Protecting Roma children against preventable diseases
By Catherine Langevin-Falcon
NEW YORK, 19 September 2005 – An unpaved road, gutted with potholes and strewn with debris, leads to the 37 Stadium Street settlement in Kraljevo (Serbia and Montenegro), home to 1,400 internally displaced persons, most of them Roma who fled Kosovo after the 1999 bombing.
The settlement adjoins a garbage dump and is overcrowded, rundown and dirty. Among the many barefoot children who swarmed the car of a community leader on a recent visit was one young girl holding out her index finger to show the scar where a rat had bitten her.
“We are invaded by rats,” said one mother who lives here. “If I could only take my possessions with me I would move away, because it is such a dirty place to live.”
The potential for an outbreak of disease in such squalid conditions prompted local health authorities in 2002 to step up efforts to ensure that children living at 37 Stadium Street were fully immunized and registered in the health system.
The house-to-house mapping, community outreach and other intensive activities that took place in Kraljevo were replicated in other districts in 2003–2004, and the experience now forms the basis for the country’s model for immunizing children who are the poorest of the poor.
It also resulted in a change in national health policy. New legislation enacted in 2004 requires municipalities to immunize every child, with specific provisions for reaching marginalized populations like the Roma, internally displaced persons and children with disabilities.
Serbia and Montenegro has low child mortality levels (the under-five mortality rate was 14 per 1,000 live births in 2003) and routine immunization coverage near 90 per cent nationally. But the figures mask important disparities.
Disease-related mortality is highest in children living in poverty and in marginalized groups like the Roma, among which immunization levels are lowest.
“It is their constant movement, their seasonal work and a lack of fixed settlements” that make it difficult to reach Roma families with health and immunization interventions, said Dr. Mila Vucic Jankovic, head of Disease Prevention and Control of the Serbian Public Health Institute.
She added that 15 per cent of Roma children are not registered in the health system and 10 per cent of Roma mothers don’t take advantage of the services offered.
“It is our goal to reach 100 per cent of all children, not just those included in the health system,” she said.
Campaigns conducted in 2004 identified 16,000 unimmunized children, mostly Roma, living in nine districts of the country. These children were immunized against the major vaccine-preventable diseases, given health cards and incorporated into the health system.
Verica Djukic led the teams of health workers in Novi Pazar and Tutin, two municipalities in Kraljevo District that formed the pilot research.
“We suspected mothers weren’t bringing their children in [for immunization] because they were unfamiliar with the benefits and didn’t trust the health services,” said Ms. Djukic, coordinator of the Public Health Institute of Kraljevo.
Many mothers surveyed were eager to immunize their children, but either lived too far from the immunization point and didn’t have a way to get there or couldn’t take time away from their work to bring their children to the immunization point when it was open.
Kraljevo District added new immunization points in three municipalities and extended their hours of operation. Announcements were sent by mail and broadcast on local radio stations. UNICEF donated a transportation vehicle.
Health workers went house-to-house, combing the area for unimmunized children. One of every three children was found to be without a health card.
Zoran Petrovic, a leader of the Roma community in Kraljevo, dedicated himself to overcoming resistance to immunization, mostly among uneducated Roma. Petrovic one Saturday brought his own son to the community centre, and, as an example for other parents, rolled up the boy’s sleeve and had him vaccinated.
While supplementary immunization, mop-up and catch-up activities continue as part of the country’s newly mandated public health programme, outreach will continue to depend largely on the mobilization of local Roma leaders and community-based organizations.
“As community leaders, our direct contact with parents strongly contributes” to the immunization project, said Petrovic. “The main thing is building the trust and keeping the trust.”