bluuebunny/crossref_metadata_2025_split huggingface dataset:
Policies for tackling health inequities in migrants in an irregular situation: learning from Italy
Authors: Sesti F , Rosano A , Ingleby D , Baglio G , Bell R , Geraci S , Marceca M 
Published: November 2019

Abstract

Issue
With increasing of numbers of people moving in Europe and around the world, the health of migrants has become a key global public-health issue. Migrants in an irregular situation (MIS) represent an important part of the migration phenomenon, whether they have become irregular by entering a country without authorisation or by overstaying a visa, including whose applied unsuccessfully for asylum.

Description of the problem
Overstaying of visas is not unusual in EU countries and during 2015 and 2016 in particular, many countries experienced a large number of unauthorised entrants. Health policies for MIS are increasingly a matter of concern. Using the 2015 Migrant Integration Policy Index Health strand (MIPEX HS) it is possible to conduct an analysis of health policies, focusing on access to health services by MIS.

Results
Among the 34 European countries covered by the MIPEX HS, Italy’s overall score of 65 is exceeded only by Switzerland (70) and Norway (67). Averaging the indicators of access for MIS, Italy obtains the highest score (83), followed by Denmark, France, the Netherlands, Romania, Spain, Sweden and Switzerland with 67. Its score for legal entitlements to health care is 75 (the same as Sweden), while reporting of MIS to the immigration authorities is prohibited and there are no sanctions against helping them. However, legislation introduced by the new government in 2018 has restricted some of their rights.

Lessons
Current migration to Europe requires dealing with short-term health needs as well as strengthening public health and health systems in the long term. This presentation will discuss the lessons that can be learned from the comparative analysis of health policies for MIS using the MIPEX HS.

Key messages
Affordable health care is a human right, which should not be denied to any migrant. Policy analysis plays a key role in identifying interventions for promoting health equity.
Barriers to health access for women during forced migration: An exploratory study
Authors: Durham J 
Published: November 2019

Abstract

Background
Mass migration is a global crisis that has a number of significant public health implications for Europe. With more than a billion migrants worldwide, Europe receives a significant proportion of those, many of whom are forced migrants, possessing particular health and social vulnerabilities. Many forced migrants transit through, or settle within Europe. Despite this, there is a dearth of literature examining the experiences and perspectives of forced migrants or the barriers they may face in accessing health services. Understanding these barriers is integral to developing an effective international response.

Methods
Using purposive sampling, 8 female key informants from displacement backgrounds were recruited for in-depth interviews from Queensland, Australia. The interview questions focused on past experiences of accessing healthcare during displacement and were formulated around the 5 dimensions of health access described by Levesque, Harris and Russell (2013). Data was analysed using qualitative content analysis.

Results
Under the five dimensions of health access (approachability, acceptability, availability, affordability and appropriateness) twelve sub-themes were identified that were specific to the displacement context. Common sub-themes included mistrust of health services, irregularity in access, focus on acute health conditions, limited healthcare capacity, self-treatment; with pharmacies often the first point of contact, and the neglected health needs of vulnerable populations, such as women.

Conclusions
The current global mass population flows, display a need to consider the long-term health effects of displacement and how these experiences shape migrants’ future health-seeking behaviours. A significant number of forced migrants transit or settle within Europe and therefore there is a demonstrable need to understand the perspectives and experiences of those individuals, if equitable health access is to be attained.

Key messages
This is the first study to the authors’ knowledge that applies a structured framework to the displacement experience, providing novel insights of an under-researched population. It is essential to understand the perceived barriers to health access of forced migrants in order to reduce morbidity, mortality, inequity and associated healthcare costs.
Health experiences of asylum seekers and refugees in Wales
Authors: Scott R , Ellis L , Khanom A , Rhydderch M , Richardson G , Russell D , Russell I , Snooks H 
Published: November 2019

