Project evaluation
PHARE No 2003-004-995-01-06
Improving access of Roma minority to health care in Slovakia
Introduction
Phare project No 2003-004-995-01-06 Improving access of Roma minority to health care in Slovakia, which was managed and implemented by the Ministry of Health of the Slovak Republic (MZ SR), was completed on 31 January 2007.
The project was funded by PHARE, the Financial Memorandum 2003.
In 2003, MZ SR developed a project plan aimed at improving the availability of healthcare for marginalized Roma communities, through pilot testing of selected instruments (daily work in communities through trained field health assistants directly in the locations of Central and Eastern Slovakia, provision of educational equipment, reconstruction and repair of local health centres along with minimum equipment and provision of mobile units).
The project was linked to the tasks set out for the Ministry in Resolution No 278/2003 (introducing a system of health assistants, a system of mobile units, providing information on planned parenthood and others).
Due to the funding of the project from the pre-accession fund of the European Union PHARE, all the tools and components provided under the project were procured in accordance with current legislation in the field of public procurement through the Ministry of Finance of the Slovak Republic, Department Central Finance and Contracting Unit.
The project was launched in September 2005 and the implementation phase ended on 31.12.2006.
MUDr was the material guarantor of the project. Peter Tatár, project manager on behalf of MZ SR was Ing. Zuzana Pikulová.
Project components
The project consisted of the following components in the amount (excluding VAT):

  1. Procurement and performance of the field health assistant system for designated micro-regions (EUR 840 000)
  2. Training and training actions for different target groups: field assistants, local authorities and local doctors (EUR 40 000)
  3. Ensuring a set of educational aids for young Roma health education (EUR 70 000)
  4. Purchase of medical equipment and equipment for health centres (EUR 70 000)
  5. Purchases of mobile medical units (€480,000)
  6. Renovation of selected health centres (EUR 90 000)

The task of TZA was to:
· acting in designated microregions continuously on a daily basis, working with local doctors in prevention, vaccination, healthcare provision
· establishing cooperation with local authorities, creating partnerships
· information on the project at local, regional and national level
· carrying out an entry survey of selected sites with a focus on knowledge:
on the starting point in locations and communities (risks in project implementation, human capital, cooperation with local authority, school, doctor, activities implemented, cooperation with NGOs)
on the health status of local Roma community according to basic parameters established in cooperation with MZ SR
· Carrying out regular basic statistical surveys and monitoring of the health status of Roma in selected locations, these will follow up on a basic survey on the health status of the local Roma community, so that the benefits of using individual instruments of the overall project on the ground can be continuously evaluated in relation to the change in the health status of local Roma.
· assistance by local physicians in monitoring relevant health data on the target population, in the vaccination process (this will also include the collection of evidence of current vaccination status), in preventive medical examinations and with appropriate treatment.
· implementation of regular health education in selected locations for young Roma. Education will be aimed at promoting healthy lifestyles, hygiene habits, drug prevention/risk reduction and negative effects of drug use, reproductive health, motherhood, parenthood, possible health risks and prevention.
Output:
· 40 trained TZA, working in a functional model, with established cooperation with communities and local authorities (health workers, schools, municipal authorities, NGOs),

