Slovakia

Target communities: Marginalized Roma communities

Vaccine(s): Human Papilomavirus (HPV)

Description of the target community

Roma are the largest and one of the most disadvantaged ethnic minority in Europe as well as in Slovakia 1European Union: European Agency for Fundamental Rights (FRA). Fundamental Rights Report 2019. Publications Offce of the European Union, Luxembourg, 20192Ministry of Interior of the Slovak republic. Atlas rómskych komunít 2019. [Atlas of Roma communities 2019]. 2019. Available online: http://www.minv.sk/?atlas-romskych-komunit-2019. Out of approximately 440 000 Roma in Slovakia, more than half live in marginalized Roma communities 3Ministry of Interior of the Slovak republic. Atlas rómskych komunít 2019. [Atlas of Roma communities 2019]. 2019. Available online: http://www.minv.sk/?atlas-romskych-komunit-2019 characterized by spatial and social distance from the majority population. Roma living in marginalized communities often experience discrimination, generational poverty, limited access to education, employment, housing, and various types of services including health care 4Ministry of Interior of the Slovak republic. Atlas rómskych komunít 2019. [Atlas of Roma communities 2019]. 2019. Available online: http://www.minv.sk/?atlas-romskych-komunit-201953. European Commission. Civil Society Monitoring Report on Implementation of the National Roma Integration Strategy in Slovakia: Focusing on structural and horizontal preconditions for successful implementation of the strategy. Directorate-General for Justice and Consumers. European Commission, Brussels, 201864. Jarcuska, P., Bobakova, D., Uhrin, J., Bobak, L., Babinska, I., Kolarcik, P., … & Geckova, A. M. (2013). Are barriers in accessing health services in the Roma population associated with worse health status among Roma?. International journal of public health, 58(3), 427-434.. These circumstances are reflected in health inequities between Roma and the majority population 7Ministry of Interior of the Slovak republic. Atlas rómskych komunít 2019. [Atlas of Roma communities 2019]. 2019. Available online: http://www.minv.sk/?atlas-romskych-komunit-20198Tombat, K.; van Dijk, J. P. Roma Health: An Overview of Communicable Diseases in Eastern and Central Europe. Int. J. Environ. Res. Public Health. 2020, 17(20), 7632.

Vaccine uptake

Specific data on HPV vaccine uptake in the Roma community is lacking. In the Slovakian general population, the uptake of HPV vaccination in 12-year olds in 2019 was 23%. Given the low HPV vaccination uptake in the general population and the lower uptake of other vaccinations like DPT, Polio, MMR and BCG in the Roma community, it can be assumed that HPV vaccination rates among Roma are very low.9Laetitia Duval, François-Charles Wolff, Martin Mckee, Bayard Roberts. The Roma vaccination gap: Evidence from twelve countries in Central and South-East Europe. Vaccine, Elsevier, 2016, 34 (46), pp.5524 – 5530. ff10.1016/j.vaccine.2016.10.003ff. ffhal-01385007f

Contextual factors:

Approximately 260,000 Roma live in more than 1,000 registered concentrations characterized by the spatial and social distance between Roma and the majority population of Slovakia. Another approximately 75,000 Roma live in more or less confined communities within municipalities with a share of the Roma population over 30%, while in many villages Roma are even in the majority.10Ministry of the Interior of the Slovak Republic. (2019). Atlas of Roma Communities 2019. Available from: http://www.minv.sk/?atlas-romskych-komunit-2019 The population living in marginalized Roma communities is on average younger than the majority population in Slovakia. Roma living in these marginalized communities have worse access to proper housing, education, health care, job opportunities, and basic services. Their use of health care is 36% lower than in the national population, which points to barriers in access to health care.30 Among these barriers are lower health literacy, lack of funding for transport and medication, fear, mistrust, and bad experience with discriminatory practices of health professionals.11Jarčuška, P., Bobáková, D., Uhrín, J., Bobák, L., Babinská, I., Kolarčík, P., Veselská, Z., Madarasová Gecková, A., HepaMeta Team. (2013). Are barriers in accessing health services in the Roma population associated with worse health status among Roma? International Journal of Public Health, 58, 427-434.12Belák A., Fiľakovská Bobáková D., Madarasová Gecková A., van Dijk J.P., Reijneveld S.A.: Why don´t health care frontline professionals do more for segregated Roma? Exploring mechanisms supporting unequal care practices. Social Science & Medicine 2020, 246:112739.

Health system barriers:

Due to migration between settlements and abroad there is a lack of vaccination data which leads to a suboptimal health information system, which is necessary to understand, act if necessary and compare data. The Roma community in Slovakia often are unaware of the importance of immunization. Secondly, they experience challenges in accessing vaccination services. The Roma community in Slovakia use health services less frequently compared to majority of the population; they only tend to use health care in acute cases. Limited use of vaccination services is partly explained by significant information barriers, discrimination and the absence of a doctor to approach when needed. In addition, limited language and cultural understanding of healthcare professionals often result in the indirect unavailability of vaccination services. Finally, the lack of governmental financial resources lead to disruption of programmes focusing on the improvement of Roma health, including vaccine preventable diseases. Transport and medical costs are additional barriers to accessing healthcare services among the Slovak Roma community, 9.2% could not afford or did not want to pay a fee for immunization.

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