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December 2015

“Humanity do not know about differences” – a project which improves attitudes among doctors and Roma patients

30.12.2015

poster - humanosta ne poznava razliki - enMutual negative attitudes, rejections and isolated opinions create multiple discrimination and/or obstacles in the communication between doctors and Roma patients that often are based on stereotypes and prejudice, and directly affect the way the treatment and attitude towards health is realized.

    In order to investigate the key factors that influence the situation, formative research was conducted in the period from February to June 2015 by the association ROMA S.O.S. from Prilep in partnership with three other associations: LIL from Skopje, SONCE from Tetovo and ROMANO AVAZI from Skopje. Therefore, health workers from the primary health care were covered, which represents the initial phase of the request/providing health services (dentists, gynecologists and general practitioners) in the municipalities of Prilep, Karpos – Gorce Petrov, Cair, Tetovo and Roma communities Trizla 2 Zlokukani and Dame Gruev, Topaana and Potok.

For the needs of the research the following activities have been conducted:

  • 48 pre-tests with doctors,
  • 22 in-depth interviews with doctors,
  • focus groups in Roma communities, which were attended by 96 Roma,
  • 10 stories that were personal experience of Roma patients were documented about their treatment in the health facilities.

and they resulted in the following key findings:

  • Poor living conditions for Roma contribute to low level of hygiene and untidy appearance,
  • Lack of finances contributes to irregular examinations and asking for medical care at the final stage of the disease,
  • Lack of personal documentation of Roma contributes to untimely monitoring of the administrative procedures and inappropriate use of prescribed therapy and services from secondary health care,
  • Low level of health education of Roma contributes to not practicing preventive measures in maintaining health, with a special focus on oral health,
  • Health workers pay less attention to Roma patients because of the low level of hygiene,
  • Health care workers do not trust Roma patients and thus they are inferior to their complaints that they are not able to cover financially their future health services and therapies,
  • Prejudices towards Roma patients are more visible and more serious in the secondary health care because of more complex administrative procedures and protocols that have to be followed, and the perception of health workers that are not responsible in supplying appropriate documentation,
  • Nurses have more negative attitudes about Roma patients than the doctors because of their task to establish order and discipline in the infirmaries and the impression that they are loud and present in large numbers,
  • Health care workers are not familiar with the culture of the Roma, but the ones that have more experience or a greater number of patients in typically Roma communities are more sensitized to work with Roma without any negative perceptions about them,
  • Health care workers, do not register the ethnicity of Roma and consider that segregated data collection for certain ethnic groups, is discrimination against other ethnic groups,
  • Taking into consideration cultural values and lifestyle, Roma go to an examination in bigger group with more family members, but respect the rules of medical facilities,
  • Health workers agree that Roma live in isolated areas in one part of the town, but it is because of practical aspect, their relatives are nearby, they are familiar with the surrounding and thus they feel secure in their environment,
  • General attitude of both, health workers and Roma is that the media promote negative image of Roma, especially when poverty and begging are emphasized, and very often children are abused in these articles.

In the period from September to December 2015 by overtaking creative and innovative field activities, the associations aimed to create conditions for mutual interaction and education that would contribute to more efficient access of Roma to health services, while respecting diversity and rights as well as the need for active participation in the health system that should be opened for all.

  1. Community Forum

Community forum was formed in the four municipalities separately and included 10 Roma from various parts, the ones who managed to articulate the needs and obstacles in the most concrete way during the focus groups.

This activity contributed to a complete coverage of the population with information about the purpose and activities of the project. The involved parties through the three monthly coordinative meetings discussed about the results of the survey, conveyed the information in the community, defined activities aimed at overcoming the key findings and participated directly in the implementation of field activities taking over different roles and tasks.

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  1. Preparation of a poster

In order to present the purpose of the project and the key findings in a more picturesque way, and thus to provide greater visibility, public promotion and recognition of the condition, a Poster that emphasizes humanity of the health activity and the need for equal treatment of patients regardless the appearance, clothing and lifestyle was created.

