Roma social and health mediators in Ukraine by Міжнародний фонд "Відродження"

report/Ń&#x20AC;.

Section 1

Roma social and health mediators in Ukraine: achievements, challenges, opportunities Authors: Olga Tsviliy, expert in issues of health care and socially dangerous deseases. Zemfira Kondur, Vice-President of ICO «Roma Women Fund «Chirikli». Editing: Eleonora Dobrovolska Translated by Andrew Chernousov Design&print: «Aladdin-print»

This publication was made possible with financial support of the Program Initiative «Roma of Ukraine» of the International Renaissance Foundation and Program «Roma Health» of the Open Society Foundation (Budapest). Authors assume full responsibhility for the content of the publication and it can not be regarded as reflecting the position of the International renaissance Foundation. While in a position of social exclusion, Roma (particularly those who live in compact settlements) have limited access to medicine and education, have little opportunity to find job. In view of the special situation of the Roma minority in Europe it was developed and successfully implemented a number of models that significantly improve the protection of Roma rights. According to authors, the domestic social and health systems that need to be focused primarily on people and their needs can not ignore the specifics of a particular social or ethnic group. This publication informs on Roma social and health mediators (how this model worked, which were results of its introduction, that are prospects in Ukraine, how can this model be improved to enhance its performance). Authors hope that the experience of mediators in Ukraine will contribute to that and such a model will be accepted by public authorities, and that it will receive oﬃcial recognition and institutional support. Authors with a group of experts developed recommendations on how social and health model of mediation can be incorporated into the state system of health and social protection. The purpose of the Program initiative «Roma of Ukraine» of the International Renaissance Foundation is to prevent discrimination and provide equal opportunities for the realization and rights protection of the Roma population.

Introduction

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

The pilot Program of introduction of Roma social and health mediators was started on April 2010 in Ukraine, under support of the International Renaissance Foundation, Open Society Institute and Council of Europe. The Main Goal of the Program is to propose for Roma communities the mediation services which will help to resolve their problems in communication with public authorities and obtaining qualified and in-time help.

Before starting the Program there were a number of events. In 2008 with the purpose of endorsement of Program understanding and ongoing introduction, further analysis of Roma conditions, and identifying their needs authorized representatives of the Council of Europe conducted a number of meetings with representatives of ministries and governmental agencies of Ukraine. Simultaneously the management of the Program Initiative «Roma health» of the Open Society institute (Budapest, Hungary) conducted a number of meetings with the Deputy Minister of Health of Ukraine aimed on studying Roma problems in Ukraine. In the course of meetings governmental oﬃcials, including the Ministry of Health, expressed significant interest to studying of European experience of improving the access to medical services by Roma people.

medical and socio-medical services provided by medical personnel and representatives of authorities, in the context of a positive, nondiscrimination and respect for them and communicate with them in the process of resolving their vital issues.

Later in November, 2008 Council of Europe conducted a steering seminar on health problems of Roma in Ukraine. The seminar was attended by representatives of Ministries of Ukraine, UNICEF Oﬃce in Ukraine, International Organization for Migration, World Bank, Embassy of Norway in Ukraine, National Roma Agency (Romania), CSO Romani Criss (Romania) and Roma CSO of Ukraine.

Roma health mediators Program is implemented for more than 4 years. During this time it has a number of achievements, apparent problems yet to be solved, there is a change of the political situation related to «Roma issues».

Delegates of the seminar admitted the urgency of the introduction the Program of Roma mediators. As a result of the seminar was developed and adopted the Declaration «About necessity of Roma mediators on health issues in Ukraine». The most powerful argument in favor of this work is the need for Roma to obtain appropriate

In this project a priority from the start was defined medical care, but during its implementation has not been possible to obtain such assistance at no additional work on paperwork, including passports, obtaining information in medical and other institutions in order to obtain social benefits for seriously ill, disabled, single mothers with children, aged people, homeless and other vulnerable groups of the population. As it turned out, most Roma could not independently and individually decide these issues.

As a result, there is a need to generalize and to structure this Program, define the situation (political and general situation of the Roma community) and outline future prospects of the Romani social and health mediators Program in Ukraine. Thus, the purpose of this report is to determine specific issues of the Roma community, first of all in social and health care; assessment of the state participation in resolving of these problems, defining the role of the Program of Roma

Council of Europe. Special recommendation — Rec (2006) 10 of 12 July 2006 — dedicated to the obligation of states to ensure best access for Roma to services in health care.

The mediation practice is very common in Europe and around the world. These services cover a variety of the most vulnerable people — disabled, migrants, members of specific national groups, including the Roma.

In October 2010, aﬅer a high-level meeting of the Council of Europe on the situation of Roma, member states of the Council of Europe signed the Strasbourg Declaration. The Declaration contains a list of priorities and actions of the Council of Europe. In 2011, Ukraine signed the Council of Europe Action Plan for Ukraine for the period 2011-2014, in which Roma mediators and institutionalization of the Program is a top priority.

Roma mediators program currently works in 20 European countries, including France, Romania, Serbia, Hungary, Macedonia, Moldova, Italy, Bulgaria, Greece, Germany, Finland, Turkey, United Kingdom, Albania, Belgium, Moldova, Spain, Portugal, Czech Republic and Ukraine. In different countries, the practice has proved the necessity and usefulness of Roma mediators in various fields, and therefore are mediators in culture, education, medicine, social, medical, mediators in the community, mediators in employment as well as multi-mediators. In many countries, Roma mediators became the official mediation profession and are regulated by orders of ministries and other central authorities. In some countries there are national associations of Roma mediators. The international community and international organizations (UN, Council of Europe and the European Union) consider the introduction of mediation as an effective and organic method of integration — the «social inclusion» of vulnerable citizens in public and even social and political life. Therefore, in recent years they have worked out a number of international instruments in varying degrees, are binding on the states — members of these organizations, including Ukraine. The active position of international organizations, first of all — the Council of Europe expressed in the recommendations and resolutions of the Committee of Ministers and the Parliamentary Assembly of Council of Europe member states — said of Recommendation Rec (2001) 17 and Rec (2005) 4 with respect to improving the economic and employment situation of Roma and nomads in Europe, Rec (2008) 5 for government policies on Roma and nomads in Europe, № 1557 ( 2002) on the legal situation of Roma in Europe, № 1924 (2010) on the situation of Roma in Europe and relevant activities of the

European Committee on Human Rights sent to Ukrainian government a separate list of critical issues about Roma population living conditions and violation of their rights on the results of the 106th session in which these issues voiced by representatives of the European Roma Rights Centre. The paper highlights the state of affairs in the field of civil and political rights set forth in Ukraine and recommendations, including the rights of Roma. The Committee welcomed steps taken by Ukraine to improve the situation of Roma, including the adoption of the Strategy of protection and integration into Ukrainian society of the Roma minority in the period up to 2020, were also highlighted the importance of effective implementation of protection strategies and the integration of the Roma minority, the Government of Ukraine was called to allocate sufficient resources to achieve this goal. Unfortunately, Ukraine is not sufficiently active participant in international efforts to integrate Roma into society and improve their quality of life. In particular, Ukraine is still not a party to the Decade of Roma inclusion. Decade of Roma inclusion is an international platform, which includes 12 countries: Albania, Bosnia and Herzegovina, Bulgaria, Spain, Macedonia, Romania, Serbia, Slovakia, Hungary, Croatia, Czech Republic, Montenegro. Slovenia and the United States have observer status. Partners of the initiative are the United Nations Development Program, UNICEF, World Bank, Open Society Foundation, European Commission and others. The Platform was established to address discrimination against Roma, who live in member states of the Decade of Roma inclusion and maximize all social processes in these countries.

report/р.

health mediators and presentation of results of its implementation and, finally, recommendations for further Program implementation and appropriate public policy in general.

Introduction

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

As part of the initiative going on an international exchange of best practices for implementation of the state policy on Roma, to coordinate eﬀorts to improve Roma access to education, medicine, employment and housing. On 19-20 June 2013 Ukrainian delegation participated in the 24th meeting of the International Steering Committee of the Decade of Roma inclusion. Currently, joining of Ukraine to Decade actively supported by NGOs, these actions are supported by number of oﬃcials. It is through their promotion it was made possible the preparation of this publication. We are grateful to Roma health mediators and their clients because they shared their problems, results and plans, as well as physicians who cooperate with social and health mediators, national experts, who agreed to an interview. Their estimates, opinions and suggestions formed the basis of this publication.

Methodology used in the publication For the purpose of collecting necessary information for the Report we’ve arranged small qualitative research. The aim of the research is to collect information that will determine the context of health and social problems that Roma population encounter with, to describe the political context that has emerged around the «Roma issue» in Ukraine and make a complete picture of the Roma health mediators program, its content and results.

Research objectives: 1) evaluate access to medicine: challenges and current health and social conditions of the Roma who live in areas of housing and dispersed; 2) describe the political situation, stating that the legal and regulatory framework for the

Roma population operates in Ukraine, the political processes taking place on this issue and what advocacy activities are necessary; 3) describe the nature and objectives of then Program of Roma health mediators , implemented in Ukraine, as well as source through which it is implemented; 4) reveal the means for achievement the Program goal.

Methodical approaches and information sources: 1)

3) 4)

analysis of national and international legislation, scientific and practical publications prior research (desk research); interviews with health mediators and their clients, health professionals and national experts; a survey of medical mediators; participation in working groups / meetings, counseling.

Research methods: — interviews: 1) with three health mediators (Kirovohrad, Odesa, Kyiv); 2) with three health workers who cooperate with social and health mediators (the same cities as mediators); 3) with six clients of social and health mediators (2 customers for each social and health mediators); 4) with two national experts (Representatives of the Parliamentary Commissioner for Human Rights and the trainer program of social and health mediators — the representative of the Training Centre for Hygiene of the Ministry of Health of Ukraine); — questioning of 29 health mediators (see attached questionnaire); — participation in 2 workshops with the Secretariat of the Parliamentary Commissioner for Human Rights Round Table on the development of an Action Plan to implement the Strategy for Social Protection and Integration of Roma people in the Ukrainian society by 2020, and working meetings with representatives of the CSO «Fund» Chirikli» and International Renaissance Foundation.

1. Decree of the President of Ukraine «On protection strategy and integration into Ukrainian society of the Roma minority in the period up to 2020» from 04.08.2013 № 201/2013. 2. Cabinet of Ministers of Ukraine Resolution «On approval of a plan to implement protection strategies and integration into Ukrainian society of the Roma minority in the period up to 2020» on September 11, 2013 № 701-r. 3. Cabinet of Ministers of Ukraine Resolution «On approval of the social order through the budget» on April 29, 2013 № 324. 4. Order of the Ministry of Social Policy of Ukraine «On approval of the structure and staﬀ of republic (Crimea), regional, Kyiv and Sevastopol city, county, city, borough, town and village centers of social services for families, children and young people» from June 8, 2012 № 344. 5. Order of the Ministry of Social Policy of Ukraine «On Amendments to the Order of Ministry of Social Policy of Ukraine dated June 08, 2012 № 344» on September 5, 2013 № 544. 6. Order of the Ministry of Social Policy of Ukraine «On approval of the list of social services provided to individuals who are in crisis and are not able to overcome it» on September 3, 2012, № 537. 7. Order of the Ministry of Social Policy of Ukraine «On Approval of recommendations identifying the needs of the population of the administrative and territorial units for social services» on October 15, 2012 № 648. 8. Coalition of Roma organizations Project under support of the International Renaissance Foundation «Priority Action Plan for implementation of the» Strategy for the protection and integration into Ukrainian society of the Roma minority in the period up to 2020. 9. Project «Improving access to social and health services of Roma in Ukraine through implementation of the Program of Romani social and health mediators», supported by the Open Society Institute and the International Renaissance Foundation, 2010.

10. Final report on work of health mediators in the Transcarpathian region for the period of March-October 2012, presented at the seminar for TB doctors, family doctors and Roma health mediators conducted by ICF «Roma Women’s Fund «Chirikli» together with the Transcarpathian Regional Department of Health and regional coordinator on December 10, 2012 in Uzhgorod, Ukraine. 11. Roma Health Mediators SUCCESSES AND CHALLENGES, Roma Health Project, Open Society Public Health Program, October 2011. 12. The publication «Determination of the level of knowledge, attitudes, practices and behavior of TB in the general population and specific groups of Ukraine. Analytical report of the qualitative component of the study (survey of Roma and attached), under «Stop TB in Ukraine» implemented by Rinat Akhmetov, Development of Ukraine Foundation, Kyiv, 2013. 13. Press release from the round table «Problems of access of Roma, especially children, to social and medical services», http://www. ombudsman.gov.ua/ 14. Press release on the presentation of monitoring study «Respect of Roma Rights in law enforcement» July 31, 2013 at the Secretariat of the Verkhovna Rada of Ukraine on Human Rights, http://www.ombudsman.gov.ua/ 15. Press releases on monitoring visits of the Representative of the Parliamentary Commissioner for Human Right on children’s rights, non-discrimination and gender equality Oksana Filipishyna to Roma-populated areas in Transcarpathia and Odesa, Kyiv City, http://www. ombudsman.gov.ua/ 16. Press release of Zemfira Kondur speech, Vice President ICF «Fund» Chirikli» at the Verkhovna Rada of Ukraine meeting «State of Human Rights in Ukraine» 6/12/2013, the main problems concerning the Roma population in Ukraine.

report/р.

Information sources:

Introduction

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

Access to healthcare Unlike most of other minorities the Roma minority have not their own state. They are long-term residents in diﬀerent countries defined their international legal status as a transnational minority

Roma health condition

In Ukraine, according to oﬃcial statistics, there are 47,587 Roma (Census data in 2001). However, according to estimations their number ranges from 120 to 400 thousand people.

In Ukraine, there is no disease statistics in terms of ethnicity. There are isolated cases, but this information is not transmitted to the general public. We can make any idea about the disease, spread among the Roma population, only by responses of social and health mediators to the questionnaire. Thus, the most frequently mentioned viral, Catarrhal diseases and respiratory diseases (22 mentioned by social and health mediators 29), followed by — TB (19 social and health mediators), which may be due to the characteristics and direction of the project, which are social and medical mediators, third — cardiovascular diseases (12 social and health mediators). In addition, the mentioned social and health mediators skin, gynecological and oncological diseases. According to information provided in their reports of social and health mediators, mainly Roma people suﬀering from infectious, cancer, endocrinological, cardiovascular virus, gastric diseases.

Adverse living conditions of Roma people, including direct or veiled politics of ethnic and socio-economic discrimination, led to a weakening of its integration and the consequent marginalization of certain parts of it. In addition, the Roma is the second largest ethnic minority that has suﬀered genocide during World War II.

