Advocacy
The tops of the flops – the tops of the tops
Amsterdam 26th February 2015
MdM International Network
BE: BELGIUM Doctors of the World:
FLOP: AMU for undocumented migrants
- AMU (full specific health coverage for UDM) exists since 1996
but deterioration since 2008.
Our message:
- Now: need better harmonization with local authorities
- Long term: universal coverage with centralized system
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Many stakeholders (local, regional, federal) in complex
hierarchy: difficulties to build simple messages
-
Difficult to build a coalition within civil society
Short win with local authorities but very fragile
BE: BELGIUM: Doctors of the
World: TOP: Green Book- White Book
- Green book: more than 30 contributors (health system actors
+ NGOs actors): shows problems in access to healthcare.
January 2014
- Conference with all the actors to discuss the green book.
Over 350 participants. March 2014
- White book with 5 actions point . September 2014
1. Process with mainstream actors + civil society
2. White book included in declaration of new government.
3. Process still « on going » with follow up committee
BG: BULGARIA: - Health and sexuality education in
the mandatory school curriculum: FLOP
 20 years of efforts of NGOs, UN agencies and even the
ministry of Health
 Long path of failures and successes, several times being
THAT close
 Hearings in Parliament, work with MPs and Ministry of
Education, mobilizing partners resources, petition in
Internet…
 Lack of political will
 Actually the battle goes on – in the new Law of school
education is foreseen a special educational standard
“Health, civil and intercultural education”
 Strong oppositional movements, bad tricks in public space
BG: BULGARIA: The success: Roma Health Mediators
(RHM) - from NGO initiative to state policy: TOP
 Roma Health Mediators – the bridge between vulnerable
communities and health and social services; Roma – the biggest
minority in Europe, difficult access to health services and state
institutions
 What we achieved with our 10 years of advocacy efforts:
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the profession got into the official list of Ministry of Labour
RHM are civil servants – in municipalities, paid by the Ministry of Finance
Education – in Medical colleges; approved curriculum, certificates
Selection criteria selected by a commission
Lifelong learning,
National Network established in 2007
The model is developing
CA: CANADA: Doctors of the World: FLOP
Coffee meetings on nutrition and anxiety
• A group of staff & volunteers organised a thematic group
meeting with migrants on nutrition and anxiety in our office.
• Very few attendees and no interest to participate in these
meetings. These subjects were not a priority and migrants
were not willing to openly discuss their anxiety
CA: CANADA: Doctors of the World: TOP
Pregnant women & access to perinatal care
• Staff & volunteers undertook a tour of all major hospitals with obstetrics
departments in Montreal area.
• Meetings with doctors, nurses, clinical & administrative staff.
• Discussions on pregnancy and childbirth for precarious migrants.
• Looking for solutions to minimize risks of complications as well as abuse and
obstetrical violence towards uninsured women.
Information and dialogue with obstetrical teams opened doors for better
understanding of the realities uninsured pregnant women face.
Challenges:
1. reach financial staff to negotiate "acceptable packages" for women before labor,
thus minimizing risks.
2. obtain health coverage for all precarious pregnant women regardless of their status.
DE – GERMANY Doctors of the World: FLOP
• Access to care for UDM: Targeted advocacy towards specific
decision makers
• Official letter to new health minister after general elections in
Germany regarding access to health for people without papers
• Lots of work to get invitation for meeting with state secretary
• High input low outcome
• To influence decision makers we must be bigger or act together
with other organisations
DE – GERMANY Doctors of the World: TOP
Common political campaign with other grass root stakeholders
• Political campaign for the abolition of „German asylum seekers benefit
law” as it was UNFAIR
• Credibility through wide spectrum of participating organisations
•
and social structures
• Big audience
• Common understanding of problems
• Specific website, flyer, activities and messages
• Specific objective with defined time frame
EL: GREECE – Doctors of the World
Flops
Difficulties when dealing with the instability of the political
situation:
• MPs change quite often
• There is no result/effective solution after the meetings &
discussions
• Not even on urgent issues & needs for access to health care:
lack of vaccines, lack of medical personnel, first reception
service of migrants at the entry points of Greece.
