Role of NGOs & CSOs in healthcare for migrants & ethnic minorities: Health Services in Denmark:...

Role of NGOs & CSOs in healthcare for migrants & ethnic minorities: Health Services in Denmark: Co-operation between different sectors?

Rashmi Singla

Cand.Psych., M.Sc., Ph.D.,Specialist in Psychotherapy

Associate Professor

Department of Psychology & Educational Research

Roskilde University , Denmark

Agenda

IntroductionMajor aspects incl. ethical underpinningsDanish Red Cross: Asylum SeekersT.T.T.: Minority Youth ChallengesConclusion

Rashmi Singla, Intervention & Good Practices, Spring 2009

Introduction

“ Whatever structural, social and cultural factors lie upstream in the sequence of causes and health determinants, at some point downstream there are psychological and biological processes at work, linking the macro contextual determinants (such as the political context, immigration policies) with the micro-worlds of intervention experience (trauma, mental illness)”

- Singla, 2004

NGOs and CSOs mediate between these levels.. Meso level - comment in COST policy meeting, Malmö, Sweden, November 2007


Introduction

Dealing with the health & health promotion issues

Focus on two NGOs with different structures & target groups:

Danish Red Cross: Asylum seekers

T.T.T. (Transcultural Therapeutic Team) Ethnically diverse youth, especially those experiencing psychosocial problems


Introduction

Status quo versus social change ? Culture (as meaning) centered approach, Dutta, 2008


Introduction

Danish Welfare State can be characterised as ‘universal’, providing high quality social care and benefits to all members of the society - creche to grave services

Welfare state has taken over many of the tasks of independent care providers yet occlusions in the regime of governmentality


Major Aspects including ethical underpinnings

Understanding the social exclusions in the broad welfare state context

Empowerment by highlighting the connection between

the individual / micro and collective / macro levels, thus transcending the individualisation of powerlessness

(Andersen & Larsen,

1998)



Empowerment defined as processes through which

- People attain greater control and participate in decisions affecting their lives

- Social groups improve their ability to create, master and deal with material, social, cultural and symbolic resoources (Andersen & Larsen, 1998)


Factors important in the service provision aimed at promoting the health of vulnerable groups:

Access and promotion of the services among the target groups User involvement- recommended by international bodies Continuity of care Multi-agency coordination Cultural sensitivity Advocacy Monitoring and evaluation

(Watters and Ingleby, 2004)




Other salient aspects Interventional focus at the different categories of exclusion:

ageism, sexism as well as racism Simultaneous perception on the user/patient as a unique

person in spite of the anthropological and social psychological knowledge about the group, through asking questions

Ethnocentrism and power asymmetry to be countered by focus on the professional’s ethical standards (Singla, 2007)



“Top down” approach in Holland

Systematic, stratified and hierarchically organised

negative features - not much variation “Bottom up” approach in the UK

Grassroots oriented

Negative features: chaotic and problems in organising programmes for dispersed groups

Danish situation - A combination?


Red Cross: Asylum Seekers

On request from the state, based on seven principles of

humanity, impartiality, neutrality, independence, voluntary action, unity and universality



Medical reception of asylum seekers- Danish Red Cross offers voluntary physical and mental

screening of all newly arrived asylum seekers, high

acceptance rate Asylums department manages the centres, the asylum

seekers, teaching, activating and health

- responsible for the asylum seekers healthcare in cooperation with the Danish Immigration Service, having drawn its own set of instructions, outlining asylum seekers’ medical rights.



Asylum seekers do not have the same legal rights to medical care as Danish citizens in case of non-acute sickness. However, they also have access to non-acute treatment by applying to the Red Cross

Practically they have limited access.

Barriers - gap between ideals and practice



CSOs have been critical about Red Cross´s role in managing these rules rather restrictively

Commitment to prevent and alleviate human suffering?

Acceptance of detrimental conditions?

Neutrality?


TTT: Ethnic Minority Youth

Psychosocial service for minority youth and their families in Copenhagen, since 1991

- Grass root NGO by a group of psychologists with ethnically diverse backgrounds but academically with similar background, based on the three principles

Focus on Multiple Identity Inclusion of Family and Network Inclusion of the Broad Social Context



Ideally all services should be accessible to and appropriate for all ethnic groups but in the climate where issues of race and culture are inadequately addressed, it is inevitable that services geared for specific ethnic groups must exist side by side with more generic services

(Fernando, 1995)

TTT´s evaluation underlined the significance of understanding, sympathetic communication, ‘process of being listened to’, also negative experiences of exclusion



Barriers related to optimal use, limited resources, continued existence, collaboration with the state and mainstream organisations


Challenges

“ (…) it is not enough to simply provide people with a telephone number: they need to know what is on the other end of the line”

Ingelby, 2007


Challenges

”A person may cause evil to others, not only by his actions but by his inaction, and in either case he is justly accountable to them for the injury”

John Stuart Mill

NGOs ethical responsiblity: Millenium Development Goals for 2015… key targets in health

provision likely (non-) achievemnts

NGOs should focus on the hindrances and realistic solutions

(Erica Burman, 2009)


Good Practices Simultaneous focus at the different levels- Micro and macro- Personal, interpersonal and structural- Understanding and social change categorising of applying culture in

the context of health

Empowerment and user involvement in different phases with dialogues and generating an understanding of health meanings,

transforming the structures constraining the health experiences

Conclusion


Conclusion

Changes at European and National levels:Rapid increase in attention on the topic

Recommendation by Ministers of Council of Europe: Health care in a multicultural society

Migrant health, important element of health programme

(EU Lisbon conference, September, 2007)

In Denmark, several projects about ethic minority health at different levels:

(www.sehat.dk and www.sundhed.dk etc.)


Role of NGOs & CSOs in healthcare for migrants & ethnic minorities: Health Services in Denmark:...

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