Emese Ibolya:
Improving medical school curricula and
Roma access to health care in Hungary
Research proposal
Introduction
The Roma peoples of Hungary and the whole Central and Eastern Europe
are in the position of suffering the worst health conditions of these
societies. This statement can be supported by numerous studies carried
out in relation to this minority. As a result of these, we can conclude
that the morbidity and mortality indicators of this minority are
generally worse than the majority population’s in Hungary (Puporka
& Zádori, 1999). However, the Roma as a significant
minority, consisting of 5-6% of the whole population of Hungary are
often forced to face the negative discrimination from majority members
of society due to their unique culture besides their existing
economical, social and regional disadvantages. According to a report by
the Regional Office of the World Health Organization, the health
problems of the Roma are not of cultural but more of social origin.
Therefore, the real danger is not ethnicity, but poverty in their case
(Vadászi, 1999). However, a study made by Neményi (2001)
with nurses working in the Hungarian health care system reveals that
the ethnical background of the patients strongly affects the healthcare
providers’ perception and their treatment of them. As a consequence,
the gaps in health status between the Roma and majority population
reflect official discrimination and marginalization of this minority.
In other words, the problems affecting the health of the Roma
population are of both social and cultural origin, which areas often
overlap each other.
Background
The transition from the communist political system to market economy,
economic regression and the enacted restrictive measures had a major
impact on social and health conditions as well as on our ability to
tackle them. Hungary has already passed the most difficult phases of
transition and has accumulated enormous experience in the course of
preparing for fulfilling Community obligations and requirements. The
"Decade of Health" Government program aims at improving the health
status of the whole Hungarian population. To enhance this process, the
Government is committed not only to consolidate and modernize the
current health care system but to carry on the financing reform of the
health system. The Government implements a health-centered governmental
strategy, which mobilizes all economic means and entire mental capacity
of society in the interest of each individual. The program was adopted
by the entire consensus of Parliament and its implementation started in
April 2003. However, there are still unsolved areas remaining, which
require urgent treatment.
As for the health situation of the Roma, in 2002 the Government
launched a wide-ranging program, containing measures to provide equal
rights for the Roma, improve their quality of life and their living
conditions, develop their physical and mental health, besides providing
equal education chances and marketable job opportunities to promote
their social integration. However, the policy-making process does not
seem very effective in terms of considering the real needs of this
minority, as most of these problems are still unsolved and a large
proportion of Roma often do not have proper access to public health
services, therefore do not meet the most basic health and safety
requirements. As a result, recent health surveys confirmed a life
expectancy for Roma of 15 years below the Hungarian average (Commission
Report 2002).
Different drawbacks present in the state of health are deepened by the
intolerant and often discriminatory approach of professionals working
in health care towards this minority, which can be well demonstrated by
the following case; according to a 2004 report of Amnesty
International, a Hungarian hospital provided separate accommodation for
Romani women in the maternity ward, which is one of the widespread
forms of discriminatory cases in health care affecting the Roma.
However, this is only one case of the numerous scandals emerging from
discriminatory treatment of the Roma in health care in present-day
Hungarian society.
Even though there are numerous reports of racism on the part of health
providers towards the Roma, remedy is usually available neither in the
courts, in the training framework for healthcare providers, nor through
any other mechanism. In fact, there is an almost-complete lack of
structures for protecting and promoting health-related rights, such as
codes of ethics for health professionals, patients’ rights charters,
complaints mechanisms of any kind, or ombudsman offices concerned with
health rights. Therefore, besides the improvement of the institutional
background of the health care system, specific steps are needed to
guarantee equal rights in health care and the development of Roma
peoples’ health status.
According to Holló (2004), the current health care financing
system is not in relation to the actual needs of society. Moreover,
besides regional inequalities there is a severe lack of access to
public health care from the side of the Roma population. Neményi
(1998) and Krémer (1998) both emphasize the integration of
ethnical contents into medical schools’ syllabuses and state that
certain initiatives should be taken for the improvement of
communication between healthcare providers and the Roma. Therefore,
National Health Policies Relevant to minority inclusion include
increasing the tolerance level and conflict handling abilities of
healthcare providers, due to the high number of conflicts between Roma
patients and healthcare personnel. This tendency, according to the Roma
Integration Directorate of the Government Office for Equal
Opportunities in Hungary, requires a thorough overview of medical
schools’ curricula and cross-cultural training in the educational
programs of medical schools.
Research questions
The following research questions will be explored during the period of
the fellowship:
How much medical schools’ curricula prepare medical personnel for the
challenges of dealing with the Roma minority?
How could these curricula be filled with certain ethnical contents to
develop a more tolerant approach in medical students towards the Roma?
How do communication and cooperation could be improved between
healthcare providers and the Roma?
Design and methodological approach
To examine these issues, I will analyze the curricula of different
medical schools both on intermediate level and in higher education with
special emphasis on their ethnical content and their capability of
developing significant amount of tolerance in medical students towards
the Roma. The study will begin with a narrative of the current
situation in the involvement of ethnical elements into these schools’
curricula. It will then move on to analyze attitudes of professors of
medical studies to Roma health problems, moreover I intend to explore
what kind of effect their views have on their students’ attitudes
towards the Roma. The study will also focus on current practices
of health care institutions considering Roma patients, moreover the
communication between healthcare providers and their patients of
minority groups; and to reveal the possible barriers of satisfactory
access to health care for the Roma. I will also analyze how cooperation
could be improved between health care institutions and the Roma
minority. Subsequently, I will investigate how medical schools’
curricula could be improved in the light of the conclusions of the Roma
situation in health care. Additionally, after reviewing such curricula
in other countries, I wish to design one appropriate for teaching
professionals to deal sensitively with ethnic minorities in general.
The method employed includes a profound analytical overview of medical
school curricula, health care policies, expert studies and research,
completed with the interviewing of and collecting data from health care
experts, medical professors and students, doctors and nurses working
with Roma patients in public health care. Data will be obtained from
predominantly written sources such as scholarly publications, official
documents from governmental and supranational organizations. I will
produce recommendations to eliminate existing disadvantages and the
short-comings of the public health care system, as well as the barriers
of the system that inhibit equity in access to health care.
In this research, data and relevant information will be collected for
different regions of Hungary. Textual analysis and quantitative
analysis of statistical data will be employed to precede this data and
to generate relevant information.
Work Program
I plan to finish this research within a year. Firstly, I will collect
data and do required fieldwork. In the last phase, I will perform the
analytical section of the project and write up the conclusions and
policy recommendations for Hungarian policy makers, relevant NGOs and
public health care institutions.
Anticipated outcomes and outputs
Having understood the present practices in healthcare education
considering ethnical content and different ways of developing skills in
medical students to promote tolerance towards the Roma and their
current situation in the pubic health care system, I will produce
practical policy recommendations and an ethnic-sensitive model
curriculum to medical schools based on foreign resources. I also wish
to provide some recommendations to improve the health status and life
expectancy of the Roma population in Hungary, moreover to create a
well-functioning public health care system with even distribution of
resources based on equity and tolerance.
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