A woman visits a gynecologist for a check-up but the office demands she pay a fee for a service that is free.

A young child and his parents are never informed about vaccination for measles, mumps, and rubella.

A man in need of dialysis is thrown out of the hospital because he asks for transportation reimbursement, which is required by law.

These are just a few of the many health rights violations Roma people face in Macedonia. But the work of Roma paralegals is having a profound impact on Roma health in their communities.

To protect health rights and influence systemic change, four Macedonian organizations have joined forces. Three of them are local Roma organizations—Centre for Democratic Development and Initiatives, Humanitarian and Charitable Organization of Roma (KHAM Delcevo), and Roma Resource Center. The fourth, Association for Emancipation, Solidarity and Equality of Women (ESE), is a national human rights organization with experience in advocacy and research.

Each of the Roma organizations hosts two paralegals recruited from their communities. Their understanding of local issues and the trust they have within their communities allow them to establish strong relationships with clients. In turn, ESE provides training, oversees case management, and intervenes in particularly difficult cases.

The paralegals conduct door-to-door outreach and hold office hours. They listen, provide advice, and in some cases they intervene by accompanying clients to local authorities or clinics where they negotiate resolutions todisagreements, lodge complaints, or demand remedies for violations. They also help many Roma obtain personal identification documents, without which they cannot get health insurance to subsidize their care.

The paralegals have also contributed to systemic changes in Macedonia. For example, many health care providers used to illegally charge Roma patients for services like gynecological check-ups and vaccination certificates, and many used to confiscate Roma patients’ identity documentation if they were unable to pay hospital bills. These situations have greatly improved as a result of persistent interventions by the paralegals.

The paralegals have also helped Roma citizens advocate for their rights themselves. By conducting roundtables in local communities, paralegals have educated about health rights, and examined local problems. In Crnik, a village in eastern Macedonia, villagers successfully advocated for a local vaccination center, which will open soon, and they are in the process of applying for “rural health area” status, which would give the village access to an ambulance.

With local support, these four organizations are bringing justice to Roma health in Macedonia.

The Centre for Democratic Development and Initiatives; the Humanitarian and Charitable Organization of Roma; Roma Resource Center; and the Association for Emancipation, Solidarity and Equality of Women are grantees of the Open Society Foundations.