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Advocacy The tops of the flops the tops of the tops Amsterdam 26th February 2015 MdM International Network

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-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 - 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: FLOP : AMU for undocumented migrants

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-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 BE: BELGIUM: Doctors of the World: TOP : Green Book- White Book

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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

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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: 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

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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

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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.

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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

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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

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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.

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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

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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.

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ES: SPAIN Mdicos del Mundo: Flop: The law excluding people from Access to Healthcare: still on 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. Remains valid despite broad social refusal (NGOs, health professionals) 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

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ES: SPAIN Mdicos del Mundo: TOP : Stopping the law Project suppressing the right to Termination of Pregnancy Most restrictive project against womens 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.

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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 hasnt disappeared & clients are not penalised.

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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)

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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

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IE: IRELAND: MIGRANT RIGHTS CENTRE IRELAND: TOPS 1. The Campaign to Criminalise Forced Labour The Campaign to Criminalise Forced Labour 2.The Ratification of ILO Convention on Domestic WorkThe 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

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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.

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IT Italy NAGA - Top Possibility of enrollment in the Regional Health Service also for all irregular minors.

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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.

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JA: Doctors of the World Japan: TOP Back ground - No public assistance service available during long winter holidays (10days). Action - advocacy action in the Ministry of Health by a network of various organizations. - claimed governments responsibility during 10 days winter holiday for the people in need Outcome 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.

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NL: the NETHERLANDS Doctors of the World: FLOP 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.

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NL: the NETHERLANDS Doctors of the World: TOP 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.

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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.

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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

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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)

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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)

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RO: ROMANIA CARUSEL: FLOP Project: EPs 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. Source: http://carusel.org/blog/nu-modelului-suedez/

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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)

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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.

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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.

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UK: United Kingdom Doctors of the World FLOP: law changes Day to day lack of knowledge of entitlements in NHS England- difficulty 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 didnt explicitly consult on this Below the line public opinion

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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

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US : USA Doctors of the World : Challenges Limited Advocacy Activity New chapter, new domestic project Healthcare & immigration crowded advocacy fields Focusing on local efforts- e.g. Columbia study and report: Citywide press Local political involvement Further publication

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36 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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37 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