - former teenage mothers 64 4 29 3 Group B - mother after 18 years 81 5 10 4 Group C - never mothers 83 6 2 9 Romanians Hungarians Roma Other etnicity 0% 20% 40% 60% 80% 100% Group A - former teenage mothers 12 50 36 2 Group B - mother after 18 years 9 70 19 2 Group C - never mothers 78 10 5 6 Never married Married Consensual union Other status 0% 20% 40% 60% 80% 100% Group A - former teenage mothers 17 18 3 63 Group B - mother after 18 years 26 17 4 52 Group C - never mothers 31 11 43 15 Employed Unemployed Pupils/students Home carers or other inactive Source: Authors’ calculations using 2011 Population and Housing Census data. 388 | ANNEXES Methodology of Census of Public Social II.  Assistance Services at the Community Level The World Bank carried out a census of Public Social questionnaire was filled in by 3,014 localities out of the total Assistance Services (SPAS) in cities and rural communities in of 3,180, a completion rate of 95 percent. Romania in May 2014 as an input to the National Strategy on Because of its special characteristics, Bucharest was not Social Inclusion and Poverty Reduction 2015-2020. included in the analysis. Due to partial non-responses, The aim of the census was to map all people working for local the 40 cities with 50,000 or more inhabitants were also authorities with responsibilities in the area of social work. excluded from the analysis. Thus, the analysis presented The questionnaire gathered information on the number of in this volume covers all 279 cities with population of fewer people with responsibilities in the area of social work, the than 50,000 inhabitants and all 2,861 communes, a total of type of contract that they had, their education level and 3,140 local authorities. The data are not weighted. qualifications, and their positions within the organization. The Census Completion Rates by Urban and Rural Area and Population Size ANNEX TABLE 5.3:  No. of localities that   Population size No. of localities in Romania responded Completion rate (%) Romania Total 3,180 3,014 95 Urban 0/4,999 29 27 93 5,000/9,999 105 103 98 10,000/14,999 64 61 95 15,000/19,999 27 25 93 20,000/49,999 54 50 93   50,000/99,999 21 21 100   100,000/500,000 19 14 74   Total 319 301 94 Rural 0/1,999 751 704 94 2,000/2,999 782 739 95 3,000/3,999 603 577 96 4,000/4,999 326 315 97 5,000+ 399 378 95   Total 2,861 2,713 95 Source: World Bank, “Social Assistance Services at the Community Level” Survey May 2014. Annexes | 389 Medical Rehabilitation Services for People III.  with Disabilities In Romania, medical rehabilitation services for people with medical rehabilitation facilities have been established disabilities used to be delivered in institutionalized settings, regularly to provide ambulatory care for people with but the growing trend is for local authorities or accredited disabilities who are not institutionalized. All of these NGOs to provide these services within the community. services, including freelance professionals, must currently submit to an accreditation process to ensure that a precise Physical medical rehabilitation for children is provided in inventory exists at the administrative level of each county designated centers under the management of the Ministry (within the Directorate of Health). For-profit services of Health, either at rehabilitation hospitals in Buşteni including small, multi-disciplinary rehabilitation centers (Prahova), Gura Ocniţei (Dâmboviţa), Dezna (Arad), Băile and physiotherapy centers are also expanding very rapidly, Felix (Bihor), and Mangalia (Constanta) or at rehabilitation especially in the larger cities. centers at the county and municipal levels. These centers are relatively well equipped and are run by qualified Some examples of medical (re)habilitation services that are professionals. The current trend is moving towards having currently provided in Romania are the following: a larger number of smaller rehabilitation services located in Mainstream (re)habilitation services, including physical municipalities and managed by the DGASPCs. NGOs have medical rehabilitation services in hospitals and spas (such also been developing medical rehabilitation services since as physiotherapy, electrotherapy, and hydrotherapy) the 1990s, either in specialized centers (for example, in Cluj, Iasi, and Timisoara) or as specific services within day Specialized (re)habilitation services for people with centers or small group homes. disabilities (within day care centers, residential centers, or specific rehabilitation centers for disabled). These services Medical rehabilitation for adults is provided in public address the specific medical rehabilitation needs of various hospitals and mainstream rehabilitation units, as well groups of people with disabilities (such as cerebral palsy, as in specialized centers and spas, depending on which rare diseases, and agenesis). The DGASPCs provide type of intervention and disability is involved. However, rehabilitation services at the county level for children with there are reports that adults with disabilities find it more disabilities (through residential and daycare services) and difficult to access rehabilitation services than children. Law for adults with disabilities in the following facilities: 448/2006 gives them the right to access rehabilitation programs and medical devices free of charge based on the Framework Agreement of the National Health Insurance •  ilot Centers for the (Re)habilitation of People with P Disabilities (CPRRPH) • (Contractul Cadru al Casei de Asigurari de Sanatate or NHI). Personal assistants are required to accompany severely C  enters for the (Re)habilitation of People with and noticeably disabled individuals free of charge to these Disabilities (CRRPH) medical or rehabilitation units. However, in practice, a large majority of families claim that they are obliged to pay •  Centers for Neuro-Psychiatric Rehabilitation (CRRN) for these personal assistants, as well as for a significant • Support services for daily activities including:  • amount of medical consumables, medicines, and equipment because of the limited annual budget of the NHI. T  he production of orthoprosthetic devices and other medical equipment that increase the person’s ability Residential rehabilitation facilities are organized under the to function and carry out daily activities methodological coordination of the National Directorate for Protection of Persons with Disabilities (DPPD) and are administered by the county DGASPCs (funded by the state budget). Other medical rehabilitation centers are •  he provision of medical consumables for people T with disabilities (such as incontinence items, liquid nutrition, and wound care). administered by the Ministry of Health. Since 2007 new 390 | ANNEXES IV. Support Services for People with Disabilities Increasing access for people with disabilities to programs, facilities, and support services for independent or supported • Private residential services for people with disabilities, usually in family-like settings or group homes but living is critical to ensuring their full inclusion in society. also in larger residential settings. Independent or supported living is the domain in which the Support services for independent living or for in-home care: role of support services is key. So far, the Romanian social services system supports for the following services: Mainstream services: • Subsidized interest on bank loans taken out by people with disabilities to buy or renovate/adapt a • house or apartment • Social housing – The allocation of a rent-free social house to people with disabilities should be Personal assistant a priority for social service providers. There should be one additional room for the family of a person with disabilities. State-owned apartments can be • Supported housing in apartments or homes that are located in the community used to accommodate people with disabilities (Law • In-home support for daily routines and activities • 448/2006). • Respite centers for families • Elderly