Swiss Red Cross Research Articles

Anti-SARS-CoV-2 total immunoglobulin and neutralising antibody responses in healthy blood donors throughout the COVID-19 pandemic: a longitudinal observational study.

Quantifying antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and neutralising antibodies may help to understand protection at the individual and population levels. Determination of neutralising antibodies using classical virus neutralisation tests (VNT) is considered the gold standard, but they are costly and time-intensive. Enzyme-linked immunosorbent assay (ELISA)-based surrogate VNTs (sVNT) or anti-SARS-CoV-2 spike protein receptor binding domain immunoglobulins (anti-S-RBD Ig) may be suitable alternatives to VNTs. We aimed to (a) explore the correlations between anti-S-RBD Ig, VNT, and sVNT measurements and (b) describe humoral immunity against SARS-CoV-2 after vaccination, natural infection, and vaccine breakthrough infection in healthy blood donors. We measured total anti-SARS-CoV-2 Ig in 5714 serum samples from 2748 healthy individuals visiting the Swiss Red Cross Blood Donation Centre in Basel from 03/2020 to 04/2022. We used the Elecsys®Anti-SARS-CoV-2 immunoassay (Roche) against the N- and S-receptor binding domain (RBD) proteins. In a subset of 548 samples from 123 donors, we conducted sVNTs against the Wuhan wild-type SARS-CoV-2 (SARS-CoV-2 Neutralizing Antibodies Detection Kit; Adipogen™). In 100 samples from 40 donors, we correlated sVNT and VNTs against the wild-type (D614G WU1) virus. Surveys were sent to the blood donors to collect data on their SARS-CoV-2 infection and vaccination status. Using this data, donors were categorised as "vaccination only", "infection before vaccination", "post-vaccine breakthrough infection", and "natural infection only". Our longitudinal observation study cohort consisted of 50.7% males with a median age of 31 years (range 18-75 y). Anti-SARS-CoV-2 N protein positivity rates per month indicate 57.1% (88/154) of the cohort was infected up to 04/2022. No differences in seropositivity were found between sexes, age groups, blood types (AB0 or RhD), and cytomegalovirus serostatus. We observed a high correlation between anti-S-RBD Ig and inhibition percentage (Spearman'sρ= 0.92, Kendall'sτ= 0.77, p <0.0001). We determined the sensitivity and specificity for the manufacturers' thresholds for detecting virus-neutralising effects and computed the "best" cut-off based on our real-world data. We categorised 722/1138 (63.5%) donors as vaccination only (82.3%), post-vaccine breakthrough infection (7.8%), infection before vaccination (5.8%), and natural infection only (4.2%). We observed a lower inhibition percentage in the natural infection-only group than in all other vaccinated groups. The infection before vaccination group had higher anti-S-RBD Ig titres after the first vaccine dose than the other vaccinated groups. In total, 57.1% of healthy blood donors were infected with SARS-CoV-2, but natural infection without evidence of vaccination seems to result in substantially lower neutralising antibody levels. An estimate of antibody neutralisation may be helpful to assess reinfection risk. Total anti-S-RBD Ig correlates with surrogate virus neutralisation test results, a surrogate for neutralisation; therefore, we suggest that total anti-S-RBD Ig may estimate the level of neutralising antibodies. The threshold for protection from an unfavourable clinical outcome must be evaluated in prospective clinical cohorts.

Jointly enclosed in-between: the collective meaning of liminality in refugees’ and other migrants’ mental health care

People on the move are increasingly immobilised between and within state borders, having left ‘there’ but not allowed to be fully ‘here’. This paper presents a nuanced examination of this state of enforced in-­betweenness, exploring how refugees and other migrants negotiate collective existence through, despite, and alongside liminality. Drawing on ethnographic data collected at a Swiss Red Cross psychotraumatology centre, the study identifies factors that impede and facilitate the formation of collective identities, with temporal and spatial liminality emerging as the most central collective experience for refugees and other migrants. The findings illustrate how therapists reinforce these bonds by fostering an idealised sense of therapeutic communitas that promotes unity in adversity. However, the paper refrains from reducing the collective significance of liminality to a mere act of defiance. Instead, it critically reflects on how refugees and other migrants forge collective connections within politically and legally imposed disconnection. It accounts for the paradox of refugees and other migrants making collective lives in liminality while confronting the always-imminent possibility of this very liminality dismantling their lives.