According to social and health mediators from Odessa «...doctors pay attention to the fact, that women are giving many births (in the age of 23-25 years, she has 5-6 children), and organism could not renovate, but nobody listen to this. Then infectious diseases, allergy, summer poisoning of children, flu diseases, concentration in residence places promote diseases spread.».

Today Roma, compared to other ethnic minorities, are the most vulnerable and socially maladjusted in Europe, and most of their problems are still important.

Social and health mediators found 524 people with disabilities, only 82 of them are oﬃcially registered and received government assistance for disability.

Section 1

Social and health mediator from Kirovohrad describes obstacles in obtaining health care services related to lack of passports and birth certificates: «First of all, it’s a problem with documents. Roma women have no documents, even birth certificates. Maternity hospitals take them, but they can not register them. In regions they still accept them. The head of the village council make registration records on a husband, but in Kirovohrad (because they have a civil marriage) they refuse to make such a record. Now I have 3 Roma babies born. The chief of medical department make a record from my passport as the one who brought the woman to maternity hospital». The situation is confirmed by results of the research conducted by Rinat Akhmetov’s Foundation «Development of Ukraine» in 2012, «Determination of the level of knowledge, attitudes, practices and behavior of TB among general population and specific groups of Ukraine». The study covered in-depth interviews with 30 Roma and 6 experts (doctors, teachers, activists from among the Roma people — leaders and social workers of relevant NGOs). Experts also pointed out that Roma are oﬅen quite unaware of the legislation, which stipulates that doctors of public hospitals are obliged to accept them (and free of charge) and much of the diagnostic and therapeutic procedures are also available for even low-income people. Research indicates that some Roma people attentive to their health. They are accurate in diagnostics and comply with the recommendations of doctors, but there are very few of them. The majority of this category of patients is quite complicated. In particular, Roma have no preventive examinations, seek treatment

The situation is complicated by the fact that, according to some experts, Roma women can be treated only by female doctors. In particular, it mentioned two respondents who are themselves ethnic Roma. Though perhaps it is determined not so much ethnicity as religion, because among Roma of Odesa region involved in the research there are a lot of Muslims. Distrust of Roma in official medicine and reluctance to seek medical institutions explains how the fear of stigma and discrimination by health workers, and some skepticism about the possibilities of official medicine. For some Roma who do not speak either Ukrainian or Russian, the problem is the language barrier. Such cases mentioned experts interviewed in the Transcarpathian region. In this situation, an alternative to official medicine are folk remedies and alternative healing practices. In particular, the tradition of healing women of the older generation to actively practice the treatment of many diseases with herbs and other natural substances. According to experts, the Roma population, especially those living outside the major cities, prefer such healers (research in the framework of the Program «Stop TB in Ukraine»). Describing health condition of Roma population, it is impossible not to draw attention to their social status, as is oﬅen the health problems associated with poor nutrition, poor quality of drinking water, unacceptable living conditions. Social and health mediator, who is working in Kyiv and Region, said about the Roma Camp, who came from Transcarpathia and settled in Kiev: «They have no place for taking meals in their camp side. They came here to find a piece of metal for sell and buy a loaf of bread». Since 2010, when the Fund «Chirikli» launched the Program for Roma social and health mediators in the community, it was found that about 40% of Roma among from 49 225 have no documents identifying person. This is a major obstacle for obtaining social and health services and respect for basic human rights. Many settlements are illegal, in fact, prevents the registration of houses that were built in such areas.

Access to health care, more precisely problems of access, oﬅen caused by the lack of documents, identification and registration and the lack of funds to pay for medical services and purchase of medicines. In this regard, social and health mediators from Kyiv said: «The problem is that there is not enough funding, and treatment is expensive. We can not provide funding for treatment. It turns, that we can only express our empathy verbally. The best thing we can do is to buy cheapest medicines for our own money».

only as a last resort, and even then can ignore recommendations of doctors. report/р.

Access to medical care and attitude to health

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

report/p.

Living and housing conditions According to a survey of social and health mediators, housing conditions of Roma population remains in critical condition. Almost all families in need of better housing or at least repair of their homes. The majority of Roma families living in damaged houses for 2-3 families in one room, about 9000 people are not registered, according to mediators’ data, 193 families have no homes and live in tents and other types of temporary accommodation. 1 967 families are in need of funds to repair their homes, about 1 283 Roma families living in terrible conditions (5-10 families in one house). In addition, places Roma settling do not have centralized water supply and sanitation. Almost every Roma family needs financial assistance. Basically — assistance in obtaining treatment, food, clothing and shoes for children.

in employment centers, only 217 of them were employed.

Discrimination Interviews conducted during the preparation of this report also demonstrate the presence of discrimination against members of the Roma community by health professionals. Thus, social and health mediators of Kirovohrad says: «..despite the familiarity of the chief doctor, they do not want to work with Roma women. It happens in almost 50 % cases. Then I had to go to the Head of the Department of Health. Since I knew her, I came and described the situation, she picked up the phone immediately and phoned to the hospital, said that this is a national program, insisting that it should be done, despite the diﬀerent possible nuances. So this was done at the level of Head of City Health Department».

193 families have no homes and live in tents and other types of temporary accommodation

Employment Social and health mediators analyzed the state of the employment of the Roma population in the 12 pilot areas and reported that most of the Roma suﬀer from mass unemployment. Roma, for various reasons, are unable on equal grounds with the general population to receive benefits and government grants, bank loans. Part of Roma work on seasonal jobs or go to work outside their regions, many Roma have to either beg or settle for odd jobs.

Responding to questionnaire, 19 social and health mediators indicated that occasionally there are cases of discrimination against the Roma population, seven said it is rare and one gave contradictory answers that it happens oﬅen or that does not happen at all. Only in one case, when indicated in rare cases of discrimination dealt with Roma living in camps, in other cases it was dispersed accommodation. In general, it should be noted that in a dispersed accommodation Roma people are more socialized easily turned for help to experts and meet with fewer obstacles in obtaining this service, this also applies to attitudes of health professionals.

Documenting During this period in 12 pilot regions was conducted 84 focus groups on employment of the Roma population. 1 456 Roma were registered

The lack of a permanent job oﬅen also caused by the lack of documents, making it

In the course of problem prioritization «health problems» took third place aﬅer «unemployment» and «poor housing» so many more children growing up. There are no passport at the majority of inhabitants of this street. Main problems are: 1) passports: youth must carry passports, because police will catch them and

extort the money, 2) the second problem is poor housing, 3) work, 4) education — they go to Sunday school (learning to read and write) ashamed, they are adults, some even married, they feel ashamed to go there» (client from Odesa suburbs). According to reports of social and health mediators, about 9000 Roma in 5 pilot areas of implementation of the Program requires registration, this leads to the restriction of access to social and health services and educational services.

Currently, there are the following problems:     

The absence of registration of the place of residence and house — keeping books; lack of birth certificates; no personal or family housing; lack of education and poor awareness on the importance of documents, identifying them; lack of funds for production of relevant documents and to pay fines.

Interviewing of 29 social and health mediators in the course of preparation of this report gave the following results. During the prioritization of problems «health» took third place — aﬅer the «lack of work» and «poor living conditions.» Further problems are located as follows: the 4th place is «absence

report/р.

impossible to get. In this procedure passportisation with a significant delay (several years or even decades) is very diﬃcult. There is simply no procedure when a birth certificate is absent: the decision issuance of the certificate and passport can take only the court, but for writing a claim to the court you must have a passport. Here we can see a vicious circle. Moreover — women who do not have documents, identification, have children, and they, in turn, could not get a birth certificate because they can not write down the mother who has no documents. Here we provide citation from interview with one of mediators from Odesa: «For example, one Internet site says that the lack of registration can not be a reason for refusing to issue a passport. So, I have not had a single case of the passport issued to someone without a residence permit. Although it is written that you need birth certificate to obtain a passport, filled application, a few photos, but grows into a pile of certificates, certificates of village council, help with school, certificates of family members, photocopy of the passport of mother, father, etc.». Barriers to receiving services may also be part of the Roma population illiteracy and reluctance to demonstrate this ignorance. From Odessa again: «… there is also a question of proceeding with marital payments on child birth, some illiterate Roma could not make applications, and I do this for them». Here are few words about their problems: «He (social and health mediator) made docs for everybody in this street: for my niece and for 2 other girls. He probably could make passports for everybody, but he has diﬃculties — not everybody has residence permit. There is nothing in these houses, no house keeping book, where we can register and there

Section 1

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

of passports» and the 5th is «poor education», the sixth is «problems with processing of various documents (the right to property, disability, social benefits.), the 7th is problem with law-enforcers. While conducting research under the «Stop TB in Ukraine» Program Roma questioned whether they turn for help if they cough over 2-3 weeks (the main symptom of tuberculosis). The majority of respondents (23 people) chose the aﬃrmative answer. However, only 9 respondents declared their willingness of timely medical intervention. Significantly more respondents (14 people) specified prerequisites visit to the doctor — medical services must be free of charge and / or very poor health condition / ineﬃcient self-treatment.

Every third respondent said that Roma in-time application for medical assistance will help provide totally free or at least aﬀordable treatment or assistance in the form of food rations for needy Roma (10 people) and a general rise in the standard of living members of their community (2 people). Also, a third of respondents (10 people) drew attention to the personal factor: everyone has to take care of their own health, and if he or she doesn’t care of his/her health, than it is useless, even if the state will create perfect conditions.

In 2003, the Cabinet of Ministers of Ukraine approved a comprehensive document on Roma — the Program of social and spiritual revival of Roma in Ukraine for the period until 2006, measures which were aimed at resolving of ethno-social and ethno-cultural needs of Roma population. In particular, Program stipulated phased work on establishing conditions to meet the educational, cultural and social needs of the Roma population

This Strategy is complex, but a framework document and the Action Plan was developed for its implementation. The Ministry of Culture of Ukraine is responsible for its development and subsequent implementation. Such commission for Ministry was a challenge, because the plan was to include a range of measures to integrate Roma in Ukrainian society, and as seen from objectives of the Strategy, only a small portion of these measures should be aimed at meeting the cultural needs. Considering wrong profile of the responsible ministry, professionals working with Roma issues, raising fears about the ability and willingness of Ministry of Culture to write a document that includes specific measures to implement the Strategy. Unfortunately, due to inadequate attention to the implementation of the Program measures any significant changes were achieved in the socio-economic and material living conditions of Roma population, and much of the action was not performed because the state budget did not provide funds for its implementation. Today, the only legal document with the subject of protection and integration into Ukrainian society the Roma minority in the period up to 2020 is the Roma Strategy approved by the Decree of the President of Ukraine № 201/2013 of 24.01. 2013 http://www.president.gov.ua/ documents/15628.html The Strategy defines the main objectives in areas of legal protection of Roma, social security and employment, improving education level, health care, improved living conditions and meet the cultural and information needs of Roma.

The Representative of the Parliamentary Commissioner for Human Rights said: «In addition to the Presidential Decree on the Strategy, there are no documents regulating or singled out Roma issues at the level of the regulatory framework. And expressing concern that there is a risk of lack of concrete steps in Action Plan by the public authorities aimed to draw attention to solve the real problems of Roma... In our view, the Action Plan should include not just the specific steps to improve the situation of Roma it also has a quantitative and qualitative indicators, to which the Sate wants to come to Ukraine in 20 years, which is designed to implement the Strategy. And of course, in addition to these indicators should be established timeframes of step implementation. It should be clearly control document as having continuously monitored implementation. Risks concerning specificity of the Action Plan and their causes are completely on the surface. The

11 report/р.

Political situation with Roma people in Ukraine

Section 1

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

first risk, in our opinion, due to the fact that the Ministry, which was entrusted to be responsible for the development of the Action Plan is not the Ministry, which should be the main topic on this: The Ministry of Culture may at meeting of the Government raise the issue, underlying problems of Roma must be addressed by the Ministry of Social Policy... In our view, while it is not too late, the issue should be transferred to the responsibility of the Ministry of Social Policy, as most of steps are within its jurisdiction. This is a question for the Government is quite simple thing: just make Government instruction for consideration of the issue by the Government, and the initiative may come from the Ministry of Culture, which is now put on this responsibility. Ministry of Culture may at a meeting of the Government to raise the issue, discuss, consider, discuss, including the Presidential Strategy. The decicion must be at the level of Mininstries which Ministry should be the determining factor in the implementation of this Strategy. This question may be raised at the meeting of any of the members of the Government, the main thing is the interest in question». Round table discussion which took place confirmed fears of experts. During the discussion was proposed project of Culture Action Plan to implement protection strategies and integration into Ukrainian society of the Roma minority in the period up to 2020. Proposed and subsequently approved Action Plan also looks like a framework document, which requires specifying at the level of each Ministry, prescribed in the Plan, as an executor of certain measures. The problem of lack of indicators in the Action Plan was raised by UN Advisor on Human Rights in Ukraine. Attention is drawn to the fact that Mininstry of Culture is responsible for only 9 of the 74 measures proposed by the Plan. Here lies yet another risk — the main performer can not be responsible for the implementation of the planned activities, as funds for these measures should be laid in the budgets of other central and local executive bodies. No one knows how other actors would be interested in the Roma issue to defend the required amount of funds to the Ministry of Finance of Ukraine. The Representative of the Ombudsman also drew attention to this problem. «Today from the side on the Ministry of Culture, there is the same danger for implementation of the Concept of juvenile justice when the main developer of

the action plan and responsible for reporting to the Government is the Ministry of Justice, and the plan does not include any position for which the Ministry of Justice would be consistent: these are Mininstry of Interior, the State Penitentiary Service. And here is the same. In our view, when it is not too late, this issue should be transferred to the responsibility of the Ministry of Social Policy, as the majority of steps are within their jurisdiction... a risk that the plan will not be eﬀective is that it can not get enough funding. Although, strictly speaking, the Strategy is funded from the state budget. We still waiting from the side of interested Ministries, responsible for implementing this Strategy, formulation of some particular steps and prove to the Ministry of Finances, that these steps require certain investments. Aﬅer this we are going to evaluate intention to implement this Action Plan by Ministries.» It should be noted that at this roundtable for discussion of the Action Plan on implementation of the Strategy there was no representative from the Ministry of Social Policy of Ukraine. Similarly were absent representatives of the Ministry of Justice and Ministry of Health. This level of interest can not provide hope for further active involvement of Ministries in implementation of the developed Action Plan. Realizing the complexity of the task for the Ministry of Culture to prescribe specific actions with clear results and time-bound, non-governmental organizations, especially the International Renaissance Foundation and «Chirikli» involving directly the social and health mediators, produced a number of proposals for amendments to the draﬅ Plan presented by the Ministry. In addition, organizations have prepared an alternative draﬅ of the Action Plan, which contains very specific steps, actors and sources of funding. However, the proposed plan was not considered at the meeting, attempts to flesh out the proposed measures were not supported by representatives of central authorities. The main reason for them was established format and level of such documents. Representatives of nongovernmental sector are convinced that each of the mentioned actors in the Action Plan will prescribe a specific operational plan of activities to implement measures that are specific to their plans which will be approved by the Cabinet of Ministers of Ukraine. It is quite logical, but please keep in mind that in the approved Plan by the Cabinet of Mininsters there is no requirement to

