Building ‘muscle memory’
Strengthening national health capacity through the EU funded ‘RM Child-Health’ initiative for refugee and migrant children.
The ‘RM Child-Health’ initiative has supported work across five European countries to strengthen the capacity of national health systems to meet the health needs of refugee and migrant children. As the programme draws to a close, we review its impact on that capacity, recognizing that a health system that works for vulnerable children is a health system that works for every child.
Support from the ‘RM Child-Health’ initiative has reinforced and enhanced health systems across five European countries (Bosnia and Herzegovina, Bulgaria, Greece, Italy and Serbia), helping them to deliver the high-quality services that every child needs, regardless of where they come from.
This €4.3 million initiative, launched in 2020 by the European Union Directorate-General for Health and Food Safety, has aimed to strengthen the capacity of health systems to deliver health care to refugee and migrant children so that no child is overlooked or left behind. This has been crucial for overcoming the obstacles that have confronted so many refugee and migrant families when trying to access health care.
As the initiative ends, an independent evaluation has found that it has succeeded in its goal of strengthening the capacity of national authorities. In particular, the Initiative has helped to enhance access to mental health and psycho-social support (MHPSS), life-saving immunization, services to prevent and respond to gender-based violence (GBV), and services for maternal and new-born health care and nutrition.
Targets exceeded in all five countries
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Number of refugee and migrant children who access, with UNICEF support, health checks and referrals to public healthcare services, including to immunization. |
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Bosnia and Herzegovina: Target = 1200. Reached = 3484. Bulgaria: Target = 500. Reached = 1419. |
| Number of refugee and migrant children who participate in UNICEF-supported psychosocial support sessions and referral to specialized mental health services. |
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Italy: Target = 250. Reached = 725. Serbia: Target = 500. Reached = 2036. |
| Number of refugee and migrant children who participate in UNICEF-supported gender-based violence (GBV) prevention activities and referral to national authorities’ GBV response services. |
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Bulgaria: Target = 200. Reached = 450 Greece: Target = 300. Reached = 518 Italy: Target = 150. Reached = 450 Serbia: Target = 500. Reached = 828 |
| Number of refugee and migrant children who access, with UNICEF support, mother, and child healthcare, including infant and young child feeding counselling. |
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Bosnia and Herzegovina: Target = 1400. Reached = 3338 Greece: Target = 950. Reached = over 3000 |
Building trust
One major challenge tackled by the Initiative has been a lack of trust in health services on the part of refugees and migrants. According to research by UNICEF in Bulgaria, this lack of trust had also been compounded by negative attitudes from health providers, cumbersome and bureaucratic systems, unavoidable financial costs (for services that fall outside the state-covered health budget), and over-crowded accommodation that heightens health risks.[1]
The Initiative set out to build trust and confidence, recognizing that many refugees have come from contexts where health care may be costly, unreliable or, at worst, entirely absent. In essence, nothing builds trust and confidence in health care more than health services that are accessible, flexible and that work and for the people they serve. In particular, the evaluation found that the provision of both mental health and psychosocial support (MHPSS) and physical health services helped to build trust with refugee and migrant communities and meet their needs in a holistic and efficient manner. The availability of cultural mediators who could accompany women and children not only increased their access to public social and health services, but also improved the quality of the services delivered.
Mental health and psychosocial support
The evaluation finds that the initiative has gone much further than expected in some areas, introducing services that had never been offered to refugee and migrant children before. One particular achievement has been the delivery of much-needed MHPSS services to refugee and migrant children in all five countries. In Bosnia and Herzegovina this was a major departure: prior to the initiative, the focus for mental health services was firmly on adults rather than children. In Bulgaria, the initiative has supported the mapping of MHPSS services, as well as referral mechanisms for asylum-seeking and refugee children who need specialized psychiatric support. In Italy, the initiative supported the mapping of best practices and ‘what works’ in MHPSS services for refugee and migrant children, as well as referral mechanisms.
Support for paediatric services
In Bosnia and Herzegovina, the ‘RM Child Health’ Initiative set out to guarantee access to a comprehensive range of paediatric services for all refugee and migrant children, including the provision of dental and ophthalmological services.
For some children, such as 10-year old Maisa[2], originally from Iran, the change has been truly transformational. Back in 2020, the first year of the Initiative, she was fitted with a pair of eyeglasses at an ophthalmologists in Cazin, having been referred there by a team from UNICEF and the Danish Refugee Council. With funding from the Initiative, she chose a pair of purple-framed glasses that she took ‘home’ with her to the Sedra reception centre in Bihać. She would, she said, wear them all the time. A pair of glasses might have seemed like a small thing, given the scale of need among refugee and migrant communities, but for Maisa, this was a pivotal moment that would enhance her view of the world around her.
