WHO-HPH TF MFCCH Task Force on Migrant-Friendly and Culturally Competent Health Care

1. WHO-HPH TF MFCCHTask Force on Migrant-Friendly andCulturally Competent Health Care EVOLUTION TOWARDS MIGRANT FRIENDLY HEALTH CENTERS Méndez, Elvira. General Director Asociación Salud y Familia

2. This is a collaborative project developed during 2003-2007 by the Asociación Salud y Familia (ASF) and the public health care system (PHC) in Catalonia (Spain). ASF is a non-governmental, non-profit-making organisation which designs and promotes models for improved accessibility to and use of health services, targeting vulnerable groups as immigrants, in social and cultural disadvantaged positions.

3. ORGANIZATIONAL OBJECTIVES (I) • Improve general conditions for the provision of healthcare to the immigrant population. • Increase the availability of culturally adapted services. • Improve communication by breaking down language and cultural barriers between healthcare staff and immigrants.

4. ORGANIZATIONAL OBJECTIVES (II) • Reduce unnecessary burdens on workload through reduction of intercultural conflict. • Increase appropriate use of services and the level of satisfaction among patients from the immigrant population.

5. GENERAL OBJECTIVES (I) • To describe the effects of a stable collaboration framework between the public health system and the ASF, an expert body working independently within the sphere of immigration. • To describe the quantitative and qualitative development of the various activities carried out in the health centres by the intercultural mediators.

6. GENERAL OBJECTIVES (II) • To analyse those factors which change the way in which health centre staff use intercultural mediation services. • To analyse what impact a stable intercultural mediation program has in improving cultural competencies of staff and health organisations.

8. ORGANIZATIONAL METHODS • Broad availability of intercultural mediation services to provide support to immigrants and healthcare staff. • Identifying the needs for intercultural adaptation of the hospital’s services, products and routines. • Joint leadership between PHC and ASF to encourage collaboration and the sharing of knowledge, expertise and innovation.

9. GENERAL METHODS • The sources used are computerised records of the activities performed as well as the characteristics of the immigrants attended to by intercultural mediators in the health centres participating in the collaborative project. • Other notable sources are the periodical advisory sessions which ASF holds within the various health centres with the goal of fostering and improving the effectiveness of the collaborative project.

10. ORGANIZATIONAL RESULTS (I) • The PHC is actively using the services of 37 intercultural mediators provided by ASF, covering the areas of America Latina, North Africa, Pakistan, Rumania, Ucrania and Xina and giving direct support to 95.094 immigrant patients (2003-2007). • The PHC is developed in 5 hospitals and 30 primary health centers.

11. ORGANIZATIONAL RESULTS (II) (*) The intercultural mediation programme begun in February 2004.

12. ORGANIZATIONAL RESULTS (III) • The PHC is adapting, interculturally, numerous information and health education materials. • The PHC has initiated a revision process for procedures that generated intercultural conflict. • Intercultural organisational development has become part of PHC agenda.

13. GENERAL RESULTS (I) • The activities carried out by the intercultural mediators (providing information, support and intercultural mediation) have advanced rapidly. The variety of functions performed by the intercultural mediators has multiplied in tandem with an important rise in the number of immigrant patients attended (8.492 in year 2005 and 28.335 in year 2006). • The health centre staff members who use the intercultural mediation services with greatest frequency are doctors and nurses, followed quite far behind by the administrative staff working in patient reception and planning.

14. GENERAL RESULTS (II) • The factors which contribute most to staff’s use of intercultural mediation services are the presence of an active immigrant-friendly policy promoted by health centre management, the availability of stable intercultural mediators, and the external advisory sessions with ASF which foster a process of continual improvement. • There has been a notable increase in intercultural continued training and in intercultural adaptation of informative and educational materials in the health centres participating in the project.

16. CONCLUSIONS (I) The experience of PHC in collaboration with ASF provides a feasible and innovative model of good intercultural practice which can be expanded and adapted to other hospitals and health centers.

17. CONCLUSIONS (II) The availability of permanent intercultural mediators within a stable “Migrant Friendly Health Centres” collaborative project offers immediate improvements in the care given to immigrant patients while simultaneously facilitating a specific and substantial development in staff members’ cultural competencies through daily exposure and continued intercultural training.

21. HEALTH CENTRES COLLABORATORS HOSPITALS • Hospital del Mar de Barcelona • Centre Pere Camps de Barcelona • Hospital Clínic. Maternitat de Barcelona • Hospital Clínic de Barcelona. • Hospital Arnau de Vilanova de Lleida • Hospital Josep Trueta de Girona

22. HEALTH CENTRES COLLABORATORS PRIMARY CARE CENTRES - BARCELONA CIUTAT • CAP Drassanes • CAP Raval Nord • CAP Les Hortes • CAP Besós Mar • CAP Casc Antic • CAP Poble Nou • CAP Poble Sec • CAP Besós • CAP Manso • CAP Fondo • CAP Sant Joan • PASSIR Manso • PASSIR Santa Coloma de Gramanet PRIMARY CARE CENTRES - BAIX LLOBREGAT • CUAP Sant Ildefons • CAP Sant Ildefons • CAP Martorell

23. HEALTH CENTRES COLLABORATORS PRIMARY CARE CENTRES - LLEIDA • CAP Balaguer • CAP Rambla Ferran • CAP Aitona • CAP Tàrrega • CAP Mollerussa • SASSIR Prat de la Riba • CAP Cervera • CAP Alcarràs • CAP Serós • CUAP Rambla Ferran PRIMARY CARE CENTRES - GIRONA • CAP Can Gibert del Pla. • CAP Celrà

24. THANKS ! E.mail: saludyfamilia@saludyfamilia.es Web: www.saludyfamilia.es