Table Of Content. European network to reduce vulnerabilities in health... 2 Summary... 3 Work Package... 10

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1 Table Of Content European network to reduce vulnerabilities in health... 2 Summary... 3 Work Package Network building activities Mutual learning & sharing of expertise Data collection activities Dissemination and civil dialogue activities Coordinator, Leader contact and partners Outputs Bi-monthly newsletter Network Business Plan Membership criteria Visual identity Amsterdam kick-off meeting minutes Vulnerability position paper New MoU proposals and needs assessments Accountancy guidelines for Members Accountancy codes Yearly financial report Contractual narrative report Written external evaluation report New SGA proposal Teleconference minutes Amsterdam survey report Satisfaction survey report ToR advocacy trainer Advocacy training minutes Written data collection guidelines Paris survey report Quantitative data WS meeting minutes Follow-up webinar Raw data Translated questionnaires Testimonies, case studies, photos Exhaustive data analysis report Annual Flagship report in FR, EN, ES Press kit in 8 languages Media release output report ToR legal country reports written country reports national leaflets Progress report to Members Needs assessment reports Written dissemination plan Printed Flagship report Page 1/20

2 European network to reduce vulnerabilities in health JA GPSD [705038] START DATE: 01/01/2015 END DATE: 31/12/2015 DURATION: 12 month(s) CURRENT STATUS: Finalised PROGRAMME TITLE: 3rd Health Programme ( ) PROGRAMME PRIORITY: - CALL: Specific Grant Agreements for 2015 under the Framework Partnership Agreement for Operating Grants TOPIC: Financial contribution to the functioning of non-governmental body (Specific Grant Agreement 2015) EC CONTRIBUTION: EUR KEYWORDS: Health Inequalities, Invisible Population Groups, Resilient Health Systems, Vulnerabilities PORTFOLIO: Ethnic minorities, Migration, Social determinants and health Page 2/20

3 inequalities SUMMARY Project abstract The proposal creates a new, open European network to reduce vulnerabilities in health, bringing together NGOs and academic partners from 17 EU Member States and 2 EFTA/EEA countries. Our goal is to contribute to decreased EUwide health inequalities and to more responsive health systems that are better equipped to deal with vulnerability factors that increase health inequalities.the economic crisis has demonstrated that everyone could be vulnerable at a given moment in their life. Many members of vulnerable groups such as (undocumented) migrants or asylum seekers, sex workers, drug users, Roma, the homeless etc. are actually quite resilient. Consequently, the concept of 'vulnerability' is more useful, inclusive and more precise than the term vulnerable groups. In order for health systems in Europe to be sustainable and resilient, they need to be able to cover the whole population without any gaps and effectively deal with multiple vulnerabilities.the founding members of the Network seek to gain greater capacity and skills through mutual learning about how to improve health service delivery, patient empowerment, common data collection and advocacy. As a result, people facing multiple vulnerabilities will get access to higher quality care in the health programmes run by Network members and the skills and knowledge they need to get easier access to good quality care in mainstream healthcare systems. The Network will undertake a common data collection process to generate robust data, analysed and validated by a leading epidemiologist. This data will be valuable for academics to review and acquire greater understanding about how vulnerabilities contribute to health inequalities. It will also be a new resource for local, regional, national and EU health authorities, enlarging the evidence base on reducing vulnerabilities in health and identifying ways that health systems could become more responsive and adapted. Summary of context, overal objectives,strategic, relevance and contribution of the action While the economic crisis and austerity measures have resulted in an overall increase in unmet health needs in most countries, the most destituteincluding an increasing number of EU nationals-have been hit the hardest. Austerity policies have left almost a third of the population without healthcare coverage (OECD 2014). People experiencing numerous vulnerability factors were already facing major health inequalities before the crisis hit Europe, and continue being easily overlooked in health policy debates. 62, 9 % of the people seen by in Europe in 2014 had no health coverage. More than half of the pregnant women had not had access to antenatal care before they came to (54,2%). And yet less than half of the children seen in consultations were properly immunised against tetanus (42.5%) or measles, mumps and rubella (34.5%) although these vaccinations are known to be essential throughout the world and the vaccination coverage for measles at Page 3/20

