USAID Romania Family Health Initiative Romania Family Health Initiative

Roma Component (2004-2007)

Context · Main Activities · Key Results


The RFHI Roma component addressed the access to RH services of the Roma population, an estimated 1.5 million people in Romania and one of the largest Roma groups in Europe. This ethnic minority faces numerous complex health problems due to barriers such as low access to information, lack of identity papers, lack of health insurance, discrimination, marginalization, and self-isolation.

From a reproductive health perspective, the 2004 Reproductive Health Survey revealed that Roma women access prenatal care services later in pregnancy than women in the general population. Few Roma women used modern contraceptives, and most chose abortion as a primary birth control method.

RFHI's Roma component increased access to and use of FP/RH services by people from Roma communities with a focus on Roma health mediator (RHM) activities developed through the MOPH National Health Program # 2.

Roma health mediators are women selected from Roma communities who serve as a "bridge" between the local community where they work and health and social services. RFHI trained them to promote health and cultivate reciprocal trust between community members and medical and social services providers.

Main Activities

  • Developed the RHMs' capacity to provide FP/RH information and to refer the Roma population to health services
  • Developed simple and interactive communication materials adapted to Roma cultural characteristics
  • Conducted supportive monitoring visits to strengthen RHMs' activities
  • Organized workshops for family doctors to increase their understanding of cultural diversity and communication skills
  • Organized technical meetings between governmental and nongovernmental organizations involved with Roma health programs to support medical and social interventions in Roma communities
  • Designed identification materials (badges, rain coats, umbrellas, bags) aimed to strengthen RHM professional identity
  • Evaluated the MOPH's RHM program in order to inform nationwide extension of the program

RFHI partner, the Association of Roma Women's Emancipation (AFER), took a different approach in Cluj and Salaj districts due to the initial absence of RHMs. They first selected 26 Roma communities from Cluj and Salaj districts and trained 29 Roma women to become health mediators and in FP/RH topics. They then organized informational sessions about RH issues in all selected communities. This pilot project was based on a partnership among local authorities, family doctors, and AFER in order to support the RHMs in their work. By the end of this one year-project, the two District Public Health Authorities hired seven RHMs each.

The project extended its postabortion/postpartum care component to Roma communities in three districts, focusing on the following activities: RHMs' training in birth spacing, postpartum and postabortion education, development of informational and educational material promoting breastfeeding, and the organization of workshops on Roma cultural diversity for nurses from several maternities.

Key Results

  • Developed training package for trainers and participants
  • Trained approximately 177 RHMs from 20 districts covering over 200 communities in FP/RH
  • Designed cultural educational tools and information materials for Roma communities
  • Carried out about 6,800 information sessions in 200 communities
  • More than 260 family doctors and nurses working with Roma communities and in maternities participated in cultural diversity workshops
  • Established active working group for Roma health
  • Evaluation of the Roma Health Mediator Program as basis for future MOPH program expansion
  • Some Disrict Public Health Authorities hired new RHMs as a result of project experienece. Others are using RFHI curricula to train new RHMs hired in their districts

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The Romanian Family Health Initiative (RFHI) is implemented by JSI Research & Training Institute, Inc.
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Romanian Family Health Initiative (RFHI) Cooperative Agreement #186-A-00-01-00103-00.
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