Advocacy The tops of the flops the tops of the tops Amsterdam
26th February 2015 MdM International Network
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-AMU (full specific health coverage for UDM) exists since 1996
but deterioration since 2008. Our message: -Now: need better
harmonization with local authorities -Long term: universal coverage
with centralized system - Many stakeholders (local, regional,
federal) in complex hierarchy: difficulties to build simple
messages - Difficult to build a coalition within civil society -
Short win with local authorities but very fragile BE: BELGIUM
Doctors of the World: FLOP : AMU for undocumented migrants
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-Green book: more than 30 contributors (health system actors +
NGOs actors): shows problems in access to healthcare. January 2014
-Conference with all the actors to discuss the green book. Over 350
participants. March 2014 -White book with 5 actions point.
September 2014 1.Process with mainstream actors + civil society
2.White book included in declaration of new government. 3.Process
still on going with follow up committee BE: BELGIUM: Doctors of the
World: TOP : Green Book- White Book
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BG: BULGARIA: - Health and sexuality education in the mandatory
school curriculum: FLOP 20 years of efforts of NGOs, UN agencies
and even the ministry of Health Long path of failures and
successes, several times being THAT close Hearings in Parliament,
work with MPs and Ministry of Education, mobilizing partners
resources, petition in Internet Lack of political will Actually the
battle goes on in the new Law of school education is foreseen a
special educational standard Health, civil and intercultural
education Strong oppositional movements, bad tricks in public
space
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BG: BULGARIA: The success: Roma Health Mediators (RHM) - from
NGO initiative to state policy: TOP Roma Health Mediators the
bridge between vulnerable communities and health and social
services; Roma the biggest minority in Europe, difficult access to
health services and state institutions What we achieved with our 10
years of advocacy efforts: the profession got into the official
list of Ministry of Labour RHM are civil servants in
municipalities, paid by the Ministry of Finance Education in
Medical colleges; approved curriculum, certificates Selection
criteria selected by a commission Lifelong learning, National
Network established in 2007 The model is developing
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CA: CANADA: Doctors of the World: FLOP Coffee meetings on
nutrition and anxiety A group of staff & volunteers organised a
thematic group meeting with migrants on nutrition and anxiety in
our office. Very few attendees and no interest to participate in
these meetings. These subjects were not a priority and migrants
were not willing to openly discuss their anxiety
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CA: CANADA: Doctors of the World: TOP Pregnant women &
access to perinatal care Staff & volunteers undertook a tour of
all major hospitals with obstetrics departments in Montreal area.
Meetings with doctors, nurses, clinical & administrative staff.
Discussions on pregnancy and childbirth for precarious migrants.
Looking for solutions to minimize risks of complications as well as
abuse and obstetrical violence towards uninsured women. Information
and dialogue with obstetrical teams opened doors for better
understanding of the realities uninsured pregnant women face.
Challenges: 1.reach financial staff to negotiate "acceptable
packages" for women before labor, thus minimizing risks. 2.obtain
health coverage for all precarious pregnant women regardless of
their status.
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DE GERMANY Doctors of the World: FLOP Access to care for UDM:
Targeted advocacy towards specific decision makers Official letter
to new health minister after general elections in Germany regarding
access to health for people without papers Lots of work to get
invitation for meeting with state secretary High input low outcome
To influence decision makers we must be bigger or act together with
other organisations
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DE GERMANY Doctors of the World: TOP Common political campaign
with other grass root stakeholders Political campaign for the
abolition of German asylum seekers benefit law as it was UNFAIR
Credibility through wide spectrum of participating organisations
and social structures Big audience Common understanding of problems
Specific website, flyer, activities and messages Specific objective
with defined time frame
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EL: GREECE Doctors of the World Flops Difficulties when dealing
with the instability of the political situation: MPs change quite
often There is no result/effective solution after the meetings
& discussions Not even on urgent issues & needs for access
to health care: lack of vaccines, lack of medical personnel, first
reception service of migrants at the entry points of Greece.