4 the age of two years is around 90% in the general population in Europe. In order for health systems in Europe to be sustainable and resilient (overall objective), they need to be able to cover the whole population without any gaps and effectively deal with multiple vulnerabilities. Thanks to the support of CHAFEA, the 23 European Network members (19 in 2015 and 23 in 2016) seek to gain greater capacity and skills through mutual learning about how to improve health service delivery, patient empowerment, common data collection and advocacy (objective 1). As a result, people facing multiple vulnerabilities will get access to higher quality care in the health programmes run by Network members. In addition, they will get the knowledge they need to get easier access to good quality care in mainstream healthcare systems (objective 2). The Network undertakes on a yearly basis a common data collection process to generate robust data, analysed and validated by a leading epidemiologist (objective 3). This data are valuable for academics to acquire greater understanding about how vulnerabilities contribute to health inequalities. It is also used as an evidence based advocacy tool to influence policy makers in further supporting health protection for all (objective 4). The project activities primarily contribute to specific and operational objective 3 of the EU Third Health Programme (innovative, efficient and sustainable health systems) and also support specific and operational objective 4 (facilitate access to better and safer healthcare). The quantitative and qualitative data collection proposed by the network can provide a bottom up perspective on health inequalities and help build policies that will effectively tackle health inequalities. Similarly, collecting relevant data about social determinants of health can certainly contribute to reduce them. The Third Health Programme mentions mental health problems as a source of vulnerability and a significant contributor to health inequality. Improved mental health is clearly included in the Network members service delivery, data collection and awareness raising activities. Methods and means Everyone is likely to be vulnerable at a given moment in his or her life. Our theory of change is that to make vulnerability factors visible and to hold policy makers and health systems accountable for meeting their stated objectives of universality of coverage, we first need comparable quantitative and qualitative data as well as appropriate messages. When information is generated about the reasons for such obstacles, and brought to the attention of health authorities, advocacy can achieve changes in the system. Another parallel way to obtain change is to empower service users that are facing vulnerability factors, e.g. there are several examples throughout Europe where groups of sex workers, drug users or undocumented migrants have obtained access to better quality healthcare services once they knew how to successfully engage Page 4/20

5 with authorities. The members of the Network are all organisations reaching out to marginalized populations and with complex physical, mental and social problems. These teams are specialised in appropriately responding to urgent social and health needs in complex situations, but most of them lack experience in data collection, advocacy or policy making. This is why our network building activities and mutual learning are oriented towards starting or improving data collection and in how to engage in civil dialogue processes. The 3 year work plan ( ) is characterised by a cyclical rhythm Every year in February: an annual network meeting and an advocacy training. The Annual meetings cover discussions on the state and governance of the Network, evaluating progress made in several areas and discussing strategy, validating new membership applications, etc. The advocacy training is about sharing successes and failures concerning advocacy and civil dialogue activities. In addition to continuous dissemination activities, a European Observatory Report is published on a yearly basis featuring the results of the data collection, legal analysis and other information gathering. It was launched with a press conference in May 2015 in London and will be launched at a dissemination event in the European Parliament in 2016 and a high-level political event with all partners and stakeholders in Every year in October: an intensive learning moment (workshops) for Network members teams, on one of the four objectives (quality of service delivery, patient empowerment, gathering data or advocacy). Work performed during the reportingperiod 2015 was about laying the foundations of the Network whereas 2016 and 2017 are respectively about consolidating activities and enlarging the ambitions and thinking about the future of the network after 3 years of work together. The kick off meeting in Amsterdam (02/2015) was attended by about 70 participants from 19 countries, plus Canada, Japan and USA. It set the first rules of work for the enlarged network in order to collaborate for high quality common data collection and build a strong basis for a common advocacy plan. Network members have been kept up to date with a regular internal newsflash on activities/ events that occurred during the year and a bi-monthly newsletter. The network published three key reports in 2015: Page 5/20

6 A user-friendly 48 page European Observatory report in 3 languages (English, French and Spanish). The survey is based on 41,238 face-to-face medical and social consultations with 22,171 individuals in nine European countries (BE, FR, DE, EL, NL, ES, SE, CH, UK) in It is meant for a general audience and a wide variety of national and European policy makers; An epidemiological report version in English with full analysis of the data (9 European countries, Turkey and Canada). As it includes data on infectious deseases, it is meant for reasearchers and health profesionnals; A legal report on access to healthcare in 12 countries (BE, CA, FR, DE, EL, LU, NL, ES, SE, CH, TR and UK). In line with our objective 4, the Network engaged the political dialogue with key EU institutional stakeholders about vulnerabilities in health. We organized a meeting with the Health Commissioner Vytenis Andriukaitis, regular exchanges with DG HEALTH/CHAFEA, the health attachés of Permanent Representations (e.g. a meeting took place with the Dutch Perm Rep in March 2015 concerning their Presidency priorities) and MEPs and provided relevant input to parliamentary work (e.g. in April, the Network sent a report to the PACE Committee on Social Affairs, Health and Sustainable Development with a subsequent hearing about children s access to healthcare). Implementing high-quality comparable data collection is a heavy process that takes a long time. Therefore, we planned a 1,5 day workshop in October 2015 in Paris. It allowed people from 10 countries who directly collect data, to exchange on their practices and challenges and to acquire a deep understanding of the medical and social questionnaires. A video available on our blog is a useful tool to train national team when collecting data with patients. The main output achieved so far and their potential impact and use by target group (including benefits) The expansion of data collection by the end of 2015 seems to have enhanced the power with which can advocate. Five more Network members (MRCI from Ireland, Luxembourg, Health Centre for Undocumented Migrants in Norway, Carusel in Romania and Slovene Philanthropy from Slovenia) impressed about the advocacy power of data collection have joined the quantitative data collection in 2016 and This brings the total number of members collecting data to 16 European members in 2016 (including Canada and Turkey) instead of 9 members in Materials were made available to the network members: written data collection guidelines on how to use the medical and social questionnaires and testimonies guidelines were shared and disseminated to those collecting the data. The aim of the guidelines was to Page 6/20

