MAIN OBJECTIVE

This objective will be reached through the following main activities:

Activity 1. Developing a unitary approach at national level towards treating cancer in children using radiotherapy during project implementation.

Developing national guidelines for diagnosis and treatment, with the collaboration of professionals with experience and expertise is another objective of this project. The purpose of this action is to ensure the correct and unitary attitude towards child cancers, standardized through protocols approved by the Society for Industrial and Organizational Psychology (SIOP) or according to the European Society for Medical Oncology (ESMO), adapted to the concrete situation in Romania. A special mention is required in children with cancer who are undergoing radiotherapy, a specialty requiring special training and which should be conducted only by teams trained in this area.

Sub-activities subordinated to Activity 1:

1.1 Contracting the authors of the guidelines: a team of authors – 25 Romanian physicians – will be created. The selection will be made according to a procedure created for this activity. The authors will be selected depending on their expertise and experience in treating children with cancer, form all parts of the country. This will assure the relevance of the guidelines at national level.
The Norwegian partner will dedicate two persons in offering support to the elaboration of the guidelines.

1.2 Documentation and study visits in Norway for creating the guidelines: The contracted authors will have a period of 7 months for documentation and updating their information related to treating children with cancer. In the same period of time, 5 study visits (5 persons/visit, 5 days/visit) will be organized in Norway for the authors, in order to exchange exchanging knowledge and information in the area of treating children with cancer. The study visits will take place before the elaboration of the guidelines. The Norwegian partner will be involved in organizing the study visits. The guidelines assistant will be in charge of offering the necessary support to contracted authors for the documentation and participating in the study visits.
The persons from the Norwegian partner will also conduct their research for better understanding the Romanian situation in paediatric oncology, which will include also visiting Romania.

1.3 Elaboration of the guidelines – The authors will elaborate the guidelines according to the signed contracts and assumed roles established previously. For assuring an unitary approach in creating the guidelines, 3 coordination meetings will be organized during project implementation: at the beginning of elaborating the guidelines, which is also the beginning of documentation period (please see timetable in annex II), the second one after the documentation period (sub-activity 1.2) has finished, for drawing conclusions and monitoring if the elaboration of the guidelines is on schedule, as planned in the first meeting, and one before finishing the final draft of the guidelines, for making sure that the guidelines meet the requirements set initially.
The Norwegian partner will contribute to the elaboration of these guidelines by offering support and feedback to the authors and with text input to the final draft of the guidelines.
The final result of this activity will be the final draft of the guidelines.
The dedicated personnel from project promoter will be in charge of organising the coordination meetings between the authors and to make sure that the elaboration of the guidelines is on schedule as planned.

1.4 Guidelines approval, printing and distribution – The final draft of the guidelines created at the end of activity 1.3 will be sent for the final approval to the Romanian Health Ministry, before editing, printing and distribution. If needed, the contracted authors will make the necessary adjustments of the guide. After obtaining the approval of the Health Ministry, the guidelines will be translated in English (by a subcontracted authorized translator), then edited and printed with the support of a specialised subcontracted firm. The guidelines will be printed in 20 copies (15 in Romanian and 5 in English) for being used in publicity activities (press conferences, meetings with relevant stakeholders involved in guidelines implementation and promotion that might occur during project implementation and after the project ends). The electronic version of the guidelines will also be made available to the public through the project’s dedicated website. The Norwegian partner will also offer support and feedback related to the implementation of the guidelines.

One positions in project implementation staff (dedicated monitoring expert) will be in charge of assuring the implementation of this activity, under the coordination and supervision of project management.

Activity 2. Improving access to modern paediatric oncology treatments at national level using high performance equipment bought and installed during project implementation

Technical endowment is one of the most important factors affecting the quality of medical services. It influences not only the duration of the treatment but also the results of the medical act. In treating cancer, which is one of the leading causes of morbidity and mortality worldwide, using high performance medical equipment can lead to successful treatment of cancer and raising life expectancy.
This project involves purchasing high performance medical equipment for the 4 Romanian hospitals involved in the project – which will lead to an improvement of the access to paediatric oncology treatments at national level (the hospitals involved in the project being from all regions of the country).