residential settings • Interpreters for sign language and for easy-to- Foster care for children with disabilities without understand communication • parental care. ICT and assistive devices • Specific services for people with disabilities: • Public Centers for Care and Assistance (CIA/DPPD) • Adapted means of transport • Public sheltered homes or group homes for adults (DPPD) Counselor for independent living/case manager for people with disabilities. • Residential centers for children with disabilities (National Authority for Child Protection) Annexes | 391 Organization and Provision Principles of Services V.  for Drug Users in Romania According to the national standards developed by the of condoms; (vii) pre- and post-testing counseling; (viii) National Anti-Drug Agency,555 three levels of services are hepatitis A and B vaccination; (ix) general medical care; provided to drug users in Romania. (x) occupational therapy (ergo therapy); (xii) psychiatric medical care; (xiii) individual, group, and family psycho- Level 1 services are provided both by public institutions therapy; (xiv) standardized testing for psychological and NGOs on a small scale and at the local level. Thus, assessment; and (xv) promoting services provided by the they do not have national coverage. These services identify Integrated Care for Addictions Center (CAIA). drug users, persuade them to seek treatment, refer them to specialized services, address their basic social and medical Level 3 services consist of social reintegration services needs, and coordinate with providers of level 2 and 3 and are provided by post-treatment centers and therapy services. Specifically, the main services provided by level communities. 1 are: (i) providing substitute treatment; (ii) quick testing The principles underlying the standards that govern for HIV and hepatitis (B and C); (iii) distributing condoms; services for drug users in Romania are as follows: (i) all (iv) pre- and post-testing counseling; (v) hepatitis A and B levels of services must be available in all regions of the vaccinations; (vi) general medical care; and (vii) promoting country (possibly in each county); (ii) the treatment of the harm reduction services related to drug use problems. drug user should not just focus on treating the addiction but Level 2 services are provided by specialized units in the also in addressing the health, social, legal, and vocational public health system and in drug prevention, assessment, problems related to drug use; (iii) the necessary medication and counseling centers (CPECA). They provide specialized involved in addiction treatment must be provided in care and monitoring and refer users to level 3 services. combination with psychological counseling and behavioral Specifically, the main services provided by level 2 are: (i) psychotherapy; and (iv) the recovery of a drug addict is a providing substitute treatment; (ii) abstinence continuation lengthy process that must be monitored by specialists and treatment; (iii) outpatient rehab; (iv) drug tests in body adjusted when needed. fluids; (v) quick HIV and hepatitis testing; (vi) distribution 555 ANA (2005b). 392 | ANNEXES Organization and Types of Services for Victims VI.  of Human Trafficking in Romania According to national legislation and policy, the victims the National Agency against Trafficking in Human Beings of human trafficking are entitled to free services provided (ANITP), local authorities, the International Social Service, mostly through: (i) victims’ assistance centers; (ii) victims’ the International Organization for Migration, and other protection services and services for the social reintegration international organizations active in the field. of offenders; and (iii) NGOs. Victims of domestic violence are referred mostly by the Assistance centers are established and organized as per police, by the Directorate for Social Assistance and Child Law 678/2001 in each county and district. They exist Protection, by local authorities, and by NGOs. within the County Directorates for Social Assistance and Moreover, if a victim of human trafficking is involved in a Child Protection and are financed by the County Council, criminal proceeding filed by the authorities against the including transit centers for adults and unaccompanied traffickers, she can ask for physical protection and/or to be minors. placed in an Assistance Center or in a witness protection Victims’ protection services and services for the social program. In addition, as per Law 211/2004, victims can reintegration of offenders are established and organized receive financial compensation. as per Law 2011/2004 in each county as part of the Providers in the field are also involved in actions to courts. Both types of services serve both victims of human prevent human trafficking such as seminars, workshops, trafficking and victims of domestic violence. prevention campaigns, and the Helpline managed by NGOs can organize separate services for human trafficking ANITP. Furthermore, they help to monitor the phenomenon or in partnership with public authorities (for example, the by reporting data on service beneficiaries to the regional centers and services mentioned above or local councils). centers of ANITP or to other institutions responsible for However, NGO services for trafficking victims are organized preventing and counteracting human trafficking. separately from NGO services for the victims of domestic Apart from services provided in specialized units as violence. described above, according to the law (292/2011), victims Several institutions play a role in referring victims of human can also receive community services consisting of social trafficking to specialized services. These include the assistance, emotional support, psychological counseling, Border Police, the Office for Combating Organized Crime, legal advice, professional guidance, and help with social the Directorate for Social Assistance and Child Protection, reintegration. Annexes | 393 Types of Services Provided to Victims of Human Trafficking in Romania ANNEX TABLE 5.4:  Assistance Protection Name/Category of Services Types of Action NGOs Centers Services Information (on rights and Distribution of informative materials Yes Yes Yes available services) Face-to-face information Psychological assessment Individual psychotherapy Psychological assistance Group psychotherapy Yes Yes Yes Couples or family therapy Art therapy Help with acquiring identity documents Mediating the victims’ relations with the authorities, with their family, and with other Social assistance Yes Yes social assistance services Counseling to aid the victims’ social and professional reintegration Provision of food supplements, hygiene and Material assistance Yes cleaning products, clothes, and footwear Temporary accommodation (10 days to 3 Housing assistance months) in a victims’ reception center Yes Yes Assistance in finding a permanent home Legal aid Legal advice Yes Yes Yes Referral of victims to specialized medical Medical care Yes Yes services if they are in need of medical care Support for school Provided by cooperation with the County School Yes Yes Yes reintegration Inspectorate Vocational counseling and guidance Support for professional (As per Law 678/2001, victims of human trafficking receive “priority” services from the Yes Yes Yes reintegration County Employment and Vocational Training Agencies. 394 | ANNEXES Organization of Services for Victims of VII.  