Professional synergies for
interventions with
Excluded Population
an experience from some illegal
settlements in Madrid (Spain)
Arantxa Santa-Maria Morales
Carlos Sanz Acera
Shredding the title: Four axis
• Spain - Madrid–(Area 1 – Villa de Vallecas
District)
• Excluded Population in illegal settlements
• Interventions and services
• Professional synergies
AXIS 1: Madrid – Health Areas
AXIS TWO:
EXCLUDED POPULATION
HEALTH
RESOURCES
ISOLATION
LACK OF
MOBILITY
Lack of
DOCUMENTATION
SOCIOCULTURAL
DIFFERENCIES
ACCESS
APROPRIATE
USE
EDUCATION
RESOURCES
SOCIAL
RESOURCES
MANTAIN AND INCREASE
SOCIAL EXCLUSION
needs out of the usual assistance scope 
VILLA DE VALLECAS DISTRICT’S ILLEGAL SETTLEMENTS
Communities part of a bigger one
ACTORS (Each of them have a rol in the community)
PROFESSIONALS
TECHNICIANS WORKING IN:
RESOURCES
TERRITORY: Barranquillas and Cañada Real
INTERVENTIONS PERFORMANCE
SCIENTIST KNOWLEDGE
POPULATION
Citizens of illegal settlements
•
Cañada Real,
Barranquillas
MAIN CHARACTER
REALITY KNOWLEDGE
ADMINISTRATION
POLITICIANS
Delegate goverment of the
people
Local
Regional
State
MAKE PRIORITIES
ASSING RESOURCES
PLAN INTERVENTIONS
AXIS THREE
PROFESSIONAL
INTERVENTIONS
UP TO 1997
SEVERAL SERVICES
SPREAD OUT ACTIONS
DIFFERENT INSTITUTIONS
HARD TO COORDINATE
REGIONAL SERVICES
PUBLIC
HEALTH
TOWN
PLANNING
Epi HP
ANTIDRUG
AGENCY
NGOs
COUNCIL SERVICES
EDUCATION
IRIS
PRIMAR
Y CARE
CARE
MUNICIPALITY
HP
Council
Health
Centre
SOCIAL
SERVICES
SW & SE
“COMISIÓN DE POBLACIÓN EXCLUIDA”
Excluded Population Commission (CPE)
 Emerged as an initiative from Villa de Vallecas
District Health Council (Área 1 – Madrid)
 Its primary aim was to tackle some social and
health needs out of the usual assistance scope
 BIG PROBLEMS....
CPE OBJETIVOS
 To Analyse the social and health situation 
 To improve the coordination (P & I already involved)
 To optimise existent resources
 To prioritise interventions
 To research within Excluded Population
 To raise healthcare professionals’ awareness of an
unknown
or ignored reality
 To sensitise the public towards the socially excluded
METHODS
 Monthly
meetings
 Workgroups
 Combined actions
 Routine contact
 Democratic and consensus decision-making
 Resource-optimisation mentality
 Informal moments – interpersonal relations
SOME HISTORIC RESULTS
Several illegal settlements in the district :
•La Rosilla (1998-2000)
•El Pozo del Huevo (1998-2001)
•Cañada Real 1998-(…)
•Barranquillas 1999-(…)
• Situation analysis and needs assessment
• Vaccination campaigns
• Guide for Mediators (edition) and design of other specific training materials
• Health workshops (Women, drug users…)
• Access to medical card
• Coordinated combined interventions: Contact studies for Tuberculosis, Hepatitis
A clusters
• Coordinated efforts in scholarship process
• Inform the institutions about the urgency to tackle some situations, lack of
resources for tuberculosis management, arrival of the emergency care services to
the settlements…
SYNERGETIC EXAMPLES
1. ACCESS TO SANITARY CARD
2. CAÑADA REAL NEEDS ASSESSMENT report
1.
ACCESS TO SANITARY CARD
STARTING POINT
– A IMPORTANT PART OF THE POPULATION (CHILDS, PREGNANT WOMEN, TBC,
VIH …) CAN´T ACCESS TO SANITARY CARD
– THIS POPULATION CAN´T USE THE HEALTH RESOURCES NORMALLY, THEY
CAN´T EXERCISE THEIR HEALTH ASSISTANCE RIGHTS.
“ON CPE TABLE”
PROFESSIONALS NOTE THERE ARE SIMILAR SITUATIONS BETWEEN DIFFERENT
SETTLEMENTS (BARRANQUILLAS AND CAÑADA)
WORK IN DIFFERENT LINES
1. JOINT PROTOCOL TO SANITARY CARD FOR :
– PREGNANT WOMEN
– CHILDREN
– CHRONIC ILLNESS
2. EMERGENCY SITUATIONS: CONTACT PERSON IN CHARGE OF
REGIONAL SERVICES FACILITATES MEDICAL CARD.
