Legal advocacy as a tool to advance Roma Health.

Roma in central Europe face many violations of their rights, including those that impede their access to high-quality health care. Legal frameworks have the potential to address these violations, whereas legal advocacy services offer a means for enforcement of rights. We undertook key informant interviews with Roma civil society organisations and selected knowledgeable individuals in Macedonia, Romania and Serbia to identify lessons from the development of these services. Achievements were reported in four areas. Legal empowerment, with employment of Roma paralegals was especially effective, increasing awareness of the ability to challenge violations. Documentation of human rights violations is an important basis for advocacy, but does not guarantee redress, and may work best in combination with legal empowerment or international pressure. Strategic litigation can play a key role in removing bureaucratic obstacles that prevent Roma from exercising their right to access to health care. Progress in changing the narrative on Roma in the mainstream media has been limited but examples of good practice exist. Although much remains to be done, Roma groups report that legal advocacy has strengthened their ability to challenge rights violations, thereby enhancing their ability to access effective and responsive care.

The Impact of Legal Advocacy Strategies to Advance Roma Health: The Case of Macedonia.

Across Europe, Roma face exclusion and obstacles in access to health services, resulting in poorer health. While there are legal and policy frameworks for Roma inclusion, implementation often lags behind. Increasing the grassroots capacity of Roma to advocate for accountability in health care and against systemic impediments has been a central focus of Open Society Foundations (OSF) support. This analysis discusses the impact of an OSF-supported legal advocacy project on Roma health rights in Macedonia. The paper uses qualitative indicators to measure the capacity of nongovernmental organizations, accountability for violations, changes in law and practice, and impact on communities. The methodology for assessing the impact of legal advocacy was developed over the course of OSF's legal advocacy project and used to calculate the baseline and conduct the follow-up assessment to track progress across four strategies: legal empowerment, documentation and advocacy, media advocacy, and strategic litigation. Results show that legal advocacy has led to a notable increase in Roma awareness of their health rights. The number of lawsuits has risen dramatically, and cases are increasingly more sophisticated. Although accountability in health care is still the exception rather than the rule, blatant violations have been reduced. Some structural barriers have also been tackled. At the same time, new challenges require continuous and adaptable legal advocacy.

Assessing legal advocacy to advance Roma health in Macedonia, Romania, and Serbia.

Across Europe, Roma suffer extreme marginalisation, negatively impacting their health. Many cannot access healthcare at all. For others, the health system is a hostile place. At the same time, good legal frameworks are in place to protect health rights, and there is increasing recognition of systemic violations experienced by Roma. Essential to building on this momentum and closing the gap between standards and implementation is Roma ability to conduct legal advocacy Since 2010, the Open Society Foundations has supported Roma engagement in Macedonia, Romania and Serbia in the following advocacy strategies: i) legal empowerment, ii) documentation and advocacy, iii) media advocacy, and iv) strategic litigation. This article presents a framework developed to evaluate the effectiveness of these efforts and a baseline against which outcomes can be measured in a few years. The evaluation framework provides a qualitative assessment of Roma capacity, accountability for violations, changes in law and practice, and impact on communities. Findings reveal that that presently Roma lack knowledge of their rights and rarely challenge violations. Accountability in healthcare is practically non-existent. However, where legal advocacy has been used, violations decrease, and power dynamics shift. As healthcare becomes more responsive to communities, it also better serves non-Roma citizens.