The humanitarian-public healthcare nexus: an analysis of the power relations shaping the implementation of the Law on Urgent Medical Aid in Belgium

BackgroundAlthough migrants constitute an important proportion of the European population, little is known about migrant sexual health. Existing research mainly focuses on migrants’ sexual health risks and accessibility issues while recommendations on adequate sexual health promotion are rarely provided. Hence, this paper explores how refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands define sexual health, search for sexual health information and perceive sexual health determinants.MethodsApplying Community-based Participatory Research as the overarching research approach, we conducted 223 in-depth interviews with refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. The Framework Analysis Technique was used to analyse qualitative data. We checked the extensiveness of the qualitative data and analysed the quantitative socio-demographic data with SPSS.ResultsOur results indicate that gender and age do not appear to be decisive determinants. However, incorporated cultural norms and education attainment are important to consider in desirable sexual health promotion in refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. Furthermore, our results demonstrate that these migrants have a predominant internal health locus of control. Yet, most of them feel that this personal attitude is hugely challenged by the Belgian and Dutch asylum system and migration laws which force them into a structural dependent situation inducing sexual ill-health.ConclusionRefugees, asylum seekers and undocumented migrants in Belgium and the Netherlands are at risk of sexual ill-health. Incorporated cultural norms and attained education are important determinants to address in desirable sexual health promotion. Yet, as their legal status demonstrates to be the key determinant, the prime concern is to alter organizational and societal factors linked to the Belgian and Dutch asylum system. Refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands should be granted the same opportunity as Belgian and Dutch citizens have, to become equally in control of their sexual health and sexuality.

The literature on immigrant transnationalism and on irregular immigration suggests irregular migrants engage relatively little in transnational activities because of the obstacles associated with their legal and economic statuses. Drawing on participant observation and in‐depth interviews with a diverse population of irregular migrants in Belgium and the Netherlands, however, I shall demonstrate in this article that irregular migrants do indeed engage in various transnational activities. Moreover, I argue that a focus on aspirations helps to understand why irregular migrants either do or do not engage in specific transnational activities. Distinguishing between investment, settlement and legalization aspirations, I analyse whether and for what reasons irregular migrants carry out economic, social and political transnational activities. I conclude that future research on transnationalism and on the incorporation of irregular and regular migrants alike could benefit from contextualizing the agency of migrants by taking their aspirations into account.

Most Belgian citizens are covered by comprehensive medical insurance (AMI). Due to recent and significant undocumented immigration, an increasing number of patients have no health coverage. They may, however, qualify for "Urgent Medical Aid" (AMU). Still, some patients have no health insurance of any kind (no coverage). This study, conducted in a hospital which cares for a large number of undocumented immigrants, looked at the proportion of women benefiting from either "AMI" or "AMU" and those who have "No coverage" and addressed obstetrical outcomes in each of the three groups. Design: retrospective observational study. We collected data of all singleton pregnancies and deliveries from the CHU St Pierre maternity ward, between 1.10.2015 and 31.3.2016. Women were classified, prospectively, by our social workers, as having access to AMI, AMU or having "No coverage". Demographic, obstetrical and perinatal data were systematically collected and validated on a day-to-day basis and comparisons were then made between the three groups of women. During the follow up period, 1.439 women had access to regular social security (AMI) (87%), 142 women (10%) to AMU and 38 (3%) had no coverage. Women who benefited from AMU were younger and their first prenatal consultation occurred later in the pregnancy than it did for women with AMI. There were no significant differences in obstetrical outcomes between the three groups of women. Urgent medical aid (AMU) confers a certain normalisation of obstetrical care to pregnant women who would otherwise have no access to health care coverage.

This article explores the positions of Civil Society Organizations (CSOs) on providing humanitarian assistance to European Union (EU) citizens with limited rights to public welfare services in Norway through 19 interviews with leaders of humanitarian services run by CSOs in Oslo. The article shows a contradictory picture. On one side, leaders expressed awareness and concern regarding risks associated with the provision of humanitarian services in a country with a comprehensive and ambitious welfare state. These include creating parallel welfare services based on charity rather than rights, and that such services may hide structural violence, or give it a humane façade, thus potentially contributing to the legitimacy and preservation of exclusionary welfare policies and practices. On the other side, service leaders were sceptical towards granting all EU citizens equal access to public welfare benefits and services and reported advocating for the expansion of humanitarian services rather than inclusionary rights for all EU citizens in Norway. We suggest that this may indicate an acceptance of the EU’s principle of conditionality of welfare support on employment history, and a limited willingness or capacity of CSOs to engage in advocacy that could contribute to alternative narratives about EU citizenship and challenge structural exclusion.

