Piroska Östlin: Accountable mechanisms for health care for all


„I’m sure that there are several measures that do not need much money, it just need a political will”, says Östlin.


Piroska Östlin is the  manager of the Vulnerability and Health Programme at the World Health Organization (WHO) Regional Office for Europe. She was a part of a multicountry training in Skopje for reorienting strategies, programmes and activities on Millennium Development Goals 4 and 5 towards greater health equity with an explicit but not exclusive focus on the Roma population. Four countries are included in the training. It is organized and facilitated by the WHO Regional Office for Europe in collaboration with the Interuniversity Institute of Social Development and Peace, University of Alicante (WHO Collaborating Centre on Social Inclusion and Health) and the Spanish Ministry of Health, Social Services and Equality.

EDNO Magazine: What is the purpose of the workshop? You have information that Roma and other marginalized groups do not have equal health rights compared to the majority population or?

ÖSTLIN: We are organizing the training for multiple countries, Bulgaria, Montenegro, Macedonia and Serbia and these four countries are participating in a pilot – training in which we would like them to learn how to reorient strategies and activities related to Millennium Development Goals 4 and 5, which are about improving child health and maternal health. It is important that these strategies and policies are sensitive to the needs of socially excluded populations, like the Roma population. We would like these strategies, programs and activities to have a stronger equity focus.

EDNO Magazine: You are focusing on civil organizations that work on health issues or you are focusing on the state institutions as well?

ÖSTLIN: When we are working we would like to include civil society organizations as much as possible. For example, for this training we requested Governments to nominate also Roma association representatives because I think that it is very important that we make their voice loud and that they can really have impact on the process that we are engaged in currently.

EDNO Magazine: What are your findings, do Roma and socially excluded citizens in these countries have equal health rights like other citizens? Is there discrimination?

ÖSTLIN: They should have equal rights, but it’s not respected and that’s a problem in all over Europe. Roma populations are often discriminated and we can see that in different levels and in different areas. Also in health care, they don’t have equal access to health care and of course it has consequences of their health status.

EDNO Magazine: You’ve mentioned revision of the strategies and maybe regulations that should increase the equity of health rights. What do you mean by that? What do you suggest?

ÖSTLIN: I think Governments and also their institutions, especially the health institutions absolutely needs to improve the access to the health care, to make it possible for the most vulnerable population to receive equal and quality health care. It shouldn’t matter how rich, how educated you are and how much income you have, your health needs should be satisfied anyway. I think it’s very important to ensure that you build into the programs accountability mechanisms so that these rights are ensured and also that you are monitoring the progress, so that you can follow the health development of different population segments. I think that it’s very important for Governments when they report on the health status of the population, that they don’t report only on the national averages because behind national averages they can hide huge disparities. For example, in the case of the Millennium Development Goals, many countries can report that they will achieve the Millennium Development Goals by 2015 using the national averages in their reporting on the indicators. However, when you disaggregate the data by socio-economic status, gender and ethnicity, you will see huge disparities and these disparities are hidden by national averages. So, I think it’s very important for Governments to develop monitoring systems that takes into account the social stratification of the society, so that we can discover the disparities and try to address these disparities.

EDNO Magazine: Governments often say that they will need a lot of money in order to implement such mechanisms. Do they really need a lot of money to do that or they just hiding behind justifications?

ÖSTLIN: I’m sure that there are several measures that do not need much money, it just need a political will. But, some measures do need money. For example, developing national monitoring systems and collect health information also for the most marginalized groups cost money, but I think that many, many measures that can be taken are not costing money at all, for example, trying to change attitudes in the health care, how to meet and how to talk to marginalized populations. It doesn’t cost much money to incorporate some culturally sensitive issues in the education of health professionals.

EDNO Magazine: There are different health systems in each of the European countries and because of the world economic crisis, many poor people have no access to the health care as they cannot afford to buy medications. Do you have some kind of pilot – project for health care for poor people?

ÖSTLIN: In many countries, health care for pregnant women or mother care or child care are free of charge, and if this is not possible fees for these services should be very low, so that user fees do not become an access barrier. I think it is one requirement for achieving equity in access to health care that we do not put financial barriers for poor people. We know that too high user fees and even informer fees, “under table” fees are unfortunately common in some country contexts and these fees pose a barrier for the poorest population for accessing the health care they would need. I think that health system managers should create mechanisms, some kind of control system that would stop this.  I do not think that we should create a specific health care system for the poor, because such health care would be of poor quality. It is more appropriate to ensure that the health care that is offered to the majority of the population is also available to poor people on equal terms.


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