7 make sure all salaried and volunteer staff working in first line social and medical consultations understand why specific questions are asked, and use the questionnaires appropriately. Our main activity was producing, releasing and disseminating our three newest reports (in Brussels, London, Paris, Strasbourg, at national and local level, online etc.) mentioned above. The 48 page report had a print-run of 5,000 hard copies (2,500 in English, 2,000 in French and 500 in Spanish). A 1 page infographic was also helpful in getting the key messages across to the media. Now, it is more difficult for policy makers to ignore statistics thanks to the development of a common advocacy strategy in the Network. The data collected seems therefore to have served as a tool that has allowed to achieve further outcomes and impacts. We also created opportunities for members to speak out through written contribution to European Parliament work and political decision makers and raise visibility of the issue of access to healthcare (articles written and published, media coverage). By representing the Network at conferences and stakeholder meetings, Members achieved a better understanding of European decision making processes, while bringing direct testimonies about what is going on in the field to high-level policy makers. Achieved outcomes compared to the expected outcomes The influence on EU public Health has largely come about through social and other media (e.g. newspapers), particularly following the yearly launch of the European Observatory report in May Thanks to the Network s advocacy and awareness raising activities, information from the European Observatory Report was widely picked up by the European and National media (see section dissemination). EU institutions and Members States further expressed support for health protection for all as highlighted in several events/conferences such as the European Health Forum Gastein (09/2015) and the annual EPHA conference (09/2015). The Network have seen as well growing evidence based statements in EU public health and healthcare policy as illustrated in the EU Fundamental Rights Agency study Cost of exclusion from healthcare The case of migrants in an irregular situation. The network collaborated with many academics in The Centre for Health and Migration (C-HM) in Austria and Belgium worked on a thematic study on cost-analysis of health care provided to migrants and ethnic minorities. The Network was visible at several high level academic meetings, gave lectures at medical faculties and at the Italian Congress Page 7/20

8 of Paediatrics, and was consulted for specific EC funded research projects (PISCE). The long version of the network s report was published on Research Gate and was disseminated among more than 145 academics with a track record of interest in vulnerabilities in health. UK coauthored an article in Int. J. Health Service. Our data were cited in a BMJ article ( Restricting access to the NHS for undocumented migrants is bad policy at high cost ). A full article Obstacles to access to care for migrants, children and pregnant women in Europe was published in the WHO PHAME newsletter. The results of the Network s data collection and legal analysis was presented at the 2015 French Public Health Society (SFSP) and European Public Health Association (EUPHA) annual conferences. The importance of working with healthcare professionals, and empowering them to treat undocumented migrants, received particular attention in 2015 and was one of the main discussion points at the meeting in Amsterdam (which kicked-off the new DG SANCO-funded project). has developed special leaflets for healthcare professionals which have been distributed at events and conferences. Dissemination and evaluation activitiescarried out so far and their major results The following materials were disseminated according to a dissemination plan provided by each Network members: The 48 page European Observatory report The epidemiological Observatory report the Legal report on access to healthcare in 12 countries Production of 4 nationally / locally adapted leaflets targeting health professionals The bi-monthly newsletter and internal updates on the migrants reception crisis The Newsflash (internal update) The mapping of European stakeholders that preceded the release of the 2015 European Observatory report has been turned into a segmented mailing list, with relevant European civil society contacts (about 400), academics (145), Health Attachés, EC staff (about 40) and about 170 of the most relevant MEPs (i.e. health professionals, or members of ENVI, LIBE, EMPL or FEMM committees). This year, we have also asked all our members to establish national dissemination plans. In presence of the MEP Jean Lambert and the President of the Royal College of Midwives, the launch of the European observatory report received quite substantial media attention during the press conference in London (May Page 8/20