During the discussion of the draﬅ Action Plan was identified another problem. Approaches and requirements for registration of certain documents were approved in legal acts and are common for all citizens of Ukraine. It does not take into account the specificity of Roma population. In particular, there are difficult registration procedures for ID cards (birth certificate or passport) with significant delay and you need to collect large amounts of information, plus residence registration. It is almost impossible to issue a passport for the person if he/she never had a birth certificate. You can not get a birth certificate for the child if parents have no documents of identifying their person. In such extreme cases, the issue can only be resolved through courts, but the person who does not have a passport and oﬅen still illiterate, unable to submit an application. These stringent requirements are one of the main reasons why passportisation of Roma remains an urgent problem for a long time. There is a need for the introduction of simplified algorithms for obtaining documents of identification for Roma population at least for a limited period. Such measures were taken, for instance, in Moldova. But it is necessary to activate the maximum Roma organizations and communities to ensure an adequate level of informing the Roma population and their applications to relevant agencies for documents. Similarly, the same approach is to work with individuals and families who are in difficult life circumstances. Here is what on this occasion the Representative of the Parliamentary Commissioner for Human Rights said: «The basic layer of problems that Roma face today and which are derived to further their difficulties lie in the plane of social issues. For example, for many of them is unwillingness to be responsible parents, these are people who are not trained to live in a particular living conditions, support their children. Historically, people need to teach responsible parenthood. If we have such programs, and the Ministry of Social Policy is oﬅen states this, the training program for responsible parenthood must be oriented on Roma in a certain way». That is, in Ukraine there are many programs (social, health,

education, etc.) that are aimed at the entire population, but they do not take into account the specifics of its Roma part because these people are outside services, privileges, programs, and society in general. There is an urgent problem in the absence of such programs — both national and local — set clear conditions that would allow them to include Roma population. «Let us speak frankly: we are talking about the general social problem, in fact, a crisis in the family, regardless of ethnicity is a crisis in the family, interests of every child (regardless ethnicity of Bulgarian, Romanian, Russian family) need equal attention, caring love, material investments, living conditions. Children in all families need the same. Therefore, principles and approaches must be equal. But aﬅer today’s situation of Roma burden on the social worker should be reduced and should be specialized to needs of social workers of Roma community» (Representative of the Parliamentary Commissioner for Human Rights). Another obstacle on the path to effective implementation of the Integration Strategy of Roma population and the Action Plan for its implementation is the inconsistency of official statistics on the number of Roma in Ukraine with real figures. Strategy includes figures that were obtained during the census in 2001, i.e. 12 years ago. This was indicated by the Representative of Ombudsman: «However, when you get Roma inclusion strategy, we see there is a number of 40 or 45 thousand Roma population, while only 6 regions are on the list where the most densely populated Roma people. Thus, compared to the 47 million population — 47 thousand is a small district center. Is this a problem for high state official in Ukraine? So what is the problem of a small district center in a multimillion country? While we will not talk loudly that the Roma problem is the problem of not just one person, this community is quite large, we have to understand the scope and nature of problem, first of all, then, I think there will be more people who will hear it, talk about it and maybe turn to the problem». General question of statistics in the context of ethnic minorities in Ukraine is ambiguous. On the one hand, belonging to this or that nationality is personal data of person. He/she is not obliged to inform anyone about nationality and nobody should ask, because regulatory framework in the country applies to all citizens, regardless

report/р.

all actors of the Plan to develop, to approve and implement their sectoral operational plans of the general Plan. While representatives of several key ministers at the meeting were absent we can not be sure that the Ministry will design and implement such detailed plans without specific instructions.

Section 2

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

of nationality. On the other hand, statistics availability on health and social problems and level of passportisation and other aspects would help to plan adequate steps to address these problems. As in other issues, it is important to withstand the «sweet spot». Ombudsman Representative said: «I can’t unequivocally say: you do not need to keep statistics on Roma. Because it can be interpreted ambiguously why we have statistics for a national minority? It can be interpreted as a kind of discrimination against certain ethnic groups. But on the other hand, in order to influence the situation, we have to know the extent of the problem. When introducing statistics on Roma, it should be very reasonable and aimed only at making improvements. It should not be statistics on crime, sentencing and so on. It must be social statistics: the access to educational services for documentation, to obtain assistance in accessing health services. This should only be a statistic that indicates whether the state is solving problems».

general meaning than within the framework of Roma social and health mediators. This is confirmed even by the law, at the round table spokeswoman from the Institute of Legislation of the Verkhovna Rada of Ukraine even said that it is advisable not to use the term «social and medical mediator» or «facilitator» in some context, except as expressly provided by law. The order of the Ministry of Social Policy dated from 03.09.2012, № 537 «On approval of the list of social services provided to individuals who are in crisis and are not able to overcome it» also has a slightly diﬀerent context of service mediation. Order defines this service as an aid in conflict resolution, negotiation, processing conditions and ways of resolving conflict. Instead, the content of mediation in the Roma program is much broader and includes elements of social adaptation and integration, social support, and even representation of interests. Second, the important question is how they (if not international aid) will receive funds to pay for activities of social and health mediators? There is no special program at the state level. Local budgets too oﬅen are short of funds which prevent local authorities of taking on additional responsibilities.

Besides the President Decree and Cabinet of Ministers Ordinance there is no other document for regulation or emphasizing «Roma issue» on a legislation level Institutionalization of social and health mediator Currently profession of Roma social and health mediator or Roma health mediator is not oﬃcially recognized in Ukraine. It is prescribed only through grants/projects that are implemented by non-governmental organizations. It can be formalized by including it to «classification of professions» to the extent approved by the Order of the Ministry of Social Policy. But at the moment there are significant barriers to the implementation of this task. First, terms «mediation» and «social and medical mediator» or «facilitator» has broader

To resolve this situation we propose to use the resource of 12 thousand social workers. These additional positions have been introduced in response to the President’s initiative about a year ago, and their network covers the whole Ukraine. In particular, this proposal came from the Representative of the Parliamentary Commissioner for Human Rights. «If we talk about the system of social and health mediators, which is currently being implemented by NGOs, then in my opinion, we have to act in completely clear, legitimate and transparent way, which is now feasible. We know that a year ago social initiatives of the President were introduced and were allocated 12,000 social workers additionally and they have come to a place at the level of

Similar solution was presented by trainer of program for Roma mediators in Ukraine: «...we recently had talks about the necessity to hold social and health mediators oﬃcially. It is certainly very ambitious plans and for this we should make some changes in many legal acts. Ideally we have to develop new professon in the classification of professions «socio — medical mediator» following the example of Romania. We have a profession of «social worker» and we could make a specialization «social worker for Roma communities». We even have already developed a strategy for changes: where make changes, how make changes of series of orders the Mininstry for Social policy. For doing this in every region we should expand the number of social workers for Roma communities exclusively. It’s long, it is not easy, but we will try. I had a conversation on the subject with Department for Migration of Ministry for Social Policy. The introduction of such a position of sociomedical mediator is necessary because, the biggest motivation to work is formal employment and wages. I have lobbied the idea that this should be a social worker from the Centre of Social Services for Family, Children and Youth. When we analyzed the profession of social worker or employee, we

decided that for our social and health mediators is more suitable «worker» because the employee needs special education and for «worker» secondary education is enough». Social and health mediators have diﬀerent thoughts how to consolidate and fund their profession at the national level. There are those that fully support the idea of distributing responsibilities of social and health mediators on existing social workers: «I think the duty of social and health mediator must be part of the duty of social worker to inspect communities. Because this is not some sort of a separate post which will cost a lot, I do not really believe, but this job shoud be done and it might be a social worker» (Kirovohrad). There are those who see risks of the «absorption» by social workers profession of social and health mediators: «We need to develop a state program with profession coding as it was done in Romania. Responsible Ministries should be either Ministry of Health or Ministry of Social Policy. Social mediator work has a great specificity, moreover, the social worker has salary of 1050 UAH and you need to stay there all day long. Mediators in solving the problem oﬅen need to travel around the city and district, visit registrar, archives, passport oﬃce an make other documents. The salary should cover these costs, otherwise it will all be fiction. People will just sit, write some papers and do nothing»(Odesa). Part of social and health mediators have pessimistic attitude towards state support of the Program: «Concerning the future of mediators now I don’t forsee any state support. I have greater hope for finding new donor» (Pereyaslav — Khmelnitskiy). Trainer of Roma mediators Program in Ukraine sees output in the organization of Roma mediators at the local level: «Concerning the Program, we have strong results of cooperation with state authorities on local level. For example, it is well established cooperation with local authorities in Transcarpathian region. We still have no mass results on many regions and they are very dependent on how social and health mediators established communications with local authorities in relation to Roma in general, avoiding bias, discrimination, because some people in regions can not step over it. There are no regulations or some other document, except for the Strategy, which is a very common instrument, which would apply to all Ukraine, so we can talk about the implementation of the Program of social and health mediators on a local level».

report/р.

villages, cities and work with the community. It seems to me that we should immediately start a dialogue with the Ministry of Social Policy, as the main implementer of this social initiative. Now, as far as I know, they have not clearly spelled out responsibilities of social workers. Today we must ask the question of what should be developed specific training programs and training of social workers to work in Roma communities. Furthermore, we must anticipate that in Romapopulated areas, such quota as social workers for a certain population should be increased, because problems in these communities are usually more complicated than regular population has. And I think it’s a real chance, which must be used. If Roma Camp will have 2 social workers, we are not saying that it must be social and medical mediators it would solve a lot. If we look at qualifications and duties of ordinary social workers we see a focus on services (social, psychological, legal). That is, in fact, the full range of services that are now engaged in social and health mediators. We just use this chance. I do not see the need for entering the profession of social and health mediators separately in the classification of professions, I believe that suﬃcient resources are available, they should be simply properly redistributed, they need to be used in this regard».

Section 2

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

If we return to the Action Plan for implementation of the Strategy, then there are no measures that would clearly indicate on the implementation of the program of Roma mediators directly or indirectly through social workers/employees, but instead, the draﬅ Action Plan, which was proposed by NGOs contain special measures for implementation for work with Roma population. Thus, we can only hope that the proposed NGO activities will be included in the Sectoral Operational Action Plan of the Ministry of Social Policy of Ukraine.

However, experts believe that the involvement of Ukraine to the Decade provides additional opportunities to address Roma issues. Olga Zhmurko, Head of «Roma of Ukraine» Program (International renaissance Foundation) noted that «within the Decade Ukraine will be able to get access to the best practices in the integration of the Roma in other countries, to expand the educational program for Roma children, to gain access to other social programs for Roma who are working successfully in other countries». Representative of the Parliamentary Commissioner for Human Rights: «Roma decade is providing an opportunity to address Roma issues with additional financial sources, the European Commission funded mostly Roma programs in

We hope that proposed by NGOs events will be included into departmental operational action plan of the Ministry of Social Policy of Ukraine countries that are members of Roma Decade, and this positive aspect must be considered».

Decade of Roma inclusion An extremely important task for the Ukrainian state, which aspires to become a full member of the European Community, now is the creation of a basis for social integration of Roma in the Ukrainian society. Participation in the Decade of Roma inclusion has opened perspectives for Ukraine to participate in international initiatives and European Union programs aimed at the development and implementation of national policies for social inclusion of Roma. But Ukraine is not a party to the Decade. And according to the Representative of the Parliamentary Commissioneer for Human Rights «The Government now is not even considering this issue. These questions are challenged by NGOs, human rights organizations, there is a certain appeal for the Roma Decade. But at the Ministry of Culture, which was again defined as principal, and at the Ministry of Foreign Aﬀairs the situation is not moving».

In addition, according to the Representative of the Parliamentary Commissioner for Human Rights, «the issue of Ukraine’s joining the Roma Decade would be a very positive development, including improving country’s image as one that has decided to return to issues facing Roma and announce it on international level. In addition, participation in the Roma Decade is high-level conference mainly involved top oﬃcials (level of deputy prime ministers, ministers), is a high level of communication and exchange of experience». But if there are so many benefits of Ukraine’s participation in the Decade of Roma inclusion, the question arises: why our country has not joined this initiative yet? The only risk associated with Ukraine’s accession to the Decade, identified by Representative of the Parliamentary Commissioner for Human Rights: «Of course, the risk is that members of the Roma Decade assume certain obligations and that financial liability —

Today NGOs are not abandoning their attempts to influence the people who make the decision on Ukraine’s accession to the Decade of Roma inclusion. Olga Zhmurko, head of IRF «Roma of Ukraine» Program emphasized that the Program initiative «Roma of Ukraine» actively promotes the dialogue between the Secretariat of the Decade and representatives of the government of Ukraine to clarify prospects, commitments and additional features related to the accession of Ukraine to this international initiative. Perhaps Ukraine’s accession to the Decade of Roma inclusion will happen when oﬃcials realize that problems of the Roma population is not a problem exclusively of ethnic groups, but a problem of Ukrainian society. That’s what Representative of the Parliamentary Commissioner for Human Rights said, «insulating the problem of Roma without solving, the state only deepens the situation and the crisis of the Roma issue. Now, the number of children in Roma camps is growing exponentially, including the

factthat payments for birth, baby care, benefits for single mothers today have grown significantly. Accordingly, at times increasing the number of children born. The number of people today who are not educated, not well maintained, have no vaccinations are unemployed population that does not have the habit of keeping a certain way of life. And of course, with the increase of the number of risk to others on all parameters (epidemiological situation, large numbers of starved people that can not find a job because of lack of occupations, knowledge, skills, abilities) will increase. In the interests of the Ukrainian state is to teach them, give them a job to ensure their safety and health. This is a security for the nation as a whole. I’m sorry to say... the comments from ordinary citizens to my monitoring visit was purely negative, there was a conviction of visits to places densely populated by Roma. The reason for this is certainly stereotypes. These stereotypes need to be broken. People need to be explained that Roma aren’t more dangerous than other categories of the population. Roma child could if it is put behind a school desk and give the opportunity to learn 1, 2, 3 education level, learn a foreign language and communicate to others».

report/р.

an annual fee of 20 thousand Euro. And for the government — it is an obligation that must be fulfilled».