Domestic Violence in Romania Measures to prevent and counteract domestic violence in The approach to combating domestic violence is a cross- Romania are described in the most recent policy document, cutting effort under the coordination of the MLFSPE in the National Strategy for the Prevention of and Fight partnership with the Ministry of the Internal Affairs, the against Domestic Violence for 2013-2018.556 Ministry of Health, and the Ministry of Justice. Social Services for Victims of Domestic Violence and Attackers in Romania, 2012 ANNEX TABLE 5.5:  Number of units/ Type of unit Description coverage in territory Shelters (reception centers for emergencies) 26/ not in all counties Social assistance units with or without legal Recovery centers for victims of domestic violence structure providing accommodation, care, and social 15/ not in all counties rehabilitation and reintegration of victims Centers for preventing and counteracting domestic 12/ not in all counties violence Information and public awareness centers 8/ not in all counties Offices for preventing and counteracting domestic 3/ not in all counties violence Social assistance units with or without legal structure that provide a residential or half-residential system for the rehabilitation and social reintegration Assistance centers for attackers 2/ not in all counties of attackers, education, counseling, and family mediation, as well as psychiatric or detox treatments (in cooperation with specialized hospitals/clinics) Emergency reception centers for minors 11/ not in all counties Foster centers 4/ not in all counties Social assistance units that also provide services to 22/ not in all counties victims of domestic violence Restraining order (measure as per Law 25/2012) as a tool to assist victims of domestic violence and to Country-wide aid the recovery/rehabilitation of the attacker Primary social services provided within the Country-wide community 556 MLFSPE (2012). Annexes | 395 Annex 6: Education I. Statistical Data Explanatory Model of Early School Leaving among Adolescents ANNEX TABLE 6.1:  aged 15-18 Years Old   Odds Ratio   Model 1 Model 2 Model 3 Rural v. Urban 1.8*** 3.3*** 2.0*** Men v. Women 1.5*** 1.2*** 1.5*** Mothers’ education: Primary at best v. High school or over 49.4*** 23.8*** Mothers’ education: Gymnasium v. High school or over 10.7*** 6.7*** Mothers’ education: Lower secondary v. High school or over 3.7*** 2.7*** 1st Decile v. 5th decile or higher 4.0*** 2nd decile v. 5th decile or higher 2.4*** 3rd-4th decile v. 5th decile or higher 1.5*** Constant 0.08*** 0.5*** 0.01*** Pseudo R^2 0.04 0.21 0.23 Log likelihood -4193 -2570 -2485 LR chi2; df, prob>chi2 375; 2; 0.0 1326; 5; 0.0 1497; 8; 0.0 Source: World Bank calculations using pooled data from the 2009-2012 HBS. Legislative Framework and Education II.  Network for People with Disabilities The legislative framework that regulates access to education for people with disabilities is extensive and covers • Law on Education, no. 1/ 5.01.2011 (see mostly chapter 2, sections 13 and 16). • all aspects of education from preschool to tertiary education and vocational training. Law 448/2006 on the protection and promotion of • rights of people with disabilities. • The Constitution of Romania (article 16, Equality in rights). Law 272/2004 on the protection and promotion of • children’s rights. • Law 221/2010 on the ratification of the UN Convention on the Rights of Persons with Disabilities. Ordinance 137/2000, approved by Law no. 48/2002 • regarding the prevention and sanctioning of all forms Law 18/1990 on the ratification of the UN Convention of discrimination, with all modifications and updates on the Rights of the Child, republished in the Official (published in the Official Gazette no.69, January Gazette no 314/2001. 2002). 396 | ANNEXES • Law 107/2004 amending Law 76/2002 on unemployment insurance (with reference to free-of- • Order of the Minister of Education no. 3414/16.03.2009 regarding the organization of charge training for unemployed adults). special technological high schools (grades IX to XI). Plus the following: • Ministerial Order no. 4928/8.09.2005 regarding the • Decision no.1251/2005 of the Ministry of Education on measures related to the improvement of organization of classes/groups/or special schools that enroll children with severe, accentuated, or associated disabilities (grades I to X). education, compensation, rehabilitation, and social protection of children/pupils/young people with special educational needs, within the special and special integrated system of • Ministerial Order no. 4927/08.09.2005 regarding the organization of classes/groups in mainstream and special schools that enroll children with light and education (http:/ /lege5.ro/Gratuit/haydgojw/ medium disabilities. • hotararea-nr-1251-2005-privind-unele-masuri- de-imbunatatire-a-activitatii-de-invatare-instruire- Ministerial Order 5379/25.11.2004 regarding the compensare-recuperare-si-protectie-speciala-a-cop- methodology for educational support services for iilor-elevilor-tinerilor-cu-cerinte-educative-speciale-) children with special educational needs who are • enrolled in mainstream education (support teachers/ Order no.6552/2011 of the Ministry of Education, mobile teachers). • regarding the functioning of the Evaluation and School Orientation Commission, for children with Decision 522/8.05.2003 regarding the methodology special educational needs, within the County Center for implementing Ordinance 129/2000 on the for Resources and Educational Assistance (CJRAE). professional training of adults. • Order 5555/2011 regarding the functioning of CJRAE/CMBRAE. Annexes | 397 Annex 7: Health The Minimum Package of Primary Healthcare Services for the Uninsured ANNEX TABLE 7.1:  Population, 2014 No. Senior Frequency of Monetary value GPs fee Service points GP fee visits of points (RON) (RON) per visit (RON) 1 visit per 1.Medical services for medical/surgical emergencies person per 5.5 1.83 10 12 episode 1 visit per 2. Surveillance and detection - infectious diseases with endemic/ person per 5.5 1.83 10 12 epidemic risk - suspected and confirmed disease 3. Pre- and post-natal care 3.a. Pregnancy registration - first quarter 1 visit 5.5 1.83 10 12 1 visit per 3.b. Monthly monitoring (months 3-6) 5.5 1.83 10 12 month 2 visits per 3.c. Bi-monthly monitoring (months 7-9) 5.5 1.83 20 24 month 3.d. Postpartum care - home visit after discharge 1 home visit 15 1.83 27 33 3.e. Mother check-up 4 weeks after delivery 1 visit 5.5 1.83 10 12 2 visits per 4. Family planning services 5.5 1.83 20 24 person per year 5. Release of death certificate 1 home visit 15 1.83 27 33 Source: Data from the Framework Contract and its application norms regarding the 2014-2015 service delivery within the Health Insurance System (Gov. Decision 400/2014; Ministry of Health-Health Insurance House Ordinance 619-360, May 2014). 398 | ANNEXES Annex 8: Housing I. Statistical Data Private Ownership of Housing Stock in EU-28: the Five Countries with the ANNEX TABLE 8.1:  Highest Percentage and Those with the Lowest, 2000 and 2012 2000 2012 Total Poor Total Poor EU27 70.4 52.6 Romania 97 95 96.6 96.0 Lithuania 95 92 91.9 85.6 Hungary 94 86 90.5 82.9 Slovakia 90.4 82.3 Croatia 89.5 87.3 Denmark 64.3 29.1 France 70 52 63.7 35.2 Austria 69 68 57.5 30.5 Germany 56 36 53.3 24.9 Switzerland 43.8 31.7 Source: Eurostat. Percentage of Young Adults Aged 18-34 Living with Their Parents ANNEX TABLE 8.2:    2007 2008 2009 2010 2011 2012 EU-28 47.1 47.5 47.7 47.4 48.2 48 Romania 57.2 57.1 58.3 58.9 60 61.7 Lithuania 54.7 54.8 55.4 55.7 54 56.6 Hungary 51.5 53.2 58.2 60.6 61.9 63.1 Croatia 68.7 70.5 71.3 Bulgaria 59.7 62.7 62.8 66 66.7 64.5 Italy 60.7 60.5 61.1 60.5 62.6 64 Poland 59.4 58.5 58.2 58.4 60.5 60.2 Source: Eurostat. Annexes | 399 Number of People per Lived-in Room, 2012 ANNEX TABLE 8.3:  ROMANIA URBAN RURAL Income Std. Std. Std. Mean Min Max Mean Min Max Mean Min Max deciles dev. dev. dev. D1 1.44 0.91 0.13 7 1.76 1.11 0.13 7 1.37 0.84 0.20 7 D2 1.02 0.64 0.13 7 1.35 0.80 0.25 6 0.92 0.54 0.13 7 D3 0.92 0.57 0.13 4 1.22 0.68 0.14 4 0.80 0.48 0.13 4 D4 0.91 0.56 0.17 5 1.17 0.65 0.17 4 0.77 0.45 0.17 5 D5 0.88 0.52 0.14 6 1.06 0.58 0.20 4 0.73 0.43 0.14 6 D6 0.83 0.48 0.13 4 0.96 0.52 0.25 4 0.67 0.35 0.13 4 D7 0.81 0.44 0.14 4 0.90 0.46 0.17 4 0.65 0.34 0.14 2 D8 0.79 0.40 0.14 4 0.85 0.40 0.14 3 0.66 0.36 0.14 4 D9 0.79 0.39 0.17 3 0.84 0.40 0.17 3 0.61 0.29 0.17 2 D10 0.73 0.37 0.13 3 0.76 0.38 0.13 3 0.55 0.28 0.17 2 Source: National Institute of Statistics, 2012 Household Budget Survey. Note: Income deciles based on the total monthly household cash income per capita (without self-consumption). Surface of Lived-in Rooms (Square Meters) per Person, 2012 ANNEX TABLE 8.4:  ROMANIA URBAN RURAL Income Std. Std. Std. Mean Min Max Mean Min Max Mean Min Max deciles dev. dev. dev. D1 14.79 10.98 1.17 200.0 12.93 12.45 1.17 200 15.25 10.54 1.50 95 D2 20.64 13.39 2.29 130.0 16.41 11.07 2.29 88 22.00 13.79 2.29 130 D3 23.36 14.92 3.43 147.0 18.03 12.81 3.50 87 25.42 15.17 3.43 147 D4 23.66 15.29 3.00 130.0 18.72 12.31 3.00 120 26.34 16.06 3.00 130 D5 24.59 14.73 3.50 180.0 20.94 12.95 3.50 100 27.49 15.39 3.50 180 D6 26.42 16.10 3.13 170.0 22.91 13.43 3.33 96 30.74 17.95 3.13 170 D7 26.46 14.79 3.00 120.0 23.45 12.86 3.00 100 31.62 16.39 6.00 120 D8 27.00 15.36 3.00 150.0 24.91 13.74 4.80 112 32.05 17.73 3.00 150 D9 26.81 14.29 4.14 135.0 25.08 13.22 4.14 120 32.33 16.07 6.00 135 D10 29.40 15.27 4.67 140.0 28.10 14.33 4.67 140 35.76 17.95 7.00 128 Source: National Institute of Statistics, 2012 Household Budget Survey. Note: Income deciles based on the total monthly household cash income per capita (without self-consumption). 