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DE GERMANY Doctors of the World: FLOP Access to care for UDM:
Targeted advocacy towards specific decision makers Official letter
to new health minister after general elections in Germany regarding
access to health for people without papers Lots of work to get
invitation for meeting with state secretary High input low outcome
To influence decision makers we must be bigger or act together with
other organisations
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EL: GREECE Doctors of the World - Tops Access of children to
health care: meetings with Greek MPs, representatives of the CoE,
directors of public hospitals and representatives of the
municipalities concerning the barriers in the access of children to
health care. First Reception Service of migrants / Entry points of
migrants in Greece: meetings with Greek MPs and representatives of
the Greek ministries and the W.H.O concerning the reception of
migrants at the entry points of Greece where MdM Greece is present
(Chios, Lesvos). Access to medicines: invitation from the MEP
Kostas Chrysogonos at the European Parliament (event Can we afford
our medicines? Situation & solutions to the access to medicines
crunch in Europe). MdM Greece was awarded by the Academy of Athens
for its humanitarian aid in Greece and abroad.
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ES: SPAIN Mdicos del Mundo: Flop: The law excluding people from
Access to Healthcare: still on Publication of the report Two years
of health reform: more human lives at risk on the World Health Day
(7th April) & on anniversary of law RDLey 16/2012 (20th April).
Communication success. Remains valid despite broad social refusal
(NGOs, health professionals) Agreement with Parliament groups to
sign a Pact to suppress the law as soon as the political
equilibrium in Congress has changed. Granada Declaration to take
concrete steps to protect the health of migrants and ethnic
minorities in Europe (5th EUPHA European Conference on Migrant and
Ethnic Minority Health- Granada - April 2014. Press conference
(sept 2014) Continuous actions to denounce effects of limited
access to care. BUT still no results
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ES: SPAIN Mdicos del Mundo: TOP : Stopping the law Project
suppressing the right to Termination of Pregnancy Most restrictive
project against womens rights in 25 years : destruction of Spanish
model on gender equity. Big mobilization of health professionals, 2
years fighting against the law. MdM International Network has run
actions (FR, NL, UK, US): Campaign Names not Numbers, exhibitions,
demonstrations, street actions, collection of signatures Right of
each woman to decide if & when to have a child. Figures
released: 50 000 women die/year of unsecure abortion, 50% of
abortions with no medical supervision Participation to
international meetings at United Nations, to the CEDAW report &
activism among Spanish NGOs.
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FR: FRANCE: Doctors of the World: FLOP Since 1999 constant
advocacy to include specific health coverage for undocumented
migrants (AME +- 180 000 persons) into universal health coverage
(CMU +- 5 millions persons). Fight since 2002 against specific law
against sex workers : criminalisation of passive solliciting. We
also oppose new law project penalizing clients. Penalisation of
passive solliciting hasnt disappeared & clients are not
penalised.
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FR: FRANCE: Doctors of the World: TOP In 2012, a new
restriction was voted: undocumented migrants had to pay 30 to
obtain specific full health coverage. We obtained in 2013 from new
government free access to specific health coverage (AME)
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IE: IRELAND : MIGRANT RIGHTS CENTRE IRELAND : FLOP Campaign for
the right to change employer What did we learn? The ask was too
broad (Overhauling the Work Permit System) It is important to have
a series of target that build on each other and are realistically
achievable Building the base for political lobbying takes time
Partnerships with power-holders work better than confrontation
Sometimes going public is not the best option
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IE: IRELAND: MIGRANT RIGHTS CENTRE IRELAND: TOPS 1. The
Campaign to Criminalise Forced Labour The Campaign to Criminalise
Forced Labour 2.The Ratification of ILO Convention on Domestic
WorkThe Ratification of ILO Convention on Domestic Work What worked
well? Strategic Litigation Public Direct Action Media Work and
Awareness Raising National and International Partnerships
Individual Advocacy Political Lobbying
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IT Italy NAGA - Flop Missed inclusion of the right to health
for irregular minors in the Conclusions of the Council of Health
Ministers of European Union, December 1, 2014.