Section 2

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

Roma health mediators activity

The project started in April 2010 with 14 Roma mediators working in 5 pilot regions of Ukraine. In 2012, the number of mediators was increased to 50, the program was run in 12 regions of Ukraine: Odesa, Lviv, Transcarpathian, Donetsk, Kyiv, Zaporizhzha, Kherson, Kharkiv, Dnipropetrovsk, Luhansk, Kirovohrad oblasts and Crimea

Fund «Chirikli» provided assistance to mediators-pioneers and solved issues of the normative and institutional framework of their activities with the advice and with the support of the Open Society Institute and the International renaissance Foundation has established work with authorities of Ukraine, which jurisdiction includes the issue of health and social services for adults and children, registration services, and training projects required regulations. Due to this cooperation we have developed criteria for the selection of candidates for Roma mediators, draﬅ provisions on intermediary instructions for daily operation of the organization, established contacts and cooperation with the relevant ministries and departments of the local authorities.

It has been prepared and published 2 types of manual-guides to the legislation of Ukraine, which provide answers to the most common questions that Roma mediators respond. «Practical Guide Directory for citizens to acquire legal status and public services» issued to help Roma and Roma social and health mediators for inspection and use in solving issues related to obtaining health and social services, as well as identification documents — birth certificates, passports of citizens of Ukraine and passports of citizens of Ukraine for traveling abroad to obtain preliminary information on rights of citizens in their relations with public authorities. Gaining this knowledge, citizens’ awareness of their capacity and ability to use constitutional rights has greatly facilitated resolution of cases. During the project it was revealed the need of information and methodological support for daily work of Roma social and health mediators. Therefore, analyzing the most pressing problems that were outlined by them, prepared a second practical guide for Roma social and health mediators on organization of work in Roma communities. This manual is issued to help the Roma social and health mediators and Roma to increase awareness and use in solving issues related to obtaining of health and social services, and primary information on rights of citizens in their relations with public authorities. Together with UNICEF — Ukraine we have developed informational materials for Roma communities on the following topics: maternal and child health, development of children from birth to 5 years, reproductive health, and breast cancer. Materials distributed by Roma social and

Roma social and health mediators have been trained under the program of the Council of Europe ROMED and training program was approved by the Ministry of Health of Romania. In 2012, aﬅer the end of the training course program developed by the Council of Europe and the Centre for Hygiene Health of Ukraine, mediators got their certificates. «Mediator training course was in Romania, I received certificate there, then- in Slovakia and once again — in Romania. Issues of mediation, social centres were covered by International renaissance Foundation and «Chirikly» (social and health mediator, Odesa). In general, the project «Roma social and health mediators» aims to improve the health of the Roma through strengthening self identification of Roma communities and improve access to health and social services.

     

Selection criteria for mediators 



 The main objective of the project is to propose for Roma communities mediation services that would solve a number of problems both in their relations with government agencies and providing with qualified and timely assistance, and also help to raise awareness among Roma in Ukraine on health care system, the possibility of treatment, including tuberculosis, but would also provide a referral system between NGOs and the medical and social institutions. The project involves the organization of Roma social and health mediators in twelve pilot regions of Ukraine, namely: Odesa, Transcarpathia, Zaporizhzhya, Kharkiv, Kherson, Luhansk, Donetsk, Dnipropetrovsk, Kirovohrad, Kyiv and Lviv oblasts and Crimea, which is to introduce best practices in European countries with the professional training of Roma social and health mediators and institutionalization of their work in Ukraine. Health mediators have a status of technical performers and must have at least secondary or special secondary education and special training course for medical mediator. The mediator should have experience with Roma population, must be fluent in Ukrainian and other languages that speaks the local Roma population.

The work of health mediators guided by: legislative and normative acts regulating the appropriate issue; sphere of social and legal relations; teaching materials relating to issues of work; regulations of labor discipline and ethics of communication; rules and standards of hygiene and safety; guidelines of the Project manager.



At least secondary or special secondary education, medical or social education provides an advantage, but not mandatory; communication experience with Roma population, Ukrainian language and other languages that local Roma population speaks; the person must have good communication skills and knowledge required to communicate with local government, health, social institutions and communities; to have credibility in the communities in which it will operate, and have easy access to Roma communities; personal qualities related to this position: discipline, punctuality, willingness to learn and ability to absorb information associated with the work, and a sense of responsibility; the ability to be a bridge that connects the culture of the community with a national culture; moral and ethical qualities, community recognition, the ability to observe the principle of confidentiality.

Social and health mediator duties:  To identify members of Roma population in need of health and social care that is concerned with ensuring their access to health services («I want to bring a district or family doctor here in every home, and get friendly relations with everybody. We need to start a database». Social and health mediator, Pereyaslav-Khmelnitsky);  Establish cooperation and cooperate with health care providers and (inform them about Roma population in need of medical assistance (including in connection with tuberculosis, skin, venereal and other diseases). («I’ve started my work with the fact that I met all chiefs of clinics.

report/р.

health mediators during the focus groups, visits to Roma families or at individual meetings.

Section 3

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

I’ve described the problem, they agreed with me and decided that we should work in this direction... We have connection with TB hospital, they have a mobile X-ray unit, they have driven around the area looking for Roma settlement to arrange X-ray inspection. We’ve already covered 3 districts, and by the end of the year we plan more. There are schedule and routes of mobile fluorography and we are trying to coordinate with it. The unit reaches not only districts in region, but in the remote districts of Kirovohrad where private houses prevail». — Social and health mediator, Kirovohrad);  Apply with the request for a patient who need help at home and in hospital (including snding to TB or other specialized hospitals). («We need to convince the client in the necessity of examination, organize them, and they agree, for example to get X-ray but they are afraid of possible mistreatment in hospitals. Therefore we’ve agree as follows: we meet at the hospital and then I will bring them wherever it is necessary. We should accompany not less than 50% of our customers». Social and health mediator, Kirovohrad);  Send physician / medical assistant / nurse observations regarding the general condition of patients treated at home (pain, fever, cough). («First of all, I come and tell what they need to do: pass inspection (not just TB), start a medical file for all family members. Previously, there was a program for prevention of oncological diseases — for women, they had a mammology, if necessary, some even bring a notebook to start a medical file for a child. I spoke about the necessity of vaccinations, although some Roma refuses.

When we are planning activities, such as mobile fluorography or routine vaccination, I bring these people there, they all are being inspected». Social and health mediator, Odesa);  Facilitate the monitoring of the health status of Roma women about early detection of gynecological diseases to prevent complications of pregnancy, childbirth and the postpartum condition («Then I’ve visited all maternity hospitals and antenatal clinics. Chiefs of maternity hospitals told me: «We will not accept unexamined patients. We accept this lady because she is about to give birth, we will inspect her here and the rest of patience must have medical files». So I had to go round all antenatal clinics and they are very tough treated to the fact that it was a woman directly from their district, even if it’s a woman without registration, they wrote for her actual residence and the neighboring districts did not, so I had to go round them all». Social and health mediator, Kirovohrad);  Cooperate with health care institutions and local authorities with the purpose to endorse support sanitary and hygine condition of Roma settlement («We’ve talked with medical assistant and district pediatrician about the fact that they all need to pass quarter anthelmintic prophylaxis because they constantly send a few people from school. They are being treated, give anthelmintics, but because they live in the neighborhood and there are cats and dogs, they get infected again in 2-3 months. Then we discussed this issue and came to the conclusion that we need to treat them all there at once to solve this situation. Probably we will start this in fall before the school». Mediator, Odesa);

The Project of Roma social and health mediators is directed on improving Roma people health

 To inform the Roma population on the types of services provided by health care facilities and social service agencies and provision process, including disseminating information materials and instructional materials («I told them where are clinics, where are doctors. When they might have a disease, I will also help». — Social and health mediator, Odesa);  Independently and / or with health professionals, competent non-governmental organizations and media arrange information and educational work among the Roma population regarding the usefulness of medical, social and educational services to promote healthy lifestyles, family values and responsible parenthood («The goal is to liberate the people, and that they are too closed and difficult to get contact with the medical profession, with different agencies. They are hard to open. It is especially hard to stir unfamiliar audience. Therefore, the mediator should be local, from their environment, it is very important». — Social and health mediator, Pereyaslav-Khmelnitskiy);  By cooperating with local authorities to promote the registration of Roma people without documents who need medical care or social services («The mediator helps to make documents (passports, birth certificates, registration), provide material help: firewood, clothes and food for the poor.» — Client, Odesa; «He helped everybody, he made a passport for my niece, he restored electricity supply to our house, we had a fine, we were cut off, he helped. He goes from house to house asking whether who needs help. Most of requests are passports, some papers if necessary». — Client, Odesa);  By cooperating with local authorities to promote the registration of Roma children and their access to health and education services («He

made birth certificates for children. He organized a Sunday school, children study there». — Client, Odesa; «When I’m helping to make documents such as a birth certificate out of time when the child is 3 years old, I need help of health professionals, such as a certificate from a medical assistant, it must be certified by the district dispensaries. Finally, in the presence of the mother and the child it is being signed by the district pediatrician and I carry these documents to the registrar. Plus I need certificates from archives that he/she had never had birth certificate and he/she is receiving birth certificate. Therefore it is important for me that paramedic and midwife knew them as those who have medical files». Social and health mediator, Odesa);  Involve Roma population in the daily work for resolving sanitation, health and related social problems. That’s what they say about the work of social and health mediators doctors: Odessa: «She helps us all: child carries on X-ray and medical examination, was Krasnosilska clinic drove children to routine medical examination, collecting all the children, we were brought to the vaccine, the cloak, he collected all brought. They do not have to pay so much attention, But take maximum, he talks to them and they listened.». Pereyaslav-Khmelnitsky: «The primary goal of social and health mediator in his work is to organize a medical examination, to control how they pass it, all of them or not all of them, then see what is the result, how many patients in which familywere revealed. Then working with us to determine how we can continue to ensure that this person was treated and all other family members were examined. Especially if it’s tuberculosis».

Social and health mediator must not:  Make injections, even if she/he has special training;  Engage in political activities, conduct political agitation among Roma population, not to confuse the role of social worker with the role of leader;

report/р.

 Establish cooperation and cooperate with the local government in issues of registration of social assistance and pensions for chronically sick, disabled, families with children, mothers, and in matters of employment and, if necessary, qualification, re-qualification or unemployment benefits («Also about employment. If they have the desire, I take them set on record to the employment center with the subsequent possibility to take courses, if necessary — to give recommendations». — Social and health mediator, Odesa);

Section 3

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

 Resolve any conflicts on their own, especially those that are not related to access to health care and related social services as social and health mediators are the only tool in the solution of the conflict, rather than any defender of any kind of interest;  Guarantee or promise immediate and complete resolution of problems, because any delay or hindrance destroy the credibility of the Roma community and the government;  Require or promise property or monetary reward for assistance and help in getting health and social services and registration services (documentation); To work with long-term and short-term plan, in this case work of social and health mediator may be equivocal. In addition, health mediator must respect the culture and traditions of the Roma population, to recognize and accept their needs in dealing with health and related social problems, remember that the behavior of the medical agent must be correct and persuade that he/she is trustworthy and care for the Roma population and the local government; promote awareness among the Roma community rights and obligations of a citizen of Ukraine; observe the ethics of business communication and negotiation between representatives of Roma community and local authorities; facilitate the formation and consolidation of the representatives of local government attentive to social, health and cultural and educational needs of Roma population. An important prerequisite for the success of the health mediators is the establishment of close cooperation with the Roma community as well as with representatives of the medical, social, educational spheres and local administration. The survey results show that the average estimation of social and health mediators and their cooperation with specialists of various fields is quite good, from 3.4 to 3.8 with a maximum rate of 5 points. 21 out of 28 respondents among social and health mediators evaluate their level of cooperation with state structures positively, 25 respondents are satisfied with their interaction with the community. There is an interesting cooperation experience has health and social mediator in

Odesa: «Local authorities: I have good relations with physicians, the village council and a social worker, here is the issue with children’s benefits, some are illiterate, I come to write statements for them. Village Council is really appeasable. In Korsuntsy Roma even got land, some disabled has even 2. The only requirement from the village council is to have a passports and house boooks. Those that have them received land: they were writing, waiting for 2-3 years, but in the end they received them aﬅer new distribution. There was a problem with electricity and they did not want to supply in this quarter, so the Chairman visited electric supply company to negotiate this. First I went, then deputy, then the Chairman, and aﬅer they decided to provide electricity there. Though they have to pay higher price, not as individuals, but as a company. Anyway they have electricity there. The military account service gives me questionnaires for filling by youngsters of premilitary age, as many of them illiterate, and without these profiles they do not get passports. Inintially they did not understand who I am and what I need, and now they are calling themselves, police is calling, if any problems. When it is necessary to make the identification, the beat oﬃcer talked to me and I collect these 3 people to confirm, he assigns time and we come together. So, they treat me as a colleague on some issues. When the medical examination is planned, I collect people bring them...». Thus, we see that social and health mediators involved in the community as a whole, but not limited to medical aspects. In some cities, such cooperation has acquired, including formal characteristics — in Beregovo, Odesa, Donetsk, Kyiv health mediators are included in the public councils at municipal councils. Health mediators in Odessa became a member of the Coordinating Council on AIDS and tuberculosis. International charity organization «Roma Women’s Fund» Chirikli» on an ongoing basis provides technical support to Roma health mediators and monitors their activities. In addition to training and regular meetings, experts of Fund «Chirikli» regularly (at least once a month) communicate with the social and health mediators on phone and email. «Coordination from «Chirikli» side is that they call me and ask on my plans. I write a work plan for the quarter, for a month, make reports, sometimes their representatives come directly to communicate with people. Several times a year they arrange meetings, training seminars. I receive calls every week, a lot of messages coming via e-mail». —

 Monitoring of Roma health mediators is provided by employees of medical institutions (in each there was a curator in each region, which is a medical employee that coordinates and directs the work of health mediators). Every month health mediators send original reports to Fund «Chirikli», such as:

housing problems, the number of persons in need of documents, the number of focus groups, the number of persons admitted to passport oﬃces, social services et al., the number of meetings with authorities and the list of problems of the social and health mediator), served once a month,  A survey of Roma mediators conducted if necessary (but not less than 2 times a year), 

Communication by telephone,

 Outbound monitoring in pilot regions (visits to Roma camps and survey of Roma population in localities where there are social and medical mediators work), carried out by the project manager and members of the working group. Monthly reports of social and health mediators are reduced into a single document that is stored in electronic and printed form.

