The Challenges

The Ministry of Health passed a reform to make immunizations free of charge to all Macedonian residents, regardless of age, ethnicity or employment status. Employers pay a monthly rate for insurance and those who are unemployed register with the Department of Labor every 6 months to receive "insurance stamps" to exchange for regular check-ups, vaccinations etc. This system seems to be working for modern Macedonians, but falls short when it comes to the Roma communities.

To receive insurance stamps you have to provide documentation: a birth certificate, an address, etc and few Romas can provide this kind of documentation. Most families receive "invitations" or postcards to invite their children to be immunized or to remind them of follow up immunization sessions, but many Roma families lose the cards, or never receive them because the Roma areas of the city don't have street names or addresses. The largest Roma community in Skopje is its own municipality called Shuto Orizari, (also referred to as Shutka), has a high birth rate, and totals around 30,000 people.

Prompted in part by an outbreak of measles in this community last year, ESE and Masecina conducted a study and composed a comprehensive report entitled Research on the Immunization Coverage of Roma Children in the Republic of Macedonia, which brought to light the glaring discrepancies in immunization coverage between Roma communities and non-Roma communities. The report proposes four solutions that would help improve the vaccination rate, including preventative measures such as educational workshops for parents and active measures like increasing the number of "Patronage Nurses" and frequency of visits to each community corresponding to the rate of vaccination and population being served but its message was lost in how it was presented.

ESE's campaign targets specific members of the Ministry of Health, policy makers, other NGOs and also the general public to represent the information from the report and to implement their proposals. Parson's Fellow Jeanna Hamilton worked through the Summer of 2010 to visually present the information in a more visually engaging way that would supplement and showcase all the data that had been collected.

The Solutions

Working closely with the staff of ESE, Jeanna came up with three mediums that would visually represent the information from the report to its targeted stakeholders.

Publication Design
All of ESE's previous materials had been designed and printed by outside firms. Each publication was designed to individually address a specific topic or issue rather than to represent ESE as a NGO, so there was little consistency between each publication. Jenna worked with staff to design ESE's 2008 - 2010 Biannual Report to create two versions of the policy briefs, which summarized the "Research of the Immunization Coverage of Roma Children in the Republic of Macedonia" to focus on the proposed solutions to help address the pitfalls of the current vaccination system and hopefully to raise the overall vaccination rate in Roma communities.

The shorter version would be available for higher end officials to skim and the longer brief would be addressed for more attentive members to review in greater depth. Statistical data, charts displaying low vaccination rates within the Roma communities and the faces and stories of people affected were represented so readers could absorb more information while viewing fewer pages.

Video Documentation
Series of interviews were conducted with Roma mothers, medical professionals and experts on Roma issues to support the research findings and to ease the enacting of the proposed solutions. After much persistence, National Coordinator of the Decade and the National Strategy for Roma Nezdet Mustafa met with ESE and acknowledged, on camera, ESE/Mesecina's Research Report and policy briefs that the government had a responsibility to serve and implement public health policies to all populations, and in this case, especially the Romas.

Website Additions
Mesecina expressed a desire for the research and related media to be available for publication and distribution via its website. A redesign of the website included the housing and promotion of the video interviews, summary and highlights of the main points of the immunization research report and to provide a link to the PDF of the full report.