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Roma Minority and Social Accountability in Macedonia

copasahRoma minority in the countries of the South Eastern European region represents the most marginalized minority of people who live in unfavorable social and economic conditions compared to the general population. Roma people are deprived in many spheres of their lives, including housing, education, employment and health, access to health care and discrimination in health care settings. Social determinants of health have especially negative influence on Roma health, including but not limited to poverty, social exclusion, low level of education, to name a few, thus resulting in poorer health outcomes among Roma in comparison to the rest of the population in the region. For example, estimates are that the life expectancy among Roma in average is 10 years shorter in the region, with infant and maternal mortality rates higher among Roma. There is a an absolute lack of health statistics segregated by ethnicity, as well as absence of relevant research studies conducted and/or developed by competent state institutions. This leads to the fact that the data on the many public health conditions among Roma people are solely based on the research reports conducted by Civil Society and international institutions. Additionally, the lack of data aggravates the health condition since the states do not have comprehensive data as guidance for policy planning and implementation. In order to improve the conditions of Roma minority the countries from the region in 2004 signed the Declaration for the Decade for Roma Inclusion for the period 2005 – 2015 and made a commitment to undertake measures to improve the conditions of the Roma minority. Yet although a decade has ended, there is no significant improvement in the status of Roma minority in the countries of the Region. This is due to the lack of political commitment and funding for the adopted policies aimed to improve the status of the Roma people.

Roma Integration 2020 is a new initiative for improvement of the condition of Roma people, initiated by the European Union.

In Republic of Macedonia, the official census data, which is 14 years old shows that the Roma represents 2.6% 2 to 6% of the population, yet the findings of the civil society organizations shows that this number is much higher and probably reaching 5% to 6% of the population. The situation about Roma minority in South Eastern Europe described previously is also valid for the Roma minority in Macedonia.

Social accountability

Social accountability for the improvement of Roma health was initiated in Macedonia in 2009, by the Association for Emancipation, Solidarity and Equality of Women (ESE). ESE is funded by the Open Society Institute and Foundation Open Society Macedonia,that aims to
improve the health status and immunization of Roma children. In 2011, the Government for the first time allocated funds specifically aimed for Roma in one of the preventive Programs under the Ministry of health. This was the result of the work initiated with the process of applied budget work, advocacy and civil society participation.

The activities included: health education of Roma people, increased number of visits of community (patronage) nurses to Roma women during the period of pregnancy and one year after the delivery of the child, along with measures for active identification and immunization of non-immunized Roma children. In order to strengthen the demand for
health rights and entitlements, civil society organizations (ESE, KHAM, CDRIM, LIL and Roma SOS) started to implement community monitoring work.

Through this work Roma communities where strengthened such that they received the rightful entitlements through the Programs for preventive health care of mothers and children. Later on, community monitoring work was expanded to include examining
the policies for improvement on reproductive health of women, specifically for the Program for cervical cancer screening . Furthermore, the Civil Society Organisations (CSOs) added the social audit methodology into their work.

Parallel budget monitoring work was conducted in order to track the budget allocation and execution for the foreseen measures aimed for Roma. The entire work was followed with
advocacy efforts at the national and local level. The community took an important role especially in the local level advocacy process.

Many challenges were detected that related to the national level implementation of the activities aimed for Roma, including insufficient budget allocation , frequent amendments of the Program(annual budgeted program under the Ministry of Health) during the fiscal year, lack of capacities of the public health institutions to deliver the services, lack of oversight mechanisms as well as  lack of transparency and accountability especially within the Ministry of Health. Community monitoring on local level showed how the problems detected on national level influence on poor service delivery at the local level. The findings from the Roma communities showed that the foreseen activities, like additional visits by patronage nurses in Roma families or educational activities for chilld’s health and immunization are not implemented and does not reach the Roma people. Yet this process empowered Roma people to take ownership of their rights and entitlements and for the first time it enabled them to proactively demand fulfillment of their rights from the health care providers . The majorimpact is seen in the increased immunization coverage rates of Roma children that is a result of the proactive demand from the Roma communities and not a result of the measures foreseen by the Ministry of Health.

