Supporting access to healthcare for refugees and migrants in European countries under particular migratory pressure.

BACKGROUND: In 2015 the increased migratory pressure in Europe posed additional challenges for healthcare providers. The aim of this study was to inform the development of a "Resource Package" to support European Union (EU) member states in improving access to healthcare for refugees, asylum seekers and other migrants. METHODS: A mixed method approach was adopted: i) interviews and focus groups were carried out to gather up-to-date information on the challenges the different healthcare providers were facing related to the refugee crisis; ii) to complement the results of the FGs, a literature review was conducted to collect available evidence on barriers and solutions related to access to healthcare for refugees and migrants. RESULTS: The different actors providing healthcare for refugees and migrants faced challenges related to the phases of the migration trajectory: arrival, transit and destination. These challenges impacted on the accessibility of healthcare services due to legislative, financial and administrative barriers; lack of interpretation and cultural mediation services; lack of reliable information on the illness and health history of migrant patients; lack of knowledge of entitlements and available services; lack of organisation and coordination between services. These barriers proved particularly problematic for access to specific services: mental health, sexual and reproductive care, child & adolescent care and victim of violence care. CONCLUSIONS: The findings of this study show that solutions that are aimed only at responding to emergencies often lead to fragmented and chaotic interventions, devolving attention from the need to develop structural changes in the EU health systems.

What are the roles of intercultural mediators in health care and what is the evidence on their contributions and effectiveness in improving accessibility and quality of care for refugees and migrants in the WHO European Region?

Intercultural mediators are employed to resolve linguistic and cultural barriers in a variety of health-care contexts. This report examines the main roles performed by intercultural mediators in health care across the WHO European Region and analyses evidence on their effectiveness in improving accessibility and quality of care for refugees and migrants, and the factors that enable them to have a positive impact. The beneficial impact of intercultural mediators is hindered by a lack of professionalization, insufficient training and the non-systematic and inconsistent implementation of intercultural mediation programmes. Developing training programmes and accreditation systems, further research into the effectiveness of intercultural mediators in health care, and the development of strategies that guarantee access to intercultural mediators in health care wherever and whenever needed will enormously improve the quality of health care for refugees and migrants.

What are the roles of intercultural mediators in health care and what is the evidence on their contributions and effectiveness in improving accessibility and quality of care for refugees and migrants in the WHO European Region?

Intercultural mediators are employed to resolve linguistic and cultural barriers in a variety of health-care contexts. This report examines the main roles performed by intercultural mediators in health care across the WHO European Region and analyses evidence on their effectiveness in improving accessibility and quality of care for refugees and migrants, and the factors that enable them to have a positive impact. The beneficial impact of intercultural mediators is hindered by a lack of professionalization, insufficient training and the non-systematic and inconsistent implementation of intercultural mediation programmes. Developing training programmes and accreditation systems, further research into the effectiveness of intercultural mediators in health care, and the development of strategies that guarantee access to intercultural mediators in health care wherever and whenever needed will enormously improve the quality of health care for refugees and migrants.

Towards fair health policies for migrants and ethnic minorities: the case-study of ETHEALTH in Belgium.

BACKGROUND: In Europe, progress in the development of health policies that address the needs of migrants and ethnic minorities has been slow. This is partly due to the absence of a strategic commitment by the health authorities. The Ministry of Public Health commissioned the ETHEALTH (EThnicity &HEALTH) group to formulate relevant recommendations to the public authorities with a view to reducing health inequalities among ethnic minorities. This paper describes the political process and the outcomes of the ETHEALTH expert group. RESULTS: After ten meetings, the ETHEALTH group came up with 46 recommendations, which were presented at a national press conference in December 2011. Target groups concerned by these recommendations covered both irregular migrants and migrants entitled to the national insurance coverage. Recommendations were supported by the need of combining universal approaches to health care with more specific approaches. The scope of the recommendations concerned health care as well as prevention, health promotion and access to health care. When analysing the content of the recommendations, some ETHEALTH recommendations were not fully measurable, and time-related; they were, however, quite specific and realistic within the Belgian context. The weak political commitment of an executive agency was identified as a major obstacle to the implementation of the recommendations. CONCLUSIONS: The ETHEALTH group was an example of scientific advice on a global health issue. It also demonstrated the feasibility of coming up with a comprehensive strategy to decrease ethnic health inequalities, even in a political context where migration issues are sensitive. Two final lessons may be highlighted at the end of the first phase of the ETHEALTH project: firstly, the combination of scientific knowledge and practical expertise makes recommendations SMART; and, secondly, the low level of commitment on the part of policymakers might jeopardise the effective implementation of the recommendations.