Community Perceptions of Facilitators and Barriers to Post Natal Care access in Rural Laos

Abstract Background The quality of Maternal, Neonatal and Child Health (MNCH) services delivered varies widely in Lao People Democratic Republic. Swiss Red Cross (SRC) provides support to the country to improve the quality of reproductive health services, enhance access, and positively change health behavior through the MNCH2 project. This implementation research was then undertaken aiming to identify factors affecting decision-making of women relative to accessing postnatal care (PNC) and explore opportunities for improving SRC programming. Methods From August 2020 to January 2021, 33 in-depth interviews and 6 focus group discussion (FGD) with 54 women were conducted. Women who had given birth in the last six months were purposively selected from several ethnic groups residing in Chomphet and Phonexay Districts in Luang Prabang province. Socio-cultural and behavioral factors affecting women's decision to access PNC were assessed during the interviews and FGD. Additional perceptions were gathered though interviews with the partners, health service providers, village heads, and external project stakeholders. Results Traditional practices such as smoking ritual, strict practice of keeping the baby in the house within the first three days, and the treatment and disposal of placenta were identified as the main barrier for women to access PNC. Perceived importance of these traditional practices, however, are affected by family hierarchy especially with older family members insisting on its practice. Economic, road conditions, and transport challenges were also identified as significant barriers. Conclusions Traditional practices and family hierarchy, together with physical and economic access limit women's capacity to engage with facility-based postnatal care. Thus, quality outreach with home visits are critical. Gender inclusive health education given not only to pregnant women but to all family members was also identified as critical and is recommended to improve PNC access. Key messages

Pédiatrie. Accès au lait de donneuses en Suisse et création de la première banque de lait maternel romande au CHUV : enjeux et perspectives

Mother's own milk (MOM) is ideal for infant growth and health. When MOM is unavailable, donor human milk (DHM), rather than infant formula, is recommended for at-risk, preterm or sick neonates (NN), in view of its protective effects. Human milk banks (HMB) collect, secure, process and distribute DHM. In Switzerland, there is insufficient and unequal access to DHM in the absence of a national policy framework. With the support of the State of Vaud, the CHUV and the Interregional Blood Transfusion of the Swiss Red Cross will open the first HMB in Romandy in 2022. This HMB offers an innovative system in Switzerland, based on complementary expertise, in order to guarantee the quality and safety of DHM and to support the promotion of breastfeeding and human milk donation.

Digital Health Intervention to Support Refugees in Switzerland.

Experiences of war and persecution often lead to mental health problems, resulting in post-traumatic stress disorders. In this work, we design a digital platform that aims at helping refugees coming to Switzerland by providing exercises for their mental health and information about daily life in Switzerland. In collaboration with the Swiss Red Cross (SRC), we collected requirements and developed a concept for information provision through in this platform. The architecture of a progressive web application (PWA) was identified as to best fulfill the given requirements. Based on the collected requirements mockups were created. In user interviews, we received feedback regarding the future system. We learned that the platform should include an avatar, which guides the user through the entire platform and asks questions. All texts should be accessible by a read-aloud function and exercises should be provided as videos. In summary, we learned that it is essential to involve the future user group in the development process since it is characterized by cultural diversity that has to be considered in the development and design. Enriched by this input, the next step is to realize the application in terms of a prototype.

Mutual learning on the local level: The Swiss Red Cross and the Village Health Committees in the Kyrgyz Republic

The importance of mutual learning between providers and recipients of development assistance has been emphasised for decades. Nevertheless, its practical implementation remains limited, primarily due to organisational issues and unequal power relations in development aid. Using the ‘design-thinking’ approach, this study demonstrates the possibility of mutual learning utilising the example of the Swiss Red Cross and the Village Health Committees in the Kyrgyz Republic. Based on the related project documentation and interviews with relevant partners, this article provides an insight into the factors enabling mutual learning in practice. It suggests that decentralisation of the organisation, its leadership and response to failures, continuous contact between provider and recipient of development assistance, and emphasis on local expertise contribute to learning. Although context-specific, these findings are essential to understanding the mutual learning in general and taking this phenomenon from theory to practice.

