1. Lisbon, Portugal, May 13, 2016

2. PROJECT GOALS Direct Grant Agreement awarded to IOM from the EC DG SANCO, through CHAFEA under the Health Program: Re-Health will provide support to EU Member States under migratory pressure, helping them in addressing health-related issues of arriving migrants, follow up and continuity of care, through: Strengthening national cross-border surveillance and response capacities. Ensuring that health assessment and preventive measures are provided. Ensuring that data initially collected are kept in an online database platform in order to be available at the destination country.

3. MAIN ACTORS TARGET: EU Member States (EU MS) National and local health authorities Civil Society Organizations (CSOs) OTHER STAKEHOLDERS: Migrants, with special attention to minors and vulnerable groups European Commission (EC): DG SANTE, CHAFEA, DG HOME IOM

4. RECENT ARRIVALS FIGURES 03/05

5. PURPOSE of PHR & HANDBOOK HB Handbook: An overview of the migration health assessment process; guidance on conditions of importance for health assessment; Standardized process to obtain appropriate, accurate and comprehensive information. PHR Personal Health Record (PHR): Fosters standardized HA and used to records data collected by medical staff in different stages. Handed to migrants for continuity of care. Electronic version in final stages PLATFORM Based on Migration Management Operational System Application (MIMOSA) the new platform is almost ready to capture and store the PHR. Among the Equi-Health (2013-2016) project findings: to promote a mechanism for systematic data collection on migrant health and to provide a referral.

6. PERSONAL HEALTH RECORD (PHR) and HANDBOOK: Development requested by EC /DG SANTE to IOM For EU Health Professionals to perform Health Assessment of newly-arrived refugees and migrants in the EU/EEA Ensure a comprehensive approach at EU level to foster health provision of arriving migrants, facilitating follow-up and continuity of care. http://ec.europa.eu/dgs/health_food-safety/docs/personal_health_record_english.pdf http://ec.europa.eu/dgs/health_food-safety/docs/personal_health_handbook_english.pdf PHR: Developed by IOM with the support of the EC and the contribution of ECDC Intended as unified instrument for the voluntary assessment of health status of refugees and migrants and the provision of personal health record for those arriving to the EU/EEA To ensure continuity of care provision and data flow, as well as support cross border cooperation. Available in 9 EU languages and in Arabic MILESTONES 6

7. CORE WPs Setting up of a PHR electronic database PHR Electronic database and e- platform development (based on IOM-HAP experience) M1-M4 Training on the utilization of PHR database and e- platform M3-M10 Exploratory phase 4 exploratory missions (tentative countries Greece, Croatia, Slovenia and Italy) M1-M4 Consultative process M4-M10 Piloting of PHR Piloting of PHR and roll- out in other MS. Support of the implementation of PHR via health mediators/ interpreters Training of health mediators/interpreters Feasibility study and report Health promotion activities Piloting of community response M5- M12

8. CONSULTATIVE PROCESS CROATIA: ONGOING MEETINGS WITH INSTITUTIONS GREECE: MEETINGS NOV 15’-MARCH ‘16 NCC SLOVENIA: APRIL 22, ‘16 NCC ITALY: APRIL 7, 16’ PHR USE BY EU PROJECTS INTERNAL STAKEHOLDERS ENGAGMENT AVOID DUPLICATIONS EXTERNAL STAKEHOLDERS ENGAGEMENT

9. LEGAL FRAME E-PLATFORM International Health Regulations (IHRs) 2005 http://www.who.int/ihr/9789241596664/en/ Directive 95/46/EC: Protection of Individuals with regard to the processing of personal data and its free movement. http://ec.europa.eu/justice/policies/privacy/docs/95-46-ce/dir1995- 46_part1_en.pdf  Built-in Consent form in compliance with Member States’ regulations EU Legislation on Communicable diseases http://ec.europa.eu/health/preparedness_response/policy/decision/index_en. htm EU definition of reportable diseases http://ec.europa.eu/health/communicable_diseases/early_warning/comm_le gislation_en.htm MIMOSA was first developed in 2001 to capture migrants information in order to provide better services to migrants that IOM was assisting. By 2010 was deployed in 92 sites (1200 workstations) and consisted of 7 modules  Among which the Medical for management of health assessments, pre-departure medical screening, and other medical services (used in the USA and Australia). An upgraded version of the platform was launched in 2010 and its used as base for the Re-Health Platform MIMOSA was first developed in 2001 to capture migrants information in order to provide better services to migrants that IOM was assisting. By 2010 was deployed in 92 sites (1200 workstations) and consisted of 7 modules  Among which the Medical for management of health assessments, pre-departure medical screening, and other medical services (used in the USA and Australia). An upgraded version of the platform was launched in 2010 and its used as base for the Re-Health Platform

10. THE E-PHR The application developed for RE- Health will be for only those with granted access. Password protected (user authentication) Different levels of permission (i.e. registration, signing medical services, filling medical forms) can be granted. HTTPS encryption

11. E-PHR (continued ) The user after his/her log-in will be able to perform data entry, but also find cases and look at previously registered PHRs. (Photo optional). Data from the participant single case are captured, the principal case applicant Data can be extracted in single (one PHR) or aggregated form and exported to Excel or Pdf. Compliance with the IHRs 2005 HTTPS encryption

12. E-PHR PROCESS FLOW HTTPS encryption  CASE REGISTRATION

13. E-PHR PROCESS FLOW ( continued) HTTPS encryption  INDIVIDUAL REGISTRATION  CASE MANAGEMENT a dashboard for each case that gives a brief overview of the case information Acts as an access point to the medical forms (via the Exam Status link) and printing (print button) Allows for adding of new Case Members

14. E-PHR PROCESS FLOW (continued) HTTPS encryption  MEDICAL FORM Re-Health captures medical examination data Also includes capturing medical history and physical examination data  PRINTING OF THE PHR All or only specific data can be printed or a code can be provided for the migrant to access the data.

15. LANGUAGES and TRAINING The first version of the e-PHR will be in English, shortly after in different languages. Paper already. Training for the application will be performed in person or through web and video facilities. IOM approach: Train the Trainers Length of the Training for the PHR app: 1 to 2 days Training and Recruitment of Health mediators/interpreters

16. PILOTING AND IMPLEMENTATION OF THE PHR Feasibility Report A feasibility report will be drafted based on feedback collected on the utilization of the PHR and in line with the electronic database development and collection of medical data. Specifically: Quantitative evaluation will be used to give numerical results. (i.e. refusals) Qualitative evaluation will use narrative/descriptive data. (i.e. behavior of medical staff and migrants/refugees) Drafting of an open questions questionnaire (as a self-assessment tool or to interview those participating to the pilot)

17. FURTHER STEPS Community Response Map (CRM) How it works? 1.During the HA migrants will be informed to contact IOM ( via sms, e- mail, social media, phone) if help is needed to access health within the EU MSs. 2.When requested IOM staff (or i.e. mediators) will provide information needed. 3.These type of interaction will be recorded in the CRM 4.The CRM information will be used for evaluation purpose. The CRM is an IOM online data platform to receive direct feedback from beneficiaries (especially when contacts are difficult): Enables evaluation Promotes contacts with beneficiaries

18. Obrigada pela sua atenção! IOM- Regional Office for the European Economic Area, the European Union and NATO RE-HEALTH WEBSITE: http://re-health.eea.iom.int/