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IT Italy NAGA - Top Possibility of enrollment in the Regional
Health Service also for all irregular minors.
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JA: Doctors of the World Japan: FLOP Pleading to obtain
protection for homeless also during winter holidays: Difficult to
build a well functioning network, Cooperating with groups in
conflict: bad for networking & for people in need, We need more
strategy to choose groups for alliance. Need to organize clearly
decision process & functional action.
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JA: Doctors of the World Japan: TOP Back ground - No public
assistance service available during long winter holidays (10days).
Action - advocacy action in the Ministry of Health by a network of
various organizations. - claimed governments responsibility during
10 days winter holiday for the people in need Outcome Tokyo
metropolitan government sent a note in order to ensure all
structures are ready to protect the homeless during winter
holidays. Tokyo officially acknowledged the responsibility of its
Administration regarding protection for homeless people even during
holidays.
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NL: the NETHERLANDS Doctors of the World: FLOP Problem? A man
(mental health issues), in migrant detention due to be expelled to
Liberia: Ebola was a serious threat. The lawyer needs documentation
for the Court. How? DRI sent a medical statement on the severe
risks to expel an unstable (or any) person to an Ebola-area. Also a
NL hospital/ specialist gave a statement. Result? The court did not
take into account these medical statements, nor the actual
Ebola-risk, BUT postponed the verdict based on the weak health of
the client due to a hunger strike.
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NL: the NETHERLANDS Doctors of the World: TOP Problem? in 2014
new regulation: all UDM should pay 5 cash for medicines. Some
chronical patients & multi-medicine-users have problems paying
& sometimes stop (part of) their treatments. Support
organizations and other volunteers pay the 5 to avoid problems, but
cannot sustain this. How? Advocacy in cooperation with other
support organizations at Municipality level (Amsterdam): presenting
monitoring data on number of patients, amount of money paid by
support organizations. Case studies presented to representatives of
left-wing parties. Publication of a press release. Result?
Municipality installed emergency fund to cover the 5 paid by
support organizations in 2014. A covenant will be signed between
municipality, pharmacies and support organizations, to manage the
fund in 2015.
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NO: NORWAY: Health centre for undocumented migrants: Flop Drown
in the debate between asylum activists and the government. 3
biggest parties are strict in these issues. Profiled debate over
years about regularisation of children who have been in Norway for
a long time. Very difficult to create a humanitarian space within
our own country. Never managed to discuss the issue with health
politicians.
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NO: NORWAY: Health centre for undocumented migrants : Tops
Before creating the Health Centre the organisations managed to
change the Immigration Act: giving humanitarian care to
undocumented migrants was not illegal any more. We managed together
with the doctors & nurses Unions to push the government to
clarify the rights to health care for undocumented in the Norwegian
law. Advocacy based on experience in a very polarized debate
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PO: POLAND : SIP- FLOP Ban on immigration detention of children
was not introduced into the Polish law (migrant children can still
be detained) Still no identification procedures of PTSD/torture
victims (but the decision-makers are apparently working on this
issue)
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PO - POLAND : SIP- TOPS Improvement of living conditions in
detention centres in Poland; the prison-like regime reduced Some
positive changes in the immigration law: Possibility to apply the
alternatives to detention The court has to consider the best
interest of the child each time when deciding about detention Ban
on detention of the traumatised/victim of tortures UDM (before it
concerned only Asylum Seekers)
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RO: ROMANIA CARUSEL: FLOP Project: EPs FEMM report on sexual
exploitation and prostitution (January - February 2014) Aim:
Convince Romanian MEPs not to vote for the report on sexual
exploitation and prostitution (Mary Honeyball, UK MEP) on
criminalization of clients of sex workers. Strategy: coordination
with International Committee on the Rights of Sex Workers in Europe
(ICRSE) (email, Skype); letter to Romanian MEPs; organization of a
meeting with feminists NGOs to gain allies; send the letter signed
by 16 Romanian NGOs and other update documents to Romanian MEPs by
email; call the Romanian MEPs; send the letter against
criminalization of SW clients, signed by 560 NGOs and 94
researchers, to all MEPs. Results: Out of 33 Romanian MEPs: o 20
Romanian MEPs voted for; 2 Romanian MEPs voted against; 2 Romanian
MEPs abstained from voting; 9 Romanian MEPs were non-voters.
