Health services for asylum-seekers: evidence from countries of arrival, transit and destination

Abstract

Abstract Background Systematic assessments of health services for asylum seekers are relevant to identify strengths and weaknesses of responses to migration movements. Building on recent research, the presentation maps and summarises health service responses in Germany and six countries of the European Union and derives lessons learnt. Methods The presentation builds upon three pieces of evidence: 1. A health system assessment of Germany's response to refugee movements in 2015 using data from a national survey among public health services. 2. A scoping study of six EU countries in which 27 semi-structured in-depth interviews with first-line staff and health officials to collect information about existing guidelines and practices at each stage of reception in first-entry (Greece/Italy), transit (Croatia/Slovenia), and destination countries (Austria/Sweden). 3. A study assessing mental health care services in Germany from initial registration to follow-up after transfer in districts. Results The studies highlight system related shortcomings related to coordination of care, lack of standardisation, fragmentation of services and financing structures, inter- and sub-national governance structures, as well as limitations in communication and data collection systems that translate into poor health services, duplication of efforts, and discontinuity of care during the migration trajectory. Conclusions While the studies assessed the situation between 2015 and 2018, structural approaches, innovations and system level reforms will be needed to improve health system responses in the future. Such reforms, however, appear to be absent from the policy discourse so that increased efforts from the public health community are required to strengthen and improve health services for asylum seekers.