The importance of health promotion assistants in public health

The purpose. Healthy Regions is the only organization that carries out health awareness activities in marginalized Roma communities. The aim of this paper was to point out the importance of health promotion assistants in the health system of the Slovak Republic, which also includes marginalized Roma communities through the intervention of health promotion assistants. Methods. A descriptive method was used to write this paper. Results. The article describes in detail the specific interventions of health promotion assistants who perform in the public health system when working with marginalized Roma communities. Conclusions. The position of health promotion assistants in society reflects their irreplaceable role in public health.


Introduction
The Ministry of Health of the Slovak Republic has established a state contributory organization Healthy Regions, which employs health support assistants and coordinators of health support assistants in the Slovak Republic in excluded Roma communities.As a rule, health promotion assistants themselves come from these socially excluded communities in which they work.Marginalized Roma communities are also part of the public health system in Slovakia.Health promotion assistants work with people from Roma settlements, but also with doctors, hospital workers or other health professions, as mediators, with a view to the effective provision and use of public health services.
The aim of this contribution is to highlight the importance of health promotion assistants in the public health system.All people with no differences are part of the health system.Working with marginalised Roma communities has different specificities.People from Roma settlements are often not oriented in the health system.They lack relevant information with which to work effectively when using the services of the health system.Healthcare professionals have different communication skills with users of the health system.There are a lot of patients, paramedics shortages.The interventions of health promotion assistants are purposefully targeted at key areas.They help integrate marginalised Roma communities into the public health system.They help ensure acceptance of otherness in the health system.

List of interventions by health support assistants in the public health system
Healthy regions are a state contributory organization of the Ministry of Health of the Slovak Republic.The motto of Healthy Regions is that:,"Caring for vulnerable groups is the key to the health of the whole of society".As further stated on the Healthy Regions website:,"Our activities and activities focus on social determinants of health, which include healthrelated behaviours, material conditions, psycho-social factors, barriers to access to healthcare, health literacy and structural constraintse.g.discrimination, racism, low level of education, related legislation....") [1].
Health education is one of the basic tasks of health promotion assistants and coordinators of health support assistants in locations where marginalised Roma communities live.The 2018-2019 Annual Reports of Healthy Regions [2,3] show that the main objectives are: -reducing barriers to access to healthcare (including increasing the availability of healthcare services and informing MRK residents in the field of health care and prevention); -increasing health literacy (including raising awareness in the health care of MRK residents); -improvement in health-related behaviour (in particular, reduction of lifestyle risk).
According to the scientific article: The demand for training in non-medical health professions is important that health care and its study are promoted more and more people are addressed.As the number of older people in the population increases worldwide and thus the higher rate of health complications, the need and demand of available health workers is also increasing at the same time [4].

general groups of interventions by health support assistants:
1. Support for preventive health programmes This category of interventions focuses on compulsory vaccinations, preventive examinations, maternity counselling and, during the COVID-19 pandemic, vaccination against COVID-19.Field health support assistants invite clients for vaccinations, preventive examinations or maternity counselling in consultation and agreement with doctors.The important role of assistants is mainly in ensuring that clients complete these medical procedures with doctors at a set time.

Clients come to compulsory vaccinations instructed by assistants on what vaccinations to undergo, what side effects can occur after vaccination and how clients should be prepared
for these side effects.Preventive examinations form a large group of interventions in both children and adults.Regular preventive examinations, help doctors to monitor the health of clients continuously.They help to capture possible diseases at an early stage, and this contributes to saving public funds for possible more demanding treatment of clients.Health support assistants regularly communicate with the mothers of children invited by doctors to maternity counselling.The aim is to ensure the healthy development of children.For all these interventions, health support assistants use their communication skills, social relationships, and ties with clients, as well as passing on information to them.The aim of health support assistants is to lead clients to autonomy, responsibility to their own health and the smooth running of the health system.

Cooperation with healthcare providers
In this category of intervention of health support assistants, it is about telephone and personal communication with general practitioners for adults, pediatricians, specialist doctorsspecialists and hospitals.Health support assistants maintain regular personal or telephone chats with doctors.This is due to the regular exchange of information between doctors and assistants.Health support assistants work on the ground, right where the patients of the doctors live.They supervise adherence to treatment to be determined by doctors.They help people in the household to properly dispense drugs.Alternatively, if they are elderly or immobile people, health support assistants help them remove medicines from the pharmacy.An important task in this category of intervention for the health system is to order people for routine or specialized examinations at doctors.Health support assistants help communicate with doctors.Based on medical reports, doctors can pass on information from medical reports in a clear, comprehensible manner and order the client for the necessary examinations.The client is always present at such a telephone ordering and engages in communication with doctors and assistants.Assistants try to get clients to come to the doctor on the ordered appointment.The assistant can teach them how to prepare for a medical examination.Some medical examinations require not to eat or drink a lot of water before the examination, or people have to bring some biological sample with them.Assistants in this case have a big part in the fact that people come for medical examinations exactly on time and ready.Paramedics often communicate very professionally.The Health Support Assistant, if the client so wishes, can accompany him to the examinations and assist with mutual communication between the doctor and the patient.

