best pracces in implemen*ng ihr key points from session 5: migraon and public health ·...
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Bestprac*cesinimplemen*ngIHRKeypointsfromsession5:
Migra&onandpublichealth
C.Botsi,MD,MScHCDCP
Migrants,refugees2018• 250millioninterna&onalmigrants
750millioninternalmigrants
1inevery7isamigrant
Source:IOM
Previousyears Seaarrivals Deadandmissing
2017 172,301 3,139
2016 362,753 5,096
2015 1,015,078 3,771
2014 216,054 3,538
MediterraneanSeaarrivalsin2018:28,633Lastupdated25May2018Deadandmissingin2018(esDmate)628Lastupdated23May2018
UNHCR
Countryoforigin Source Datadate PopulaDon
SyrianArabRep. 30Apr2018 18.6% 4,151
Others 30Apr2018 11.9% 2,649
Iraq 30Apr2018 9.8% 2,185
Tunisia 30Apr2018 8.6% 1,910
Eritrea 30Apr2018 8.1% 1,810
Guinea 30Apr2018 5.4% 1,204
Côted'Ivoire 30Apr2018 4.5% 1,011
Mali 30Apr2018 4.4% 987
Afghanistan 30Apr2018 4.3% 955
Algeria 30Apr2018 3.4% 755
MostcommonnaDonaliDesofMediterraneanseaarrivalsfromJanuary2018
Migra&onmanagementEUCRISISMANAGEMENTTOOLS
The 2015-16 refugee crisis took Europe by surprise. To avert a humanitarian crisis and enable a joint response to this challenge, the coordination and crisis management systems had to be activated. The Commission took the lead in ensuring timely information exchange with all actors at EU level. While the overall migration pressure has decreased, the availability of support remains key when responding to any future crisis.
Coordina&onteam• TheweeklyCoordina&onTeamMee&ngwasestablishedinJan2016.ItistheCommission’scentraltooltocoordinateallac&onstakingplacetoaddressthemigra&oncrisis.
• ServicestakingpartintheCoordinaDonTeamMeeDng:DGHOME(migra*onandhomeaffairs),DGDEVCO(development&coopera*on),DGNEAR(neighbourhoodandenlargement),DGECHO(europ.Civilprotec*on&humanitarianaid
opera*on),EuropeanExternalAc&onService(EEAS),Secretariat-General.DGSANTE??
• Throughvideo-conference:EUDelega&oninTurkey,TeamoftheEUCoordinatorfortheimplementa&onoftheEU-TurkeyStatementinAthens,Migra&onmanagementteaminRome
EUEMERGENCYFUNDINGFORMIGRATIONMANAGEMENT
ThecommissionsupportsnaDonaleffortstoimprovemigraDonmanagementwithdedicatedfundingonmulD-annualnaDonalprogrammes.MSalsohavethepossibilitytoapplyforemergencyassistance
Challengeshealthsectorhadtofaceduetomigra*onpressure:• Massivemigra&onwavestoEurope• Impactofjourneysonmigrants’health• Challengetherefugeesrepresenttopublichealth• Howtoadapthealthservicestorefugees‘needs• ToimproveHealthworkerscapacitybuildingastheyshouldlearntoworkwithdifferentculturalcontextofhealthanddisease(healthbeliefmodel)
• Totrainrefugees/migrantsonthewayhealthsystemworksandlinkthemtothesystem
•
Under3rdpr/meinthefieldofhealth(2014-2020)throughaspecialcall,DGSANTEprovidedfinancial
supportFOR:• improvinghealthcareforvulnerablemigrants• integra&ngmigrantsintona&onalhealthcaresystems• traininghealthcareprofessionals.TheEUprovided:• €7.2millionin2015tosupportEUcountriesfacingpar&cularly
highinfluxofmigrantsandrefugeestohealth-relatedchallenges• €7millionin2016forsharingbestpracDcesonhealthcare
modelsforvulnerablemigrants,andtraininghealthprofessionalsandenforcementofficers.
• In2017,€1.3milliontoassessthefeasibilityofaEuropeanexpertnetworkforrarepathologieslinkedtomigraDon,toassesstheactualhealthstatusofthenewlyarrivedmigrantsandrefugees,andtosupporttheimplementaDonoftoolsforintegraDonofmigrantsandrefugeesintheEUhealthsystems.