The challenges of impact evaluation: Attempting to measure the effectiveness of community-based disaster risk management

Although disaster risk management is becoming increasingly important in development cooperation, there is still a lack of robust evidence regarding its effectiveness. Few studies based on a counterfactual have been conducted in the fields of disaster management and disaster risk reduction. This article describes a methodological approach to enabling more rigorous evidence-based decision-making in community-based disaster risk mitigation, and notably for assessing the degree to which it increases preparedness for the adverse effects of hazards in vulnerable communities. The effects of actions designed to reduce disaster-induced loss, damage, injuries, fatalities and resource degradation were evaluated at a Swiss and Honduran Red Cross’ intervention area in Honduras. Our results show that the intervention has had a significant positive effect in three important areas of resilience: knowledge and preparedness (e.g., existence of an early warning system); social cohesion (e.g., community institutions); and management of natural assets (e.g., firewood consumption). Our findings indicate that the intervention program has enhanced the capacities of treated communities to prepare for future hazards and to respond in case of an emergency at both household and community levels.

Linguistic Needs and Language Support in Health Care Professions

In 2015 the Swiss Red Cross and the State Secretariat for Migration launched the SESAM project with the aim of training refugees and temporarily admitted persons as care assistants, thus offering them the chance of rapid integration into the Swiss labour market. The work-related language training posed a challenge. The present paper will give a rough outline of the SESAM project and present the concept of continuous profession-specific language support developed within the project. Additionally, this specific project should serve as a basis for a fundamental reflection on the content, didactic methods as well as the moral and ethical questions associated with language training for professional purposes.

Progress towards an appropriate pathogen reduction technology for whole blood in Africa

BackgroundInterest in an effective pathogen reduction technology (PRT) for whole blood (WB) tailored to address specific needs of limited‐resource settings is growing. The Swiss Red Cross Humanitarian Foundation (SRCHF) supports a clinical programme to promote PRT for WB in resource‐limited settings where rates of WB use and transfusion‐transmitted infections are high.Pathogen reduction technology for whole bloodCerus Corporation (INTERCEPT® Blood System) and Terumo BCT (Mirasol®) are investing in clinical trials for red‐blood‐cell (RBC) and WB PRT. The SRCHF selected the INTERCEPT WB PRT for its clinical programme in Africa based on data related to the INTERCEPT system's pathogen reduction effectiveness and the company's goal of producing a processing kit requiring minimal electricity.Adapting the INTERCEPT RBC PRT for WBThe INTERCEPT PRT for RBC and WB uses amustaline (0·2 mm) to irreversibly cross‐link nucleic acids and glutathione (GSH) (20 mm for RBC and 2 mm for WB) to quench unreacted amustaline. Laboratory and clinical trial results for the RBC PRT form the basis for the WB PRT. Preliminary studies have demonstrated preservation of RBC quality in amustaline/GSH‐treated WB. A Phase 1 safety trial in Côte d'Ivoire and development of a WB processing kit requiring limited electricity are described.DiscussionAssessing the clinical safety of a WB PRT under local conditions is a positive step in the development of a suitable WB PRT for low‐resource settings.

III.2. La Croix-Rouge suisse, Secours aux enfants. Les grandes figures de Justes et le sauvetage

