Access to primary healthcare services for the Roma population in Serbia: a secondary data analysis

Abstract

Background: Serbia has proclaimed access to healthcare as a human right. In a context wherein the Roma population are disadvantaged, the aim of this study was to assess whether the Roma population are able to effectively access primary care services, and if not, what barriers prevent them from doing so. The history of the Roma in Serbia is described in detail so as to provide a context for their current vulnerable position.

Methods: Disaggregated data were analyzed from three population groups in Serbia; the general population, the Roma population, and the poorest quintile of the general population not including the Roma. The effective coverage framework, which incorporates availability, affordability, accessibility, acceptability, and effectiveness of health services, was used to structure the secondary data analysis. Acute respiratory infection (ARI) in children less than five years of age was used as an example as this is the leading cause of death in children under 5 years old in Serbia.

Results: Roma children were significantly more likely to experience an ARI than either the general population or the poorest quintile of the general population, not including the Roma. All three population groups were equally likely to not receive the correct treatment regime of antibiotics. An analysis of the factors that affect quality of access to health services reveal that personal documentation is a statistically significant problem; availability of health services is not an issue that disproportionately affects the Roma; however the geographical accessibility and affordability are substantive issues that disproportionately affect the Roma population. Affordability of services affected the Roma and the poorest quintile and affordability of medications significantly affected all three population groups. With regards to acceptability, mothers from all three population groups are equally likely to recognize the importance of seeking treatment.

Conclusions: The Roma should be assisted in applying for personal documentation, the geographical accessibility of clinics needs to be addressed, and the costs of healthcare visits and medications should be reviewed. Areas for improvement specific to ARI are the costs of antibiotics and the diagnostic accuracy of providers. A range of policy recommendations are outlined.

Figure 1

Steps that must be undertaken by an individual in order to receive effective coverage.

Figure 2

The proportion children under five with symptoms of acute respiratory infection in previous two weeks. The 95% confidence intervals for each proportion are indicated on the graph. The Sample sizes are: General Population 2223/Roma 1218/Poorest quintile 397. The data source is the MICS 2005 (UNICEF).

Figure 3

The proportion of the population that could not afford to purchase prescribed medications within the previous 12 months. The 95% confidence intervals for each proportion are indicated on the graph. The Sample sizes are: General Population 5961/Roma - 831/Poorest quintile - 1292. The data source is the UNDP Vulnerability Survey 2006

Figure 4

The proportion of children under 5 with a suspected ARI that received any medication versus antibiotics. Blue bar = Actual utilization - the child was given any medication to treat the acute respiratory infection. Red bar = Effective coverage - the child was given the correct treatment (in this case antibiotics) to treat the acute respiratory infection. The 95% confidence intervals for each proportion are indicated on the graph. The Sample sizes are: General Population - 114/Roma - 172/Poorest - 9. The data source is the MICS 2005 (UNICEF).