Hanna Dobronauteanu, M'D'

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Health Mediators in Roma Communities 3 Years on
a New Way

• Hanna Dobronauteanu, M.D.
• Counselor of Minister,
• Ministry of Health,
• Romania

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REMEMBER OBSERV IMPROVE
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REMEMBER
ACCESS OF ROMA TO HEALTH SERVICES Deficiency of
practical access to ? GP (Family doctor) ?
Preventive services Due to ? Lack of identity
documents ? Cultural barriers ? Lack of
information
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REMEMBER
Number of Roma population Ethnical
strata Different groups/clans/families ?
The definition of the public health target
group The Roma Community
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REMEMBER
Romani CRISS 1997
Ministry of Health 2001
HEALTH MEDIATORS IN ROMA COMMUNITIES
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REMEMBER
THE HEALTH MEDIATOR Respected member of the
community Woman /mother/ Cross-cultural
bridge ? Information ? Communication ?
Conflict prevention
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REMEMBER
THE HEALTH MEDIATOR SYSTEM Jobs for Roma
women in their community Active creation of
profound changes Opportunity to fight
discrimination
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REMEMBER
OPERATING TERMS Of the functioning of Health
Mediator System Declared respect for the Roma
culture tradition Commitment of the Roma
Representatives (in planning,
implementation, and evaluation at central
local level too) Offer of solutions for the
problems of ? Roma people ? Health care
system Monitoring Flexibility
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HEALTH MEDIATORS IN ROMANIA
Selection of candidates for training ?
Local Roma NGO ? Roma community leaders
Training Institution NGO partnership ?
First Step/Basic/Training Romani CRISS ?
Professional Training organized by County
Public Health Authorities
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HEALTH MEDIATORS IN ROMANIA
2002 112 Health Mediators in 32 counties
2005 222 Health Mediators in 40
counties /Romania 42 counties/ Coordination
County Public Health Authorities
Activity well defined job description
Finance Ministry of Health /National
Program/
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• Works for
• 916
• Beneficiaries

• Can be contacted by
• 1560
• Beneficiaries

1 HEALTH MEDIATOR 2003/2004

• Helps
• 219
• Roma to be included in
• the Health Insurance System

Holds 34 37 Health
Education Sessions
Helps 19 40
Pregnant Women to access health
services
Accompanies 53 114
Children to vaccination
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HEALTH MEDIATORS IN ROMANIA

• Public Health Indicators
• of communities with health mediator
• ? Vaccination coverage rate
• ? 68?95 Bihor
• ? 45 ?90 Maramures
• ? 20 ?90 Dambovita
• ? 100 Brasov, Mehedinti
• ? Infant mortality
• ? 46,2 o ? 6,8 o Ialomita
• ? 47,6 o ? 0 Sibiu
• ? 0 Braila, Dambovita, Dolj, Maramures,
  Mehedinti
• ? Addressability to reproductive health services
• ? ? with 50 of therapeutic abortion - Harghita

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HEALTH MEDIATORS IN ROMANIA
CHALLENGES TO FACE To complete the external
evaluation process (started in 2004) To
identify the place of health mediators in the
reformed Romanian health system To
improve ? Professional training of health
mediators ? Program management and
monitoring ? Networking
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Emotions will not be denied. Once an emotion is
created, it lives as chemicals in your
system. You have to use emotions to create the
right kind of thinking. Bill Jensen
/Simplicity The New Competitive Advantage In a
World of More, Better, Faster/