Health mediators in action in Slovak hospitals

By Marcela Adamova, EPHA Fellow, Manager for implementation Roma health mediators in the hospital environment – Healthy Regions Slovakia.

A new service in Slovakia aims to support Roma from marginalised communities to better benefit from healthcare to increase their health and wellbeing. The employment of Roma Health Mediators (RHM) in hospitals is a pilot initiative of Healthy Regions, an organisation which supports the Ministry of Health to develop and implement temporary affirmative action for the most vulnerable groups in the area of health.

Since April 2018, Healthy Regions has developed partnerships with 6 hospitals in Eastern Slovakia, both private and state owned, to employ 8 RHM in their gynaecology, maternity and paediatrics departments. As their job title suggests, they aim to raise awareness about health, act as mediators between Roma and health professionals and provide psychosocial support. They are all educated to at least secondary education, have previous experience of working with vulnerable groups and speak the Roma language.

Roma people seeking healthcare, particularly gynaecological, maternity and paediatric care face many barriers. The most common barrier is in communication which results in many misunderstandings and tensions; but there are also barriers relating to inter-generational poverty and exclusion including: patients not prepared for hospital stays or not knowing the hospital’s internal rules; unhealthy lifestyles; poor hygiene; lack of preparation for parenthood; women leaving hospital without being discharged, or children not being picked up; fear of the hospital environment.

The health status of Roma in Central and Eastern Europe (including Slovakia) is significantly worse compared to the majority of the population, mostly because a significant number of Roma who live in the excluded environments do not benefit from health services compared to the rest of the population.. The health status of Roma in this region is generally much worse than average levels of health in these countries in most of the measured indicators (Cook et al., 2013; EUC 2014, FRAEU and UNDP 2012).

In line with current epidemiological theories on ethnic health determinants (Diez Roux 2012, Dressler et al., 2005), this is because a large proportion of the Roma population in individual countries is exposed to relatively unfavourable health conditions – intergenerational poverty, socially and physically excluded enclaves with little or no sufficient infrastructure surrounded by discriminatory environments. (Belak et al., 2018; Cook et al., Janevic et al., 2012, Kolarcik et al., 2012).

National Project Healthy Communities

More than 250 Roma Health Mediators have been working in 265 marginalised Roma localities across Slovakia. Their role is to improve the health situation of Roma in the poor and segregated Roma localities through so- called “health mediation”, a specific type of community work specialized in health awareness-raising, breaking communication barriers, and providing psycho-social support for people living in such environments. Based on previous experience, their efforts are being redirected to tackle the more  upstream social determinants of health in marginalised communities such as poor public and household infrastructure, poverty, or exclusionary and self/exclusionary ideologies and practices involved both Roma and non-Roma. This initiative is part of the “National Project Healthy Communities” funded by the European Social Fund and the European Fund for Regional Development between 2017-2019. The project is implemented by Healthy Regions, a state contributory organisation established by Ministry of Health of the Slovak Republic. An important element of the project is its innovative cross-cutting and integrating character. Through employment of people from a target group and specialized education are all field activities focused on the improving of the health of disadvantaged groups, especially marginalized Roma communities.

Healthy Regions took a participatory approach and work together with partner hospitals to improve their health outcomes by enabling their better access to the healthcare.

“In Healthy Regions we believe, that the Roma health mediators working in hospitals will bring positive results for both, Roma people and our partner hospitals, and that the competent people and society realize the benefits of having such a job position institutionalised. From a long term perspective we hope to see more Roma staff in the healthcare not only as mediators but also as doctors, nurses, pharmacists, or physiotherapists.”

Belak A, Madarasova Geckova A, van Dijk JP, Reijneveld SA (2018) Why don’t segregated Roma do more for their health? An explanatory framework from an ethnographic study in Slovakia. International Journal of Public Health 63(9):1123-1131 doi:10.1007/s00038-018-1134-2
Cook B, Wayne GF, Valentine A, Lessios A, Yeh E (2013) Revisiting the evidence on health and health care disparities among the Roma: a systematic review 2003–2012.International Journal of Public Health:1-27
Diez Roux AV (2012) Conceptual approaches to the study of health disparities. Annual Review of Public Health 33:41-58
Dressler WW, Oths KS, Gravlee CC (2005) Race and Ethnicity in Public Health Research:Models to Explain Health Disparities. Annual Review of Anthropology 34(Oct):231-252
Kolarcik P, Geckova AM, Orosova O, van Dijk JP, Reijneveld SA (2009) To what extent does socioeconomic status explain differences in health between Roma and non-Roma adolescents in Slovakia? Social Science & Medicine 68(7):1279-1284
Janevic T, Jankovic J, Bradley E (2012) Socioeconomic position, gender, and inequalities in self-rated health between Roma and non-Roma in Serbia. International Journal of Public Health 57(1):49-55

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