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IntroductionSince 1986, the cohesion policy of the EuropeanUnion (EU) has been set out in a number of treaties,which have had the objective of decreasing the dif-ferences concerning development between differ-ent regions and member states within the EU, inorder to consolidate economic and social cohesion.With the integration of ten new member states in2004 (Cyprus, Czech Republic, Estonia, Hungary,

Latvia, Lithuania, Malta, Poland, Slovak Republic,Slovenia), and then Bulgaria and Romania in 2007,this policy needed further impetus [1]. TheEuropean Regional Development Fund (ERDF)was called upon to provide for the economic devel-opment of the new partners.

In the meantime, the whole EU faced chal-lenges due to the acceleration of economic reorgan-isation following globalisation, open trade, techno-

A Report of a Romanian–Bulgarian Cooperation Cross-BorderCollaboration in Oral Health

Agripina N. Zaharia1, Cristina I. Nuca2, Mircea Grigorian3, Mihaela Duta4, Cristina G. Puscasu5, Cristian Raspopa6, Corneliu I. Amariei7

1 Ph.D., D.D.S. Associate Professor, Department of Dental Prosthodontics and Occlusal Dentistry, Faculty of Dental Medicine,Ovidius University, Constanta, Romania. 2 Ph.D., D.D.S. Associate Professor Department of Preventive Dentistry, Faculty of DentalMedicine, Ovidius University, Constanta, Romania. 3 Ph.D. Student. Assistant Professor, Department of Physiology, Faculty of DentalMedicine, Ovidius University, Constanta, Romania. 4 Ph.D., D.D.S. Lecturer, Department of Dental Biomaterials, Faculty of DentalMedicine, Ovidius University, Constanta, Romania. 5 Ph.D., D.D.S. Lecturer, Department of Periodontology, Faculty of DentalMedicine, Ovidius University, Constanta, Romania. 6 Fifth-Year Student. Faculty of Dental Medicine, Ovidius University, Constanta,Romania. 7 Ph.D., D.D.S. Professor, Department of Oral Health and Dental Management, Faculty of Dental Medicine, OvidiusUniversity, Constanta, Romania.

AbstractThis report describes a Romanian–Bulgarian cross-border collaboration in oral health that has been run as a project toimprove cross-border cooperation within the European Union. Aim: The aim of the collaboration was to improve the quality of life and health of the population of this essentially ruralarea and to reduce the differences in oral health between the populations of the two border regions. Methods: After anintroduction that sets the scene in the context of the European Union’s programme for border areas, the report details theselection of the geographic areas that were (and are) involved in the project, the selection of partners and beneficiaries,the selection of the participating pilot clinics, and agreements between local authorities, regional authorities and theFaculty of Dental Medicine, Ovidius University, Constanta, Romania. It then explains how the oral health problems ofthe population of the cross-border area were identified, the joint planning that was necessary, the organisation of inter-active training sessions and media conferences, the collection of clinical oral health data, the acquisition and distribu-tion of IT equipment for the pilot clinics, and the creation of a network between them and the Faculty of DentalMedicine. Results: The results so far have included better access to oral health care and oral health education for thepopulations of the border areas, the foundation of an Oral Health Cross-Border Research Centre, the development of theRomanian–Bulgarian Network for Cooperation in the Field of Oro-Dental Health (ROBUDENT), increased availabilityof continuing professional education for local dentists, and computerisation of the oral health clinics in the cross-borderarea. Conclusions: The Romanian–Bulgarian cross-border cooperation has led to the development of professional net-works in the field of oral health and the creation of a strong partnership between the local authorities, dentists from thepilot oral health clinics who take part in the cooperation, and the Faculty of Dental Medicine, Ovidius University,Constanta.

Key Words: Cross-Border Cooperation, Oral Health, Romania–Bulgaria, ROBUDENT Network, European Union

Corresponding author: Agripina Zaharia, 1 Decembrie 1918 Str. no. 31, L28, C, Apt. 56, Constanta, Romania; e-mail:agrizaharia@yahoo.com

logical innovations, development of knowledge, anageing population, and an increase in immigration[2,3].