FUNDEDPROJECTS&COORDINATORSWorkprogramme20151. SH-CAPAC,Suppor*nghealthcoordina*on,assessments,
planning,accesstohealthcareandcapacitybuildinginMemberStatesunderpar*cularmigratorypressure(hhp://www.sh-capac.org/),Spain
2. EUR-HUMAN,EuropeanRefugees-HumanMovementandAdvisoryNetwork(hhp://eur-human.uoc.gr/),Greece
3. 8NGOin11States,8NGOsformigrants/refugees'healthneedsin11countries(hhps://webgate.ec.europa.eu/chafea_pdb/health/projects/717307/summary,France
4.CARE,CommonApproachforRefugeesandothermigrants'health(hhp://careformigrants.eu/),Italy5.IOM-Re-HealthI,II(hhp://re-health.eea.iom.int/),Belgium
Workprogramme20161. WHO-MIHKMA,Migra*onandHealthKnowledge
Management,Denmark2. ORAMMA,Opera*onalRefugeeAndMigrantMaternal
Approach(hhps://oramma.eu/),Greece3. MyHealth,ModelstoengageVulnerableMigrantsand
Refugeesintheirhealth,throughCommunityEmpowermentandLearningAlliance(hhps://ec.europa.eu/health/sites/health/files/migrants/docs/20170717_projects_en.pdf),Spain
4. MigHealthCare,StrengthenCommunityBasedCaretominimizehealthinequali*esandimprovetheintegra*onofvuln.migrantsandrefugeesintolocalcommuni*es,Greece
WorkProgramme2017• IOM-Re-HealthII,(hhp://re-health.eea.iom.int/)IOM,Brussels,Belgium• Re-HealthaimedatimprovingthecapacityofEUMemberStatestoaddressthehealth-relatedissuesofmigrantsarrivingatkeyrecep&onareas,whilepreven&ngandaddressingpossiblecommunicablediseasesandcross-borderhealtheventsbasedontheexperienceIOMEQUIHealth(2ndprogramme2008-2013)projectaimedtoimprovetheaccessandappropriatenessofhealthservices,healthpromo*onandpreven*ontomeettheneedsofmigrants,theRomaandothervulnerableethnicminoritygroups,includingirregularmigrantsintheEU/EEA.
ComprehensiveEmergencyHealthResponsetoRefugeeCrisis_MoH
PHILOSprojectGreece(2016-today)
AMIFFUNDING
CAREproject:CommonApproachforRefugeesandothermigrants’health
• TheCAREprojectaimedtopromoteandsustainthegoodhealthofmigrantsandlocalpopula&onsinfiveMemberStatesexperiencingstrongmigra&onpressure:Italy,Greece,Malta,Croa&aandSlovenia.
Anintegratedelectronicsystemtorecordandmonitorthehealthstatusofrefugeeshasbeendevelopedandtestedatthehotspotsconsis&ngof:1)anelectronichealthcaremanagementsogware-complyingwithallapplicableprivacyregula&ons-installedonthecomputerusedbythedoctorsand2)aportabledevice(USBcard)tobedeliveredtoeachmigrant,whohasundergoneclinicalexamina&ons.
CAREproject• theCAREprojectproduced
policyorientedac&vi&es,whichanalysedtheexisDngsituaDononhealthmanagementofmigrantsandrefugeesin3EUMemberStates(Slovenia,Greece,Italy)anddocumentedgoodprac&ces
TheCAREprojectfocusedon2maindomains:• -Howtotakecareof
migrants’healthintohotspotsandothermigrants’centres
• -Howtomakecountriesinvesteitherontheirowncommuni&esandontheirhealthsystems’preparedness.
