Social Accountability for Improved Access to Health Services for Roma Community
Borjan Pavlovski ESE, Macedonia
Association for Emancipation, Solidarity and Equality of Women (ESE), in partnership with local Roma Civil Society Organisations (CSOs) is engaged in social accountability work since 2011. It works towards improving health and access to health care for mothers and children among Roma communities in seven municipalities in Macedonia. In 2014, ESE also included Roma women’s access to preventive gynaecological services. ESE’s work engages Roma communities across four municipalities in Macedonia.
The work initially focused on the preventive programs implemented by the Ministry of Health. These programs were funded from the state budget and aimed at vulnerable groups of the population.
ESE’s programmes and services under each program include:
Programme for active health care of mothers and children focuses on the services of immunization, visits from the patronage (outreach) nurses during pregnancy and after delivery and activities aiming for health promotion and health education;
Programme for medical check-ups of pupils with emphasis on activities for children out of education system;
Programme for cervical cancer screening
Strategies and Processes: The key strategies of the work of ESE include
Community Monitoring: Involved entitlement awareness about rights and obligations related to immunization, preventive health services for mothers and children, and cervical cancer screening. As a key strategy of community monitoring mapping communities process helped in identifying Roma children of immunization age (0-15 years) and covered 900 households, as well as identifying women for cervical cancer screening (age group 24–60 years) covering 1500 women in four municipalities. Information was disseminated and rights awareness programmes held. Community- based inquiry on utilisation of health services was done and quality of service delivery report cards were prepared by using score cards. Consequently public debates and discussions involving the community aimed finding local solutions to issues were held.
Social Audit: The objective of social audit was to inquire about the delivery of health services by outreach nurses and gynaecologists. Findings were shared with managerial staff at the municipal Health Centre in order to indicate to inconsistencies in delivery of services. Significance: There are no mechanisms for supervision of performance at public health facilities, hence this fills the gap.
Budget monitoring and analysis: To examine planning and implementation of funds allocated under preventive health programs. This approach allowed ESE to establish trends in terms of allocation and spending of funds and to identify all anomalies and changes within the budgeting process, which have an impact on funds allocated and spent. Inadequate planning, inconsistency of anticipated measures, lack of public data, continuous increase of the health budget compared to decrease of budgets under preventive health programms, etc., are just few of identified gaps.
Advocacy: Findings from different levels are cross-checked and used as measures aimed to improve health services at local level (specific issues) and at national level (issues that are common). Every year results of the processes are used to develop local advocacy strategies and one joint national advocacy strategy. Local strategies aim towards adoption of changes at local and municipal level, while the national strategy aims to promote state-of-affairs at national level. The advocacy process is conducted with active participation and support of Roma communities.
Outcomes, Results and Learnings The work pursued by the ESE has led to some significant outcomes and several learnings have been made through the process which can be discerned as:
Empowerment of Roma community, especially Roma women
Identification of accountability gaps, health care issues and problems, and articulation to the authorities
Demanding accountability of decision makers and pressing for action for improving access to health care services
Continued advocacy before competent state institutions for systemic changes to complement the local efforts at resolving obstacles to access
Roma organisations, through this approach, have started actively involving communities in promotion of their health rights.
Results of continued advocacy: A Municipal Health Centre obtained vehicle for the patronage nurses, which was identified as one of the major obstacle in their work. However, lack of nurses still remains a problem, since national authorities are not approving employment of nurses.
At national level, action was taken towards benefitting Roma women under the Program for Active Health Protection of Mothers and Children for 2018. Based on the demands of ESE in the last years, the programme’s budget has increased to 17 million MKD in 2018 as compare to 10.5 million MKD in 2017.
Due to advocacy efforts of ESE since 2016, the Ministry of Health in 2018 introduced a series of measures in the Programme for Cervical Cancer Screening, to improve quality in screening performance and monitoring.
Learning and adapting newer strategic approaches: After having perceived the need for integrated work, in 2015 ESE has started integrating the approaches of social accountability and legal empowerment strategy in order to maximize impact on the rights of Roma communities.
About the author: Dr. Borjan Pavlovski , Association for Emancipation, Solidarity and Equality of Women – ESE, Macedonia. He coordinates Public health and women’s health related activities at ESE. He graduated from the Medical Faculty in Skopje, department for general medicine. He has previous work experience as assistant and coordinator of health programmes. As part of the team of ESE he works on the promotion and advocacy for-promotion of women’s health and health of marginalised communities with focus on Roma people; promotion of the access to health services for women and marginalised groups with focus on Roma people; realization of rights in the sphere of health and human rights, in general, for women and marginalised groups; improvement of budget transparency of health institutions and increasing their efficiency in the implementation of measures for preventive health care and use of funds from the budgets on national and local level. For more information on ESE, please visit: www.esem.org.mk