Today they are empowered to take a rights based approach to securing their health needs. It is heartening to see that Roma people have started to voice out their dissatisfaction from the services provided, in comparison to the previous time where they felt disenfranchised. Today they demand higher quality of services. Coordinated advocacy at the national and local level has resulted in better functioning of health centers, building infrastructure and equipment, refurbishment and vehicles.

Today, ESE has initiated its work to improve transparency and accountability with the Ministry of health, continuing its work for the demand of the fulfillment of the needed services.

The groups of CSO (ESE, KHAM, CDRIM and RRC) are continuing their social accountability work in order improvement of the health and access to health services for Roma minority in Macedonia.

About the Author
Borjan Pavlovski is the coordinator of the program for public health and women’s health in Association for Emancipation, Solidarity and Equality of women in Macedonia ( ESE). ESE develops and assists the women’s and civic leadership (especially that of Roma community) for development and implementation of human rights and social justice in Macedonia using approaches of monitoring and budget analysis, monitoring of human rights and providing assistance and information.

ESE primarily focuses on meeting the urgent needs of citizens, in particular the vulnerable groups of citizens, and on influencing the creation of long-term changes. ESE also provides legal and paralegal protection, as well as information to different categories of citizens and introduces them with the possibilities for protection of their rights. For more details on ESE
please see: http://www.esem.org.mk/en

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The Roma People in Europe : A Story of Marginalization and Exclusion-COPASAH GLOBAL SECRETARIAT

The Roma People and related minority communities constitute Europe’s largest and most vulnerable minority andblog-photo are present in nearly all member states. There are an estimated 10-12 million Roma in Europe, particularly in Bulgaria (10.33% of total population), Republic of Macedonia (9.59%), Slovakia (9.17 %), Romania (8.32%), Serbia (excluding Kosovo) (8.18%) and Hungary (7.05%). Turkey, Albania, Greece and Spain are other countries where they constitute close to 3 % population of the total. Well over a million Roma live in North and South America today, with the Kalderash clan forming the majority. Of the Romani populations across the world, there is no official, reliable count. Part of the reason for this is their own refusal to register their ethnic identity in official censuses for fear of discrimination, complexity of determining who is a Roma and reluctance on the part of some governments to count Roma People for fear that it will lead to political movements to remediate discrimination against them.

Tracing the early history of the Romas is like unravelling a conundrum of information lying scattered. The Roma are known to have made an appearance in Europe speaking an Indian language, but there is no sure trace of their passage across the Middle East. Their language proves to be the key to the route of their travels as they may have borrowed words from the various peoples they met during their sojourn westward. In fact genetic studies in recent years substantiate this by demonstrating that, despite inter marriages; the ancestral line of most of Europe’s Roma groups can be traced to the Subcontinent.

There have been arguments among scholars about the period and manner in which they left India, but it is generally accepted that they did emigrate from northern India sometime between the 6th and 11th centuries, then crossed the Middle East and came into Europe. Some groups stayed in the Middle East. The first Roma groups reached Europe from the East in the fourteenth and fifteenth centuries.

Early Romas were horse traders and trainers, basket makers, metal-smiths, woodworkers, singers and musicians. Whatever they did, they mostly traversed land to do it. To understand the Roma problem, it is important to look at this itinerancy, which is characterised by continuous adjustment and adaptation to a changing environment.

By most measures, the Roma are a people or a nation in the strict sense of the term. They have a dominant language, a culture and, above all, a sense of being a people, although they have sought neither a country nor any form of political sovereignty or government structure for their group/community. Roma identity is inherently linked with rootlessness.

The Roma People in Europe are a very diverse group in terms of religion, language, occupation, economic situation and way of living; and although traditionally nomadic, today, a great majority of Roma and related groups are sedentary. Dozens of Romani language dialects are spoken throughout Europe, and a number of groups frequently affiliated or associated with Roma also speak other European minority languages, such as Shelta and Yenish.

