The state of community health practice in the Czech Republic: Saste Roma project

Abstract

Abstract A central public health objectives of the Czech government is to reduce health inequalities for community members living in deprived areas of Czechia, where Roma are the most frequent inhabitants. This is achieved through Community Health Workers (CHWs) and subsidies for NGOs. However, they often lack the necessary training in health promotion. Developing more systematic intervention tools could help tackle this challenge, thus improving community health practices and decreasing the burden on the health system. The Saste Roma project responded to the lack of systematic community health practices. It aimed to improve secondary prevention in Roma by developing several interventional tools. Socio-culturally appropriate printed materials are to be used by CHW, as well as by doctors and community members; e-learning is intended for implementation as a part of the school curriculum. These tools have the potential to lower the burden on the health care system to improve community health as they act as communication channels between health professionals and the community. The development of the above tools was carried out with the help of governmental and non-governmental organizations, CHWs, and community members. During the development of the project, some shortcomings of Czech community health services were identified. They include the low competence of CHW, the unwillingness of different sectors to cooperate, refusal of schools to participate due to poor school attendance and workload from other projects. Thus, despite the large government investments in the policy of reducing health inequality, at the local level, it often does not work as it was officially stated. Moreover, despite a 20-year Roma-oriented policy, no evaluation has yet been carried out. Intervention tools from the Saste Roma project can be a first step to get community health practice more systematic in Czechia. The Randomized-control-trial to evaluate the efficacy of developed tools will follow.