International Charity Organization Roma Women’s Fund «Chirikli» provides technical support to Roma social and health mediators and monitor their activity on a constant base  Working plan of the mediator (approved by physician) — filed quarterly,  Medical report (list of those Roma who have been sent by the social and health mediator to doctor examination and results of these surveys) — served once a month,  Medical report of physician (medical doctor’s report confirming the number of persons examined, stamped and signed by a physician), served once a month;  General report of social and health mediator (it indicates the number of people visited, the number of health problems, the number of

Twice a year, this information is sent to Representative of the Council of Europe, who analyze the success of mediators. Social and health mediators communicate to each other to share experience and help in solving existing problems: «We call each other, especially when Odesa had several mediators. I have all contacts of all mediators. Well, I had a question with a woman from the Crimea I phoned there and solved the problem». — Social and health medicator, Odesa. About a year ago it was used as the practice of exchange visits to each other to share experience.

report/р.

Social and health mediator, Odesa. Social and health mediators receive links to new regulations and results of other projects that solve similar problems which may be useful in their work from the Foundation «Chirikli». Provide handouts for clients. Great use was from Memorandum of cooperation between the «Ukrainian Centre for TB control «of the Ministry of Health of Ukraine and International charity organization «Roma Women’s Fund «Chirikli», which was signed on 14 February 2012. According to this Memorandum, the Centre prepared a letter to local health departments, which helped social and health mediators to establish partnership with medical institutions to which Roma were sent for examination.

Section 3

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

The main result expected from the work of mediators is to improve Roma condition, to improve access to social services and bridge the gap between Roma and non-Roma population access to these services. Another expected result is to increase skills and capabilities of the Roma community to ensure dialogue between Roma and socio-medical institutions, as well as understanding of the work of the Roma population by social and health workers. Implementation of the Program of Romani social and health mediators in health care and social security should promote:  Raising awareness of Roma in Ukraine on the health care system;  Improving awareness of possibilities and Roma access to health and social care;  Improving access to health and social care services;

 Improving the speed and quality of response of health care and social services to meet the needs of the Roma population; 

Improving access to social services;

 Improving the knowledge of the basic rights and duties of citizens;  Dialogue between Roma and health and social institutions;  Improving of information and stimulating eﬀective approach to rights and obligations under the existing mechanisms of social protection;  Mobilizing members of the community through public health programs (vaccination campaigns, information, education and awareness campaigns in health promotion, elimination of chronic diseases, etc.).

6705 Roma people were sent to doctor, organized a Chest X-Ray of 3978 persons, 430 were sent for medical treatment, 3205 Roma children were vaccinated and 1670 focus groups on the topics «Compulsory vaccination», «How to prevent TB», «The importance of depth medical examination», «Personal and household hygiene» were held. Social and health mediators and Charity Fund «Blago» in Uzhgorod arranged water supply and sewer to camps and set toilets (toilets and showers). Fund «House of Mercy» helped Roma families to receive food, building materials and firewood for heating.

The results of Roma health mediators work are written on the basis of their reports on the following projects:  «Improving Access of Roma population to health services in TB by the Roma health mediators» (supported by the Foundation «Development of Ukraine» and International Renaissance Foundation),  «Improving Access of Roma population to health services in TB by the Roma health mediators» (supported by ICF «Coalition of HIVservice organizations» under the 9th Round of the Global Fund).

7200 persons were registered using social mediators, 1900 persons received passports, 2 878 persons received birth certificates, 180 individuals completed documents for a pension and 120 — for disability and 270 families received house books for this period. Social and health mediators conducted 370 talks with Roma families on «The importance of regular school attendance», 424 children were returned to school through the work of mediators While the program of health mediators implemented at all levels (national, regional, local), advances may be noted at each of these levels.

National level: During the period of the Programme from 2011 to June 2013 social and health mediators visited 56,900 people in 12 pilot regions.

In November 2012 Zemfira Kondur, vicepresident of «Chirikli», took part in the 5th Session

25 report/р.

Achievements of the Program of Roma social and health mediators

Section 1

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

of the UN Forum on Minority Issues. Mrs. Zemfira reported in paragraph 5, «Obstacles and problems encountered in the practical realization of the Declaration,» in particular obstacles in access to social and health care services and education for Roma children, and discrimination by lawenforcement authorities to Roma. In the course of realization of the Program of social and health mediators, were arranged series of meetings with representatives of the central government aimed at Roma priority issues and policy, state response to the needs and problems of the Roma population. Fund «Chirikli» conducted a large number of meetings with representatives of the Ministry of Social Policy, the Ministry of Culture, Ministry of Health. In addition, the Fund «Chirikli» organized a large number of round tables, the Foundation participated in working groups aimed at the presentation of the results of the social and health mediators and develop strategies to ensure the continuity of the work and the dissemination of lessons learned on the whole territory of Ukraine by the state. Combining expertise of leading donors, such as the International Renaissance Foundation with the experience of Roma NGOs (such as the Program for Roma social and health mediators, coordinated by the Fund «Chirikli») allowed the public to actively participate and realize the Strategy for protection and integration of Roma national minority into Ukrainian society until 2020, which was approved by the Decree of President of Ukraine. At the time of this report, the public is actively involved in developing an Action Plan to implement the Strategy, in cooperation with the Ministry of Culture, Fund «Chirikli» also ensured involvement in the development of the Action Plan directly to social and health mediators. «Roma issue» actively rises at the level of the Parliamentary Commissioner for Human Rights: Representatives of the Commissioner held a series of roundtable discussions with representatives of central authorities, nongovernmental organizations, including the Fund «Chirikli», and directly with social and health mediators. During these events were considered as the state of health of Roma population and human rights abuses and their documentation. In addition, Representative of the Parliamentary Commissioner for Human Rights made two monitoring visits (to Transcarpathian and Odesa regions), during which experts from the Fund

«Chirikli» were able directly acquaint officials with the living conditions and problems of Roma population. On June 12, 2013 a representative of the Fund «Chirikli» Zemfira Kondur, was invited to the Parliamentary hearing in the Verkhovna Rada of Ukraine on «The State of Human Rights Protection in Ukraine», which had a chance to give a speech on «The State of Roma rights protection in Ukraine». In 2011, Fund «Chirikli» became part of the Interagency Council on Social Affairs, which deals with problems of obtaining services (social, health, assistance in registration) and homeless persons released from prison. Chaired by the Vice-Prime Minister of Ukraine on humanitarian issues. On April 27, 2012 at the Institute of Legislation of the Verkhovna Rada of Ukraine held a scientific and practical conference «Strasbourg Declaration on Roma: implementation in the context of democratic reforms in Ukraine» was aimed at discussing ways to improve public policy, legislation and practice on the basis of certain guidelines of European integration, international standards and standards to improve the efficiency of integration of Roma in the Ukrainian society and to promote their participation in social, political and public life. The event was organized by the Institute of Legislation, Ministry of Culture of Ukraine and ICF «Roma Women’s Fund «Chirikli». The conference was attended by representatives of the Verkhovna Rada of Ukraine, executive authorities of the central and local governments, local authorities, civil society and international organizations, including the Council of Europe, the International Organization for Migration, the International Fund «Revival» and the U.S. Embassy in Ukraine, as well as representatives of media. As discussed during the conference participants adopted a final document of the scientific and practical recommendations, which were sent to Committees of the Verkhovna Rada of Ukraine, the relevant authorities and NGOs. The outcome of health mediators work was decided to include the Program of Roma health mediators to existing national programs for the Ministry of Health and Ministry of Social Policy (to improve performance in work with crisis families).

infantile TB specialists were conducted focus groups in schools, was held a press conference devoted to the Roma Day and distributed information about the program.

In addition, the project made a presentation on the National radio, Christian radio, on OSCE conference in Warsaw as the presentation of successful experience in solving problems of Roma access to quality health care.

As a result of meetings with regional phthisiology physicians were organized a series of field fluorography surveys, particularly in Pereyaslav-Khmelnitsky, Uzhgorod, Mukachevo, Chop, Saki. Organized outdoor examinations in camps in Pereyaslav-Khmelnitsky, Uzhgorod, Mukachevo, Chop, Djankoi, Donetsk.

In Kharkiv region, in addition to meetings with doctors was held a meeting with representatives of the District Department of Labour and Social Welfare, which discussed the topic of low-income families, mediators were sent to parents to get the oﬃcial status of many children families.

Regional and local level: The first barrier, which was met in the activity of social and health mediators was paid x-ray in certain areas namely, the need to buy film for examination. To support activities of social and health mediators in regions held roundtables with representatives of local authorities and medical institutions. The result of these roundtables was to reach agreement on a free survey of Roma in Kirovohrad, Kharkiv, Simferopol, in Zaporyzhzhya were appointed days, when Roma can be tested for free. Aﬅer some time, also the problem was fixed in Lviv and Odesa. Currently, in all regions where the Program of Roma social and health mediators works, Roma have the opportunity to be screened for free. In Transcarpathia, Luhansk, Kyiv and Odesa were approved orders phthisiologists cooperation with social and health mediators, conducting free medical examinations and so on. In Lviv University hospital «Prince Leo» went to meet Roma mediators and agreed to conduct a free x-ray and screening for cancer. In Uzhgorod social and health mediators were invited to a conference on tuberculosis, as well as a meeting with the chief of the infectious department of the Transcarpathian regional hospital and a meeting with the head of the Center for Prevention and Control of HIV/AIDS. In Odesa region social and health mediators arranged meetings in passport oﬃces, along with

In Uzhgorod social and health mediators have repeatedly drawn attention to the inadequate responses of employees of Uzhgorod ambulance to calls of Roma families. This problem was described in a letter to ICF «Roma Women’s Fund» Chirikli» to Health Oﬃce of the Transcarpathian Regional State Administration. There was held a working meeting dedicated to this issue, as a result the decision contained in the oﬃcial letter of response from the Health Care Administration:  Chief Physician of the Transcarpathian center of emergency medical help must develop an algorithm of cooperation with a social and health mediators on the challenges of emergency medical care;  Chief Physician of Regional Health Center must organize a meeting with the social and health mediators of Uzhgorod to familiarize them with the procedure for emergency medical care by the end of May 2013,  Divide and assign to each of the eight social and health mediators of Uzhgorod area of residence of the Roma population to explain to Roma families the agenda of seeking emergency medical care». Later it was decided that social and health mediators assigned to the respective neighborhoods should promptly check the feasibility of ambulance call control the arrival

report/р.

At the beginning of 2012 the Fund «Chirikli and the Ukrainian Center for Tuberculosis Control signed a memorandum of cooperation. It is further provided an opportunity to turn to chiefs of TB services at the local level, based on the document as the political will of the central executive body. As a result, local health departments and TB services were ready to cooperate and began to perceive activities of social and health mediators as an important component in the organization of health of Roma population, and most social and health mediators as full partners.

Section 4

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

process and to ensure order during the provision of medical care. Social and health mediators not only motivate Roma to screening for tuberculosis and negotiate on outdoor survey, they conducted monitoring of timely re-examination and outpatient treatment of patients with tuberculosis. Due to the fact that many of the Roma are not too carefully comply with the recommendations of doctors at the request of phthisiologists social and health mediators provide supervised treatment of tuberculosis, they give drugs and monitor the timely intake of drugs by patients. In the framework of the project «Improving Access of Roma population to health services in the area of TB by the Roma health mediators» main focus, of course, was on tuberculosis. But while sending to screening on tuberculosis, were revealed other pathologies:     

Heart disease, Pneumonia, Inflammation of airways, Asthmatic diseases, Cancer.

In the project framework in Dnipropetrovsk region has being also organized a meeting with a gynecologist, TB specialists and mammologist of Novomoskovsk hospital and conducted a focus group for Roma women in the prevention of cancer and self-diagnosis of breast cancer, as well as on family planning.

Mediators consistently collected information about needs of the community. These data help to identify real needs and the number of Roma population in need of medical and social care. The data was sent to local authorities for their consideration in the current work and in planning of future activities and local budget.

Achievements of some health and care mediators: In Pereyaslav-Khmelnitsky social and health mediator on the ground of the authorization of City Department of Education with TB doctors conducted a focus group in school concerning dangers of tuberculosis and its prevention measures. Very important was also her care for adults: «Last year my son had a stane on the right lung and was told in cases of poor treatment he will get TB. We stayed for 3 weeks in Pereyaslav hospital. I do not want to say something on doctors. He was treated, they made injections... but they didn’ have equipment. The high temperature persisted. I’ve turned to her again. She made a call, negotiated. Treatment lasted for a month. He was initially treated for month here, then in Kyiv. There a spot was revealed, but at early stage. (Client, Pereyaslav — Khmelnitskiy). In Odessa young Roma woman went to hospital with suspected tuberculosis, but doctors did not pay enough attention to the woman and did not provide proper treatment. Aﬅer the intervention of social and health mediator woman was transferred to the regional hospital with providing adequate volume of treatment for her disease.

Free of c harge Roam screening is the result of numerous round tables

In the Transcarpathian region in Beregovo, social and health mediators held in the camp focus group on «The symptoms of tuberculosis» in the camp. She was approached by the woman and said that her daughter has similar symptoms, but does not want to go to the survey, says it’s cold, which passes itself. Socio- medical mediator visited home and persuaded the patient to go to survey. It turned out that the woman was suﬀering from MDR TB. Currently she is being treated. Were examined persons who lived with her. Thanks to the work of social and health mediator was prevented the spread of a dangerous disease to other family members. In the Transcarpathian Region TB patient woman systematically avoided the entire course of treatment and always ran away from the hospital. Doctors could not do anything with her because they could not find her. They appealed to social and health mediator. Once the mediator has found a woman, it was found that the disease is in a poor condition. But now she continues treatment, social and health mediator controls that she pass to the end of treatment. Currently the patient feels better, even her vision improved during treatment.

In the Transcarpathian Region woman of 18, who has a 3 year old child and is pregnant, suﬀering from tuberculosis. In May, she did not finish the course of treatment, interrupted treatment and ran home from TB hospital. Doctors could not force the person for treatement, because she categorically denied that she is ill. Social and health mediators helped doctors providing controlled treatment of patients at home: she gave drugs and controlled medicines. However, due to the pregnancy status of women’s health deteriorated, she went to gynecologists and doctors, not knowing that she is sick with open tuberculosis hospitalized and placed into gynecology chamber togerher with other patients. Social and health mediator who brought her remedies, received from husband of patient information that she is in the department of gynecology. Social and health mediator notified doctors of tuberculosis treatment unit, which, in turn, reported the information to his colleagues on the treatment which was now. Finally, the patient was transferred to the Uzhgorod regional tuberculosis treatment unit, where she was given the necessary care and treatment. Since this hospital is far away from the place of residence of the patient, we hope that this time she will not escape and successfully complete treatment. In Odesa social and health mediator carried out the work in the community and noticed 8-year girl with TB symptoms. When he turned to the mother of a child with a request to send her to the x-ray, she has refused, because every day she sends girl begging near the church. And if the girl «will not work» for a day, the family will stay without money. Within two months, the mediator tried to send this girl to be examined and to persuade her mother that she must seriously react to the child’s health. Only in March 2013 the girl was able to pass the survey and TB was revealed. Then the mother was explained the seriousness of the disease. Social and health mediator is currently watching the passing examination of the rest of family. That’s what medical professionals say about results of social and health agent in Odesa Region: «Earlier TB was a big problem and many people died. But now the situation is better, everybody screened and everything is fine. We could take police, but we do not want to, because people knows us and and don’t want aggressive attitude».

report/р.

