Roma 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 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