Health mediators – a unique link
Health mediators have a positive influence on the quality of life in Roma families
Novi Sad, Serbia, February 2023 – “Snezana means a lot to me when we need something for the Red Cross, for vaccinations, for gynaecological check-ups. She comes and tells us where to go. Snezana went to sort out our health insurance. I couldn’t go. How can I go with five children?” explains twenty-five-year-old Sadbera and introduces us to Snezana Nikolic, the health mediator who is always welcome in her house, in the Roma settlement of Veliki Rit in Novi Sad.
It’s never boring in the Aliti family of seven. Mom Sadbera and dad Alija are always busy with their five children. They say it’s quiet only when the kids are asleep. Their oldest daughter, six-year-old Bajramsa, likes drawing and colouring. She is starting preschool this year.
While we are talking with Snezana and Sadbera, curious five-year-old Kemalj is pulling his dad’s sleeve and asking him to play. He wants to learn colours and letters. What he likes best is when they are guessing the names of fruits from a colouring book. Quiet, four-year-old, Sara likes to eat fruit, draw, and copy what her older sister does. Her brother Eldin, who is two years younger, listens carefully to our conversation, holding his blanket, but his sleepy eyes signal that it’s nap time. Sadbera holds Sunaj in her arms, a smiling nine-month-old boy, the youngest member of the Aliti family.
Snezana has known Alija for 14 years now. She supported him to finish primary school and get a job, which improved the family’s standard of living and therefore, positively impacted the children’s healthier way of life and development.
Alija goes to work every day, so Sadbera is always very busy in a house full of children. That’s why Snezana’s help is often so valuable. Sadbera says she also feels safer when she knows she can contact Snezana at any time.
“I have her phone number, so we call her when we need something from the Red Cross, some clothes, packages, firewood,” Sadbera explains.
Snezana has been a health mediator since 2009. For years, she has been visiting and helping Roma families in 13 settlements in Novi Sad. She has known most of today’s parents since they were little.
This is the first family I visited when I came to this settlement. The parents of today’s children were underage back then. The family didn’t have health insurance, the children were not going to school regularly. I helped them get health insurance and kept track of the children’s vaccination status. I also helped them get the child allowance, explains Snezana.
Snezana has known Sadbera since 2015, when she married into the Aliti family. Snezana helped her schedule gynaecological check-ups and register the birth of her first child, Bajramsa. Today, she is advising Sadbera and Alija on the health and development of their children.
“I taught them how to play and how children can learn through play, to develop motor skills and knowledge, and that early childhood development is very important. As for hygiene, they must teach the children to wash their hands, brush their teeth, go to bed on time, and that eating is also a part of hygiene,” says Snezana and adds that children are fully vaccinated and on time.
Such advice is crucial because the mortality rate of infants and children under the age of five in Roma settlements, despite a significant decrease in the past 5 years, is still high (9 per 1,000 live births). That’s 50 per cent higher than in the general population. The body weight of Roma children at birth is still almost two times lower than that of newborns from the general population. Unfortunately, hygiene conditions have not improved in Roma settlements throughout Serbia, many settlements still have limited access to running water, and other infrastructure has not been significantly improved either.
Regular visits by health mediators to Roma settlements and their work with each individual family - connecting them with health care, education, and social protection services, as well as the local self-government - have a positive impact on children's development and is the best way to overcome these problems.
Health mediators are also addressing the issue of irregular school attendance among Roma children. They advise parents about the importance of education for their children's future and encourage them to prepare their kids for school.
“I have a list of children who are 6 years old, and those who are already approaching 7. Those are the children who need to enrol in primary school. I’m here, helping the families [get their children ready for school, including by] scheduling vaccination appointments. I collect all the information, do all the preparations with parents. Then we go to school, and I help enrol children in school,” says Snezana.
Snezana not only assists Roma families in accessing health care, education, and social protection services, but also provides support in resolving any other problems they may have.
“They often require help with documents or birth registration. I ensure they get food, firewood, hygiene products through the Red Cross. I schedule their health check-ups, gynaecological check-ups. We measure blood pressure and blood sugar levels in the settlements,” Snezana explains.
Health mediators were particularly important for the Roma community during the COVID-19 pandemic - helping them access health care, social protection, and education services. Through mobile phone applications and social media networks, Snezana and her colleagues were always in touch with hundreds of Roma families in Novi Sad.
“I gave them advice on maintaining a two-metre personal distance, disinfecting their hands, and on avoiding gatherings”, explains Snezana.
Both Sadbera and Alija remember that they felt safer because they were always in touch with Snezana.
“She brought masks, disinfectants, gloves. Everything we needed,” says Sadbera.
As we are finishing the conversation, we realize that all the children have fallen asleep, after a snacking on apples and tangerines. And everyone continues with their chores – Alija is putting away the toys, Sadbera is making lunch, and Snezana is leaving to visit other families in the neighbourhood who need her help.
The Ministry of Health of the Republic of Serbia initiated a project in 2008, which established a network of health mediators, educated, and empowered to support Roma communities in the health care system. The integration of health mediators into the system is still ongoing. The pandemic highlighted their crucial role as a bridge between the Roma community and key systems like health care, education, social protection, and the local community. The health mediators are helping to identify and respond to the needs of Roma families, especially those with young children. They have built trust with the families, resulting in their significant influence.
UNICEF, as a long-standing partner of the Ministry of Health, supports the continuity and improves the quality of work of health mediators thanks to the financial support of GlaxoSmithKline (GSK), which is dedicated to improving the health and development of Roma children in Serbia and the countries of the region through the Together for Better Health initiative.