Contributions of HPH to meet health needs of refugees and migrants
Antonio CHIARENZA Chair of the HPH Task Force on Migrant-Friendly and Culturally Competent Health Care, Head of Research and Innovation Unit, and, Local Health Unit of Reggio Emilia, Emilia Romagna, ITA
I have a degree in Political Science from the University of Bologna (Italy), a Master degree in Promotion and Governance of Health Research from the University of Modena & Reggio Emilia, and a PhD by research in Sociology from the University of Leicester (UK). Since 2001, I am the Head of Research and Innovation Department of the Local Health Authority of Reggio Emilia in Italy (AUSL-RE). Since 2005, I lead the international HPH-Task Force on Migrant-Friendly Hospitals and Health Services and the Regional Health Promoting Hospitals Network of Emilia-Romagna. I have a specific expertise on the impact of health inequalities and health service access barriers on the health status of migrants in Europe and have published articles and presented papers on the issue of migrant's health care in national and international journals and conferences.
Following my doctorate in sociology my research interests have focused on health promotion, migrants’ health and health care services’ responsiveness and adaptation to diversity. I have been directly involved in a number of international projects: the Migrant-Friendly Hospitals (2002-2005); Race, Criminal Justice & Drugs (2007-10); ChAPAP (2007-2010); NowHereCare (2008-2011); COST Action HOME (2007-2011); PROMOVAX (2010 – 2012); EURO Monitoring Migrant Health (2013- 2015); COST Action ADAPT (2012-2015); MEM-TP (2012-2015) Migrant and Ethnic Minorities Training Packages; SH-CAPAC (2016) “Supporting health coordination, assessments, planning, access to health care and capacity building in Member States under particular migratory pressure”. At present, I coordinate the international project on the development of Standards for Equity in Health Care for Migrants and other Vulnerable Groups.
Abstract summary: Introduction and background
In 2015 more than a million refugees and migrants took their chance aboard unseaworthy boats in a desperate bid to reach Europe. The vast majority of those attempting this dangerous crossing are in need of international protection, fleeing from war, violence and persecution in their country of origin (source UNHCR). The enormous influx of migrants towards Europe has posed new challenges for health care providers. Countries have been affected differently, depending on whether they are arrival, transit or destination countries. Yet despite the differential exposure, the situation has proved similar: asylum seekers faced barriers to access adequate health services. Asylum seekers may face serious medical and psychological problems, yet they frequently do not receive the care they need because European health-care systems have still not adapted in order to respond adequately to the needs of these vulnerable groups. In this scenario in January 2016 the European project "Supporting health coordination, assessments, planning, access to health care and capacity building in Member States under particular migratory pressure" (SH-CAPAC) was launched in order to help European countries to face this challenging situation. The project received funding from CHAFEA within the European Union’s Health Programme (2014‐2020) and aimed at developing supportive frameworks and tools able to strengthen health systems' capacity in addressing the health needs of refugees, asylum seekers and other migrant populations.
Methods
As part of the SH-CAPAC project, the HPH-Task Force on Migrant Friendly and Culturally Competent Health Care (HPH-TF MFCCH) developed the "Resource package for ensuring access to health care of refugee, asylum seekers and other migrants in the European Union (EU) countries" aiming to address barriers to access to health care and to ensure continuity of care for these vulnerable populations throughout the migration journey: arrival, transit and destination. Specific objectives of this resource package are to provide: i) evidence on the new challenges for health services related to the current refugee crisis; ii) a framework and outline of steps for improving access to health care for refugees asylum seekers and other migrants; iii) evidenced tools and measures and other resources that can support member states addressing formal and informal barriers that hinder or limit access to health care for refugees and asylum seekers. In order to gather updated information on the new challenges for health professional and services related to the current refugee crisis and to identify gaps between barriers and solutions, a mixed method study was performed. Firstly, a series of interviews and focus groups were carried out in 10 EU countries connected to the HPH-TF MFCCH and secondly, on the base of the results of the interviews and focus groups, a systematic review (SR) was conducted to systematically collect, summarize and critically appraise the available evidence on access to health care services for asylum seekers and refugees. Studies were included in the review if they were: published in journals from January 2008 to July 2016, written in English, French, Italian, Spanish and Dutch.
Results
The analysis of the interviews and focus group provided indications on what should be included in a resource package and informed the search strategy of the SR. Results concerning evidence on barriers and solutions have been grouped into two categories: general barriers concerning access to healthcare services and barriers concerning access to specific healthcare services. The first category provides evidence on legislative, administrative and bureaucratic barriers; linguistic and sociocultural barriers; organisational barriers and obstacles to ensuring equitable quality of care; lack of coordination between services; lack of information for health providers and difficulties in ensuring continuity of care; lack of information and education for refugees and asylum seekers. The second category provides evidence on barriers and solutions concerning mental health care, sexual and reproductive care, children and adolescent care, and care for victims of violence.
Conclusions
The results of the focus groups, interviews and literature review clearly show that a resource package containing tools and measures to improve access to health care for refugees and asylum seeker should be adapted at national/local level. The context in which health professionals and managers operate is different from one country to another and so is the situation for migrants. Information on available measures and resources useful to support access to health care should be integrated into the national and local means of communications and established network of cooperation. The proposed resource package is to be seen, therefore, as a support tool for the development and dissemination of measures at country/regional/local level, depending on its level of implementation. Furthermore, national governments should allocate funds to improve the support to those already working with asylum seekers and to develop plans to improve integration in society of asylum seekers.