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Supporting health coordination, assessments, planning, access to health care and capacity building in Member States under particular migratory pressure (SH-CAPAC) [SH-CAPAC] [717275] - Project
Project abstract

The general objective of the project is to support EU Member States (MS) under particular migratory pressure in their response to health related challenges. Specific objectives of the project are to support MS’s coordination, assessments, planning of a public health response, fostering access to health care and capacity building efforts through training of health workers. Target countries are Bulgaria, Croatia, Greece, Hungary, Italy, Romania, Slovakia, Slovenia (first arrival and transit countries); Austria, Belgium, Denmark, France, Germany, Malta, Sweden, The Netherlands (traditional destination countries); and Portugal, Poland, Spain (new destination countries). The ultimate beneficiaries are registered and unregistered refugees asylum seekers and other migrants, while direct beneficiaries are the health systems of each EU MS and their health workers. The project will contribute to meeting the objectives and priorities of the Annual Work Programme 2015. SH-CAPAC is being submitted by 7 European health institutions, 6 of them have developed the EU-funded MEM-TP project under the same lead institution (EASP, Spain). The partners will function as a collective entity for developing the necessary instruments and tools through a division of labour; carrying out regional advocacy and capacity building activities; conducting site visits to target countries for specific technical assistance; coordination activities with national health authorities and other relevant national stakeholders as well as with relevant international organisations and the EU. The project comprises 6 WP -including different tools and instruments to be developed- which are organized as a set of processes that will be structured as complementary, intertwined and synergistic streams of work, mutually reinforcing each other. They are intended primarily to support MS to strengthen their health systems for addressing the health needs of the refugee, asylum seekers and other migrant populations.

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

In light of the increased migratory influx into the European Union, the European Commission decided to provide support from the Health programme to organisations able to quickly support Member States under particular migratory pressure to rapidly respond to possible health threats. It was also deemed as necessary to support public health capacity-building and develop appropriate tools, as well as increase access to medical expertise and information to support Member States to deliver the necessary health care. CHAFEA and a consortium of seven European institutions, coordinated by the Escuela Andaluza de Salud Pública (EASP), signed a grant agreement for a one-year action on December 2015. The action was called ‘Supporting heath coordination, assessments, planning, access to health care and capacity building in Member States under particular migratory pressure’ (SH-CAPAC). The grant was awarded under an EC emergency call for proposals in response to the refugee situation in Europe. The initiative began on 1 January 2016 and was scheduled to last 12 months. It was completed on 31 December 2016. The other consortium members have been Azienda Unita Sanitaria Locale di Reggio Emilia in Italy, Trnava University in Slovakia, University of Ghent in Belgium, Jagiellonian University in Poland, Copenhagen University in Denmark and Academic Medical Centre of the University of Amsterdam.

The general objective of the project was to support Member States under particular migratory pressure in their response to health related challenges. This support was particularly geared to build and strengthen capacities among relevant stakeholders in the 19 target Member States covered by the project so they can attain an effective coordination of the health response, undertake population based needs assessments, develop action plans and contingency plans for improving the health response, identify and reduce access barriers for the vulnerable populations and train health workers, health managers and other professionals on the necessary skills and competences for improving the health response to refugees, asylum seekers and other migrants as well as for providing migrants’ and refugee’s sensitive health care.

Methods and means

The EASP has been responsible for planning, monitoring and evaluation of the project activities in close consultation with each partner, as well as for reporting to the European Commission on progress attained and the final results obtained. The partners that constitute the consortium for the implementation of the project SH-CAPAC have functioned as a collective entity for:

a. Developing the necessary instruments and tools through a division of labour among the members of the consortium.
b. Carrying out regional advocacy and capacity building activities (seminars and workshops), organized by the members of the consortium with the participation of relevant stakeholders in each of the target countries.
c. Conducting site visits to those target countries, which are interested in receiving technical assistance from the consortium to develop country specific activities within the scope of the project.
d. Coordinate with the national health authorities in the target countries, as well as with other relevant national stakeholders (i.e. Red Cross and NGOs) involved in responding to the health needs of the refugee population.
e. Coordinate with the international organizations working to respond to health needs of refugees, asylum seekers and other migrants in the target countries, especially WHO, IOM, UNHCR, OCHA and the different relevant actors of the European Commission.
f. Coordinate with other grantees under this call for optimisation and coordination of resources and impact.

