Developing Sexual & Reproductive Health Capacity in Roma
Communities in Romania
D.Iancu, M. Gasco,
John Snow Research &Training Institute (JSI), Bucharest,
Romania
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.