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INCLUSION OF ROMA- HEALTH EU SOCIAL INCLUSION SEMINAR ON ROMA. WHO Country Office in Serbia Dr. Dorit Nitzan. HEALTH SYSTEMS APPROACH TO MEETING THE NEEDS OF ROMA EXPERIENCING SOCIAL EXCLUSION. Analysis based on the four functions of health systems: Stewardship Service delivery

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inclusion of roma health eu social inclusion seminar on roma

INCLUSION OF ROMA-HEALTHEU SOCIAL INCLUSION SEMINAR ON ROMA

WHO Country Office in Serbia

Dr. Dorit Nitzan

health systems approach to meeting the needs of roma experiencing social exclusion
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
important health indicators
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

stewardship
STEWARDSHIP
  • Strengthening the universality of health systems
    • MoH & the Republic Institute for Health Insurance
slide8

“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”
stewardship continued
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

stewardship cont
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

stewardship cont11
Stewardship – cont.
  • Cross-governmentunderlying determinants of health
  • DPM, PRSP, Government, municipalities

Support of EC, UNCT (e.g. SWIFT), NGOs

stewardship cont12
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

service delivery
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

service delivery cont
Service Delivery – Cont.
  • Formalize the role of mediators and outreach workers from the Roma community
  • Health Mediators
resource generation
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
financing
Financing
  • Mitigating the burden of out-of-pocket health spending

MoH, Republic Institute for Health Insurance

Support of WB and WHO

financing cont
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

financing cont18
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
challenges
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
slide20

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

  • Bottom up top down
  • Horizontal
  • Partnership mechanisms
  • Local ownership
working together swiftly

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