Work performed during the reporting period

The activities, distributed into six Work Packages, have been to develop framework and tools, carry out regional training and dissemination of workshops, offer technical assistance through country missions, carry out regional advocacy and capacity building activities, conducting visits to target countries and coordinate with national health authorities and international organizations.

An organisational framework was established to carry out the project, which included mainly a Steering Committee, a Project Director and a Technical Secretariat. The first task was to draw up the Manual of Rules and Procedures (including the Communication Plan), which, within the framework of the general rules applicable to the action, clarified and established the processes and procedures to follow to carry out the range of activities envisaged in the proposal.

In the framework of WP 6, an inception and coordination meeting of the SH-CAPAC project was held on January 14, 2016 in Granada, Spain. A meeting with international stakeholders, who are part of the health response to refugees, asylum seekers and other migrants, was held back to back with the inception and coordination meeting on January 15, 2016. It included representation from CHAFEA, IOM, WHO and ECHO. Furthermore, an internal consortium meeting of all Consortium members was held in Trnava, Slovakia, on April 8, 2016. This internal workshop permitted cross-fertilisation between the different work packages. It also facilitated the review of the different deliverables to ensure a cohesive approach to the SH_CAPAC activities and products.

The action, divided into 6 work packages, comprised 14 deliverables as well as 25 milestones. During the execution of the project and following recommendations from CHAFEA, the language of the original deliverables and milestones were slightly adjusted to better reflect the exact nature of the work that was being conducted. Some adjustments in the due dates of the deliverables and milestones, resulting from the need for incorporating the rich feed-back received from target Member States in the multiple consultations, were introduced as well.

No new deliverables nor milestones were added and the scope and nature of the deliverables and the milestones remained unchanged. These modifications were incorporated in the amendment (AMD-717275-1) to the Grant Agreement.

In addition to the above-mentioned meetings, three specific workshops have been held in Ghent, Copenhagen and Bologna in the framework of the activities and products foreseen in WP 1 to 5. These workshops have been further useful to disseminate the SH-CAPAC project, highlight the need to intensify coordination of all health actors as well as to discuss and gather feed-back and inputs related to the different Guides, Frameworks and other relevant documents.

In relation to the training activities, a regional workshop on implementing a training strategy for the development and strengthening of refugee/migrant sensitive health services and adapting training materials to national, regional and local contexts was held in Granada, Spain, on 15-16 September 2016. The online training course took place from 20th October 30th November.

Initially, seven country support missions were foreseen. Unfortunately time restrictions as well as last minute cancellation of the mission in December to Portugal only permitted the completion, of a total of six missions to Bulgaria; the South-Aegean region, Greece; the Catalonian Region, Spain; Slovakia; the Andalusian Region, Spain and Greece.
The six missions to Member States were carried out for introducing, disseminating and discussing the frameworks, methodologies and tools developed. They allowed for discussions with multiple national and local stakeholders involved in the health response to refugees, and an exploration of possibilities for improving coordination and coherence in the response.

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

The following paragraphs offer a summary by Work Package of the salient aspects of each stream of work, of the planned meetings organised and of the deliverables produced between January and December 2016

Work package 1: Health sector coherence and coordination

1. Report on the workshop for the framework for national and regional coordination and coherence.
2. Coordination Framework for addressing the health needs of the recent influx of refugees, asylum seekers and other migrants into the European Union countries. It was used in the country support missions and has been disseminated in all the SH-CAPAC workshops as well as in the on-line training course.
3. Mapping of the response to the health needs of refugees, asylum seekers and other migrants: 19 Country Profiles were completed (Belgium, Bulgaria, Croatia, Denmark, Greece, Malta, Netherlands, Poland, Portugal, Romania, Slovakia and Sweden as well as draft versions for Austria, France, Germany, Hungary, Italy and Slovenia).
4. Umbrella document that provides background information on the health response to the recent migratory influx into the EU. It draws preliminary conclusions from the mapping has been produced.
5. Reports on 6 country support missions.