Source: http://carusel.org/blog/nu-modelului-suedez/
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RO: ROMANIA CARUSEL: TOP Project: Roma Harm Reduction Advocacy
Project (November 2013 October 2013) Aim: to sensitize the National
Agency for Roma (NAR) and 2 Roma NGOs (Impreuna Agency and Romani
CRISS) in regards to the drug use situation in the community,
especially regarding the vulnerability, stigma and discrimination
that Roma drug users face. Strategy: dissemination of key human
rights and public health messages, trainings for sensitizing and
capacity building, field visits for data collection, outreach to
community leaders, supervision of activities. Results: o the 2 NGOs
are providing financial assistance for CARUSEL to purchase harm
reduction supplies and technical expertise to report human rights
violations against all drug users o the needs of Roma drug users
including culturally appropriate harm reduction activities are
addressed in the national strategy and action plans of National
Antidrug Agency Source: Consolidated guidelines on HIV prevention,
diagnosis, treatment and care for key populations, WHO, July 2014,
Annex 5 On the ground: Programs serving the needs of key
populations (case studies)
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SI: SLOVENIA: The worst experience During lobbying to sign the
European declaration of health professionals (Towards
non-discriminatory access to health care) in 2010, the Medical
Chamber of Slovenia was not ready to support and promote the
declaration with excuse that medical workers should anyhow respect
the Code of medical ethics and that this was enough.
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SI: SLOVENIA: The best experiences Slovenian Philanthropy has
established good cooperation with the Ministry of Health. In most
cases the Ministry provides payment of medical services for
beneficiaries of the clinic for people without health coverage
(co-founded by Slovene Philanthropy), on the basis of professional
opinion of expert worker of the clinic.
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UK: United Kingdom Doctors of the World FLOP: law changes Day
to day lack of knowledge of entitlements in NHS England- difficulty
escalating and getting ownership Initial focus on primary care then
announced A&E and further primary care charges 150% of charge
for non-EEA migrants-Department of Health didnt explicitly consult
on this Below the line public opinion
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UK: United Kingdom Doctors of the World TOPS Ongoing dialogue
with Department of Health Deferring later stages of programme
Publishing a report with Demos shifting the frame of the debate
Influencing the Lords- Information sharing with Home Office
Guidance Potential for further exemptions-support from colleges on
children
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US : USA Doctors of the World : Challenges Limited Advocacy
Activity New chapter, new domestic project Healthcare &
immigration crowded advocacy fields Focusing on local efforts- e.g.
Columbia study and report: Citywide press Local political
involvement Further publication
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36 MdM DRI - International Network - FLOP Advocacy towards
European institutions CONCRETE measures for VACCINATION - Not
enough follow-up (got lost in too many different advocacy topics) -
Difficult subject due to middle-class resistance (anti-pharma
scepsis) + anthroposophic EPHA members blocking a common position -
Not enough time to create alliances with other civil society
partners health professionals
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37 MdM DRI - International Network: TOP Advocacy towards
European institutions High European visibility of our topics, with
relatively few human resources (1,5 FTE), e.g. increasing # of
speaking slots at high-level policy events - All representation
work is rooted in concrete field expertise, brought by field
experts + unique data collection (Observatory) - smart alliances
(both formal and informal) with other NGOs, institutions, civil
servants etc. - MdM is regularly asked for contribution, no more
need to run after stakeholders