Access to Immunization for Roma children: in eastern Macedonia it is a question of advocacy
REYN member Zoran Bikovski is active in addressing the causes of low levels of immunizations for Roma children in eastern Macedonia. He explains his experience and successes working with Ngo Kham.
Since we have started our “Community Monitoring and Accountability in Health” project in eastern Macedonia, our primary goal was to increase the level of immunization of Roma children to the same level as that of the majority Macedonian population. In particular, we work in three specific communities in this part of the country: Delchevo, Village Crnik, and Vinica.
The first phase was Community mobilization. In this way we hoped to strengthen the Community’s knowledge about immunizations, and about their rights to free immunizations for their children. For the very first time, members of the Roma community were put in a position where they could sit at the same table with representatives of the institutions, and where they could discuss their own problems and help make the decisions about how best to solve them.
As the next step, surveys were conducted in all three communities to ask residents if they were receiving the necessary immunization services. Kham created a “Score Card” to identify barriers to immunization. Then, again working with all the stakeholders, the Coordinative body in each locality created an action plan to overcome the barriers to immunization.
In Village Crnik, the biggest barrier was the 15 kilometre distance between Crnik and Pechevo, the closest location where children could be immunized. Transportation to get children to Pechevo is irregular and expensive. To overcome this barrier, community leaders and members of the Coordinative body organized the community to submit a petition to the Director of the Pechevo Health Centre calling for immunizations to be provided in Crnik. Nearly all residents of Crnik living in the village at the time signed the petition. As a result of this action from the community, the Health Centre and Local Self-Government Office agreed to establish a health centre in Crnik and provide health care professionals to administer immunizations in Crnik.
In Vinica one of the biggest barriers to immunization is the movement of the Roma population for seasonal work in countries outside of Macedonia. Families may leave for long periods of time and the children will not be at their residence to receive immunizations. Additionally, through community mapping Kham learned that many of the homes in the Roma community in Vinica are not properly numbered or maybe not numbered at all, so health care workers cannot locate the houses with children needing immunizations. The Coordinative body worked very hard in the field in the Roma community. That was the reason two Roma leaders member of Coordinative body were selected from political parties, and now they are members of the current Council and will be for the next four years. They will be a very important tool in solving problems and overcoming barriers in the field of immunization, rights of the patients, and other priorities of the Roma community.
In Delchevo one of the major barriers to immunization was the failure of Pediatrician health care workers to pay house calls in the Roma community as they are supposed to do. They should visit homes five times per year, but they were not doing so. In many cases, they did not know the location of the children they were supposed to visit. Another problem is the lack of a car for visiting families. In addition, the community had a lack of Pediatricians after the retirement of the former one. After our advocacy, the Health Centre successfully applied for specialization for a new Pediatrician.
In addition to this, we organized a media campaign with Radio Zora, which broadcasts to all of Eastern Macedonia, to describe and explain the problems that Roma children experience in obtaining immunizations. This is very important tool in our advocacy process. Kham staff, health care professionals, and members of the Roma communities speak on weekly radio broadcasts. On that way we make a pressure to the Health centers to work to overcome barriers for regular Immunization because they are obligated by Governmental programs to do this.