Across Europe, Roma face exclusion and obstacles in access to health services, resulting in poorer
health. While there are legal and policy frameworks for Roma inclusion, implementation often lags
behind. Increasing the grassroots capacity of Roma to advocate for accountability in health care and
against systemic impediments has been a central focus of Open Society Foundations (OSF) support.
This analysis discusses the impact of an OSF-supported legal advocacy project on Roma health rights
in Macedonia. The paper uses qualitative indicators to measure the capacity of nongovernmental
organizations, accountability for violations, changes in law and practice, and impact on communities.
The methodology for assessing the impact of legal advocacy was developed over the course of OSF’s
legal advocacy project and used to calculate the baseline and conduct the follow-up assessment to track
progress across four strategies: legal empowerment, documentation and advocacy, media advocacy, and
strategic litigation. Results show that legal advocacy has led to a notable increase in Roma awareness
of their health rights. The number of lawsuits has risen dramatically, and cases are increasingly more
sophisticated. Although accountability in health care is still the exception rather than the rule, blatant
violations have been reduced. Some structural barriers have also been tackled. At the same time, new
challenges require continuous and adaptable legal advocacy.