Developing Sexual & Reproductive Health Capacity in Roma Communities in Romania


Developing Sexual & Reproductive Health Capacity in Roma

Communities in Romania

D.Iancu, M. Gasco,

John Snow Research &Training Institute (JSI), Bucharest,


Background: Romania has the largest Roma population in

Europe, with 2 out of the 7-9 million Roma living in Europe. Roma people often

live in unsanitary conditions which compromise their hygiene and health, and

suffer from poor health outcomes in comparison with other ethnic groups: life

expectancy 10 years less than the non-Roma population, more chronic and

infectious diseases. Reproductive health (RH) indicators are consistently the

worst in the nation: 80% of Roma women don’t receive adequate prenatal care;

infant mortality (50.6) is double than the non-Roma children (26.9); 93% of Roma

women never had a Pap smear. In order to ameliorate this situation, Romanian

Family Health Initiative, a project implemented by JSI in collaboration with the

Ministry of Health, developed targeted intervention to reach this population.

One of the most effective approaches has been the involvement of representatives

of the Roma community, as mediators. As an active interface between governmental

and non-governmental structures and the community, Roma mediators not only

transmit information, but also soften the interaction between community members

and service providers. In 2004 JSI has started to complement the training of

Roma mediators, to empower them to provide sexual education and promotion of RH

services, and to increase cross-cultural understanding between health

professionals and Roma.

Objectives: 1) to improve knowledge among Roma population

about RH issues; 2) to facilitate access to client-centered RH services; 3) to

increase the use of RH services by Roma people.

Design and methods: the project is targeted to the

existing 185 Roma Health Mediators, to policymakers and health professionals.

The main interventions are: 1) training of Roma mediators in RH, communication

for behavior change and group education; 2) training of health professionals for

addressing barriers stemming communication and cultural issues; 3) ensuring

education, counseling and modern contraception method-mix supplies in Roma

communities; 4) developing culturally-appropriate IEC materials.

Results: 1) culturally adapted training curriculum for

training Roma Mediators in Sexual and Reproductive Health, developed based on

the needs identified during 7 focus group discussions and interviews with

policymakers; 2) the Manual for Roma Mediators developed, printed and

distributed; 3) 35 mediators (serving around 20,000 Roma people) trained until

June 2005 (out of which 13 have subsequently received additional training and

became instructors for RH); 4) educational materials drafted, involving

beneficiaries; 5) National Roma Working Group established, involving Ministry of

Health representatives, donors, NGOs; 6) regular meetings hold, providing a

forum for information-sharing between projects working on Roma health issues,

leading to better coordination and increased collaboration among partners and

lowering the risk of duplication.

Conclusions: we appreciate this project as a model for

reducing health inequities, scaling-up community-based interventions and using

the existing human resources, based on the principles of peer-education.

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