Community monitoring in order to ensure the provision of preventive health services and vaccination for Roma children in RM.
In accordance with the Constitution and laws, preventive health care for children and vaccination are guaranteed for all citizens of Republic of Macedonia. Preventive programs under the competence of the Ministry of health further regulate the measures and activities for preventive health care and vaccination for children, thus guaranteeing a range of free services in this area. The 2011 Program for active health care of mothers and children included specific measures and activities aimed for preventive health care of Roma women and children. The Program included specific measures and activities for improvement of the health of mothers and children in the Roma ethnic community: additional patronage visits to Roma families, educational workshops for child’s health and vaccination in the Roma communities and distribution of educational materials in the Roma communities.
However, despite the legal provisions and specific measures foreseen for the promotion of health of Roma children, data from the field and conducted surveys show that Roma are not included sufficiently in these preventive activities and that Roma children are covered by vaccination to a lower percentage.
In order to ensure adequate implementation of the foreseen measures and activities for preventive health care of mothers and children, it is necessary to provide continuous monitoring on the implementation of preventive measures, as well as taking activities for increased transparency and accountability of the state institutions regarding the implementation. Therefore, we use the concept of monitoring in the community, whereby the Roma community oversees the implementation of measures and activities for preventive health care of mothers and children by the state.
Given the importance and possibilities offered by this concept – monitoring in the community, ESE in partnership with four Roma civic organizations, conducts the monitoring of the preventive measures for health care of mothers and children in eight municipalities, i.e.: Suto Orizari, Delcevo, Pehcevo, Vinica, Gorce Petrov, Karpos, Saraj and Prilep. In the implementation of the monitoring, we cooperate with the NGO “KHAM“ from Delcevo, Centre for democratic development and initiatives – CDRIM from Suto Orizari, Association of educational workers and protection of the rights of women and children – LIL from Skopje and the Roma organization for multicultural affirmation S.O.S. – ROMA from Prilep.
We strengthened the capacities of the four partner organizations for work in the field of monitoring, transparency and accountability, through trainings and provision of continuous technical assistance and support.
In cooperation with partner organizations, we strengthened the capacities of the Roma population in the eight municipalities with regard to their rights to preventive health care. In addition, we mobilized the community so that it can get involved in the advocacy process and request for realization of their rights to preventive health care.
We prepared tools (questionnaires) and methodology for conducting a survey in the community so as to establish the extent of implementation and quality of preventive health care services in the Roma communities in the eight municipalities. Along with the Roma organizations, we conducted a survey to assess the situation with regard to the following: scope of provision of health services for vaccination, implementation of activities in the communities (educational workshops and educational materials), knowledge of Roma parents about vaccination, access to health services for vaccination, submission of invitations for vaccination in the Roma communities, quality of services for vaccination, communication of the medical staff with the population, identification of unvaccinated children, payments related to the preventive services, patronage services, coordination between different vaccination services, as well as coverage of Roma children with vaccination.
We prepared the methodology for representation of data in the form of Community score card so that it can be understandable also for the Roma community. According to this methodology, each municipality is divided in different Roma settlements. Therefore, we prepared Community score cards for 15 Roma settlements in the eight municipalities. In order to ensure the understanding of the card’s content, the findings about the situation which were subject of survey, were presented in the following categories: unsatisfactory, partially satisfactory and satisfactory.
Through monitoring in the community in the eight municipalities, we established the following situation:
- The coverage of Roma children with vaccines is still lower than the national average, and accounts for 92%–95% on national level, whereas wih regard to the coverage of Roma children aged 0–6 for different vaccines in the municipalities, the data have shown the following: in the municipality of Suto Orizari, the coverage of Roma children accounts for 50% - 94%; in the municipality of Gorce Petrov it accounts for 30% - 89%; in the settlement of Zlokukani – municipality of Karposh, it accounts for 20%- 50% and in the municipality of Prilep it accounts for 54% - 93%.
- The implementation of the activities in the community foreseen in the 2011 Program for active health care for mothers and children (educational workshops for children’s health and vaccination, as well as distribution of educational material in the Roma communities) was assessed as unsatisfactory in 13 Roma settlements, i.e. Roma did not attend such educational workshops, nor were given educational materials in the community. The situation is assessed as partially satisfactory only in one Roma settlement in the municipality of Prilep.
- With regard to the knowledge of Roma parents about vaccination, the situation is assessed as unsatisfactory in three municipalities, i.e. – Delcevo, Crnik (Pehcevo) and Vinica. The situation is assessed as partially satisfactory in 10 Roma settlements, i.e. in the settlement Dame Gruev (Gorce Petrov), Saraj, Zlokukani (Karpos), in four settlements in Suto Orizari and in all four settlements in Prilep. The situation was assessed as satisfactory only in 1 (one) settlement, i.e. in Suto Orizari.
- The situation with regard to the submission of invitations was assessed as unsatisfactory in four Roma settlements, i.e.: Dame Gruev, Saraj, Zlokukani and one settlement in Suto Orizari. In 10 settlements, the situation was assessed as partially satisfactory, i.e. in Delcevo, Vinica, in all settlements in Prilep and in 4 settlements in Suto Orizari. Only in the village Crnik (Pehcevo), the submission of invitations for vaccination was assessed as satisfactory.
- The patronage nursing services were assessed as unsatisfactory in 4 (four) settlements, i.e. in Delcevo and in 3 (three) settlements in Suto Orizari. Partially satisfactory were the services in 9 (nine) settlements, i.e. in Saraj, Zlokukani, village Crnik, in 2 (two) settlements in Suto Orizari and in all settlements in Prilep. Complete satisfaction was assessed about the services in the 2 (two) settlements, i.e. in Dame Gruev and Vinica. Dissatisfaction from patronage services is due to the fact that Roma women are not sufficiently visited by patronage nurses, whereas certain part of the population expressed dissatisfaction due to very short visits by patronage nurses.
Along with partner organizations, we prepared and implemented a strategy for advocacy in the course of 2012, which was directed towards the Ministry of health and other competent health institutions for adoption and implementation of preventive measures and activities for improvement of health and increased scope of vaccination of Roma children. The strategy for advocacy on national level requested that the Ministry of health adopts and implements the following measures for increase in the scope of coverage of Roma children with vaccination and preventive health services: additional 2 500 patronage visits to the Roma families in order to identify and register the unvaccinated Roma children and their referral to the health homes for vaccination; implementation of 60 educational workshops in the Roma communities on the topic Child’s health and vaccination; preparation of educational materials (brochures) for child’s health and vaccination, translation in Romani language and distribution in the Roma communities; implementation of 3 (three) field actions for identification of unvaccinated and irregularly vaccinated Roma children in the Roma communities (identical to the activities being realized as part of the campaign Week of immunization); employment of Roma messengers in the health homes in the 10 municipalities where majority of Roma live.