Abstract

There are concerns that people seeking sanctuary (asylum seekers and refugees) in Wales, UK, have unmet health needs and face difficulties accessing services, but little collated evidence. This study addressed this gap to inform policy and practice in reducing health inequities. It aimed to: investigate the health, wellbeing and healthcare experiences of adults seeking sanctuary in Wales, including the views of healthcare recipients and providers; and establish what helped or hindered the healthcare experiences of those seeking sanctuary. It is the most comprehensive study of this population in Wales.
A mixed-method approach was taken, including a literature search, a cross-sectional survey of 210 adults seeking sanctuary, telephone interviews with 32 health professionals and third sector support workers, and 8 focus groups including 57 people seeking sanctuary and those supporting them.
Eight trained volunteer peer researchers, themselves asylum seekers or refugees, administered the surveys. Interviews were digitally recorded, transcribed and analysed using a standard framework.
The literature search identified 5 themes that help or hinder people seeking sanctuary to access healthcare. The survey found 79% of respondents attended an initial health assessment on arriving in Wales, with 94% currently registered with Primary healthcare. 64% reported difficulties in accessing health services. Awareness of services was mixed, with 66% having used healthcare in working hours (planned) and 28% out of hours (unplanned).
Mainstream health professionals felt they lack capacity to deliver care effectively due to time and other pressures on the healthcare system and the need for appropriate translation/interpretation services.
This study triangulates the experiences of people seeking sanctuary with those providing healthcare and general support. Peer researchers maximised sanctuary seekers’ participation. Many of its methods and findings have relevance to other countries in Europe.

Key messages
Improving health equity is key to realising Wales’ ambition to become a Nation of Sanctuary. Peer Researchers enabled participation by sanctuary seekers and revealed useful findings to steer future policy and practice.
Access to abortion of undocumented migrants seen by Médecins du Monde in the Humanitarian Hub
Authors: Ben Abdelahfidh L , Huber J , Rojas López F , Glorie C , Vanden Bussche I , Coiret C , Spoel E , Pignard A-L , Heymans S , De Bethune X 
Published: November 2019

Abstract

As of June 2017, the population of the Maximillian Park (an undocumented migrant camp in Brussels) is mainly Eritrean and Sudanese migrants who intend to continue their journey to the United Kingdom (Depraetere, 2017; Daher, 2018). In response to demanding needs, Médecins du Monde together with 8 organisations, created a one-stop service centre, The Humanitarian Hub, in January 2018 to offer a set of basic services to the migrants.
The Hub implemented a voluntary de-medicalized midwifery clinic. The medical team noted an under-representation of women, 40 out of 745 (5,4%), while the coordination team identified a number of complex unwanted pregnancies, many of which relating to violence. Accessing free abortion for undocumented women in Belgium requires the Urgent Medical Assistance certificate. This often takes several weeks, making it unrealistic to obtain in time for an abortion. Accordingly, the women or family planning centres cover the financial cost. The Hub’s midwifery clinic thus focused on building trust with the women, and facilitated referrals to family planning centres.
By taking steps to create a more gender-sensitive Hub, the proportion of women seeking consultations doubled. In 2018, 955 out of 8990 (10,6%) patients were women, totalling 324 midwifery consultations. 65 of these women were pregnant, and the 23 who sought abortion were referred to family planning centres. None had Urgent Medical Assistance.
It is crucial to consider the particularities of a population and their social determinants of health when implementing a holistic system. For instance, focusing on violent experiences in medical consultations can help better understand women’s situation. The coordination between The Hub and family planning centres helped in reducing barriers for migrant women. The project has seen success, thanks to the flexibility of the family planning centres in quickly receiving these pregnant women, and to the four centres who covered abortion costs.

Key messages
It is evident that the magnitude of these women’s situation is undervalued, thus it is important to increase sensitization and advocacy in order to offer them greater support. The Hub has provided a number of services for undocumented migrants, notably abortion, and removed some barriers in accessing care. However, it is a fragile solution to a structural problem.
Factors related to emigration self-efficacy among university students in Slovakia
Authors: Hajduch B , Orosová O 
Published: November 2019

Abstract

Background
Emigration self-efficacy (ESE) as the confidence in onés ability to successfully handle migration is an important characteristic of a migrant. We hypothesized that positive migration experience might increase ESE. We also explored whether personality factors such as extraversion, openness to experience, neuroticism, conscientiousness and agreeableness might be related to the ESE of young people (under 30 years old) in Slovakia. The moderation effect of gender in the relationship between the independent variables and ESE was also tested.

Methods
The sample consisted of 474 students from Slovakia (76.8% women, M = 22.4, SD = 2.13) all participating in the Student Life Cohort Study (SLiCE 2016) which focuses on the emigration intentions and risk behaviour of university students. The data were collected via an online survey. Standard multiple regression was used and the analysis was adjusted for gender.

