1. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems The experience at Hospital Punta de Europa, Algeciras, Cádiz SPAIN

2. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems 1994199519961997199819992000200120022003 TOTAL185511953916686356165719599122330881394048443085429524 Europa66966456600415921257354032785994112619154589165037 Africa4704502746728389131182024854241557975515658807 Asia17371722128019452549358710127110411155913915 América53946304470693231572434863180316214349221580191577 Oceanía203024386997203242201188 -Fuente: Estadística de Variaciones Residenciales. INE.

3. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems

4. Área de gestión sanitaria del Campo de Gibraltar MFH EU NETWORK Kaiser-Franz-Josef-Spital, Vienna, Austria Immanuel-Krankenhaus GmbH, Rheumaklinik Berlin-Wannsee, Berlin, Germany Kolding Hospital, Velje-Kolding, Denmark Hospital Spiliopoulio Agia Eleni, Athens, Greece Hospital Punta de Europa, Algeciras-Cádiz, Spain Turku University Hospital, Turku, Finland Hôptial Avicenne, Paris, France James Connolly Memorial Hospital, Dublin, Ireland Presidio Ospedaliero della Provincia di Reggio Emilia, Reggio Emilia, Italy Academic Medical Center, Amsterdam, The Netherlands Hospital Nossa Senhora do Rosário (HNSR) Barreiro/Lisbon, Portugal Uppsala University Hospital, Psychiatric Centre, Uppsala, Sweden Bradford Hospitals NHS Trust, Bradford, U.K. AT DE DK EL ES FI FR IT NL PT SV UK IR

5. Área de gestión sanitaria del Campo de Gibraltar Common issues differences in hospital's ownership differences in demography of the clientele differences in degree of settlement of populations... Some areas were common concern all over the EU

6. Área de gestión sanitaria del Campo de Gibraltar Problem Areas Communication Austria Denmark Finland France Germany Greece Ireland Italy Portugal Spain Sweden The Netherlands United Kingdom

7. Área de gestión sanitaria del Campo de Gibraltar Problem Areas Understanding cultural differences Austria Finland France Germany Ireland Italy Portugal Spain Sweden

8. Área de gestión sanitaria del Campo de Gibraltar Problem Areas Lack of structures for migrant health Austria Denmark Finland Germany Greece Italy Sweden The Netherlands

9. Área de gestión sanitaria del Campo de Gibraltar Problem Areas Lack of adequate patient information Austria Denmark Finland Germany Greece Ireland Portugal Spain Sweden

10. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems Our health authority district Geography 234,000 inhabs. Two hospitals 10 primary health care centers 10 primary health care centers Located at the very south of Europe Located at the very south of Europe At only 18 Km from Africa At only 18 Km from Africa

11. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems Our Health authority district demography We attend more than 120,000 emergencies/year two million people cross the Strait of gibraltar from Spain to Morocco and backwards. We attend people that irregularly entered our country Population in transit Population with irregular entrance Settled population

12. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems Why did we get involved in MFH? answers to the challenge of a growing diversity in clinical settings service must be sensitive to the demands of social forces adapted to the population it serves

13. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems WHAT OBSTACLES WILL HAVE TO BE OVERCOME IN ORDER TO MEET THE NEEDS OF THESE PATIENTS?

14. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems EQUITABLE IS NOT ALWAYS EQUAL

15. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems LANGUAGE CULTURAL KNOWLEDGE ORGANIZATION

16. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems LANGUAGE CULTURAL KNOWLEDGE ORGANIZATION

17. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems LANGUAGE CULTURAL KNOWLEDGE ORGANIZATION

18. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems LANGUAGE CULTURAL KNOWLEDGE ORGANIZATION

19. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems LANGUAGE CULTURAL KNOWLEDGE ORGANIZATION

20. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems in addressing this issue, have in mind The response Managerial Staff Clientele National non nationals

21. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems in addressing this issue, have in mind Local policies hospital ownership integrate within the political framework of the health system on equality, diversity and access to it equality in access public ownership free health care - even in irregular entrance

22. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems EQUITABLE IS NOT ALWAYS EQUAL

23. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems Different geographical context administrative situations language Culture Religion economic situation Demography geographical distribution

24. Área de gestión sanitaria del Campo de Gibraltar WHAT IS (ARE) YOUR LOCAL POPULATION(S) LIKE?

25. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems WHAT CHANGES IN WORK ROUTINE WILL BE NECESSARY?

26. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems BAD NEWS! there are no magic recipes, tailor to your local situation

27. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems GOOD NEWS!! LEARN WERE YOU ARE LEARN FROM THE EXPERIENCES INCLUDE CULTURAL DIVERSITY AS A TOPIC TO BE ADDRESSED OVERCOME THE BARRIERS LOOK FOR AN ORGANISATIONAL CHANGE DEVELOP PARTNERSHIP STRATEGIES DEVELOP A SUPPORTING GROUP

28. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems GOOD NEWS!! LEARN WERE YOU ARE LEARN FROM THE EXPERIENCES INCLUDE CULTURAL DIVERSITY AS A TOPIC TO BE ADDRESSED OVERCOME THE BARRIERS LOOK FOR AN ORGANISATIONAL CHANGE DEVELOP PARTNERSHIP STRATEGIES DEVELOP A SUPPORTING GROUP

29. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems Part A: MF characteristics of service General resources to facilitate communication and information Accessibility, pre-entry and entry into hospital Whilst in hospital Hotel services Medical / nursing treatment Discharge MF patient education / health promotion / empowerment

30. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems Part B: MF Support System General quality system in hospital Does your hospital have a written MF policy ? MF budget Is a specific MF management structure in place? Involvement of migrant representatives in organisational change Marketing of MF internal marketing of MF (at the hospital) External marketing of MF (to the public) MF training and education for staff

31. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems Part B: MF Support System Monitoring of migrant clientele Monitoring of migrant-specific service outcomes Method/approach used for monitoring migrant data Monitoring of MF impact on organisational quality Reporting system on MF activities and impact Partnerships and partner alliances

32. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems GOOD NEWS!! LEARN WERE YOU ARE LEARN FROM THE EXPERIENCES INCLUDE CULTURAL DIVERSITY AS A TOPIC TO BE ADDRESSED OVERCOME THE BARRIERS LOOK FOR AN ORGANISATIONAL CHANGE DEVELOP PARTNERSHIP STRATEGIES DEVELOP A SUPPORTING GROUP

33. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems GOOD NEWS!! LEARN WERE YOU ARE LEARN FROM THE EXPERIENCES INCLUDE CULTURAL DIVERSITY AS A TOPIC TO BE ADDRESSED OVERCOME THE BARRIERS LOOK FOR AN ORGANISATIONAL CHANGE DEVELOP PARTNERSHIP STRATEGIES DEVELOP A SUPPORTING GROUP

34. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems GOOD NEWS!! LEARN WERE YOU ARE LEARN FROM THE EXPERIENCES INCLUDE CULTURAL DIVERSITY AS A TOPIC TO BE ADDRESSED OVERCOME THE BARRIERS LOOK FOR AN ORGANISATIONAL CHANGE DEVELOP PARTNERSHIP STRATEGIES DEVELOP A SUPPORTING GROUP

35. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems GOOD NEWS!! LEARN WERE YOU ARE LEARN FROM THE EXPERIENCES INCLUDE CULTURAL DIVERSITY AS A TOPIC TO BE ADDRESSED OVERCOME THE BARRIERS LOOK FOR AN ORGANISATIONAL CHANGE DEVELOP PARTNERSHIP STRATEGIES DEVELOP A SUPPORTING GROUP

36. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems GOOD NEWS!! LEARN WERE YOU ARE LEARN FROM THE EXPERIENCES INCLUDE CULTURAL DIVERSITY AS A TOPIC TO BE ADDRESSED OVERCOME THE BARRIERS LOOK FOR AN ORGANISATIONAL CHANGE DEVELOP PARTNERSHIP STRATEGIES DEVELOP A SUPPORTING GROUP

37. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems GOOD NEWS!! LEARN WERE YOU ARE LEARN FROM THE EXPERIENCES INCLUDE CULTURAL DIVERSITY AS A TOPIC TO BE ADDRESSED OVERCOME THE BARRIERS LOOK FOR AN ORGANISATIONAL CHANGE DEVELOP PARTNERSHIP STRATEGIES DEVELOP A SUPPORTING GROUP

38. Área de gestión sanitaria del Campo de Gibraltar MFH EU NETWORK Kaiser-Franz-Josef-Spital, Vienna, Austria Immanuel-Krankenhaus GmbH, Rheumaklinik Berlin-Wannsee, Berlin, Germany Kolding Hospital, Velje-Kolding, Denmark Hospital Spiliopoulio Agia Eleni, Athens, Greece Hospital Punta de Europa, Algeciras-Cádiz, Spain Turku University Hospital, Turku, Finland Hôptial Avicenne, Paris, France James Connolly Memorial Hospital, Dublin, Ireland Presidio Ospedaliero della Provincia di Reggio Emilia, Reggio Emilia, Italy Academic Medical Center, Amsterdam, The Netherlands Hospital Nossa Senhora do Rosário (HNSR) Barreiro/Lisbon, Portugal Uppsala University Hospital, Psychiatric Centre, Uppsala, Sweden Bradford Hospitals NHS Trust, Bradford, U.K. AT DE DK EL ES FI FR IT NL PT SV UK IR

39. Área de gestión sanitaria del Campo de Gibraltar Common issues differences in hospital's ownership differences in demography of the clientele differences in degree of settlement of populations... Some areas were common concern all over the EU

40. Área de gestión sanitaria del Campo de Gibraltar The 5 most frequent problem areas Communication Cultural differences Lack of structures for migrant health Lack of documentation + research Lack of adequate patient information number of mentions in all interviews (n=97, including multiple mentions)

41. Área de gestión sanitaria del Campo de Gibraltar The Amsterdam declaration –December 04 The Amsterdam declaration Towards migrant friendly hospitals in an ethno-culturally diverse Europe

42. Área de gestión sanitaria del Campo de Gibraltar The Amsterdam declaration –December 04 www.mfh-eu.net/conf/downloads/AmsterdamDeclaration2004.pdf

43. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems WHAT BENEFITS CAN BE EXPECTED FOR PATIENTS?

44. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems Increased quality of service For staff For patients For the organisation

45. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems For staff Reduce staff workload Increase staff skills to manage congflict Reduce the stress of staff during cross cultural encounters Reduce the opportunities to malpractice Increase level of comfort Increase level of knowledge

46. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems For patients A more person oriented service Reduce the opportunities of inadequate use of service Increase the level of comfort during hospital stay

47. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems For the organisations Integrate the hospital in a networking process Increase effectiveness Send a clear message to all stakeholders A less expensive and more sustainable health system

48. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems IN SHORT… LEARN NETWORK MARKETING

49. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems

50. Área de gestión sanitaria del Campo de Gibraltar The southernmost entrance to the European Health systems THANK YOU!.