Roma, Sinti and Kale are the three main branches. Sinti are found mainly in German-speaking regions, Benelux and certain Scandinavian countries, northern Italy and the south of France (Provence), where they are known as Manush. The Kale (commonly known as “Gypsies”) inhabits the Iberian Peninsula and North Wales. The term “Travellers”, used in France, Switzerland and Belgium, also includes non-Roma groups having an itinerant lifestyle. There may be different communities in the same country: so for example, in Germany and Italy, the communities are referred to as “Roma and Sinti”.During the Byzantine Empire, Roma groups migrated from India to Europe via Persia, Armenia and Asia Minor. The eastern branches of the Roma are still found in the Caucasus, Turkey and the Middle East, where they are referred to as “Lom” or “Dom”.

The variation in Roma reality is also enormous. The historical experience of various groups, their encounters, stopping-places, routes travelled and intersected, and the diversity of their contacts with constantly changing surroundings, have given rise to a great range of cultural and social characteristics within various groups and this continues to evolve. Even so,there seems to exist a feeling of closeness and community; for example, in some groups the saying ‘sem Roma sam’ (‘we are Roma, after all’) is frequently cited to emphasize Roma identity and in praise of cherished group values (hospitality, generosity, friendship), to soothe interfamily tensions or as an expression of a desire to unite in the face of adversity brought about by non-Roma.

Issues of vulnerability and marginalisation

The Roma are at the bottom of the European ethnic heap, under-housed, undereducated, underemployed, underserved, underrepresented and actively discriminated against by landlords, employers, school administrators and governments. Their socio-economic condition differs across different countries but nowhere is their situation good.

The history of European repression against the Roma goes back several hundred years – following the Roma migration from the Indian subcontinent between the 11th and 14th centuries.There are records of enslavement, enforced assimilation, expulsion, internment and mass killings.

One of the first instances of discrimination faced by the Roma People settled in Europe was during the 15th-17th centuries, under the Ottoman Empire in Central Europe. In Western Europe too they were marginalised and persecuted. In the 18th century, which was incidentally the period of the “Enlightenment” in European history, the Roma faced new forms of discrimination: in Spain they were interned, in the Austro-Hungarian Empire, various laws ordered their forced assimilation. In Russia, however, they were considered as equal subjects of the Tsar and were accordingly granted all civil rights. A second wave of migration took place in the 19th century, with Roma groups in central and Eastern Europe leaving for other parts of Europe. Some even crossed the sea. In 1860, Roma slavery was abolished in the Romanian principalities. Nevertheless, at the end of the 19th and beginning of the 20th century, discrimination became more intense, largely in those regions which had been part of the former Austro- Hungarian Empire.

Discrimination reached its peak during the Second World War, with a genocide orchestrated by the Nazis; nearly 500,000 Roma and Sinti were massacred by the Third Reich. During the Nuremberg Trials, no mention was made of this genocide and no assistance or compensation was given to the Roma who had survived the concentration camps. Migration of Roma from Eastern Europe to Western Europe and then to the United States, Canada and Australia, was initially part of the movement of migrant workers. With the collapse of the Soviet Union and its satellites, and the disintegration of Yugoslavia, this took on much larger proportions. The wars in the Balkans in the 1990s affected the Roma in myriad ways: they were war victims; they were expelled (in particular from the province of Kosovo in 1999) and were granted only “economic refugee” status in the countries of destination. These events must have had spiritual and cultural repercussions on their social fabric.

Human rights violations

The Roma community is the largest ethnic minority in Europe and is a definitely situation of social exclusion and wide-ranging poverty experienced by a significant proportion of them. Over several decades, the analyses presented in reports compiled for numerous international institutions, as well as studies undertaken by various nongovernmental organizations, have all converged and condemned one aspect: the difficult conditions in which Roma families live, or are forced to live.

Examples of direct or indirect discrimination in children are abundant: exclusion from formal schooling is reported in a number of European states and ranges from complete exclusion from mainstream schools to school truancy and abandonment. Roma children are often over-represented among the children placed in out-of-family care, including in institutional, foster care and for residential schools for children with mental challenges. Roma children are in some cases removed from their families on the sole ground that homes are not suitable and stable or that economic and social conditions are unsatisfactory and in some countries, this was a result of communist- era policies where in the state was promoted as superior to parents in raising children. Roma are reportedly trafficked for various purposes including sexual exploitation, labour exploitation, domestic servitude, illegal adoption and begging. Roma women and children are seriously overrepresented as victims in all forms of trafficking.