400 | ANNEXES Severe Housing Deprivation by Poverty Risk and Age (Children), 2007-2012, (%) ANNEX TABLE 8.5:  Romania EU-28   2007 2012 2007 2012 Total population 31.8 22.8 7.2 5.0 Population at risk of poverty 52.6 49.2 15.6 12.6 Children 46.1 36.9 10.0 7.5 Children at risk of poverty 71.4 63.6 21.8 18.1 Source: Eurostat. ANNEX TABLE 8.6: Proportion of Population Suffering From Different Types of Housing Deprivation (%)   2007 2008 2009 2010 2011 2012 Lacking a bath or a shower inside the EU-28 3.6 3.4 3.1 2.9 2.8 2.7 dwelling Romania 41.8 41.7 41.2 38.9 36.8 35.4 Lacking indoor flushing toilet for the sole use EU-28 4.1 3.7 3.5 3.4 3.1 3 of the household Romania 44 41.2 42.5 40.8 38.7 37 Leaking roof, damp walls, floors, or EU-28 28.2 26.4 25.8 25.7 24.3 23.5 foundation, or rot in window frames or floor Romania 44.9 37.7 34.9 33.2 35.1 30 EU-28 8.2 7.2 7.3 6.8 6.8 6.1 The dwelling is considered too dark Romania 7.6 8.2 8.7 7.6 7.7 6.4 Source: Eurostat. II. Situation of Social Housing (SSH) Survey In October 2014 as part of the preparation of the National Data were collected between September and November Strategy on Social Inclusion and Poverty Reduction 2015- 2014. The sample consisted of all Romanian urban 2020, the World Bank557 in collaboration with the Ministry administrative units - 319 cities and six Bucharest of Regional Development and Public Administration sectors. The aim of the SSH survey was to provide an (MRDPA)558 carried out a Situation of Social Housing overview of publicly owned housing units in Romania. The (SSH) survey in all urban municipalities. The survey was questionnaire gathered information on the following topics: conducted as a collaboration between two teams working 1. Social Housing on two different World Bank projects: (i) Support for the Preparation of a National Strategy and Action Plan on - Stock of Social Housing Social Inclusion and Poverty Reduction 2015-2020 and - Supply and Demand (ii) Assisting in Housing and Infrastructure Development Strategy (Regional Development Program 2, Harmonizing - Beneficiaries and Occupancy of Social Housing Public Investments). - Quality of the Social Housing Stock - Overdue Debts to Utilities and Rent in Social Housing 557 Research team included Corad Bogdan, Cătălina Iamandi-Cioinaru, Monica Marin, Georgiana Neculau and Andreea Trocea, with the support of Alexandra Călin. 558 The World Bank team’s counterparts in the MRDPA were Mr. Teofil Ghercă and Mr. Bogdan Ghinea. Annexes | 401 2. Housing Programs - Housing Units for the Mobility of Specialists • Social housing is defined under the Housing Law 114/1996 as a dwelling that is allocated by a public authority for a small rent (subvention) to individuals - Emergency Houses or families who cannot otherwise afford to buy or rent a house from the free housing market. This definition - Youth Housing Program does not include housing services for vulnerable - Land Plots for Young Families groups such as shelters for the homeless. - Other Types of Rental Housing Units Owned by Local Public Authorities • H  ousing units with a social character (named also “affordable houses” by local public authorities) - Shelters for Homeless People represent the housing stock owned and managed by the local public authority that are rented to the 3. Local Housing Policies and Management poor population. This fund is not “social housing” - Local Strategies and Local Budgets Allocated to as it does not comply with the legal requirements. Social Housing Most often this stock consists of nationalized or low- quality houses that have been neglected in the past Budgets for Building, Renovating, and Maintaining - few years and are located in unattractive, difficult to Social Housing in 2012-2013 access, and poorly endowed urban areas, with a low - Main Problems in Managing the Housing Stock market price. Owned by the Local Public Authorities The questionnaire was filled in by the staff of 300 urban Main Problems in Developing the Housing Stock - municipalities and three sectors of Bucharest, a total Owned by the Local Public Authorities response rate of 93 percent. The highest response rates In accordance with current legislation, the SSH survey used were registered in the South-East (97 percent) and Center the following definitions for social housing: (96 percent) regions, while the lowest rates were in the Bucharest-Ilfov (79 percent) and North-East (89 percent) regions. Also, there was a low response rate from the new small towns designated between 2002 and 2006. 402 | ANNEXES SSH Survey Response Rates by Region, Population Size, City Composition, and History ANNEX TABLE 8.7:  Non- Responses Total Response response rates (number) (number) (number) (percent) TOTAL 22 303 325 93.2 Development 1 North East 5 41 46 89.1 Region 2 South East 1 34 35 97.1 3 South Muntenia 3 45 48 93.8 4 South West 4 36 40 90.0 5 West 2 40 42 95.2 6 North West 2 41 43 95.3 7 Center 2 55 57 96.5 8 Bucharest-Ilfov 3 11 14 78.6 Population 1.6-9.9K 7 127 134 94.8 Size 10-19.9K 8 83 91 91.2 (2011 Census) 20-49.9K 2 52 54 96.3 50+K 2 38 40 95.0 Bucharest 3 3 6 50.0 City Cities without incorporated villages 4 76 80 95.0 Composition Cities that incorporate villages 18 227 245 92.7 City History Old small cities (with fewer than 20,000 residents) 9 165 174 94.8 designated before 2002 New small cities (with fewer than 20,000 residents) 6 45 51 88.2 designated after 2002 Medium and large cities (with more than 20,000 residents) 7 93 100 93.0 Source: MRDPA and the World Bank, Survey on Situation of Social Housing (SSH), September-November 2014. Notes: N=300 cities and 3 Bucharest sectors. Data from the questionnaires were supplemented by information provided by the Bucharest General Mayoralty (PGMB) at the Stakeholders’ Meeting organized by the World Bank within the project Regulatory Impact Assessment (RIA) Framework in Romania, held in Bucharest on February 12, 2015. Three sectors of Bucharest (sectors 1, 2, and 6) responded to the survey while the PGMB provided additional data on the other three sectors (sectors 3, 4, and 5). Annexes | 403 ANNEX FIGURE 8.1: Profile of the Stock of Social Housing in Urban Romania as at September 1, 2014 33507 Villages Cities which incorporate villages 16427 Cities without incorporated villages 14000 12740 Bucharest 9534 1534 50+K 20478 15677 Size 20-49.9K 8662 6106 10-19.9K 4941 3157 1.6-9.9K 3892 2693 B-Ilfov 9871 1584 Center 6725 4921 N-W 5555 4534 W 5170 Region 3611 S-W 3892 2419 S-Muntenia 3817 Number of social housing plus units with social 2970 8473 character S-E 6161 Number of dwellings offi cially registered as N-E 4004 social housing 2967 0 5000 10000 15000 20000 25000 30000 35000 40000 Source: MRDPA and the World Bank, Survey on Situation of Social Housing (SSH), September-November 2014. Notes: N=300 cities and 3 Bucharest sectors, completed with data from the General Mayoralty of Bucharest regarding sectors 3, 4 and 5, as of February 2015. Total number of social housing = 29,167 units. Total number of social housing plus units with social character = 47,507 units. 