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 – ROMANIA

Full Report available here

Roma integration has been on the Romanian Government’s agenda since the year 2000 and several policies and initiatives aiming to improve the lives of the Roma population have been implemented since then. These initiatives included two National Roma Integration Strategies (NRISs) for the period 2001-2010 and 2012-2020 respectively (2nd NRIS currently being revised), and other policy documents such as the National Plan for combating poverty and promoting social inclusion 2002-2012. However, despite the improvements achieved in Roma access to healthcare services, particularly thanks to the Roma Health Mediation (RHM) programme1, more efforts are necessary in order to tackle major Roma health issues and social determinants such as extreme poverty, low education and high unemployment.

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 Romania for the period 2005-2014.

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

In the context of Roma integration strategies adopted in Romania since the year 2000, health issues have been addressed as one of the main pillars in all policy documents and initiatives. However, problems related to lack of sustainable funding, poor monitoring processes, and the perception and addressing of Roma health issues in a simplistic manner have lowered the expected outcomes aiming to improve Roma health and Roma access to healthcare services. Nevertheless, evaluations of the revised draft of the second NRIS point out that the in-depth situation analysis of Roma health takes into account the need for a comprehensive approach, linking social determinants with health outcomes.

The access to the healthcare system is regulated through the social health insurance system that requires regular financial contributions, depending on employment status and professional activities. Consequently, considering several particularities within the Roma community such as the absence of personal identification and the lack of information on how to be enrolled in the social health insurance, there is a low insurance coverage of the Roma population. Furthermore, the lack of financial means and discrimination on the ground of ethnicity constitute additional threats as regards access to healthcare services.

The Roma Health Mediation (RHM) programme, launched in 2002 in the context of the first NRIS is considered to be one of the most successful actions aiming at improving Roma health. Impact evaluations of the programme showed the improvements made on Roma access to healthcare services as a result of the increased enrollment in the health insurance system, and information campaigns on vaccination within the Roma community. Despite the positive reviews of this initiative, assessments on the implementation and impact of the RHM showed several areas where improvements are needed, including the unclear standards and procedures for monitoring and evaluating the RHMs’ activities and the lack of supervision applied by the district and local public authorities. Consequently, most of health mediators were providing services to a considerable number of persons and carried out numerous activities, some of them being unrelated to their tasks.

In this context, despite the implementation of several initiatives and policies related to Roma integration and the importance given to the health component and Roma access to healthcare services, the assessment carried out concludes that more efforts are necessary towards improving Roma health. Although a high commitment demonstrated by the Romanian Government, stronger cooperation between relevant stakeholders is needed in order to strategically define and implement health policies targeting the Roma community.

Furthermore, the revision of the second NRIS should consider, amongst other, a secured sustainable funding and concrete monitoring and evaluation indicators, as well as offering adequate support to local public administrations addressing the provision of community health services, which resulted from the decentralization process in the health sector.

Finally, even though the RHM profession is established and regulated, findings highlight the need to further update and adapt training to the needs of RHMs and to establish performance criteria for their provision of services.

The Progress Report was produced under IOM MHD, RO Brussels guidance by Adrian Pana, and benefitted from peer reviews by Adriana Galan and Mariya Samuilova. DJ Krastev copy-edited, proofread, and assist with the general editing.


1One of the most successful outcomes of the first NRIS (National Strategy for Improving the Situation of Roma)