Association ESE


   Association for Emancipation, Solidarity and Equality of Women.

Roma Health

According to the 2002 Census, there are 53.879 members of the Roma ethnic community in the Republic of Macedonia, which is 2.66 % of the total population. However, according to other studies based on different research methods, it has been pointed out that the real number of Roma is higher than that, estimated between 80.000 and 135.000 of Roma living in Macedonia.

The Roma are a marginalized group in many aspects of public and social life, including access to health services and their quality. The situation of the Roma in Macedonia is characterized by a high poverty rate, unemployment, marginalized and poor settlements, substandard infrastructure, low health status, low level of education, as well as insufficient representation in the political and the public spheres.

With regards to the health condition of the Roma, research has shown a more disadvantaged health condition compared to the majority of the population. Health of this population is characterized primarily by a higher rate of chronic diseases, and a shortened life span by 10 years compared to the rest of the population. 

Field data and research findings point out to the existence of a series of obstacles the Roma population faces regarding access to health services.  These obstacles consist of hidden discrimination in the treatment of patients, inability to pay for the necessary health services, distance to the health institutions, insufficient knowledge regarding their health rights, as well as lack of information among health workers on special needs and habits Roma have when they access health services. Unfavorable conditions for obtaining health insurance, as well as the failure to take into account the social needs of the Roma when adopting health regulations, additionally increases inequality. All mentioned conditions are obstacles in the process of acquiring health insurance, but even more, they are risk factors for the health condition of the Roma population. The lack of health statistics segregated by ethnic background results in a lack of relevant official data on the health condition of the Roma, which in its turn is an additional problem to solving the health problems of the Roma population.  

The marginalized state of the Roma minority in the countries of Europe, as well as needs to improve the situation of this minority, was recognized also in the Decade for Roma Inclusion 2005-2015. The Republic of Macedonia as a country signatory to the Decade, adopted a series of documents and policies towards improving the health condition of the Roma and decreasing the gap between the Roma and the rest of the population. However, analysis of the monitoring of these policies unfortunately points out to insufficient and improper implementation of national and local policies for improving the health of the Roma in the past years. Thus, a large number of problems the Roma have been facing regarding their health and access to health care are still persisting.

After the end of the Decade for Roma Inclusion, the European Union adopted a framework on National Strategies for Roma Integration by 2020, building up on the achievements of the Decade. The 2020 EU Framework continues to commit to improving the social and economic condition of the Roma, by working towards integration of Roma issues into the current policies in education, employment, housing and health care, and taking into account basic principles of Roma inclusion, as well as ensuring equal access to quality services and providing best use for available funds and resources. Through the framework the European Union calls upon the member countries to eliminate the gap between the marginalized Roma communities and the majority population, as well as to provide equal access in practice.

The Republic of Macedonia as a candidate country for the European Union has promised to align with standards and guidelines of the 2020 EU Roma Agenda, and the first step in this process was the adoption of the Roma Strategy 2014-2020 by the Government. A National Action Plan on Roma Health is in the process of adoption as well.


Monitoring and analysis of the Program on Active Health Care for Mothers and Children

By work related to this Program, we are contributing to improving the coverage of mothers and children from the Roma community with preventive health services including vaccine coverage, visiting nurse service coverage, as well as health education and information. 

We carry out these activities by continuously monitoring activity implementation and budget funds spending intended for the Roma population, as well as by continuous advocacy for adoption and implementation of measures for increased vaccination coverage of Roma children.

Program monitoring at national level is carried out by collecting and analyzing data from the responsible health institutions, using the Law on Free Access to Information of Public Character and analysis of the obtained data. Also we monitor the coverage with measures from the Program for Roma women and children from the municipalities of Shuto Orizari, Delchevo, Pehchevo and Vinica. When the analysis results are completed, we draft detailed reports on the monitoring carried out, and findings are used for advocacy and for improving the situation. In addition, we continuously advocate for them at the institutions responsible at national and local level, primarily at the Health Ministry, the Finance Ministry, the Health Care Institute for Mothers and Children and the local health institutions, all for the purpose of increasing the scope of mothers and children covered with preventive health services. 

At the same time at public events and press conferences we continuously inform Roma organizations and the public about findings of the Program monitoring. 


Community monitoring

In cooperation with three Roma civil organizations we work in the field of monitoring the implementation of preventive health services in Roma regions in four municipalities in Macedonia. Health services observed are related to child vaccination, nurse home visits, general health examinations of pupils and students, activities on health education and information carried out by health institutions and the Health Care Institute for Mothers and Children, as well as activities planned in the Cervical Cancer Screening Program. 

