Based on a study of the Roma health mediator model in Bulgaria, Finland, and Romania, it aims to identify both the potential and shortcomings of health mediator programs (RHM) in addressing the determinants of Romani health, including unhealthy living conditions, as well as other social issues, such as poverty and discrimination.
The study also considers the health promotion approach via the EU enlargement process and the Decade of Roma Inclusion initiative, both of which support Roma health mediation. It concludes that both processes are marked by deficiencies.
Definition of Roma Health Mediators
RHM programs are part of government strategies to address Romani health status and are implemented by members of the Romani community themselves.
The stated aims of RHM programs are to improve community health by:
“1. mediating between Romani patients and physicians during medical consultations,
2. communicating with Romani communities on behalf of the public health system,
3. providing basic health education, and,
4. assisting Roma in obtaining the health insurance or identity documents necessary to visit the doctor”.
Main findings
The study’s findings were generally favourable with regard to the efficacy of RHMs in assisting individual Romani clients. At higher levels, however, the structural inequities hindering improvement in Romani health are not targeted by RHM activities sufficiently to bring about systemic change. More specifically, it was found that some of the mediation programs failed to be supported by legislative changes or to be integrated into the overall public health system.
A number of obstacles to Roma health promotion were identified within both the Romani community and the medical community. These “trends” include limited perceptions of the meaning of health (both Romani and medical communities), lack of demand for preventative services (Romani community), and lack of focus in increasing patient health knowledge (medical community), amongst others. Ultimately however, mediator programs fail to tackle the deeper-rooter obstacles to improved Romani health, which need political support and other resources to reduce health obstacles.
However, on the level of individual RHM programs, mediators are reported to effectively address several components of Romani health. This is mainly achieved by reducing bureaucratic and communication obstacles faced by the Romani community.
Recommendations
The report offers specific and separate recommendations to each of the three major actors involved in efforts to improve community health, including RHM program implementers, national level policymakers, and donors.
Recommendations focus on increased individual/community health empowerment, as well as improved complementary legislative reforms to health and social assistance systems. These measures will ultimately reduce dependency on health mediation in the longer term. It calls for comprehensive efforts from all actors in improving health system equity and overall health status.
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