Discrimination in access to housing often takes forms such as denial of access to public and private rental housing on an equal footing with others, and as refusals to sell housing to the Roma. Many Roma People continue to live in sub-standard conditions in most European countries, without heat, running water or sewerage. Due to lack of adequate recognition of tenure there is always the risk and threat of forced eviction. In some countries, the number of evictions has seen an increase in recent years, often targeting the same migrant Roma families, including children, on several occasions over a short period of time.

Challenges affecting the inclusion of Roma in the labour market are numerous and result in the near complete exclusion of Roma and Travellers from decent work in Europe. Despite positive efforts in some countries towards inclusiveness, levels of unemployment among Roma and Travellers in Europe are invariably higher than among non-Roma. They face discrimination in access to hotels, discotheques, restaurants, bars, public swimming pools and other recreational facilities, as well as in access to services crucial for small business activity, such as bank loans.

One would seldom find a Roma in elected bodies at local, regional, national and supra-national level. Their participation is limited in the European parliaments, with the exception of certain countries in central and southeast Europe. In some countries, the numbers of local representatives including mayors and local councillors appear to have been rising over the past decade but even then the proportion is extremely low by comparison with their representation among the population-at-large.

In the absence of a formal administrative existence, social exclusion only worsens.

Many factors contribute to hindering Roma access to documents and effective citizenship, including armed conflicts and forced migration, breaking down of the former countries (like Yugoslavia), extreme poverty and marginalisation and, above all, the lack of genuine interest on the part of authorities to address and resolve the issues. Restrictive citizenship laws have created additional obstacles with many Romas not being considered as nationals by any state and are frequently denied basic social rights and freedom of movement with the problem particularly acute in the western Balkans.

There is a range of avoidable injustices suffered by the Roma community, particularly with regard to health, and this sprouts from a range of issues – inadequate access to housing, education, employment and other needs, barriers to Roma access to health services. Even in instances where services are available, there is discrimination and a lack of adaptation to efficiently use these services. The precarious health situation among the Romas is not reflected in reliable and up-to-date statistics or data, a fact which further hinders the planning of targeted interventions designed to reduce and ultimately eliminate inequality.

The Roma community is particularly vulnerable to the effects of social conditions on health . Roma populations living in rundown neighbourhoods, sub-standard housing or shanty towns and those with less access to health-care and social services have deficient health habits, high morbidity rate and lower life expectancy vis-a-vis other Romas in the state or Europeans at large. Roma women suffer discrimination at three levels: for being women in a patriarchal society, for belonging to an ethnic minority affected by negative social perception and for belonging to a culture whose gender values have been associated almost exclusively to the function of mother and spouse.

The health inequities faced by the Roma People must be tackled with an understanding that Roma health is not merely to be resolved by national health systems and health professionals but addressed concurrently in all social fields and by all stakeholders. Intersectoral policies in education, training, labour market inclusion, housing and health must be implemented; the Roma population must actively participate in all processes of intervention; health programmes targeting the Roma population must be normalised and strengthened along with adopting a gender perspective and youth empowerment.

More remains to be done in order to achieve respect for the rights of the Roma minority. In many ways Roma demonstrate better adaptation to, both present and to future ones, than other sections of the population: due to their economic flexibility, geographic mobility, in-family education, and communal lifestyle linking the individual into a network of reciprocal security, giving him or a sense of identity. There are possibilities for concerted action. After six centuries in Western Europe, the Roma Population is still waiting for a coherent, respectful policy concerning them to be drawn up and applied.

Roma Organisations and Response of the World Community

The history of Roma organizations goes back a long way, and has passed through a number of stages. In the aftermath of the Second World War, there is hardly a state in Europe in which Roma organizations have not emerged. In conjunction with the profound transformations taking place in the states of Central and Eastern Europe since 1989, there has been a mushrooming of Roma associations there, and these are taking their place in the political arena; the number of associations is on the rise in Western Europe too.