Results
The model explained 23.1% of the variance in ESE. An evaluation of migration experience was found to make the largest unique contribution in explaining ESE (β = 0.317, pα&lt;0.001). Regarding personality factors, only neuroticism was found to be significantly related to ESE (β=-0.155, pα&lt;0.05). The main effect of gender was also significant (β=-0.179, pα&lt;0.001) with males scoring higher in ESE although the moderation effect of gender in the relationship between the independent variables and ESE was not significant.

Conclusions
This study provides an insight into the role of personality factors and evaluation of migration experience in relation to ESE among Slovak university students. Future research may focus on a deeper exploration of the other factors affecting neuroticism, as reducing the level of neuroticism could be beneficial in experiencing healthier and safer migration and adaptation process.

Key messages
A more positive migration experience and lower level of neuroticism are related to emigration self-efficacy among university students in Slovakia. Emigration self-efficacy is an important factor of healthy migration.
Factors influencing the migration intention of dental and medical graduates in developing countries
Authors: Hajian S , Khoshnevisan M H , Yazdani S h , Jadidfard M P 
Published: November 2019

Abstract

Background
Migration of skilled health workers could result in shortage of human resources and rising inequalities in service provision in source countries. To date, most of relevant papers are focused on rate and reasons of migration while the need for conducting studies on modelling of factors is more vividly felt. The aim of this review was to determine the factors influencing the migration decisions of medical and dental graduates migrating from developing countries and to introduce a practical conceptual framework for health worker migration.

Methods
Electronic databases PubMed, Google Scholar and relevant Journals were systematically searched for English language publications from January 2009 to April 2019. The inclusion criteria were: 1) article stated factors affecting migration decisions of medical doctors and/or dentists, 2) the source country in the study was a developing country, 3) participants’ primary qualification country was in a developing country,4) the study used primary data both qualitative or quantitative.

Results
The search identified 814 articles from which we included 23 full-text studies after applying eligibility checklist. Push and pull theory was the most popular model to describe the migration driving factors. Poor socio-economic situation, political instability, lack of professional and educational opportunities together with family concerns found as strong common push factors that perpetuate migration. The most influencing pull factors were desire for better quality of life, career and training opportunities and financial gain.

Conclusions
Despite the fact that health workers migrate for different reasons, they follow a same route for decision to stay or leave their own countries. Un-fulfillment of expectations in mother land in addition to media reconstructed reality of life in foreign land can develop a positive attitude for migration Which should be considered before weighing up the push and pull factors of both sides.

Key messages
A better understanding of the migration motives of health professionals will help health authorities to improve their workforce recruitment and retention strategies and health service planning. Our simple yet comprehensive framework can mainly identify the development of migration desire through combining different models and concepts of migration, behavioral change, values, needs and so on.
Experiences of specialist social workers for asylum seeking patients at a large Swedish hospital
Authors: Svärd V , Nilsson M , Sernbo E 
Published: November 2019

Abstract

Background
In 2016, the Karolinska University Hospital introduced a one-year-project with a mobile team of five asylum social workers (ASW), specializing in migration. This study evaluates the ordinary hospital social workers (HSW) experiences of introducing ASWs for asylum seeking patients.

Methods
Descriptive analysis was made of answers from a questionnaire sent to all 144 HSW at the hospital (57% response rate). Qualitative content analysis was made of written comments.

Results
Of the HSWs, 51% always and 29% sometimes contacted an ASW in relation to asylum seeking patients. Of those who contacted an ASW, 74% stated that the ASWs increased the efficiency of care of asylum seeking patients. 65% agreed that ASWs had an improving effect on the quality of encounters between staff and asylum seekers. Also, 67% agreed that the ASWs off-loading function improved the HSWs working conditions. Even though the ASWs were working at two hospitals located in different parts of the region, 78% of HSWs found them to be available. The main reason to not always contact an ASW was that it was not necessary in the specific case (55%). A majority (66%) reported increased knowledge about asylum processes as an outcome of introducing the ASWs at the hospital. This was also highlighted in the written comments, where ASWs detailed and updated knowledge as well as established contacts with e.g. the Swedish Migration Board was emphasized. ASWs specialist competence enabled patients to quickly receive legally correct and accurate information, which decreased worries among patients as well as staff members.

