Access to primary health care for asylum seekers and refugees: a qualitative study of service user experiences in the UK

Kang, Cara Pippa; Tomkow, Louise; Farrington, Rebecca

doi:10.3399/bjgp19x701309

Cited by 118 publications

(158 citation statements)

References 29 publications

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“…The proportion of the UK population with Limited English Proficiency (LEP) is growing [33] and they are more likely to be in poor health [34]. Too often they report that their medical professionals are inadequate, or even disinterested, in using interpreters, with dramatic impact [3,35]. It has been reported in the United States that physicians fail to use interpretation even when it is readily obtainable [36].…”

Section: Context and Communicationmentioning

confidence: 99%

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Consternation and complexity: learning from people who seek asylum

Farrington

2020

Education for Primary Care

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People seeking asylum experience health inequalities, and it is challenging to meet their needs in primary care. Consultations can feel overwhelming; however, there are excellent opportunities for Transformational Learning, transferable to other vulnerable people. A critical approach to evidencebased medicine, emphasising values, can be used to mitigate the consternation generated by these encounters and expand learners' perceptions about their roles and responsibilities. Global health, diversity, discrimination, intersectionality and power differentials can be explored. Realisation of the part practitioners play in leadership and advocacy is key. Helping the most marginalised is crucial to understanding patient-safety and quality improvement. Community-orientated approaches are performed well by Voluntary and Community Organisations. There is much to learn about coproduction and their 'No Wrong Door' philosophy. Recognition of health literacy and promoting cultural sensibility for a growing population with Limited English Proficiency, also requires learning advanced communication skills. Developing therapeutic trust with forced migrants subjected to illtreatment brings skills and behaviour relevant to other challenging encounters in primary care. Vicarious traumatisation is well-recognised when dealing with the sequelae of violence and, aided by their educators, primary care learners must understand ways to protect themselves and reflect on vicarious resilience, through recognising meaning in their work.

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Section: Context and Communicationmentioning

confidence: 99%

“…It is important to acknowledge that the consternation felt in consulting with forced migrants is a paltry reflection of what they experience in their battle to access meaningful care [3]. They are not a homogenous group.…”

Section: Introductionmentioning

confidence: 99%

Consternation and complexity: learning from people who seek asylum

Farrington

2020

Education for Primary Care

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“…If you have to pay the full cost of treatment or again it must use a private health insurance policy, which is not regulated the state then considers that the right care is not provided. (12) The right to health services, including the right to health insurance is regulated by the Foreigners Law (13) (14) and the Health Insurance Act. By this law there are three types of international protection: recognized refugees, persons under subsidiary protection and persons with temporary protection.…”

Section: Public Health Challenges -Access and Availability Of Health mentioning

confidence: 99%

The Right of Access to Health Care for Migrants in the Republic of North Macedonia - Barriers and Challenges

Jankulovska¹,

Tozija²

2020

JHMN

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Introduction: In recent years hundreds of thousands of refugees and migrants who have left their homes in order to reach the EU member states have transited through The Republic of North Macedonia (RNM). The dynamics of the refugee crisis in this period continually tested the readiness of the state to fully respect the guarantees of basic human rights, cultural and social differences, as well as respect for human dignity. The R. of North Macedonia throughout the crisis has remained a country of transit, not a target destination for refugees and migrants. The increasing number of migrants makes much more pressure on health systems in countries. Access to health services is one of the most basic issues, because high-quality care and health care is not effective if people don`t have access to it.Purpose of the paper is to represent the right and access to health care for migrants in the Republic of Northern Macedonia, the restriction of the health system, as well as the policies for improving the availability of health services for migrants.Material and Methods: In this paper are used, a public health approach, an infromatic-analytical method and sinteses evidence, and a review of the existing legislation, strategic documents and other documents. The materials whish were used are electronic databases such as PubMed, HINARI, EBSCO, Google Scholar, Scopus, and special search strategies for each keyword database based on inclusion criteria. For a detailed and specific view, were used reports from the International Organization for Migration (IOM)Results and Discussion: With an overall assessment of MIPEX 38/100, the country's policies are barely conducive to social integration. These policies are the result below the European average and an average slightly better than other countries in the region. Migrants lack targeted state support to find the right job, improve their children's education or benefit from consultative bodies. After the adoption of the National Strategy for the Integration of Refugees and Migrants in 2017, as one of the key documents of the Ministry of Labor and Social Policy that regulates the country's policy in dealing with affirmed refugees and foreigners on its territory, in 2018, the Action plan for the integration of refugees and foreigners 2017-2027. Migrants and refugees have multiple barriers to access to health care, as well as discrimination in access to the asylum procedure-which indirectly affects the exercise of healthcare rights.Conclusion: Despite the efforts made to give a quick response to the migration-refugee crisis, the Republic of North Macedonia needs further improvement of the respect and protection of the human rights of migrants and refugees. Health system reforms are needed in order to provide a faster and more efficient response to the needs of vulnerable groups who are staying and transiting through the Republic of North Macedonia.

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“…As a result, AS&Rs encounter extensive barriers to accessing health care [5,10] and have substantial unmet mental health needs [11]. In the UK, the situation is especially problematic for asylum seekers without leave to remain who are at risk of destitution yet are required to pay for specialist health care [12,13].…”

Section: Background Introductionmentioning

confidence: 99%

Lay-therapist-delivered, low-intensity, psychosocial intervention for refugees and asylum seekers (PROSPER): protocol for a pilot randomised controlled trial

Rawlinson

Aslam

Burnside

et al. 2020

Trials

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Background: Asylum seekers and refugees (AS&Rs) experience impaired mental health and wellbeing, related to stresses in their country of origin, experiences in transit and reception on arrival, including significant barriers to accessing mainstream services. Their contact with health care is often crisis-driven and mediated through nongovernmental organisations (NGOs). Problem Management Plus (PM+) is a psychosocial intervention recommended by the World Health Organisation to address distress experienced by adults affected by humanitarian crises. We are investigating its application for the first time in a high-income country. Methods: In a pilot randomised controlled trial (RCT), PM+ will be delivered to AS&Rs in contact with NGOs in Liverpool City Region, UK by lay therapists who have lived experience of forced migration. Following systematic review and stakeholder engagement, PM+ has been adapted to the local context, and lay therapists have been trained in its delivery. We will assess the feasibility of conducting a three-arm RCT of five 90-min sessions of PM+, delivered individually or in groups by lay therapists to AS&Rs experiencing emotional distress and functional impairment, compared with each other and with usual support offered by local NGOs. Distress and impairment at baseline will be measured by the Hospital Anxiety and Depression Scale (HADS) and the WHO Disability Assessment Schedule (WHO-DAS). We aim to recruit 105 participants, 35 per arm. Primary health outcomes are anxiety and depressive symptoms at 3 months, measured by HADS. Secondary outcomes include subjective wellbeing, functional status, progress on identified problems, presence of posttraumatic stress disorder and depressive disorder and service usage. Longer-term impact will be assessed at 6 months post baseline, on the same parameters.

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Access to primary health care for asylum seekers and refugees: a qualitative study of service user experiences in the UK

Cited by 118 publications

References 29 publications

Consternation and complexity: learning from people who seek asylum

Consternation and complexity: learning from people who seek asylum

The Right of Access to Health Care for Migrants in the Republic of North Macedonia - Barriers and Challenges

Lay-therapist-delivered, low-intensity, psychosocial intervention for refugees and asylum seekers (PROSPER): protocol for a pilot randomised controlled trial

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