One aspect of EU cohesion is cross-bordercooperation. This represents direct cooperationbetween neighbouring regions of EU memberstates along their borders in all aspects, betweenlocal and regional authorities, involving all the par-ticipating groups (local authorities, the population,social and health services, including doctors anddentists).

The aim of cross-border cooperation is totransform member states’ borders from dividinglines into channels of communication betweenneighbours. It is also to try to end mutual prejudicesand animosities between the border populations, toreinforce democracy, and to help administrativestructures to evolve, so that they become capableand functional at regional and local levels.

Guidelines Governing Every Cross-BorderJoint Activity

There are a number of guidelines to encouragecross-border activities and cooperation, whichinclude:

1. Partnership: This can be vertical, refer-ring to the relations established between differentlevels (EU, national, regional, local) from bothneighbouring regions, and horizontal, referring tothe relations between the neighbouring partners.

2. Subsidiarity: Cross-border cooperation isefficient and functional only when the local andregional performers take the initiative and are readyto take responsibility. Subsidiarity involves actionby local and regional organisations that are themost appropriate for cross-border cooperation.These organisations have the necessary freedom toovercome existing differences regarding structuresand capabilities between the neighbouring regionsand, if necessary, to collaborate within the cross-border structures.

3. Joint programme of cross-border devel-opment: Partnership and subsidiarity are veryimportant for the process of implementing cross-border strategies and programmes. Designingstrategies for development is essential for underlin-ing shared problems, realising the potential fordevelopment, overcoming isolated single initiativeson both sides of the border, and ultimately for cre-ating a common perspective for development.

4. Regional and local analogue structuresand independent sources of finance: Cross-bor-

der cooperation is not just limited to neighbouringborder regions that pursue their own programmes,priorities or projects, independent of one another. Itis also possible at a national level. Indeed, nationalapproval is invariably necessary in order to obtainfinance for the project(s).

Political ConsiderationsThe realities of Europe are not just about a diversi-ty of culture and history but also the existence ofnumerous borders between states. These state bor-ders have been consolidated in Europe over the lastthree centuries. They often separate regions whoseinhabitants share a common ethnicity. Thus, artifi-cial borders between states have been created, andbecause of fears regarding possible military aggres-sion, the border regions have become sparsely pop-ulated. Economic activity, population migrationand commerce all frequently conspire to margin-alise border regions and make their populationspoorer when compared to central regions.Therefore, European cross-border regions are oftenconsidered undeveloped peripheral areas [4].Furthermore, the inhabitants of border regions havesuffered from the consequences of historic con-flicts, and have developed mutual feelings of fearand uncertainty. This ever-changing situation hasnegative effects on willingness to cooperate andestablish closer relationships. The basic principle ofcross-border cooperation is accomplishing contrac-tual frameworks within the border regions in orderto find joint solutions to shared problems. In gener-al, national Governments are not ignorant of theparticularities and specifics of border-related prob-lems.

A cross-border region is an area that frequent-ly has a common history, ecology, ethnicity andeconomy, but is limited by the sovereignty of thestates on each side of the border. In spite of thesecommonalities, there may be widespread differ-ences in the provision of services on each side of aborder. Thus health care provision may vary wide-ly across EU member state borders.

Historically, the EU policy for health isderived from ECCS (European Community of Coaland Steel) and EURATOM (European Communityof Atomic Energy) treaties regarding health andsafety [5,6].

The treaty regarding the European Union (alsocalled the Treaty of Maastricht—TEU), was signedby the Council of Europe on 7th February 1992 inthe Dutch city of Maastricht. It set the basis for the

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EU and for the first time, even if it is subordinate tothe principle of subsidiarity, public health was pro-moted as an official issue within the EU. The treatystates that “The EU will ensure a high level ofdefence for public health by encouraging the coop-eration among the member states and if it is neces-sary, will support their pursuits” [7].

