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INCLUSION OF ROMA-INCLUSION OF ROMA-HEALTHHEALTH

EU SOCIAL INCLUSION EU SOCIAL INCLUSION SEMINAR ON ROMASEMINAR ON ROMA

WHO Country Office in Serbia

Dr. Dorit Nitzan

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iaHEALTH SYSTEMS APPROACH TO MEETING

THE NEEDS OF ROMA EXPERIENCING SOCIAL EXCLUSION

• Analysis based on the four functions of health systems:– Stewardship– Service delivery– Resource generation– Financing

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Important Health Indicators

• WHO SWIFT Roma Health & Nutrition Survey 2009

– All surveyed reported that their children were immunized - 88% had a Card

• Full DPT – 16.7%• Full OPV – 16.0%• MMR – 14.3%

The strongest determinant for being immunized: Health Card

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ia% Receiving Social Welfare

Survey Population Receiving Social Benefits

LSMS 2007 General Population 14.7%

SWIFT Survey 2009Roma Waste

collectors 16%

SWIFT Survey 2009Roma Non Waste

collectors 23%

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TIMES OF CHANGES

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iaSTEWARDSHIP

Strengthening the universality of health systems MoH & the Republic Institute for Health

Insurance

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ia• “Roma people who have no permanent

residence…are entitled to full healthcare services coverage and without copayment.

• The Republic Institute for Health Insurance simplified procedures…– an applicant should submit a personal

statement…of being a Roma, a proof or registered residence, and/or personal statement on a temporary domicile…

• Their cards are valid for one year”

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Stewardship - continued

Evaluate interventions and disseminate promising practices on Roma health, including through inter-country exchange in the context of the DecadeRoma Health Forum:

1st meeting of MoH with neighboring MoHs -December 2009

Cross European – November 17, 2011

MoH with WHO, UNICEF, OSCE and more

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Stewardship – cont.

Health information systems that allow for health equity surveillance

Planned- MOH-EC funded HIS Project: to be implemented by WHO

logistic support by UNOPS

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Stewardship – cont.

Cross-government underlying determinants of health

DPM, PRSP, Government, municipalitiesSupport of EC, UNCT (e.g. SWIFT), NGOs

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Stewardship- cont.

• Equity-oriented health impact assessment of other sector policies, to ensure the needs of the Roma and other communities are met

MoH and WHO - 2011

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iaService Delivery

Cultural competence & non-discrimination in services

Services that account for adverse living and working conditions

Outreach to increase health system literacy among Roma populations, also for promotion and prevention services

Strengthened PHC that interfaces between health services and the Roma community

MOH Health Mediatorssupport of OSCE, UNICEF, WHO

SWIFT Initiative (funded by Norway)Support of WHO, IOM, UNOPS

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Service Delivery – Cont.

Formalize the role of mediators and outreach workers from the Roma community

Health Mediators

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iaRESOURCE GENERATION

• Increase health professionals’ know-how

• Offer continuing education programmes for health professionals on Roma healthMOH Health Mediators

SWIFT (funded by Norway)

World bankIntegration in medical, nursing schoolUse CME platform

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iaFinancing

Mitigating the burden of out-of-pocket health spending

MoH, Republic Institute for Health Insurance

Support of WB and WHO

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Financing – cont.

Raise awareness about Roma entitlements and obligations with regards to health system financing

Health Mediators

Municipalities

Republic Institute of Health InsuranceSupport of WHO, SWIFT

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Financing – cont.

• Ensure sustainable allocation of monies for activities servicing the Roma (eg., for funding mediators, for action plan implementation)

MoH Requested support - OSCE, UNICEF, WHO, EC

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Challenges• Health– emphasis on tackling SDH• Health – beyond medical care -> public

health, health literacy, NCDs • Sustainable allocation of funds• Roma specific health data• Roma sensitive and if needed Roma specific

health services:– Further training of Health Mediators– Further training of health workers– Reproductive health– Domestic violence – Vaccination

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Comprehensive, multifaceted, holistic approach through the local and national authorities and communities:

•Bottom up top down

•Horizontal

•Partnership mechanisms

•Local ownership

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iaWorking Together SWIFTlyWorking Together SWIFTly

SWIFT I - Responsible implementers/ Overall management-WHO

SOCIAL MOBILIZATION

WHO

INCOME GENERATION

Belgrade Municipality

Ministry of Health

Institute of Public Health

UNOPS IOM

HEALTH COMPONENT

Belgrade Municipality

Belgrade Municipality

UNOPS – Administrative Agent – admin and finance

Communities & Civil Society

Ministry of Labor & Social Affairs

Ministry of Labor & Social Affairs

Ministry of Education

Ministry of Environment

DPM, PRSP

Ministries of Health and Environment

Ministry of Minorities

Institute of Health Insurance

Chamber of Commerce

Ministry of Economy & Region Develop

Ministry of Labor & Social Affairs

Ministry of Internal Affairs

Institute of Occupational Health

Communities & Civil Society

Communities & Civil Society

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It takes a village to raise a child

Thanks!