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Barriers Faced by Refugees to Access Health Care Services in Finland

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Barriers Faced by Refugees to Access Health Care Services in Finland Barriers Faced by Refugees to Access Health Care Services in Finland Sukhwinder Kaur 2021 Laurea 3 Laurea University of Applied Sciences Barriers Faced by Refugees to Access Health Care Services in Finland Sukhwinder Kaur Global Health & Crisis Management Master’s thesis June, 2021 4 Laurea University of Applied Sciences Abstract Degree Programme in Global Health & Crisis Management Master of Health Care Sukhwinder Kaur Barriers Faced by Refugees to Access Health Care Services in Finland Year 2021 Number of pages 74 The main aim of the thesis was to identify various internal, structural, financial, and socio- cultural and communicational barriers faced by refugees in accessing health care services in Finland, and to propose suggestions to overcome those barriers. The thesis was a part of the Master’s degree programme in Global Health and Crisis Management offered by Laurea University of Applied Sciences in Finland. The population on which the research was conducted were refugees in a reception center of South Finland. Ethical issues related to the thesis were evaluated by “The Human Sciences Ethics Committee of the Helsinki Region Universities of Applied Sciences”. The data were collected after the ethical evaluation and permission from the reception center. The existing literature suggested the presence of barriers like lack of awareness, language, acculturation, scheduling conflicts, and long waiting lists. Inadequate cooperation at different levels, lack of will and means to cooperate, legal and economic barriers have also been reported in the past by different studies. Qualitative methods were used to conduct this thesis. The sample size was nine as it was the saturation point. Convenience sampling method was used in recruitment of participants and the data were analysed using deductive content analysis method. The data were collected by focused interviews, analysed and managed in a professional way using the ethical code of conduct. This thesis found out that the internal barriers in health care in Finland for refugees were internal fear, refugees’ own attitude, lack of knowledge of the complicated health care system, and mistrust in the beginning because of hard and bad experiences with health care professionals in other countries where they stayed as refugees before reaching Finland. The structural barriers faced by refugees while accessing health care in Finland were the long distance between hospitals and reception centers, long waiting times for appointments, scarcity of public transport in remote areas, and missing previous reports. The financial barriers in Finland faced by refugees were insufficient finances available for phone calls to be made for booking appointments when calls are long, and some financial difficulties in case they need to buy some medicines from their available monthly allowances. The communicational and socio- cultural barriers faced by refugees in Finland were the difficulty to understand the Finnish language, difficulty with interpreters, cultural differences, and lack of cultural competency in health care system. Despite of the barriers faced by refugees in accessing the health care system in Finland, almost all the participants appreciated the health care system, and health care professionals in one way or the other. The suggestion given by the participants to reduce the barriers was creating a parallel health care system for refugees to have easy access and less waiting time. To reduce communicational barriers participants suggested providing information in more languages than Finnish and English. To reduce cultural barriers more culturally competent health care professionals were suggested. The distance between hospitals and reception centers should be smaller to reduce structural barriers. Keywords: Refugees, Healthcare, Access, Barriers, Immigrants. Contents 1 Introduction ............................................................................................. 7 2 Basic concepts .......................................................................................... 8 2.1 Barriers to health care ....................................................................... 9 2.1.1 Internal barriers ...................................................................... 10 2.1.2 Structural barriers ................................................................... 11 2.1.3 Financial barriers .................................................................... 11 2.1.4 Communicational and socio-cultural barriers ................................... 12 2.2 Refugees and healthcare ................................................................... 13 2.3 Refugees in Finland ......................................................................... 17 2.4 Health Care Services for refugees in Finland ............................................ 18 2.5 Challenges faced by refugees to access health care in European countries ....... 20 2.6 Challenges faced by refugees in accessing heath care globally ...................... 23 3 Development of thesis ............................................................................... 26 3.1 Purpose and objectives ..................................................................... 26 3.2 Methodological solutions ................................................................... 27 3.3 Population, sample size, and sample selection criteria ............................... 28 3.4 Collection of data ........................................................................... 29 3.5 Analysis of data .............................................................................. 30 3.6 Data management plan ..................................................................... 31 4 Results .................................................................................................. 33 4.1 Internal barriers ............................................................................. 33 4.1.1 Internal fear .......................................................................... 34 4.1.2 Internal attitude and mistrust ..................................................... 35 4.1.3 Lack of knowledge ................................................................... 36 4.2 Structural barriers ........................................................................... 36 4.2.1 Long distance with to travel and different doctors in different appointments ................................................................................. 37 4.2.2 Difficulty with the transport and long waiting time ............................ 37 4.2.3 Missing previous reports ............................................................ 38 4.3 Financial barriers faced by refugees to access health care in Finland .............. 38 4.4 Communicational and socio-cultural barriers ........................................... 39 4.4.1 Language barriers .................................................................... 39 4.4.2 Difficulties with the interpreters .................................................. 40 4.4.3 Cultural barriers ..................................................................... 41 4.5 Positive experience of refugees about Finnish health system ........................ 42 4.6 Suggestions to reduce or overcome barriers ............................................ 43 5 Discussion, conclusions and reflections ........................................................... 44 5.1 Assessment of the development settings ................................................ 48 5.2 Areas of further development ............................................................. 49 5.3 Funding ........................................................................................ 50 5.4 Ethical issues and privacy protection issues of research .............................. 50 5.5 Conclusion .................................................................................... 52 References .................................................................................................. 53 Figures ....................................................................................................... 61 Tables ........................................................................................................ 61 Appendices .................................................................................................. 61 7 1 Introduction The right of highest attainable standard of physical and mental health for all is established in the constitution of World Health Organization from 1948 stating that health is a fundamental right of every human being without distinction of race, religion, political belief, economics and social condition (World Health Organization (WHO) 2020). We live in a world where people from one nation are migrating to other nations to take refuge for the reason of war and unsafety in their own nations. In the process of this immigration as a refugee food, shelter and health are the basic needs which need to be met at nation where they escape for because of danger to their life in their own country. As health is considered as basic right of any individual by World Health Organization, so it is crucial to take care that basic need of health is met at all the points in foreign lands. World Health Organization states that health is fundamental to be attained for security of people depends upon the co-operation of states. (WHO 2020.) In practice however, according to the European Union (EU) Agency for Fundamental Rights states that fundamental rights
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