PROTOCOL: Participation, inclusion, transparency and accountability (PITA) to improve public services in low- and middle-income countries: a systematic review.

This article builds on previous studies concerning the question of street-level bureaucracy, an expression coined by Lipsky (1980) – Street-Level Bureaucracy. Dilemmas of the Individual in Public Services (New York: Russel Sage Foundation) – to highlight the importance of the discretionary power that professionals in public agencies exercise during the implementation of laws, standards and guidelines. Discretion may depend on the need to compromise between the limited resources available and the claims of citizens, or between administrative policy directives and assessments, on the one hand, and their interpretation by “street-level” bureaucrats, on the other. This article focuses on the dilemmas that labour inspectors face when dealing with employment irregularities involving domestic workers. Based on nine months of observations in a local office of the Italian Labour Inspectorate, it aims to understand how labour inspectors make use of their discretionary power when the workplace is the home. This article connects studies of street-level bureaucracy with the new institutional organisational analysis, focusing on the isomorphic pressures from the institutional field in which the labour inspectors operate, together with the manner in which such pressures shape labour inspectors’ discretion. Through this connection, the article aims to extend the scope of both theories.

SUMMARY This paper explores the perceptions of social disqualification or 'stigma' that service users attrib uted to public child welfare services in random samples of service users taken from the Netherlands, a part of Spain (Catalonia) and a part of the United Kingdom (Wales). It was found that, in all three samples, foster and residential care invoked the greatest sense of stigma, while the health related and the preventive family services were perceived as the least stigmatizing types of public welfare services. Comparative analysis further revealed that a positive attitude towards the use of public welfare services, a perception of supportive or non-stigmatizing social norms regarding the use of such services, and a perception of public welfare services as helpful correlated in all three samples with higher levels of user satisfaction and involvement in the services. It was further found that, in the British and Spanish samples, a positive attitude towards public welfare services, as well as a perception of public welfare services as helpful for their recipients, were the predominating factors promoting higher levels of satisfactory user involvement in the services, while, in the Dutch sample, a perception of supportive social norms was the factor that most promoted satisfactory user involve ment Most countries of the Western world have an array of welfare services to help troubled children and their families. Such services typically range from preventive child and family services, through day-care and foster care for children, to residential treatment of children with behavioural difficulties

The purpose of this study is to suggest the criteria to public welfare service support for improving life quality of the haenyeo (female divers) through analyzing public welfare services and desires of the haenyeo in Jeju, Busan, and Tongyeong. Accordingly, research period was set from May 11 to June 21, 2010. The haenyeo in each region of Jeju, Yeongdo-gu (Busan), Tongyeong-si were selected as subjects. Recording of interviewing methods was used to recognize current status of public welfare. We analyzed by comparing desires of the haenyeo to public welfare services by dividing them economically, medically, educationally, and culturally. As a result of researching public welfare services to the haenyeo in each region, supports for protection of diving, growing area, public welfare service for aged diving haenyeo, and medical service were conducted. Tewak protecting net, Seonjinji visiting, and welfare facilities are supported in Busan-si but there is no support in Tongyeong-si. Therefore, desires of the haenyeo to such public welfare services are as followings: First, the desires of the haenyeo in Jeju to economic supports are indicated as supports for haenyeo experience spot, diving suit, and overseas visiting. To educational supports, it is indicated as supports for identity education, diving disease prevention education, and foreign language education. To cultural supports, it is indicated as supports for installation of welfare hall and exchange visit to foreign haenyeo culture. Second, in Busan, there were desires to establish changing room and fishery sales lot and to support diving suit as for economic supports, desires to support diving disease and medical benefits as for medical supports, desires to education of diving skill as for educational supports, and desires to establish welfare hall and haenyeo museum as for cultural supports. Third, in Tongyeong where public welfare services to the haenyeo are very poor, there were desires to support diving suit and to support changing room as for economic supports, as same as in Busan, desires to support diving disease and medical benefits as for medical supports

