Table 2 How access to healthcare is shaped by PROGRESS

Place of Residence:

The Roma tend to live in ghettoized settlements on the outskirts of cities, which are separate from the general population's place of residence. As seen above, slum housing in these settlements is quite common. In addition, the distance and lack of transportation from primary care centers may be an issue for some poor individuals.

Race/ethnicity/culture:

The Roma people have been widely discriminated against throughout Europe because of their ethnicity and culture. Decades of social exclusion have created a situation in which healthcare workers are not educated in cultural sensitivity to the Roma population [8].

Occupation:

High rates of unemployment amongst the Roma may be the result of a number of issues including lack of education and social exclusion. As many Roma are not formally employed, they do not have access to health insurance under the Health Insurance Fund [9].

Sex/Gender:

Roma women and single mothers are particularly vulnerable due to their precarious position and reliance on those with power within the family structure [43]. A systematic review of studies on Roma women in Central and Eastern Europe revealed that Roma women tended to have more issues related to reproductive health, have their first pregnancy earlier, and have less knowledge about contraceptive methods than the general population [44].

Religion:

Religion and ethnicity are closely intertwined in Serbia and in many cases it is difficult to identify discriminatory acts as primarily religious or primarily ethnic in origin. The lack of communication between the general population and the Roma people has caused religious tensions in the past around patient preferences and the refusal of treatment. Analyses of patient preferences and values would aid in the cross-cultural translation of interventions.

Education:

Education is a major predictor of success in breaking out of the cycle of poverty and ill health. Improvement in the education of public health and prevention among mothers has consistently been linked to the better health status of children.

Socioeconomic Status (SES):

Poverty has consistently been linked to poorer health status. In Serbia, 58% of the Roma are living below the World Bank absolute poverty line, defined as purchasing power parity of USD 4.30 per day, compared to only 9% of the general population [13]. There is no data on chronic poverty in Serbia; however, it is generally acknowledged that a much larger percentage of the Roma live in chronic poverty than their non-Roma counterparts.

Social Capital:

Roma appear to be high in social capital as a result of close-knit families and communities. Social networks provide day care for children of ill parents, palliative care to the elderly by younger generations in the household, and care giving to neighbours and friends [17]. Recent plans to move or demolish Roma settlements may have severe detrimental impacts on these social networks and support mechanisms.