3. COMMISSION FROM REGIONAL SERVICES WORKING IN A
HEALTH DOCUMENT PATHWAY FOR THE REST OF PEOPLE
WITHOUT IDENTIFICATION.
1.
CAÑADA REAL SITUATION ANALYSIS AND NEED ASSESSMENT
STARTING POINT
•MULTI-PROBLEMATIC REALITY (Childhood and human rights are violented)
•INTERVENTIONS AND REALITY KNOWLEDGE WERE PARCIAL. Each resource know and
interacted with its piece.
•INSTITUTIONS DIDN’T TACKLE THE PROBLEM.
NEED TO STUDY THE REALITY RAISE UP TO “CPE TABLE” (APRIL 2005)
TECHNICIANS STARTED THE NEEDS ASSESSMENT PROCESS
- Gathering information
- Circulate a questionnaire among the resources operating
- Fieldwork investigation
-Institutional data collection
- Workgroup
- Meetings
- Document set up and edition
A REPORT IS COMPLETED (JULY 2005)
DOCUMENT DISTRIBUTION
• RESOURCES (PROFESSIONALS)
• INSTITUTIONS (TECHNICIANS AND POLITICIANS)
PRESS TO GET THE PROBLEM TACKLED
…AND NOW
•
MADRID CITY COUNCIL APROVE TO WORK ON A INTERVENTION PLAN FOR
CAÑADA REAL
POLITICIANS USE THE NEED ASSESMENTS BUT DON´T CONSULT TO
TECNICIANS NEITHER TO POPULATION
•
KNOWLEDGE AND PERCEPTION OF REALITY IS MORE INTEGRAL
•
SYNERGIC PROCESS GROW, COORDINATION IS GETTING BETTER
•
WE HAVE A PRODUCT, ANOTHER STARTING POINT
•
WORK AROUND POSSIBLE INTERVENTION TRACKS
•
HOW TO SUM MORE RESOURCES TO THE PROCESS?
HOW TO ENGAGE EDUCATIONAL RESOURCES?
•
HOW TO INVOLVE THE PEOPLE IN A PARTICIPATORY PROCESS?
HOW DOES THE PEOPLE PERCEIVE THEIR OWN REALITY?
•
HOW TO CREATE COMMUNICATION CHANNELS AMONGST THE THREE
ACTORS?
INTERVENTION SUBJECT: THE COMMUNITY
GOAL : TO IMPROVE COMMUNITY’S CONDITIONS
SOCIAL INTERVENTIONS
•
•
•
•
Individual intervention
Groupal intervention
• Street work
COMUNITARY WORK
HEALTH
INTERVENTION
AREAS
SOCIAL CONDITIONS:
• EDUCATION
• EMPLOYMENT
• HEALTH
•
Primary care
• Specialised care
• (…)
• PUBLIC HEALTH –
HEALTH PROMOTION
•
HEALTH CONDITIONS:
• BIOLOGICAL
• PSICOLOGICAL
• SOCIAL
ULTIMATE OBJECTIVES
- To reduce inequities
-To promote better living conditions
- To make easy the access to the
resources
- To promote social & participatory processes
- To develop social and health policies
-To promote sustainable environments that
facilitate people to live healthy
INSTITUTIONAL UMBRELLA
TIME 4 PROCESS
COMMON GOAL
COLEADERSHIP
SHARED EFFORTS
NEED TO SOLVE
SWING
HARD NUCLEUS
SHARED FRUITS
+ FRESH AIR
SPACE FOR ALL
TANGIBLE FRUITS
OPEN KNOWLEDGE
+ RYTHM
MUTUAL
TRUST
HUMAN
RELATIONSHIPS
COMMITMENT
MUTUAL
RECOGNITION
HONESTY
ALTRUISM
“Synergetic Habits”
COMMON ORIENTATION OF WILLINGNESS
TERMS OF REFERENCEAWARENESS OF DIFFERENT TIMINGPERSEVERANCE
OBJECTIVES
FLEXIBILITY
CREATIVE
COMPETENCE
BIG COMMUNICATION FLOW
APPROACH
RESPONSIBILITY
METHODS
LISTEN AND VALUE
UNDERSTANDING THE SYNERGY VALUE
STARRING
NGOS
ACCEM (Asociación Comisión Católica de Migración)
Mercedes Bernardino Rodríguez.