DE – GERMANY Doctors of the World: FLOP
• Access to care for UDM: Targeted advocacy towards specific
decision makers
• Official letter to new health minister after general elections in
Germany regarding access to health for people without papers
• Lots of work to get invitation for meeting with state secretary
• High input low outcome
• To influence decision makers we must be bigger or act together
with other organisations
EL: GREECE – Doctors of the World - Tops
• Access of children to health care: meetings with Greek MPs, representatives of
the CoE, directors of public hospitals and representatives of the municipalities
concerning the barriers in the access of children to health care.
• First Reception Service of migrants / Entry points of migrants in Greece:
meetings with Greek MPs and representatives of the Greek ministries and the
W.H.O concerning the reception of migrants at the entry points of Greece where
MdM Greece is present (Chios, Lesvos).
• Access to medicines: invitation from the MEP Kostas Chrysogonos at the
European
Parliament
(event
‘’Can
we
afford
our
medicines?
Situation & solutions to the access to medicines crunch in Europe”).
• MdM Greece was awarded by the Academy of Athens for its humanitarian aid in
Greece and abroad.
ES: SPAIN – Médicos del Mundo: Flop:
The law excluding people from Access to Healthcare: still on
Remains valid despite broad social refusal (NGOs, health professionals…)
 Publication of the report “Two years of health reform: more human lives at risk” on the
World Health Day (7th April) & on anniversary of law RDLey 16/2012 (20th April).
Communication success.
Agreement with Parliament groups to sign a Pact to suppress the law as soon as the
political equilibrium in Congress has changed.
Granada Declaration to take concrete steps to protect the health of migrants and
ethnic minorities in Europe (5th EUPHA European Conference on Migrant and Ethnic
Minority Health- Granada - April 2014. Press conference (sept 2014)
 Continuous actions to denounce effects of limited access to care.
BUT still no results
ES: SPAIN – Médicos del Mundo: TOP:
Stopping the law Project suppressing the right to Termination of Pregnancy
» Most
restrictive project against women’s rights in 25 years :
destruction of Spanish model on gender equity.
» Big mobilization of health professionals, 2 years fighting against the
law.
» MdM International Network has run actions (FR, NL, UK, US):
Campaign Names not Numbers, exhibitions, demonstrations, street
actions, collection of signatures… Right of each woman to decide if &
when to have a child.
» Figures released: 50 000 women die/year of unsecure abortion, 50% of abortions
with no medical supervision…
» Participation to international meetings at United Nations, to the CEDAW report &
activism among Spanish NGOs.
FR: FRANCE: Doctors of the World: FLOP
• Since 1999 constant advocacy to include specific health
coverage for undocumented migrants (AME +- 180 000
persons) into universal health coverage (CMU +- 5 millions
persons).
• Fight since 2002 against specific law against sex workers :
criminalisation of passive solliciting. We also oppose new law
project penalizing clients. Penalisation of passive solliciting
hasn’t disappeared & clients are not penalised.
FR: FRANCE: Doctors of the World: TOP
• In 2012, a new restriction was voted: undocumented migrants
had to pay 30€ to obtain specific full health coverage.
• We obtained in 2013 from new government free access to
specific health coverage (AME)
IE: IRELAND: MIGRANT RIGHTS CENTRE IRELAND : FLOP
Campaign for the right to change employer
What did we learn?
 The ask was too broad (Overhauling the Work Permit System)
 It is important to have a series of target that build on each other and
are realistically achievable
Building the base for political lobbying takes time
 Partnerships with power-holders work better than confrontation
Sometimes going public is not the best option
IE: IRELAND: MIGRANT RIGHTS CENTRE IRELAND: TOPS
1.
The Campaign to Criminalise Forced Labour
2. The Ratification of ILO Convention on Domestic Work
What worked well?
• Strategic Litigation
• Public Direct Action
• Media Work and Awareness Raising
• National and International Partnerships
• Individual Advocacy
• Political Lobbying
IT – Italy – NAGA - Flop
Missed inclusion of the right to health for irregular
minors in the Conclusions of the Council of Health
Ministers of European Union, December 1, 2014.
