WHO-HPH TF MFCCHC/COST Action HOME Barcelona Meeting

November 6th – 7th, 2008

The implementation of transcultural competence in the clinical context:

preconditions and challenges

Dagmar Domenig, PhDDirector of Health and Integration Department

Swiss Red Cross, Head Quarter, Berne

The United Nations recognize that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without discrimination.

Bangkok Charta for Health Promotion in a Globalized World 2005

Every person has a right to appropriate health care!

Appropriate Health Care (Kälin/Wyttenbach, 2007)

universal availability

universal accessibility

universal acceptability

sufficient quality

Migrants in Switzerland?

Universal accessibility

affordable primary health carephysically reachable promotion of health literacymigrant-specific information in migrant languagesno (racial) discrimination

Universal availability

available also to migrantscompulsory health insurance

“Health literacy is the ability to make sound health decision in the context of everyday life – at home, in the community, at the workplace, the health care system, the market place and the political arena. It is critical empowerment strategy to increase people’s control over their health, their ability to seek out information and their ability to take responsibility.”

(Kickbusch et al., 2005: 10)

Health literacy in Switzerland (Wang/Schmid, ISPM Zurich, 2007)

health literacy increases with the educational background

wish to participate actively

health decisions are very complex

lack of information

information difficult to comprehend

For further information see www.ispmz.ch

Universal accessibility

affordable primary health carephysically reachable promotion of health literacymigrant-specific information in migrant languagesno (racial) discrimination

Universal availability

available also to migrantscompulsory health insurance

Universal acceptability

No (racial) discrimination

transcultural competence among health professionals

adequate inclusion of migrant’s needs and expectations

No generalized ethno-specific cultural recipes

Treatment based upon individual conception of health and sickness

“Transcultural competence means the ability to perceive and comprehend individual life-worlds in a specific situation and in various contexts, and hence to infer appropriate ways of action.”

(Domenig, 2007: 174)

Universal acceptability

no (racial) discrimination

transcultural competence among health professionals

adequate inclusion of migrant’s needs and expectations

no generalized ethno-specific cultural recipes

treatment based upon individual conception of health and sickness

Sufficient quality

transcultural change

migrant-specific measures

link to the general quality management

improvement of the quality for all patients

Preconditions for a transcultural change

System-Managementtranscultural commitment of top-management (top-down-strategy, migration unit, measures, kick-off, bottom-up-process)migrant-specific actual state analysis and target analysis (annual goals!)appointment of a qualified person for migrant-specific/transcultural issues (transcultural mainstreaming, contact point)migration-specific adaptation of organizational processesmigrant-specific adaptation of documents (policies, standards, concepts)

Preconditions for a transcultural change

Marketing-Managementeducation and further training in transcultural competencetranscultural group processes (transcultural teams, case conferences)promoting health literacy among migrants (information material, health [system] trainings) cooperation with migrant communities (involvement of key persons, networking, common activities)collaboration with experts, migrant-specific servicescollaboration with scientific community (applied research)

Preconditions for a transcultural change

Resource-Managementproviding enough resources for a transcultural change (money, manpower, knowledge)promoting health professionals with a migration background (recruitment of migrants, recognition of specific skills, transcultural teams, personnel development, measures against [racial] discrimination)buildup of interpreting services (educated interpreters, further education for health professionals)

Challenges for a transcultural change

System-Managementtranscultural commitment of top-management (top-down-strategy, migration unit, measures, kick-off, bottom-up-process)migrant-specific actual state analysis and target analysis (annual goals!)appointment of a qualified person for migrant-specific/transcultural issues (transcultural mainstreaming, contact point)migration-specific adaptation of organizational processesmigrant-specific adaptation of documents (policies, standards, concepts)

We did not succeed in changing hospitals on a systemic level!

Challenges for a transcultural change

We succeeded in some areas, especially in education, further training and promoting health literacy

Marketing-Managementeducation and further training in transcultural competencetranscultural group processes (case conferences)promoting health literacy among migrants (information material, health (system) trainings) cooperation with migrant communities (involvement of key persons, networking, common activities)collaboration with experts, migrant-specific servicescollaboration with scientific community (applied research)

Swiss Red Cross: further education

promote self-reflection

learn to perceive and comprehend the other by changing the perspective

learn to take a medical history without cultural stereotypes

learn to build up relationships in a migrant-specific context

background information about migration, integration, medical anthropology…

communicate measures for a transcultural change

Over 360 training days for nearly 5000 health professionals in the last 8 years!

Swiss Red Cross: further education

“This training gives me the motivation to change things and to conduct conversations with another point of view.”

“Tolerance towards migrants should be a precondition for becoming a health professional. Initiative and the will to assist migrants should be taken for granted.”

“It was encouraging to hear that the point is not knowing all cultures but asking the patients what they need individually.”

“The care of migrants is very complex. There are no specific recipes because all is individual, this I learned today. What I need is listening, seeing and a lot of tolerance.”

www.transkulturelle-kompetenz.ch

Information, tools, hints and links

Swiss Red Cross: promotion of health literacy

Health Guide in 18 languages

VIA, trainings for migrants by migrants about health and Swiss health system

www.migesplus.ch

Federal Office of Public Health(www.admin.bag.ch)

Challenges for a transcultural change

We succeeded in some areas, especially in building up interpreting services

Resource-Managementproviding enough resources for a transcultural change (money, manpower, knowledge)promoting health professionals with a migration background (recruitment of migrants, recognition of specific skills, transcultural teams, personnel development, measures against [racial] discrimination)Buildup of Interpreting services (educated interpreters, further education for health professionals)

Sufficient quality

transcultural change

migrant-specific measures

Link to the general quality management

Improvement of the quality for all patients

© Departement Gesundheit und Integration / Weiterbildung und Gesundheitsförderung

individual transcultural competence

structural and institutional

implementation of transcultural competence

Diversity

migrant friendly hospitaltranscultural change

...a big CHALLENGE!

Implementation of transcultural competence in the clinical context is still….