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European network to reduce vulnerabilities in health [Vulnerability NW] [709966] - Operating Grant
Project abstract

The ‘European Network to reduce vulnerabilities in health’ was founded in 2015 with NGOs and academic partners from 19 European countries. Our goal is to contribute to decreased EU-wide health inequalities and to more responsive health systems that are better equipped to deal with vulnerability factors. By collecting robust, comparative routine data (quantitative and qualitative) we aim to improve the quality of service delivery and build a solid evidence base for advocacy for people facing vulnerabilities. If this application is successful, we expect to integrate five new member organisations into the Network. The creation of the Network has been welcomed by its members, who confirmed the relevance to their everyday work and the added value of exchanges in the four strategic objectives: mutual learning, empowerment, data collection and advocacy. In addition to the data collection, analysis of legal frameworks in different countries, workshops and training activities, in 2016, we will begin peer reviews to allow members to directly experience different modes of providing health and care services. The Network will continue the process of rigorous data collection and analysis with specific support being provided by the Network secretariat to the five members that expect to start collecting data for the first time in 2016. The Network invites academics to independently review the data and understand how vulnerabilities contribute to health inequalities. The Network also engages with European institutions and stakeholders. Given the unprecedented economic crisis and the unpredictable, fast-changing refugee situation, and the fact that our members are in the front line in responding to their humanitarian needs, the Network may need to re-prioritize its mutual learning goals in the coming months.

Summary of context, overal objectives, strategic, relevance and contribution of the action

The 'European Network to reduce vulnerabilities in health' (hereafter ‘the Network’) brings together NGOs and academic partners from 23 European countries. The members work in different fields of health and social care provision and support a variety of target groups, from the homeless, drug users, sex workers, Roma to migrants. This diversity creates the potential for rich exchanges on good practices and an opportunity for more effective common advocacy activities across Europe. The Network's overall goal is "to contribute to the reduction of EU-wide health inequalities and to improve the response from better equipped health systems so as to deal with vulnerability factors". In 2017 - last year of the project - we will focus on capitalizing on lessons learnt over the three years and enlarging ambitions for future collaboration.

In Europe, 2015 will stay in all our memories as the year where international solidarity with migrants and refugees showed its strength and weaknesses. This strength was seen in the thousands of individuals of all nationalities responding to people’s needs and hopes, organising themselves to help; it was also seen in all the NGOs who concentrated their volunteers and staff to provide help all along the migratory route. Weaknesses were seen in the coordination between individuals and NGOs, between NGOs, between state initiatives, NGOs and individuals. Nevertheless, the solidarity of all these people and organisations worked. And it worked everywhere thanks to the strength and determination of the migrants and refugees to survive and live in a protective environment.
The real deception came from most European governments, who were unable to translate this solidarity into reality, unable to share common rules, in order to provide a positive, respectful response to the needs of the people fleeing wars, conflicts and life-threatening circumstances.
At the same time, the population in Greece is still afflicted by the social and economic crisis. And the austerity measures are harsh in their impact on everyday life. As the new president of the International Federation for Human Rights, Dimitris Christopoulos, said: “The violation of social rights [education, health, work] resulted in my country […] in an almost systematic violation of individual rights. The austerity policies reinforce the idea that social cohesion is not so much an obligation of the state but an act of charity”.

In order for health systems in Europe to be sustainable and resilient (overall objective), they need to be able to cover the whole population without any gaps and effectively deal with multiple vulnerabilities. Thanks to the support of CHAFEA, the 23 European Network members (19 in 2015 and 23 in 2016, 23 in 2017) seek to gain greater capacity and skills through mutual learning about how to improve health service delivery, patient empowerment, common data collection and advocacy (objective 1). As a result, people facing multiple vulnerabilities will get access to higher quality care in the health programmes run by Network members. In addition, they will get the knowledge they need to get easier access to good quality care in mainstream healthcare systems (objective 2). The Network undertakes on a yearly basis a common data collection process to generate robust data, analysed and validated by a leading epidemiologist (objective 3). This data are valuable for academics to acquire greater understanding about how vulnerabilities contribute to health inequalities. It is also used as an evidence based advocacy tool to influence policy makers in further supporting health protection for all (objective 4). The project activities primarily contribute to specific and operational objective 3 of the EU Third Health Programme 2014-2010 (innovative, efficient and sustainable health systems) and also support specific and operational objective 4 (facilitate access to better and safer healthcare).