Individuals who reside in a country without regular authorisation generally find it difficult to access public medical services beyond emergency treatment. Even in countries with universal healthcare, there is often a gap between rights on paper and their implementation. Civil society organisations (CSOs) fill this gap by providing medical services to vulnerable populations, including irregular migrants. What, if any, are the ethical dilemmas that arise for CSO staff when delivering such services in countries with universal healthcare? Under what conditions do these dilemmas arise? And what strategies do CSO staff use to mitigate them? We answer these questions using 40 semi-structured interviews with CSO staff working in two European countries with high levels of irregularity, universal healthcare provisions on paper, and significant differences in approaches and availability of public services for irregular migrants: Italy and Spain. We show that CSO staff providing medical services to irregular migrants in places with universal healthcare coverage face a fundamental dilemma between humanitarianism and equity. CSO staff respond to the humanitarian belief in the value of taking all possible steps to prevent or alleviate human suffering, thus promoting a decent quality of life that includes access to both emergency and non-emergency care. In doing so, however, they run the risk of substituting rather than complementing public provisions, thereby preventing governments from assuming responsibility for these services in the long term. Individuals who acknowledge the existence of this dilemma generally oppose the creation of parallel structures; that is, services specifically developed for irregular migrants outside the public system; while those who ignore it essentially subscribe to a tiered system, giving up on considerations of equity. We argue that CSOs involved in the provision of healthcare to irregular migrants do not simply provide services; they also play an inherently political role.

The article examines the role of non‐governmental organisations (NGOs) in addressing regional inequalities for ensuring access to public services in Slovenia. Drawing on recent mixed methods research and theoretical frameworks, we analysed the capacity and impact of Slovenian NGOs in improving access to public services. The data show regional differences in the availability of these services. Areas poorly covered by public social services are identified, and the possibilities of NGOs increasing users’ overall access to public services are explored. Results of the study show that NGOs have an important role in advocating for marginalised populations, promoting inclusion, and assuring that services are distributed equitably. We propose practical strategies to more effectively address the deficiencies regarding services. Key recommendations include improving NGOs’ infrastructure, professionalisation, and collaboration with different professional groups to ensure that isolated and vulnerable populations have access to programmes. The results also stress the need for policy support to strengthen NGOs (often users’ closest allies), and to promote their role in complementing public sector initiatives. By leveraging the strengths of NGOs in community involvement and flexible service delivery, Slovenia can move towards more inclusive and accessible public services. The presented system‐level analysis, combined with community insights reported by NGOs, contributes to the ongoing discourse on social inclusion and provides valuable insights and actionable strategies for policymakers and other stakeholders to make social welfare more accessible for all.

Although women, young people and refugees are vulnerable to sexual and gender-based violence (SGBV) worldwide, little evidence exists concerning SGBV against refugees in Europe. Using community-based participatory research, 223 in-depth interviews were conducted with refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. Responses were analysed using framework analysis. The majority of the respondents were either personally victimised or knew of a close peer being victimised since their arrival in the European Union. A total of 332 experiences of SGBV were reported, mostly afflicted on them by (ex-)partners or asylum professionals. More than half of the reported violent experiences comprised sexual violence, including rape and sexual exploitation. Results suggest that refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands are extremely vulnerable to violence and, specifically, to sexual violence. Future SGBV preventive measures should consist of rights-based, desirable and participatory interventions, focusing on several socio-ecological levels concurrently.

Research on the impact of post-migration experiences on the mental health of migrant populations has shown a predictive link between post-migration living difficulties and psychological distress. While many studies have focussed on refugees and asylum seekers, there is a considerable gap in the literature concerning undocumented migrants. The aim of this study was to assess the differences in mental health between documented and undocumented migrants in Belgium. It identified the post-migration difficulties encountered by these two groups and measured their impact on their levels of trauma, resilience, anxiety, depression and their assumptive world. This study involved 69 participants, aged 18 to 68 years, who were either documented or undocumented resident in Belgium. Our data collection included the Post-Migration Living Difficulties Checklist for the measurement of post-migration difficulties, the Posttraumatic Stress Disorder Checklist - DSM-V version for the measurement of trauma, the World Assumptions Questionnaire for the measurement of the assumptive world, the Hopkins Symptom Checklist-25 for the measurement of depressive and anxiety disorders and the Adult Resilience Measure - Revised for the measurement of resilience. Our analyses showed that the mental health of undocumented migrants was poorer than that of documented migrants, with higher levels of trauma, anxiety and depression, a more negative assumptive world, a lower sense of control and lower total and personal resilience. Our results also revealed that post-migration living difficulties were more severe and more numerous for undocumented migrants, and that they were associated to different themes in both groups. The fact that post-migration experience plays such an important role in the mental health of migrant populations raises significant clinical, political and societal considerations. Furthermore, it would appear that undocumented migrants represent a distinct migratory group with their own specificities in terms of migration journey and mental health.

