Migrant-friendly hospitals: a paediatric perspective - improving hospital care for migrant children

Abstract

BackgroundThe European Union (EU) Migrant-Friendly Hospital (MFH) Initiative, introduced in 2002, promotes the adoption of care approaches adapted to meet the service needs of migrants. However, for paediatric hospitals, no specific recommendations have been offered for MFH care for children. Using the Swiss MFH project as a case study, this paper aims to identify hospital-based care needs of paediatric migrants (PMs) and good service approaches.MethodsSemi-structured interviews were conducted with principal project leaders of five paediatric hospitals participating in the Swiss MFH project. A review of the international literature on non-clinical hospital service needs and service responses of paediatric MFHs was conducted.ResultsPaediatric care can be complex, usually involving both the patient and the patient’s family. Key challenges include differing levels of acculturation between parents and children; language barriers; cultural differences between patient and provider; and time constraints. Current service and infrastructural responses include interpretation services for PMs and parents, translated information material, and special adaptations to ensure privacy, e.g., during breastfeeding. Clear standards for paediatric migrant-friendly hospitals (P-MFH) are lacking.ConclusionsInternational research on hospital care for migrant children is scarce. The needs of paediatric migrants and their families may differ from guidance for adults. Paediatric migrant needs should be systematically identified and used to inform paediatric hospital care approaches. Hospital processes from admission to discharge should be revised to ensure implementation of migrant-sensitive approaches suitable for children. Staff should receive adequate support, such as training, easily available interpreters and sufficient consultation time, to be able to provide migrant-friendly paediatric services. The involvement of migrant groups may be helpful. Improving the quality of care for PMs at both policy and service levels is an investment in the future that will benefit native and migrant families.

Brechas de desigualdad en salud en niños migrantes versus locales en Chile

“…Recientemente se ha reconocido que la condición migratoria puede ser un indicador de vulnerabilidad social o de desigualdad social en salud al interior de un país 1-4,9,10 y que variables migratorias específicas, posibles de modificar o prevenir, pueden ser determinantes en este proceso 8 . Los principales factores que afectan a la salud de los migrantes internacionales son condiciones laborales, barreras culturales, acceso y uso a servicios de salud, condiciones previas en el país de origen, tiempo de residencia en el país de destino (asociados a fenómenos de asimilación y aculturación), procesos sociales de integración/exclusión y experiencias de estigma y discriminación 11,12,13 . El último reporte de niñez de las Naciones Unidas del 2016 (Estado Mundial de la Infancia 2016: una oportunidad para cada niño) entrega información crí-tica acerca de la importancia de nacer y crecer en un espacio familiar, comunitario y socio-cultural estable, seguro y que ofrece oportunidades de crecimiento sano y permanente 3 .…”

ISSOP position statement on migrant child health

“…In order to provide appropriate and effective care, health systems must bridge language and cultural barriers and ensure that health workers are skilled in providing culturally competent, trauma‐informed care. Awareness and knowledge of the different needs of all involved, from the individual to the institutional level, on common challenges, such as linguistic and intercultural differences or financial constraints, may help form health services that are not only effective from a paediatric perspective but are also migrant friendly (Jaeger, Kiss, Hossain, & Zimmerman, ).…”

“…Examination of existing health services with the help of migrant children and families' perspectives can help to set criteria and standards for “migrant‐friendly care” that improves both the quality of care they receive as well as their experience of this care (Jaeger et al, ). Health systems should engage with migrant populations and incorporate their feedback for how to improve the health system more responsive to their needs.…”

“…Health systems should engage with migrant populations and incorporate their feedback for how to improve the health system more responsive to their needs. Migrant children and families may express specific needs such as a welcoming and child‐friendly environment, creation of safe spaces, assistance with communication, confidentiality, and attention to religious needs such as the provision of a space for prayer or for food that respects religious practices (Berlin, ; Jaeger et al, ). They may also express a need for privacy, for example, when breast feeding or when having to undress for examination (Jaeger et al, ).…”

“…Migrant children and families may express specific needs such as a welcoming and child‐friendly environment, creation of safe spaces, assistance with communication, confidentiality, and attention to religious needs such as the provision of a space for prayer or for food that respects religious practices (Berlin, ; Jaeger et al, ). They may also express a need for privacy, for example, when breast feeding or when having to undress for examination (Jaeger et al, ). Adapted signposts (e.g., pictograms and colour codes) may be helpful in paediatric hospitals (Jaeger et al, ), as well as translated health information materials, adequate time allocated for interpreters, and including the entire family when providing health information or education (Jaeger et al, ; Saladin, ).…”