15/07/200815/07/2008 11

Building Capacity for the Health of Building Capacity for the Health of EuropeEurope’’s Roma Communitiess Roma Communities

Second Conference on Migrant Health in EuropeSecond Conference on Migrant Health in EuropeMalmMalmöö, Sweden , Sweden –– 22 May 200822 May 2008

Jennifer Hollings, Migration Health, IOM BrusselsJennifer Hollings, Migration Health, IOM BrusselsÁÁrprpáád Bard Barááth, University of th, University of PPéécscsIstvIstváán Sziln Sziláárd, University of rd, University of PPéécscs

Roumyana Roumyana PetrovaPetrova--Benedict, Migration Health Department, IOMBenedict, Migration Health Department, IOM

15/07/200815/07/2008 22

The International Organization for The International Organization for Migration (IOM) isMigration (IOM) is……

�� Intergovernmental organizationIntergovernmental organization

�� HQ in Geneva and EU Liaison/Representation in HQ in Geneva and EU Liaison/Representation in BrusselsBrussels

�� 122 Member States 122 Member States

�� >400 field locations globally>400 field locations globally

�� Some 5500 employees working on >1600 projectsSome 5500 employees working on >1600 projects

�� Committed to the principle that humane and orderly Committed to the principle that humane and orderly migration benefits migrants and societiesmigration benefits migrants and societies

�� Migration Health DepartmentMigration Health Department: Promote the : Promote the

health of migrants and mobile populations; advise health of migrants and mobile populations; advise states and partnersstates and partners

15/07/200815/07/2008 33

MIGRATION AND

DEVELOPMENT

FACILITATING

MIGRATION

REGULATING

MIGRATION

FORCED

MIGRATION

IOM

MAIN AREAS

Technical Cooperation & Capacity Building

Migrants’ Rights & International Migration Law

Data & Research

Policy Debate & Guidance

Regional & International Cooperation

Public Information & Education

MIGRATION HEALTH

Gender Dimension

Integration & Reintegration

15/07/200815/07/2008 44

�� Facilitating access to social and health services (Central Facilitating access to social and health services (Central Europe)Europe)

�� Roma business cooperatives (Poland)Roma business cooperatives (Poland)

�� Humanitarian and Social Assistance Programme (worldwide)Humanitarian and Social Assistance Programme (worldwide)

�� Employment assistance, and community stabilization (support Employment assistance, and community stabilization (support to livelihoods, income generation through small and to livelihoods, income generation through small and microenterprises etc.) in disadvantaged Roma communities microenterprises etc.) in disadvantaged Roma communities (Kosovo)(Kosovo)

�� Support services to improve employability of Roma (Greece)Support services to improve employability of Roma (Greece)

�� Labour market training to mitigate emigration pressures Labour market training to mitigate emigration pressures (Slovakia)(Slovakia)

�� Training for engagement of Roma woman in civil society Training for engagement of Roma woman in civil society (South(South--eastern Europe)eastern Europe)

�� CounterCounter--trafficking (e.g. in Macedonia) trafficking (e.g. in Macedonia)

�� Documentary interviews with Roma holocaust survivors (Baltic Documentary interviews with Roma holocaust survivors (Baltic States, Macedonia (FYROM), Moldova)States, Macedonia (FYROM), Moldova)

Examples of IOMExamples of IOM’’s work with Romas work with Roma

15/07/200815/07/2008 55

Challenges in Roma Access to Challenges in Roma Access to HealthcareHealthcare

� Est. 8-10 million Roma in Europe

� Little information on Roma health status, in particular on non-communicable diseases

� Estimated Roma live about 10 years less than majority populations

� Research shows that Roma living conditions and health access have worsened in the last 20 years

� They are like migrants in their home country

15/07/200815/07/2008 66

Key Barriers and Health Key Barriers and Health Inequalities faced by RomaInequalities faced by Roma

�� Persistent poverty and social exclusionPersistent poverty and social exclusion