404 | ANNEXES ANNEX FIGURE 8.2: Supply and Demand for Social Housing in Urban Romania as of September 1, 2014 80000 67100 70000 60000 55317 47507 50000 40000 29167 30000 20000 10000 0 Number of dwellings Number of social housing Number of applications for Demand for social housing officially registered as social plus units with social social housing estimated by local housing character authorities (number of units) SUPPLY as at September 1, 2014 DEMAND as at September 1, 2014 Source: MRDPA and the World Bank, Survey on Situation of Social Housing (SSH), September-November 2014. Notes: N=300 cities and 3 Bucharest sectors, completed with data from the General Mayoralty of Bucharest regarding sectors 3, 4 and 5, as of February 2015. ANNEX FIGURE 8.3: Beneficiaries and Occupancy Rates of Social Housing in Urban Romania as of September 1, 2014 30000 1070 25000 Not occupied 11226 835 20000 15000 7861 Rented to other people 10000 235 16021 3531 5000 10887 Rented to low-income 4968 families 0 Total social housing Social housing in Social housing in BLOCK-of-FLATS OTHER TYPES of BUILDINGS Source: MRDPA and the World Bank, Survey on Situation of Social Housing (SSH), September-November 2014. Notes: N=168 cities and 3 Bucharest sectors, with state-owned dwellings officially registered as social housing; N=154 cities and 3 Bucharest sectors, with social housing in blocks of flats; and N=102 cities with social housing in other types of buildings. Rented to low-income families according to art.42 in the Law no. 114/1996. Annexes | 405 ANNEX FIGURE 8.4: Quality of Social Housing in Urban Romania as of September 1, 201 70 63 58 60 49 50 45 40 31 33 29 30 24 20 14 15 13 6 8 7 5 10 0 0 1.6-9.9K 10-19.9K 20-49.9K 50+K Non-response % of cities with social dwellings either in ... lower than 37 sqm block-of-flats or in other types of buildings with an average surface … … between 37 sqm and below 52 sqm … of 53 sqm or larger Source: MRDPA and World Bank, Survey on Situation of Social Housing (SSH), September-November 2014. Notes: N=168 cities (Bucharest sectors not included) with state-owned dwellings officially registered as social housing. 406 | ANNEXES Social Dwellings with Debts to Utilities and/or Rent Payments ANNEX TABLE 8.8:  Number of dwellings officially registered Number of social Number of social as social housing that dwellings without debts dwellings with debts responded to SSH Utility Payments TOTAL 20,399 14,365 6,034 Development 1 North East 2,829 1,542 1,287 Region 2 South East 2,272 1,426 846 3 South Muntenia 2,832 2,081 751 4 South West 1,491 971 520 5 West 3,312 2,502 810 6 North West 3,961 3,026 935 7 Center 2,968 2,300 668 8 Bucharest-Ilfov 734 517 217 Population Size 1.6-9.9K 2,205 1,480 725 (2011 Census) 10-19.9K 2,806 1,986 820 20-49.9K 4,439 3,243 1,196 50+K 10,265 7,168 3,097 Bucharest 684 488 196 Subsidized Rent TOTAL 26,559 17,032 9,527 Development 1 North East 2,925 1,530 1,395 Region 2 South East 4,999 3,249 1,750 3 South Muntenia 2,950 2,147 803 4 South West 2,053 1,477 576 5 West 3,611 2,073 1,538 6 North West 4,374 2,368 2,006 7 Center 4,913 3,633 1,280 8 Bucharest-Ilfov 734 555 179 Population Size 1.6-9.9K 2,534 1,521 1,013 (2011 Census) 10-19.9K 3,068 2,102 966 20-49.9K 6,106 3,382 2,724 50+K 14,167 9,506 4,661 Bucharest 684 521 163 Source: MRDPA and the World Bank, Survey on Situation of Social Housing (SSH), September-November 2014. Notes: N=168 cities (Bucharest sectors not included) with state-owned dwellings officially registered as social housing. Annexes | 407 Annex 9: Social Participation Social Dwellings with Debts to Utilities and/or Rent Payments ANNEX TABLE 9.1:  People Heavy Drug Criminal Homo- Mus- Differ- Immi- Gypsies with Jews drinkers addicts record sexuals lims ent race grants AIDS Gender Male 62% 64% 58% 60% 47% 43% 22% 21% 21% 18% Female 70% 66% 61% 59% 45% 43% 24% 20% 21% 19% Age 18 - 49 years old 66% 63% 57% 56% 44% 42% 21% 22% 21% 20% 50 - 64 years old 65% 67% 60% 60% 47% 42% 22% 18% 20% 18% 65 and over 73% 69% 68% 68% 49% 50% 28% 22% 21% 17% Education Primary 69% 68% 67% 65% 51% 53% 32% 28% 28% 19% Secondary 64% 66% 63% 64% 45% 47% 25% 21% 20% 20% High school 67% 63% 56% 54% 46% 39% 20% 20% 20% 19% Tertiary 70% 66% 52% 54% 36% 29% 12% 11% 14% 9% Activity status Working 65% 64% 57% 55% 43% 39% 20% 21% 20% 18% Unemployed 66% 74% 46% 70% 42% 47% 21% 9% 9% 12% Retired 71% 68% 66% 66% 53% 48% 27% 21% 22% 18% Other inactive 65% 64% 58% 58% 39% 46% 22% 20% 22% 21% Size of community Under 5k 67% 69% 64% 66% 48% 48% 29% 29% 27% 25% 5k - 20k 64% 60% 61% 58% 41% 49% 25% 18% 19% 18% 20k - 100k 64% 66% 51% 60% 42% 37% 17% 17% 17% 18% 100k - 500k 70% 62% 61% 52% 52% 36% 20% 17% 19% 11% Over 500k 67% 71% 53% 55% 39% 38% 13% 12% 14% 15% Region North-East 65% 63% 66% 62% 52% 56% 33% 30% 33% 26% South-East 53% 47% 47% 44% 40% 23% 29% 28% 25% 17% South-Muntenia 67% 67% 42% 68% 54% 45% 16% 21% 18% 23% South-West Oltenia 74% 65% 68% 57% 48% 44% 22% 21% 20% 17% West 75% 65% 82% 70% 45% 45% 15% 10% 17% 12% North-West 79% 81% 64% 65% 59% 54% 20% 16% 15% 17% Center 60% 63% 60% 52% 26% 37% 22% 12% 11% 11% Bucharest – Ilfov 68% 74% 57% 58% 41% 40% 18% 19% 19% 20% TOTAL 67% 65% 60% 59% 46% 43% 23% 21% 21% 19% Source: 2008 European Values Study. Note: Data in cells represent the percentage of the population who would not like to have the corresponding group as neighbors. 408 | ANNEXES Targets of Intolerance among High School Students in Romania, 2011 ANNEX TABLE 9.2:  People with Homosexuals Gypsies Muslims Jews Different race AIDS HH Education Stock Without high school 82% 65% 74% 52% 45% 33% High school 78% 70% 65% 47% 36% 29% College 66% 74% 59% 40% 30% 20% Post-graduate 56% 79% 55% 32% 27% 18% Self-assessed poverty Poor 72% 63% 55% 46% 35% 30% Average 75% 69% 66% 45% 35% 26% Rather wealthy 74% 76% 64% 48% 39% 26% Wealthy 72% 80% 69% 47% 41% 37% Rural/ Urban Rural 82% 70% 70% 52% 46% 36% Urban 68% 72% 60% 40% 29% 21% TOTAL 74% 71% 65% 45% 36% 27% Source: Open Society Foundation (2011). 559 Note: Data in cells represent the percentage of the high school students who would not like to have the corresponding group as neighbors. 559 /www.fundatia.ro/romanii-devin-mai-toleranti-religios. Survey on Religion and Religious Behavior carried out in June 2011 on a sample of 1,204 persons aged 18 years or over, http:/ Calculations done by Claudiu Tufiș. Annexes | 409 Annex 10: Area-based Policies Statistical Data on Small and Very Small Villages I.  and Those with Aging Populations ANNEX TABLE 10.1: Distribution of Villages and Rural Population by Village Population Size, 2011 Village population Number of Share of total number of Total Share of total rural population size ... villages villages (%) population (%) <50 inhabitants 830 7 20,822 0.2 50-99 780 6 57,746 0.6 100-149 787 6 98,533 1.1 150-199 775 6 134,729 1.5 200-249 686 6 153,920 1.7 250-299 663 5 181,677 2.0 300+ inhabitants 7845 63 8,615,424 93 Total 12,366 100 9,262,851 100 Source: World Bank calculations based on 2011 Population and Housing Census. ANNEX TABLE 10.2: Distribution of Small Villages (Fewer than 200 Inhabitants) by Region, 2011 Number of Small Larger Small Larger Share of total Total villages villages villages villages villages numberof villages (%) <200 inh. 200+ inh. <200 inh. 200+ inh. Regions (%) (%) (%) (%) (%) North-West 1,744 14 13 14 24 76 100 Center 1,688 14 22 11 41 59 100 North-East 2,332 19 14 21 19 81 100 South-East 1,385 11 10 12 23 77 100 South Muntenia 1,959 16 10 18 17 83 100 Bucharest-Ilfov 89 1 0 1 3 97 100 South-West Oltenia 1,939 16 17 15 27 73 100 West 1,230 10 14 9 36 64 100 Total 12,366 100 100 100 26 74 100 Source: World Bank calculations based on 2011 Population and Housing Census. 