Work package 2: Health situation and health care assessments

1. Report on the combined regional WP2 and WP3 workshop (needs assessment component).
2. Guide for Assessing Health Needs and Health Protection Resources.
3. Reports on 6 country support missions.

Work package 3: Planning the implementation of a public health response

1. Report on the combined regional WP2 and WP3 workshop (action planning component).
2. Guidelines for the development of Action Plans for implementing a public health response and strengthening health systems in order to address the needs posed by the influx of refugees, asylum seekers and other migrants.
3. Report on 6 country support missions.

Work package 4: Improving access to health care

1. Resource package for ensuring access to health care of refugees, asylum seekers and other migrants in the European Union countries. It identifies a series of barriers for accessing health care, and formulates recommendations to overcome those barriers. The Resource Package is based on a large number of interviews and focus groups, conducted in several project target countries.
2. Report on combined WP4 and WP5 workshop (improving access component).

Work package 5: Training activities

1. Design of a training strategy and a on the health response to refugees, asylum seekers and other migrants.
2. Report on Training of Trainers workshop for discussing the adaptation of the training materials and strategy to national and subnational situations.
3. Report on design, development and evaluation of the online training course.

Work package 6: Coordination of SH-CAPAC

1. Work plan of the project (including design of a web site and communication platform).
2. Report of the inception and coordination meeting (Granada, 14th January 2016).
3. Report of the meeting with international stakeholders (Granada, 15th January 2016).
4. Manual on Rules and Procedures, including a Communication Plan.
5. SH-CAPAC brochure.
6. Interim Technical Report.
7. Final Technical and Financial Report.
8. Laymen Report.

The above mentioned products are available on the SH-CAPAC webpage (www.easp.es/sh-capac).

In terms of the potential impact and use by the target group it is important to highlight the following aspects.

All the activities of the project were directed to support Member States, in close collaboration with WHO, IOM, UNHCR, and the Commission in the establishment of national and international health sector coordination mechanisms for implementing a coherent and consolidated national and international response to the health needs of the refugee asylum seekers and other migrants population especially in Member States of the Western Balkans’ route and of the Mediterranean coast subject to an inc

Achieved outcomes compared to the expected outcomes

1.- Coordination platforms for implementing a coherent national and international response to meet the health needs of the refugees, asylum seekers and other migrant’s population established.

The 6 missions conducted in Bulgaria, Greece (2), Spain (2) and Slovakia to introduce, disseminate and discuss the elaborated Coordination Framework allowed for discussions with multiple national and local stakeholders involved in the health response to refugees, and an exploration of possibilities for improving coordination and coherence in the response. In addition to the Coordination Framework, the following supporting documents have been elaborated: 19 Country Profiles and an Umbrella Document, which provides background information.

Time restrictions as well as last minute cancellation of the mission in December to Portugal only permitted the completion of a total of six missions, instead of the 7 foreseen.

2.- Assessments of health challenges posed by the massive refugee flow and of the health care response and public health interventions needed for the refugee refugees, asylum seekers and other migrants’ population conducted in at least 8 affected countries

The 6 missions conducted in Bulgaria, Greece (2), Spain (2) and Slovakia to introduce, disseminate and discuss the elaborated Guide for Assessment of Health Needs and Health Protection Resources allowed for discussions with multiple national and local stakeholders involved in the health response to refugees, and discussed the possibilities for applying the Guidelines for conducting population based assessments on the health situation of and health response to refugees, asylum seekers and other migrants.

Time restrictions as well as last minute cancellation of the mission in December to Portugal only permitted the completion of a total of six missions, instead of the 7 foreseen.

