Romanian Family Health Initiative: Roma Component

This component of RFHI focused on the participation of Roma health mediators (RHMs): women selected from Roma communities who serve as a "bridge" between the local community where they work and health and social services. JSI Research & Training Institute provided face-to-face training sessions that focused on building the RHMs' capacity to provide FP/RH information and to refer the Roma population to health services. In addition, the project extended its postabortion/postpartum care component to Roma communities in three districts, focusing on the following activities: RHMs' training in birth spacing, postpartum and postabortion education, development of informational and educational material promoting breastfeeding, and the organisation of workshops on Roma cultural diversity for nurses from several maternities. To facilitate this process, organisers developed simple, interactive communication materials adapted to Roma cultural characteristics. Throughout the training, emphasis was placed on how the RHMs could cultivate reciprocal trust between community members and medical and social service providers. One strategy for empowering the RHMs to play this role involved designing materials (such as badges, rain coats, umbrellas, and bags) aimed to strengthen RHM professional identity. Organisers also conducted supportive monitoring visits to strengthen RHMs' activities, and evaluated the RHM programme in order to shape nationwide extension of the programme.

Partnership between governmental and non-governmental organisations (NGOs) also shaped this effort. For example, working within Cluj and Salaj districts - where there had initially been no RHMs - the Association of Roma Women's Emancipation (AFER) joined with local authorities and family doctors to select 26 Roma communities from these districts. They then trained 29 Roma women to become health mediators, and organised informational sessions about RH/FP issues in the selected communities. By the end of this one year-project, the two District Public Health Authorities hired seven RHMs each. To cite another example, RFHI organised technical meetings between governmental organisations and NGOs involved with Roma health programmes to support medical and social interventions in Roma communities, and established a joint working group for Roma health.

Based on the belief that family doctors play a pivotal role in sustaining a medical system that contributes to the health of a community irrespective of religion, ethnic group, or other criteria, RFHI placed heavy emphasis on supporting family doctors in improving their relationship and communication with Roma patients. JSI conducted workshops in six counties that focused on topics including barriers to access to health care services for disadvantaged populations, discrimination and social labeling, elements of Roma culture and customs, and the need for increasing social capital within Roma communities. To complement this interpersonal component, RFHI commissioned academics, practitioners, and journalists to collaborate on a written guide [PDF] that is designed to help family doctors understand, appreciate, and communicate openly with the Roma community.

Family Health, Reproductive Health, Women.

The Roma constitute an estimated 1.5 million people in Romania. This ethnic minority faces numerous complex health problems due to barriers such as low access to information, lack of identity papers, lack of health insurance, discrimination, marginalisation, and self-isolation. The 2004 Reproductive Health Survey [PDF] revealed that Roma women access prenatal care services later in pregnancy than women in the general population. Few Roma women were found to be using modern contraceptives; most chose abortion as a primary birth control method.