IT – Italy – NAGA - Top
Possibility of enrollment in the Regional
Health Service also for all irregular minors.
JA: Doctors of the World Japan: FLOP
Pleading to obtain protection for homeless also during
winter holidays:
• Difficult to build a well functioning network,
• Cooperating with groups in conflict: bad for networking & for
people in need,
• We need more strategy to choose groups for alliance. Need to
organize clearly decision process & functional action.
JA: Doctors of the World Japan: TOP
Back ground
Action
Outcome
- No public assistance service available during long
winter holidays (10days).
- advocacy action in the Ministry of Health by a
network of various organizations.
- claimed government’s responsibility during 10 days
winter holiday for the people in need
Tokyo metropolitan government sent a note in order to
ensure all structures are ready to protect the homeless
during winter holidays.
Tokyo officially acknowledged the responsibility of
its Administration regarding protection for
homeless people even during holidays.
NL: NETHERLANDS Doctors of the
World: FLOP
the
» Problem? A man (mental
health issues), in migrant detention due to be
expelled to Liberia: Ebola was a serious threat. The lawyer needs
documentation for the Court.
» How? DRI sent a medical statement on the severe risks to expel an
unstable (or any) person to an Ebola-area. Also a NL hospital/
specialist gave a statement.
» Result? The court did not take into account these medical
statements, nor the actual Ebola-risk, BUT postponed the verdict
based on the weak health of the client due to a hunger strike.
NL: NETHERLANDS Doctors of the
World: TOP
the
» Problem?
in 2014 new regulation: all UDM should pay 5€ cash for
medicines. Some chronical patients & multi-medicine-users have problems
paying & sometimes stop (part of) their treatments. Support organizations and
other volunteers pay the 5€ to avoid problems, but cannot sustain this.
» How? Advocacy in cooperation with other support organizations at
Municipality level (Amsterdam): presenting monitoring data on number of
patients, amount of money paid by support organizations. Case studies
presented to representatives of left-wing parties. Publication of a press
release.
» Result? Municipality installed emergency fund to cover the 5€ paid by
support organizations in 2014. A covenant will be signed between municipality,
pharmacies and support organizations, to manage the fund in 2015.
NO: NORWAY: Health centre for undocumented migrants: Flop
• Drown in the debate between asylum activists and the
government.
• 3 biggest parties are strict in these issues.
• Profiled debate over years about regularisation of
children who have been in Norway for a long time.
• Very difficult to create a humanitarian space within our own
country.
• Never managed to discuss the issue with health politicians.
NO: NORWAY: Health centre for undocumented migrants: Tops
• Before creating the Health Centre the organisations managed
to change the Immigration Act: giving humanitarian
care to undocumented migrants was not illegal any more.
• We managed together with the doctors & nurses Unions to
push the government to clarify the rights to health care
for undocumented in the Norwegian law.
• Advocacy based on experience in a very polarized debate
PO: POLAND : SIP- FLOP
• Ban on immigration detention of children was not
introduced into the Polish law (migrant children can still
be detained)
• Still no identification procedures of PTSD/torture
victims (but the decision-makers are apparently working
on this issue)
PO - POLAND : SIP- TOPS
• Improvement of living conditions in detention centres in Poland;
the prison-like regime reduced
• Some positive changes in the immigration law:
Possibility to apply the alternatives to detention
The court has to consider the best interest of the child each time
when deciding about detention
Ban on detention of the traumatised/victim of tortures UDM
(before it concerned only Asylum Seekers)
RO: ROMANIA CARUSEL: FLOP
Project: EP’s FEMM report on sexual exploitation and prostitution (January - February 2014)
Aim: Convince Romanian MEPs not to vote for the report on sexual
exploitation and prostitution (Mary Honeyball, UK MEP) on criminalization of
clients of sex workers.
Strategy: coordination with International Committee on the Rights of Sex Workers in
Europe (ICRSE) (email, Skype); letter to Romanian MEPs; organization of a meeting
with feminists NGOs to gain allies; send the letter signed by 16 Romanian NGOs
and other update documents to Romanian MEPs by email; call the Romanian
MEPs; send the letter against criminalization of SW clients, signed by 560 NGOs
and 94 researchers, to all MEPs.
