Eight NGOs will support the health authorities of 11 Member States (BE, BG, DE, EL, ES, FR, HR, IT, NO, SE, SI) in providing adequate and accessible health services to newly arrived migrants with a specific focus on children, unaccompanied minors and pregnant women. Where needed, flexible and adaptive mobile health surveillance and response units will identify arrival and transit locations and provide general health assessments. Individual mental and physical health assessments will be conducted using the standardized personal health record developed by IOM and DG SANTE. Migrants will receive a health booklet to facilitate referrals to adequate and accessible primary healthcare (including vaccinations). Psychosocial support and preventative care will also be delivered. Depending on the rapidly changing context, and as long as adequate patient privacy can be ensured, actions will take place in mobile units, in temporary ‘clinics’ or in already existing centres run by the partner organizations or one of their associate local partners. Wherever possible, access to national health systems will be supported through social and health mediation activities and the provision of information on migrants’ rights to access care.
Experiences and lessons learned will be systematically shared with local, national and European health authorities. Core indicators on migrants’ health and main vulnerability factors will be routinely collected and used both to improve field teams’ responses and to inform health authorities. Finally, teams’ capacities will be reinforced through active European coordination and mutual learning mechanisms, including an intermediary workshop.
As a result, geographically changing needs will continuously be assessed and met, cross-border health threats will be reduced, local coordination between all operational actors will be improved and applicants and their teams’ capacities in responding to urgent migrants’ health needs will be strenghtened.
Over the year 2016 and early 2017, the migration reception crisis has been ongoing in Europe even though the context changed significantly during that period. The total number of arrival significantly decreased due to a sharp drop of sea arrivals on Greek islands following the EU-Turkey agreement signed on March 18th 2016. At the same time the number of sea arrivals in Italy kept increasing (+18% in 2016 compared to 2015). Due to the closure of the borders on the “Balkan road”, more than 70 000 people have progressively been stranded in Greece end in the different Balkan countries.
From January 2016 to March 2017, eight NGOs supported the health authorities of 11 Member States (Belgium, Bulgaria, Germany, Greece, Spain, France, Croatia, Italy, Norway, Sweden, Slovenia) in providing adequate and accessible health services to migrants (known as “8/11 project”).
Mobile units and teams have been deployed and adapted their locations and strategies to the evolving context, in order to monitor the migrants’ needs and ensure the activities carried out remained relevant at all times. Physical health assessments were conducted by mobile teams in every country on different scales (27 326 in Greece, very few in Sweden or Norway) and through different means (mobile units, temporary premises, etc.). Although on a lower scale, mental health assessments were also performed when needed alongside the physical ones. These assessments led to refer patients to various appropriate public health structures or to permanent heath facilities managed by non-governmental actors, for further diagnosis and proper physical and mental care. Social consultations were also carried out in most countries, in order to provide information on migrants’ rights and refer them to the relevant actor depending of the assessed needs. In some countries, miscellaneous group workshops were organized, especially to alleviate the psychological burden so many migrant experience. Health promotion activities took many forms, from group informational sessions to distribution of leaflets presenting relevant information.
In each country, interactions with local actors have been at the center of the projects. Most of the partners participated in coordination meetings with local authorities and other organizations involved in migrants’ assistance. Through these various meetings, workshops, conferences and other informal contacts, information and experiences were shared and relations and cooperation were improved between different actors.
Last but not least, a special attention was given to collecting data through the health assessments, in order to have a better understanding of the needs, so as to share with authorities and improve partners’ response.
- Methods and means to reach SO 1 – respond to rapidly changing needs : mobile units and mobile teams to assess evolving needs and to provide urgent health assessemnts when necessary
- Methods and means to reach SO 2 – reduced cross-border health threats : Individual needs assessments of physical & mental healthcare (including dental assessments in Belgium) [Please note that doctors, nurses, psychologists or other medical staff providing direct care were funded by other donors or own funds and not charged to the budget even if their activities are reported here as they were linked to this project.] / Referral to healthcare services / Psychological health assessment, psychosocial support to beneficiaries, traning on psychological first aid for the teams / psychosocial and health mediation activities and provision of adapted information on national health systems and migrants’ rights to access healthcare / Adapted health education and health promotion material (in relevant language depending of the countries of origin).