By recommendation of the government, the Swiss Red Cross merged with the volunteer organisation Secours aux enfants (Children’s Aid Society) at the end of 1941, even though it had been involved in this issue since 1917. Between 1933 and 1939, Mathilde Paravicini, on behalf of the Comite suisse d’aide aux enfants d’emigres (Swiss Emigrant Children’s Assistance Committee), gave approximately 5,000 children of emigrants safe haven in Switzerland. Young Swiss men and women sided with the Republican cause during the Spanish Civil War alongside the Comite neutre de secours aux enfants d’Espagne (Neutral Assistance Committee for Spanish Children), a popular organisation known as Ayuda suiza. During the winter of 1939, they took care of Catalan, Spanish, French, and later Jewish children in southern France. By January 1940, they oversaw, as part of the Cartel suisse de secours aux enfants victimes de la guerre (Swiss Aid Association for Child War Victims), ten children’s homes, two infant care centres, and a nursery for mothers and young children. In the 1940s, nurses started setting up temporary health clinics in prison camps, where they took care of children and the elderly. The directors of the Swiss Red Cross, specifically the top officers in Bern, tried to stop young activists from saving Jews. Until the summer of 1944, Switzerland’s official policy did not accept refugees “solely for racial reasons”. The result was the tragic conflicts that occurred in southern France. The Red Cross and Children’s Aid Society failed to fulfill their humanitarian mission. The officers even refused to save 500 Jewish children from deportation to extermination camps. The organisation’s workers, however, stepped in to usher them to safety.The founder of the nursery in Elne, Elisabeth Eidenbenz, was recognised as a Righteous Among the Nations at Yad Vashem, alongside the nurse Friedel Bohny-Reiter, who saved Jewish children and adults at the Rivesaltes Camps, and her eventual husband, August Bohny, who protected Jewish refugees in the children’s homes in Chambon-sur-Lignon. Rosa Naf, Anne-Marie Im Hof-Piguet, Gret Tobler, and Sebastian Steiger, who saved adults and children in the La Hille children’s home, were also honoured at Yad Vashem, as well as Maurice Dubois, the director of the Swiss Aid Association for Child War Victims in southern France. The administrators of Yad Vashem declined to recognise the children’s home directors Ruth von Wild, Elsa Ruth, and Emma Ott, even though they also saved Jewish children and adults. In honour of her efforts to protect French refugees and children and bring them to safety in Switzerland, Mathilde Paravicini was awarded the Legion of Honour by the French government after the end of WWII.

Addressing fragility through community-based health programmes: insights from two qualitative case study evaluations in South Sudan and Haiti

BackgroundFragility can have a negative effect on health systems and people’s health, and poses considerable challenges for actors implementing health programmes. However, how such programmes, in turn, affect the overall fragility of a context is rarely considered. The Swiss Red Cross has been active in South Sudan and Haiti since 2008 and 2011, respectively, and commissioned a scoping study to shed new light on this issue within the frame of a learning process launched in 2015.MethodsThe study consisted of a document review, qualitative field research undertaken between June and August 2015 in South Sudan and Haiti, and two data triangulation/validation workshops. Semi-structured key informant interviews and focus group discussions included 49 purposively sampled participants who helped build a deeper understanding of what constitutes and drives fragility in the respective countries. Moreover, interviews and focus group discussions served to grasp positive and negative effects that the Swiss Red Cross’s activities may have had on the overall state of fragility in the given contexts.ResultsQualitative data from the two case studies suggest that the community-based health programmes implemented in South Sudan and Haiti may have influenced certain drivers of fragility. While impacts cannot be measured or quantified in the absence of a baseline (the projects were not originally designed to mitigate overall fragility), the study nevertheless reveals entry points for designing programmes that are responsive to the overall fragility context and contain more specific elements for navigating a more sustainable pathway out of fragility. There are, however, multiple challenges, especially considering the complexity of fragile and conflict-affected contexts where a multitude of local and international actors with different goals and strategies interfere in a rapidly changing setting.ConclusionsHealth programmes may not only reach their health objectives but might potentially also contribute towards mitigating overall fragility. However, considerable hurdles remain for aid agencies, especially where scope for action is limited for a single actor and where engagement with state structures is difficult. Thus, cooperation and exchange with other aid and development actors across the spectrum has to be strengthened to increase the coherence of aid policies and interventions of actors both within and across the different aid communities.

Addressing social determinants of NCDs through community mobilisation: comparative research for effectiveness assessment