At an international level, the Comité International Tsigane (International Gypsy Committee) was founded in 1967; which organized the first World Gypsy Congress (London, 1971) with delegates from 14 countries and observers from world over. A new international organization, Romano Ekhipe (Romani Union) emerged from the second Congress held in Geneva in 1978 which got full Consultative Status in the UN in 1993. The organization has also set up a cultural foundation, Romani Baxt, with its headquarters in Warsaw, and is gradually establishing branches further afield.

Since the early 19902, the International Romani Union has played an increasingly important role as a pressure group. The Roma political movement is taking shape on other continents as well. The International Roma Federation was founded in 1993 in the United States, with the aim of intensifying cooperation between Roma in the US with those in Europe. There are also organizations in Latin America and Australia.

In May 1989, the member states of the European Union passed a significant resolution that “acknowledges and recognizes that Roma culture has formed part of the European heritage, and this places a duty on the international authorities and governments of the member states to provide this culture and language with the means, not merely to survive, but to develop”.

Public misunderstanding of Roma tends to have a direct impact on policies affecting them. Policies towards Roma often always constitute a negation of the people, their culture and their language, and this can be broadly grouped into three categories: exclusion, containment, and assimilation.

2005-15 was declared as the Decade of Roma Inclusion and the aim was to end discrimination and ensure Roma equal access to education, housing, employment, and health care. An overview of the activities of the past few years shows that European institutions have responded positively and member states are taking an active stance with respect to the Romas. An encouraging sign is that more and more states are endorsing international conventions, particularly those which open up possibilities for combating discrimination on ethnic and racial grounds. Despite the steps takenby governments during the course of the Decade, they were far from sufficient to have any substantial impact, resulting with the lack of progress on the ground. If the Decade is to be judged on its own terms – i.e. its pledge “to close the gap” between Roma and non-Roma within ten years – then clearly it has not been a success. However, all the available information suggests that education is the priority area in which the most progress has been made. Despite a slow start in designing health-related policies, available data suggests there was more progress (albeit slow and uneven progress) made in health than employment or housing.

In 2011 the European Commission adopted in 2011 an EU Framework for National Roma Integration Strategies focussing on four key areas: education, employment, healthcare and housing.Resulting in development of an EU framework for national Roma integration strategies up to 2020. The EU Framework for National Roma Integration strategies up to 2020 brought about a change in the approach to Roma inclusion: for the first time a comprehensive and evidence-based framework clearly linked to the Europe 2020 strategy was developed. The EU Framework is for all Member States but needs to be tailored to each national situation. To reduce the health gap between the Roma and the rest of the population, the EU Framework calls on Member States to provide access to quality healthcare especially for children and women, and to preventive care and social services at a similar level and under the same conditions as the rest of the population. Following the analysis of health measures by 2014, it can be concluded that healthcare and basic social security coverage is not yet extended to all. Promising initiatives should be extended and multiplied to make a real impact on the ground.

Roma organisations

The decade for Roma inclusion contributed to the increased movement of Roma civil society. This led contributed towards formation of new Roma CSOs and building their capacities. In the course of the decade many organizations strengthened their capacities, and through their efforts in practically implementing many decade projects, raised their international profiles and won wider recognition for their achievements. But overall, Roma participation was judged to be more form than substance in terms of outcome and impact. Beyond the Roma elites and organizations, the ambition to involve Roma communities actively in the decade went unrealized, and the reports from all participating countries indicated low levels of awareness and only sporadic community participation. Nevertheless this process enabled Roma civil society to grow and build capacities and currently there are numerous profiled Roma CSO which work on local, national and  international level.

