Applying a community-based participatory research approach to improve access to healthcare for Eritrean asylum-seekers in Israel: a pilot study

Abstract

BackgroundIsrael hosts approximately 50,000 asylum seekers, most of them from Eritrea. Exclusive policies restrict their access to healthcare. In 2013, local activists partnered with Eritrean asylum seekers to assess health needs as well as willingness to pay for health insurance among the Eritrean communities. This initiative was meant as a step towards jointly advocating access to Israel’s public healthcare system and towards strengthening collective efficacy among the asylum-seeking communities, as well as a first attempt to apply a community-based participatory research (CBPR) approach to migrant health research in Israel.MethodsApplying a CBPR approach, a 22-item survey was developed by a team of activists, academics and community members. It was administered by community members in four different cities. Cell weighting was applied to align sample estimates with the population distribution. The results were analyzed by means of a Generalized Linear Model. Six follow-up interviews and two focus group discussions helped interpret the quantitative findings and provided additional information.ResultsThe results from 445 questionnaires show that most (95%) asylum seekers are interested in purchasing health insurance. To this end, more than half of the respondents are willing to invest up to 300 NIS monthly, which represents a significant part (5–7.5%) of their median monthly income. Willingness to pay for health coverage was independent from employment and income; it was significantly associated with city of residence – which translates into current healthcare options - understanding of health insurance, and health seeking motives. The study further highlights the role of labor policies in shaping not only asylum seekers’ access to care but also psychosocial wellbeing.ConclusionsThe study provides initial evidence for asylum seekers’ willingness to pay monthly contributions into a public health insurance scheme, in spite of economic hardship, and it points to understanding of and trust in the healthcare system as a central factor influencing willingness to pay. The outcomes of this initiative further offer some support for the potential of CBPR to enhance research into the health of marginalized populations and, moreover, to counter their social exclusion through capacity building and strengthening of collective efficacy.Electronic supplementary materialThe online version of this article (10.1186/s13584-017-0185-9) contains supplementary material, which is available to authorized users.

Healthcare providers’ images of refugees and their use of health services: an exploratory study

“…Several studies show that refugees do make use of healthcare services in host countries, although their usage is characterized as "limited" (Carolan, 2010), "underutilized" (Choi et al, 2015), "restricted" (Gottlieb et al, 2017;Langlois et al, 2016) or "low" (Correa-Velez and Ryan, 2012), especially compared to citizens' use of these services in the host country. Studies that analyze the underlying mechanisms of such user rates tend to focus on visible, measurable factors, such as availability (e.g.…”

“…In theory, the abovementioned services are available to all in Israel, citizens and refugees alike. However, in practice, not all Eritrean refugees have health coverage, although exact numbers are unknown (Gottlieb et al, 2017). For uninsured migrants, the Terem Clinic, run by the Israeli Medical Association with help from the Ministry of Health, offers basic pregnancy services.…”

What is required for community-based participatory research to be effective? Studying asylum-seekers’ access to healthcare

“…In an article recently published in the IJHPR, Gottlieb et al [ 4 ] reported the results of the first attempt to apply a community-based participatory research (CBPR) approach to migrant health research in Israel [ 4 ]. That pilot study was conducted among Eritrean asylum seekers in four Israeli cities.…”

Eritrean Refugees’ Utilization of Antenatal Services in Israel

“…Meta‐reviews have concluded that such utilization is “limited” and “late” (Carolan, : 411), “low” (Correa‐Velez and Ryan, : 14) and “less” and “later” than user rates of host country citizens (e.g., Munro et al., : 283). Numerous case studies also point to refugees’ problematic or low utilization of health services (e.g., Asgary and Segar, ; Correa‐Velez and Ryan, ; Michaan et al., ; Choi et al., ; Langlois et al., ; Gottlieb et al., ), although a few studies argue that there is “no evidence of under‐use” (Kiss et al., : 57), that access for refugees is “relatively good” (El Arab and Sagbakken, ), and that refugees’ demands for health services are “largely met” (Borgschulte et al., : 6). The findings of both positive and negative health service utilization in host countries begs the question of how such use is conceptualized and operationalized, as well as how it is contextualized, that is, what country‐specific legislation relates to refugees and their entitlement to health services in the host country.…”

“…At the same time, Gottlieb et al. () contend that Eritrean refugees in Israel are willing to obtain health insurance and place great value on health services, suggesting that their general lack of health insurance in Israel is the result of structural constraints rather than personal preference. Taken as a whole, these studies suggest that Israel is a problematic context for refugee health service utilization in terms of both legislation and practice.…”