In Krasnosilky village of Kominternivsky district of Odesa Region there is a house of Roma family. Social and health mediator received a request from social workers, because the family has two patients with tuberculosis, but aﬅer inspection they refused of treatment. Social and health mediator conducted work with this family, but unfortunately, two people who were sick before died. However, in the family were still brother and sister, who categorically refused examination, and danger was aggravated by the fact that under the same roof with these people lived four children. Family had a problem with the housing documentation that they could not resolve themselves. That is why social and health mediator started resolving the issue under condition that the family would be screened. The woman had positive TB result, she was directed in treatment course and the entire term of treatment social and health mediator was watching the patient compliance and requirements of treatment. The children were examined and underwent a course of preventive treatment. Five people were saved from tuberculosis, while social and health worker helped the family to resolve legal problems of housing.

Section 4

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

In order to address these painful for Roma issues as poverty, lack of money for basic needs, the Fund «Chirikli» involves religious or charitable organizations that can help with medicines, clothing and food rations, because without such support Roma can not aﬀord 6 months treatment and leave their families. Social and health mediators, with the support of «Chirikli» turning to charitable organizations for help. So Roma families from Uzhgorod received help with winter clothing and medicine; in the village Kontsovo was given medication; two camps in Kyiv received clothing, food, also Roma passed medical examination under support of International Renaissance Foundation.

It should be noted that Ukrainian social and health mediators underwent selection among social and health mediators from all countries who were invited to participate in the European Congress of Roma social and health mediators, which took place in Brussels January, 17 2012. Seven social and health mediators were selected for participation in the first European Congress of Roma social and health mediators, and work of the Ukrainian Program of Roma social and health mediators have been identified as one of the most successful. In 2012, the Council of Europe held a contest for the best story of the social and health mediator. Two stories from Ukraine were selected among 15 countries. Maxim Juma and Valentina Zolotarenko were among the winners and were invited to participate in a meeting of the Council of Europe (Strasbourg) dedicated to Roma social and health mediators.

Mediators continuously collected information of community needs

In the course of preparation the publication in communication with experts, social and health mediators and Roma communities at events dedicated to the Roma subjects, voiced and discussed various risks related to successful implementation of the Program of Roma health mediators, and the implementation of the state policy of integration of the Roma population in Ukrainian society. As a result, it was determined a number of challenges and threats.

(among 74 proposed measures only 9 are under the jurisdiction of the Ministry of Culture). 3. There are doubts about the interest of all actors of the Action Plan to implement the Strategy in its high-quality design and eﬀective implementation: the result can be a lack of credibility of «disinterested» performers for the Ministry of Finance to allocate funds for the mplementation of activities assigned under the Plan.

Regarding the implementation of public policy aimed at the integration of Roma in the Ukrainian society: 1. The only document that defines a public policy is the Strategy of protection and integration into Ukrainian society of the Roma minority in the period up to 2020, approved by the Decree of the President of Ukraine. This document is a framework: it does not contain specific measures to achieve this goal, most vectors defines the eﬀorts that must be applied. 2. To implement this Strategy, Action Plan is being developed, but responsible for its development and subsequent implementation the Ministry of Culture of Ukraine, which has no experience in implementing measures of «Roma subjects» and is not main executor of this Plan

4. Action Plan to implement the Strategy doesn’t contain indicators, it has no clearly specified outcomes. Responsible representatives of the Ministry expect further develop of detailed operational plans for each of the actors mentioned in the Action Plan, although some points, which would oblige them to do so, are asent in the action Plan. 5. NGOs involvement in the development of the Action Plan is quite formal, central authorities are not prepared to take into account all comments oﬀered by NGOs, especially those relating to the Plan and the specificity of their results. 6. General state sectoral programs which being implemented in Ukraine does not take into account the specifics of Roma population; as a result, the most vulnerable of its representatives can not use services and other possibilities that are created by these programs. This is due to the lack of identity documents, documents confirming the status, illiteracy and inexperience of a large part of the most vulnerable Roma population.

31 report/р.

Challenges and threats

Section 1

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

7. Inconsistency of oﬃcial statistics on the number of Roma in Ukraine to real figure does not allow scheduling the necessary measures to overcome problems of Roma environment completely. Ukraine has never provided an opportunity to gather statistics about belonging to a particular ethnic group in the context of the issue: on the one hand, it does not allow the use of such data for the purpose of statistical discrimination, on the other hand it does not assess the content and extent of the problems inherent in Roma community. 8. Most of procedures for obtaining documents and individual benefits, especially if the time for obtaining of documents were overdue, are very hard or even not registered. This complicates the integration of Roma as not having documents identifying a person can not even be considered a citizen of the country, and moreover it can not enforce his/her rights. 9. The specificity and depth of Roma population problems requires a comprehensive approach and significant continuous and sustained eﬀorts to improve it, with the expectation of the future, which is not typical for our public policy. The latter depends on many factors, first of all, it is a political will, which varies depending on political personalities, besides available resources for its implementation, which is never enough, especially when it comes to non-priority issues for authorities. 10. Low priority of «Roma issue» for the government: rather than solving the problem, it is just trying not to notice at all levels as long as possible. Ukraine is still not a party to the Decade of Roma inclusion, the Ministries registered as performers of Action Plan to implement the Strategy of integration of the Roma population, not too interested in taking on additional commitments for the successful implementation of this Plan and the Strategy as a whole. Regional authorities are trying to ignore the problem in regions, focusing not on problems, but on their negative consequences when they touch not only Roma, but also other people. 11. Intolerant perception of the Roma by greater population of Ukraine, leading occasionally to the extreme manifestations: prejudice, discrimination and even hostility in its physical manifestation, entails low endorsement of government policy aimed at improving Roma lives.

Concerning realization of the Program of Roma health mediators in Ukraine: 1. The program is funded by international donors, which does not ensure its stability (in the case of changing donor priorities, the Program will cease to exist); in addition, the focus of donors, and therefore their requirements for maintenance projects are funded under the health mediators do not always correspond to the real needs of Roma population. Thus, social and health mediators have in their efforts to balance demands of donor and customer needs. For example, the Council of Europe, which includes Ukraine, directed their efforts primarily on the development and training of Roma mediators. Unfortunately, under this Program we can not ensure salaries and stability of the Program requires, above all, regular remuneration of mediators, which is the most severe challenge for this Program. Another example: the Foundation «Development of Ukraine», in which by far the greater part of the wages paid to the social and health mediators focused on TB, therefore, requires social and health mediators effort and performance indicators in this direction, but this direction judging from these questionnaires and interviews is not a requirement for Roma population. 2. Health mediators receive low salaries compared to other professions, the source of this wage is unstable, unstable as is funding from donors, so, during 2013 the salary of social and health mediators delayed twice, these delays were 2.5 months. 3. Now 50 social and health mediators are supervised by 2 persons from the Fund «Chirikli» considering that social and health mediators operating in 12 regions, it is impossible to organize a high level of supervision, because it is required maintenance supervision instead of human resources sufficient only for provision of controlling functions, supervision is carried out only in certain cases, in an emergency or at the request of social and health mediator. It has no regular and comprehensive nature. 4. Profession of Roma social and health mediator or Roma health mediator is not officially recognized in the Ukraine, and prospects for its recognition are very doubtful. More likely to enter the task facing mediators, to social worker duties, additional positions that were introduced last

5. Ministry of Social Policy of Uraine approved Order dated May, 09 2013 № 544 «On Amendments to the Order of Ministry of Social Policy dated June 08, 2012 № 344». This Order amends the activities of social services for family, children and youth at various levels, including significantly reduced quotas social workers, compared to the present. This order came into force on January, 1 2014. Rather, these quotas have decreased due to lack of funds in the budget of 2014, because those positions were funded with direct subvention from the state budget. 6. Even if there is an opportunity for social and health mediators to move to the position of social worker that provides services exactly to Roma population, not everyone will be able or willing to do so, on the one hand, not all social and health mediators are required for the post of social worker skills, on the other hand. Working conditions within the state structure are diﬀerent from conditions of work in the project: salaries can be even lower than they are now. There is less opportunity for flexible schedule, lack of compensation for overhead costs. The latter

Profession of Roma social and health mediator or Roma health mediator is not oﬃcially recognized in Ukraine results in inability to cover travel costs to camp or to the institution to which you want to apply with the problem of the client. As a result social

and health mediators — social workers can not accompany clients and pay their fares (most oﬅen they have no money to travel). All this will have negative eﬀect on the eﬃciency of their work. 7. Formally, the possibility of specialization of social workers on Roma population is not stipulated in the legislation, including the draﬅ Action Plan to implement the Strategy of integration of the Roma population. 8. The government is not using the experience and expertise of the Program of Roma social and health mediators in the development of Roma programs, involving representatives of the Roma community and non-governmental organizations seems rather formal. 9. Social and health mediators have to build cooperation at the local level with other stakeholders in the field of medicine and in the social sphere. These parties are not always actually «interested» and are ready to meet in order to solve problems of Roma population. This is due to the lack of cooperation, including the lack of a comprehensive policy on this issue at the national level and non-recognition of Roma health mediators as equal participants of the process. 10. Specialists of state agencies and institutions sometimes translate onto social and health mediators their duties. Roma health mediators sometimes have to perform other duties, including electricity provison of roma settlements. This is oﬅen driven by high expectations of Roma

report/р.

year in Ukraine in the amount of 12 thousand. But! Currently, they are not able to work with Roma population, they need special training, a separate part of the specialization of workers, in addition, Roma are reluctant to go to the contact with people outside there community. That is why Roma mediator and social worker with relevant responsibilities is not the same thing. It is important to consider this while working towards shiﬅing responsibilities of Roma health mediators for social workers.

Section 5

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

population on social and health mediators, as clients address to them for any reason, not limited to the list of duties of social and health mediator. Not fulfilling the clients requests, social and health mediators are in danger of losing their aﬀection and trust by responding — he takes excessive liabilities that are not always able to execute, which leads to burnout because of congestion and loss of confidence due to non-fulfillment of his promises. In such circumstances of pressure on social and health mediators it is diﬃcult to hold out as part of their duties, and as a result — as part of this activity. 11. Roma people are oﬅen so poor that he can not even pay for transportation to obtain services or purchase prescription drugs, and if the first case of social and health mediators could still cover the travel expenses of the client at the expense of

overheads (not yet changed the conditions of the project) in the second case he/she is powerless. As result, efforts of social and health mediator on the accompanying the client to a medical facility are futile, because the client still has no money. As you can see from the above listed, challenges and threats to the implementation of the Program of Roma health mediators in Ukraine are different. They are caused by both external political context and disabilities program (financial, organizational, inter-sectoral). Their removal requires an integrated approach and considerable efforts. But, first of all, we need a common vision of public policy for Roma population, a clear division of responsibilities of institutions and organizations involved in solving problems, and effectively established intersectoral collaboration.

report/Ń&#x20AC;.

Recommendations

Section 1

initiated and implemented by the EU. This will allow during the implementation of the Strategy and Action Plan based on experience and support of other European countries â&#x20AC;&#x201D; participants of the Decade, as well as provide access to the Decade that its member-states can use for measures aimed at integrating Roma into the general society. 3. NGOs that are engaged in the adaptation of the Roma population in society, it is necessary to analyze the existing national programs in the social, educational and medical fields in terms of the availability of their resources for the Roma population, to develop proposals to address identified barriers.

Recommendation on development and realization of state policy in Uraine in the sphere of Roma population protection 1. The primary task for Ukraine is to implement Strategy of protection and integration into Ukrainian society the Roma minority in the period up to 2020, approved by the Decree of the President of Ukraine in April 2013 and the Action Plan for the implementation of this strategy, adopted in September 2013. However, welltrained and aptly directed joint action by public authorities and civil society should ensure that the specification of certain points of the Plan and clearly define the responsibilities of executors of the central and local levels. 2. For Ukraine there is an urgent need for joining the Decade of Roma inclusion, which

4. Reliable data on the number of Roma population and the extent of a problem among Roma can be obtained only by applying a comprehensive approach that includes also the involvement of specially trained interviewers during the census and conducting devoted studies, including in the regular state household survey of living standards. Specific problems of Roma community and its estimated number can be found by working as social and health Roma mediators, and using large-scale social research. This paper provides a detailed picture of issues such as identifying the key social, educational, medical, legal and other requirements, assessment of demographic conditions of Roma minority. 5. The lack of documents, which leads to limited access to social security and benefits (this applies to documents identifying the person, entitle to a particular type of social security,

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

certifying the right to property), the algorithm requires the development of action under the law. This algorithm involves defining a list of common problems with documents available to the members of the Roma population and development to proceed in each case, in accordance with existing in Ukraine legal framework. Thus it is necessary to identify barriers in the regulatory framework, if any, and to submit proposals for their elimination. Additionally, there is a necessary legal assistance to Roma population on the ground that will give people the opportunity to use an approved mechanism.

 Assistance in receiving documents of identity and other documents for registration.

6. In the field of education: school premises during the holidays should be used for the organization of «leveling courses» for education of Roma children behind the school curriculum, and evening adult education. It is necessary to make a distribution for such courses visitors, taking into account the specific needs of the population.

 Assistance in establishing a dialogue with representatives of state structures with Roma.

7. In order to create a positive image of Roma community in society should launch a broad public information campaign, especially in media. As antidiscrimination mean may be acting in Ukraine hotline and helpline for work with representatives of the Roma communities for violations of their rights in case of wide publicity campaign among Roma population about the work of hotlines. 8. At the local level, an eﬀective means of providing access for Roma population to health services may be establishing of mobile medical teams, involving a variety of health professionals and social and health Roma mediators who conduct visits to places of compact residence of Roma. These teams should be provided with diagnostic equipment and supplies, as well as a set of medicines essentials.

Recommendations on establishing and realization of public policy in social sphere. 1. In order to include social workers and social work professionals to work with the Roma population we should clearly define the specifics of this work:  Determining the needs of the community, the collection of statistics on Roma without citizenship documents.

 Assistance in visiting schools by children and adults.  Increasing access to health care, including regular physical examinations, family planning services, gynecological examinations and vaccinations.  Information service on rights and responsibilities, opportunities to protect rights.

