Health

Short name of the identified problem

Description of the problem

Identified differences (inequalities) with the Bulgarian population, in regard to the problem

Identified reasons for the problem

Possible ways to solve (overcome) the problem

 High infant mortality rate

· Children are born prematurely or with congenital diseases

· Children, who were born healthy, die of diseases, related to lack of proper nurture conditions

· Lack of proper communication (or difficult communication) between doctor and patient / relatives of a sick child (for instance parents are not well explained about the rules for admittance to a hospital of their sick child)

· The pregnancy development of Roma women doesn’t always go under doctor’s surveillance

· Roma could not always ensure the necessary conditions of life for nurture

· Low health culture in the Roma community

· Young age of mothers

· Pregnancy not under surveillance, because of the lack of health insurances

· Lack of pre-natal diagnostics and pregnancy surveillance

· Lack of doctors control of infants and lack of immunizations

· Improper nurture 

· Patients are not able to buy the prescribed medication because of their low social status

· Poor social services network – lack of enough social workers to deal with concrete cases

· Late demand of doctor’s help

·       Opening of services for free pregnancy surveillance

·       Motivation of pregnant women for planned visits to gynecologist

·       Using social workers, trained to work within the Roma community, to mediate between mothers and doctors  

High rate of the so called poverty diseases (poverty pathology) – infectious diseases, STI 

· Because of their low living standard, Roma often have unhealthy lifestyle. This leads to higher spread of diseases like tuberculosis, STI, etc.

· Main inequalities come from the difference in the living standard and the level of information (concerning prevention and treatment of diseases) 

· Lower health culture among Roma

· Health is not considered a priority by Roma

· Lack of health insurances

· Lack of alternatives for health care for those without health insurances

· Low health culture

· Health is not considered a priority by Roma

· High spreading of the so called harmful habits (tobacco smoking, alcohol), which have a stronger consequences when combined with poverty

· Involvement of under-aged children in socially unacceptable labor forms 

· Creation of alternatives for health care for those without health insurances

· Creation of preconditions for increase of the health culture among Roma

Early pregnancies and births

· Due to cultural specificities Roma start their sexual activity early (get married at the age of 12-14). This leads to early pregnancies and births

· Lack of family planning

· Prejudice against abortion and contraception, created by different religious movements

· Presence of “taboo” topics, related to sexual education and safe sex

· Poor family planning

· Approachable awareness raising methods, regarding sexual education, family planning, safe sex, etc. (using of moderators)  

Diseases with heavy courses and complications

· Diseases have heavier course and take longer and more complex treatment

· Roma prefer to try untraditional  ways of treatment first

· Roma are impatient in treatment – they require immediate effect; unable to follow long-term and complicated treatment scheme

· Late demand of doctor’s help

· Using moderators to explain in a comprehensive way the necessity of on-time doctor’s help

Health care

Short name of the identified problem

Description of the problem

Identified differences (inequalities) with the Bulgarian population, in regard to the problem

Identified reasons for the problem

Possible ways to solve (overcome) the problem

Difficult access to health care

· Obstacles to access health care due to different reasons – financial problems, remoteness from the health care services, lack of health insurances

· Major part of Bulgarians have health insurances or are able to pay for medical help

· For Bulgarian to be far away from the health care service is not a reason to abstain from demand of medical help

· Lack of health insurances

· Remoteness of the neighborhoods from the health care services (sometimes hospitals are in a different town)

· Lack of information for the necessary procedures

· Limited social contacts

· Unwillingness of doctors to provide care in the ghettos, because of the complicated situation (for instance communication problems)  

· Opening of doctor’s rooms (polyclinics) next to the community

· Using specially trained staff to serve the community (regarding communication)

Lack of social and administrative skills  

· Unripeness for adaptation to changes – for example change in the “consumption attitude”

· Lack of knowledge and skills to deal with communication in different institutions

· Illiterateness

· Lack of specific knowledge about their rights

· Lack of motivation in specialists to train Roma in skill building

· Impatience and lack of stimulus in Roma to acquire skills    

· Trained mediators to facilitate the contact with institutions

· Trainings on health and social skills

· Establishment of centers for education and information

Difficult communication between doctors and patients

· Doctors’ health messages are not always accepted by patients, which makes the treatment difficult or impossible

· Difficult to take anamnesis, due to cultural specificities of the community and low educational level

· Doctors’ messages are not always understood  - illiterateness, language barrier

· Breaking the limit doctor-patient from patient’s side (familiarity with the doctor, who has helped) 

· Language and emotional barrier

· Prejudice from both sides

· Lack of trust to doctors

· Uncompleted treatment – run away from hospitals

· Increasing the effectiveness of communication

· Doctor’s approach should correspond to the patients’ cultural specificities

· Doctors should use understandable language

Lack of adapted prophylactics programs

· Existing prevention programs do not correspond to cultural specificities and beliefs of different subgroups

· Roma can hardly adapt to already existing programs

· Difficulties to attract Roma to participate in prevention programs

· Lack and capacity and resource for implementation of such programs  

· Creation of programs, which correspond to cultural specificities and concrete needs of Roma community