Table 2 The 46 recommendations of the ETHEALTH group designed to address health inequalities among migrants and ethnic minorities in Belgium
Topics | Recommendations |
|---|---|
Level 1:Content and socio-economic position | |
(1) Data on MEM | 1.1. Identification of migrants and ethnic minorities in systematic health care register |
1.2. Improvement of the statistical power of the National Health Interview Survey for MEM | |
1.3. Encouragement of research into MEM health status and health care | |
2) Coordinating efforts to develop a global and coherent strategy between the different levels of governance | 1.4. Improvement of coordination between federal, regional, Community, and municipal levels of governance |
1.5. Encouraging public health authorities to join international networks active in intercultural health care, such as the Migrant- friendly Hospitals network | |
(3) Training and licensing culturally competent health professionals | 1.6. Making cultural competences training a licensing criterion for health professionals |
1.7. Encouragement of the orientation of MEM towards the health professions, to add to the diversity of health care teams | |
Level 2: Differential Exposures (risk factors) | |
(1) Reduction of socio-economic inequalities | 2.1. Combating labour market discrimination and application of existing legislation in companies |
2.2. Taking into account the specific needs of MEM, especially first-generation, in education, but preventing the creation of educational ghettos and discouraging the systematic orientation of MEM to specialised schools | |
2.3. Taking initiatives in several areas to allow the participation of MEM in decisions that concern them | |
(2) Culturally competent health prevention, health promotion, and health education, including strengthening community health | 2.4. Increasing the awareness of health professionals in primary care services of the specific risks experienced by MEM and the higher risk of developing certain diseases, such as tuberculosis, while preventing “ethnification” or “racialisation” of these diseases |
2.5. Structural integration of preventive activities into the existing health care services | |
2.6. Adopting proactive initiatives to provide comprehensible and adapted information on the health care system for MEM, with strengthening the role played by the sickness insurance funds in informing clients | |
2.7. Considering community health as a main activity of the primary health care services | |
2.8. Taking into account, as far as possible, the context of the client in the delivery of health care facilities, especially in chronic treatment and in residential treatment, to avoid dropping out | |
2.9. Improvements to the curriculum of community health nurses, in nursing school as well as in the field, and including community health in the agreed standards for primary care services | |
Level 3: Differential vulnerability (at-risk groups) | |
(1) Irregular migrants and migrants with a precarious legal status, including asylum-seekers | 3.1. Clarifying the application of the legislation on Urgent Medical Aid and ensuring a clear framework of reimbursement for health care for migrants with a precarious legal status |
3.2. Entrusting the Public Centres of Social Action with the social inquiry to decrease the burden on social services in hospitals | |
3.3. Delivering to all irregular migrants a voucher entitling them to request assistance from different social and medical institutions | |
3.4. Extending the use of the “medical card” to all irregular migrants, entitling them to urgent health care | |
3.5. Diversification of the health professionals and health services available to treat MEM with a precarious legal status or in irregular situations, so as to prevent the formation of “health ghettos” | |
3.6. Provision of a temporary residence permit for irregular migrants with contagious diseases such as tuberculosis, in order to create confidence and ensure MEM follow a full course of treatment | |
3.7. Requiring better support from the Federal Agency for the Reception of Refugees and Asylum Seekers (FEDASIL) for the provision of specific training for these health professionals | |
3.8. Ensuring decent reception conditions, that respect human dignity, for all asylum-seekers, to avoid situations where their place of residence may increase mental and physical health problems | |
3.9. Ensuring access to all health care services for all asylum-seekers, whatever their conditions of reception/detention | |
(2) Migrants and ethnic minorities with mental health problems | 3.10. Developing and providing culturally competent preventive actions in mental health care, developed in partnership with the target population |
3.11. Developing and providing culturally competent mental health services, especially in urban centres in all the regions of Belgium | |
3.12. Developing interpreting facilities and intercultural mediation within mental health care services | |
3.13. Improving access to specific training in mental health for health professionals | |
3.14. Improving collaborative links and referral between mental health services and associations that assist MEM, whatever their legal status | |
3.15. Increasing awareness of mental health problems and adequate referral of clients within the primary care services | |
(3)Women | 3.16. Improving management of MEM women in maternity units, accident and emergency departments, and gynaecological services, with due consideration for cultural, financial, linguistic, or social obstacles |
3.17. Developing diversified responses to the struggle against genital mutilation and sexual violence | |
3.18. Improving prevention in relation to sexual and reproductive health for MEM women by improved information on their rights (including abortion, contraception, and protection against conjugal violence) | |
3.19. Promoting access to prenatal care and screening services for breast or cervical cancer | |
Level 4: Differential health outcomes | |
(1) Reinforcing the accessibility and quality of health services | 4.1. Reinforcing the accessibility and organisation of primary care services, especially where needs for intercultural care are more predominant |
4.2. Ensuring free access to health care services and basic drugs for all clients between 0 and 18 years | |
4.3. Stimulating a stable relationship with the general practitioner and the creation of a global medical file | |
4.4. Stimulating the creation of frontline primary health care centres, working in interdisciplinary teams with integration of social, community, and mental aspects into health care facilities | |
4.5. Stimulating the creation of efficient networks involving primary-care services, specialised health care services, support structures in other sectors (labour or housing), and representatives of MEM, in order to ensure the transmission of information and the adequate orientation of clients | |
4.6. Providing adequate information to MEM about health and preventive/curative health care services | |
(2) Promoting culturally competent health care services | 4.7. Increasing the accessibility of, and encouraging collaboration with, interpreters and intercultural mediators in all health services |
4.8. Increasing awareness of culturally specific components in health care delivery, with a view to improving the accessibility and quality of health care for MEM (e.g. adaptation of meals to religious precepts or religious facilities inside the institution) | |
4.9. Stimulating the openness and awareness of health professionals to diagnosis and management of MEM | |
4.10. Promoting collaborative work with diversified health care teams (gender, age, culture, or educational level) | |
4.11. Encouraging each health professional and each health service to develop action plans and to mobilise resources to meet the needs of MEM | |