Conclusions
The HSWs described the ASWs as being important to patients as well as to staff. The ASWs improved the quality of encounters between staff and asylum seekers and strengthened the patient’s right to health and social care. The HSWs also reported an off-loading function, improving the working conditions and the over-all efficiency of care.

Key messages
The HSWs found that the ASWs increased the efficiency of care and quality of encounters between staff and asylum seekers. ASWs detailed knowledge and established external contacts enabled patient to receive accurate information quickly, which decreased worries among both patients and staff members.
Optimum control of TB in the EU by addressing migrant health effectively in an interconnected world
Authors: Koster D M , Bootsma A J 
Published: November 2019

Abstract

Worldwide, tuberculosis is one of the top 10 causes of death. Although most EU/EEA countries are low-incidence, TB remains a public health issue. In this region, TB predominantly affects vulnerable populations, including migrants (ECDC/WHO, 2019). Since migration has been increasing over the last several decades, the health needs are considerable and merit great attention for several reasons. First, migrants have a right to health. Second, health promotion and disease prevention among migrants contributes to overall public health. Last, healthy migrants contribute to positive development outcomes (WHO, 2016) (IOM, 2017).
In order to meet the health needs of migrants, prevention is an important step. Part of preventive care is detecting illness at an early stage (for example by screening), so that treatment can be introduced when it works best (WHO Europe, 2018). However, screening of a population is only beneficial if a positive result leads to effective actions independent of geographic location (Jackson, 2017).
So, how does one facilitate a fluid care pathway for TB-elimination? In the Netherlands, the Community Health Services (GGDs) carry out TB-control non-geographically. All 25 GGDs use iTBC, a nationwide, integrated platform that supports and connects all TB processes, independent of place and time. The appropriate TB screening pathway is selected, based on prevalence in country of birth, for all migrants resulting in optimized screening, treatment and control. In a PPP between Topicus, the Dutch Association of GGDs (GGD GHOR Nederland) and the Central Agency for the Reception of Asylum Seekers, this process has been automated for asylum seekers. By safely sharing relevant data, migrants can be screened and treated effectively. Resulting in health needs of migrants being met and optimum control of TB in low-incidence countries. The aim is to screen, treat, control and end tuberculosis whilst scaling the Dutch blueprint across the EU/EEA region.

Key messages
TB-screening contributes to EU public health if follow-up actions are facilitated non-geographically. The Dutch blueprint for TB-control shows how migrant health needs are met in an interconnected world.
Asylum seekers’ healthcare in Italy: policies and practices among different regions
Authors: Milani C , Bianchi J , Bordin P , Bortoluzzi S , Gianfredi V , Mammana L , Paglione L , Salvia C , Corsaro A 
Published: November 2019

Abstract

Background
The Italian law provides for international protection and universal health-care coverage for asylum seekers (AS). Indeed, they are entitled to be regularly registered at the National Healthcare Service. Before submitting the application for refugee status, medical assistance to migrants is up to local administration. Our aim was to describe and compare policies and protocols regulating AS healthcare from their arrival to their application for refugee status, at national and regional level. Moreover, we investigated the daily healthcare practice addressing potential gaps between policies and practice.

Methods
The research team is a subgroup of the Inequality working group of the Italian hygiene society and it is composed of public health residents. The research involved also local health workers and other professionals belonging to regional groups of Italian migrant medicine society (SIMM). We collected national, regional and local policies and protocols and we compared them using a specific framework. Furthermore, we achieved a mapping of daily practice implementation at local health organization (LHO) level using a checklist.

Results
The most relevant findings were that regional policies themselves vary notably from each other and, as regard practices, LHO implement differently the same regional legislation. Furthermore, we found some critical issues: the delayed inclusion in primary care assistance and lack of continuity of care and of a computerized system of recording information.

Conclusions
The lack of uniformity concerning policies and practices of AS healthcare might also result in unawareness and uncertainty about how to access to healthcare services by migrants. An enhanced cooperation between groups dealing with migrants’ issues may lead to avoid variability at the implementation. Finally, a computerized system for data collection might facilitate the continuity of care and the assessment of the real health needs of the AS population.

Key messages
It is a priority challenge for health systems to strengthen the interventions aimed at overcoming the linguistic, economic, cultural and administrative barriers to the health services access. It is crucial to improve the recording information system to detect the real health needs of AS, their change and the inequalities in access and to improve collaboration between groups and university.