RegionalRegional PublicPublic HealthHealth AuthorityAuthority in in KosiceKosiceKatarinaKatarina StrmenskaStrmenska, MD, MD

Regional Public Health OfficerRegional Public Health Officer

Health promotion program Health promotion program of marginalized communities of marginalized communities

Jana Jana KollKollarovaarova, MD, Department , MD, Department ofof HealthHealth PromotionPromotionLuxembourgLuxembourg, 5 , 5 –– 6 6 AprilApril, 20, 201111

•• Act No. 355/2007 on Protection, Support and Development Act No. 355/2007 on Protection, Support and Development of Public Healthof Public Health

•• Executive Public Health bodiesExecutive Public Health bodiesMinistry of Health of the Slovak Republic Ministry of Health of the Slovak Republic -- defines priorities of state health policy in the sector of publidefines priorities of state health policy in the sector of public healthc healthPublic Health Authority of the Slovak RepublicPublic Health Authority of the Slovak Republic-- manages, controls and coordinates the execution of state adminismanages, controls and coordinates the execution of state administration carriedtration carriedout by regional public health authoritiesout by regional public health authoritiesRegional Public Health AuthoritiesRegional Public Health Authorities in Slovakiain Slovakia-- 36 in accordance to 36 in accordance to 8 regions and 79 districts8 regions and 79 districtsRegionRegional Public Health Authority in al Public Health Authority in KosiceKosice isis state budgetary organisationstate budgetary organisationlinked with its financial relations to the budget of thelinked with its financial relations to the budget of the Ministry of HealthMinistry of Health, , lead by lead by Regional Public Health OfficerRegional Public Health Officer

Public Health System in SlovakiaPublic Health System in Slovakia

Health promotion program of marginalized communitiesApproved by the Government of the Slovak Republicfor period 2007 – 2015

Implementation 30 community health workers working in 12 Regional PublicHealth Authorities in the Slovak Republic under the responsibility of professional health promoters

Aim - Protect and promote health of people living in marginalized Roma

communities- Increase health awareness, improve an access to health care by

providing relevant information, mediate medical check- ups - Reduce health inequalities determined by social and economic position

Methods and principals:Multi-sectoral cooperation – municipalities, NGOs, health care providers,social community workers, schools...Long term and intensive work with target groups(stimulation of the community in its natural environment)Searching for the natural leaders in communities, their education (positive examples for others)

Facts and estimates

• In Slovakia, 80,627 Roma (1.52% of the citizens of Slovakia), officially declaredthemselves as such.

• According to estimates of the urban and communal offices of the stateadministration, however, as many as 253,943 Roma live in Slovakia, thusconstituting 4.8% of the population.

• Roma political and cultural activists estimate that the number of Roma in Slovakiais even higher, citing a figure of 350,000 to 400,000 in Slovakia.

• The average life span of Roma women and men is from 12 to 15 years less than the numbers for the majority population.

• Approximately half of the Roma population is integrated among themajority population.

• The rest live in marginalized communities which are classified as segregated and separated (within municipalities) and concentrated (inurban areas) with elements of ghettoization.

• Total number of Roma settlements is 691 (data from June, 2010). The number has increasedin the last 4 years (from approx. 620)

Implementation of the Program in RPHA Implementation of the Program in RPHA KoKoššiceice3 community health workers working especially in Kecerovce and Olsavamicro-region (11 separated and segregated Roma communities in Rankovce,Kecerovce, Boliarov, Vtáčkovce, Bidovce)Schedule of work – 4 days directly in the communities, 1 day in RPHABrief description of the microregion:

Proportion of marginalized population is 50% (in many villages 70-90%) High level of unemployment – 32%Low level of education - 2/3 of inhabitants are people with only basic educationHigh level of birthrate The average age of the population is significantly lower than the national one

„„if there is no if there is no capacitycapacity to bring up the change to bring up the change in the community, no change will comein the community, no change will come……““

Starting pointsStarting points::

EmpowermEmpowermeentnt ofof internal internal capacitycapacity of Romaof Romacommunities through the local leaderscommunities through the local leaders–– necessity to achieve community necessity to achieve community

developmentdevelopment

““Peer activistPeer activist”” as a mediator of socially acceptable as a mediator of socially acceptable attitudesattitudes –– main idea of peer main idea of peer approachapproach and effective way of and effective way of mobilizing self mobilizing self –– centered centered Roma communitiesRoma communities