Trabajadora Social
HEALTH SERVICES
Yolanda Bonilla Palomares. Trabajadora social Centro de Salud Rivas
Ruth Cabras Sánchez DUE C.S. Villa de Vallecas
Adriana Sarries Urzurrum Enfermera EAP Villa de Vallecas Marta
Fernández Núñez. Trabajadora Social. C.S. Entrevías
ASOCIACIÓN BARRO
Mª Antonia Martín García. Educadora
María García Onieva. Pediatra C.S. Entrevías
Ana Isabel Gudiño. DUE C.S. Villa de Vallecas
CRUZ ROJA
Alicia Esteban. Trabajadora Social
Concha Pozo Pino. Trabajadora Social C.S. Villa de Vallecas
Encarnación Ruipérez Rodríguez. DUE C.S. Villablanca
ISIDROBUS
Virginia Ruescas Mecinas. Trabajadora Social
María Jesús Calvo Mayordomo Directora Enfermería Atencion Primar
Julia Cecilia Navazo Subdirectora Médica Atencion Primaria.
UNIVERSIDA
Jaime Alvarez Presidente.
Concepción Pozo Pino Trabajadora Social EAP Villa de Vallecas
Ana Miquel Gómez Directora Médica SUMMA 112
ASOCIACION EL FANAL
Rosa Gómez Jiménez
Paloma Jover de Celis
Arantxa Santa-Maria Morales. MIR de M. Preventiva y Salud Pública
Jose Zarco Montejo. Jefe de la Unidad Docente de Medicina de
Familia. Representante en la CPE de la Gerencia de Atención Primaria.
TOWN PLANNING: INSTITUTO DE REALOJO E INTEGRACIÓN
SOCIAL
(IRIS)
Javier Alonso Diez. Coordinador CPC Madrid Sur, UTS Santa Catalina y Barranquillas
Héctor Fernández de Carrascosa. Educador Social Santa Catalina y Trigales
Mª José Muñoz Pedregal. Trabajadora Social Santa Catalina y Trigales
Carmen Paniagua Marcos. Trabajadora Social Cañaveral
Carolina Parra Simón. Trabajadora Social Barranquillas Y Cañada Real
Carlos Roca Sierra. Educador Social Barranquillas y Cañada Real
STARRING
MADRID COUNCIL
SOCIAL SERVICES
Carlos Sanz Acera. Educador Social. SS SS. Junta Municipal de Villa de Vallecas
Gemma Pau Ruiz. Educadora Social. Servicios Sociales. Junta Municipal de Villa de Vallecas
Concha Martín Gayubo. Trabajadora social. Servicios Sociales. Junta Municipal de Villa de Vallecas
Belén Ruiz Cubero. Trabajadora Social. Servicios Sociales. Junta Municipal de Villa de Vallecas
Rosa Cerviño de la Fuente. Jefe del Departamento de Servicios a la Ciudadanía de Vicálvaro.
Montserrat Díaz Palacios. TS del Centro SS SS Entrevías. Junta Municipal de Puente de Vallecas
MUNICIPALITY HEALTH CENTRE
Luz Carmelo Martínez. Trabajadora social del CMS Vicálvaro
Carmen Barcenas Gutiérrez. Pediatra CMS (Centro Madrid Salud) Villa de Vallecas
Javier Capdepon Serrano. Coordinador CMS Villa de Vallecas
Laura Pérez. Trabajadora social de los CMS de Puente y Villa de Vallecas
STARRING
PUBLIC HEALTH & HEALTH PROMOTION - AREA 1
Victoria Cid Deleyto. Jefa de Sección de Sanidad Ambiental e Higiene Alimentaria.
Margarita García Barquero. Jefa de Sección de Prevención y Promoción de la Salud.
Mª José López Limiñano. Técnico de Sección de Prevención y Promoción de la Salud.
Silvia de Ramón de Zarate. Técnico de Sección de Prevención y Promoción de la Salud.
Silvia Sánchez Buenosdías. Técnico de Sección de Prevención y Promoción de la Salud.
Félix Villarreal del Pozuelo. Técnico de Sección de Prevención y Promoción de la Salud.
OTHER COUNCILS’ SERVICES
EDUCATION
Pablo Fernández Díaz. Técnico de educación (Rivas)
Vito Martínez Latorre. Equipo Directivo.
CENTRO ENSEÑANZA INFANTIL Y PRIMARIA (CEIP) JULIAN
BESTEIRO
Mar Jiménez Crespo EQUIPO DE ORIENTACIONPSICOPEDAGOGICA GETAFE
Cristina López Cantebrán EQUIPO DE ORIENTACIONPSICOPEDAGOGICA GETAFE
SOCIAL SERVICES
Montserrat López Bayona. Educadora social. Servicios Sociales Municipales
MUNICIPALITIES HEALTH SERVICES
Jose Luis Sánchez Fernández. Jefe de Servicio de Sanidad (Rivas Council)
GRACIAS
Carlos Sanz-Acera
Arantxa Santa-Maria Morales
arantxa.santamaria@salud.ma
drid.org