An introduction: Since 2014, Swiss Red Cross has been running a “Community Action for Health” project in Belarus. Directly implemented by the Belarus Red Cross, the project is aimed at improving knowledge, changing attitudes and behaviour of the local population on such determinants of NCDs as physical activity and healthy nutrition via establishing Initiative Groups IGs in the communities. To identify effectiveness of the community mobilisation approach, a project end-line survey was done in March-July 2017. Theory/Methods: Community mobilisation was implemented in selected geographical areas of 5 pilot districts. Base-line data on NCD related knowledge, attitudes and behaviour of people living in the pilot districts was collected in 2014. The end-line data collection was organised using quasi-experimental method. 1866 respondents were organised in three target groups TGs: 417 IGs members and volunteers with full coverage; a sample of 385 systematic random sampling from 76,500 people in pilot communities covered by the IGs’ work; a sample of 1,067 people not covered by the IGs’ work multistage samplings with district stratification at the first stage, rural/urban stratification at the second stage from 208,411 people living in the pilot districts. First two groups were considered as experimental, the third one – as a control group. The end-line results were also compared with the base-line data. Results: Not only people directly involved in the IGs – members and volunteers, - but also people “covered” by the IGs’ work are more physically active ride a bicycle every day/few times a week 31.9% of “covered” population versus 19.2% of general population; go for a walk 71.4% versus 58.5% respectively. The IGs members/volunteers and the “covered” population reported switching to healthier diet 53.3% and 41.5% respectively and weight loss 29.2% and 20.1%. Discussions: How does the research - assess “spill over” effect of targeted interventions; - eliminates role of “external environmental factors” increased state attention to the NCD prevention over the recent years; - foster programme sustainability and development. Conclusions: The research showed a high degree of effectiveness of the community mobilization approach in improve both the health status and life quality improving subjective well-being, increasing communication of the population covered by the project activities. Survey results: broadly used for advocacy, played an important role in further geographical expansion of and stronger involvement of the state health institutions in community mobilization for NCD prevention. Lessons learned: Comparative analysis experimental and control groups made a stronger policy influence; Distribution of the information on the IGs work during interviews with the “non-covered” population target group 3 was a good strategy of involving new people/communities in NCD prevention. Limitations: Questions on subjective assessment of health and wellbeing change within the project time-frame were used only for the experimental groups. Difficulties in defining “covered” population target group 2 in the urban areas. Suggestions for future research Longitude survey, based on the existing questionnaire could be used to monitor longer-term impact of community mobilisation for NCD prevention.

Community elderly care enhances quality of life for peers

Introduction: 14% of Bosnia and Herzegovina BIH population is over 65 years old. Strategies and action plans that address the needs of the elderly population have not been adopted. Traditionally the family institute in caring for its aged is very strong, but has been diminishing rapidly due to economic issues and young people leaving the country. Since 2013 up-to-date; 150’000 people 5% have permanently left the country. Because of this many elderly people have been left without any type of care. Therefore, older people’s volunteering is a tool that fights social exclusion and promotes elderly inclusion and cohesion. In 2013, the Swiss Red Cross SRC started a project with the aim to increase the health and wellbeing of vulnerable elderly and disabled people in Tuzla Canton, BiH. In the frame of this project, participation and integration of the elderly was strengthened by building 20 Initiative Groups IG of over 1000 elderly people in two cities where the Red Cross RC Home Based Care HBC centres were opened. Description: The project actively involves local communities, health and social institutions and the RC in designing sustainable community care services. About 100 elderly volunteers in communities are dedicated to visiting the vulnerable and fragile who, due to limited opportunities and financial concerns, have certain restrictions in relation to assisted living. The reduced presence of traditional family care givers initiated a coordinated response that was organized by older people who are community and care orientated. The response includes activities on strengthening neighborhood elderly groups in providing visiting, psycho-social and administrative support. The RC has trained the elderly volunteers in accordance with the International Federation of RC minimum standards for HBC volunteers in order to provide better quality care for their peers. The designed community care social services are monitored by responsible RC HBC staff. Impact: The RC has been providing HBC services for up to 426 clients. 34% of clients are visited by elderly volunteers. This makes 27% of the total RC HBC services, amounting to 10’000 voluntary service hours. Elderly volunteers in conjunction with the RC provided the needed impulse towards community officials and authorities to respond and start co-financing services. Through this approach, the RC and elderly volunteers, enable the most vulnerable to maintain their physical capacities and receive an affordable service. Among others this approach increases the integration of marginalized elderly people in community life by re-establishing social ties. Conclusion: Social and health needs of the targeted population are satisfied. The joint efforts of neighborhood peer volunteers and the RC contributes to effective care and reducing care costs making services affordable to a larger group of elderly and increasing their quality of life. The costs of these services are 20% of the full service price provided by professionals as it includes only the costs of training and motivation for volunteers. Apart from providing care services, the community volunteers have a role in demanding and lobbying for the sustainability of HBC services.