The subsequent Treaty of Amsterdam, Art. 152(129), states that “by defining and implementing allof the policies and activities, the Community willensure a high level of protection for public health”[8].

Aims of Romanian–Bulgarian Cross-Border Cooperation

In this context, the aims of the Romanian–Bulgarian cooperation described in this paper were(and are) to support the continuous evolution ofcross-border cooperation, in order to improve fur-ther the quality of life and health of the populationswho live in the predominantly rural environmentson each side of the border, and to reduce the differ-ences between the two neighbouring regions,Constanta (in Romania) and Dobrich (in Bulgaria),by improving the quality of life of the two popula-tions.

These aims are based on the concept of theevolution of public health. A vital component isdeveloping a population-oriented infrastructure forthe public health system, involving humanresources, information systems and partnerships toprotect and support public health. Human resourcesare among the key factors that determine the ade-quate functionality of a health-care system. Healthand social services in the cross-border area play animportant role in cross-border cooperation.

Issues Taken Into ConsiderationThe Romanian–Bulgarian cross-border cooperationfor oral health was based on identifying the mainissues in the respective countries, especially in theregions involved [9]. These were seen as:

A lack of cross-border medical and dentalnetworks to ensure joint services for pre-vention and the development of oral healthcare.Very poor dental services in the rural envi-ronments on both sides of the border,where they are very undeveloped or non-existent.The necessity to respect the requirementsof the European Directives, according to

which it is the right of every European cit-izen to have access to health services.A lack of health education and informationfor the population.An insufficient number of dentists andmodern dental offices in the border area.The lack of programmes to prevent oraldiseases and a poor level of knowledge,skills, attitudes and perceptions regardingoral health.The lack of medical and dental education,which had a negative impact on the gener-al health of the population, thus decreasingtheir quality of life. The population in therural area is in general unaware of the needfor oral health, its interaction with generalhealth, and its influence on quality of life.The poor standard of equipment found indental clinics in rural areas and the lack ofan adequate health-monitoring system,conditions that allow the dental practition-er to provide only simple treatment, such asemergency extraction of teeth, while com-pletely ignoring prevention measures.The low level of education of the popula-tion in the rural region, which influencesthe patient’s decisions regarding oralhealth. Some individuals with a limitededucation assume that the symptoms ofdisease are normal and that preventive den-tistry is useless. Therefore, educationalprogrammes concerning oral health arebadly needed to allow parents to under-stand better the importance of oral health.The long distances to travel to dentaloffices, the high costs of dental health serv-ices, and budget difficulties consequent tothe economic crisis.

Current SituationThe European Commission considers that EUmember states should design their health-care sys-tems, including cross-border health, so that theircitizens’ needs are best met. In this context, cross-border medical assistance is defined as medicalassistance offered in a different member state to theone in which the patient concerned is insured.

Since they were admitted to the EuropeanUnion, Romania and Bulgaria have taken measuresto support rapid development in all areas that mayreduce the differences in social and health carebetween their border regions and other, better-

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developed regions of each country. The social com-ponent is another aspect of development and,together with a concern for the quality of life andpublic health, is a major objective of both Europeanand national policies.

Key Targets for Oral HealthAs far as the cross-border collaboration was con-cerned, a number of key targets related to oralhealth were identified within the need to establish across-border medical cooperation network. As aresult, a model has been piloted, which it is hopedeventually to extend. Within the pilot, the initialtargets were to modernise six cross-border clinicsfor oral health and to connect them with a researchcentre with experience in dental public health, sothat realistic programmes to improve oral healthfurther, involving both preventive and curativetherapies, could be developed. Within this overalltarget, the following targets were identified:

The need to increase population access topreventive and curative dental health serv-ices within the border regions.The need to convince the population thatpreventive measures not only help savemoney, but also improve quality of life.The need to establish a forum for scientificresearch in order to improve the quality ofdental assistance and the necessity forcareer development for the Romanian andBulgarian dentists involved in theexchange.The need for continuing education trainingprogrammes for all staff from the six pilotdental clinics, to meet any deficiencies intheir knowledge, skills and attitude if thesebecame apparent.