STOPASTOPA Project Project –– SystSystemem of teenof teen--age education, age education, alcoholism and other abuse preventionalcoholism and other abuse prevention

AimAim: : training of selected Roma leaders training of selected Roma leaders in in thethe field of drug abuse field of drug abuse preventionpreventionPProjerojecctt activitiesactivities: : 1. 1. Systematic education and support Systematic education and support

for individual personality development for individual personality development of selected young peopleof selected young people

-- 70 hours of intensive interactive training, 70 hours of intensive interactive training, informal, friendly approachinformal, friendly approach

2. 2. Establishment and management Establishment and management of youth clubsof youth clubs

-- activation peer activistsactivation peer activistsTarget groupTarget group –– 16 young people16 young people in the age from 13 to 19 yearsin the age from 13 to 19 yearsA necessary requirement for young people selection A necessary requirement for young people selection –– recommendation recommendation of local authority of local authority ((““vajdavajda””) )

ProjeProjecct STOPA t STOPA –– training of peer activiststraining of peer activists

STOPASTOPA clubsclubs

Main results Main results –– expectations for the futureexpectations for the future

60 young people involved in club activities (4 clubs)Changed attitudes to alcohol, smoking, drugs, reducingalcohol consumption among clubbers (Reported byquestionnaire survey, observation, intensive work in communities)Personal development of young people – social skills gainedPossibility to spend leisure time without drugs and alcohol (sports activities, discos, parties)Increase knowledge on issues of addictionBetter information on the incidence of addiction in the region2 clubs continue to operate even after the project(volunteering approach)

Health Program for Romani mothersHealth Program for Romani mothers„„Quatrefoil of preventionQuatrefoil of prevention””

Aim: increase health awareness and development of support group Aim: increase health awareness and development of support group Program activities: 4 thematic courses on prevention of communicProgram activities: 4 thematic courses on prevention of communicable andable andcardiovascular diseases, reproductive health and injury preventicardiovascular diseases, reproductive health and injury prevention on Interactive learning, and personal counsellingInteractive learning, and personal counsellingTarget group Target group –– Romani women aged 18Romani women aged 18--50 years, 4 groups of 15 to 25 50 years, 4 groups of 15 to 25 women from villages women from villages KecerovceKecerovce, , RankovceRankovce, , BidovceBidovce, , VtVtááččkovcekovceNatural proactive leaders, accepted by the community, with an inNatural proactive leaders, accepted by the community, with an interest in terest in education, recommended by local authoritieseducation, recommended by local authorities

Main results & expectations for the futureMain results & expectations for the future

Increasing health awareness, confidence in institutions and educIncreasing health awareness, confidence in institutions and education ation programsprogramsIncreasing the number of preventive medical checkIncreasing the number of preventive medical check--ups and vaccinatedups and vaccinatedchildrenchildrenLifestyle improvement (hygiene, eating habits, physical activityLifestyle improvement (hygiene, eating habits, physical activity))Ability of peer activists independently propose and organize meAbility of peer activists independently propose and organize meetings,etings,sport and leisure activities sport and leisure activities Serving as mediators between community workers and the communityServing as mediators between community workers and the community..

The most serious problems in meeting the programInternal:

The specifics of culture andtraditions of Roma ArchaicCommunities - collective decision making, joint ownership,focusing on the presence, self-centred communitiesUsury - the long-term dependencyof families on usury, whichdeepens poverty. Force of usurers in the community is crucial.

External:

Legislation with a possible negative impact Absence of facilities for community work (community centres, clubs)Insufficient number of communityworkers regarding to the numberof Roma living in settlementsContinuity of the program,lack of financing

Save us from usury

Other interrelated activities

Basic approaches:Vertical - from local to international levelHorizontal – public health practice, research, policy Multi-sectoral - public health, economy, environment, education, social security, statistics...

Ongoing international activitiesBiennial Collaborative Agreement – basic document for cooperation between Office for Investment for Health and Development in Venice, and Regional Public Health Authority in Kosice- Multi-disciplinary Working Group on social inequities in health in the Slovak Republic

Cooperation with Sheffield Primary Care Trust (England)- exchange of experience of working in communities

Cooperation with Govanhill (Glasgow, Scotland)

Contact: ke.kollarova@uvzsr.sk

This paper was produced for a meeting organized by Health & Consumers DG and represents the views of its author on thesubject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumers DG's views. The European Commission does not guarantee the accuracy of the dataincluded in this paper, nor does it accept responsibility for any use made thereof.