La chirurgie de la cataracte à petite incision manuelle : experience d’un service régional de soins oculaires au Togo

In order to fight against blindness in the central region of Togo, a project was implemented in a partnership between the Ministry of Health and an international Non-Governmental Organization: the Swiss Red Cross. Cataract surgery underwent an annual audit of the research-action type, in order to improve the functional results of patients. One of the recommendations of these audits was the introduction of manual small incision surgery in place of the classic extracapsular technique. This study had for its objective to evaluate the functional results and follow-up of patients undergoing the new technique compared with quality standards of cataract surgery according to the World Health Organization. This study was carried out by retrospective analysis of records and operative reports of patients over twenty years of age undergoing manual small incision cataract surgery from June 2012to June 2015. Out of a total of 1292patients undergoing cataract surgery in the five districts covered by the project during the same period, 1003patients met the inclusion criteria (77.63%). Among the 1003cases, 504 (50.25%) were male, while 499 (49.75%) were female. The overall mean age was 62years. The cataract was total in 84.65% of cases and partial in 15.35% of cases where visual acuities were quantifiable. Postoperative complications were dominated by corneal edema (22%). On the first postoperative day, the good results (visual acuity≥3/10), the average results (visual acuity between 3/10and 1/10) and the poor results (visual acuity<1/10) were respectively 41.2%, 50.60% and 8.2% without optical correction, changing to 64.40%, 28.90% and 6.70% after optical correction. Between the first and third week, 855patients (85%) were seen again. The good, average and poor results were respectively 61.90%, 35.70% and 2.40% without correction, going to 85.30%, 12.70% and 2% after optical correction. Among the 85.30% good results, 53% had a visual acuity≥5/10. Residual ametropias are the main cause of poor functional results and the introduction of biometry can contribute to their improvement. Cataract surgery through a well-controlled manual small incision is a promising alternative to the technique of choice, phacoemulsification, which is not yet widely accessible in our low-income countries.

Saving Foreign Children From "Moral Decay": Switzerland's Children's Homes During the Second World War

During Second World War, Swiss Red Cross provided assistance to destitute children in France and Belgium through various initiatives, including establishing Swiss-run children's homes. However, strong Swiss curriculum at Boitsfort Children's Home in Belgium also sought to inspire Swiss nationalism within children, in order to cure what Swiss termed as the moral decay of child. Therefore, goal to redeem both child's health and child's national character were central to Boitsfort operations, providing unique historical insight into vital link between children and nationhood during war.

Care at home for elderly – lessons learnt from the Swiss Red Cross “Integrated Home Care” in Eastern Europe/CIS

Care at home for elderly – lessons learnt from the Swiss Red Cross “Integrated Home Care” in Eastern Europe/CIS

Application of the RC service model of HBC into the social and health system of Bosnia and Herzegovina (achievements and challenges)

Introduction: Bosnia and Herzegovina is country with population of 3,531.159 and 14% of total population is over 65 years. In BiH there are no policies to respond to demographic change and its consequences especially to the category of elderly population. Traditionally, the role of the family institute in caring for its aged has been very strong in Bosnia and Herzegovina, but has been diminishing rapidly. The social situation, status of elderly is further aggravated by the late payment of pensions, increase in prices of food and medicine. Health and social protection is characterized by fragmented funding, uneven and often unequal provision of services and unequal access to assistance. The needs for care of sick elderly who live at home remain unmet. State health centres are obliged to provide medical care at home. Their service is time limited and do not include home care services for elderly people with chronic and long term conditions who need regular support to stay at home. As a respond to these growing needs the Swiss Red Cross (SRC) supported the local Red Cross (RC) to build up a new model of Home Care in Tuzla Canton. Description: In order to know the needs in primary care at community level a baseline assessment on 219 respondents aged 60-90 was conducted. Based on those results in two pilot areas - one urban with 150’000 and one rural with 46’000 inhabitants - a model of providing social and medical care at home was built up. The “Home Care” model has four pillars of care provision: Medical care provided by professional nurses; Individual care (personal hygiene of semi-mobile and immobile clients, etc.) and household services (laundry washing, cleaning etc.) provided by trained auxiliary nurses; Social services provided by younger and older volunteers trained in psycho-social support. The RC Home Care model allows elderly people to remain much longer in their habitual environment with the best care possible. Legislative regulations, payment mechanisms, quality standards for social and medical care at home provided by non-governmental organisations do not exist. To lobby and promote them a multi-actor and cross-sector working group was started in 2016. This working group has already achieved an important milestone when the authorities agreed to co-finance the services. Conclusion: After almost four years of hard work, first results are visible. In 2014 Red Cross HBC Centres started to provide services for 14 clients by one nurse and two auxiliary nurses, while in 2016 nursing staff (2 nurses and 14 auxiliary nurses) and 36 volunteers provided services for 260 clients (over 18.000 hours). The most requested services were individual care. Progress in care is evident. Clients are more independent and their mobility is increased. However, there is no unique solution to the increased demand of home care due to the social and demographic changes in Bosnia and Herzegovina. The following issues were crucial to build up the model: need for home care services and type of service confirmed by in depth assessments; services need to be demand driven; existing legal framework is an important factor for economical sustainability; nurse-led services requires a shift of paradigm and change in the legislative framework. This requires evidence based advocacy to withstand a strong lobby; well trained home care staff and their continuous education.