The model was a Roma woman from the municipality of Prilep who was actively involved in the research activities and the Community forum, and the poster was distributed in Roma communities and healthcare facilities as a call for mutual respect and understanding.

  1. Local Action Plans were created and implemented within the three municipalities according to local findings and context
  • Prilep: based on the conclusion that maintaining hygiene in the Roma community is a factor which mainly affects the relationship with healthcare workers and it is directly related to the living conditions of Roma, an action for setting water supply in order to access clean water for drinking was initiated and maintenance of hygiene in two settlements which are not part of the urban plan of the municipality of Prilep, Tri Bagremi and Debarca where more than 200 families live.

Support from the Public Company “Water Supply and Sanitation” and Local Government was obtained in a form of material contribution i.e. investment in setting up a drainage and supply in both settlements, supply of faucets and taps, supply of hose and engaging workers, and it ended with the construction of a street dredging and a tap by the association ROMA S.O.S. that will practically help residents to access water and maintain hygiene.

Formal commissioning under the slogan “Hygiene is half health” was organized on 02.12.2015 – outdoor event supported by Dr. Dafina Bogeska, a dentist who at the same time held a Lecture on hygiene for the attendees. The need for the lecture was the reason that oral health is identified area that is least known and people do not pay much attention to, and is also directly related to the maintenance of hygiene. Dr. Dafina practically demonstrated proper brushing, and the children who were attending were given toothpaste and toothbrushes in order to acquire the habit in their use.

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  • Karpos-Gorce Petrov: based on the conclusion that preventive measures for preserving the health are not practiced by the Roma patients which contributes to non-timely detection of certain illnesses, and often results in chronic diseases such as diabetes and hypertension, that reproductive health care for women is neglected and nobody pays attention to the oral health, an action was initiated in order to create conditions for mutual education of primary care physicians and Roma patients and their greater interaction would contribute to increase their confidence and overcome the current

On 17.11.2015 in the premises of the local community Dame Gruev, Mini Conference was held entitled as “Prevention is better than cure” and the attendees that were identified as critical in collaboration with the family doctors in specific areas were divided in three working groups for which  GP Dr. Emil Petrovski, gynecologist Dr. Bojan Mitanoski and the dentist Dr. Milosav Markovic gave lectures on the topics: “Prevention of diabetes and hypertension”, “Reproductive health” and “Children’s oral health”.

Local Government – Gorce Petrov also contributed organization of the event by providing free space and refreshments for the attendees.

Use of devices for measuring pressure and sugar, toothpaste and toothbrush as well as contraceptives, as a precautionary measure to preserve the health were presented by the doctors to Roma patients, and after the lecture they were given to them in order to use them at home.

  • Cair-Topaana: based on the conclusion that Roma have a low level of health culture that contributes to not practicing preventive measures in preserving health, while regular physical activity and sports reduce the risk of cardiovascular and other chronic diseases, in the settlement Topaana an action about reconstruction of a sports field was initiated in order to promote the habit and conditions for practicing physical activity among the Roma community.

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Municipality of Cair also supported and contributed the action specifically in terms of cleaning the ground, supplying flashlights, benches and trash bins.

On 28.12.2015 the event under the motto “In a healthy body, healthy mind” was organized and the playground was officially put into use, and the importance of physical activity and sport was emphasized by the lecture given by Dr. Katerina Dimitrieska, a general practitioner and by Dr. Mirela Omerovikj, a dentist, while afterwards a football match was played between the members of the Forum.

  1. Organizing “Friendly evenings” between health workers and the Roma community

Doctors who were involved in the research and the members of the Community forum at a joint meeting on 29.12.2015 discussed the key findings of the research. At the same time the fact that the meeting was conducted in a friendly atmosphere provided conditions for their better acquaintance as persons who belong to different nationalities with their own customs, traditions and culture.

Thereby, potential future opportunities/activities for overcoming stereotypes and prejudices were considered as well as some general directions for approaching Roma patients by the doctors were suggested. This activity was organized simultaneously by all four associations in their municipalities.