- Methods and means to reach SO 3 – improved local coordination : participation to coordination mechanisms, sharing of semestrial needs assesments with local authorities, common needs assessments with local authorities when possible.
- Methods and means to reach SO 4 – teams’ capacity building: coordination meetings every two weeks with all the projects, mutual learning workshop, trainings, sharing of tools.
Mobile units and mobile teams have been set up in 8 countries. These teams remained active through the entire project, adapting their locations and strategies to the evolving context, in order to monitor the migrants’ needs. These needs were constantly monitored through many sources (i.e. social media, newspapers, etc.) and frequent contact with relevant actors (i.e. other NGOs, local and national authorities, etc.). When needed, especially in Italy, Belgium and Bulgaria, emergency health assessments were offered to migrants in need. These activities correspond to the Work Package 2 (WP2).
The activities carried out depended in each country on the context and the identified needs. Physical health assessments were conducted in every country on different scales (41,841 of all in Greece, very few in Sweden and Norway) and through different means (mobile units, temporary clinics in camps or accommodation centers, etc.). Although on a lower scale, mental health assessments were also performed when needed alongside the physical ones (in all the countries but Sweden). These assessments led to refer patients to various appropriate public health structures for further diagnosis and proper physical and mental care, or to permanent health care centers managed by non-governmental actors. Trainings and awareness raising activities were provided to many health actors in order to improve their response to migrants needs. Social consultations were also carried out, mainly in order to provide information on migrants’ rights. In some countries, miscellaneous group workshops were organized, especially to alleviate the psychological burden so many migrant experience. Health promotion activities took many forms, from informational group sessions to distribution of leaflets presenting relevant information. These activities correspond to the WP3.
In each country, interactions with local actors have been at the center of the carried out actions. Most of the partners participated in all coordination meetings with local authorities and other organizations involved in migrants’ assistance. Through these various meetings, workshops, conferences and other informal contacts, information and experiences were shared and relations and cooperation were improved between different actors. Memorandums of Understanding were frequently signed with authorities in order to facilitate the activities and improve the migrants’ situations. Special attention was given to collecting data through the health assessments, in order to have a better understanding of the needs, so as to share with authorities and improve partners’ response. These activities correspond to the WP4.
A successful main mutual learning workshop was organized mid-2016 in Athens in order to strengthen all the partners’ capacities on identified topics, such as violence, mental health, data collection, and so on. In addition to daily bilateral exchanges through phone and emails, bimonthly coordination teleconferences were held to address together various issues and support each partner on specific problems. Many field visits were also organized to provide additional support and train field teams and improve the actions carried out. Several other workshops and trainings (psychological support, cultural mediation, migration procedures, unaccompanied minors, etc.) participated in the overall strengthening of each partners’ teams. An online exchange platform dedicated to the consortium’s partners also allowed the sharing of information and lessons learned that directly improved their capacities. These activities correspond to the WP5.
Specific Objective 1 mainly consisted in being able to continuously assess the migrants’ needs by setting up adaptable mobile units and teams. Along the project, their numbers evolved depending on the needs in order to adapt and move to new places when needed. By March 2016 (Milestone M2.1), 5 mobile units were fully equipped and 6 mobile teams recruited. By May, there were respectively 8 and 10; and from June on, there were at least 11 mobile units and teams (up to 13 during the last months of 2016). The information collected regarding context and needs’ evolutions were assiduously communicated by field teams to the consortium coordinator through monthly situation reports (Deliverable 2.1) and semestral needs assessments reports (Deliverable 2.2). A few additional assessment reports were also performed when necessary (Milestone M2.2), to reach a total of 24 reports over the course of the project.