Active, Empowered And Young At Heart

Introduction: In 2003, the SRC started with participatory community work (PCW) and empowerment of older people[1] in Bulgaria alongside a home care program. The participatory methods with older people were new to the SRC and its partners. The SRC and partners followed the principles of the Madrid International Plan of Action on Aging (UNECE, 2002). Through the introduction of participatory approaches, the SRC aimed to change the agenda of local Red Cross Partners from doing things FOR older people to do things WITH and BY older people. Older people, based on the past cultural/political context belong to the vulnerable layers of the society, with low pensions, low recognition and high exclusion from information and entitlements. Objectives: In March 2016 the Swiss Red Cross reviewed the approaches and measured the impact of participatory work in three “Active Ageing/Advocacy Projects” with Elderly implemented in Bosnia-Herzegowina, Bulgaria and Belarus in relation to empowerment, improvement of wellbeing and reduced vulnerability. The review was conducted using questionnaires, individual interviews and focus group discussions with elderly people engaged in community groups, project staff and authorities. In total 454 persons participated in focus group discussion and 565 questionnaires were analysed.The five levels of analysis addressed the general context and its most relevant enablers and hindrances for active ageing; approaches used in the whole PCW process, Initiative Groups’ (IG) activities/results and finally the impact of PCW in terms of reducing the vulnerability and empowerment at individual, community and social level. Results: The review revealed the greatest change at the individual level. In all three countries, partners have succeeded in establishing groups of older people who are committed and making a difference in their communities. There is a perceived increase in their social capital, self-reliance and decrease in social vulnerability. Success factors mentioned were: trainings, peer-exchange and doing good for other people. Initiative groups advocated for specific concerns affecting their everyday life. Triggers for moving into advocacy[2] were: experience of working together for a common cause; a good reputation in communities; partnerships with local institutions; good knowledge of local needs and training (introduction to tools, methods and rights-based documents). Empowered community groups effectively influence local decision making bringing changes into their communities: establishment of advisory bodies in LPA, introduction of new services or reduction of prices of some services, improved accessibility and affordability of infrastructure. Conclusion: Older people benefitted through their involvement in Initiative groups or as volunteers of local Red Crosses. Interviews showed, that groups are mainly bringing together older, already active people. Future activities should focus on involvement of self-isolated, passive people While advocacy work was done by 30% of all groups successfully, more support by partners is required to connect state strategies with the realities of older people in communities. The review has also demonstrated how participatory approaches transform the organisational culture of the implementing partner over time i.e. moving away from a pure charity approach. The review could not identify the most effective tools that lead to participation because the result depends on how we use participatory methodologies - not in the fact that we use them. At the same time, it concluded the crucial role of three components: 1) developing capacity of vulnerable people for analysing their circumstances of living, their potentials and their problems in order to actively decide on changes (through learning by doing); 2) creating spaces for practicing new skills (through support to local initiatives); 3) promoting the value of participation. [1] 65+, but as well younger people were involved, often young pensioneers (invalids). [2] Rights-based approaches

Overcoming social exclusion and promoting dignity of older people in a post-war country