Sub-activities subordinated to Activity 2:

2.1 Purchasing the medical equipment – IOCN will organise the purchase procedures, according to the legislative provisions in Romania (elaborating the necessary documentation and implementing the necessary procedures). The activity will lead to signing the purchase contracts for the following equipment`s: 1 CT with simulation radiotherapy technologies, 2 chemotherapy dilution devices, 1 CT-IMRT, 2 anaesthesia machines, 4 portable ultrasounds, 2 Gamma Probe, 2 Eco Doppler, 3 PCs (including software), 2 multifunctional printers.

2.2 Installing and using the medical equipment – after the purchasing procedures are finished, IOCN will receive the equipment which will be installed by the provider. The activity will also include training the operators of the equipment which will also be provided by the contracted supplier. After installation and assimilating the use instructions, IOCN specialists will start using the equipment during the usual procedures. The use of the equipment will be done according to the usual procedures of IOCN.

The equipment purchased under this activity is an integral and necessary component for achieving the outcomes of the project; therefore, the entire purchase price of that equipment is exempted from the application of the article 8.2.4 of Regulation. In such case, the Project Promotor and Romanian project partners will comply with the obligations mentioned within article 8.3.2 from Regulation.

Activity 3. Capacity building of medical staff from Romania for treating children with cancer

For improving care for children with cancer and thus obtain survival rates comparable to those in more economically developed country, a training course for physicians who treat children with cancer using chemotherapy or irradiation will be roll-out. Paediatric Oncology network in Romania has grown much during the last 2 years in terms of medical units offering specialized services and technologies used. Thus, many young doctors need solid theoretical and practical continuous training, especially for using radiotherapy in treating children with cancer, which needs a specific training. Now in IOCN there is only one doctor prepared for using radiotherapy in treating children with cancer – which is insufficient compared to the large number of cases.

Sub-activities subordinated to Activity 3:

3.1 Contracting the trainers of medical staff
A team of 6 trainers will be established in the 4 Romanian hospitals involved in the project, as following: Iasi Regional Institute of Oncology and Timisoara Emergency Clinical Hospital will select 1 trainer each, while IOCN and Bucharest Institute of Oncology will select 2 trainers, since they are dealing with a larger number of cases and have a larger team of specialists. The selection will be based on necessary qualifications and expertise in the area and the training assistant from IOCN will make sure that the selection is done according to the planned timetable. They will work for 20 hours for 15 months which means 3 months for preparatory activities related to training and 12 months for training itself.
The Norwegian partner will offer support to the elaboration of the training programme, allocating 2 persons directly in the elaboration of the training curricula and in offering support during implementation of training sessions (involving also visits in Romania, reflected in the project’s budget).

3.2 Creating the training curricula – the contracted trainers will create one common training curriculum for all of the 4 Romanian hospitals involved in the project, also with the support and input offered by the Norwegian partner’s specialists. The curricula will take in consideration the needs of hospitals involved and the needs of the physicians which will be trained. For creating the training curricula, a coordination meeting will be organised at Cluj between the selected trainers and the specialists from the Norwegian partner. The trainings assistant will oversee organising the coordination meeting and will make sure that the training curricula will be created in the planned period of time.

3.3 Organizing the trainings for the medical staff
Based on the created curricula, the trainings will be organized and held in each of the 4 Romanian hospitals after a schedule planned for each hospital, taking in consideration the working schedule of the doctors and other aspects that can influence the training activity. The training sessions will be organised 20 hours per month, within 12 months. 84 persons will be trained during project implementation, as follows:
– 5 trainees on radiotherapy IOCN
– 9 trainees on paediatric oncology from IOCN;
– 18 trainees on paediatric oncology from Timisoara Emergency Clinical Hospital;
– 5 trainees on radiotherapy from Iasi Regional Institute of Oncology;
– 10 trainees on radiotherapy from Bucharest Institute of Oncology;
– 7 trainees on paediatric oncology from Bucharest Institute of Oncology;
– 5 trainees on paediatric oncology from the Emergency Clinic Hospital for Children Marie Curie in Bucharest;
– 25 trainees on paediatric oncology from the Clinical Institute Fundeni in Bucharest.