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* The project is supported by Open Society Foundations through Media and Health Program from New York and was realized in the period from January to December 2015.

“Roma civil paralment” has debated on Roma health through the prism of laws

24.12.2015, Prilep

DSC01414

While the public has been debating the last period demanding responsibility for recent deaths among patients and their families who have suffered particular damage as a result of medical negligence, no one dared to mention the Roma patients.

We wonder whether their lives are not important? Is this ignoring of the cases in which victims or damaged parties are Roma is just another form of social discrimination?

Trying to find answers of the above issues, at today’s discussion in Prilep in a form of “Roma civil parliament” we deduced the following conclusions:

November 2015

Health Insurance Fund (HIF) abandoned the pre-registration of health insurance for the unemployed and people with lower income, and criminal charges as well. What is next?

November, 2015

The efforts of the association ROMA S.O.S. from Prilep in cooperation with associations [1] from 10 municipalities in Macedonia, in the period 2013 – 2015, resulted in introduced amendments to the Law on contributions for compulsory social insurance (LCCSI) in December 2014 and amendments to the Law on Health Insurance (LHI) in June 2015.

Legislative amendments contributed to simplify the procedure for exercising the right to health insurance for the unemployed and people with lower income (HIF insurance category), thereby providing continuity in the enjoyment of the right and constant health treatment for the most vulnerable insurers.

October 2015

ROMA S.O.S. among the nine finalists at the Health Rights Film Festival

16.10.2016

Health Rights Film FestivalMilan, Italy – the Association of Schools of Public Health in the European Region (ASPHER) launched the inaugural Health Rights Video Film Festival. The online film festival highlighted video stories about accessibility, health care issues, stigma, and human rights issues. The following are award winners from the festival:

Impact Award

The impact award recognizes outstanding achievement in the use of video for advocacy. The winners were selected by a jury of international experts in public health and digital advocacy.

July 2015

“Humanity does not know differences” – a project which will improve the attitudes of doctors towards patients Roma

15.07.2015

DSC00397At coordinative meeting, the partners were evaluating the progress with the activities

Life in poverty, in isolated and segregated communities as well as social determinants of poverty maintain a large social distance between Roma and non-Roma in all areas of daily life. Additionally, all this is backed up with stereotypes and prejudices in society in general, and in particular in health area.

The following statements are used by health workers when Roma people are not provided with health services and identified by organizations working on health issues of Roma:

– Roma people are without health culture.

– Roma people are not routinely immunized.

– Roma women give birth to many children, and it is common among these women to deliver a baby at home in cases when they have no health insurance.

– When seeing a doctor, Roma people have to have a bath and look after their personal hygiene.

– Roma people take medicines on their own initiative.

– When children are sick, Roma people visit faith-healers.

– I have no more ideas how to explain them what papers / documents they need.

Thus, many general practitioners refuse to treat Roma patients saying they reached the limit of number of patients.

Until present, no one has tried to understand and describe the background of these issues as well as to think about the reasons i.e. why that is so. If we think about all these negative attitudes towards Roma people and their way of living, we ask ourselves if cultural differences are influencing the opinion.

The perceived negative attitudes, denials and opinions create multiple discrimination in the health system that is experienced through low level of qualitative health services, bureaucratic denial to access health insurance and health care which lead to Roma exclusion.

From these reasons, ROMA S.O.S. in partnership with three associations LIL from Skopje, SONCE from Tetovo and ROMANO AVAZI from Skopje undertook initiative to dial with changing negative opinions, attitudes and behaviors of health workers towards Roma. By undertaking creative and innovative research as well as field activities, associations aim to effectively ensure Roma access to primary health care, while respecting the diversity and rights through active participation in the health system and maintaining the health system open to all.

