The Roma Community in Bulgaria faces one of the most severe exclusions in access to health. The health status of Roma is significantly lower than that of the majority of the population of Bulgaria. Bridging the health gap requires intervention from both the Roma community and health system institutions. Since 2011, the CenterAmalipe, a national Roma organization in Bulgaria has been introducing Community monitoring for Roma women and children on healthcare services. This initiative is supported by Accountability and Monitoring in Health Initiative Program of Open Society Foundation. It is used as an approach for strengthening community-informed and community driven advocacy to improve health service delivery and health outcomes.
The two rounds of monitoring are conducted every year, to examine women and children’s health indicators and the emergency medical services. The monitoring uses standardized tools, to follow-through the changes that are observed in the health system with respect to the quality of services provided. It is due to the monitoring, community involvement and advocacy activities that there has been much progress made. The result of the monitoring is shared with the community and health institution staff to take further actions to better improve the different aspects of health care services provided to women and children. . Based on the results from each survey, an action plan is designed to address the harshest problem where the action items of recommendations made are implemented the next half year.
The approach of community development and involvement in monitoring health care services and follow-up advocacy actions have led to significant changes in the health status of the Roma community. Besides, it has proved helpful in raising awareness among the Roma community about healthcare rights and health services. For instance between the first two rounds of community interventions, Roma women who could identify their local primary care physician increased from 83% to 94%. However, all the rounds of community survey reflected significant concerns that communities encounter in their access to healthcare. For example, over 50% of women over 18 years did not have health insurance and so on.
The actual monitoring is preceded by various community mobilization activities in the field of healthcare. Following this approach a campaign was organized by Center Amalipe and the Community Development Center in Pavlikeni to raise awareness and encourage people to restore their health insurance status. This was further necessitated by a change in the Bulgarian health insurance law that introduced a change in the period of insurance for a person, after which insurance status would have to be restored. The order came into force on December 28, 2015, where the period of insurance was increased from three to five years. If this change was not implemented, then it would be practically impossible to secure the health needs of the socially disadvantaged people of Roma to get back again into the health system.
Preparing for Community Monitoring Exercise
The campaign was based on the approach of shared responsibility. Center Amalipe with the support of the Fundamental rights agency (as part of the project LERI, implemented by the European Union Fundamental Rights Agency (FRA)) has offered ten of its most active community volunteers to cover half of their health insurance tax. In turn, they need to cover the other half and start paying their monthly health taxes regularly in oder to continue to be active, and to further engage intensively with community health issues. On December 21, Center Amalipe supported 10 active volunteers at the Community Development Center of Pavlikeni to restore their health rights. The approach for supporting persons without health insurance ensures their participation and engagement: they have to pay half of the amounts for the previous 3 years as well as the entire amount since January 2016. It also stresses the community engagement: every grantee is a volunteer of the Community Development Center – Pavlikeni or the local clubs in Byala cherkva, Batak and Stambolovo. They will continue their community volunteer work.
Conclusion
Changes in policies often reflect on the most vulnerable groups and sometimes this impact does not bring a positive development. In this sense, the increase of the years to be covered in order to get back into the health care system would result in a harsher exclusion of the most vulnerable groups such as Roma. At the same time a strong community development and monitoring approach towards the healthcare services and the changes in health policies might help these groups react timely and decrease the gap through improving the access and quality of healthcare services.
About the Author: Teodora Krumova is a Roma activist from Bulgaria. She holds Masters in History and Archaeology from Veliko Turnovo University, Bulgaria, and in medieval studies from Central European University, Budapest, Hungary. She is the Program Director of Center Amalipe in Bulgaria and one of the co-authors of the Roma Culture Classes Program, which is being implemented in more than 250 Bulgarian schools. She has also written a number of publications on Roma history and culture, textbooks on Roma culture, monitoring and evaluation reports on Roma-oriented policies and impact of national and European policies on the Roma community, and other scholarly publications. She is an evaluation expert for applying the model of community monitoring of healthcare services in the Roma community implemented by Center Amalipe in Bulgaria since 2011. To know more about Amalipe visit http://amalipe.com/index.php?nav=home&lang=2