�� Lack of documentationLack of documentation

�� Discrimination in national health policies Discrimination in national health policies

and healthcare facilitiesand healthcare facilities

�� Lower vaccination rates and higher Lower vaccination rates and higher

prevalence of communicable disease than prevalence of communicable disease than

majority populationsmajority populations

�� Low health awareness and unhealthy Low health awareness and unhealthy

behavioursbehaviours

15/07/200815/07/2008 77

Building Healthy Roma Building Healthy Roma Communities ProjectCommunities Project

Funded by the Government of the Kingdom of BelgiumFunded by the Government of the Kingdom of Belgium

Partners: Resource Centre for Roma Communities (Romania), Partners: Resource Centre for Roma Communities (Romania), ETP Slovakia, and Gandhi Foundation (Hungary)ETP Slovakia, and Gandhi Foundation (Hungary)

©ETP Slovakia

15/07/200815/07/2008 88

� Build human capacity to deal effectively with minority group needs, reduce discrimination and support Roma access to heath social services

� Provide opportunities for exchange and learning

� Pilot a community assistance model

AimsAims: Building Healthy Roma : Building Healthy Roma Communities ProjectCommunities Project

Target Countries: Hungary, Poland, Romania and Slovakia

15/07/200815/07/2008 99

Building Healthy Roma Building Healthy Roma Communities ProjectCommunities Project

Phase I (Dec 2005 Phase I (Dec 2005 –– Nov 2006)Nov 2006)

�� Assembly of international expert team (Hungary, Assembly of international expert team (Hungary, Poland, Romania and Slovakia )Poland, Romania and Slovakia )

�� Development of training curriculum and manualDevelopment of training curriculum and manual

�� International training of trainers course in PolandInternational training of trainers course in Poland

Phase II (Dec 2006 Phase II (Dec 2006 –– Feb 2008):Feb 2008):

�� 4 country4 country--level training courses: Hungary, level training courses: Hungary, Poland, Romania and SlovakiaPoland, Romania and Slovakia

�� Pilot Equality Support Unit to encourage selfPilot Equality Support Unit to encourage self--help help and communityand community--based health promotion based health promotion ((NegrestiNegresti, Romania), Romania)

15/07/200815/07/2008 1010

Training Objectives:Training Objectives:

•• To train practitioners from a variety of To train practitioners from a variety of

professional backgrounds who actively work professional backgrounds who actively work

with Roma communitieswith Roma communities

•• To promote and support (To promote and support (trans)nationaltrans)national

exchange and mutual learning exchange and mutual learning

•• To empower Roma activists with knowledge and To empower Roma activists with knowledge and

skills to act in their communities to ensure skills to act in their communities to ensure

inclusioninclusion

•• To build a core group of local practitioners able To build a core group of local practitioners able

to initiate and support the implementation of to initiate and support the implementation of

communitycommunity--level assistancelevel assistance

15/07/200815/07/2008 1111

Cluj Napoca, Romania

3-8 July 2007

Levoca, Slovakia

14-19 October 2007

Country-LevelTraining2007

15/07/200815/07/2008 1212

Pécs, Hungary4-9 November 2007

Warsaw, Poland10-15 November 2007

Country-LevelTraining2007

15/07/200815/07/2008 1313

Training CurriculumTraining Curriculum

1. Roma in Europe: An Overview

2. Health Promotion and Assistance

3. Social Exclusion

4. Education

5. Participatory Community Development

6. Human Rights Protection

for Minorities

7. Leadership Development

8. Group work to develop a

project proposal

15/07/200815/07/2008 1414

Results of Pilot TrainingResults of Pilot Training

� 15 trainers certified in September 2006

� Training manual translated into 5 languages: Hungarian, Polish, Romani, Romanian and Slovak

� 77 trainees took part in 4 courses in target countries in 2007

� Diverse trainees: Roma/non-Roma, activists, government officials, health mediators, educators, students