410 | ANNEXES Distribution of Very Small Villages (Fewer than 100 Inhabitants) by Region, 2011 ANNEX TABLE 10.3:  Number of Very small Larger Very small Larger Share of total Total villages villages villages villages villages number of villages (%) <100 inh. 100+ inh. <100 inh. 100+ inh. Regions (%) (%) (%) (%) (%) North-West 1,744 14 12 14 11 89 100 Center 1,688 14 29 11 27 73 100 North-East 2,332 19 11 20 8 92 100 South-East 1,385 11 10 11 12 88 100 South Muntenia 1,959 16 8 17 7 93 100 Bucharest-Ilfov 89 1 0 1 1 99 100 South-West Oltenia 1,939 16 14 16 12 88 100 West 1,230 10 16 9 21 79 100 Total 12,366 100 100 100 13 87 100 Source: World Bank calculations based on 2011 Population and Housing Census. Share of Children and Elderly in the Total Population of Small and Very Small ANNEX TABLE 10.4:  Villages, 2011 Very small Larger Small Larger Total Total villages villages villages villages Population aged ... <100 inh. (%) 100+ inh. (%) (%) <200 inh. (%) 200+ inh. (%) (%) <18 years old 16 22 22 18 22 22 50+ years old 50 37 37 47 37 37 55+ years old 45 32 32 41 31 32 60+ years old 38 25 26 35 25 26 65+ years old 29 18 18 26 18 18 70+ years old 24 14 14 21 14 14 75+ years old 16 9 9 14 9 9 Source: World Bank calculations based on 2011 Population and Housing Census. Annexes | 411 Share of Dwellings Connected to Utilities in Small and Very Small Villages, 2011 ANNEX TABLE 10.5:  Very small Larger Small Larger Total Total villages villages villages villages <100 inh. 100+ inh. <200 inh. 200+ inh. Dwellings with… (%) (%) (%) (%) (%) (%) Piped water from the public network 32 32 32 28 33 32 Sewage disposal system connected to a public 4 6 6 4 6 6 sewage disposal plant Electrical lighting 99 99 99 99 99 99 Gas from public network for cooking 10 10 10 9 10 10 Source: World Bank calculations based on 2011 Population and Housing Census. Share in Total Population of People with Limitations because of Health Problems ANNEX TABLE 10.6:  in Small and Very Small Villages, 2011 Very small Larger Larger Share of total Small villages villages villages villages People with limitations because of health population Total number <100 inh. (%) 100+ inh. (%) <200 inh. (%) 200+ inh. (%) problems ... (%) ... with significant difficulties, of which: 264,416 2.9 4.4 2.8 4.0 2.8 - without aid from someone else 177,083 1.9 3.1 1.9 2.9 1.9 ... with complete inabilities, of which: 57,299 0.6 0.8 0.6 0.8 0.6 - without aid from someone else 17,099 0.2 0.3 0.2 0.2 0.2 Source: World Bank calculations based on 2011 Population and Housing Census. Villages with Aging Populations, 2011 ANNEX TABLE 10.7:  Share of total Villages with more than 50% Number of Share in total Average village Children living in number of Total population of individuals aged … villages rural population size these villages* villages (%) (%) (%) 50+ years old 2,342 18.9 637,760 6.9 272 14 55+ years old 1,288 10.4 238,183 2.6 185 12 60+ years old 625 5.1 70,587 0.8 113 10 65+ years old 208 1.7 8,973 0.1 43 5 70+ years old 108 0.9 2,859 0.03 26 3 75+ years old 32 0.26 270 0 8 0 Total rural population 12,366 100 9,262,851 100 749 Source: World Bank calculations based on 2011 Population and Housing Census. Note: * Share of total number of children aged 0 to 17 years living in these villages in total population of these villages. 412 | ANNEXES Distribution of Villages with Aging Populations by Region, 2011 ANNEX TABLE 10.8:  Villages with more than 50% of Villages with more than 50% of Villages with more than 50% of individuals aged 50+ years old (%) individuals aged 55+ years old (%) individuals aged 60+ years old (%) Regions No Yes Total No Yes Total No Yes Total North-West 78 22 100 86 14 100 92 8 100 Center 81 19 100 88 12 100 93 7 100 North-East 93 7 100 97 3 100 99 1 100 South-East 82 18 100 90 10 100 96 4 100 South Muntenia 83 17 100 91 9 100 96 4 100 Bucharest-Ilfov 98 2 100 100 0 100 100 0 100 South-West Oltenia 72 28 100 85 15 100 94 6 100 West 72 28 100 86 14 100 93 7 100 Total 81 19 100 90 10 100 95 5 100 Source: World Bank calculations based on 2011 Population and Housing Census. Share of Dwellings Connected to Utilities in Villages with Aging Populations, 2011 ANNEX TABLE 10.9:  Villages with more than 50% of Villages with more than 50% of Villages with more than 50% of individuals aged 50+ years old (%) individuals aged 55+ years old (%) individuals aged 60+ years old (%) Dwellings with… No Yes Total No Yes Total No Yes Total Piped water from the public 33 26 32 32 27 32 32 29 32 network Sewage disposal system connected to a public 6 3 6 6 4 6 6 4 6 sewage disposal plant Electrical lighting 99 99 99 99 99 99 99 99 99 Gas from public network for 11 6 10 10 7 10 10 6 10 cooking Source: World Bank calculations based on 2011 Population and Housing Census. Annexes | 413 Statistical Data on Small Communes II.  (with Fewer than 2,000 Inhabitants) Distribution of Communes and Rural Population by Commune Population Size, 2011 ANNEX TABLE 10.10:  Commune population Share in total number of Share in total rural Number of communes Total population size ... communes (%) population (%) <1,000 inhabitants 88 3 65,117 1 1,000-1,499 247 9 314,583 3 1,500-1,999 416 15 727,606 8 2,000-2,499 419 15 941,083 10 2,500-2,999 363 13 992,611 11 3,000+ inhabitants 1,328 46 6,221,851 67 Total 2,861 100 9,262,851 100 Source: World Bank calculations based on 2011 Population and Housing Census. Distribution of Small Communes (Fewer than 2,000 inhabitants) by Region, 2011 (%) ANNEX TABLE 10.11:  Communes by population size Small Larger (number of inhabitants) communes communes 1000- 1500- 2000- 2500-   <1000 3000+ Total <2000 inh. 2000+ inh. Total 1499 1999 2499 2999 North-West 6 21 13 15 15 13 14 15 14 14 Center 27 17 16 13 12 9 12 17 11 12 North-East 0 5 13 14 17 24 18 9 21 18 South-East 16 11 12 12 9 13 12 12 12 12 South Muntenia 6 11 13 20 18 21 18 12 20 18 Bucharest-Ilfov 0 0 0 0 0 2 1 0 2 1 South-West Oltenia 15 16 19 18 17 10 14 18 13 14 West 31 18 14 8 12 6 10 17 7 10 Total 100 100 100 100 100 100 100 100 100 100 North-West 1 13 13 16 14 43 100 27 73 100 Center 7 12 18 15 13 35 100 37 63 100 North-East 0 3 11 12 12 63 100 13 87 100 South-East 4 8 14 14 10 50 100 26 74 100 South Muntenia 1 5 11 16 12 55 100 17 83 100 Bucharest-Ilfov 0 0 0 0 0 100 100 0 100 100 South-West Oltenia 3 10 20 19 15 34 100 32 68 100 West 10 16 20 11 15 28 100 46 54 100 Total 3 9 15 15 13 46 100 26 74 100 Source: World Bank calculations based on 2011 Population and Housing Census. 414 | ANNEXES ANNEX TABLE 10.12:  Share of Dwellings Connected to Utilities by Commune Population Size, 2011 (%) Communes by population size (number of inhabitants) 2000- 2500- Dwellings with… <1000 1000-1499 1500-1999 3000+ Total 2499 2999 Piped water from the public network 31 28 34 28 29 33 32 Sewage disposal system connected to a 5 4 6 3 4 6 6 public sewage disposal plant Electrical lighting 99 99 99 99 99 99 99 Gas from public network for cooking 12 9 8 7 6 12 10 Source: World Bank calculations based on 2011 Population and Housing Census. Share of Dwellings Connected to Utilities in Small Communes, 2011 (%) ANNEX TABLE 10.13:  Small communes Larger communes Dwellings with… <2000 inh. 2000+ inh. Total Piped water from the public network 32 32 32 Sewage disposal system connected to a public 5 6 6 sewage disposal plant Electrical lighting 99 99 99 Gas from public network for cooking 9 11 10 Source: World Bank calculations based on 2011 Population and Housing Census. Statistical Data on Small Urban Towns III.  (fewer than 20,000 inhabitants) ANNEX TABLE 10.14: Distribution of the Urban Population by City Size and Region (%) Small towns Medium cities Large cities 1,641-20,000 inhabitants 20,000-200,000 inhabitants >200,000 inhabitants Total North-East 2.8 7.2 2.7 12.7 South-East 1.9 5.8 4.9 12.5 South Muntenia 3.2 6.3 1.9 11.4 South-West 2.9 3.5 2.5 8.8 West 2.7 4.8 2.9 10.5 North-West 2.6 7.0 3.0 12.6 Center 2.9 7.4 2.3 12.6 Bucharest-Ilfov 0.5 1.0 17.3 18.9 TOTAL 19.3 43.1 37.6 100.0 Source: World Bank calculations based on 2011 Population and Housing Census. Annexes | 415 Distribution of Small Towns and Urban Population by Population Size, 2011 ANNEX TABLE 10.15:  Localities (number) Population (number) Small towns Small towns Small towns Small towns Population size ... designated before recently Small towns total designated before recently Small towns total 2002 designated 2002 designated 0-4,999 inhabitants 19 10 29 65,175 42,585 107,760 5,000-7,499 42 23 65 270,593 144,109 414,702 7,500-9,999 33 7 40 288,993 61,129 350,122 10,000-14,999 54 10 64 643,044 121,406 764,450 15,000-19,999 26 1 27 444,489 15,329 459,818 Total 174 51 225 1,712,294 384,558 2,096,852 Source: World Bank calculations based on 2011 Population and Housing Census. Average Levels of Local Human Development (LHDI) by Locality Type and ANNEX TABLE 10.16:  Population Size, 2002 and 2011 Small towns (fewer than Small towns (fewer than Larger cities 20,000+ Rural 20,000 inhabitants) 20,000 inhabitants) inhabitants communes declared before 2002 recently designated Population size ... LDHI 2002 LDHI 2011 LDHI 2002 LDHI 2011 LDHI 2002 LDHI 2011 LDHI 2002 LDHI 2011 0-4,999 inhabitants - - 41.7 43.9 37.4 41.1 31.9 35.7 5,000-7,499 - - 40.8 43.7 37.4 41.4 36.0 40.6 7,500-9,999 - - 42.9 46.0 39.3 43.6 38.0 44.1 10,000-14,999 - - 44.2 46.9 39.1 43.9 39.9 46.3 15,000-19,999 - - 46.4 48.3 * * - - 20,000 or over 49.7 52.1 - - - - * * Total 49.7 52.1 43.2 45.9 38.1 42.5 32.6 36.6 Source: The Local Human Development Index (LHDI) developed in World Bank (Ionescu-Heroiu et al, 2013a). Note: *Only one case. 416 | ANNEXES A Comparison of Local Budget Indicators: between Small Towns, Larger Cities, ANNEX TABLE 10.17:  and Rural Communes by Population Size Self-generated revenues of localities (annual average per Total volume of expenditures on European funded projects, inhabitant, in 2009 constant RON) in the period 2009-2012 (Euro per capita) Small towns Small towns Small towns Small towns Population size designated before recently Rural communes designated before recently Rural communes 2002 designated 2002 designated 0-4,999 186 151 54 75 14 143 5,000-7,499 150 84 70 55 55 83 7,500-9,999 158 69 108 79 46 48 10,000-14,999 178 130 113 37 87 41 15,000-19,999 148 * * 63 * * Total 164 107 58 57 51 133 / Source: World Bank’s calculations using local budget execution data posted by the Ministry of Administration and Interior available at: http:/ www.dpfbl.mai.gov.ro/sit_ven_si_chelt_uat.html (date of accession: January 10, 2014) as well as population data from 2011 census (National Institute of Statistics). Note: * Only one case of 15,000 inhabitants or over.560 560 At present, the local budget execution data are reported by the Ministry of Finance. The Ministry of Administration and Interior is the Ministry of Internal Affairs. Annexes | 417 Average Shares of Dwellings Connected to Utilities in Small Towns ANNEX TABLE 10.18:  and Communes, 2011 (%) Small towns Small towns Small towns Small towns Population size designated before Rural communes designated before Rural communes recently designated recently designated 2002 2002 Sewage disposal system connected to a public sewage Piped water from the public network disposal plant 0-4,999 75 48 27 48 23 3 5,000-7,499 70 40 33 42 15 7 7,500-9,999 74 41 44 52 16 13 10,000-14,999 79 45 47 56 21 22 15,000-19,999 81 * * 63 * * Total 75.5 43 28 52 19 4 Gas from public network for cooking 0-4,999 36 15 6 5,000-7,499 25 21 13 7,500-9,999 37 28 25 10,000-14,999 47 25 34 15,000-19,999 51 * * Total 39 23 8 Source: World Bank calculations based on 2011 Population and Housing Census. Notes: The size of the locality and the county to which the locality belongs were held constant. In order to compare similar rural and urban localities, the propensity score method was used. * Only one city and one commune of 15,000 inhabitants or over. ** For comparison, the average shares of dwellings connected to utilities in larger cities (20,000 or more inhabitants) are the following: 92 percent piped water from the public network, 85 percent sewage disposal system connected to a public sewage disposal plant, and 75.5 percent gas from public network for cooking. 418 | ANNEXES ANNEX FIGURE 10.1: Distribution of Working Age Population Not in Education or Training by the Highest Level of Education Achieved, in Small Towns and Communes, and by Population Size, 2011 (%) 0 10 20 30 40 50 60 27 0-4,999 41 50 31 5,000-7,499 43 44 30 7,500-9,999 41 42 27 10,000-14,999 41 36 15,000-19,999 23 Small towns designated before 2002 Small town recently designated Rural communities Source: World Bank's calculations using data from the 2011 Population and Housing Census. Notes: For recent small towns and communes, the category of 15,000 to 19,999 inhabitants was not included because of the small number of localities in this category (only one city and one commune). Primary education in Romania refers to grades 1-4, while lower secondary education is gymnasium (1-8 grades). Annexes | 419 Employment of Working Age Population in Small Towns and Communes ANNEX TABLE 10.19:  by Size, 2011 (Average %) Small towns Small towns Small towns Small towns Population size designated before recently Rural communes designated before recently Rural communes 2002 designated 2002 designated Self-employed (including family’s unpaid helper) Employee in agriculture 0-4,999 51 43 27 4 11 28 5,000-7,499 48 41 31 5 11 24 7,500-9,999 50 40 36 5 10 17 10,000-14,999 52 44 41 3 10 17 15,000-19,999 52 * * 3 * * Total 51 42 28 4 11 27 Unemployed Inactive other than students or pensioners 0-4,999 inhabitants 7 7 4 14 19 21 5,000-7,499 7 6 4 18 20 20 7,500-9,999 8 6 4 17 22 23 10,000-14,999 7 6 4 16 19 19 15,000-19,999 7 * * 15 * * Total 7 6 4 17 19 21 Source: World Bank calculations using data from the 2011 Population and Housing Census. Note: * Only one city and one commune. ANNEX TABLE 10.20:  Employment of Working Age Population in Large Towns by Size, 2011 (Average %) 20,000-199,999 200,000+ Total Employees 57 60 57 Self-employed (including family’s unpaid helper) 1.2 0.4 1.1 in agriculture Unemployed 6 5 6 Inactive other than students or pensioners 12 8 12 Source: World Bank calculations using data from the 2011 Population and Housing Census. 420 | ANNEXES IV. Statistical Data on Marginalized Areas Three Criteria of Marginalization with Key Indicators and their Corresponding ANNEX TABLE 10.21:  National Thresholds in Urban and Rural Areas (%) URBAN RURAL Criteria/ Dimension Key indicators 80th percentile Key indicators 80th percentile = national urban = national rural threshold *) threshold **) Human capital Proportion of population aged 15-64 22.1 Proportion of population aged 15-64 59.3 years old who completed 8 grades years old who completed 8 grades or less or less Proportion of people with 8 - disabilities, chronic diseases, or other health conditions that make their daily activities difficult   Proportion of children (0-17 years) in 20.5 - total population Employment Proportion of people aged 15- 22.2 1: Proportion of people aged 15-64 72.1 64 years old neither in formal years old neither in education employment (employees or nor have ever been in formal employers) nor in education employment (employees, employers or pensioners) Proportion of dwellings not 0.0***) Proportion of dwellings not 2.7****) connected to electricity connected to electricity Housing Proportion of overcrowded dwellings 54.7 Proportion of overcrowded dwellings 26.1****) (<15.33 square meters per person) (Eurostat indicator*****)   Insecure tenure: proportion of 12.3 Proportion of dwellings not 87.9****) households that do not own their connected to piped water dwelling Source: For urban areas, the World Bank (Swinkels et al, 2014a: 9). For rural areas: NIS, 2011 Population and Housing Census. Notes: * In urban areas, thresholds are calculated using only census sectors of households with between 50 and 500 inhabitants. ** In rural areas, thresholds are calculated using only census sectors of households with 50 or more inhabitants. *** Fewer than 1 percent of the urban dwellings are not connected to electricity and the 80th percentile is therefore 0 percent. Any urban census