CAREprojectTostrengthencapacityinpreven&nganddetec&ngcommunicablediseasesamongthenewlyarrivedmigrantpopula&onswithinpar&cipa&ngcountries(Italy,Greece,Malta,Croa&a,Slovenia)andPortugal,throughasyndromicsurveillancesystempiloted
• AssessthecurrentpolicyinthevaccinaDonoffertarge&ngnewlyarrivedmigrantsand
• Provideinforma&ononendemicandcurrentlyepidemicdiseasesinthecountriesoforiginandtransitofnewlyarrivedmigrantstofrontlinehealthcareworkers
SH-CAPACSupportHealthCoordina*on,Assessment,Planning,AccesstohealthCareand
capacitybuilding
• Theprojectisdirectedatsuppor&ngcountries’healthsystemsandpublichealthinfrastructuresinthefollowingnineteenEUMemberStates:
• AustriaBelgiumBulgariaCroa&a,DenmarkFranceGermanyGreeceHungaryItalyMaltaNetherlandsPolandPortugalRomaniaSlovakiaSloveniaSpainSweden
SH-CAPACproject• SupportMemberStatesto:• 1.establish,mechanismsto
respondtothehealthneedsoftherefugeesandasylumseekers
• 2.analysehealthchallengesandhealthneedsthatthemassivepopula&oninfluxposes,aswellastoconductperiodicassessmentsofthehealthcareresponseandpublichealthintervenDonsneeded.
• 3.developacDonplansforimplemenDngapublichealthresponse
• 4.promoteandensureaccessofthemigrantpopula&onstohealthcareandpublichealthinterven&onsthroughthereducDonofaccessbarriers
SH-CAPACproject• Buildna&onalcapacitythroughtrainingoftrainersinaffectedcountries,onculturalandonamigrantsensi&vehealthcaredeliverymodel,respec&nghumanrightsanddignity.
CHALLENGES
Emphasisonhealthsystems’preparednessassessment,riskcommunica&onstrategies(effec*vecommunica*ontogeneralpublic),healthsystembarriers,dataavailability,con&ngencyplansandmigranthealthprofessionaltraining.
EUropeanRefugees-HUmanMovementandAdvisoryNetwork(Jan2016,1-yearEUproject)
§ Needandopinionsofbothrefugeesandstakeholdersfor
measuresneededforhealthcareassessment,andprevenDveacDviDesincludingvaccinaDons,generalhealthhygienemeasures,chronicdiseasemanagement,andpsychosocialsupport.
§ Establishservicecontentandapproach,incl.Output,i.e.,clinicalprotocols,guidelinestogetherwithhealtheduca&onandpromo&onmaterialandaswellasatrainingprogrammeforstaffservingtherefugees/migrantsandtailoredprotocolsandpilottes&ng,closeworkwithSH-CAPAC
EQUI-HEALTH
• TocontributetotheECPublicHealthProgrammeACTION:«Iden*fyingthecausesandreducinghealthinequali*eswithinandbetweenMS&suppor*ngcoopera*ononcross-bordercareandpa*ent/healthprofessionalmobility»
• EU/EEAMemberStates
2013-2016Promo&ngappropriatehealthcareprovisiontomigrantsattheSouthernEUBorder• RomaHealth(na&onals’and
migrants’• MigrantHealth
EQUI-HEALTH
• Belgium;,Italy;Portugal:;SwissEmbassyinCroa&a,andIOM
• Migra&onHealthDivision
PARTNERS
• Governmentalpartners/localauthori&es
• EUagencies:ECDC,FRONTEX,FundamentalRightsAgency(FRA)
• IOs:WHOEURO,UNHCR(BG),OHCHR,UNICEF,UNDP,UNFPA
• Academic/researchnetworksandpublichealthins&tutes/schools,CSOs
EQUI-HEALTHRomaHealthsubproject
• MonitoringProgressoftheimplementa&onofNRIS(Na*onalRomaIntegra*onStrategies)intheEU.Focus:
• RomaNa&onals,• Romamigrants(EU)• RomaTCNs• Belgium,Bulgaria,Croa*a,
CzechRepublic,Italy,Romania,Slovakia,Spainand,France
BARRIERS• CoordinaDonchallengesat
na&onalandbetweencentralandregionallevels;
• theHealthcomponent,missingdedicatedfunds
• Majorgapandneeds:trainingofHealthstaffinservingdiversepopula&ons;discrimina&onprac&cesnotaddressedattraininglevel
EQUI-HEALTH
objecDves• Toincreaseunderstanding
oftheneedsforimprovingmigranthealthindeten&onandborderfacili&es
• Promotesystema&cdatacollec&on
• Strengthenthecapacityofhealthworkersandlawofficers
• TofosteraharmonizedEUapproachtoaccesstoandprovisionofhealthcareformigrants,includingestablishmentofamechanismforcollabora&onatregionalandna&onallevel
RE-HEALTH-IOMAIM
• Co-fundedbytheEuropeanUnion(EU),implementedbythe(IOM)–Migra&onHealthDivision,withtheaimtosupportEUMemberStates(Greece,ItalyCroa*a,Slovenia)in:
• .