Results: Out of 33 Romanian MEPs:
o 20 Romanian MEPs voted “for”…; 2 Romanian MEPs voted “against”; 2
Romanian MEPs abstained from voting; 9 Romanian MEPs were non-voters.
RO: ROMANIA CARUSEL: TOP
Project: Roma Harm Reduction Advocacy Project (November 2013 – October 2013)
Aim: to sensitize the National Agency for Roma (NAR) and 2 Roma NGOs (Impreuna
Agency and Romani CRISS) in regards to the drug use situation in the community,
especially regarding the vulnerability, stigma and discrimination that Roma drug users
face.
Strategy: dissemination of key human rights and public health messages, trainings for
sensitizing and capacity building, field visits for data collection, outreach to community
leaders, supervision of activities.
Results:
o the 2 NGOs are providing financial assistance for CARUSEL to purchase harm reduction
supplies and technical expertise to report human rights violations against all drug users
o the needs of Roma drug users – including culturally appropriate harm reduction
activities – are addressed in the national strategy and action plans of National Antidrug
Agency
Source: “Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations”, WHO, July 2014, Annex 5 – “On
the ground: Programs serving the needs of key populations (case studies)”
SI: SLOVENIA: The worst experience
During lobbying to sign the European declaration of health
professionals (Towards non-discriminatory access to health care)
in 2010,
the Medical Chamber of Slovenia was not ready to support and
promote the declaration with excuse that medical workers should
anyhow respect the Code of medical ethics and that this was
enough.
SI: SLOVENIA: The best experiences
Slovenian Philanthropy has established good
cooperation with the Ministry of Health.
In most cases the Ministry provides payment
of medical services for beneficiaries of the clinic
for people without health coverage (co-founded
by Slovene Philanthropy),
on the basis of professional opinion of expert
worker of the clinic.
UK: United Kingdom – Doctors of the World
FLOP: law changes
• Day to day lack of knowledge of entitlements in NHS Englanddifficulty escalating and getting ownership
• Initial focus on primary care then announced A&E and ‘further
primary care’ charges
• 150% of charge for non-EEA migrants-Department of Health
didn’t explicitly consult on this
• ‘Below the line’ – public opinion
UK: United Kingdom – Doctors of the World TOPS
• Ongoing dialogue with Department of Health
• Deferring later stages of programme
• Publishing a report with Demos shifting the frame of the debate
• Influencing the Lords• Information sharing with Home Office
• Guidance
• Potential for further exemptions-support from colleges on children
US: USA Doctors of the World : Challenges
Limited Advocacy Activity
• New chapter, new
domestic project
• Healthcare & immigration
crowded advocacy fields
• Focusing on local effortse.g. Columbia study and
report:
• Citywide press
• Local political
involvement
• Further publication
Argentina Belgium Canada France  Germany Greece Italy  Japan Luxembourg Netherlands Portugal  Spain Sweden
Switzerland United Kingdom United States of America
MdM DRI - International Network - FLOP
Advocacy towards European institutions
CONCRETE measures for VACCINATION
- Not enough follow-up (got lost in too many different
-
advocacy topics)
Difficult subject due to middle-class resistance (anti-pharma
scepsis) + anthroposophic EPHA members blocking a
common position
Not enough time to create alliances with other civil society
partners – health professionals
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Argentina Belgium Canada France  Germany Greece Italy  Japan Luxembourg Netherlands Portugal  Spain Sweden
Switzerland United Kingdom United States of America
MdM DRI - International Network: TOP
Advocacy towards European institutions
High European visibility of our topics, with relatively few human
resources (1,5 FTE), e.g. increasing # of speaking slots at high-level
policy events
- All ‘representation’ work is rooted in concrete field expertise,
brought by field experts + unique data collection (Observatory)
- ‘smart’ alliances (both formal and informal) with other NGOs,
institutions, civil servants etc.
- MdM is regularly asked for contribution, no more need to run after
stakeholders
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