SUPPORTING HEALTH COORDINATION, ASSESSMENTS, PLANNING, ACCESS TO HEALTH CARE AND CAPACITY BUILDING IN MEMBER STATES UNDER PARTICULAR MIGRATORY PRESSURE — 717275/SH-CAPAC RESOURCE PACKAGE FOR ENSURING ACCESS TO HEALTH CARE OF REFUGEES, ASYLUM SEEKERS AND OTHER MIGRANTS IN THE EUROPEAN UNION (EU) COUNTRIES 717275 – SH-CAPAC – Resource Package on ensuring access to health care (WP4) © – 2016 – Escuela Andaluza de Salud Pública. All rights reserved. Licensed to the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA) under conditions. This document is part of the project ‘717275 / SH-CAPAC’ which has received funding from the European Union’s Health Programme (2014-2020). The content of this document represents the views of the author only and is his/her sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the Consumers, Health, Agriculture and Food Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains. 717275 – SH-CAPAC – Resource Package on ensuring access to health care (WP4) – Deliverable 4.1 Table of contents User’s guide ............................................................................................................... 2 1 Why do we need to address the particular barriers faced by asylum seekers .............. 3 2 The aim of this Resource Package ........................................................................... 3 3 Setting the scene .................................................................................................. 4 4 Qualitative study: interviews and focus groups ......................................................... 4 4.1 Summary results of the qualitative study .......................................................... 5 5 Systematic literature review ................................................................................... 7 5.1 Summary results of the systematic review ......................................................... 7 6 Guidance on addressing barriers to access to health care services ............................. 7 6.1 Legislative, administrative, financial and bureaucratic barriers ............................ 8 6.2 Linguistic and socio-cultural barriers ............................................................... 11 6.3 Organisational barriers and obstacles to accessing health care services of equitable quality ................................................................................................................... 15 6.4 Lack of information for health providers and obstacles to ensuring continuity of care 19 6.5 Lack of information and continuity of care for refugees and asylum seekers ....... 23 6.6 Lack of coordination between services ............................................................ 28 7 Guidance on addressing barriers to access to specific health care services ............... 31 7.1 Barriers to accessing appropriate mental health services .................................. 31 7.2 Barriers to accessing appropriate sexual and reproductive health services ......... 35 7.3 Barriers to accessing appropriate health services for children and adolescents ... 39 7.4 Barriers to accessing appropriate health services for the victims of violence ....... 43 8 Concluding remarks ............................................................................................. 47 Annex I: Detailed results of the qualitative study: focus groups and interviews . Annex Ia: challenges related to the current refugees crisis . Annex Ib: list of measures to address barriers in health care collected through the focus groups . Annex Ic: development and dissemination of the Resource Package Annex II: Detailed description of methods and results of the systematic review Annex III: List of complete references included in the systematic review 717275 – SH-CAPAC – Resource Package on ensuring access to health care (WP4) User’s guide The present document aims at supporting individual EU Member States in defining the fundamental elements that ought to be present in the development of a resource package for ensuring access to health care of refugees, asylum seekers and other migrants in the European Union countries. This resource package aims to support the multiple national, regional and local stakeholders involved in the response to the health needs of refugees, asylum seekers and other migrants who are part of the recent influx into the European Union. This resource package is primarily addressed to the national or subnational health authorities responsible for defining an operational strategy harnessing the contributions of different actors to the provision of accessible health care and the implementation of specific strategies and measures addressing the barriers to access to quality health care for these migrant populations. It is also intended for the different governmental and non-governmental actors as well as international and civil society organizations who participate in the national and local efforts directed at responding to the health needs of these vulnerable populations. Flexibility in the application of this resource package is highly recommended. Any governmental authority can select the parts that are relevant for their country/context and customise it to develop or strengthen their context-specific strategy to improve access to health care for refugees and asylum seekers. The context in which health professionals and managers operate is different from one country to the other and so is the situation for migrants. Information on available measures and tools contained in this resource package should be integrated in the national and local means of communications and established network of cooperation. Therefore the resource package proposed in this document is to be seen as a support tool for the development and dissemination of a resource tool at country/regional/local level, depending on its level of implementation. This resource package was developed and presented at the SH-CAPAC workshop on 16th and 17th June 2016 in Reggio Emilia, Italy and has since integrated the recommendations from the meeting and been adjusted to the new circumstances of the migrant flows. A first draft was discussed at the SH-CAPAC meeting on April 6th 2016 in Trnava, Slovakia. Further amendments may be needed in the future. Revisions will be made publicly available on http://www.easp.es/sh-capac/. 2 717275 – SH-CAPAC – Resource Package on ensuring access to health care (WP4) 1 Why do we need to address the particular barriers faced by asylum seekers For migrants, barriers to accessing healthcare represent a complex picture. It has long been recognised that newly arriving migrants may face special health risks and frequently do not receive the care they need. There are also important access problems faced by people living in temporary reception centres and by irregular migrants in general. Moreover, there are many challenges for providing healthcare to these vulnerable groups. These include: complex legislative requirements for obtaining permanent status, lack of knowledge about available services; language and cultural barriers, administrative and bureaucratic factors, and mistrust of health providers, particularly for those fearing detection. Norredam et al. (2006) argue that a wide range of pre- and post-migration risk factors contribute to increasing the vulnerability of asylum seekers, particularly in their access to healthcare. Pre-migration factors include torture and refugee trauma, while post-migration factors may include detention, length of asylum procedure, language barriers, and lack of knowledge about the new healthcare system. As with other categories of migrants, these factors often interact with a component of deprivation in the host country. Asylum seekers also frequently experience social exclusion. A common aspect is that in most countries asylum seekers are entitled only to basic treatment for acute diseases. Current regulations in some countries impose severe limitations on the entitlement of asylum seekers to healthcare services under public programmes. A consequence is that changes in immigration policies may have a negative impact on access to healthcare. 2 The aim of this Resource Package The present document is aimed at supporting EU Member States to address barriers to access to health care and to ensure continuity of care for refugees, asylum seekers and other migrants along the whole migration journey, from arrival to transit areas of reception, to regions/countries of destinations. This action aims to ensure emergency as well as routine treatment by facilitating access to mainstream services, to primary care services and ancillary services addressing specific refugees, asylum seekers and other migrants needs. It also aims to ensure the entitlement to health care for failed asylum seekers. These aims will be achieved through the development of a resource package based on available evidence and expertise involving health and social authorities, IOs and NGOs active in the field. The objectives of the resource package are to: Provide evidence on the new challenges for health services related to the current refugee crisis Provide a framework and outline steps for improving access to health care for refugees, asylum seekers and other migrants. Provide evidenced tools and measures and other resources that can support MS addressing formal and