Background - ’Together for Better Health for us, by us’ (T4BH)

Tb4H is a consortium of four non-government organizations - National Network of Health Mediators (Bulgaria), Partners Hungary Foundation (Hungary), OvidiuRo Association(Romania), and Association for Culture, Education and Communication (Slovakia) - working to improve access to healthcare for socially excluded Roma communities in Central and Eastern Europe. The project was established in 2011 with GlaxoSmithKline (GSK) and the three-year programme seeks to address some of the gaps of Roma integration by promoting the training and employment of Roma Health Mediators.

Country visit to Romania - Roma Integration as a public health emergency

EPHA joined the T4BH delegation to visit isolated locations in rural areas of Romania, including a study visit to the school and kindergarten of Araci/Árapatak village and a field visit to a Roma settlement in Hetea/Hete in Transylvania.

The field visit reinforced available evidence on poor Roma health. Roma are found at the very bottom of our society; they suffer worse health than the majority because of the range of unfavorable factors that influence health, such as education, employment, food, indoor and outdoor air quality, housing, access to water, access to transport, poverty and access to healthcare.

One of the most visible signs of Roma segregation were the very poor housing conditions: the large majority of dwellings were made of wood, large families live in very small rooms with no access to appropriate water, sanitation or even public transport. The village visited among the mountains is completely isolated from the surrounding urban areas. [1]

How to improve Roma Health in Romania?

Romania has the largest population ratio of Roma in Central and Eastern Europe with available data showing that there is a disparity in the major health indicators between Roma and non-Roma populations (see Table 1):

The hosting Romanian NGO, OvidiuRo‘s (OvR) tries to break the vicious circle of poverty and Roma exclusion.

Asociatia OvidiuRo’s co-founders, Romanian teacher Maria Gheorghiu and American volunteer Leslie Hawke, observed first hand that if poor children were deprived of early learning opportunities, most never caught up again with other children. Their experience in the field, beginning in 2001, reinforced what international research reveals: early education has the highest return on investment of any poverty intervention. The mission of OvidiuRo is to make quality early education available to every poor child in Romania – so they have a chance to become active members of society.

The ’Together for Better Health’ project added a health component to OvidiuRo‘s early educational programme, by providing funds to cover some of the most pressing health needs of impoverished preschool children.

The project aims to:

  • Create health awareness and give parents tools to help prevent outbreaks of infectious diseases and other health issues that affect school attendance;
  • Ensure children receive required vaccinations and regular check-ups;
  • Facilitate closer collaboration with local health mediators and/or family doctors;
  • Enable impoverished parents to purchase medicines, vitamins, and hygiene supplies;
  • Encourage mothers to have gynecological check-ups and use contraceptives for family planning.

A roundtable discussion with key stakeholders to address the pressing need of Roma integration in Romania

The stakeholder dialogue hosted by Jan Gabor, Ambassador of Slovakia to Romania, gathered key stakeholders in Romania, including officials from Romanian national institutions, from the Ministry of Health, Labour, and European Funds, the Bulgarian and the British Ambassadors, Roma Health Mediators and representatives from Romanian civil society.

Based on their experience of working with Roma Health Mediators (RHMs), NGOs could inform officials of what is really happening on the ground when it comes to Roma access to health care, and what the real obstacles are in everyday life.

The discussion focused on common issues and lessons learned and on ways NGOs and the private sector can influence governments in addressing the most critical problems and ways to disseminate and replicate good practices.

EPHA’s contribution to the debate

By actively participating in the discussion, EPHA highlighted the following key points in respect of progress made in different countries:

  • Romania was hit very hard by the economic crisis and the austerity measures imposed by the IMF programme, resulting in serious shortages in the healthcare workforce which badly affected the population’s health. The sooner the bureaucratic obstacles are reduced in the hiring of Roma Health Mediators, the better Roma health results can be achieved.
  • Roma integration is one of the most relevant societal challenges in Hungary which makes the field work of Hungarian Roma Health mediators extremely important. Using official health indicators on Roma health could give additional evidence on the poor health situation of Hungarian Roma.
  • The key of success of the Roma Health Mediators programme in Slovakia is the good cooperation between the Slovakian government, civil society and the private sector which resulted in the official recognition of the Roma Health Mediator programme in the country.
  • The partnership with Medical Universities is key for Bulgarian NGOs in the project, which made it possible to apply high quality standards to the Roma Health Mediators’ (RHM) professional qualifications


The field visit to Romania and the roundtable discussion gave additional ideas of what can be done in the short to middle term so that Roma life expectancy and quality of life are on par with that of the rest of our countries’ population.

Photo’s source: © [Pictures made in the Romanian village Hetea/Hete]

EPHA Position on Roma Health in Europe (1 page summary, pdf)

FULL EPHA Position on Roma Health in Europe (pdf)

Roma-related EPHA articles


[1] FRA data showed that in the Roma households surveyed, on average more than two people were living in one room. About 45% of them were living in households that lack at least one basic amenity, such as an indoor kitchen, toilet, shower or bath, as well as electricity. 42% of the Roma surveyed live in conditions of severe housing deprivation, e.g. having no piped water and/or sewerage and/or electricity in comparison to 12% of non-Roma living nearby. Roma households with four or more children face a higher proportion of severe housing deprivation.

Last modified on August 21 2014.