Other cooperation
Here we count interventions relating to cooperation with other assisting professions or institutions and these include: local government, regional public health authority, community centres, field social work, emergency health service, etc.).
Health support assistants regularly work with field social workers and staff in community centres.All these assisting professions operate together in the same location.They have the same clients.They solve a complex of common problems.This cooperation helps all, but especially the people themselves, for whom these assisting professions operate in the localities.The important role of health promotion assistants lies in communicating with the regional public health authority.Cooperation with operational centre 112 is very important.It is an emergency hotline used as a rule by people who are in danger of life or cannot cope with their health at home on their own.However, the experience of paramedics suggests that these are often unreasonable calls or unfounded.Even often this is inaccurate information from people, and emergency services are also called to cases where people can cope on their own.They did not take medications that they had or had the opportunity to go to the doctor on their own.Health promotion assistants seek to eliminate unauthorized trips by paramedics to marginalised Roma communities.They try to make regular enquiries about when to call the 112 emergency number and when they don't.When can people help themselves and how.When people can ask for help from a field assistant.It is different if the health support assistant calls the 112 emergency number.The assistant has experienced training based on which he/she knows the exact procedures of communication.He knows how to answer objective questions on the 112 emergency number.He knows the situation in which the client is located.He can monitor the client's health based on the instructions on the 112 emergency line.In the event of an acute deterioration, he knows he has to call the 112 emergency number again.The aim of these interventions is to reduce the unjustified exits of rescuers to marginalised Roma communities.This increases the chances that paramedics will be sent where there is a high risk to life.For example, in traffic accidents, fires, floods, or other events.

Direct assistance to clients This group of interventions consists of interventions
such as: measurement of blood pressure, first aid, treatment of minor injuries, accompanying for examination, area of health insurance, compensatory aids for disabled people, medicines, tele-medicine, and activities carried out in cooperation with the regional public health authority.Health support assistants have a pressure gauge at their disposal in the field.They use it at the request of a doctor and to measure blood pressure to clients who are treated for blood pressure.They write down the values of the measured blood pressure and the client consults the doctor for these values.Health support assistants have received training aimed at treating minor injuries or providing first aid.Treatment of minor injuries makes it possible to provide assistance to clients on the ground as soon as they need it.When providing first aid, health support assistants are perceived as the eyes and hands of paramedics.The assistant is a trained layman.He knows what to do and how to handle first aid until paramedics arrive.He needs a cell phone and call the 112 emergency number.The operator on the emergency line communicates with the health support assistant very quickly when saving the lives of clients in the field.He gives expert advice to the health support assistant, which has been explained to him in detail at training, and the assistant follows the agreed procedure and waits for paramedics to arrive.Tele-medicine is also an important part of the work of the Health Promotion Assistant.This has become particularly important during the COVID-19 pandemic.The elimination of patients in healthcare facilities was important, especially during the COVID-19 pandemic.Even then, however, people from marginalised communities had health problems that needed to be communicated directly with doctors.In this case, health support assistants helped, via telephone consultation or video calls between people from marginalised Roma communities and doctors.The assistant also had a mediation role in this case and helped in effective communication with doctors.At the same time, he helped explain to the client, everything the doctor said, in a simpler way.

Other activities
Health support assistants in the field also perform other activities.These include: charity activities, brigades, collections and other activities.

Pandemic COVID-19
The specific role of health support assistants was during the COVID-19 pandemic.According to the study (Attitudes of Roma Towards Quarantine and Restrictions Due to Spreading COVID-19 and their Impacts on Life in the Roma Settlement), which analysed the perception of the risks of the COVID-19 pandemic, as well as their attitudes to quarantine, emergency measures and flu vaccinations and their willingness to vaccinate with the COVID-19 vaccine Roma living in the Roma settlement of Žehra, it has been confirmed that that increasing roma's motivation to comply with the rules, restrictions and quarantine is not only about financial penalties and threats, but above all it is important to increase health and information literacy and their confidence in the authorities [5].
Moreover, this study states that up to 41.8% of Roma used masks solely because of government regulations in places where it is mandatory and not for personal reasons in order to protect the respondents themselves or others.There is therefore a significant correlation between poor motivation to wear masks, lack of information and a misunderstanding of government restrictions in quarantine.This research, sampled by 98 Roma aged 25-60 during the first wave of the COVID-19 epidemic between April and May 2020, confirms that health assistants and their roles such as information, assistance, and advice, as well as contact with the community during the pandemic, are an important part of helping public health in the overall management of the pandemic.
Information as such is also necessary according to (Brozmanová Gregorová et al. (2012) [6].It is also one of the important aspects in volunteering, which is a key activity in attracting and converting potential volunteers into active volunteers and volunteers.It was volunteering that was an important part of the series of mandatory nationwide testing for COVID-19, which are still active today.
Another study (Rehabilitation and Nursing Homes with Elderly and Homeless Population, Lessons not only for Physiotherapy but also for Epidemiology?)[7], which examined frequent infections occurring in residents of nursing homes, such as pneumonia, recommends regular monitoring of epidemics in the social group, as well as testing antibodies and resistant bacteria or viruses as a prevention against epidemics in the social group.

Discussion
Healthy regions are a state contributory organization established by the Ministry of Health of the Slovak Republic.It employs health support assistants and health support assistant coordinators.Health promotion assistants are part of the public health system.They help people in marginalised Roma communities access healthcare.They also assist public health system actors in working with marginalised Roma communities.The Health Promotion Assistant in our society has an important position as a mediator between marginalised Roma communities and people who work in the public health system.

Conclusions
The aim of the work was to highlight the importance of health promotion assistants in public health.Every day, health promotion assistants are directly in locations where people from marginalised Roma communities live.Every day they come into contact with representatives of the health system.They seek to meet the needs of people from marginalised Roma communities and to cooperate effectively with marginalised Roma communities.They regularly receive training to increase knowledge, skills, and communication.