Municipalities of Prilep, Tetovo, Gjorge Petrov – Karpos, Topaana – Center are covered with the activities, and in the period until June a research was conducted among gynecologists, general practitioners and dentists, as well as between Roma communities, thus the following has been implemented:

  • 43 pre-tests with the doctors,
  • 22 depth interviews with doctors,
  • 8 focus groups in the Roma communities which was attended by 96 Roma,
  • 10 stories from personal experience of Roma patients about their treatment in medical institutions were documented.

Summing up the results in a Report with key findings is the next step which will create possibilities for realization of parallel and complementary outreach activities among health workers and Roma communities to discus and overcome the identified key factors.

The project is supported by FOSM through Media and Health Program from New York (OSF), at is implemented in the period January till December 2015

DSC00395   DSC00398

May 2015

LEGAL CHANGES IN THE BENEFIT OF THE CITIZENS OR “COSMETIC CORRECTIONS” OF THE REGULATIONS IN FAVOUR OF THE STATE/BUDGET

25.05.2015

prasalnik-zdravstvni-pravaAccess to the right of Health insurance

Permanent amendments to the Regulations on the manner and procedure for exercising the rights of citizens contribute to creating continuous obstacles, even in cases when laws are in their favor.

For instance – amendments were made to the Law on contributions of compulsory social insurance from 1st December 2014 and by these amendments the Statement of income in the previous year was abolished from the procedure for pre-registration of health insurance for unemployed and people with lower incomes.

It is confirmed – Health Insurance Fund of Macedonia will check the income through Public Revenue Office ex officio, and by that crowds and giving false information by the insurers would be avoided → pre-registration of the insurers who enjoy the right on the burden on the budget of the Republic of Macedonia will be facilitated.

09.02.2015 – changes to the Regulations on the content and manner of exercising the rights and obligations of the compulsory health insurance by which a new form was introduced in the procedure i.e. Request for determination of the status of the insurer – “crucial” document/form that completes offered option about the amount of income in the previous year.

Attached documents:

  • Application for compulsory health insurance,
  • A copy of birth certificate of the applicant and all members of the family (certificate of the book of marriage if he/she is married),
  • A copy of the identity card with consent of the applicant,
  • Health insurance card for the applicant and family members.

What is the procedure for exercising the right to health insurance for the first time?

  1. Families/person with lower incomes on the burden on the Budget of the Republic of Macedonia

– do not have income higher than 105.600,00 denars in the previous year.

– they have income higher than 105.600,00 denars but not exceeding 189.864,00 denars, they are able to exercise the right if in the last two months of the current year had had income lower than 17.600,00 denars.

      2. Families/person with higher income who pay health insurance by themselves

If in the previous year they had income higher than 105.600,00 denars and income higher than 17.600,00 denars in the last two months of the current year, the amount of the contribution will be:

– 1155,00 denars per month for income higher than 105.600,00 and lower than 189.864,00 denars,

– 2310,00 denars per month for income higher than 189.864,00 denars.

How is the pre-registration process of insurers implemented?

  1. Extension of the right

For families/person who during 2014 have pre-registered by submitting a Statement of income, the right to health insurance will be automatically extended from 1st April 2015 by adopting a Decision for extension of the right.

      2. Termination of right

A Decision to terminate the right will be issued for the following categories:

– starting from 01.06.2015 for insurers who in 2013 had income higher than 96.600 denars and in the Statement they had submitted in 2014 did not declare this condition,

– starting from 01.09.2015 for insurers who in 2014 had income higher than 105.600,00 denars and will not report the change to the Health Insurance Fund of Macedonia in this period.

What are the consequences:

– a prohibition to use orthopedic devices within 6 months,

– compensation for using  health services after calculation made by the Health Insurance Fund of Macedonia by sending an invitation to the holder of the insurance that if he/she does not pay the damage, a procedure in front of enforcement agent will follow.

      2. Extension of the right when it is terminated

When the right is terminated by а Decision from 01.06.2015, and in 2014 insurers did not have income higher than 105.600,00, they should submit complete documentation to the Health Insurance Fund of Macedonia as a family/person who seeks access to compulsory health insurance for the first time.