This paper presents an evaluation index system of public service quality, which contains 35 indexes from the dimensions of the output and effect. Based on data from 2010 to 2017 in 12 coastal provinces and cities of China, this paper assesses public service quality by using the methods of entropy weight order preference similarity to the ideal solution (TOPSIS) and analyzes the effect of fiscal transparency on public service quality. The results show that the public service quality in the 12 coastal provinces and cities of China studied is relatively high, and fiscal transparency has a positive effect on public service quality. This analysis showed that an increase of 1% in fiscal transparency would lead to an increase of 0.0323% in the quality of public services. Fiscal transparency contributes to the quality of public services by improving the scale of investment and the efficiency of public services expenditure; this is because fiscal transparency can increase the expenditure on public welfare services and curb official corruption. Furthermore, the proposed evaluation index can enable government administrators to take the necessary steps on the appropriate dimensions to improve public service quality. This study can provide some guidelines for other countries, especially to improve public service quality by increasing fiscal transparency.

The aim of this paper is to highlight use of different digital solutions and systems in two public welfare offices in Norway, and the impact this has on recently graduated students work practices in the public welfare services. This requires new knowledge, theories, methods and ethics related to professional work. In this paper, innovation theory is used to promote the understanding of work practices using technology in public welfare services. When using a qualitative method, the advantages and disadvantages of using current digital practices among newly graduated workers in public sector are analyzed. The results are linked to activities that can contribute to realizing potentials for further innovation in public welfare services through the use of technology. There is a need for educational institutions to facilitate educations for more knowledge and competence in public welfare services regarding digital competence, technology, and innovation to be able to help develop the service in the future.KeywordsInnovation diffusion theoryPublic benefit organization decision makingDigital work practicesUse of technology

Our study focuses on the challenges facing sustainable urban mobility in the megacity of Sao Paulo. We aim to explore the panorama of active mobility initiatives, proposing to analyze the relationship between urban commons and innovation in public services. We selected the Reduced Speed Zone and Complete Street initiatives, which aim to improve road safety conditions (public services focused on common infrastructure), active mobility and access to public transport, and may also potentially help to reduce noise levels, improve air quality (social dilemmas/common issues/negative externalities) and reduce greenhouse gas emissions (global commons). Based on an analytical model for interpreting innovation in services, considering competences and techniques originating from the provider (municipal government) and users (through civil society organizations), our findings identified innovations at a local level within infrastructure treatment for pedestrians. These public services were introduced in a participatory process and a collective re-appropriation of urban space. The projects contribute to the development of service provider competences, related to various interactions with civil society, resulting in a systemic view with regard to the uses, local dynamics and behavioral aspects of the users themselves. Service provider techniques may be both temporary and permanent intervention methodologies, besides methodologies for project impact evaluations. These techniques are associated with tactical urbanism as a technique for temporary urban interventions. User techniques were identified for application of the propensity score-matching method, which aims to evaluate the impacts of an instance of intervention through the comparison of groups, as well as through technical inspections and local interviews. The relationship management generated relational and organizational competences for civil society organizations. However, despite the advances indicated by the analyzed experiences of active mobility – highlighting the role of civil society organizations – and by some progress made in the regulatory framework, innovative practices have been restricted to the treatment of infrastructure for pedestrians, a change of speed limit for vehicles, and horizontal signaling to mark the perimeter of these areas. Therefore, there is a large-scale potential for the continued introduction of innovations regarding the improvement and scale gains of public services for pedestrian mobility, promoting participatory restructuring as a form of (re)appropriation of urban public spaces by its own users, improving the current negative externalities and social costs of urban mobility.