To Build a Bridge

Training for Health Professionals and Law Enforcement Officers

Summary Report on the MIPEX Health Strand and Country Reports

Border Management and Detention Procedures: Health Perspective

guidelines

Guidelines

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Migration Health: Better Health for All in Europe

AMAC

Assisting Migrants and Communities

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Improving HIV data comparability

HIV1 

HIV-related data on migrant and ethnic minority populations in EU/EEA/EFTA

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Mobility of Health Professionals

MHD RO Brussels Publications

Implementation of the National Roma Integration Strategy (NRIS) and Other National Commitments in the Field of Health – CROATIA

Full Report available here

Visible improvements in some areas of the Roma socio-economic life, particularly in education have been achieved in Croatia in recent years. The Government of Croatia and civil society actors have been addressing various Roma issues and challenges, mainly in education and housing by using Pre-Accession Assistance funding targeting Roma issues. The implementation of a policy framework for Roma inclusion, including adoption of National Roma Integration Strategy (NRIS) in 2012 and a National Action Plan in 2013, brought Croatia’s legal framework in line with the EU policy objectives for National Roma Integration Strategies.

Nevertheless, the Croatian authorities are still facing obstacles and challenges regarding the implementation of measures, mainly concerning access to healthcare. Therefore, the main obstacles and challenges related to the successful implementation of the NRIS concerns the lack of communication and cooperation between different state and local entities, the allocation of planned financial resources, and the difficulty of collecting Roma related health data.

The Progress Report, part of the EQUI-HEALTH project – Roma health sub-action, presents the results of the assessments on the relevant developments made in respect to Roma health in Croatia for the period 2005-2014.

Based on desk research, fieldwork and interviews with different stakeholders, including professionals working with Roma, health providers, and civil society organizations, the report provides an analysis on the implementation of the Croatia NRIS and other national commitments in the field of healthcare.

The Croatian Government has adopted a National Roma Inclusion Strategy (NRIS) addressing Roma issues and challenges in areas such as education, employment and healthcare, and promoting positive discrimination with the goal of ensuring equal access to social services. Nevertheless, many stakeholders interviewed during the fieldwork pointed out the unsatisfactory implementation of the NRIS health component, due to insufficient funding allocated towards addressing Roma health issues. Therefore, evidences based on interviews conducted with civil society organizations suggest the existence of inconsistencies in integrating the Roma minority at various social-economic levels in Croatia, aggravated by the lack of communication and cooperation between different national and local levels of governments and organizations.

 

“Health is a very specific area. You cannot use general models in health; they have to be sector-specific and it is necessary for health specialist to be involved. Health actions need to be targeted.” (Roma CSO representative)


“Health is included in the national strategy (NRIS) but even where there are tenders for health, nobody applies because people are not familiar with the health situation…” (Roma CSO representative)


Furthermore, another major problem undermining the successful implementation of the NRIS in Croatia concerns the inadequate collection of ethnically disaggregated health statistics. Although various Croatian institutions collect specific statistics on the Roma community, the lack of clear regulation/directives regarding the collection of statistical data disaggregated by ethnicity makes this type of data inaccessible; the information is not collected in an adequate specified method.

 

“At the national level this (author’s note: records of patients according to ethnic belonging) is not possible. On some protocols, to facilitate tracking of patients, we just mark it (author’s note: Roma ethnic identity). However, this is not actually allowed. If you (author’s note: doctors on local level) want to draw out some statistics related to health, we should be facilitated the task of recording patients’ ethnic identity. This would be very useful for us, as it would allow us to monitor our Roma patients…” (Health professional, Medimurje County)


In terms of Roma health mediation programmes, Croatia currently does not have any programme covering mediation initiatives addressing socio-cultural barriers which negatively impact the access and quality of healthcare of the Roma community. However, the Ministry of Health recognizes that health mediators could be a valuable link between the health system and the Roma population and is therefore committed to gradually launching a Roma health mediation programme by 2015. For this reason, the National Action Plan for the implementation of the NRIS considers the development and implementation of educational programmes for health mediators and the launch of a health mediation pilot project which would serve as an initial analysis on the effectiveness of the approach.

In this context, findings from the assessment acknowledge that issues and challenges concerning equal access to social services of the Roma population in Croatia have recently come to the attention of the civil society and public institutions. Therefore, the Croatian Government has been developing and implementing concrete policy framework for Roma inclusion. Findings suggest the need to further improve coordination within the public administration and between civil society organizations in order to overcome the current inconsistencies which threaten the successful implementation of the NRIS.

Furthermore, evidence from fieldwork highlights the need to improve the insufficient funding allocated towards addressing Roma health issues which represents one of the main obstacles and challenges related to the well implementation of the NRIS in Croatia.

On the other hand, findings based on interviews conducted stress the need to work towards collecting ethnically disaggregated health data by developing a systematic data gathering method that would collect the necessary health-related information for Roma. This would be of significant importance to address many of the challenges in implementing the health aspects of the NRIS.

Finally, concerning the commitment of the Croatian Government in gradually launching a Roma health mediation programme in 2015, development of a detailed and sustainable mediation programme is suggested, taking into consideration the capacity of Roma people to participate in health mediation programmes, to identify the potential benefits by conducting assessment of needs and social impact, and the development of a support and supervision system for health mediators.

The Progress Report was produced under IOM MHD, RO Brussels guidance by Irena Martinovic Klaric, Lana Peternel, and Branko Ancic, and benefitted from pre-reviews by Mariya Samuilova. DJ Krastev and Annie Raykov copy-edited, proofread, and assist with the general editing.