Health Managers urged to support refugee and migrant access to healthcare

Professor Anne MacFarlane

Health Managers were urged to support and champion adaptions to the Irish health services to improve refugees’ and migrants’ access to healthcare, by Prof Anne MacFarlane PhD, Chair of Primary Healthcare Research in the School of Medicine, University of Limerick* when she addressed  a HMI West/North West  Regional seminar.  Maureen Browne reports.

“Managers across the HSE are such an important group in this area. Actions are needed as individuals, within the HSE and across sectors, to learn from each other about the best ways to make our health services accessible to refugees and migrants living in Ireland.   You can take areas of good practice and mainstream them,” she said.

“Where migrant health is concerned, Health Managers are needed to make senior level decisions, working operationally and strategically.  Your commitments and actions are very important.”

Prof. MacFarlane is also Director of the Public and Patient Involvement Research Unit, which is a World Health Organisation Collaborating Centre for Refugee and Migrant Involvement in Health Research.

The webinar on “Access to Healthcare in Ireland for Refugees and Migrants” looked at evidence about challenges and solutions for delivering accessible, quality healthcare in Ireland to our increasingly culturally and linguistically diverse population. It explored, who is a ‘migrant,’ migration as a social determinant of health, key barriers to equitable access, lessons learned from COVID-19 and solutions and resources for improving access.

Prof. MacFarlane said the (CSO, 2016),  showed there were over 600,000 people in Ireland (13% of the overall population) who were multilingual, speaking a language other than Irish or English at home, while based on the last census, about 20 per cent of our population had been born outside Ireland. 

She said one of the priorities in health was the implementation of trained health interpreters. Trained health interpreters were people who are impartial and support patients and healthcare workers to have an effective dialogue together about  health

She said we should all reflect, as individuals, on our understanding of, and relationship with, migration.    Migration was happening to so many people and not just under specific labels. Migration was a longstanding and normal part of social life around the globe. It was not new in Ireland.  It  created social, cultural and linguistic diversity.

Many of us were migrants, or had been migrants in the past, with our own migration story.  She, for example, had been born in Cork, studied in Galway,  moved to London for work, moved back to Galway for work and more recently moved to limerick for work.  “So, I am a migrant within Ireland and outside the country, according to the official definition by the International Organization for Migration (IOM) – “Migrants are people who have moved away from their place of usual residence, whether within a country or across an international border, temporarily or permanently, and for a variety of reasons.”

“The discussion about migration is increasingly politicised and racialised.  We start to think of migration as a problem and forget people have always migrated.  Migration is a normal thing to do.  Reasons for migration differ, and the length of their stay and the vulnerability of migrant groups can vary.   But it is normal and usual, it is not to be shied away from and it will not go away. “  She emphasised the social, cultural and economic value that migrants bring to the countries that they settle in.

She said the scale of the challenge to the health services because of the number of Ukrainians who had come to Ireland as a result of the war in Ukraine, was unprecedented.

There were definitions and legal status associated with different kinds of migrants. Temporary refugees from Ukraine had  higher rights than international protection applicants.

People could move between different categories. Migrants would have different experiences and opportunitiesdepending on the group into which they fell  It was quite a challenging time for migrants and refugees who were not Ukrainian.  “There is a feeling of hurt that migrants who have been living in Ireland for a long time still have difficulty in accessing health, work, housing and education.  This may give rise to the idea that some migrants are more worthy than others.”

Prof. MacFarlane said that migration was a social determinant of health. People in more vulnerable circumstances had poorer health outcomes than the host population When someone started to move from their usual place of residence, their residence, economic class, legal status and cultural background would all shape how difficult or not it was to be a migrant and settle into new society and how that whole process effects their health.  She reflected that her own experience had many advantages because of language and employment opportunities. It is not the case for other migrants who can be in more vulnerable situations.

Migration cuts across the social determinants of health.  While biological and genetic factors could affect people’s health outcomes, so could general socio-economic and cultural factors.  However, their health would also be influenced  by migrant friendly health services. Then there were policies that were supporting migration. celebrating cultural diversity, or policies which were hostile to migrants.

“As health managers, it is important to see how you can participate in work to make health systems migrant friendly.

“We can’t present a health system of one size fits all.  It will not address the patterns of inequity documented by the WHO.  One problem is that we do not routinely collect data on the number of migrants who access our health services, which means we do not know what is going on and what the problems are.  This also means we have not been in a position in Ireland to document the impact on COVID on our migrants as other countries have been.

“A second issue is communications.   Patients come into busy clinics, where they speak a different language to the health provider.   What happens next can vary from country to country.  The most common response is that they revert to informal responses where a family member, friend or neighbour may act as an interpreter or the patient may learn off a few words to describe how they are feeling.   While these informal responses can have pragmatic benefit at some level, they are not adequate, because the patients cannot engage in dialogue about their health.  A woman may be availing of her daughter as an interpreter.  Then she develops a health problem which she does not want her daughter to know about.  So, she doesn’t go to the doctor. Sometimes there is a more formal response and an interpreter is provided.   The problem in Ireland is that many paid interpreters working for commercial agencies are not sufficiently trained in the health area.  It is essential that there is more investment in accredited training, professional development and supports for interpreters in the Irish healthcare system.

Prof MacFarlane said that there are multiple Irish health policies that show we are committed to the idea that people are experts in their own health and should be treated as partners.

Prof. MacFarlane said it was not, however, a routine experience in Ireland for migrants to be involved in research or in development of the health services.  Where it was done, it was rare, done on ad hoc basis and unevenly spread throughout the country.  But there were pockets of good practice. “We need participatory partnership in research by migrants.  It is important to hear people’s voice in research,” she said.

Prof. MacFarlane said she had been so impressed with the work of the National Social inclusion Office and their regional colleagues.  It was relatively rare for a country to have an intercultural health strategy and Ireland was on its second one.  When we look at this area internationally, Ireland comes up with a gold star.   The office has many projects under way. “I   would like the work of the Offices for Social Inclusion to become integrated and a mainstream part of work across the HSE.”

The meeting was chaired by Elaine Prendergast HMI West/North West regional committee

The meeting was sponsored by GSK.

*Professor MacFarlane is a graduate of University College Cork and the University of Galway. She is a social scientist who has been researching refugee and migrants’ access to healthcare in Ireland and international settings since 2002. She has led multiple HSE, HRB and EU funded projects that have involved refugees and migrants as research partners. All projects are designed to generate action-oriented recommendations and evidence for healthcare practice and policy in Ireland and abroad.