MethodsFor cross-border cooperation to succeed, it wasnecessary to establish the basis of an agreementbetween partners, with a well-defined purpose andan interdisciplinary approach.

It was also necessary to stress this purpose andto establish the duration of the cooperation with thedirect participation of communities, territorialauthorities and organisations, and their associates.Thus, the following steps were taken:

The selection of the cross-border areas ofwhich seven were in Romania (the districtsof Mehedinti, Dolj, Olt, Teleorman,Giurgiu, Calarasi, and Constanta) and

seven in Bulgaria (the districts of Vidin,Vratsa, Montana, Pleven, Veliko Tarnovo,Ruse Silistra, and Dobrich). The Constantadistrict, Romania, and the Dobrich district,Bulgaria, were chosen from the sevenlargely because the Constanta DistrictCouncil has strong ties with the DobrichCity Hall, Bulgaria.For the oral health cooperation, the areas ofNegru-Voda and Baneasa from theConstanta district and the areas of General-Toshevo and Krushari from the Dobrichdistrict were selected.The collaborating partners were thenfinalised as the Faculty of Dental Medicine(Ovidius University, Constanta), theConstanta District Council, Negru-VodaCity Hall, and Baneasa City Hall.Oral health clinics from each county with-in the collaboration were then selected totake part in a pilot 12-month collaboration(one clinic in Negru-Voda, two clinics inBaneasa, two clinics in General-Toshevo,and one clinic in Krushari).The project management team was thenrecruited. It consisted of:- A coordinator, who oversaw the project.- Assistants selected from among the

teachers at the Faculty of DentalMedicine, Ovidius University, Constanta,who were responsible for organisingevents within the collaboration, preparingall documents and other papers through-out the collaboration, maintaining thelinks between the Bulgarian andRomanian public authorities, and ensur-ing good communication between allthose involved in the project.

- An information technology (IT) specialistfrom within the Ovidius University ofConstanta, who was responsible for theadministration of the Romanian–BulgarianNetwork for Cooperation in the Field ofOro-Dental Health (ROBUDENT) web-page and for hosting this site on the web-page of the Faculty of Dental Medicine,Ovidius University, Constanta.

- A technical team, composed of lecturersand professors, entrusted with the profes-sional training of dentists from the sixoral health pilot clinics that took part inthe project. They were also responsible

for public information campaigns in theRomanian and Bulgarian counties wherethe pilot oral health clinics were located.

- Volunteers (students of the Faculty ofDental Medicine, Ovidius University,Constanta, years five and six).

Target groups were established:- As previously mentioned, the dentists

from the six oral health clinics wererecruited to the project.

- Some 600 schoolchildren in grades 1 to 8(6 to 14 year olds) from schools in Negru-Voda, Baneasa, General-Toshevo, andKrushari (150 children from each of thefour areas) were recruited.

- Socially deprived patients with lowincome and other disadvantages from thesame four areas were recruited.

- The population of the four border coun-ties: Negru-Voda, Baneasa, General-Toshevo, and Krushari (50,000 inhabi-tants).

- All other dentists from the Constanta andDobrich districts.

Agreements were signed with all partiesinvolved.An inauguration meeting for the collabora-tion, held at the Faculty of DentalMedicine, Ovidius University, Constanta,was organised and attended by the dentistsfrom the six pilot oral health clinics andtranslators.Interactive training sessions (seminars,workshops) and media conferences wereorganised, in which common issues andsolutions were developed. Also withinthese seminars, the objectives of this col-laboration were presented and the sourcesof information for cross-border coopera-tion were identified; an exchange of infor-mation and knowledge was accomplished;possibilities for the dissemination of thecross-border cooperation results were dis-cussed, and new avenues of interests/opportunities for future cooperation wereestablished.Clinical data relating to the oral health ofthe population within the study were col-lected, in order to obtain a baseline.Each pilot centre was given a computerwith a multifunctional printer, a projectorscreen, a video-projector, a laptop and a

