Health-mediation for segregated Roma: evaluation of a community-based participatory program in Slovakia

Abstract

Background In Central and Eastern Europe (CEE), health-mediation programs are becoming adopted as central policy instruments to tackle health inequalities among segregated Roma and general populations. We performed a qualitative evaluation study of one such program based in Slovakia. Our study aim was to evaluate whether the program: 1) addressed social determinants of health (SDH), and 2) enabled emancipatory participation. Methods To produce detailed data on the program everyday practice, we used primarily ethnographic techniques across all organizational levels of the program over a period of 17 months. To evaluate the merits of the program, we then summarized through a qualitative content analysis in what the thus reconstructed practice of the program were consistent with: 1) the World Health Organization framework on SDH (WHO SDH), and 2) contemporary anthropological critiques of participation in development.WHO Findings We found that in both respects, the program’s theory was too narrow and inconsistent. The program’s goals, targets and procedures: 1) focused solely on health-related behaviour and access to health-care, and 2) conceived off participation in a superficial way. However, we also found that in the actual everyday implementation, the program’s staff managed: 1) to cover more SDH aspects, and 2) to facilitate participation in a more emancipatory way than set out in the program’s theory. Discussion The CEE health-mediation trend presents an unprecedentedly hopeful approach to health inequalities among segregated Roma and respective populations, but its theory and related implementation procesess need to be extended with a more structural and emancipatory focus.