· written reports describing progress in all municipalities submitted on a monthly basis throughout the project, including photo documentation,
· results of individual surveys and monitoring carried out by TZA.
Following public procurement, this component was provided by EuroPlus Management and Consulting, s.r.o.
2. The aim of the training activities was primarily to train the TZA itself to work in locations from the perspective of various aspects (theater community work, basics from the field of health legislation, the implementation of surveys, the implementation of health education and education, the creation of partnerships) so as to be able to operate effectively in selected locations on the ground on a daily basis, in order to help local health personnel to ensure full health care, but in particular to provide prevention and provision of vaccination, and to carry out the required surveys and monitoring and the implementation of health education.
The second part of the training was aimed at training local doctors and relevant health personnel in 59 municipalities to ensure close cooperation with TZA.
This included organising regular meetings for local non-Roma residents in all selected municipalities to improve relations between members of different ethnic groups living in the locality and raise awareness of their health needs, risks and health-enhancing approaches.
Finally, all supporting documents and forms were required to be drawn up and the methodology for conducting surveys and monitoring through TZA and the creation of documents necessary to provide health education in selected locations through TZA.
Output:
· monthly reports from the period in which individual trainings were carried out,
· training materials,
· proposals for individual questionnaires;
· Manual for TZA,
· 4 Manual for Health Education for different target groups (Programme for the training of hygiene habits in Roma children aged 5 to 6 years, Programme for the health education of Roma children aged 8-9 years, Health education for future parents (children / youth aged 14-16), Health education for girls and boys aged 11-14).
Following public procurement, this component was provided by EuroPlus Management and Consulting, s.r.o.
3. As part of the component "Providing a set of educational aids for the health education of young Roma', educational aids in the composition of the following were acquired by young Roma in local primary schools or community centres:

A set of educational aids was used in the implementation of health education aimed at promoting healthy lifestyles, hygiene habits, eating habits, prevention of drug use/reduction of risks and negative effects of drug use, reproductive health, motherhood, parenthood, childcare, motherhood, possible health risks and their prevention, including vaccination and provision of healthcare in general (medical treatment for the patient). Health education was carried out by field medical assistants at the school or community centers, and the target group was young Roma (levels I and II). DS).
The basic supporting topics of health education were processed in the form of educational videos and supplemented by specially designed and manufactured brochures. Videos were screened using a video recorder TV. Some specific topics have been explained more specifically on illustrative tools (dolls with accessories).
Output:
· 15 sets (TV and video player)
· 1280 pcs sets dolls with accessories (vanette, soap, clothing ...)
· 4 kinds of films per topic, each film of 64 pieces:
o THE FAMILY AND HUMAN RELATIONS
CARE FOR THE CHILD,
ON OWN HEALTH CARE FOR PREVENTION AND IMPACTS
o SEXUAL AND REPRODUCTIONAL HEALTH, BEARING AND CALLING
· 2 types of health education booklets with a focus on grade I and grade II 10,000 copies each (total 20,000 booklets)
Following public procurement, this component was provided by EuroFinanc, s.r.o.

4, 5. The objectives of the components "Buy mobile health units" and "Buy medical devices and equipment for health centres" were to ensure healthcare in remote areas with Roma populations. In this context, mobile health units (health vehicles) with equipment and medical equipment, devices, materials for health centres serving as a place for primary health care were subject to procurement.
Output:
· 8 mobile medical units (vehicles), including interior equipment
· basic equipment for 9 medical centres
Following public procurement, this component was provided by Chirosan, s.r.o.
6. The subject of the ÞRenovation of selected health centers" component was the provision of construction and reconstruction works of premises in buildings owned by the municipality, which serve as a place to provide primary health care. Reconstructions were carried out in 5 facilities, of the original 9. No tender was submitted for the other 4 installations.
Output:
· reconstructed facilities in municipalities: Spišské Tomášovce, Podhorany, Vydrník, Kecerovce, Chminianska Nová Ves.
Following public procurement, Arprog, s.r.o. and PKB Invest, s.r.o. provided this component.
External project monitoring
From Article 10 General Coordination Directive for Foreign Aid to the EU and its Member States the managing programmer is under an obligation to administratively manage the programming, implementation and monitoring of EU financial assistance projects.
In order to ensure independent monitoring, the Ministry concluded an agreement with two external experts to carry out project monitoring, the primary supporting component of TZA. External monitoring was carried out between October and December 2006.
Monitoring included the following activities:
  1. evaluation of field health assistant and project team activities
  2. Assessment of the impact of the actions undertaken on the target group and changes in its behaviour
  3. performance of continuous monitoring of TZA work and project team directly on the ground (59 municipalities)
  4. monitoring of other project components.