Output indicaors :
Mobile units move to new spots (depending on needs): 66 new spots visited by the mobile teams for general health assessments
Number of detected spots that are actually visited by mobile teams within areas of intervention (target 70%): 96%
Number of urgent individual health assessments with newly arrived migrants: 2,195
Specific Objective 2 aimed at reducing the cross-border health threats by providing migrants with mental and physical health assessments (and referral to public healthcare when needed), social consultations, and useful information about health prevention and their rights. Throughout the 11 countries of the consortium between January 2016 and March 2017, a total of 50,773 physical health assessments were performed, as well as 1,507 mental health assessments and 5,765 social consultations. 3,533 people were referred to public health care providers, while 34,432 informational leaflets were produced and/or disseminated. Most of these activities started as planned in March 2016 at the latest (Milestone M3.1).
Ouput indicators :
Number of health booklets delivered: 1,994
Number of physical health assessments: 50,773
Number of mental health assessments: 1,507
Number of social consultations: 5,765
Number of referrals to public health care providers: 3,533
Number of information leaflets produced and disseminated: 34,434
Where relevant: number of calls to the hotline (BE / SE): 262 (GE/FR/BE/SE)
Where relevant: number of migrant group sessions (info / education): 481 (in every countries except EL/HR/SE)
Specific Objective 3 consisted in improving the local coordination between all operational actors. All along the project, information and lessons learned were shared with the relevant actors in each country (Milestone M4.1), when necessary through specific awareness raising material (Deliverable 4.3). All these contacts were described in the monthly situation reportss (Deliverable 2.1). The needs assessments conducted were shared with partners and authorities (Deliverable 2.2) in order for all stakeholders to be able to adapt their response to the real needs of migrants. The data analysis reports, at country and global level were finalized (Deliverable 4.2) and were shared (or will be share soon in some countries) with relevant actors.
Output indicators :
National / cross-country data collection reports (target= 11 countries, 1 cross-country report) : 9 national reports (not enough data collected for Norway and Sweden) + cross country report
Number of situation reports sent to local authorities, partners and Consortium coordination in Paris (target 11 countries, on a monthly basis): 10 monthly reports (including 1 for January to March 2016, 1 for July-August 2016, and 1 for January-February 2017, monthly reports for all the other months of the period)
Where relevant: number of health professional participants to sessions: 500 (in every countries except EL/HR/BG/SE)
Specific Objective 4 was for consortium’s partners to strengthen their own capacities regarding the response to migrants’ health
Specific Objective 1 mainly consisted in being able to continuously assess the migrants’ needs by setting up adaptable mobile units and teams. Along the project, their numbers evolved depending on the needs in order to adapt and move to new places when needed. By March 2016 (Milestone M2.1), 5 mobile units were fully equipped and 6 mobile teams recruited. By May, there were respectively 8 and 10; and from June on, there were at least 11 mobile units and teams (up to 13 during the last months of 2016). The information collected regarding context and needs’ evolutions were assiduously communicated by field teams to the consortium coordinator through monthly situation reports (Deliverable 2.1) and semestral needs assessments reports (Deliverable 2.2). A few additional assessment reports were also performed when necessary (Milestone M2.2), to reach a total of 24 reports over the course of the project.
Outcome indicaors :
Needs assessment report with recommendations for further action is produced and can be shared with local authorities (target At least once / semester for each mobile unit): 26 (6 in Greece, 3 in Italy, 4 in Croatia, 3 in Bulgaria, 2 in Slovenia, 2 in Germany, 2 in Belgium, 2 in Sweden, 2 in Norway)
Local authorities and other relevant actors confirm that all needs have been assessed by the mobile teams in our area of intervention: Each partner of the consortium is locally considered as one of the main actors regarding migrants’ health and confirm that all needs have been assessed.
Specific Objective 2 aimed at reducing the cross-border health threats by providing migrants with mental and physical health assessments (and referral to public healthcare when needed), social consultations, and useful information about health prevention and their rights. Throughout the 11 countries of the consortium between January 2016 and March 2017, a total of 50,773 physical health assessments were performed, as well as 1,507 mental health assessments and 5,765 social consultations. 3,533 people were referred to public health care providers, while 34,432 informational leaflets were produced and/or disseminated. Most of these activities started as planned in March 2016 at the latest (Milestone M3.1).
Outcome indiocaors :
Migrants/ refugees are satisfied with their access to health and information received as verified through two satisfaction surveys (external evaluation) (target 60%): The external evaluators were not able to conduct a representative satisfaction survey (only 24 people interviewed on a single site). Nonetheless, the report states that “the majority rated the service as good”.
