Roma Health

• The Roma population is young: 35.7% are under 15 compared to 15.7% of the EU population overall. The average age is 25 among Roma, compared with 40 across the EU. The vast majority of working-age Roma lack the education, cannot access labour market and consequently fall out of the social and health services package that in addition hampers their health.
• Life expectancy at birth in the EU is 76 for men and 82 for woman. For Roma, it is estimated to be 10 years less. In addition, while the infant mortality rate in the EU is 4.3 per thousand live births, there is evidence that the rate is much higher among the Roma communities. A United Nations Development Programme report on five countries noted that Roma child mortality rates are 2 to 6 times higher than these for the general population, depending on the country.
• High levels of infant mortality among the Roma community are reported in other countries. Although few countries have national level Roma health data, research show that Roma are disproportionately unvaccinated; have poorer than average nutrition; and experience higher rate of tuberculosis. Among children between 0 and 2 years, the incidence of influenza, ear infections, intestinal infections and viral diseases was significantly higher among the Roma than among the ethnic majority population of a comparable socioeconomic status.
• This disparity reflects the overall gap in health between Roma and non-Roma. This difference is mainly due to their poor living situations, lack of access to quality healthcare and persistent discrimination and marginalization. In the Fundamental Rights Agency survey, discrimination by health care personnel emerged as a particularly acute problem for the Roma: 17% indicated they had experienced discrimination in this area in this area in the previous 12 months.

Open Society Foundations, Roma Health Project currently supports three main programs to address the health inequalities Roma experience:

1. Roma health mediator

One of the most efficient strategies used to date to address Romani health issues has been the creation, over a decade ago, of Roma Health Mediator (RHM) programs, carried out under the impulsion of Roma Civil Society Organizations.

Members of the Romani community themselves, Roma Health Mediators work as a bridge between the community, physicians and the local health authorities to improve access to health care for Roma. Though job descriptions vary from country to country, Roma Health Mediators` responsibilities usually include:

1. Facilitating interaction between the Roma population, health institutions and medical doctors, and mediating between Romani patients and physicians during medical consultations.
2. Assisting Roma in obtaining identity documents (including birth certificates) and health insurance, registering with a general practitioner (GP) or accessing social services by helping them navigate administrative labyrinths.
3. Supporting medical personnel in health education and in optimizing the implementation of prevention programs amongst Roma (immunization; identification of infectious diseases; ante and post natal care etc).

RHM is implemented in Bulgaria, Slovakia, Romania, Macedonia, Serbia and Ukraine.

2. Paralegal program

The poor health status of Roma results from a range of factors, among others, the low level of knowledge of the Roma population about health rights and the possibilities for their protection. Frequent changes in the provision of health care and health insurance in our country additionally aggravate the enjoyment of the right to health of Roma people.

Therefore, in 2011, in cooperation with CDRIM, KHAM and RRC we introduced programs for provision of paralegal assistance and support to the Roma population in the municipalities of Delcevo and Suto Orizari.

In a period of one year (2011-2012), we provided assistance and support to 587 Roma regarding the realization of the right to health and other legally specified rights.

Hence, we enabled the realization of their rights, such as: right to disability pension; right to care from another person; right to adequate treatment by the health workers; right to health insurance; right to realization of gynecological health care; right to spa treatment; right to realization of different types of social financial allowances and right to refunding and release from payment of participation fee.

By use of the informative activities of the type – from door to door- we managed to inform more than 2300 Roma about the possibilities, i.e. the type of assistance and support offered by paralegals within the paralegal program. This is how we enhanced the possibilities that they are informed about their health rights, including the possibilities for their protection.

We carried out 11 educational round tables on topics related to health care, health insurance and protection of patients’ rights, which helped to increase the level of information of 230 Roma.

In cooperation with the competent institutions, we organized public debates to discuss the public services provided by medical institutions, the quality of provided services and possibilities to improve the situation.

3. Community monitoring

The program overall objective is to establish community monitoring of health services in minority ethnic communities in Bulgaria to strengthen "bottom - up" advocacy which will enable local communities to participate in politics and governance processes at local level. The program aims further to improve health services and improve the health status of Roma and other ethnic groups.

The model follows the methodology of the so-called community monitoring. "Community inquiry”, including periodically (twice a year) consultations with the local community about the health services they receive. We supplemented this with advocacy activities at local and regional health institutions, as well as health education campaigns in the community.

Recommendations from Open Society Foundations, Roma Health Project:

• raising the life expectancy of Roma;
• raising child vaccination rates to the level of the level of non-Roma population.
• Equal access access to quality health care and social services to the Roma at the similar level and under the same conditions as the rest of the population should be provided.
• Where possible, there should be an increased involvement of qualified Roma in health care programmes targeting their communities.
• Action to improve the health of Roma populations are requires a commitment to the shared values of solidarity, equity and participation, which should be manifested in health policies, resource allocation and service delivery.
• As importantly, necessary measurements should be taken to ensure the elimination of individual and systematic discrimination against Roma in health care services.

Improving Roma health requires a real and long-term political commitment to the European values of solidarity, equity, and participation. The European Union’s Europe 2020 strategy calls for smart, sustainable, an inclusive growth. We cannot hope to achieve this while leaving millions of Roma at the margins of society with no health insurance, identity documents and experience discrimination by health care providers. Positive models of Programs like the Health Mediator, Paralegal program and the community program could be scaled up by the European Commission so Roma’s health is improved and then can enjoy a quality life as all the rest of European population.