1. ROMA MATRIX Bulgaria: National Network of Health Mediators Tackling health inequalities through health mediators and champions and understanding models from across Europe Dr. Radosveta Stamenkova www.zdravenmediator.net

2. What are the deficits - data Demographic and health issues concerning Roma: Lower life expectancy Higher maternal and child mortality Lack of basic living conditions – running, water, sanitation, electricity Lower level of education Lower compatibility at the labor market – vicious circle of poverty Higher percentage of chronic diseases Abandonments of children in institutions And we can extend the list to more problems and deficits not only in Bulgaria, but in all neoghbouring countries www.zdravenmediator.net Тази публикация е издадена с финансовата подкрепа на програма „Основни права и гражданство“ на ЕС. Съдържанието на публикацията е отговорност единствено на Сдружение НМЗМ и по никакъв начин не трябва да се възприема като израз на становището на Европейската комисия.

3. Living conditions in some neighborhoods are really difficult

4. Types of health inequalities Excluded from the health insurance system Difficult or no access to family planning methods and reproductive health services Communicative problems with service providers – language barrier, stigma, traditions of community Difficult access – territorial, institutional, transport, financial Judgmental and underestimating attitude of medical specialists Dental medicine and some other “non basic” – impossible luxury Lack of national screening programs that could include the most vulnerable and provide a minimum package The challenges in health provision for women and children… Men are not well served too… The ghetto in the ghetto – where ambulances do not enter www.zdravenmediator.net Тази публикация е издадена с финансовата подкрепа на програма „Основни права и гражданство“ на ЕС. Съдържанието на публикацията е отговорност единствено на Сдружение НМЗМ и по никакъв начин не трябва да се възприема като израз на становището на Европейската комисия.

5. Immunizations are very important for child health

6. What can be done – the health mediators and other community champions The bridge between underserved communities and health providers From the community, with minimum high school education, knows the community language, accepted by both sides Delivers understandable messages; health campaigns Is “legitimate” for institutions – civil servant, clear mandate Appropriately trained, including with lifelong learning concept Info and education sessions – young people, women, families Volunteers mobilization Prevention of school dropouts Immunizations and maternal and child health Easier access to contraception and to social services Good for the community practice example Inter-institutional partnerships www.zdravenmediator.net Тази публикация е издадена с финансовата подкрепа на програма „Основни права и гражданство“ на ЕС. Съдържанието на публикацията е отговорност единствено на Сдружение НМЗМ и по никакъв начин не трябва да се възприема като израз на становището на Европейската комисия.

8. The concept of lifelong learning – health mediators receive additional training on hepatitis B and C

9. What can be done - national strategies and legislation Provision in national health strategies for special attention and specific approach towards vulnerable groups Health insurance system – main issue – to include everyone in services provision The GP – converted into distributor and local administrator Lack of specialists in key spheres of medicine Lack of enough GPs especially in rural and poor areas Lack of nurses, midwives and other health specialists – trials to install the position of the visiting nurse is doubtful to happen Chaos in the health system, lack of strategic thinking – the most vulnerable groups suffer the most Attitude towards minorities used in many political parties strategies – the demographic card is played with special focus on Roma issues Inter-institutional p[latforms and strategies, with NGO participation www.zdravenmediator.net Тази публикация е издадена с финансовата подкрепа на програма „Основни права и гражданство“ на ЕС. Съдържанието на публикацията е отговорност единствено на Сдружение НМЗМ и по никакъв начин не трябва да се възприема като израз на становището на Европейската комисия.

10. Mobile reproductive health and family planning program

11. What can be done – the change in formation of health specialists Include in the students curriculum sessions on different vulnerable and underserved groups, how to work in multiethnic environment, communicative skills and counselling Conduct a sound strategy to retain young medical specialists in country - good conditions for specialization, motivation to work in distant areas etc International networks mobilized in order the work to be attractive for young national health specialists and to provide quality of care to Roma and other vulnerable groups (similarly to some educational programs and to the Piece Corp volunteers) – Medecins du Monde and others Field visits to Roma neighborhoods with health mediators Strengthen the programs for Roma medical students with programs to motivate young Roma medics to work for the community www.zdravenmediator.net Тази публикация е издадена с финансовата подкрепа на програма „Основни права и гражданство“ на ЕС. Съдържанието на публикацията е отговорност единствено на Сдружение НМЗМ и по никакъв начин не трябва да се възприема като израз на становището на Европейската комисия.

12. Health specialists must understand the needs and values of the target group

13. What can be done – the change in media and mainstream population Media to be influenced to promote not only the sad and frightening image of Roma with focus on criminal events Good practice examples to be present – mediators, students, intellectuals, self-made successful people Delivering simple, but effective messages to mainstream population in order to understand that supporting the vulnerable does not mean neglecting the majority Promoting the idea that health needs of all, including vulnerable groups have to be respected Promote messages as “If we want to have a really health environment for ourselves, we have to make sure everyone is included in the health system and diseases are controlled” Create opportunities different groups to interact and know more about each other www.zdravenmediator.net Тази публикация е издадена с финансовата подкрепа на програма „Основни права и гражданство“ на ЕС. Съдържанието на публикацията е отговорност единствено на Сдружение НМЗМ и по никакъв начин не трябва да се възприема като израз на становището на Европейската комисия.

14. Roma young people are happy to get health information if delivered in a youth friendly way