9 2015). Moderated by Fiona Godlee, Editor in Chief of the prestigious British Medical Journal, the event was attended by at least 12 journalists (BBC, AFP, Spanish National Radio, Onda Cero Radio and Telecino (Spain), British Journal of Midwifery, Nursing Times, etc.) and generated 128 articles across Europe. Major media outlets such as The Guardian and The Independent in the UK, De Standaard in Belgium, the NOS in the Netherlands published article and interviews on the subject. Page 9/20

10 Work package Work Package 1: Network building activities Start month: 1 End month: 12 Work Package Leader: For the network members, year 1 will be about laying the foundations of the network by discovering our 'diversity within unity': -Getting to know in more detail about each other s specific objectives, activities, and expertise; -More in-depth sharing about everyone s expectations about what this Network will be able to deliver. Face-to-face meetings are a valuable opportunity to assess learning needs, the strengths of individual members of the network, and their capacities. -One of the aims of the meeting already planned for February 2015, will be to develop a common understanding of vulnerabilities and how that relates to health, resulting in a statement of values and principles of the Network that will be used for future work (making sure everyone s experience contributes to a common position statement about vulnerabilities and what that means for individual health and how health systems can respond). -Discussing and validating the draft network business plan and strategy; -Exploring membership criteria and outreach strategies to enlarge the network. Advocacy is an essential element in the work of the members of the network, because it is how they achieve social change. Therefore, we ve built into the cyclical rhythm of the three-year working programme an advocacy skill building training event linked to the annual business meeting. In 2015, this will be about sharing Tops & Flops : we are currently developing a format that will allow each participant to share in a safe way their successes and failures in order to learn from each other, and how to successfully undertake advocacy actions with high level stakeholders involved. Many of these organisations work in challenging environments and face hostility and prejudiced attitudes concerning the groups they serve. Therefore, the advocacy skill building will include mutual learning with an experienced trainer on how to develop and pass messages in these types of contexts. In addition to the Network kick-off meeting and advocacy skill-building training next February, regular teleconferences, frequent contacts with the Network Secretariat, and the data collection learning workshop will also contribute to building a Network with strong ties. Work Package 2: Mutual learning & sharing of expertise Page 10/20

11 Start month: 1 End month: 12 Work Package Leader: Year 1 will be about kick-starting the Network and learning how to collect quantitative data. Specific learning activities on how to raise the quality of service and how to improve patient empowerment are only planned for However, in our experience, bringing together people who provide frontline services always leads to intensive exchange about service delivery issues. The programme is designed to facilitate formal and informal sharing, and we will seek to capture some of these exchanges to prepare for the 2016 focus on improving quality. Furthermore, implementing the data collection can also be a mechanism to systematically improve the quality of service delivery. Work Package 3: Data collection activities Start month: 1 End month: 12 Work Package Leader: One objective for 2015 will be to sensitize academics about gaps that exist, getting academic review and endorsement of the concept of vulnerability in health (changing the language from vulnerable groups to vulnerabilities) through a position paper and the Network s first flagship publication. The latter will be based on the data already collected in the course of 2014 by its more experienced members. The process will allow for a transfer of knowledge and capacity to the newer members of the Network on the process of data collection, how it is analysed and how the data can be used for advocacy. Based on the analysis and interpretation of the data collected, a user-friendly 48 page flagship publication will be issued in at least 3 languages (English, French and Spanish). A second, complete version with full lists of raw data, reasons for inclusion / exclusion of various data points, detailed interpretation, missing values and methodological challenges will be drafted in English. A different dissemination strategy is foreseen for both documents: the first is rather for policy makers (SO4), the second for academics (SO3) will also be about achieving appreciation and understanding about what we mean by quality data and why it should be comparable across countries. The Secretariat will document the lessons learned concerning data collection, disseminating it through members in advance of the training workshop given by the social epidemiologist, data collection manager and programme leader. At the end of year 1, at least 11 Network members should be ready to participate in the common data collection. Eight experienced Network members will also conduct a legal review (in theory and practice) about access to healthcare. The Secretariat will explore the existing skill sets in communication by inviting members to prepare materials such as case studies, patient testimonies or articles and photos for the newsletters or website. Page 11/20