About the Author

This article has been developed by the COPASAH Secretariat which is currently hosted by Centre for Health and Social Justice

(CHSJ) New-Delhi (India) with inputs from Jojo John (India), an expert in social development, environmental governance,right to information, sustainable agriculture and ecological restoration. We acknowledge the inputs from Borjan Pavlovski,

ESE, Macedonia.To know more about COPASAH visit: http://www.copasah.net

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Report on the East and Southern Africa (ESA) Regional Strengthening Meeting July 26-27,2016, Kampala, Uganda

Since the inception of Community of Practitioners on Social Accountability and Social Action in Health (COPASAH), the East and Southern Africa (ESA) member institutions have registered achievements as individual initiatives owing to the knowledge acquired from Facilitated Learning Exchange Visits. However, the COPASAH ESA membership has experienced limited engagement among members thus affecting further growth both in terms of membership and ideas for advancement of the network.

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Strengthening Social Accountability through Community Dialogues- Joan Kilande, Eric Wakabi (Uganda)

The Coalition for Health Promotion and Social Development (HEPS UGANDA) Uganda is successful in implementing the Citizen’s Engagement initiative to Stop Medicine Stock Outs (COME) that aims to fostering action, engagement and participation of the community. This initiative which was kick started in March 2014 has today shown that the community engagement can increase social accountability. Community leaders are forging a path towards advocacy of health rights for all.  This includes ensuring every citizen has access to essential medicines in every public health facility, where the availability of essential drugs is adequately provided and above all health care services are improved to serve the community.

The focus of the initiative was to get the public health facilities in Lira and Kiboga districts up to health care standards. Citizen Report Card (CRC), a social accountability tool was used to provide feedback received from the users of public services to the public health agency. The feedback was received through the sample surveys that were conducted on different aspects of service quality. This enabled the public agencies to identify strength and weaknesses in their work. The CRC was further used to identify key gaps, with a way-forward, a plan to fix the gaps that came up during the discussions between the community, service providers and duty bearer.new-color-1_orig

A woman drops a suggestion in the suggestion box that was provided during the implementation of the community action plan. This resulted in community dialogues and interface meetings at Katwe HCIII, Dwaniro Sub County, Kiboga District.

The Uganda Government recognizes the importance of community involvement in the successful fulfillment of the right to health. The National Development Plan (NDP), the overall Government development strategy, sets and prioritizes the empowerment of individuals and communities for a more active role in health development and the implementation of the Uganda National Minimum Health Care Package (UNMHCP).

During the project life-cycle, it was heartening to see collective action at work, especially when a community gets together to demand for their entitlements. Such is the chronicle of the residents of Dwaniro Sub County, Kiboga District, who observed that a lack of adequate and standard infrastructure compelled them to lobby for a positive change in the status of their health centre, eventually achieving 50% of service enhancement of what was originally targeted.

In Kiboga District, inadequate infrastructure is affecting access to services in all the health facilities. For example, the district hospital is a 100 bed capacity but the intake of patients is over 150 which puts the pressure of hospital management at risk. This means that the current ward capacity which has limited capacity cannot match with the volume of admissions. It is often a common sight to see patients sleeping under beds, or in the veranda. Male and female patients are put-up in the same ward. These are reasons to believe that the health consumers are shunning away from public health facilities as they lack adequate care. The community work experience in Dwaniro Sub County is an ideal example to showcase how monitoring service delivery can yield positive outcomes through the process of social accountability and community participation. During the interface meetings facilitated by HEPS Uganda between the health workers, community leaders and community members in the last quarter 2014, Katwe community members identified issues that were affecting their health centre and these were prioritized in the community action plan. The health centre lacked a clear complaint and redress mechanism, a placenta pit, and had poor accommodation facilities for staff. The General ward and OPD department were of substandard, a situation that had affected the access to services in this health facility.

The community members of Dwaniro Sub County in collaboration with the health unit management committee members and the health facility in-charge agreed to submit a proposal to the sub county, district headquarters, politicians and development partners to solicit for support to improve the health facility infrastructure. In addition, community fundraising conferences were held to supplement the development works at the health centre.

The district councilor Nelson Agaba, informed community members of Dwaniro Sub County during a quarterly community action plans review meeting that due to the lobbying, the staff quarters were included in the district work plan for the year 2015. In this regard, through community fundraising meetings, the community members also contributed money, bought building materials to help in the construction of the health workers staff houses.

