1. Association- National Network of Health Mediators Outreach work. Challenges and Opportunities

2. About The Network The National Network of Health Mediators is the biggest Non-Governmental Organization in Bulgaria with more than 150 members, 130 of whom of Roma background who daily facilitate the integration of their communities through healthcare. We have received long-term support to launch and realize a number of collaborative programs: “Roma Matrix”- a European project that aims to combat racism, intolerance and xenophobia towards Roma in a partnership with 19 other organizations in 10 EU member states, financed by DG Justice; Strong support from a large organization like (ECDC) European Centre for Disease Prevention and Control– project “Let’s talk about protection” for introduction of materials for increasing the immunization coverage of vulnerable groups ; Opportunities, provided by “Glaxo” to share our experiences and improve our practices.- project “Together for health” in partnership with Slovakia, Romania and Hungary.

3. Aims and Objectives The Network has it aims and they go far beyond the frame of the health mediator’s job description: To assist and facilitate the access to health and social services for everybody in disadvantaged position; To improve the quality of health and social services in Bulgaria; To raise the health culture of disadvantaged ethnic minorities; To raise public awareness and information to citizens on health related issues; To develop and strengthen European practices and approaches for facilitation of the disadvantaged groups access to health services; To create and develop higher quality services in the field of mediation and provision of health services; To exchange experience between health mediators throughout the country; To raise the health mediators’ capacity and skills; To participate in civil society development, democratization and transparency in the actions of the central and local governments by implementing civil initiatives and cooperation with government institutions, local and regional authorities.

4. Resources Our biggest resource is people: health mediators, colleagues, friends, partners and supporters.

5. Challenges faced by the Health Mediator OUTREACH Developed by Krasimir Kirilov – National Network Of Health Mediators

6. Challenges with the Institutional Frames and Positioning Challenges with Traditions and Prejudices Challenges with Infrastructure and Living Conditions Challenges with Stigmatization, Xenophobia, Discrimination and Rejection. Challenges with Low Education and Unemployment

7. The Health Mediator - The One to Face Them All

8. Medical professionals complain that the majority of Roma are not health insured and therefore doctors are forced to deny provision of health care to them. GPs face difficulties to find their patients for vaccination, prophylactics or follow-up examinations. People from the community complain that institutions are not understanding and responding to their health needs. Main Challenges with the Institutional Frames 1

9. The health mediator is working in close collaboration with GPs, Regional Health Inspectorate, Local Hospitals, Social care institutions and Municipality to help both: The Roma community - to access adequate health care and Health and Social Care professionals - to get their job done. “We offer our help for free - to reach and vaccinate your patients”… “ Roma do not comply the laws and regulations…” Institutions Health Mediator

10. There is a long list of unhealthy prejudices and traditions that the community continue to practice like: Early marriages and early pregnancies, prejudices concerning abortions and vaccinations, non-healthy domestic practices during pre and post natal period, mistrust to the official medical care providers, mysticism concerning general health condition and pregnancy. Challenges with Traditions and Prejudices 2

11. The health mediator searches and develops educational tools and activities in understandable for the community language and in accepted by the community form to provoke the establishment and sustainability of healthy behavior at individual and community level.

12. Most of the Roma live in segregated communities, in illegal houses, built by themselves that do not meet the healthy standards for living, with limited access to clean water and electricity, lack or bad functioning canalization, on streets full of garbage with no green areas and with polluted air from the chimneys during the winter. Challenges with Infrastructure and Living Conditions 3

13. The health mediators is working with the community - to build awareness about the common healthy standards of living conditions and with the concerned institutions to bring their attention to the problem and provoke decisions of policy makers to help improving the living conditions of Roma

14. Both Gadjo and Roma bare a heavy burden of centuries-long prejudices against each other. Unawareness, broken Communication, Fear from the un-known have built heavy layers of Stigmatization, and Hostility that result in Discrimination and Rejection in all aspects of live including access to health care. Challenges with Stigmatization, Xenophobia, Discrimination and Rejection. 4

15. The health mediator constantly tries to find ways to improve communication between both: social and health professionals- from one side and the Roma community- from the other side, in order to help them understand each other better and find their common healthy future together.

16. Many Roma have limited access to health care because of Unemployment. Many Roma are illiterate or with very low education that limits their communication with social and health care professionals. Many Roma children study in segregated schools and drop out at the age of 11-12 because of marriage arranged by their parents. Challenges with Low Education and Unemployment 5

17. The Health mediator motivates parents and children to invest in education and assist teachers in their endeavors to reflect adequately to the individual needs of the children and their families. The health mediator is fully aware of the fact that his personal live and his educational and professional achievements serve as a model for the community. His daily life is more than just a job but rather- a mission

18. To serve as a bridge between the Roma community and the social and health care institutions in order to facilitate the improvement of the health status of the Roma population. To support the integration of the Roma community trough healthcare. To advocate with his life and work for general attitude and behavior change towards mutual respect and equal rights for Roma and Non-Roma..

19. Training

20. Support

21. Togetherness

22. Partnership

23. OUTREACH Developed by Krasimir Kirilov – National Network Of Health Mediators Association- National Network of Health Mediators Bulgaria 1303 Sofia 81 V, “Alexander Stamboliiski” Blvd., floor 2, app. 4 Tel./fax: +359 2 986 71 13 e mail: info@zdravenmediator.net www.zdravenmediator.net