Mediating Romani Health: Policy and Program Opportunities

1. Mediating Romani Health: Policy and Program Opportunities Study Presentation Marta Schaaf, December 2005

2. Presentation • Goal • Methodology • Country Programs: Finland, Bulgaria, Romania • International policy context • Components of health RHMs effectively address • What current RHM programs less effectively address • Recommendations and Conclusions

3. Goal: identify the potential and limitations of health mediator programs for addressing the determinants of Romani health • the history, structure and efficacy of health mediation programs • how these programs fit into overall governmental strategies and actions to address Romani health

4. Methodology • Literature Review • Qualitative Field Assessment in Bulgaria, Finland & Romania • Stakeholder Interviews

5. Country Programs FINLAND Total Population: 5 million Roma Population: 10,000

6. Country Programs FINLAND • Initially a voluntary professional association • 1994: Creation of Romany Education Unit • 2001-2004 EU Socrates Program • Finnish citizenship - Child care • Social services - Educational system • Health services - Unemployment

7. Country Programs FINLAND Mediation Today • About 10 mediators • Governmental agencies who mediate • Ministry of Social Affairs & Health National Advisory Board on Romany Affairs • Four provincial boards on Romany Affairs • University certificate as Romany Cultural Instructor • Government-sponsored manuals

8. Country Programs BULGARIA Total Population: 7.5 million Roma Population: 600,000-750,000

9. Country Programs BULGARIA • Initiated by Bulgarian NGO • 2001-2004 Phare-funded training of 50 RHMs, 30 nurses, and 30 GPs • Trained to address: • Health and social assistance system • Pertinent health issues • Documentation

10. Country Programs BULGARIA Mediation Today • 10 currently employed • 50 more to be trained as part of new Phare project • National RHM program part of MoH strategy for Minorities and Decade Action Plan

11. Country Programs ROMANIA Overall Population: 22 million Roma Population: 2.5 million

12. Country Programs ROMANIA • Initiated by NGO • 2002: Ministry of Family and Health institutionalized RHM • Local Romani organizations selected about 200 female RHMs • Trained to address: • Access to health and social system • Documentation • Pertinent health issues

13. Country Programs ROMANIA Mediation Today • Decade Plan continued expansion and training of RHMs • Additional training for health personnel

14. International Policy Context Definition and Determinants of Health • Health: state of complete physical and mental well-being • Social determinants of health: • Poor housing • Poor access to food • Unequal access to education and employment • Perceptions of relative poverty • Lack of control • Discrimination • Social Exclusion • Political disenfranchisement • Unequal gender norms

15. International Policy Context Definitions and Determinants of Health • Whitehall Studies • Studies of 18,000 British social servants showed those at the bottom of the hierarchy four times as likely to die of heart disease between the ages of 40-64 than those at the top • Controlling for height, high blood pressure, high cholesterol and smoking explained only 1/3 the difference in heart disease mortality between bottom and top group

16. International Policy ContextDefinition and Determinants of Health

17. Components of health RHMs effectively address • Facilitating patient/doctor communication • Navigating bureaucratic procedures • Communicating with the Romany community

18. What current RHM programs less effectively address • Discrimination • Income poverty • Doubly marginalized groups • Health policy and legislation • Lack of resource commitment and political will at local and national levels • Insufficient number of mediators w/too few resources • Lack of political will at the local level • Lack of political will at the national level

19. Recommendations and Conclusions To RHM Program Implementers: • Evaluate ongoing programs • Re-orient training and job descriptions to facilitate health literacy development • Provide training and support to address doubly marginalized groups • Provide additional professional support to RHMs • Institutionalize mechanisms to capitalize on RHM knowledge

20. Recommendations and Conclusions To RHM Program Implementers: • Strengthen mechanisms of supervision and accountability • Increase physician involvement • Increase the number of mediators

21. Recommendations and Conclusions To National Level Policy Makers • Improve health action plans to better address social determinants of Roma health • Create separate programs to address issue of documentation • Create multiple links between Romani community and service providers • Integrate Roma health needs into overall health and social services reform

22. Recommendations and Conclusions To Donors • Support Action Plan implementation monitoring or evaluation • Build Romani and other NGO capacity in health promotion • Fund legislative or policy audits of health and social assistance laws

23. Conclusions and Recommendations To Donors • Facilitate information sharing across municipalities • Facilitate information sharing of RHM models • Fund innovative community level programming and document successes