Development and empowerment of community health promoters in Prilep – North Macedonia

Abstract

Abstract Hidden discrimination in treatment, inability to pay for health services, insufficient information about health and social rights, are just some of the obstacles faced by Roma population and other marginalized communities in terms of achieving health rights in North Macedonia. Previous experience has shown encouraging community activism and following social determinant in the exercise of health rights are of particular importance for achieving positive outcomes. Therefore, in the past year, a group of 18 Roma community activists called Community Health Promoters was formed. Their task was to monitor community movements, share promotional materials, initiate discussions on health care topics, identify what problems citizens are experiencing especially the ones that may be a sign of systemic barriers. What is also very important and, to our opinion, a revolutionary step to building up this group is that we had additional 4 non-Roma activists who voluntarily applied to be part of it. Community Health Promoters by the end of the previous year reached the number of 22 people (18 Roma and 4 non-Roma). More than 100 individual cases and 2 major systemic barriers to the exercise of rights have been identified - the first concerned the right to health insurance for persons who have just turned 18 years and are not in regular education, and the second on inadequate regulation in the new Law on Social Protection, regarding the obligation for the beneficiaries to seek allowance from his/her adult children not living in their household. In both cases, written reactions were submitted to the competent bodies. In the first case, a notification was received that a technical solution to the problem was already been prepared, and in the second case, within one month, an amendment to the Rulebook was made, for more appropriate regulation. Through these two cases, it has been demonstrated that this approach is critical to achieving adequate and equal access to health protection for all. Key messages If the legislation is not for all, it is not a right but a privilege. Community-based work is the only way to find out if the laws are applicable for all or just for the few.