To Build a Bridge

Training for Health Professionals and Law Enforcement Officers

Summary Report on the MIPEX Health Strand and Country Reports

Border Management and Detention Procedures: Health Perspective

guidelines

Guidelines

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Migration Health: Better Health for All in Europe

AMAC

Assisting Migrants and Communities

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Improving HIV data comparability

HIV1 

HIV-related data on migrant and ethnic minority populations in EU/EEA/EFTA

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Mobility of Health Professionals

MHD RO Brussels Publications

Implementation of the National Roma Integration Strategy (NRIS) and Other National Commitments in the Field of Health – BELGIUM

Full Report available here

liegehospital2Despite of the adoption of the National Roma Integration Strategy (NRIS) in 2012 and the continuously efforts made in adapting the Belgian healthcare system to the changing socioeconomic realities and needs faced by vulnerable groups such as undocumented migrants, concrete policy developments on the inclusion of Roma remain a major challenge, particularly in adapting health services to an increasing diversity of patients. However, as part of the NRIS, intercultural mediation programs appears to be the most relevant and effective approach for Roma communities regarding access to healthcare services. Nevertheless, further efforts in supporting policy developments on Roma health are needed, including better data collection and improvements in the overall communication.

The Progress Report, part of the EQUI-HEALTH project – Roma health sub-action, presents the results of the assessments on the relevant developments made in respect to Roma health in Belgium.

Based on desk research, fieldwork and interviews with different stakeholders, including professionals working with Roma, health providers, and civil society organizations, the report provides an analysis on the implementation of the Belgian NRIS and other national commitments in the field of healthcare.

As a result of a general governmental and administrative decentralization in Belgium, policy responses are different from one region to another. Although the NRIS in Belgium seems to be coherent and that significant efforts have been made in the field of Roma integration, the political commitment focus Roma healthcare, particularly at regional and local level remains weak and diverse, lacking concrete objectives and evaluating mechanisms concerning Roma integration and access to healthcare. Consequently, the Belgian health system remains difficult to orientate within its complex procedures and administrative requirements and could pose difficulties to medical aid seeking migrants.

 

“… As we are not registered at the municipality, we have received medical coverage thanks to the ‘urgent medical care’ (AMU)… We couldn’t register at the municipality because we did not have all necessary documents… Once we have got all the required documents, we registered at the municipality and received an ‘Appendix 19’. From that moment on, we have lost our healthcare coverage. Finally we did not receive a resident permit because we could not prove sufficient financial resources. However, we could ask again for the AMU and restart the whole procedure.” (Roma migrant from Slovakia)

 

Furthermore, evidence demonstrates that there is no comprehensive available data on the health of the Roma population and/or their problems related to the healthcare system at the national level. In addition, the only calculations available are of non-governmental origin and data collection differs between regions in Belgium, thus influencing the policy making at federal level.

In terms of intercultural mediation in healthcare, programs have been developed to address intercultural difficulties and to overcome barriers, such as language and socio-cultural differences, which negatively impact on the access and quality of healthcare of the Roma community. For this reason, mediation programs have been launched aiming to minimize language barriers and unequal quality and access to healthcare.

 

“Our mission is far more than a simple interpretation. The more experienced we are, the more we know how to adapt our interventions, so it can be more useful and efficient.” (HM)


“At the intercultural mediation unit, we are often in charge of making appointments, patients are used to calling us and we schedule the appointment with the doctor afterwards. It is much easier for everybody this way.” (HM)


Although intercultural mediation appears to be an effective means of improving the quality and access to healthcare services of the Roma community, intercultural mediators face obstacles in their work due to lack of cooperation from healthcare providers and/or lack of recognition of their work, caused by unawareness of their profession.

In this context, the NRIS, which appears to be the only policy commitment at the national level that specifically addresses Roma, requires adaptations and more quantifiable objectives and monitoring mechanisms. In this line, the European Commission1 recommends that Belgium should further clarify goals and develop an action plan with detailed measures.

On the other hand, the lack of data on various vulnerable groups living in Belgium, due to strict interpretation of the EU Data Protection Directive2 in Belgium, undermines the development of efficient programmes addressing inequalities and the monitoring of existing barriers to access healthcare services. Moreover, while the European Commission against Racism and Intolerance (ECRI) 2014 report on Belgium3 suggests considering collecting data broken down into categories, unlike the Wallonia region, the Flemish Government attempts to legislate on encouraging sensitive data collection. Therefore, the assessment highlights the apparently necessity to further develop data collection on Roma health and other vulnerable groups, particularly at national level.

Regarding access to healthcare services, the complexity of procedures and the existing administrative barriers of the Belgian health system hinder the access to health services for the Roma community as well as for EU citizens without residence permit, which depends on their length of stay in the country. Consequently, this report also concludes that it is necessary to minimize situations without healthcare coverage and to make the complaint filing process more accessible.

Finally, as intercultural mediation programs appear to be an effective approach for the Roma community in facilitating access to healthcare, further efforts should be made in implementing these programs as well as developing a proactive approach towards the recognition of intercultural mediators.

biser1

The Progress Report was produced under IOM MHD, RO Brussels guidance by Maria Krislova, and benefitted from pre-reviews and editing by Mariya Samuilova.


1EC Communication “National Roma Integration Strategies: A First Step in the Implementation of the EU Framework” (May 2012); EC, Steps forward in implementing national Roma integration strategies (2013) EC, Proposal for a Council recommendation on effective Roma integration measures in Member States (2013)

2Directive 95/46/EC of the European Parliament and the Council of 24 October 1995 on the protection of individuals with regard to the processing of personal data and on free movement of such data.

3ECRI report on Belgium, fifth monitoring cycle, adopted on 4 December 2013, recommendation n18