1. WHO Country Office in Serbia INCLUSION OF ROMA- HEALTH EU SOCIAL INCLUSION SEMINAR ON ROMA WHO Country Office in Serbia Dr. Dorit Nitzan

2. WHO Country Office in Serbia HEALTH SYSTEMS APPROACH TO MEETING THE NEEDS OF ROMA EXPERIENCING SOCIAL EXCLUSION Analysis based on the four functions of health systems: –Stewardship –Service delivery –Resource generation –Financing

3. WHO Country Office in Serbia Important Health Indicators WHO SWIFT Roma Health & Nutrition Survey 2009 –All surveyed reported that their children were immunized - 88% had a Card Full DPT – 16.7% Full OPV – 16.0% MMR – 14.3% The strongest determinant for being immunized: Health Card

4. WHO Country Office in Serbia % Receiving Social Welfare SurveyPopulation Receiving Social Benefits LSMS 2007General Population 14.7% SWIFT Survey 2009 Roma Waste collectors 16% SWIFT Survey 2009 Roma Non Waste collectors 23%

5. WHO Country Office in Serbia TIMES OF CHANGES

6. WHO Country Office in Serbia STEWARDSHIP Strengthening the universality of health systems MoH & the Republic Institute for Health Insurance

7. WHO Country Office in Serbia

8. “Roma people who have no permanent residence…are entitled to full healthcare services coverage and without copayment. The Republic Institute for Health Insurance simplified procedures… –an applicant should submit a personal statement…of being a Roma, a proof or registered residence, and/or personal statement on a temporary domicile… Their cards are valid for one year”

9. WHO Country Office in Serbia Stewardship - continued Evaluate interventions and disseminate promising practices on Roma health, including through inter-country exchange in the context of the Decade Roma Health Forum: 1 st meeting of MoH with neighboring MoHs - December 2009 Cross European – November 17, 2011 MoH with WHO, UNICEF, OSCE and more

10. WHO Country Office in Serbia Stewardship – cont.  Health information systems that allow for health equity surveillance Planned- MOH-EC funded HIS Project: to be implemented by WHO logistic support by UNOPS

11. WHO Country Office in Serbia Stewardship – cont. Cross-government underlying determinants of health DPM, PRSP, Government, municipalities Support of EC, UNCT (e.g. SWIFT), NGOs

12. WHO Country Office in Serbia Stewardship- cont. Equity-oriented health impact assessment of other sector policies, to ensure the needs of the Roma and other communities are met MoH and WHO - 2011

13. WHO Country Office in Serbia Service Delivery Cultural competence & non-discrimination in services Services that account for adverse living and working conditions Outreach to increase health system literacy among Roma populations, also for promotion and prevention services Strengthened PHC that interfaces between health services and the Roma community MOH Health Mediators support of OSCE, UNICEF, WHO SWIFT Initiative (funded by Norway) Support of WHO, IOM, UNOPS

14. WHO Country Office in Serbia Service Delivery – Cont. Formalize the role of mediators and outreach workers from the Roma community Health Mediators

15. WHO Country Office in Serbia RESOURCE GENERATION Increase health professionals’ know- how Offer continuing education programmes for health professionals on Roma health MOH Health Mediators SWIFT (funded by Norway) World bank  Integration in medical, nursing school  Use CME platform

16. WHO Country Office in Serbia Financing Mitigating the burden of out-of-pocket health spending MoH, Republic Institute for Health Insurance Support of WB and WHO

17. WHO Country Office in Serbia Financing – cont. Raise awareness about Roma entitlements and obligations with regards to health system financing Health Mediators Municipalities Republic Institute of Health Insurance Support of WHO, SWIFT

18. WHO Country Office in Serbia Financing – cont. Ensure sustainable allocation of monies for activities servicing the Roma (eg., for funding mediators, for action plan implementation) MoH  Requested support - OSCE, UNICEF, WHO, EC

19. WHO Country Office in Serbia Challenges Health– emphasis on tackling SDH Health – beyond medical care -> public health, health literacy, NCDs Sustainable allocation of funds Roma specific health data Roma sensitive and if needed Roma specific health services: –Further training of Health Mediators –Further training of health workers –Reproductive health –Domestic violence –Vaccination

20. WHO Country Office in Serbia Comprehensive, multifaceted, holistic approach through the local and national authorities and communities: Bottom up top down Horizontal Partnership mechanisms Local ownership

21. WHO Country Office in Serbia Working Together SWIFTly SWIFT I - Responsible implementers/ Overall management-WHO SOCIAL MOBILIZATION WHO INCOME GENERATION Belgrade Municipality Ministry of Health Institute of Public Health UNOPS IOM HEALTH COMPONENT Belgrade Municipality UNOPS – Administrative Agent – admin and finance Communities & Civil Society Ministry of Labor & Social Affairs Ministry of Education Ministry of Environment DPM, PRSP Ministries of Health and Environment Ministry of Minorities Institute of Health Insurance Chamber of Commerce Ministry of Economy & Region Develop Ministry of Labor & Social Affairs Ministry of Internal Affairs Institute of Occupational Health Communities & Civil Society Communities & Civil Society

22. WHO Country Office in Serbia It takes a village to raise a child Thanks!