      3. Change on the basis of insurance

If they have income higher than anticipated in 2014 for the category Families/person with lower income, it is necessary to change the basis for insurance through submission of complete documentation to the Health Insurance Fund of Macedonia as Families/person with higher income in order not to face termination/consequences.

What makes it easier?

– Obligation for pre-registration of unemployed who do not have income higher than 105.600,00 denars in the previous year has been abolished and the right is automatically continued.

– Families who had higher income in the previous year may change the basis for insurance no later than 1st September of the current year in order not to face termination of the right (a period when the PRO issues Certificates of income).

What makes it difficult?

– Health Insurance Fund of Macedonia introduces a template in the procedure which has not been previously determined by legal provision → repetitive application of an unlawful act.

– Termination of the right from 01.06.2015 on the basis of a submitted Statement of income in 2013 without the Health Insurance Fund of Macedonia to prove the guilt of the insurer in a criminal proceeding (applied procedure for given false statements for 2011 and 2012) → retroactive application of the Regulations from 09.02.2015.

– In the new Form insurers provide data on their income in the previous year → repetition of the practice of personal responsibility and providing false information.

– For compensation for used health services in cases when false data were provided by the insurers, the Health Insurance Fund of Macedonia will initiate a procedure in front of an enforcement agent and direct payment from transaction account → contrary to the Law on Health Insurance: “If the damage is not compensated in the specified period, the Health Insurance Fund of Macedonia may submit an appeal to the competent court.”

April 2015

Annual report of the Network for protection against discrimination (NPD)

21.04.2015

mreza_ne-disriminacija.enThis report refers to the operation of the Network for protection against discrimination in the past 2014 year.

The report aims to provide information for the realization of the protective function of the institutions responsible for protection against discrimination, in particular the Commission for Protection against Discrimination and the Ombudsman through presentation of the manner it has been acted in regard to the complaints that were submitted last year by the members of  NPD to these institutions and in the previous three years.

The report can be seen at this link or download here.

PUBLIC ANNOUNCEMENT

08.04.2015

08042015Today is 8th April – International Roma Day, day when the position, cultural, historical and traditional values of the Roma population are promoted worldwide in order to reduce ethnic, educational and socio-economic discrimination.

In the same context, the Government of the Republic of Macedonia in 2005 adopted the Strategy for Roma (2005-2015) as a public document intended to achieve better inclusion of the Roma in the society and to increase the opportunities for a better life and at the same time Action plans from the Decade of Roma Inclusion.

March 2015

272 persons celebrated the International Women’s Day – 8th March

08.03.2015

podaj_rakaAs a sign of solidarity under the motto “Let’s have fun and help – from women to woman!”

On the occasion of 8 March was organized an event that was intended to help Magbule Osmanovska – Roma woman from the settlement Trizla 2 – Prilep, mother of eight children living in substandard conditions. In the entire implementation of the charity event were included a total of 272 persons, of which 252 were Roma women and teams from association ROMA S.O.S., the orchestra Prilep Stars and cameraman and photographer. Restaurant “Centar” with its service and support ensured all necessary conditions to implement the event.

Announcement regarding racist attitudes towards “Gypsies”

07.03.2015

Association ROMA S.O.S. from Prilep emphasized its concern about recent statements that echoed in the air yesterday, and refers to the published phone calls of the opposition’s “bomb” and attitude of the decision makers and state institutions towards the Roma community.

Although yesterday a press conference was organized in which 12 associations (together with LIL Skopje, KHAM Delcevo, NRC Kumanovo, H.E.R.A. Skopje, RRC Skopje, SONCE Tetovo, ESE Skopje, “Bela Kula”-Kicevo, CDRIM – Skopje, “Bairska Svetlina” – Bitola and Association for Roma Rights – Stip) proved that Roma organizations are committed to improving the situation of ALL citizens equally, without discrimination on ethnic and national origin, in order to improve certain public policy related to health insurance for the poorest citizens [1]. However, the result at end of the day showed that our efforts are “an illusion.”