Introduction: Bosnia and Herzegovina (BiH) is a post-war society with a huge destruction of infrastructure; lack of housing, health care, job opportunities; and the most important, there are a lot of victims of war including internally displaced people and returnees. Many communities are in the process of re-establishing their life and social ties. Persons aged 65 and above comprise 14.19% of the total population in BiH. Nearly 60% of them are not covered by regular old-age pension benefits or any other scheme. This low coverage represents a serious problem and makes population vulnerable to poverty and social exclusion. Strategies and action plans that address the needs of the elderly population have not been developed. The system of home based care is practically absent, and the majority of seniors have no access to health care and social services. Description: In 2013, the Swiss Red Cross started a project with the aim to increase the health and wellbeing of vulnerable elderly and disabled people in Tuzla Canton, Bosnia and Herzegovina. The project inspired over 700 older adults and elderly to form 20 initiative groups, focusing on mutual help, assistance to vulnerable, participation in decision making on issues related to their lives. The project has a two- fold approach: development of a home based care system, and integration and participation of the elderly with the view of building up age friendly environments. People from different regions learn from each other, realizing they are not alone in their endeavor and have peers with whom they can lobby one day in the future on a regional or national level, i.e. work together on establishing an AA network, which will be the main axis of sustainability. Alongside the process of enhancing older people’s participation in defining and analyzing problems in their communities, collective decision making, promoting teamwork and delegating responsibilities, the project helps build confidence in their abilities and contribution in community development. AA groups are becoming a recognized and integrated part of the society. In line with this, AA group members take part in volunteering for the home-based care component of the project. AA groups are also partnering with different social care service providers of their particular interest, such as the Red Cross, whose professional staff and AA volunteers provide visiting services. AA volunteers pay house visits for talks, walks, bringing groceries and paying bills. The overall health of AA members is monitored through health promotion activities organized in their groups, by both the project, Red Cross and local health facilities. Aim of Change: Active ageing is considered to be instrumental in improving social determinants of health and mutual support. The theory of change of the project: empowered older adults and elderly people have higher self-esteem and social capital, and are able to overcome after-war crisis, influence decisions and improve their everyday life. Impact: The results of the project prove the theory of change developed by the project. Nearly two thirds of members of initiative groups are feel more self-reliant now, have more friends and know more people in community, more actively participate in community events, and help other people. As they become more visible and reputable, they are able to influence decisions of local municipalities. Examples of successful advocacy include: correction to working hours of local health post, prices of public transport and garbage removal; adapted access to public local community facilities and preventing closure of secondary school. Activities organized by initiative groups influence the whole life of communities were people affected by war were neglected and encapsulated in their problems: more people in need are served by volunteers and neighbors, communities have place where people can come and regain social ties and feeling of neighborhoodness, younger generations better understand older people and organize joint activities, local media features issues related to ageing. Conclusion/Recommendation: Results obtained by the project prove that empowerment of older people and support to their involvement into community life significantly increase their self-esteem, inter-connectedness, resilience, and ability to influence decisions related to their needs. It leads to improved social determinants of health. It also permits to integrate older volunteers into home care and mutual support, as well as to better understand needs of older vulnerable people. The project approach provides integrated community based social care for older people who are willing to donate their knowledge, expertise, experience and free time for the greater cause of preserving dignity, and delivering a change that matters to people.

Selective Testing of At-Risk Blood Donors for Trypanosoma cruzi and Plasmodium spp. in Switzerland

Background: Population migrations and overseas recreational travel to regions at risk for tropical diseases are increasing. A major challenge in non-endemic countries is to decrease the number of blood donor deferrals due those tropical disease pathogens, without compromising the high level of blood safety. The protozoans Trypanosoma cruzi and Plasmodium spp., the causative organisms of Chagas disease (CD) and malaria are becoming a major focus in the blood transfusion community. Methods: National guidelines of the Blood Transfusion Service of the Swiss Red Cross propose an algorithm for dealing with these pathogens, including a mandatory selective serological testing of donors at risk. Results: 6,978 donors at risk for CD were tested. Three of them were confirmed anti-T. cruzi-positive, and in one case a transfusion-transmitted infection was highly possible. The specificity of the assay was 99.94%. For malaria 12,887 donors were at risk and 178 were confirmed positive. The specificity of the assays was 92.8%. Conclusion: CD and malaria in non-endemic countries may represent a certain risk for blood transfusion. Switzerland chose a selective testing approach. The specificity of the assays is a crucial topic for this approach because it ensures a minimal loss of false-reactive donors and helps towards an easier counselling of implicated donors.