1. SUPPORTING HEALTH COORDINATION, ASSESSMENTS, PLANNING, ACCESS TO HEALTH CARE AND CAPACITY BUILDING IN MEMBER STATES UNDER PARTICULAR MIGRATORY PRESSURE — /SH-CAPAC
MODULE 2:Strengthening institutional capacity to organize the response Unit 1:Framework for coordination and Intersectoral collaboration
Prepared by: Jacqueline Gernay, EASP

2. Outline of contents Introduction: Learning objectives of this unit
Different groups of course participants
Course content
Why do we need coordination and intersectoral collaboration?
The health coordination framework and mechanism
The health coordination team
References

3. 1. Introduction: objectives
At the end of this unit, participants should:
Understand the need for coordination and intersectoral collaboration to address the health needs of the refugees asylum seekers and other migrants who are part of the recent influx into the European Union.
Understand the use of the coordination framework as a tool that facilitates the establishment or strengthening of the coordination of the health response to the refugees asylum seekers and other migrants.
Use the information received to describe and analyze the type of coordination and intersectoral collaboration that exists in their country at their level of work with regards to addressing the health needs of the refugees asylum seekers and other migrants and make recommendations.

4. 2. Different groups of course participants (at national, subnational or institutional level)
Health managers may not work in the MOH but another ministry/national agency in charge of the response to the refugee crisis, hence not au fait with the refugees’ health needs. They may be in contact with the various ministries and national and international agencies involved. At institutional level, they will influence the policies affecting patient care and need to ensure a team approach.
They may be called upon to coordinate and even lead the health response for the refugees, migrants and asylum seekers.
Health professionals are directly in contact with the patients. They may receive referrals from reception centres, NGO’s or other institutions. They will benefit from a wider team approach; internal multidisciplinary ( mental health, SGBV…)and external.
Administrative staff may or may not be in direct contact with the patients. They need to be an integral part of the health team to ensure smooth running of the operations. i.e. they may be the ones making appointments with social agencies, interpreters etc…
IOM 2014.

5. A. Why do we need a health coordination and intersectoral collaboration (1)
Despite the international bill of human rights, and specific EU charts and directives ( see module 1 unit XX), countries have their own regulations and laws pertaining to migration and health care entitlements.
Refugees have varying and evolving needs in first arrival, transit, or destination countries (or mix) as well as specific health requirements such as sexual and reproductive health and mental health. The link with social determinants of health needs to be made ( see module 1 unit 4)
The Ministry of health is not always in charge of the health response ( Ministry of interior, Asylum agency…)
There are organizational challenges of availability, accessibility and quality in addition to care givers’ attitude, understanding and responsiveness. .

6. A. Why do we need a health coordination and intersectoral collaboration (2)
The health response to the refugees influx has been fragmented with involvement of multiple partners resulting in overlapping, duplication and unmet needs.
Some EU member states already have experience and /or coordination mechanisms in place, others not.
The crisis is dynamic, influenced by politics and the evolution of the major conflicts triggering it.
There is need to offer a flexible coordinated response, anchoring migrants’ health in a human rights framework, harnessing all partners, stakeholders and goodwill at all levels.
Good communication and information towards all stakeholders and regular citizens is of paramount importance ( media to be on board) .

7. B. Health coordination framework aim: strategic guidance
The Health coordination framework is a tool to establish/strengthen a health coordination mechanism lead by a health coordination team

8. The Health Coordination Mechanism aims to align all actors providing care to refugees, asylum seekers & other migrants
Purposes:
To share information
To adopt a coordinated approach
To establish common objectives
To harmonise efforts
To use available (human and financial) resources efficiently
To ensure access to appropriate integrated health services
To appoint a health coordination team
There is no one size fits all.

9. Multiple actors are to be involved & flexibility is needed

10. Collaboration/ Partnerships
A partnership is a relationship based upon agreements, reflecting mutual responsibilities in furtherance of shared interest.
2 crucial elements:
Specification of the shared objectives. Partnerships only work when all parties benefit from the relationship
Mutual responsibility: all parties will share risks and benefits ( how sharing the benefits is to be clear from onset)
Compulsory activity 1 (CA1) video: inter professional partnerships: University of Leicester
Focus on the “ sure start” program from minute 11:22 to end (7 minutes )
Optional reading 1 (OR1) (: An overview of Public Private partnerships in Health: Marc Mitchell, Harvard School of Public Health:

11. Health coordination mechanism
Compulsory activity 2 (CA2): Case study
Healthy Housing Programme – Public health, public housing, joint action (Extracted from Country case study; New Zealand Dialogue on intersectoral action)
(page 9 to 11)
The paper is the starting point for a forum discussion on intersectoral collaboration. Participants are asked to present examples of intersectoral collaboration in their country ( pertaining to migrants, refugees or ethnic minorities)

12. Stepwise activation of health coordination mechanism (1),
The ministries/authorities in charge of responding to the migrants 'health needs , APPOINT the health coordination team composed of:
Team leader/Coordinator
Health information management specialist (epidemiologist, health statistics)
Public health expert of authority
Communication specialist
Other experts depending on specific needs (eg local hospital director or maternal health expert if many pregnancies in the setting considered )

