1. WHO-HPH TF MFCCHC/COST Action HOME Barcelona Meeting November 6 th – 7 th, 2008 The implementation of transcultural competence in the clinical context: preconditions and challenges Dagmar Domenig, PhD Director of Health and Integration Department Swiss Red Cross, Head Quarter, Berne

2. The United Nations recognize that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without discrimination. Bangkok Charta for Health Promotion in a Globalized World 2005 Every person has a right to appropriate health care!

3. Appropriate Health Care (Kälin/Wyttenbach, 2007) universal availability universal accessibility universal acceptability sufficient quality Migrants in Switzerland?

4. Universal accessibility affordable primary health care physically reachable promotion of health literacy migrant-specific information in migrant languages no (racial) discrimination Universal availability available also to migrants compulsory health insurance

5. “Health literacy is the ability to make sound health decision in the context of everyday life – at home, in the community, at the workplace, the health care system, the market place and the political arena. It is critical empowerment strategy to increase people’s control over their health, their ability to seek out information and their ability to take responsibility.” (Kickbusch et al., 2005: 10)

6. Health literacy in Switzerland (Wang/Schmid, ISPM Zurich, 2007) health literacy increases with the educational background wish to participate actively health decisions are very complex lack of information information difficult to comprehend For further information see www.ispmz.ch

7. Universal accessibility affordable primary health care physically reachable promotion of health literacy migrant-specific information in migrant languages no (racial) discrimination Universal availability available also to migrants compulsory health insurance

8. Universal acceptability No (racial) discrimination transcultural competence among health professionals adequate inclusion of migrant’s needs and expectations No generalized ethno-specific cultural recipes Treatment based upon individual conception of health and sickness

9. “Transcultural competence means the ability to perceive and comprehend individual life-worlds in a specific situation and in various contexts, and hence to infer appropriate ways of action.” (Domenig, 2007: 174)

10. Universal acceptability no (racial) discrimination transcultural competence among health professionals adequate inclusion of migrant’s needs and expectations no generalized ethno-specific cultural recipes treatment based upon individual conception of health and sickness

11. Sufficient quality transcultural change migrant-specific measures link to the general quality management improvement of the quality for all patients

12. Preconditions for a transcultural change System-Management transcultural commitment of top-management (top-down-strategy, migration unit, measures, kick-off, bottom-up-process) migrant-specific actual state analysis and target analysis (annual goals!) appointment of a qualified person for migrant- specific/transcultural issues (transcultural mainstreaming, contact point) migration-specific adaptation of organizational processes migrant-specific adaptation of documents (policies, standards, concepts)

13. Preconditions for a transcultural change Marketing-Management education and further training in transcultural competence transcultural group processes (transcultural teams, case conferences) promoting health literacy among migrants (information material, health [system] trainings) cooperation with migrant communities (involvement of key persons, networking, common activities) collaboration with experts, migrant-specific services collaboration with scientific community (applied research)

14. Preconditions for a transcultural change Resource-Management providing enough resources for a transcultural change (money, manpower, knowledge) promoting health professionals with a migration background (recruitment of migrants, recognition of specific skills, transcultural teams, personnel development, measures against [racial] discrimination) buildup of interpreting services (educated interpreters, further education for health professionals)

15. Challenges for a transcultural change System-Management transcultural commitment of top-management (top-down-strategy, migration unit, measures, kick-off, bottom-up-process) migrant-specific actual state analysis and target analysis (annual goals!) appointment of a qualified person for migrant- specific/transcultural issues (transcultural mainstreaming, contact point) migration-specific adaptation of organizational processes migrant-specific adaptation of documents (policies, standards, concepts) We did not succeed in changing hospitals on a systemic level!

16. Challenges for a transcultural change We succeeded in some areas, especially in education, further training and promoting health literacy Marketing-Management education and further training in transcultural competence transcultural group processes (case conferences) promoting health literacy among migrants (information material, health (system) trainings) cooperation with migrant communities (involvement of key persons, networking, common activities) collaboration with experts, migrant-specific services collaboration with scientific community (applied research)

17. Swiss Red Cross: further education promote self-reflection learn to perceive and comprehend the other by changing the perspective learn to take a medical history without cultural stereotypes learn to build up relationships in a migrant-specific context background information about migration, integration, medical anthropology… communicate measures for a transcultural change Over 360 training days for nearly 5000 health professio nals in the last 8 years!

18. Swiss Red Cross: further education “This training gives me the motivation to change things and to conduct conversations with another point of view.” “Tolerance towards migrants should be a precondition for becoming a health professional. Initiative and the will to assist migrants should be taken for granted.” “It was encouraging to hear that the point is not knowing all cultures but asking the patients what they need individually.” “The care of migrants is very complex. There are no specific recipes because all is individual, this I learned today. What I need is listening, seeing and a lot of tolerance.” www.transkulturelle-kompetenz.ch Information, tools, hints and links

19. Swiss Red Cross: promotion of health literacy Health Guide in 18 languages VIA, trainings for migrants by migrants about health and Swiss health system www.migesplus.ch Federal Office of Public Health (www.admin.bag.ch)

20. Challenges for a transcultural change We succeeded in some areas, especially in building up interpreting services Resource-Management providing enough resources for a transcultural change (money, manpower, knowledge) promoting health professionals with a migration background (recruitment of migrants, recognition of specific skills, transcultural teams, personnel development, measures against [racial] discrimination) Buildup of Interpreting services (educated interpreters, further education for health professionals)

21. Sufficient quality transcultural change migrant-specific measures Link to the general quality management Improvement of the quality for all patients

22. © Departement Gesundheit und Integration / Weiterbildung und Gesundheitsförderung individual transcultural competence structural and institutional implementation of transcultural competence Diversity migrant friendly hospital transcultural change

23. ...a big CHALLENGE! Implementation of transcultural competence in the clinical context is still….