Veronika Vashchenko, UNICEF Deputy Representative for Bosnia and Herzegovina, reports that UNICEF has provided continuous support for such services with the support of the ‘RM Child-Health’ initiative:
“Thanks to the financial support of the EU General Directorate of Health (DG Santé), “more than 2,500 children benefited from improved access to paediatric health care in 2021, and more than 1,800 infants, children and parents had access to health and nutrition services through mother and baby corners.”
Other successes have included ensuring immunization for refugee and migrant children. Again, this was a major step forward in Bosnia and Herzegovina where, prior to the Initiative, refugee and migrant children were not being routinely vaccinated against potentially lethal diseases. The extension of immunization services to include them has obvious benefits for the wider population, closing a critical gap in the prevention of infectious diseases. In Serbia, the Initiative supported the development of guidelines for the immunization of refugee and migrant children.
Gender-based violence
The Initiative has supported the delivery of GBV prevention and referral services to women and girls across all five countries. In Greece, for example, this has included the mapping of GBV service providers and referral mechanisms to state-run shelters and counselling centres. The work of UNICEF’s implementing partner, Melissa, has been notable for empowering women through group therapy and the development of a code they can use to ask for help and protection. Women have also been provided with tablets that they often call “Melissa’s eyes in their house”, feeling safer in the knowledge that they can use them to record domestic violence if need be.
Prevention and networking
A strong health system is a preventive health system, and the Initiative has supported a range of prevention activities since it was launched. In Serbia, for example, UNICEF has been able to build capacity not only to respond to substance abuse among refugee and migrant children and adolescents, but also to create a more proactive, preventive environment. This allows service providers to respond to urgent cases, while also providing them with tools to better identify and refer the children and adolescents who are at risk.
Finally, the Initiative has helped to create and strengthen vital cross-sectoral, multidisciplinary networks and referral mechanisms across governmental and non-governmental actors. In particular, these link protection, nutrition and health, recognizing that a strong health system relies on collaboration that goes far beyond the health sector itself.
Its emphasis on system strengthening has supported the expansion of capacity in situations where these systems have been over-stretched. This can be seen on the island of Lesvos, Greece, where human resources in state-run facilities have faced serious constraints in meeting the demand for health care, and where partnership with Reception and Identification Centres has proved crucial.
The Initiative’s preventive, cross-sectoral and comprehensive approach to health is helping to build long-term resilience. One concrete example can be seen in Italy, which has seen more refugees arriving from Greece and Turkey, rather than via the usual North Africa route. What’s more, refugees are arriving in different locations, such as Calabria and Sardinia, rather than Lampedusa in Sicily. Some have landed on the shores of Roccella Ionica, for example, a small town of just 6,000 inhabitants in Calabria, where health facilities are limited. However, UNICEF and its partners have been able to draw on the experience of the ‘RM Child Health’ Initiative to create a resilient response by:
- mapping existing services at the regional level so partners can refer new arrivals
- setting up services at the disembarkation point as well as reception facilities, so that a team at the disembarkation point can gather key information about the number, sex, age and health of any unaccompanied and separated refugee and migrant children and send it ahead to the team at the reception centre
- establishing networks of local authorities, service providers and other non-governmental organizations to facilitate and speed up the response
- drawing on the Initiative’s previous experience on the provision of psychological first aid, the type of information refugees and migrants need, and activities to reduce stress so that local partners have ‘ready-made’ solutions to offer new arrivals
- establishing a partnership with an association of cultural mediators that has a roster, enabling partners to mobilize mediators who speak different languages and who understand diverse cultures.
All of the resources created by the Initiative over recent years to strengthen health systems are now permanent and can be mobilized to respond to any future external health shock. As one stakeholder noted, the Initiative has helped to create “muscle memory” that can be used by governments and non-governmental organizations in the future to respond to pandemics, influxes of refugees and migrants, and emerging health needs.
This story is part of the Project ‘Strengthening Refugee and Migrant Children’s Health Status in Southern and South Eastern Europe’, Co-funded by the Health Programme of the European Union (the ‘RM Child-Health’ initiative). It represents the views of the author only and is her sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the European Health and Digital Executive Agency (HaDEA) 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.
https://www.unicef.org/eca/stories/strengthening-national-health-capacity-refugee-and-migrant-children
[2] Name changed to protect privacy.