digital camera for taking pictures duringthe training courses and information cam-paigns. The photos were (and are)uploaded on the ROBUDENT website. Thecomputers were linked the Faculty ofDental Medicine, Ovidius University,Constanta, where the server was (and is)located.A team from the Faculty of DentalMedicine, Ovidius University, Constanta,comprising the coordinator, assistants, thetechnical team and student volunteers,developed posters for ROBUDENT andthe Oral Health Education brochure, pub-lished in both Bulgarian and Romanian.(The team also organised visits and provid-ed information to the local authorities andbriefed the mayors, vice-mayors, andsocial and health workers from the cityhalls.)To reinforce the collaboration, all printedmaterial carried the logos and heraldicsymbols of the local communities in thecross-border area.

Outcomes1. The Constanta District Council together with

the Commission of European Integration, aregional authority in the Constanta District withexcellent cooperation relationships with localauthorities from Bulgaria, maintained a verystrong link with all the partners and in particularwith the Romanian and Bulgarian local authori-ties. This helped to ensure smooth joint actions.

2. The city halls of Negru-Voda, Baneasa,General-Toshevo, and Krushari were given oralhealth promotion material by the collaborationteam. These posters and leaflets were distrib-uted to the population in all the counties takingpart in the collaboration. The four local authori-ties within the project publicised ROBUDENTamong other local authorities in order to informother dental clinics about the newly created net-work. The partner city halls offered public hallsand meeting places where continuing profes-sional training seminars for dentists from the sixoral health pilot centres took place. They alsopublicised the opportunity for free-of-chargeconsultations during the collaboration to social-ly deprived people.

3. Schools from Negru-Voda, Baneasa, General-Toshevo, and Krushari hosted the information

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and education campaigns for the school popula-tion, provided classrooms, and ensured that theirpupils attended. They also distributed postersand leaflets received from the collaboration’smanagement team.

Thus, the cross-border collaboration had twomajor components, which were:

1. An organisational component comprising(a) the inauguration of the first “Cross-BorderCentre for Research in Oral Health” in Constanta,within the Faculty of Dental Medicine, OvidiusUniversity, Constanta, and (b) the establishment ofa cooperation network for oral health, ROBU-DENT, consisting of six pilot oral health clinics inthe border regions of Bulgaria and Romania.

2. A component for professional training forRomanian and Bulgarian clinicians from the borderregion involving continuing medical (dental) edu-cation and free-of-charge consultation campaignsfor schoolchildren and for socially and economical-ly deprived people from the border regions.

Activities Within the CollaborationThe following activities formed the initial basis forthe collaboration:

The inauguration of the first “Cross-BorderCentre for Research in Oral Health” withinthe Faculty of Dental Medicine, OvidiusUniversity, Constanta (Figure 1).

Figure 1. Opening of the Oral Health Cross-Border Centre for Research in Oral Health at theFaculty of Dental Medicine, Ovidius University,

Constanta.

The acquisition of IT equipment and thedevelopment of a webpage within theexisting website www.oralhealth.ro for theCross-Border Centre for Research in OralHealth (Figure 2).The creation of ROBUDENT and its con-nection to the Cross-Border Centre forResearch in Oral Health in Constanta(Figure 3) and the organisation of the “OralHealth: An Essential Factor for the Qualityof Life” workshop (Figure 4).

Figure 3. The ROBUDENT network.

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Figure 2. Distribution of IT equipment toRomanian and Bulgarian partners.

Figure 4. Participants in the "Oral Health: An Essential Factor for the Quality of Life"

workshop.

The organisation of seminars for profes-sional training concerning oral health, thecreation of the Oral Health Educationbrochure in both Bulgarian and Romanian,and the development of oral health promo-tion and free-of-charge consultations in thefour counties within the project [10].