The quantitative and qualitative data

Methods and means

Everyone is likely to be vulnerable at a given moment in his or her life. Our theory of change is that to make vulnerability factors visible and to hold policy makers and health systems accountable for meeting their stated objectives of universality of coverage, we first need comparable quantitative and qualitative data as well as appropriate messages. When information is generated about the reasons for such obstacles, and brought to the attention of health authorities, advocacy can achieve changes in the system. Another – parallel – way to obtain change is to empower service users that are facing vulnerability factors, e.g. there are several examples throughout Europe where groups of sex workers, drug users or undocumented migrants have obtained access to better quality healthcare services once they knew how to successfully engage with authorities.
The members of the Network are all organisations reaching out to marginalized populations and with complex physical, mental and social problems. These teams are specialised in appropriately responding to urgent social and health needs in complex situations, but most of them lack experience in data collection, advocacy or policy making. This is why our network building activities and mutual learning are oriented towards starting or improving data collection and in how to engage in civil dialogue processes.

The 3 year work plan (2015-2017) is characterised by a cyclical rhythm…
• Every year (first half of the year): an annual network meeting and an advocacy training. The Annual meetings cover discussions on the state and governance of the Network, evaluating progress made in several areas and discussing strategy, validating new membership applications, etc. The advocacy training is about sharing successes and failures concerning advocacy and civil dialogue activities.

• In addition to continuous dissemination activities, a European Observatory Report is published on a yearly basis featuring the results of the data collection, legal analysis and other information gathering. It was launched with a press conference in May 2015 in London and in November 2016 in Brussels. A political event with all partners and stakeholders in 2017 will take place to launch the report and capture the lesson learnt of those past three years.

• Every year: intensive learning moments (workshops, seminars, exchanges of practices) for Network members’ teams, on one of the four objectives (quality of service delivery, patient empowerment, gathering data or advocacy).

Work performed during the reporting period

2015 was about laying the foundations of the Network whereas 2016 and 2017 are about consolidating activities and enlarging the ambitions and thinking about the future of the network after 3 years of work together.

The launch of the Observatory report in Brussels (11/2016) was attended by about 50 participants from all over Europe. The press conference were structured around two panels.
The first panel welcomed respectively the President of Doctors of the World – Médecins du monde (MdM) Spain and France, Mr Jose Felix Luis Hoyo and Ms Françoise Sivignon, and the Advocacy Coordinator from Doctors of the World Greece, Mr Stathis Poularakis.
The second panel welcomed Ms Cecilia Wikström, Swedish Member of the European Parliament (MEP) and Rapporteur for the reform of the Dublin Regulation, Ms Isabel de la Mata, Principal Health Advisor for DG Health, European Commission and Françoise Sivignon.
The discussion were kindly led by Pablo Rojas., our Network Partner from Migrant Right Centre Ireland (MRCI).

MdM Network members have been kept up to date with a regular internal EU newsflash on activities/ events that occurred during the year and a quartely newsletter sent to more than 500 EU stakeholders (NGOs and civil society platforms, researchers, health professionals, EU Permanent representatives, EU representatives)

The Network published two key reports in 2016:
- A user-friendly European Observatory report in 3 languages (English, French and its executive Summary in Spanish). This new report of the international LObservatory on access to healthcare shows again how inequitable access to healthcare remains in Europe for people facing vulnerabilities. The Network’s report “Access to healthcare for people facing multiple vulnerabilities in health”, based on medical and social data collected throughout 2015 in 31 cities in 12 countries, reveals once more exclusion from mainstream healthcare systems:
- Its executive Summary in English
- A legal report on access to healthcare in 17 countries (BE, CA, FR, DE, EL, IE, IT, LU, NL, NO, RO, SI, ES, SE, CH, TR and UK).

In line with our objective 4, the Network engaged the political dialogue with key EU institutional stakeholders about vulnerabilities in health. We had the opportunity to meet several times with the DG Justice Commissioner Vera Jourova to discuss the issue of children in migration and their access to healthcare, regular exchanges with DG HEALTH/CHAFEA, several MEPs (bilateal meetings with Network Members or regular meetings with for instance Cecilia Wistrom).

This year, we have started organisating exchange of practices between members. This year was about sex work and access to healthcare and the issue of empowerment (focus on migrants). In 2017, we will continue organising such meetings between the members that are very much appreciated because we touch base on concrete challenges faced in the daily work of the partners.

The main output achieved so far and their potential impact and use by target group (including benefits)

The expansion of data collection by the end of 2015 seems to have enhanced the ‘power’ with which MdM can advocate.