The health centre beefed up its health education programmes to keep to the goal of information dissemination, now to include health rights and responsibilities of clients and the use of rational medicines among others.

In Uganda, the range of health services varies with the level of care in public and private health facilities. Public health facilities up to Health Centre III (HCIII) offer basic services as per the minimum health care package. HCIIIs in particular the lowest facilities accessed at village level render a comprehensive health care package. At HCIIIs there are provisions for laboratory services for diagnosis and it is the first referral cover for the sub county as the third lowest unit of local government. But, access to services in these health facilities is limited due to a number of factors such as sub-standard health care facilities, unavailability of drugs and lack of awareness of community about their rights and standards of service.

Healthcare promotion in Uganda is strongly dependent on availability of adequate infrastructure, facilities, and technology. To a large extent, the infrastructure, equipment, furniture and vehicles define the capacity of a health centre to deliver health services to the population. However the state of the current infrastructure is below the standard of the adequate infrastructure set by the Ministry of Health.

ABOUT AUTHORS

Joan Esther Kilande holds a bachelor’s degree in Social Sciences and majored in Gender Studies. She has a certificate on Primary Health Care. She has certificates in Reproductive Health and Human Rights, Policy advocacy and Social media campaigns. She has been working with Journalists for the last 5 years in various health and human rights campaigns and has skills and experience in using social accountability approaches specifically the Citizens Report Card (CRC), Community Score Card (CSC) and the HEAR model.

Wakabi Eric is an all-round communication specialist and journalist with more than three years of experience in, health policy advocacy and communicating development issues to various Newspapers, Magazines, and Internet Productions, NGOs in Uganda and South Sudan. He holds a B.A Mass Communication degree of Makerere University and currently pursuing Bachelor of Laws at the same University. He’s currently a communications officer at HEPS –UGANDA

 

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A Story in Words and Images from Cassa Banana Informal Settlement, Zimbabwe- TARSC, ZIMBABWE, CBCHC AND COMMUNITY PHOTOGRAPHERS

Background

The Training and Research Support Centre (TARSC) and Zimbabwe Association of Doctors for Human Rights (ZADHR) has reported on different platforms of COPASAH and in the COPASAH Communique earlier,  as  how Participatory Action Research (PAR) was used in the Cassa Banana community to explore, analyze and take action on priority health problems faced by the community. PAR activities led to the formation of a Community Health Committee (CHC) and the development of a community action plan that prioritized lack of clean water and poor sanitation as the key health problem in the area. Initially, the CHC focused on clarifying the confusion in roles and responsibilities between two district councils, both of whom denied responsibility for supporting Cassa Banana. More recently, the CHC has focused on organizing community actions and engaging with the relevant duty bearer in demanding the delivery of basic services, including access to health services, waste collection, and the improvement of sewage and water supplies.

Cassa Banana is one of many informal settlements that have sprung up around Harare, the capital of Zimbabwe, over the last 20 years or more. In most cases, these unplanned urban settlements are overcrowded, lacking in basic infrastructure and services, with poor environmental conditions for health. Residents are facing a range of other social and economic challenges  common throughout the country, including rising urban poverty, falling access to improved water and sanitation, and lack of overall growth in the economy, employment or household incomes post 2013 (TARSC and MoHCC Zimbabwe Equity Watch 2014). The current Public Health Act has provisions for addressing water and sanitation but these are poorly implemented with an underfunded public health system. Diarrhea, intestinal infections and periodic outbreaks of cholera are not unusual in settlements such as Cassa Banana.Despite these challenges, there are opportunities for health and social accountability. The right to health care, water, food and shelter was included in the new Constitution of 2013.

Zimbabwe has seen improvements in the Human Development Index mainly due to better health and HIV outcomes, as there is sustained gender parity in education. Improvements in health and well being in Zimbabwe depend, among other things on engaging with the strong social assets within and improving dialogue between  communities, state and private sector, in raising and addressing barriers to resources and services for health, and in supporting community efforts to define and act on problems in order to transform their own environments.

ariel view of Casa Banana

An aerial view of Cassa Banana © L. Dhumukwa 2015

Within this context, the work in Cassa Banana is building a body of knowledge on strategies to support community efforts to take action and on how to hold duty bearers accountable. As part of this process, in October 2015, nine community members were trained as community photographers using a PAR tool called Photovoice.