 From side of doctors and social workers — to change attitudes relevant to Roma patients and clients.  Ensuring access of Roma to social assistance and other social services.  Assistance in finding jobs and information about other services in this area.  Building trust in Roma communities in social and public sectors and facilitate their consolidation. 2. For the purpose of timely and eﬀective implementation of the abovementioned tasks should be carried out adequately trained social workers and professionals in social work and engage in these tasks Roma mediators. We must develop, adopt and implement a training program for these professionals. 3. Provide funding for programs for Roma mediators available from local budgets by government order to perform certain services (pilot project planned in Kirovohrad Region in 2014). 4. Develop and adopt standards for the provision of social services to members of Roma community. 5. To make eﬃcient use of all available resources it is necessary to start an electronic database of social service providers, given the potential of civil society, and recipients of such services with details of the service provided.

7. In order to improve cooperation between state authorities and civil society it is necessary constantly carry out communication activities at central and regional levels. Implementation of the abovementioned recommendations require consolidation of eﬀorts on both public and civil society sectors, as well as active involvement of the Roma community. In addition, the proposed measures require additional resources than those who which available now.

The model of roma social and health mediators: As stated in recommendations, activities of Roma social and health mediators could be financed by using a mechanism of social order. In this case, it must must be used a mechanism of social order, which at this point is trying to declare and implement the Ministry of Social Policy. Local budgets will purchase only those services that were in the list of social services provided to individuals who are in crisis and are not able to overcome them, approved by the Order of Ministry of Social Policy. This list of services is not «tied» to a particular social group, respectively, there are no services focused exclusively on the Roma community. Among the list approved by the Order, as such, that is to some extent relevant and meet needs of Roma population are the following: Service of social adaptation — is a help in analyzing life situations, identifying main problems and ways to solve them, a plan for way out of the diﬃcult life situation; involvement of the recipient ‘s own solution to a diﬃcult life situation; providing information on social welfare; education, formation and development of social skills, social competence; representation of interests; correction of psychological state and behavior in daily life; providing psychological support; assistance in obtaining documents; employment assistance; assistance in strengthening/restoring family ties and community service; organizing clubs, clubs active longevity, university of the Third Age; assistance

in organization of daily employment and leisure; promotion of self-helping groups and activities. Asylum — providing beds with communal services; providing a solid, soﬅ inventory, clothing, shoes, food; creating conditions for the implementation of sanitary measures, personal hygiene; assistance in creating conditions for getting children education based on their level of education; organization for maintaining of personal belongings; providing information on social protection; assistance in obtaining legal aid; representation of interests; development, creation and support of social skills; assistance in analyzing of life situations, identifying main problems and ways to solve them; attracting recipient to solve their own diﬃcult circumstances; organizing health care services; medical examinations; counseling; assistance in the organization of interaction with other professionals, services. Crisis and emergency intervention — psychological support (counseling, support, diagnosis, counseling, correction, therapy, rehabilitation); providing information on social protection; assistance in the organization of interaction with other professionals and agencies; representation of interests, correction of family relations; assistance in obtaining of legal aid; organization of emergency medical care, organization of asylum. Consulting — assistance in the analysis of life situations, identifying major problems, their solutions, a plan for overcoming the diﬃcult life situation; counseling; assistance in obtaining of legal aid. Social accompaniment/patronage — a survey, needs assessment, identification of ways to solve major problems; drawing up an individual plan for social accompanimednt; involvement of recipients to the individual social support plan; evaluation of results of individual plan of social support; regular meetings or visits with recipients to monitor performance tasks; assistance in obtaining other services of interaction with other actors of social support; assistance in recognizing the importance of action and / or the ability to manage the development; training and skills development; counseling; psychological support. Social accompaniment for employment and at workplace — regular meetings with service recipients; visit the workplace; facilitate the

report/р.

6. To further planning activities within regions should undertake mapping of «Roma» settlements indicating the number of people living there, and needs of every single person.

Section 6

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

adaptation of a person to perform job functions, adjust to workplace for persons with disabilities; assistance in obtaining of other services of interaction with other actors of social accompaniment; training and development of human and social skills; counseling; psychological support.



development of proposals for the development and optimization of social services;



determining staﬃng, financial resources necessary for the organization of social services.

Representation — negotiating on behalf of recipients of social services; assistance in obtaining or renewal of documents; assistance in registration of residence or stay; help in tracing relatives, restoration of family and social ties; assistance in securing access to resources and services for residence/stay, networking with other professionals, services, organizations, businesses, agencies, institutions and so on.

Responsible for organization of assessment process needs are Departments of Social Protection (regional, district and city). They are responsible for information gathering, synthesis, analysis, prioritization.

Based on specific challenges facing the social and health Roma mediators that best reflects their activity service «representation of interests». However the fact that the service is included in the list is not suﬃcient. It is assumed that competition for social order will be carried out by collecting local needs and their prioritization. It is therefore necessary that this service has been defined as priority in the region. For this purpose, regions annually at the beginning of the year must arrange needs assessment. It is the first stage of the social order — definition of order, that is the scope and range of social services which priority for the people of the territory. Needs assessment conducted for: 

definition of social groups in need of social services, the number of actual and potential beneficiaries of social services;



definition of social problems that need solving through social services;



study of the system of social services including providers, list, scope, access and quality of services;

This given assessment is conducted in accordance with the Guidelines for identification of needs of the population of the administrativeterritorial units for social services, approved by Ministry of Social Policy. These guidelines give target groups which will need social services. Because belonging to the Roma community is not in itself a factor of vulnerability, it is proposed to choose among target groups those whose needs are the nearest to needs of the Roma population. In particular, it can be:    

«Family who are in diﬃcult circumstances», «Women with newborn children», «Children who are in diﬃcult circumstances», «Persons living in emergency premises»

Roma social and health mediators themselves are not an organization that provides social services, so they can not submitted to the Oﬃce/Department of Social Protection information on the scope of their services and needs, which are being addressed by clients. To address this issue we have 2 options: 1)

It can make local Roma NGOs;

Roma social and health mediators establish an association authorized to act throughout Ukraine and mediators are its representatives in the field.



determining the scope and range of social services;

Considering that Roma NGOs are not available everywhere and mediators network is more extensive, it is better to use the second option. Thus, we propose the following model of work.



assessment of the current system of providing social services to the identified needs of the population;

Association of Roma social and health mediators involves in collection of needs for social services at the beginning of the year, submit

Thus, the work of Roma health mediators through the Association will provide: 1.

The possibility of financing through mediators mechanism of social order;

The flexibility of the schedule and content of services depending on needs of local Roma community;

The ability to raise additional funds from other sources, in addition to local budgets;

Coordination of activities of mediators from the central level to ensure their methodological support;

The ability to engage in advocacy at both local and national levels.

In addition transfer of the activities of Roma social and health mediators on formal basis and providing funding for this activity by public funds at the local level, there should be another component, without which the wor of mediator is impossible. This is training. We will need help of the international community, because this training costs money. In addition to periodic training required is ongoing supervision and technical support to the Roma social and health mediators.

report/р.

to the Oﬃce/Department of Social Protection information on the scope of their services and needs, which are being requested by customers. At the stage of prioritizing these needs local Oﬃce/ Department and allocating resources to meet them in local budgets Association conducted advocacy campaigns. As a result of these campaigns funds for services provision to Roma population should be incorporated in Programs of economic development of the region for the relevant year for the further implementation of the social order. When local administration will announce competitions according to the Circulation of CMU on April 29, 2013 № 324 «On approval of the social order through the budget», The Association has to go to these competitions. Considering long experience of Roma social and health mediators, positive assessment of their activities by local authorities, and a small number of organizations dealing with the social problems of the Roma community, it is a very high probability that this association will become the winner of these competitions.

Section 6

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

report/p.

Appendice 1

THE CABINET OF MINISTERS OF UKRAINE ORDINANCE September, 11 2013 Ń&#x20AC;. â&#x201E;&#x2013; 701-r Kyiv

On approving the Action Plan to implement the Strategy for protection and integration into Ukrainian society of Roma national minority until 2020

1. Adopted an Action plan to implement Strategy for protection and integration into Ukrainian society of Roma national minority until 2020 consider as apporoved. 2. Ministries, other central executive bodies responsible for the implementation of this Regulation approved action plan, the Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations, the National Academy of Sciences to ensure its timely execution and submission by 1 February each year to the Ministry of Culture information on the status implementation of the plan for the generalization and representation before March 1 to the Cabinet of Ministers of Ukraine.

Prime-Mininster of Ukraine

M. Azarov

Appendicies

ACTION PLAN on the realization of Strategy for protection and integration into Ukrainian society of Roma national minority until 2020. GENERAL ISSUES 1. Conduct awareness raising campaign aimed at combating prejudice against persons belonging to the Roma national minority. State Committee of Radio and television, Ministry of Justice, Ministry of Culture, Ministry of Education, Ministry of Interior, the Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations, CSO (by agreement). 2014-2020 years. 2. Organize for persons belonging to the Roma national minority educational activities in order to raise awareness about human rights. Ministry of Justice, the Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations, the Commissioner of the Verkhovna Rada of Ukraine on Human Rights (with constnt), Roma associations and international organizations (with consent). 2014-2020 years. 3. Ensure organization of joint meetings among Ukrainian State Registrar and State Migration Service with representatives of Roma NGOs to study the registration of persons belonging to Roma national minority, birth certificates and passports of Ukraine. Ukrainian State Registrar and State Migration Service, Roma NGOS (with consent). I quarter of 2014. 4. To assist persons belonging to the Roma minority and legally resident in the territory of Ukraine, with processing documents, identification and proof of citizenship, birth certificates and the state registration of acts of civil status.

Registrar

and

State

5. Establish record keeping of Roma who received a document that proves identity and citizenship. State Migration Service. 2014 and 2015 years. 6. Publish and distribute in areas where persons belonging to the Roma minority, informational materials regarding the procedure of obtaining documents, identification and proof of citizenship, birth certificates and the state registration of acts of civil status. International Renaissance Foundation (with consent), Roma NGOs (with consent). 2014 and 2015 years. 7. Ensure in areas of compact living persons belonging to the Roma minority, conducting law enforcement and social services, prevention activities aimed on avoiding homelessness, homeless children, to prevent their involvement in criminal and other unlawful activities, prevention of domestic violence, drug abuse, smoking and alcoholism. Ministry of Interior, Ministry of Social Policy, the Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations. 2013-2020 years. 8. Involve expertise and technical capacity of international organizations to carry out tasks of integration into Ukrainian society of persons belonging to the Roma national minority. Ministry of Culture, Ministry of Foreign Aﬀairs, Ministry of Education, Ministry of Social Policy, Ministry of Interior, Ministry of Health, Ministry of Economic Development, the Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations. 2013-2020 years. 9. Prepare and involve persons belonging to the Roma national minority in the next Census. State Statistics Service. 2014.

Ordinnance of CMU dated September, 11 2013 р. № 701-r

Ukrainian State Migration Service. 2013-2020 years.

report/р.

APPROVED

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

10. Ensure cooperation between the executive bodies and Roma NGOs on issues of life activity support for the Roma minority. Ministry of Culture, Ministry of Social Policy, Ministry of Health, Ministry of Education, Ministry of Interior, Ministry of Justice, Ministry of Regional Development, the Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations, Roma NGOs (with consent). 2013-2020 years. 11. To involve Roma NGOs to assess the eﬀectiveness of implementation of the Strategy protection and integration into Ukrainian society of the Roma minority in the period up to 2020. Ministry of Culture, Ministry of Social Policy, Ministry of Education, Ministry of Health, Ministry of Interior, Ministry of Justice, Ukrainian Stata Registrar, State Migration Service, Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations, Roma NGOs (with consent). 2014-2020 years.

religious organizations (with consent). 2013-2020 years. 15. Conduct at placese of compact living of the Roma minority inform measures about social services provided by the State Employment Service. State Employment Service, Roma NGOs (with consent). 2013-2020 years. 16. Provide under the written request of persons belonging to the Roma national minority in places of compact residence the career guidance aimed at motivation to work, getting actual labor market occupations and specialties, as well as measures to inform to launch own business. State Employment Service. 2013-2020 years. 17.

Provide assistance to Roma NGOs in:



involvement of persons belonging to the Roma national minority participation in job fairs; employment of graduates belonging to the Roma minority and completed studies at institutions of higher education in Roma-populated areas; graduates of secondary, vocational and higher education institutions belonging to Roma national minority in employment, including public and other works of temporary character.

SOCIAL PROTECTION AND EMPLOYMENT



12. Provide identification and coverage of social services for Roma families with children who are in diﬃcult circumstances.



Ministry of Social Policy, the Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations. 2014-2020 years. 13. To monitor the destination and use of state social benefits, including childbirth. Ministry of Social Policy, the Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations. 2013-2020 years. 14. Promote involvement of charitable, civil and religious organizations to provide social assistance to persons belonging to the Roma national minority. Ministry of Culture, Ministry of Social Policy, the Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations, civil society organizations and

State Employment Service, Roma NGOs (with consent). 2013-2020 years. IMPROVING OF EDUCATION LEVEL 18. Ensure the conduct of the teaching staﬀ of secondary schools, education authorities of local administrations and local authorities and civil society groups including persons belonging to Roma national minority advocacy on importance of education, especially children and youth. The Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations, Roma NGOs (with consent). 2013-2020 years.

The Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol City State Administration, Ministry of Education, Roma NGOs (with consent). 2013-2020 years.

Ministry of Education, the Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations. 2014-2020 years.

25. Take eﬀorts to increase the number of Roma students who complete studies in secondary schools.

20. Preparation and publication of textbooks for secondary schools, which enrolled persons belonging to Roma national minority.

The Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol City State Administration, Ministry of Education, Roma NGOs(with consent). 2013-2020 years.

Transcarpathian Administration. 2014-2015 years.

Regional

State

21. To explore the issue of providing Roma students with gratuitous transportation in areas of compact livivn of persons belonging to Roma minority, located at a distance of more than three kilometers from the nearest educational institution. Ministry of Education, the Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations. 2014. 22. Take eﬀorts to increase the number of Roma children aged from three to six years old who attend preschool education. The Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol City State Administration, Ministry of Education. 2013-2020 years. 23. To provide for registration of children of school age Roma in order to maximize their involvement in the educational process. The Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol City State Administration, Ministry of Education, Roma NGOs (with consent). 2013-2020 years. 24. Establish a control for visiting of Roma pupils of secondary schools and to take measures to parents or persons in loco parentis, to ensure regular attendance of classes.

26. Promote involvement of Roma pupils to extracurricular activities, participation in competitions, sporting events, clubs and more. The Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol City State Administration, Ministry of Education, Roma NGOs (with consent). 2013-2020 years. 27. Provide profiles of school improvement of labor education in secondary schools, where study Roma students on the basis of traditional Roma craﬅs. Ministry of Education, the Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations. 2015. 28. Provide by school psychologists help to Roma students for their successful adaptation to the educational process. Ministry of Education, the Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations, Roma NGOs (with consent). 2013-2020 years. 29. Examine the need for teachers of Romani language. Ministry of Education, the Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations, the National Academy of Pedagogical Sciences (with consent). 2014 and 2015.

report/р.