• improvinghealthcareprovisionformigrantsandintegraDngthemintonaDonalhealthcaresystems
• PrevenDngandaddressingcommunicablediseasesandcross-borderhealthevents
Projectcomponents/ac&ons• Electronicpersonalhealthrecord(pa&ent’smedicalhistory)– Exploratoryphase– Pilo&ngPHRindifferentcountriesacrossEurope
– ImplementtheuseofPHR
– Developrevisedversionofthetoolandtheplaporm
– Assessthefeasibilityandlimita&onsofPHR
• Capacitybuilding• Healthmediators
par&cipateincapacitybuildingac&vi&esinrespecttorefugeeshealthneeds– Facetofacetrainings– Onlinetrainingcourse
PHILOS
TheMoHthroughKEELPNOreactedtoemergencysitua&on,protec&ngpublichealthandthehealthofrefugees.Aim:• toaddresstheemergencysitua&oninthemainlandandsincelastsummerintheRICs
• Toreinforcethecapacityofthepublichealthsystemandepidemiologicalsurveillance
• Toensureonsitehealthcareandpsychosocialservicesincollabora&onwithDGECHO/HOMEpartners
• TosupporttheseverelyunderstaffedandunderfundedNHS,primaryhealthcarestructuresandEKAB
Sub-ac&ons• Management–coordina&on• AMigra&onHealthsurveillancesystem(syndromicsurveillanceincampsandhotspots)
• Toorganizeandconductmassvaccina&oncampaignsinthemainlandbutalsotoprovideimmuniza&ontonewlyarrivedrefugees.
• Primaryhealthcare/psychosocialsupportprovisionforrefugeecampsandhotspots.
• Stafftrainingprogram• ReinforcementofNHSonaffectedregions• Medicalassessmentpsychosocialsupport,vulnerabilityassessmentintheRICs,ageassessmentforUAMs
Projectsfunded,commonpointsproject SituaD
onassessment
surveillance
Traininghealthworkers
Traininglawofficers
Trainingmigrants
awareness
E-databases
Roma Providinghealthcare
CARE + + + +
SH-CAPAC
+ +
Equi-health
+ + + +
RE-HEALTH
+ + +
PHILOS + + + +
EUR-HUMAN
+ + +
8NGOs/11MS
+ +
OrganisaDonalbarriers• ServicesARELimited,healthworkersarenotasmanyastheyshouldbe
• Specialistcarehardtoreach(e.g.:mentalhealth);• Lackofupdatedhealthrecords(e.g.:vaccina&onstatusofchildren,chronicdiseases)
• Appointmentsystemsforspecialistcareatthelocalhospitalsarenoteasilyaccessible
• Theinforma&ononthepa&ent’shealthissuesdoesnotalwaysfollowhim/her
• Therefugeesdonothavetheinforma&onhowtonavigatethesystem.
• ThehealthworkersintheNHSdonotknowhowtoadapttheirworkculturally
LessonslearnedHealthsystemshavebeenaffectedsubstan&allybymigrantsarrival.
Health-caresystemshavesDllnotadaptedtorespondadequatelytotherefugeesneeds.
Staffcapacityofalllevelsshouldbebuiltaddressingdiversity
Barrierspreven&ngpeopleaccessinghealthcareshouldbeaddressedandaccesstocaremustbeensured
Itisachallengetocon&nuetheeffortsandkeepandusethetoolsandtrainingmaterialsdeveloped.
Challenges• Responseplansshouldbeavailableandneedupdated(annually?)• Lawofficersandhealthauthori&esshouldcollaborate• Informa&onaboutresponsibili&esofdifferentna&onalservices,IHR
jointexercisesforhealthemergencypreparednessmustbeconsidered
• FollowupofrefugeeswithCDse.g.TB,mustbeinplace• Dataonoccupa&onalhealthmissing(na*onalstudies??)• Mentalhealthcareforthepersonnele.g.stressmanagement
missing• Shortageofstaff• NeedonsharingamongMSgoodprac&cesonaccesstocare• Trainingneedsofmigrants–healthpromo&onmustbeaddressed
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