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COPASAH SOUTH ASIA EXCHANGE AND STRENGTHENING MEET ON SOCIAL ACCOUNTABILITY IN HEALTH IN THE SOUTH ASIA REGION DECEMBER 4-6, 2016; KATHMANDU, NEPAL

INTRODUCTION

COPASAH – Community of Practitioners on Accountability and Social Action in Health – is a global community of practitioners who share a people –centric vision and human rights based approach to health, health care and human dignity ( http://www.copasah.net). COPASAH’S mission is to nurture, strengthen and promote collective knowledge, skills and capacity of communityoriented organisations and health activists primarily in the regional nodes of South Asia, Latin America, East Southern Africa and Central Europe working in the field of accountability and social action in health, for promoting active citizenship to make health systems responsive, equitable and people-centred.

CONTEXT FOR THE MEET AND STRENGTHENING SOCIAL ACCOUNTABILITY IN
SOUTH ASIA

In the COPASAH South Asia regional node of practice, synergy has been enhanced through
different interactions in form of workshops, Facilitated learning exchange visits and through virtual communication on the communication platforms and the COPASAH Communiqué (newsletter).At country level this has deepened but there are very few opportunities for collective deliberations on the social accountability in the region in form of face to face meetings. With a view to understanding various approaches and experiences from a range of health rights organizations and health rights activists in different countries of South Asia (India, Pakistan, Nepal and Bangladesh), COPASAH South Asia envisaged a platform for discussion to contribute to strengthening the field of accountability in health in South Asia and to deepen and expand the regional base further of COPASAH through medium of a COPASAH South Asia strengthening meeting. The objectives of the meet were:

OBJECTIVES:

  • To understand the eco-system of social accountability in health in the South Asian
    Countries
  • To facilitate mutual sharing of experiences and learning from each other
  • To strengthen South Asian solidarity to promote people oriented social accountability
    perspectives and perspectives.
  • Explore opportunities for knowledge production from accountability practice in the
    region and its exchange in form of webinars, case studies and other mediums

SESSIONS OF THE MEET

COPASAH South Asia Exchange and Strengthening Meet, was convened in Kathmandu, Nepal from Dec 4 to 6, 2016 on a very participatory note. The meet saw significant participation from countries of Srilanka, Bangladesh, Pakistan and Nepal. The meet was facilitated by COPASAH Steering Committee (SC) member Renu Khanna, with co facilitation support from COPASAH South Asia SC member Gulbaz Ali Khan.

DECEMBER 5, 2016 SESSIONS

SESSION I: MUTUAL INTRODUCTIONS, CONTEXT OF THE MEET AND COMMON
EXPECTATIONS FROM THE MEET

Representing the COPASAH South Asia practice node Surekha Dhaleta set out the tone for the South Asia meet. Through a participatory methodology COPASAH SC member Renu Khanna steered the mutual introductions, wherein the participants shared the context of their work and affiliated organizations. Representing Srilanka Dr. Harishchandra Yakandawala and Asitha Punchihewa from Family Planning Association (FPA) of Srilanka; Tharindu Gunathilaka and Sanath Mahawtihanage from the Sarvodaya Sharmadana Movement of Srilanka, elucidated that Sarvodaya is the biggest Non-Government Organisation in Srilanka and the organisations including FPA and Sarvodaya have been instrumental along with other stakeholders in proposing Health as a Right and Srilanka may soon recognize health as a Right in its Constitution.

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Representing Pakistan, Kanwal Iqbal from Community Uplift Programme (CUP) and Gulbaz Ali Khan from Centre for Inclusive Governance (CIG) highlighted that CUP has been amongst the forerunners in carrying out social accountability in Pakistan and both the organizations have experimented with use of community score cards in family planning, citizen report cards in the Khyber Pakhtunkhwa region of the country as well have had experience of experimenting with other strategies like that of budget tracking, Right to Information, Right to Public Services and developing manuals, guidelines etc. for health services providers also. Amongst the Nepal representatives, Narayan Adhikari from the Accountability Lab outlined that the organization is working towards accountability, health and migration in Nepal and is geared towards using Information Communication Technologies (ICTs) extensively with youth in Nepal. Post the April, 2015 earthquake in the country, the Accountability lab has set up citizen help desks to bridge gaps with local people on the ground and the organization has bolstered campaigns such as the Integrity Idol since 2014 to debate around the idea of integrity and demonstrate the importance of honesty and personal responsibility. Kedar Khadka from GoGo foundation in Nepal elaborated that GoGo foundation has been instrumental in conducting public hearings from village, district up to central level, and in developing social audit accountability tools which have been adopted by Ministry of Health education and other sectors also. Two participants from Nepal, Rakshya Paudyal from Beyond Beijing Committee (BBC) in Nepal pointed out the 8 BBC and Kapil Kafle, coordinator Men Engage Alliance South Asia joined the meet later in the day. Representing Bangladesh, Rowshan Ara and Maksuda Khatun from Naripokkho outlined that the organization is women’s activist organisation working for the advancement of women’s rights and entitlements and building resistance against violence, discrimination and injustice. They delineated that Naripokkho was found in 1983 and since then has been involved in numerous activities related to Violence Against Women (VAW) in Bangladesh, which include campaigns, cultural events, training, research, lobbying and advocacy. It has also vast experience in monitoring government health care facilities and in increasing accountability of service providers amongst the key components of work on monitoring, they added.

COMMON EXPECTATIONS FROM THE MEET

Advancing from formal introductions by participants around the context of their work and of their organizations, the schedule was elucidated by Renu Khanna, following which the
participants outlined their common expectations from the meet. The potentials from the meet by the invitee participants were outlined, in terms of taking it as an opportunity to understand health related issue in the South Asian countries, besides exploring it as a platform of experience sharing on challenges and success of accountability practices, and learning from each other on accountability tools, as well taking it a prospective instance to know more about COPASAH, forge cross country alliances with different organisations, networks and strengthen the COPASAH network in the South Asia region.

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COPASAH SC member Renu Khanna introducing the schedule of the meet

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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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