Access to primary healthcare services for the Roma population in Serbia: a secondary data analysis.

Leanne Idzerda,Orvill Adams,Peter Tugwell,Jonathan Patrick,Ted Schrecker

doi:10.1186/1472-698x-11-10

Abstract

BackgroundSerbia has proclaimed access to healthcare as a human right. In a context wherein the Roma population are disadvantaged, the aim of this study was to assess whether the Roma population are able to effectively access primary care services, and if not, what barriers prevent them from doing so. The history of the Roma in Serbia is described in detail so as to provide a context for their current vulnerable position.MethodsDisaggregated data were analyzed from three population groups in Serbia; the general population, the Roma population, and the poorest quintile of the general population not including the Roma. The effective coverage framework, which incorporates availability, affordability, accessibility, acceptability, and effectiveness of health services, was used to structure the secondary data analysis. Acute respiratory infection (ARI) in children less than five years of age was used as an example as this is the leading cause of death in children under 5 years old in Serbia.ResultsRoma children were significantly more likely to experience an ARI than either the general population or the poorest quintile of the general population, not including the Roma. All three population groups were equally likely to not receive the correct treatment regime of antibiotics. An analysis of the factors that affect quality of access to health services reveal that personal documentation is a statistically significant problem; availability of health services is not an issue that disproportionately affects the Roma; however the geographical accessibility and affordability are substantive issues that disproportionately affect the Roma population. Affordability of services affected the Roma and the poorest quintile and affordability of medications significantly affected all three population groups. With regards to acceptability, mothers from all three population groups are equally likely to recognize the importance of seeking treatment.ConclusionsThe Roma should be assisted in applying for personal documentation, the geographical accessibility of clinics needs to be addressed, and the costs of healthcare visits and medications should be reviewed. Areas for improvement specific to ARI are the costs of antibiotics and the diagnostic accuracy of providers. A range of policy recommendations are outlined.

Highlights

Serbia has proclaimed access to healthcare as a human right
3.0 Results In order to determine whether children in need are accessing the primary care system and receiving the correct course of treatment, i.e. antibiotics in this case, we need to analyze the factors that affect the quality of access
Need: Registered need was defined by the number of children less than 5 years who presented with an Acute respiratory infection (ARI) in the previous 2 weeks

Summary

Introduction

Serbia has proclaimed access to healthcare as a human right. In a context wherein the Roma population are disadvantaged, the aim of this study was to assess whether the Roma population are able to effectively access primary care services, and if not, what barriers prevent them from doing so. The history of the Roma in Serbia is described in detail so as to provide a context for their current vulnerable position. We first describe the situation of the Roma in Serbia including their history, current living conditions, and vulnerability to ill health described in terms of both the social determinants of health and individual factors. We assess whether the Roma, as a vulnerable population, are able to effectively access primary care services, and if not, what barriers prevent them from doing so. We conclude with some recommendations for policy change, informed by considerations of equity and by recent research on health systems and the right to health

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