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.