19. Ensure implementation of permanent workshops for teachers of secondary schools, which enrolled persons belonging to Roma national minority.

Appendicies

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

30. Provide professional development and training of teaching staďŹ&#x20AC; of secondary schools with Roma students. Ministry of Education, the Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations. 2014-2020 years. 31. Organize vocational work to stimulate persons belonging to Roma national minority to vocational and higher education. Ministry of Education, the Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations. 2013-2020 years. HEALTH CARE 32. Ensure informing employees of public healthcare facilities of particular national mentality of persons belonging to Roma national minority. The Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations, Roma NGOs (with consent). 2014. 33. Conduct in areas of compact living of persons belonging to Roma national minority advocacy for a healthy lifestyle, the need for passage of preventive screening, the importance of timely and proper treatment. Ministry of Health, the Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations, Roma NGOs, international organizations (with consent). 2013-2020 years. 34. Provide the location of health facilities and distribution in areas where persons belonging to Roma minority, reminders, leaflets, stands, etc. for promoting healthy lifestyles. Ministry of Health, the Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations, Roma NGOs, international organizations (with consent). 2014-2020 years.

35. To ensure distribution among persons belonging to Roma minority, information about the location of health care institutions, how to appeal to them and use their services. The Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations, Roma NGOs (with consent). 2013-2020 years. 36. Facilitate the access of persons belonging to Roma minority, the medical examination of inpatient care and emergency medical care in public and community health facilities. The Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations. 2013-2020 years. 37. Provide in accordance with the vaccination calendar immunization of persons belonging to Roma national minority. Ministry of Health, the Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations. 2013-2020 years. 38. Conduct in areas of compact living of persons belonging to Roma minority, mandatory preventive examinations for tuberculosis. State Service of Social Deseases, the Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations. 2014-2020 years. 39. Ensure the State Sanitary and Epidemiological Surveillance and sanitaryepidemiological surveys of places of compact residence of persons belonging to Roma national minority, involving representatives of Roma NGOs. State Sanitary and Epidemic Service. 2013-2020 years. 40. Ensure the availability of primary care clinics by forming a network in accordance with standards approved by the Ministry of Health. The Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol

45. Facilitate the establishment of centers of Roma culture in areas of compact living of persons belonging to Roma national minority.

IMPROVING OF HOUSING CONDITIONS 2013—2020 роки. 41. To assist in addressing issues under the law for persons belonging to Roma national minority in housing, improving living conditions, social infrastructure, appropriate communication and landscaping in places of compact residence. Ministry of Regional Development, the Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations, international organizations and foundations (with consent). 2013-2020 years. 42. Provide dissemination of information on programs concessional lending and purchase of housing in areas of compact living of persons belonging to Roma minority. Ministry of Regional Development, the Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations. 2013-2020 years. 43. To assist in the allocation under the law for persons belonging to Roma national minority land for individual housing (cooperative) building and operating a farm. State Land Agency, The Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations. 2014-2020 years. 44. To facilitate compliance with the legislation of participation of persons belonging to Roma national minority and are on the housing register, the program of social housing. Ministry of Regional Development, Ministry of Social Policy, the Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations. 2013-2020 years.

Mininstry of Culture, Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations. 2013-2020 years. 46. Provide support to Roma ensembles and folkclore collectives. Mininstry of Culture, Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations. 2014-2020 years. 47. Ensure the involvement of Roma art groups to participate in national and regional cultural events involving minorities. Ministry of Culture, Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations. 2013-2020 years. 48. To assist in providing on concessional conditions facilities in buildings and facilities that are state and municipal property for Roma NGOs and Roma folklore teams of cultural, informational and educational events to ensure the rights and meet the needs of ethnic people belonging to Roma minority. The Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations. 2013-2020 years. 49. To assist in carrying out:  cultural events aimed at the preservation of ethnic identity of Roma minority;  information and educational activities for the protection and integration into Ukrainian society of persons belonging to Roma national minority.  Ministry of Culture, Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations, Roma NGOs (with consent). 2014-2020 years.

SATISFACTION OF CULTURAL AND INFORMATIONAL NEEDS

50. Assist in the establishment and operation of schools adult education and leisure of

report/р.

city state administrations. 2014-2020 years.

Appendicies

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

musically talented Roma children in areas such as choreography, musical and vocal art in the Transcarpathian Regional Palace of Children and Teenagers Arts.

regional state administration, associations of Roma (with consent).

Transcarpathian Regional State Administration. 2013-2020 years.

54. Implement a content page with Roma issues in the newspaper «Odessa news».

2014 and 2015.

51. Promote the participation of Roma amateur teams in international cultural events.

Odessa regional state administration, Roma NGOs (with consent). 2014.

The Council of Ministers of the Autonomous Republic of Crimea, regional, Kyiv and Sevastopol city state administrations. 2013-2020 years.

55. Provide training and air broadcast on Odessa regional state TV of 15-minute program on the subject of Roma within the television program «Inter Odessa».

52. Conduct researches on history, culture, language, social and cultural integration of Roma minority.

State Committee on Radio and Television, Odessa Regional State TV and Radio Company, Odessa regional state administration, Roma NGOs (with consent). 2014-2020 years.

National Academy of Sciences (with consent), Ukrainian Centre for Cultural Research (with consent). 2014-2020 years. 53. Promote the publication «Roma jurisprudential Herald» scientific journal «Romenvad» («Roma learning»), collections of tales and proverbs in Romani language. Odessa

56. To assist in covering public audiovisual media issues of life of the Roma minority, measures to ensure their protection and integration into Ukrainian society. State Committee for Radio and Television. 2014-2020 years.

COUNCIL OF EUROPE HIGH LEVEL MEETING ON ROMA STRASBOURG, 20 OCTOBER 2010 THE STRASBOURG DECLARATION ON ROMA (1) Roma1 in many parts of Europe continue to be socially and economically marginalised, which undermines the respect of their human rights, impedes their full participation in society and effective exercise of civic responsibilities, and propagates prejudice. (2) Any effective response to this situation will have to combine social and economic inclusion in society and the effective protection of human rights. The process must be embraced and supported by society as a whole. A genuine and effective participation of our fellow Europeans of Roma origin is a precondition for success. (3) While the primary responsibility for promoting inclusion lies with the member states of which Roma are nationals or long-term legal residents, recent developments concerning Roma in Europe have demonstrated that some of the challenges we face have cross-border implications and therefore require a pan-European response. (4) As situations differ from country to country, the role of international organisations should be first and foremost to support and assist the efforts carried out at national, regional and especially local level. (5) Based on these considerations the member states of the Council of Europe have adopted the following «Strasbourg Declaration»: (6) Reaffirming that all human beings are born free and equal in dignity and rights; (7) Reaffirming their attachment to human dignity and the protection of human rights for all persons; (8) Recalling the fundamental values, norms and standards of democracy, human rights and the rule of law, which are shared by the Council of Europe member states and which must guide action at all levels;

(9) Confirming their commitment to promote social inclusion and create the conditions for an eﬀective exercise of civic rights and responsibilities by every individual; (10) Recalling that active participation of the Roma is crucial for achieving their social inclusion and encouraging them to participate in addressing the problems of, inter alia, relatively low rates of education and employment; (11) Bearing in mind that the process of inclusion of Roma contributes to social cohesion, democratic stability and to the acceptance of diversity; (12) Recalling that in the exercise of his/her rights and freedoms everyone must respect the national legislation and the rights of others; (13) Condemning unequivocally racism, stigmatisation and hate speech directed against Roma, particularly in public and political discourse; (14) Recalling the obligations of States Parties under all relevant Council of Europe legal instruments which they have ratified, in particular the European Convention on Human Rights and the Protocols thereto, and, where applicable, the European Social Charter and the Framework Convention for the Protection of National Minorities and the European Charter for Regional or Minority Languages; (15) Recommending that State Parties take fully into account the relevant judgments of the European Court of Human Rights and relevant decisions of the European Committee of Social Rights, in developing their policies on Roma; (16) Recalling their commitment to the principles of tolerance and non-discrimination, as expressed in the statute of European Commission against Racism and Intolerance (ECRI); (17) Drawing on the initiatives, activities and programmes already developed and conducted by member states aimed at the full inclusion of Roma; (18) The member states of the Council of Europe agree on the following non-exhaustive list of priorities, which should serve as guidance for more focused and more consistent eﬀorts at all

report/р.

Appendix 2

Appendicies

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

levels, including through active participation of Roma: NONDISCRIMINATION AND CITIZENSHIP NONDISCRIMINATION (19) Adopt and eﬀectively implement antidiscrimination legislation, including in the field of employment, access to justice, the provision of goods and services, including access to housing and key public services, such as health care and education.

ACCESS TO JUSTICE (26) Ensure equal and effective access to the justice system, including where appropriate through affordable legal aid services. (27) Ensure timely and effective investigations and due legal process in cases of alleged racial violence or other offences against Roma. (28) Provide appropriate and targeted training to judicial and police services.

CRIMINAL LEGISLATION COMBAT TRAFFICKING (20) Adopt and eﬀectively implement criminal legislation against racially motivated crime. CITIZENSHIP (21) Take eﬀective measures to avoid statelessness in accordance with domestic law and policy and to grant Roma legally residing in their national territory access to identification papers.

(29) Bearing in mind that Roma children and women are oﬅen victims of trafficking and exploitation, devote adequate attention and resources to combat these phenomena, within the general efforts aimed at curbing trafficking of human beings and organised crime, and, in appropriate cases, issue victims with residence permits.

WOMEN’S RIGHTS AND GENDER EQUALITY

FIGHTING STIGMATISATION AND HATE SPEECH

(22) Put in place eﬀective measures to respect, protect and promote gender equality of Roma girls and women within their communities and in the society as a whole.

(30) Strengthen eﬀorts in combating hate speech. Encourage the media to deal responsibly and fairly with the issue of Roma and refrain from negative stereotyping or stigmatisation.

(23) Put in place eﬀective measures to abolish where still in use harmful practices against Roma women’s reproductive rights, primarily forced sterilisation.

(31) Remind public authorities at national, regional and local levels of their special responsibility to refrain from statements, in particular to the media, which may be reasonably understood as hate speech, or as speech likely to produce the eﬀect of legitimising, spreading or promoting racial hatred, xenophobia, or other forms of discrimination or hatred based on intolerance.

CHILDREN’S RIGHTS (24) Promote through eﬀective measures the equal treatment and the rights of Roma children especially the right to education and protect them against violence, including sexual abuse and labour exploitation, in accordance with international treaties.

(32) Consider joining the campaign of the Council of Europe and the European Commission «Dosta! Go beyond prejudice, discover the Roma!» and enhance activities in this framework.

EMPOWERMENT (25) Promote eﬀective participation of Roma in social, political and civic life, including active participation of representatives of Roma in decision-making mechanisms aﬀecting them, and co-operation with independent authorities such as Ombudsmen in the field of human rights protection.

SOCIAL INCLUSION EDUCATION (33) Ensure eﬀective and equal access to the mainstream educational system, including preschool education, for Roma children and methods to secure attendance, including, for instance, by making use of school assistants and mediators.

EMPLOYMENT (34) Ensure equal access of Roma to employment and vocational training in accordance with international and domestic law, including, when appropriate, by using mediators in employment offices. Provide Roma, as appropriate, with possibilities to validate their skills and competences acquired in informal settings. HEALTH CARE (35) Ensure equal access of all Roma to the healthcare system, for instance, by using health mediators and providing training for existing facilitators. HOUSING (36) Take appropriate measures to improve the living conditions of Roma. (37) Ensure equal access to housing and accommodation services for Roma. (38) Provide for appropriate and reasonable notice and effective access to judicial remedy in cases of eviction, while ensuring the full respect of the principle of the rule of law. (39) In consultation with all concerned and in accordance with the domestic legislation and policy, provide appropriate accommodation for nomadic and semi-nomadic Roma. CULTURE AND LANGUAGE (40) Where appropriate, take measures to foster knowledge of the culture, history and languages of Roma and understanding thereof. INTERNATIONAL COOPERATION (41) Ensure focused, sustained and effective cooperation regarding Roma, at the pan-European level, between member states, regions, local authorities and European organisations, drawing on the many examples of good practice which exist at European, national, regional and local levels. In particular, encourage co-operation with the European Union, including through joint programmes such as the intercultural cities, as well as the OSCE;

(42) Ensure close cooperation with Roma communities at all levels, pan-European, national, regional and local, in the implementation of these commitments; (43) Recognising the need to contribute to the implementation of these priorities through the use of good practices, expertise and available financial resources which exist at European, national, regional and local level, the member states of the Council of Europe:  (44) welcome the decision of the Secretary General to re-organise resources in a transversal manner within the Council of Europe Secretariat with the task of further developing co-operation with national, regional and local authorities and international organisations in collecting, analysing, exchanging and disseminating information on policies and good practice on Roma, providing advice and support upon the request of national, regional and local authorities as well as practical assistance in the implementation of new policy initiatives, especially at the local level, and providing access to training, capacity-building and educational material;  (45) encourage close co-operation with member states, other Council of Europe institutions, other international organisations, especially the European Union and the OSCE, as well as civil society, including Roma associations and relevant non-governmental organisations, in order that its work complements rather than duplicates that of other bodies;  (46) agree to set up a European Training Programme for Roma Mediators with the aim to streamline, codify and consolidate the existing training programmes for and about Mediators for Roma, through the most eﬀective use of existing Council of Europe resources, standards, methodology, networks and infrastructure, notably the European Youth Centres in Strasbourg and Budapest, in close co-operation with national and local authorities;  (47) encourage member states to use a coordinated, inter-agency approach to dealing with issues which aﬀect Roma;  (48) take note of the list of good practices elaborated by the Secretary General, entitled «Strasbourg Initiatives» for which he calls for support. This open catalogue of projects having an

report/р.

Provide, where appropriate, in service training of teachers and educational staﬀ.

Appendicies

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities

immediate and measurable impact could serve as a catalyst for future action;  (49) invite the Secretary General of the Council of Europe to present a first progress report on the implementation of the «Strasbourg Declaration» to the Council of Europe Ministerial Session in Istanbul in May 2011.

Note 1 The term «Roma» used throughout the present text refers to Roma, Sinti, Kale, Travellers, and related groups in Europe, and aims to cover the wide diversity of groups concerned, including groups which identify themselves as Gypsies.

report/p.

Roma social and health mediators in Ukraine: achievements, challenges, opportunities