A recent press conference (Figure 5) wasattended by representatives of the professional

associations from Romania and Bulgaria, from thelocal authorities, members of ROBUDENT, uni-versity staff, and doctors and dentists from the twocountries. It underlined the importance of coopera-tion in oral health within the cross-border area andhighlighted the need for future cooperation pro-grammes. At the press conference, the achieve-ments so far were described as follows.

Figure 5. Final press conference of the Bulgarianand Romanian partners.

The project started in 2006 when the plans forthe Cross-Border Centre for Research in OralHealth were made during the annual InternationalCongress of Oral Health, held in Constanta. Furtherplanning took place in Varna and in Constanta. Theinauguration of the Cross-Border Centre forResearch in Oral Health in Constanta, whichensures specialised consulting for Romanian andBulgarian dentists within the cross-border region,took place early in the project. The six oral healthclinics have been equipped with IT facilities, link-ing them to ROBUDENT and connecting themwith the Cross-Border Centre for Research in OralHealth in Constanta. The Centre maintains the linkwith the other members in the pilot oral health clin-ics and hosts annual professional training pro-grammes, joint campaigns in Romania andBulgaria, and international scientific conferences inConstanta, which publicise the project internation-ally.

This Centre offers the possibility of assessingand monitoring oral health status of populations inthe cross-border region and of establishing anational and international centre of excellence foreducation and research in cross-border oral healthcare.

Another activity that was fundamental for thecollaboration consists of the seminars held for pro-

fessional training concerning oral health and thecreation of the Oral Health Education brochure inboth Bulgarian and Romanian.

The seminars were held in Negru-Voda(Romania) and General-Toshevo (Bulgaria).Continuing medical (dental) education classes andpractical demonstrations have been a part of theseseminars. The themes of continuing medical (den-tal) education were:

1. Modern practices in the prevention of oraldiseases.

2. Modern methods of oral health rehabilita-tion.

The staff of the Faculty of Dental Medicine,Ovidius University, Constanta, ran the classes.Representatives of the professional associationsfrom both countries were invited to these seminars.The evaluation of knowledge gain was carried outby taking tests at the beginning and at the end of theclasses. At the end of the training seminars, thedentists from the pilot centres received continuingeducation (CE) credits from the Romanian Collegeof Medicine (the authorising body for medical anddental CE in Romania) and learning material onCDs. These professional training seminars werefollowed by health promotion and free-of-chargeconsultations campaigns in the counties involved inthe project. Other interested dental staff from theConstanta and Dobrich districts attended the train-ing sessions. In parallel with the professional train-ing seminars, the Oral Health Education brochurein both Romanian and Bulgarian was developed,together with leaflets on oral health and posterssupporting ROBUDENT.

The information and education campaigns forthe population in the cross-border region have beencarried out in two steps: within the city halls andschools from the partner counties and within thepilot oral health clinics, where the consultationswere performed. The leaflets and the Oral HealthEducation brochure were distributed within schoolsin the cross-border region.

Results so FarThus the results so far from the collaboration [9,10]have been:

The inauguration of the Cross-BorderCentre for Research in Oral Health withinthe Faculty of Dental Medicine, OvidiusUniversity, Constanta.Establishing ROBUDENT, a permanentcooperation structure for Romanian and

Bulgarian specialists.The improvement of the professional train-ing opportunities for Romanian andBulgarian dentists within ROBUDENT.Better quality oral health care andimproved access to oral health care clinicsin the cross-border area.An improved level of awareness and oralhealth education in the population.Improved quality of life as a result of bet-ter oral health for the persons in the riskgroups (students, socially challenged);Acknowledgement of the research in thefield by the Faculty of Dental Medicine,Ovidius University, Constanta.Assessment and monitoring of the oralhealth status of the population in the cross-border region.