� Average course evaluation of 4.6/5

15/07/200815/07/2008 1515

Pilot Equality Support UnitNegresti, Romania

15/07/200815/07/2008 1616

Equality Support Unit (ESU)Equality Support Unit (ESU)NegrestiNegresti, Romania, Romania

The main objective of the ESU is to act The main objective of the ESU is to act

as a mediator between Roma and as a mediator between Roma and

majority populations and local/ majority populations and local/

regional government authorities. The regional government authorities. The

ESU provides information, ESU provides information,

awarenessawareness--raising tools, expert raising tools, expert

advice on health issues, and a forum advice on health issues, and a forum

for discussion. for discussion.

15/07/200815/07/2008 1717

Results of Pilot ESUResults of Pilot ESU

�� Customer satisfaction survey of 200 households Customer satisfaction survey of 200 households (approx. 1000 Roma) rated ESU services well(approx. 1000 Roma) rated ESU services well

�� Cooperation with partner, Resource Centre for Cooperation with partner, Resource Centre for Roma Communities (RCRC), to expand and seek Roma Communities (RCRC), to expand and seek funding for activities beyond sixfunding for activities beyond six--month pilot month pilot phasephase

�� Team visit to ESU in February 2008 showed Team visit to ESU in February 2008 showed success of multisuccess of multi--stakeholder engagementstakeholder engagement

�� Head of Equality Support Unit engaged as health Head of Equality Support Unit engaged as health mediator on the payroll of county authoritiesmediator on the payroll of county authorities

�� ESU office space donated by local authorities to ESU office space donated by local authorities to the Roma association in the Roma association in NegrestiNegresti, Romania, Romania

15/07/200815/07/2008 1818

Project Lessons LearnedProject Lessons Learned

�� Training in Poland was the final and most successful in Training in Poland was the final and most successful in terms of both trainer and trainee feedback. Lessons on terms of both trainer and trainee feedback. Lessons on recruitment and trainer preparation can be drawn:recruitment and trainer preparation can be drawn:

•• Application process for training requires careful planning, Application process for training requires careful planning, personal commitment and enthusiasm of the coordinatorspersonal commitment and enthusiasm of the coordinators

•• Trainer skills and confidence need to be developed, also for Trainer skills and confidence need to be developed, also for those active in Roma issuesthose active in Roma issues

�� Though trainers adapted materials for the country, more Though trainers adapted materials for the country, more time and resources should be allocated for such needstime and resources should be allocated for such needs--based adaptationbased adaptation

�� Where possible, training courses should include not only a Where possible, training courses should include not only a wide variety of materials and media, but also site visits to wide variety of materials and media, but also site visits to Roma settlements and discussions with local social Roma settlements and discussions with local social assistantsassistants

�� ESU surveys indicate that priorities in ESU surveys indicate that priorities in NegrestiNegresti are are increasing health knowledge among Roma, increasing increasing health knowledge among Roma, increasing access to medical services and building trust with family access to medical services and building trust with family doctorsdoctors

15/07/200815/07/2008 1919

Challenges and Next StepsChallenges and Next Steps

�� Funding for European initiatives targeting the Funding for European initiatives targeting the improvement of Roma health as well as funding improvement of Roma health as well as funding for communityfor community--level health projectslevel health projects

�� Revise and better adapt curriculum to suit needs Revise and better adapt curriculum to suit needs in individual countriesin individual countries

�� Expand training outreach within and beyond Expand training outreach within and beyond countries targeted by the Projectcountries targeted by the Project

�� Foster deeper cooperation between governmental Foster deeper cooperation between governmental and nonand non--governmental actors engaged in Roma governmental actors engaged in Roma healthhealth

�� Develop support structure for international and Develop support structure for international and nationalnational--level sharing of information and good level sharing of information and good practices on Roma health issuespractices on Roma health issues

15/07/200815/07/2008 2020

Thank you!Thank you!