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INCLUSION OF ROMA- HEALTH EU SOCIAL INCLUSION SEMINAR ON ROMA

INCLUSION OF ROMA- HEALTH EU SOCIAL INCLUSION SEMINAR ON ROMA

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INCLUSION OF ROMA- HEALTH EU SOCIAL INCLUSION SEMINAR ON ROMA

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  1. INCLUSION OF ROMA-HEALTHEU SOCIAL INCLUSION SEMINAR ON ROMA WHO Country Office in Serbia Dr. Dorit Nitzan

  2. HEALTH 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

  3. 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

  4. % Receiving Social Welfare

  5. TIMES OF CHANGES

  6. STEWARDSHIP • Strengthening the universality of health systems • MoH & the Republic Institute for Health Insurance

  7. “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”

  8. Stewardship - continued • Evaluate interventions and disseminate promising practices on Roma health, including through inter-country exchange in the context of the Decade • Roma Health Forum: • 1st meeting of MoH with neighboring MoHs -December 2009 • Cross European – November 17, 2011 MoH with WHO, UNICEF, OSCE and more

  9. 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

  10. Stewardship – cont. • Cross-governmentunderlying determinants of health • DPM, PRSP, Government, municipalities Support of EC, UNCT (e.g. SWIFT), NGOs

  11. 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

  12. Service 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 Mediators support of OSCE, UNICEF, WHO SWIFT Initiative (funded by Norway) Support of WHO, IOM, UNOPS

  13. Service Delivery – Cont. • Formalize the role of mediators and outreach workers from the Roma community • Health Mediators

  14. RESOURCE GENERATION • Increase health professionals’ know-how • Offer continuing educationprogrammes for health professionals on Roma health MOH Health Mediators SWIFT (funded by Norway) World bank • Integration in medical, nursing school • Use CME platform

  15. Financing • Mitigating the burden of out-of-pocket health spending MoH, Republic Institute for Health Insurance Support of WB and WHO

  16. Financing – cont. • Raise awareness about Roma entitlements and obligations with regards to health system financing Health Mediators Municipalities Republic Institute of Health Insurance Support of WHO, SWIFT

  17. 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

  18. 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

  19. Comprehensive, multifaceted, holistic approach through the local and national authorities and communities: • Bottom up top down • Horizontal • Partnership mechanisms • Local ownership

  20. SWIFT I - Responsible implementers/ Overall management-WHO Working Together SWIFTly DPM, PRSP Ministries of Health and Environment INCOME GENERATION HEALTH COMPONENT SOCIAL MOBILIZATION WHO UNOPS IOM Ministry of Health Belgrade Municipality Belgrade Municipality Belgrade Municipality Funded BY NORWAY Ministry of Labor & Social Affairs Ministry of Labor & Social Affairs Ministry of Internal Affairs Ministry of Economy & Region Develop Ministry of Labor & Social Affairs Institute of Health Insurance Ministry of Environment Ministry of Minorities Institute of Public Health Institute of Occupational Health Chamber of Commerce Ministry of Education Communities & Civil Society Communities & Civil Society Communities & Civil Society UNOPS – Administrative Agent – admin and finance

  21. It takes a village to raise a child Thanks!