By means of continuous training and technical support we strengthen the capacities of our partner Roma civil organizations to work in the field of monitoring and advocating, and together we strengthen the capacities of the Roma community through training, regular involvement of the community and exchange of information on their rights in the area of vaccination and preventive health care.

Community monitoring allows us to provide the Roma community an opportunity to assess the degree of implementation of health services and their quality related to preventive health care.  Simultaneously we work on strengthening and mobilizing the community to advocate for their rights at the institutions at local and national level.  

The findings of the monitoring are used in cooperation with the partner organizations for adoption and implementation of measures and activities that would contribute to increased coverage of Roma children with vaccination and preventive health services.


Social audit

Work in the field of social audit is closely related to work in the field of community monitoring, hence cooperation with the three partner Roma organizations is continued here as well. Social audit has two main goals: increasing the coverage of Roma mothers and children with nurse home visits; and increasing the coverage of Roma women with activities from the Cervical Cancer Screening Program. 

Social audit is used to check the credibility of official documents related to implementation of preventive health services by the users themselves, in this case the Roma community. We audit the journals on nurse home visits and reports on the implementation of the Cervical Cancer Screening Program.

Identified inconsistencies in official documents are shared with the Roma community, and by community participation the findings are shared also with the responsible health institutions implementing these activities. In addition, we ask the responsible institutions for consistent, timely and high-quality implementation of health services.


Providing paralegal assistance to the Roma

In cooperation with three Roma civil organizations we allow for an increased access of the Roma population to execution and protection of the right to health. We are jointly working on increasing the degree of knowledge and understanding among the Roma about the right to health care, health insurance and protection of the right of patients. By means of continuous training, including a manual and other auxiliary materials produced, we are building the capacities of paralegals and of partnership organizations for proper and timely assistance and support of the Roma population. By working on meeting the needs of the Roma population we are identifying conditions, measures and activities to be undertaken for the purpose of improving. We undertake strengthened activities for advocacy, implementation and protection of health rights of the Roma by continuous and active communication and cooperation with institutions responsible at local level. In the municipalities of Shuto Orizari and Delchevo the paralegals provided paralegal assistance and support in 587 individual cases in 2011 and 2012. In 2012 and 2013 we assisted 232 Roma. In the period 2013-2014 we provide assistance and support to 476 Roma and in the period 2014-2015 to 502 Roma individuals. The provided assistance and support allowed the Roma to exercise rights in several areas of living such as the right to health insurance in terms of reregistration of unemployed individuals to acquire this right; the right to refunding; the right to receive care from a third person; the right to single financial aid; the right to medical spa treatment; the right to using social welfare aid and providing conditions for availability of these funds; the right to provision of required documentation (health electronic card) for achieving the right of health care; and the right to use preventive measures according to some government programs on preventive health care, and other rights.   

To implement these activities we cooperate with the Centre for Democratic Development and Initiative – CDRIM from Shuto Orizari; the Humanitarian and Charity Association of the Roma – KHAM from Delchevo, Pehchevo and Vinica; and the Roma Resource Centre – RRC from Shuto Orizari.

“I Sazije am an ordinary woman facing daily life challenges in Delchevo. In June 2011 I went to the Municipality of Delchevo and upon exiting the municipal building I fell and injured my arm. My family doctor referred me to a specialist at the Kochani Hospital. The specialist examined me and set a diagnosis, referring me to therapy including an orthopedic plaster cast for my arm. Even though I felt pain in my shoulder, the cast was fitted on my forearm. Unfortunately, as time went by, instead of reducing, my pain started growing. So I went to a specialist examination in Shtip who told me that the injury was incorrectly treated, so my arm had to be broken again and a new cast to be fitted. I can’t begin to describe what difficulties and humiliations I went through.  In order to solve the situation I addressed the civil association KHAM, since paralegals had visited us at our home to tell us they were open for providing assistance and support for any need related to health services.  They drafted a complaint to the Municipal Commission on Improving the Rights of Patients. Unfortunately they didn’t help a lot. This convinced me even more that I should continue to seek justice. Upon my request, KHAM assisted me to begin a court procedure for damages. It is honorable what paralegals do. It is not only me they have helped, I am hearing that they help a lot of other Roma in filling in documents for health insurance, negotiating with health institutions and even accompanying the Roma when they go there”.

Statement of Sazije Fazlijevik, user of paralegal assistance and support from the KHAM organization -  Delchevo.  








Fiscal Transparency

Social accountability for gender equality

Health Rights

Domestic Violence 

Legal Aid Center

Health Information Centre