sector for which at least one dwelling is not connected to electricity (and thus the value is greater than 0 percent) passes this threshold. **** For the housing criterion, the rural national threshold was set at 90th percentile and the criterion is passed if any of the three indicators is higher than its corresponding threshold. ***** Eurostat indicator for overcrowding without the condition referring to a room for the household. Annexes | 421 Distribution of Census Sectors by Locality Size in Rural and Urban areas, 2011 ANNEX TABLE 10.22:  Census sectors Locality size Average number per Minimum per Maximum per Number of localities Total number Resident population: locality locality locality RURAL: 2,861 46,547 16 2 61 119-499 12 85 7 4 11 500-999 76 615 8 3 21 1,000<2,000 663 6,775 10 2 37 2,000<3,000 782 10,783 14 6 36 3,000<7,500 1,236 25,152 20 7 61 7,500<20,000 91 3,107 34 17 58 20,000<30,000 1 30 30 30 30 URBAN: 320 50,299 157 10 7,573 1,000<2,000 1 12 12 12 12 2,000<3,000 6 80 13 10 16 3,000<7,500 87 2,675 31 12 62 7,500<20,000 131 7,325 56 27 100 20,000 - 149,999 82 19,290 235 67 773 150,000 or more 12 13,344 1,112 739 1,459 Bucharest 1 7,573 7,573 7,573 7,573 Source: World Bank calculations using 2011 Population and Housing Census. Rates of Marginalization of Key Groups in Rural and Urban Areas, 2011 ANNEX TABLE 10.23:  RURAL URBAN Non- Non- Marginalized Marginalized Key indicators Marginalized Total Marginalized Total Areas Areas Areas Areas % % % % % % POPULATION (resident population) 6.2 93.9 100 3.2 96.8 100 Roma ethnicity (self-identified) 38.7 61.3 100 30.8 69.2 100 Non-Roma 4.7 95.3 100 2.6 97.4 100 People with disabilities, chronic 4.9 95.1 100 3.4 96.6 100 diseases, or other health conditions Elderly 65+ years 4.1 95.9 100 1.2 98.8 100 Children 0-17 years 9.6 90.4 100 5.8 94.2 100 Population 15-64 years old who 21.0 79.0 100 18.2 81.8 100 completed 4 grades or less 422 | ANNEXES RURAL URBAN Non- Non- Marginalized Marginalized Key indicators Marginalized Total Marginalized Total Areas Areas Areas Areas % % % % % % Population 15-64 years old who 9.9 90.1 100 8.8 91.2 100 completed 8 grades or less Working age population (15-64 5.8 94.2 100 2.9 97.1 100 years old) not in education Proportion of people aged 15-64 years old neither in education nor have ever been in formal 21 79 100 6.3 93.7 100 employment (employees, employers or pensioners) HOUSEHOLDS 100 2.6 97.4 100 Households with 5+ members 8.3 91.7 100 6.4 93.6 100 Households with 3+ children 15.9 84.1 100 14.8 85.2 100 DWELLINGS 5.2 94.8 100 2.5 97.5 100 Dwellings not connected to piped 9.9 90.1 100 11.9 88.1 100 water Dwellings not connected to sewage 7.8 92.2 100 11.9 88.1 100 system Dwellings not connected to 26.6 73.4 100 24.7 75.3 100 electricity Overcrowded dwellings*) 10.7 89.3 100 4.0 96.0 100 Households with insecure tenure 5.9 94.1 100 7.3 92.7 100 Source: Source: World Bank calculations using 2011 Population and Housing Census.For urban areas: Swinkels et al (2014a: 281). Notes: *) In urban areas, measured against a threshold of <15.33 square meters per person, in rural areas, based on the Eurostat indicator for overcrowding without the condition referring to a room for the household. Percentage of People from Rural Areas Neither Working as Employee ANNEX TABLE 10.24:  Nor in Education by Age, Gender, and Type of Area     % of people not employed or in school % of people not employee or in school Marginalized Non-marginalized Marginalized Non-marginalized 15-19   36 17 51 23 years old 20-64 Total 45 36 88 64 Men 38 33 85 59 Women 53 40 90 69 Men, Roma 62 62 92 81 Men, non-Roma 30 32 83 59 Women, Roma 69 64 95 88   Women, non-Roma 47 39 88 69 Source: World Bank calculations using 2011 Population and Housing Census. Annexes | 423 People from Urban Areas by Key Employment Indicators, 2011 (%) ANNEX TABLE 10.25:  URBAN Key indicators Marginalized Areas Non-Marginalized Areas Total Vulnerable workers*) 15-64 years old 8.2 91.8 100 Informal workers**) 15-64 years old 5.1 94.9 100 Housewives and other economically dependants 7.4 92.6 100 15-64 years old Population 15-19 years old not in employment, 13.3 86.7 100 education or training (NEET) Population 20-64 years old in employment 2.1 97.9 100 Source: Source: Swinkels et al (2014a: 281). Notes: *) Vulnerable workers include: unpaid family workers, workers in agriculture, day laborers. **) Vulnerable workers plus the self- employed. Rates of Marginalization by Locality Size and by Region in Rural and Urban Areas, ANNEX TABLE 10.26:  2011 (% of population) RURAL URBAN Marginalized Non-Marginalized Marginalized Non-Marginalized Key indicators Total Total Areas Areas Areas Areas % % % % % % LOCALITY SIZE (resident population) 6.2 93.9 100 3.2 96.8 100 < 2,000 100 11.2 88.8 100 2,000 - 4,999 100 6.9 93.1 100 5,000 - 9,999 100 9.0 91.0 100 10,000 - 19,999 100 6.3 93.7 100 20,000 - 149,999 100 3.6 96.4 100 150,000+ - - 100 1.1 98.9 100 Bucharest - - 100 0.8 99.2 100 DEVELOPMENT REGION North-East 100 4.3 95.7 100 South-East 100 4.2 95.8 100 South 100 2.9 97.1 100 South-West 100 2.5 97.5 100 West 100 3.7 96.3 100 North-West 100 3.1 96.9 100 Center 100 4.3 95.7 100 Bucharest-Ilfov 100 1.2 98.8 100 Source: For urban areas, the World Bank (Swinkels et al, 2014a: 13). For rural areas: NIS, 2011 Population and Housing Census. World Bank’s calculations. 424 | ANNEXES Proportions of Individuals Living in Dwellings without Basic Services by Ethnicity ANNEX TABLE 10.27:  and Type of Area (%) RURAL URBAN Diff Diff Non- (Roma Non- (Roma Individuals Total Roma Total Roma Roma - non- Roma - non- Roma) Roma) Non-marginalized 66 75 65 10 8 31 8 23 Piped water from the Marginalized 86 82 88 -5 34 49 30 19 public network Total 67 78 66 11 9 37 8 28 Non-marginalized 99 99 99 1 63 88 63 26 Hot water from the Marginalized 100 100 100 0 92 96 91 5 public network Total 99 100 99 1 64 91 63 27 Sewage disposal Non-marginalized 94 98 94 4 16 53 15 38 system connected Marginalized 99 100 99 0 59 77 54 22 to a public sewage- disposal plant Total 94 98 94 4 17 60 16 44 Non-marginalized 0.7 3.9 0.6 3 0.1 1.7 0.1 2 Electric lighting Marginalized 5.3 9.5 3.7 6 3.9 10.3 2.2 8 Total 1.0 6.1 0.7 5 0.2 4.4 0.2 4 Non-marginalized 89 93 89 4 25 66 24 41 Gas from a public Marginalized 98 98 98 -1 73 88 69 19 network for cooking Total 90 95 89 6 26 73 25 47 Source: World Bank calculations using data from the 2011 Population and Housing Census. Annexes | 425 Proportions of Individuals Living in Dwellings without Basic Services by Ethnicity, ANNEX TABLE 10.28:  Type of Area, and Different Percentages of Roma (%)   Share of Roma in Non-marginalized Marginalized total population of the census track Total Roma Non-Roma Total Roma Non-Roma URBAN Piped water from the public network 0 7 0 7 40 0 40 (0.1-19.9) 9 23 9 25 34 25 (20-39.9) 30 40 26 32 46 27 (40-100) 44 50 37 48 54 37 Hot water from the public network 0 60 0 60 94 0 94 (0.1-19.9) 68 83 67 90 94 90 (20-39.9) 93 95 92 91 96 89 (40-100) 97 98 96 96 97 93 Sewage disposal system connected 0 14 0 14 65 0 65 to a public sewage disposal plant (0.1-19.9) 18 39 18 48 57 48 (20-39.9) 57 69 53 57 71 52 (40-100) 77 82 70 77 84 67 0 0 0 0 2 0 2 Electrical lighting (0.1-19.9) 0 2 0 2 7 2 (20-39.9) 1 2 1 5 9 3 (40-100) 1 2 1 9 11 5 Gas from public network for cooking 0 23 0 23 80 0 80 (0.1-19.9) 28 54 27 66 78 65 (20-39.9) 62 76 56 71 86 64 (40-100) 85 91 76 82 90 69 RURAL Electrical lighting 0 1 0 1 4 0 4 (0.1-19.9) 1 3 1 4 9 3 (20-39.9) 2 4 1 6 11 4 (40-100) 3 5 1 8 9 4 Source: World Bank calculations using data from the 2011 Population and Housing Census. Programme title: Sectoral Operational Programme Human Resources Development 2007-2013. Invest in people! Project title: Provision of Inputs for the Preparation of a Draft National Strategy and Action Plan on Social Inclusion and Poverty Reduction Editor: The World Bank Publishing date: October 30, 2015 The content of this document does not necessarily represent the official position of the European Union or of the Government of Romania.