At the middle of the time period planned for organising the training sessions, a coordination meeting will be organised in Cluj, with the participation of the selected trainers from all partners involved and from the Norwegian partner, in order to monitor if the training sessions are on schedule and to discuss the eventual problems identified during the training sessions. The trainings assistant from IOCN will be in charge of monitoring the implementation of the training sessions in all hospitals involved and for organising the coordination meeting.

Training methodology developing services will be subcontracted in order to assure a common methodology for evaluating the impact of the training sessions. The subcontracted specialists will be in charge of evaluating quantitatively and qualitatively the training program created and implemented during project implementation. Aspects such as level of knowledge, preparedness of the trainees before, during and after the training sessions, number of procedures used etc. will be evaluated. Common instruments will be used by all partner institutions based on a methodology created and established by project promoter, Norwegian partner and subcontracted specialists, before the training sessions start and after the necessary specialists are subcontracted.

A dedicated monitoring expert will be in charge of assuring the implementation of this activity, under the coordination and supervision of project management.

Activity 4. Project visibility

The activity involves subcontracting necessary support services for assuring an optimum project implementation, as described below:
– Project publicity services – are needed for assuring the visibility of the project in the community. A specialised firm will be subcontracted for offering support in carrying out the project’s communication plan, as following: organising press conferences, creating project’s dedicated website, creating design and layout for the guidelines, labels for the equipment purchased within the project. The project management and implementation units will be in charge of coordinating the activity of the subcontracted firm related to the project. More details can be found on Communication Plan.

Activity 0. Project management

For reaching all the project objectives (general and specific) a cross cutting set of sub-activities were generically grouped under Activity 0. Project management. The project implementation team will assure all the needed aspects related to an efficient implementation of the project, based on an efficient communication and collaboration principles

– Establishing the project implementation team – the project implementation team will be established by designating the persons to fill the positions within the project. The necessary contracts and agreements will be signed, the roles will be clearly established. The selection will be based on the necessary expertise and qualifications needed for each position within the project.
– Purchasing necessary equipment for project implementation and management – 3 laptops and 1 multifunctional printer will be bought in the project for IOCN’s management team (project manager, project coordinator, project assistant, management experts, technical expert), for assuring the awaited medical devices technical support in project implementation. Also, office supplies (paper, toner etc.) will be purchased for assuring and efficient project implementation. The purchasing procedures will be carried out according to the applicable relevant legislation.
– Preliminary meeting with the Norwegian partner – at the beginning of the project, a preliminary meeting will be organized in Norway with the participation of the project management representatives from the project promoter (3 persons from IOCN: project manager, monitoring expert on guidelines elaboration and monitoring expert on training of medical staff) and representatives from the Norwegian partner. Through this meeting the procedures to be followed during project implementation between the two countries, established within the partnership agreement, will be discussed in detail and exact responsibilities will be delegated to the implementation team.
– Meetings of the project implementation team with national partners – the activity involves organizing at least 3 meetings at IOCN with the participation of each national partner institution’s representatives (project managers, coordinators and assistants – approximately 11 persons). The first meeting will be organized at the beginning of the project for discussing details related to project implementation. The following 2 meetings will be dedicated to discussing the eventual problems faced during project implementation and other relevant aspects and for preparing the interim and final reports. At the interim and final meetings, the representatives of the Norwegian partner will also participate. Also, IOCN, as project promoter will make monitoring visits at project partners in order to monitor the project implementation.

Project’s budget also includes travel expenses for the project management unit representatives (to assure an efficient on-site monitoring of project implementation) and for project coordinators from project partners (for participating in coordination meetings).

– Interim and final reports – all partners will be involved in creating the technical and financial interim and final reports. IOCN – as leading partner – will coordinate and will centralize the information from the other partners;
– Courier transport services – due to the localisation of the project partners in all parts of the country and the need of exchanging documents during project implementation (for reporting activities, elaboration of guidelines, implementing training sessions and evaluating the impact of training sessions), etc., a specialised courier firm will be subcontracted by IOCN. This will assure a cost-effective use of the project’s budget and will assure an efficient exchange of documents during project implementation.