1. Role of the OCMW in health care for African citizens Symposium on HIV testing for African migrants in Flanders Promotion of voluntary counseling and HIV testing September 14th, 2007

2. City of Antwerp 473 265 inhabitants 47 % single (and 8 % single parents) 26,5 % migrants 6,7 % EU 18,4 % non–EU citizens o7,5 % Morocco o1,8 % African origin (not Moroccan) Number of migrants increased by 20 % (from 2004 to 2007). Concentration of migrants in the north of Antwerp, around the Central Station, Borgerhout, Linkeroever, Kiel and Luchtbal (more than 30 %). Number of undocumented migrants?

3. City of Antwerp (2) Belgium has a two-tier benefit system: people receiving social assistance from the OCMW are considered less employable than those on unemployment benefit. Unemployment level in the city of Antwerp is 12,4 % (Flanders averages 6 %). People who benefit from the OCMW: 3 times more in the city of Antwerp than on average in Flanders. More non-EU citizens benefit social assistance: Antwerp average 2,1 % Belgian average 1,3 % 10 % non-EU citizens (Antwerp)

4. OCMW: legal context The general mission of the OCMW is to provide means for everyone to have a humain existence. Financial means: tax payers money The mandate of the OCMW for undocumented migrants is limited to: assist in provision of urgent medical care; establish whether parents are able to answer the needs of their minors. Urgent medical care includes: ambulant care; hospital care; preventive medicine; curative medicine.

5. OCMW Antwerp Social benefits on a monthly base : 6 740 persons. Non-Belgians: Morocco (611), Serbia-Montenegro (274), Russia (148), Turkye (121), Armenia (146). July 2007: 1 017 files on urgent medical care: Moroccan: 195, Serbia-Montenegro: 113, Armenia: 58. Other African countries (more than 10) : Nigeria: 53, Ghana: 39, Cameroon: 34, Congo: 34, Algeria: 26, Senegal: 22, Sierra Leone: 21, Sudan: 20, Liberia : 14, Angola: 13, Somalia: 10, Egypt: 10 July 2007: 282 new demands for urgent medical care. Less than 10 % has been refused.

6. Assistance to health care For people receiving social benefits from the OCMW, we want to ensure they get the medical attention they need. We assist in getting national health insurance (which is compulsary). We encourage people to consult one family doctor. How? through campaigns; financial incentives (reimbursement or direct payment of these family doctors); Higher costs for unwanted conduct (e.g. consulting emergency services).

7. Urgent medical care: conditions Certificate of a medical doctor that the medical assistance is urgent and is foreseen in the official RIZIV nomenclature. The undocumented migrant lives in the city of Antwerp. The undocumented migrant has no financial means. Examination of the health insurance status in the home country (for some nationalities).

8. Urgent medical care Expenses for urgent medical care are reimbursed to the OCMW by the federal government on the following conditions: Proof of a thourough social investigation Is he/she residing in Antwerp? Where did he/she reside before the medical attention was needed? Does he/she have no means of living? Does he/she have a medical insurance in the country of origin? Did someone sign a declaration and garantueed to pay all costs? The medical care is foreseen in the RIZIV nomenclature. No reimbursement of costs of staff, administration, logistics … Total cost of the social centre Plein for staff and logistics in 2006: 889 254 euro.

9. Challenge Assistance in the provision of urgent medical care for undocumented migrants (who are already residing in Antwerp and who are without means) is our legal mandate. We definitely do not want to encourage medical tourism.

10. HIV prevention: role of the OCMW HIV-testing for undocumented migrants is possible under following conditions: urgency certificate delivered by a medical doctor; he/she is residing in Antwerpen; he/she has no means for living; he/she has no insurance in his home country;   when these conditions are met, the federal government reimburses the expenses. Treatment of AIDS: same conditions. But to prevent medical tourism, we will thoroughly investigate if the person has been residing in Antwerp for some time.

11. HIV prevention: role of OCMW (2) In the past we spread information (leaflet) on HIV-prevention and distributed condoms (to undocumented migrants) via an OCMW social centre. In general we encourage pregnant women to attend medical control. We plan to provide training for the social workers on HIV- prevention. We plan to inform family doctors on conditions and procedures to be followed (for all clients). We need to examine whether the actual procedures concerning urgent medical care can be simplified. We plan to work together with experts to develop strategies to promote voluntary counselling and HIV testing.

12. Improving accessibility of primary health care for vulnerable citizens in Antwerp: Enhance collaboration within the social profit sector and health care providers; Adjust the health care offer, taking in account the expectations of the public; Changing from health prevention to health promotion based on the living standards and values of vulnerable people. Creating conditions for sexual health promotion: role of the OCMW

13. Integrating a neighborhood network of focal health points with social health support teams: Analyze triggers through contact with people during social assistance; Put problem areas into perspective of the neighborhood; Use these problem areas to guide a structural social health dialogue; Put structural urban health problems on the agenda of decision makers.