External project evaluation indicates that a majority of users know their health needs and that the most urgent needs are effectively dealt with: The external evaluators were not able to provide such information because no representative survey could be conducted.
Specific Objective 3 consisted in improving the local coordination between all operational actors. All along the project, information and lessons learned were shared with the relevant actors in each country (Milestone M4.1), when necessary through specific awareness raising material (Deliverable 4.3). All these contacts were described in the monthly situation reportss (Deliverable 2.1). The needs assessments conducted were shared with partners and authorities (Deliverable 2.2) in order for all stakeholders to be able to adapt their response to the real needs of migrants. The data analysis reports, at country and global level were finalized (Deliverable 4.2) and were shared (or will be share soon in some countries) with relevant actors.
Outcome indicators :
The external evaluation shows that the knowledge of the health needs of newly arrived migrants is used to improve local and national health responses by the end of the project. : This issue was included in the evaluative questions (cf. Evaluation report or summary above in section 1.4).
Specific Objective 4 was f
In addition to the sharing of experience and coordination with local actors (cf. section 1.7. WP4), dissemination activities towards a broader public were carried out in almost every country.
At consortium level, MdM integrated a summary of the data analysis in the report Access to healthcare for people facing multiple vulnerabilities in health in 31 cities in 12 countries, released by the European network to reduce vulnerabilities in health. The project was also presented at the Lisbon Conference on Migrant’s health organized by CHAFEA and DG Health (May 2016).
Most of the project disseminated information about the project within their integrated communication strategy, through their website, Twitter and/or Facebook and/or Instagram accounts and through other events not specifically linked to the 8/11 project. The main dissemination activities that are worth mentioning in each country are detailed in the technical report.
An external evaluation was carried out in October/December 2016 by Groupe URD, chosen after an open call for tender launched in July 2016.
The summary of the final evaluation states the following (extract from evaluation report):
The scale of the migration crisis in Europe reached a peak in 2015 as more than a million migrants and asylum-seekers crossed the sea to reach Europe, fleeing war, persecution, or poor economic conditions in their home countries. Throughout 2016, the migration situation remained unstable and unpredictable across Europe. As a matter of consequence, this continued to have terrible humanitarian consequences: the increasing number of deaths, outbursts of violence at borders and in overcrowded camps, expulsions, administrative detention, stranded populations, the risk of human trafficking, psychological effects on migrants’ mental health, etc.
In these circumstances, the 8 NGOs for migrants/refugees’ health in 11 countries programme piloted by Médecins du Monde was a unique experience as it was implemented by a consortium at a European level. At the end of 2015, NGOs were exceptionally given the possibility to apply to DG Health for operational projects. The main goal of this call for proposals was to support the local health capacities in responding to migrants’ and refugees’ needs. The co-applicants to this call were all previously linked to the MDM international network as participating members of the European Network to reduce vulnerabilities in health.
The 8/11 response was implemented by 8 NGOs in 11 countries. It began at the beginning of 2016, for an initial period of twelve months and was later extended for an additional three month period (until March 2017). It involved projects to improve access to health services, increase access to information and contribute to better coordination among partners and local authorities. These projects were targeting newly-arrived refugees and migrants, but also taking into account the needs and concerns of local health actors and authorities, and implementing partners.
Evaluation Methodology
This independent, external final evaluation of the 8/11 consortium project was commissioned by MDM-France as a consortium coordinator, and conducted by Groupe URD. The evaluation assesses the performance of the consortium project in achieving results and contributes to the existing knowledge base on how to improve a consortium approach of this kind for a large-scale migration crisis. It covers the period from January to December 2016, and is framed around the evaluation criteria of relevance, effectiveness, consortium advantage, and connectedness.
The evaluation consisted of a documentary review, interviews with key informants, an on-line survey with consortium partners, and a Beneficiary Satisfaction Survey (BSS). Field work consisted of visits to Croatia, Greece (islands and mainland), Italy, Germany and Slovenia.
Key Findings
Relevance
With the socio-political context becoming more restrictive in most European countries, in m