The Faculty of Dental Medicine, OvidiusUniversity, Constanta, has an annual programmefor continuing professional training of dentists. TheCross-Border Centre for Research in Oral Health ispart of this programme along with the dentistryoffices in the network. The programme is run with-in the annual International Congress of Oral Healthand Management in the Black Sea Region. It isattended by a wide range of international speakersand clinicians from the Black Sea countries, includ-ing the dentists from the pilot clinics.

The training of Romanian and Bulgarian den-tists who work in the pilot oral health clinics is con-tinuous, both from attendance at conferences aswell as via videoconference links.

A recent development in the project has beenthe purchase by the Faculty of Dental Medicine,Ovidius University, Constanta, of a mobile motordental caravan, which offers consultations andtreatment to the population of the cross-border area.This purchase was financed within theRomania–Bulgaria Operational Programme 2007-2013.

Some ReflectionsIn Central and Eastern Europe, the interest in estab-lishing cross-border cooperation was fairly modestafter the opening of the borders in 1989/1990. Thiswas perhaps understandable because the bordershad been strictly closed frontiers since 1945. Theneed for cross-border cooperation was felt especial-ly along the tightly closed borders. This coopera-tion concerned every aspect of the populations,communities and regions, in their attempt to over-

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come the geographic disadvantages posed by theexistence of separating borders and the major dif-ferences between income or infrastructure [11].

The current border between Bulgaria andRomania dates from 1945 when Bulgaria wasceded (received) the southern part of Dobrudjafrom Romania. Many Romanians who lived in thisarea have either died or moved away. However, tra-ditions and cultural ties with Romania remained.This factor may have contributed significantly tothe cross-border collaboration.

In other parts of Europe, cross-border move-ment of dentists and patients is frequently driven byeconomic or political forces [12]. These may notnecessarily be viewed as cooperative.

Following the implementation of activities bythe Cross-Border Centre for Research in OralHealth, a comparison of the systems for deliveringoral health care in both countries was made [13-15]. This has helped to establish a cooperative envi-ronment and friendship between Romanian andBulgarian dentists.

The six pilot oral health clinics now have a per-manent exchange of information with the Cross-Border Centre for Research in Oral Health within theFaculty of Dental Medicine, Ovidius University,Constanta, and with each other; other clinics in thearea are joining the project. This expansion has beensupported by European funding from the PhareProgram (the programme of community aid to thecountries of Central and Eastern Europe) CBCRomania–Bulgaria 2006, “Cooperation for Health”project (ROBUCOSAN), with both Romania(Ovidius University of Constanta, District PublicHealth Division, Ostrov Mayor, Baneasa Mayor) andBulgaria (Alfatar Municipality, Dobrogean DanubeAssociation—Silistra District) as partners.

ConclusionsThe cross-border cooperation described in thisreport has:

1. Created and strengthened professional net-works and developed a partnership

between local authorities, dentists from thesix pilot oral health clinics, and an academ-ic institution, the Faculty of DentalMedicine, Ovidius University, Constanta.

2. Contributed to the development of cross-border oral health care services andencouraged local involvement, which hasraised the awareness level of the popula-tion regarding access to oral health care.

AcknowledgementsThe cross-border project was funded by theEuropean Union, Phare Program CBC 2005Romania–Bulgaria Perseus Code CBCRO2005/017 535.01.03.05.

Contribution of each authorANZ was assistant manager for the project, wrotethe report, and approved the final version.

CIN taught the oral health care clinic dentistsduring the CPE sessions, edited and re-drafted thereport, and approved its final version.

MG took the photographs, assisted in theadministration of the project, and approved thefinal version of the report.

MD taught the oral health care clinic dentistsduring the CPE sessions, advised on the drafts ofthe report, and approved its final version.

CGP taught the oral health care clinic dentistsduring the CPE sessions, advised on the drafts ofthe report, and approved its final version.

CR helped with translation into English, assist-ed in the administration of the project, andapproved the final version of the report.

CIA led the project, supervised the develop-ment of the paper, and approved the final version ofthe report.

Statement of conflict of interests All the authors have taken an active role in devel-oping the cross-border initiative described in thisreport.

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