3.- Action plans to implement a public health response and strengthen a country’s health system in order to address the needs posed by the refugees, asylum seekers and other migrants’ influx formulated in at least 8 affected countries

The 6 missions conducted in Bulgaria, Greece (2), Spain (2) and Slovakia to introduce, disseminate and discuss the elaborated Guidelines for the Development of Action Plans for Implementing a Public Health Response and to strengthen Country’s Health Systems to address the needs posed by the influx of refugees, asylum seekers and other migrants allowed for discussions with multiple national and local stakeholders involved in the health response to refugees, and discussed the possibilities for applying the Guidelines for developing contingency plans to respond to the health needs of refugees, asylum seekers and other migrants.

Time restrictions as well as last minute cancellation of the mission in December to Portugal only permitted the completion of a total of six missions, instead of the 7 foreseen.

4.- Resource package containing tools and measures

The Resource Package for ensuring access to health care of refugees, asylum seekers and other migrants in the European Union countries has been developed.

Even though this was not a deliverable as such, the six missions conducted to Countries and Regions were used to introduce, disseminate and discuss this Resource package.

5.- Framework developed by the consortium for a migrant-sensitive health care delivery model to be implemented in entry, transit and destination countries and 240 health workers of health districts with a high case load of refugees in at least 8 target countries trained.

A training strategy was developed, circulated and discussed in several workshops. A Training of Trainers workshop was conducted in Granada, Spain, from September 15 to 16, 2016 to discuss the adaptation of the training materials and the training strategy to the national and regional situations in targeted Member States, as well as the proposed outline and contents of the online training course.

The online training co

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

1. Health coordination mechanism

Health coordination mechanism should bring together all stakeholders involved in the health response to the recent influx of refugees, asylum seekers and other migrants in order to coordinate their actions in a more efficient way. This involves national partners (public services and non-public sector, including NGO’s and civil society) as well as international partners.
It is highly recommended to encourage a participatory approach and to include representatives of migrant groups in the health coordination mechanism.
Due to variations in the context, scale and complexity of the problem across the European countries, flexibility in the application of the health coordination framework is highly recommended (adaptation to country-specific context/sitituation).
There is a need for ensuring that the national and local efforts directed at responding to the health needs of migrant populations fit well into the national health system. Also, for other forms of (sub) national coordination.
Adequate communication to internal and external stakeholders is of paramount importance. Communication should be aimed at a wider audience, internally (such as line ministries) but also externally at the media and the public. It should be reported in an appropriate language and highlight positive aspects of the interventions that may benefit the general population. The information should also be aimed at the political level advocating for an integrated health response. This is particularly important in destination countries, as strong evidence needs to be presented to decision makers.

2. Assessing health needs and health protection resources

Need for strong partnership among different actors in order to better develop health needs assessments and implement an adequate response. Furthermore, it is necessary to reflect the multiplicity of the challenges across Europe and to account for the different scenarios of migration: 1) first arrival to Europe/ transit and 2) settlement.

Special attention has to be given to vulnerable groups such as unaccompanied minors, pregnant women, elderly and undocumented migrants.

It has been regarded as essential to incorporate 3 tools: 1) Socio-demographic overview 2) Contextual needs and resource identification 3) Resource mapping and monitoring

3. Guide for development of action plans

It is very difficult to predict all possible scenarios in all countries. For that reason, there is a need for a very flexible and simple tool/guide for rapid action taking into account time, type of country and characteristics of the migrants.

Contingency planning is essential in order to be prepared for a possible increased influx.
It is important to have in mind the different types of migrants (economic migrants, documented/undocumented, refugees) as well as of the resources available.
Inter-sectoral approach and international coordination is crucial. There is also a need to cover different levels (local and national levels).
There is a need to place greater attention to the living conditions in camps as important determinants of health.

4. Resource Package

Health needs experienced by people during the migratory trajectory call for an intersectional approach in each phase. Each phase of the migratory route (arrival, transit, and destination) has its peculiar challenges.

There is a need to carry out changes in the administrative procedures, the information for migrants and staff on the rights to health care, and the advocacy actions to drive national governments. Interpretation of legislation in situations of big influx of migrants should be relaxed.

It is necessary to consider the impact of policies of relocation, in particular, it is important to provide support to healthcare providers for asylum seekers who are in transit; this might require, for instance, that patient information is appropriately recorded and made available to the new provider.

It is essential to undertake large num