The data collection is a dynamic process. The FPA foresaw data collection in 2015 in 11 European countries (plus Canada and Turkey), adding 3 more countries in 2016 (MRCI in Ireland, Carusel in Romania, Slovene Philanthropy in Slovenia). The Health Centre for Undocumented Migrants in Norway and MdM Luxembourg started in the course of 2015. It is not yet possible to foresee how many countries will join for the 2017 report as it is still very much depending on the quality of the data (ongoing process). However, in principle, Ireland, Romania and Slovenia should be included in the 2017 European Observatory report, making a total of 14 European countries collecting data by the end of year three (plus Canada and Turkey). Members collecting the data are very positive about the process and said that " we didn't expect – among other things - to have such a quick response to data collection, asking the new questions changed the behaviour of the staff and volunteers and our health centre more than we realised. We understand our patients better, their life history and why they act the way they do" (impact on the quality of the health service).

Our main activity was producing, releasing and disseminating our European Observatory report in Brussels. The report had a print-run of 4,000 hard copies (2,500 in English, 2,500 in French). A 4 page summary in English was also helpful in getting the key messages across to the media.

Now, it is more difficult for policy makers to ignore statistics thanks to the development of a common advocacy strategy in the Network. The data collected seems therefore to have served as a tool that has allowed MdM to achieve further outcomes and impacts. We also created opportunities for members to speak out through written contribution to European Parliament work and political decision makers and raise visibility of the issue of access to healthcare (articles written and published, media coverage). By representing the Network at conferences and stakeholder meetings, Members achieved a better understanding of European decision making processes, while bringing direct testimonies about what is going on in the field to high-level policy makers.

Achieved outcomes compared to the expected outcomes

The influence on EU public Health has largely come about through social and other media (e.g. newspapers), particularly following the yearly launch of the European Observatory report in November 2016. Thanks to the Network’s advocacy and awareness raising activities, information from the European Observatory Report was widely picked up by the European and National media (see section dissemination).
EU institutions and Members States further expressed support for health protection for all as highlighted in several events/conferences such as the European Health Forum Gastein (09/2016) and the annual EUPHA conference (11/2015), PACE Committee session of the Council of Europe (MdM presented its conclusions on medical age assessment), United Nations General Assembly and the summit on migration in New York (09/16), the European Forum on the the rights of the child (11/16).

The Network was visible at several high level academic meetings and gave lectures at medical faculties. The Network was consulted by DG Justice for its particular relevant field expertise in access to healthcare for unaccompanied minors. The long version of the network’s report was published on Research Gate and was disseminated among more than 145 academics with a track record of interest in vulnerabilities in health. MdM Network participated in the “EU Border Care Annual Conference” organized by the European University Institute in Florence the 27-28 June 2016. The Network talked about the Legal Norms and Actual Practices That Determine Undocumented Women's Access to Maternity Care in the Destination or Transit European Countries. EU BORDER CARE is a comparative anthropological analysis of undocumented women’s access to maternity care in European borderlands, with a specific focus on South and South-Eastern European borders, and ultra-peripheral regions.
The European Network wrote an article as well for a book entitled “Santé des populations vulnérables” (Health of vulnerable populations) edited by Claire Adam and V. Faucherre (Auteur). This book – education focus- is intended for medical students. The book will therefore focus on pragmatic aspects that respond to the needs of these populations. Click here to read the Network Contribution

Dissemination and evaluation activities carried out so far and their major results

The following materials were disseminated according to a dissemination plan provided by each Network members:
• The European Observatory report on access to healthcare
• the Legal report on access to healthcare in 17 countries
• The quartely newsletter (sent widely)
• The EU internal update (within the Network)

The mapping of European stakeholders that preceded the release of the 2015 European Observatory report has been turned into a segmented mailing list, with relevant European civil society contacts (about 400), academics (145), Health Attachés, EC staff (about 40) and about 170 of the most relevant MEPs (i.e. health professionals, or members of ENVI, LIBE, EMPL or FEMM committees). This year (as in 2015), we have also asked all our members to establish national dissemination plans.

The Data Collection Manager created a practical monitoring tool - at the disposal on dropbox for the Network member collecting the data – to follow how the dissemination of the Observatory report whether it is electronically (websites, media) or events. As the dissemination tool is meant for the whole 2017 year, the Network members are currently using it to update information. The health Centre for Undocumented migrants in Norway is good example and update on regular basis the tool.
We faced several constraints in term of lack of ressources and delays in producing the Obsevatory report, therefore we have decided to prioritize the updates the medical and social questionnaires to collect data in 2017 and further support members in their daily work and when collecting data and less focus this year on the dissemination.