13. Stepwise activation of health coordination mechanism (2)
2.The team leader/coordinator, :
Chairs regular successful meetings (short, simple, interesting, for action)
3. The team leader and his team :
Focus on problem solving and not just information sharing
Consider subgroups for e.g. vaccination, SGBV, mental health,…
Liaise with other national/international working groups
Follow-up on implementation of agreements made
Ensure regular feedback to all involved
Are the gate keepers for all the information received (see tasks 5 and 6)
The Ministry of Health or an equivalent health authority at national or subnational level should be in the driver’s seat/leading role
Optional activity 1 (OA1) We recommend you to watch the video: Lead like the great conductors ( 20 minutes)

14. C. Health coordination team: Who, What & How
Basic principles
Tasks : WHO-WHAT-HOW (specificities worked out in other SH-CAPAC tools)

15. Health coordination team: Tasks 1 to 6:
Task 1/6:Mapping of the stakeholders
This can be at national, subnational and/ or institutional level
Identify local and international actors. They can be internal ( i.e. different ministries and/or external: NGOs, civil society, academia, International organizations)
Map who is doing what and where (can be a round table talk in difficult setting or at onset)
Conduct a simplified resource mapping exercise in order to have a rough estimate of the available financial and human resources
Understand their mandates, expectations and constraints
Gather information, guidelines and tools

16. Health coordination team: Tasks 1 to 6 (cont.)
Task 2. Health System Assessment: Analyse needs, identify & analyse gaps:
See Guide for Assessment of Health Needs & Health Protection Resources (WP2)
Task 3. Strategic orientation and action planning:
See SH-CAPAC Guide for development of action plans (WP3)
Task 4. Coordination of the health response:
See SH-CAPAC Coordination Framework (WP1)
See SH-CAPAC Resource Package for ensuring access (WP4)
See SH-CAPAC Online training module (WP5)

17. Health coordination team Tasks 1 to 6(cont)
Task 5:Monitoring and evaluation
Identify information management and communication specialist (from onset)
Regularly collect and update minimally required information ( key indicators to be agreed on by team) and update information system
Focus on information for action that will inform national and decentralised health planning
Consolidate information from other teams/stakeholders .
Evaluate progress made towards the achievements of the set objectives
Evaluate the functioning of the coordination mechanism.

18. Health coordination team Tasks 1 to 6 (cont.)
Task 6:Information sharing, communication and advocacy
Focus on information for action that will inform (inter) national and decentralised health planning
Provide internal feedback to all partners of the health coordination mechanism and to the national coordinating body using a standard reporting format at a frequency determined by the context and agreed by team members
Frequently report to those (inter)national and local bodies
Provide information for external communication to media and public, highlighting advantages to all ( i.e. a program for gender based violence set up for refugees may benefit the general population if non existent)
Risk communication
Respect confidentiality

19. ) Compulsory Activity 3 (CA3): exercise: strengthening or creation of a coordination team (participants from the same country are encouraged to work together to reinforce the team approach)
STEPS
Indicate your country and level of work ( national, subnational, institutional).
Indicate which ministry/organization leads the process of coordinating the overall response to the influx of migrants.
Indicate who is responsible for the health response
Describe the type of health coordination that exists ( if any) with emphasis on your level of work (Use the table on the next slide to map all stakeholders* involved)
*Include internal and external stakeholders at your level of work ( national, subnational
or institutional)

20. Who are the players? Mapping of stakeholders
what
where
weaknesses
strengths
,Include yourself, internal and/or external stakeholders at your level of work ( national, subnational
or institutional) .

21. ) Compulsory Activity 3 (CA3): exercise: strengthening or creation of a coordination team (participants from the same country are encouraged to work together to reinforce the team approach): (continuation)
STEPS 5. Suggest what in your opinion would strengthen health coordination ( can be the creation of a coordination team or the modification of the existing one). 6. Indicate the team composition, roles and responsibilities and lines of communication. Think of existing personnel (not a wish list).

22. You can use the Unit forum for questions …
Thank you!
We recommend you to watch the video ”For the birds” (3:39 minutes ):
You can use the Unit forum for questions …
Pictures: Andalusian Childhood Observatory (OIA, Observatorio de la Infancia de Andalucía) 2014; Josefa Marín Vega 2014; RedIsir 2014; Morguefile 2014.

23. 4. References
1.WHO Health cluster guide; June cluster/resources/publications/hc-guide/en/
2. Global Health Cluster partners ’survey report 2012:
3. Reference module for cluster coordination at country level; IASC, July 2015:
015_final.pdf
4. Contingency planning guide IFRC: LR.pdf‎

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This presentation is part of the project ‘ / SH-CAPAC’ which has received funding from the European Union’s Health Programme ( ). The content of this presentation represents the views of the author only and is his/her sole responsibility; it can not be considered to reflect the views of the European Commission and/or the Consumers, Health, Agriculture and Food Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains.