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

Download

Migration Health: Better Health for All in Europe

AMAC

Assisting Migrants and Communities

Download

Improving HIV data comparability

HIV1 

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

Download 

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 – SLOVAKIA

Full Report available here

Although Slovakia guarantees equal health protection for all citizens regardless of ethnic or national origin, major inequalities between Roma and the rest of the population concerning healthcare continue to exist. The systematic deficiencies of the health-care system, including the lack of personnel and funding, corruption, and the marginalized situation of the Roma community are among the main barriers for Roma to access health-care services. Several governmental strategies aiming at Roma integration have also addressed the healthcare area in recent years. Although initiatives have been largely focused on children and youth, and reproductive health, significant steps in policy making in the area of health and access to health care have been made since 20031. Recently, under the National Roma Integration Strategy (NRIS-2003), Slovakia has adopted a strategy towards Roma integration through the implementation of the Revised Action Plan (2012-2015).2 The application of these two policy documents over the first 2 years of the operation has revealed that tasks in the field of health were often assigned to agencies, particularly to the Office of the Government Plenipotentiary for Romani Communities (OGPRC) that did not have administrative powers and financial resources to implement them.

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 Slovakia 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 Slovak NRIS and other national commitments in the field of health care.

Policy makers in Slovakia have often downgraded the importance of health-care inequalities experienced by the Roma community to simply health awareness and proper hygiene related problems. Additionally, the importance of participation of stakeholders and Roma civil society in activities at local level has also been downplayed when drafting policy initiatives. In addition, governments taking a more comprehensive approach towards addressing Roma healthcare issues have been confronted with budgetary constraints. In fact, the lack of funding for specific activities constitutes to be one of the main deficiencies of the Revised Action Plan and the Slovak NRIS. Furthermore, implementation of tasks in the area of health is often assigned to agencies that in fact do not have the financial means and the administrative powers to implement them.

 

“The problem with these kinds of strategies concerning the Roma or human rights is that there is no allocated funding. Hence you can do only what you do in the regular course of your work”. (Ministry of Health employee)

 

The Slovak Healthcare System guarantees equal access to health-care services on the basis of a compulsory health insurance coverage except for vulnerable groups who are covered by the state. In this case, the Slovak Administration compensates health insurance payments of vulnerable groups, including registered unemployed and people receiving social assistance benefits. Although this indicates that there is no significant disparity in health coverage between Roma and non-Roma population, the health-care system’s deficiencies in terms of quality and efficiency of services provided, negatively affect those in difficult socio-economic situations3. Furthermore, Roma in extreme poverty situation, spatial segregation (long distance between settlements and health centres), discrimination on the ground of ethnicity and low health awareness are among the main barriers to access health-care services.

 

“Women who look Romani or come from a ‘socially excluded environment’, as health personnel sometimes refer to them, are automatically placed in separate wards. This practice continues… Some non-Romani women refuse to be in wards with Romani women…it is nothing new, I encounter this all the time”. (Romani women’s right activist)

 

The health mediation program is the only state funded initiative to address problems related to Roma health and access to health-care services. According to the program assessment, the program’s success depends on strong logistics, the independence of health mediators and project coordinators form the state administration, and the increased Roma empowerment at local level (achieved by providing comprehensive education on health protection and recruiting health mediators from the Roma living in marginalized locations). The state administration has not been able to institutionalize the program and ensure sustainable funding. Nevertheless, findings from the assessment conclude that the scope of the program would remain insufficient considering the amount of marginalized Roma settlements in Slovakia.

 

“The program targeted barriers that Roma were facing in accessing health care 10 years ago. Assistants often accompanied patients to see their doctor. We could notice palpable changes in attitudes of health-care providers. Doctors changed their views and recognized sincere efforts to cooperate on the part of their Romani patients.” (Nataša Slobodníková – Regional Association of Romani Initiatives’ director)

 

In this context, the report recommends that agencies assigned to implement program’s tasks should have ensured the necessary administrative powers and capacities to develop them. Therefore, these recommendations should be taken into account under the new 2015-2020 NRIS Action Plan. Furthermore, the Slovak authorities should provide and ensure adequate funding to implement the tasks covered by the Action Plan.

On the other hand, the inherent deficiencies and barriers in the health-care system threaten the access to health-care services, including the underfunding and lack of medical staff. The Roma community and other vulnerable groups are particularly exposed to these barriers due to their difficult socio-economic situation. Policy makers should provide more culturally and social sensitive health care by addressing the specific needs of marginalized populations, such as far away locations of medical facilities, prohibitive cost of health-care services, and generally low health and legal rights awareness among Roma populations.

Finally, the health mediation program in Slovakia appears to be the only state funded initiative addressing complex Roma health related issues faced by this community and other vulnerable populations. According to the program assessment, the health mediation program has great potential for addressing health issues such as preventive care, childcare, and access to specialized services, currently inaccessible for Roma in vulnerable situation. However, there is need for a solid coordination within the program, quality training of personnel, recruitment of more health mediators, to cover the scope of Roma settlements, and ensuring their independence from local power structures. The state administration should institutionalize the program and ensure a sustainable funding for its development and implementation.

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


1Basic Theses in the Government Policy on Integration of Romani Communities - Základné tézy koncepcie politiky vlády SR v integrácií rómskych komunít, adopted by Government Resolution No. 278/2003.

2Revision of the National Action Plan to the Decade of Roma Inclusion 2005-2015.

3Mihailov, supra note 51 at 36.