INTRODUCING CASSA BANANA- Produced by the Cassa Banana Community Health Committee and Community Photographers
Cassa Banana is an informal settlement situated about 28 kms from Harare, with a population of about 850 people. The photograph below was taken from the roof of our communal ablution block. It shows how residents in our community live in one or two-roomed wooden cabins. We pay USD 17.00 a month per room to the Harare City Council (HCC). This covers the rent, water and sewage rates, but not all of us can afford to pay the City Council fee. Most of the residents in Cassa Banana are unemployed. We live by growing food, selling fish which we get from Lake Chivero a few kilometres away, providing services such as hairdressing or carpentry, or through selling vegetables, meat and other goods we get from town. Some of us also manage to find part-time work in the surrounding farms.
fishMen catch fish and women prepare the fish for domestic consumption or for selling © M. Mharadze 2015
The water and sanitation crisis is our top priority in Cassa Banana. We have serious problems with burst water pipes and a blocked sewage system. Most of our municipal water taps have not been properly repaired or replaced in a long time so we now only have five working water taps for 850 people. And sometimes the sewage seeps into our water supply through the broken water pipes. As a result, the sewage is polluting our drinking water.We are trying to keep our communal toilets and surrounding areas clean but this is difficult when the toilet flushing system is not working well due to corroded piping, we have no cleaning materials and no metal bins to throw away our rubbish. The council trucks used to come to Cassa Banana once a week to collect our rubbish, but they haven’t come now for many years. So, we dig communal rubbish pits, but these fill very quickly.
Keeping ourr community clean
 Keeping our Community Clean 
 In such an environment, it is not surprising that we have related health problems, such as intestinal parasites and diarrhea. So, what are we doing about this situation? For many years, we have been fixing our water leaks, clearing out our overflowing sewage tanks, cleaning our ablution blocks, digging rubbish pits, and organizing community cleanup campaigns. The CHC developed an Action Plan in 2014 and this has helped prioritize our work. We hold regular community meetings and, because the nearest public health clinic is 20kms away, we have strengthened our relationship with a private health clinic close by. This year they provided us with de-worming tablets.
We are in contact with the Harare City Council and they are aware of our problems. The council members mentioned their challenges of keeping up with the overall situation in Greater Harare, but nonetheless have assured the community of providing labour and technical knowhow if we can supply the plumbing materials. This goes against the constitutional obligations of the Government in providing the basic essentials to the citizens. One wonders at the  financial accountability of the government as we are unsure where the 17 USD per month rent from every household that is collected goes.
At the end of 2015, the CHC members and community photographers came together to discuss our plans for the coming year. We decided to continue to organizing ourselves and do whatever it takes to improve our environment. At the same time, we need to continue engaging with the Harare City Council in demanding that they provide health and other services as is our constitutional right. It is also important that we develop new partnerships that help us network with other communities and organizations in getting our health and other basic rights met; to share our experiences and learning with others, and to learn from them. We are proud of the photos we took last year and are happy with the advocacy booklet we produced. There is still more to do, and many other ways that we can use these photos. We understand that the photographs alone do not create the change we want. These images will be used as evidence for the change that is needed.
All photos are copyrighted to the Cassa Banana Community Photographers: Leeroy Dhumukwa, Paradzai Dimingo, Dephine Hondongwa, Misheck Mharadze, Martin Musodza, Mitchell Ncube, Talkmore Rwanyanya, Pamela Wachipa and Ruth Waeni.
About Authors:
This article is based on an advocacy booklet produced in November 2015. It was written by the Cassa Banana Community Health Committee, with support from Barbara Kaim, Training and Research Support Centre (TARSC) Zimbabwe. TARSC is a learning and knowledge organisation, with a strategic vision to inform and contribute to people and social justice change and to support sustained health and wellbeing.  See http://www.tarsc.org for more information or admin@tarsc.org.