Recommendations for Action

only use health services in the presence of very dramatic symptoms and incapacitating consequenc- es thus making it diffi cult to approach the concept of prevention;

Lack of health education to modify behaviours and attitudes. Predetermined ideas prevail as regards

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one’s body, illness, health and sexuality. This situation could be rooted in cultural customs and tradi- tional habits which hinder behavioural change;

Absence of healthy lifestyles, as for example, in the fi eld of nutrition (inadequate food consumption,

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unbalanced nutrition) and a lack of regular physical activity which is refl ected in the high percentage of individuals who are overweight and/or at risk of obesity. Thus, it is important to carry out train- ing sessions on health education. These must be part of a process of information dissemination and people must be held accountable for acquiring the knowledge, habits and attitudes which contrib- ute to health promotion and prevention.

Finally, we would point out that there is a clear situation of inequality between the Roma population

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and the majority population. In addtion to what has already been said, attitudes and health habits must change and this will only be possible with the contribution, involvement and joint work of Roma Community members and health care providers.

A Mainstreaming Strategy for the Roma Community

• – It is important to defi ne policies and more

active social inclusion measures that are not confi ned to single and fractional policies and projects lacking continuity or that are unsustainable. Therefore, integrated and overarching policies addressing diff erent areas are called for (education, health, housing, justice, employment and professional train- ing, etc.) as part of a strategy targeting the Roma community. We are talking about the need for an integrated national plan for Roma communities that eff ectively facilitates access to basic goods and services and to the exercise of full citizenship. To this end the following measures can be defi ned:

Measures to promote access to education especially aimed at eliminating direct and indirect –

segregation or assimilation practices in schools;

Measures to promote better housing conditions and to end segregated and disadvantaged –

neighbourhoods with a high concentration of Roma population;

Measures to promote access to basic goods and services, specifi cally health care services;

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Development of strategies to integrate the Roma community into the labour market through –

vocational training and follow up to monitor integration;

Awareness raising actions to “encourage” employers to hire members of the Roma community. The –

success of labour market integration must be “publicised” in order to end prejudice and raise the self-confi dence of Roma community members and to show that labour integration is possible.

Fostering the Participation of the Roma Community

• – It is important to support the participation

of Roma community members in the design, development, implementation and evaluation of policy measures. We have to work with and not for the Roma community. Cooperation is essential for more eff ective action tailored to the needs and experiences of the target group. The Roma community must be active in its inclusion process. To this end we recomment involving Roma associations, local institutions and the Roma community in order to obtain a collective perception of health education.

Networking/cross-sector work, systematic and a continuous follow up of previously imple-

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mented initiatives – Investment must be made in networking and cross-cutting actions. We must join forces and invest in networking involving stakeholders and institutions with broad experience in this area to promote the inclusion of cultural and ethnic diff erence and diversity. In this sense, the health area must always be present in the diff erent initiatives and projects in order to gather specifi c data on Roma communities enabling work on important issues. In other words, this means that we should take advantage of the inter-sectoral collaboration of professionals from diff erent fi elds through partnerships including the diff erent health structures and sectors (Ministry of Health, High Commissioner for Health, coordination for the infection of the HIV/AIDS, Ministry of Education, Roma associations and other organisations that work with and for Roma communities).

Intercultural mediation

• – Mediation is a resource bridging the gap between the Roma community and the majority society in order to promote constructive change in relations between the two.

Cultural mediation in health services will make it possible to work with the Roma population on aspects related to health education and the proper use of health services. Therefore, it is important to continue to invest in the training of mediators to work in health care services.

Training in cultural diversity for health care professionals

• – Proximity is a key element in ef-

fectively working with Roma communities and must be promoted between health professionals and these communities in an attempt to create trust and empathy with a view to eliminating preju- dice and stereotypes. Therefore, it is important to carry out ongoing awareness raising work aimed at health care professionals through multicultural training. Issues to be addressed in this traning should include respect for diff erence and cultural diversity and background knowledge of Roma culture. This is essential training for health professionals during their academic and professional lives in order to make health care provision compatible with Roma culture.

To identifi y health professionals to ensure follow up and establish a solid relationship

• – With

a view to creating trust, health care providers should be of the same gender as the patient in order to facilitate communication and avoid uncomfortable situations. It is also important to share expri- ences within health professional team in order to tackle the gender issue since some Roma women feel uncomfortable with male doctors.

Information and Public Awareness Raising Campaigns

• – In this context the following actions

may be developed:

Promote the credibility of services through guided visits supplemented by information brochures –

on the diff erent health services in order to overcome the lack of knowledge between the Roma community and health services;

Carry out campaigns adapted to these communities involving their members both as key agents –

and target groups (use key community members such as women and Roma associations);

Involve associations, local institutions and the Roma community in awareness raising actions on –

health related issues;

Use health education to work on the following areas: oral and general hygiene, nutritional habits, –

accident prevention, the importance of check ups, the adoption of healthy lifestyles, etc.;

Create working groups/fora for refl ection and debate among professionals in the social-health –

care sector who work with the Roma population with a view to reviewing professional practices and promoting access to health care services by this community.

Alternative means of information/dissemination

• – Tailored material should be created for Roma

communities to make sure that information is correctly understood and assimilated. Therefore, these strategies cannot be based solely on printed information since this community has low academic skills. It is important to use more appealing and understandable tools.

These materials/instruments should include the organization of diff erent health services and –

medical specialities.

Provide easily understandable information on diseases, treatments and preventive practices, –

avoiding extremely technical language.

Draft technical documents suited to cultural diversity.

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Install temporary mobile health units adjacent to Roma settlements in order to inform, guide and –

to create rapport and trust between health care providers and members of the Roma community.

Develop information initiatives targeting Roma communities on the mechanisms and operation –

of health services, explaining primary health care, what health services are available, access pro- cedures, etc.

Measures for specifi c health areas

• – In addition to the measures mentioned above, it is important to defi ne other specifi c ones for some health sector areas. Following are some possible strategies:

Family Planning:

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Organize sessions to reduce the number of teenage pregnancies while respecting Roma cul- a.

ture in relation to maternity, the use of birth control methods, the need for checkups through- out the pregnancy and cancer tests;

In gynaecological consultations it is important: i) that regular gynaecological diagnoses are b.

made by a woman physician; ii) to pay attention to the caretaker-patient relationship; iii) to create an atmosphere conducive to trust and understanding; and iv) to respect cultural issues when it comes to sex and reproductive functions;

Information sessions on menopause since many women are unaware of this process, espe- c.

cially changes to their body/organism.

Child health:

– Health education training sessions using games and entertaining activities in or- der to work on the following areas: the importance of vaccinations, oral and corporal hygiene, nutritional habits, accident prevention, etc.

Lifestyles:

– Awareness Raising campaigns to adopt healthy lifestyles (balanced diet, physical ac- tivity, etc.) and the importance of prevention adapted to these communities with the help of Roma community members and health care professionals.

The fi ght against poverty, social exclusion and health inequalities that aff ect Roma communities “demand incremental policies/strategies. Policies must be tailored to the context where they will be implemented and to the people they target. In this context, social change takes place from one generation to the next, building up vic- tories, recognizing and evaluating defeats and sometimes moving back two steps and starting all over again”⁹.