12 Work Package 4: Dissemination and civil dialogue activities Start month: 1 End month: 12 Work Package Leader: During 2015, the European Advocacy Coordinator will develop more expertise on the European policy cycle, with detailed knowledge of timeframes for decisions, opportunities for input, more detailed knowledge of the competencies of different EU institutions and ways to have the greatest impact for advocacy at EU level. One of the roles of the Network will be to create fast and direct channels to high level policy making (e.g. warn policy makers about the ongoing impact of the crisis in terms of vulnerability factors in health). The EAC will also coordinate the shared mapping of external constituencies such as academics and policy makers, some of whom we seek to integrate in the Network in subsequent years. The Network will facilitate participation by small front-line organisations in EU policy discussions. This role will expand as the size of the data set and the number of members collecting data grows. But participation of network members in EU civil dialogue processes based on their direct frontline experience can already start early on in As already does for all its EU advocacy work and high-level meetings, the EAC will facilitate volunteers with concrete experience in the field that is being debated to be the spokesperson. This will bring authentic voices to the policy debate and will, at the same time, represent an opportunity for national members to learn more about the EU policy context. Year 1 will be about making the existence of the Network known among EU-level stakeholders through the development of the communication tools already listed in the FPA: the website, the bi-monthly newsletter, a leaflet, a recognisable logo for all communication materials, dissemination of the position paper mentioned earlier, etc. Page 12/20

13 COORDINATOR, LEADER CONTACT AND PARTNERS COORDINATOR ASSOCIATION MEDECINS DU MONDE () 75 rue Botanique 1210 Brussels Belgium WEBSITE: PARTNERS No partners related to the current project Page 13/20

14 OUTPUTS Bi-monthly newsletter Events calendar, Member publications, EU news related to vulnerabilities Network Business Plan draft to be validated at the Feb 2015 Network kick-off meeting Membership criteria to be validated at the Feb 2014 Network kick-off business meeting Visual identity Logo, website, communication template, presentation leaflet of the Network Amsterdam kick-off meeting minutes Comments on business plan, membership criteria, visual ID & position paper Vulnerability position paper Page 14/20

15 Common understanding, values, principles, good practices, why 'vulnerabilities' instead of 'vulnerable groups' New MoU proposals and needs assessments To be submitted at the Feb 2016 Network business meeting Accountancy guidelines for Members with clear financial rules Accountancy codes Linked to the development of accountancy follow-up tools Yearly financial report validated by an independent financial auditor & by Members in February 2016 Contractual narrative report Validated by Members in February 2016 Written external evaluation report Page 15/20

16 By an independent external evaluator. New SGA proposal Taking into accout Secretariat and Members' feedback Teleconference minutes disseminated among Members and archived on Network website member space - ongoing activity (bi-monthly members' teleconference) Amsterdam survey report Needs and expectations about advocacy skill-building training Satisfaction survey report After training: results will feed into preparation of other trainings and workshops. ToR advocacy trainer Using the outcome of the survey results Page 16/20

17 Advocacy training minutes Disseminated among Members and available on the Network website Written data collection guidelines Methodological help to implement and use data collection. Paris survey report Needs and expectations about the quantitative data collection workshop Quantitative data WS meeting minutes Disseminated among Members and available on the Network website. Follow-up webinar Will remain online to ensure dissemination among members. Raw data working basis for social epidemiologist and data collection manager Page 17/20

18 Translated questionnaires questionnaires and software need to be appropriately translated into local language in order to guarantee cross-country validity and reliability Testimonies, case studies, photos High quality ensured with the support of the Secretariat Exhaustive data analysis report In English only. Detailed interpretation, missing values and methodological challenges described. Annual Flagship report in FR, EN, ES In French, English and Spanish. More user-friendly version than the exhaustive (120p) data analysis report, giving only the highlights. Reports availabe in PDF and hard copies: 2000 in English, 1500 in French, 500 in Spanish. Press kit in 8 languages Summary of the Flagship publication Media release output report Page 18/20

19 # of radio and TV articles, printed and online press publications per country ToR legal country reports Quality requirements literature review, jurisprudence, and interviews with stakeholders 8 written country reports Including a dissemination plan. 8 national leaflets National leaflets for healthcare providers, in the countries where a legal analysis of access to healthcare was conducted. Leaflets will contain a summary of the legal report and good practices. Progress report to Members Representation activities, future opportunities, etc. Needs assessment reports Network Members' needs assessment in terms of service delivery, patient empowerment, data collection and civil dialogue processes. Page 19/20

20 Powered by TCPDF ( Written dissemination plan Explicit, written dissemination plan that will be delivered before the publication of the 2015 Flagship report - will contain an update of stakeholder mapping and on our specific dissemination strategies. Printed Flagship report Report available in PDF and hard copies copies in English, 1500 in French, 500 in Spanish Page 20/20