European health systems are committed to meeting the challenge of understanding the needs of migrant populations and adapting their services to meet these needs. The difficulties inextricably linked to this challenge are caused by the complexity of migration patterns and the differences between migrant population across EU countries. At present, the limited available data show that attempts to incorporate migrants’ health needs, in particular those of migrants from non-EU countries, into EU health systems have remained scattered and uncoordinated. COHEMI’s general objective is to coordinate referral centres dealing with specific Latin American (LA) diseases in order to provide a clear understanding of the full migration cycle in relation to the health systems in Europe and Latin America. Another important objective of the COHEMI project is to provide an in-depth insight into priority, health-related aspects of LA migration in order to facilitate the development, and dissemination, of evidence and information relevant to migrant health policies.
Health through the provision of accessible healthcare services is a right for permanent and temporary residents of the EU. Limited knowledge of the priority health problems affecting Latin American migrants and a lack of data on the multiple determinants of health service utilization (accessibility, appropriateness of the care provided, and client satisfaction) negatively influence the possibility of providing adequate, quality care for migrants. The inequality of access to, and outcomes from, healthcare services between migrants and the autochthonous population is therefore an issue of concern to both healthcare providers and policymakers in Europe.
The general objective of the COHEMI project is to coordinate both referral centres in Europe and Latin American (LA) countries that deal with selected diseases in LA countries (Chagas disease, strongyloidiasis, cysticercosis) as well as other infectious and non-infectious diseases affecting LA migrants, and centres investigating migrant health in general (health systems, reproductive and child health, anthropological and psycho-social problems). Through coordination of these groups, COHEMI aims to provide a clear picture of the full migration cycle in relation to the health systems in Europe and Latin America and to suggest general and specific (disease-driven) policies to address the priority aspects related to the ill-health of the migrant population.
The activities of the COHEMI network will produce a global picture of the health and needs of LA migrants, with a focus on health systems, legislation and policies in the different European countries, gaps in prevention, screening, diagnosis, and care of selected infectious and non-infectious diseases and social and cultural factors related to health seeking, health-care, and access to health systems. Table 1 and 2 represent some main aspects of the demographic profile of Latin American migrants in a few European countries. Reviews carried out by COHEMI partners related to the different work package activities (reviews on Chagas disease, strongyloidiasis, cysticercosis, tuberculosis, hypertension and cardiovascular diseases, and socio-cultural aspects) have been essential to improving the knowledge of the current gaps in the health care and needs of LA migrants in Europe, as well as the condition of health and diseases in their countries of origin. The COHEMI network efforts also involved 7 different study designs on Chagas disease, strongyloidiasis, and cysticercosis (table 3).
In addition to the review activities and data collection, the COHEMI partnership organised many workshops (up to now there have been 1 on migrant health policies, 3 on Chagas disease, 3 on strongylodiaisis, 3 on cysticercosis, 2 on tuberculosis, 2 on hypertension and cardiovascular diseases, and 3 on socio-anthropological aspects) and international meetings to discuss and share with experts data collected and the current situation concerning access to health systems, infectious and non-infectious diseases covered by the COHEMI project, and socio-anthropological characteristics and difficulties of LA migrants. One international symposium was organised in April 2013 in Peru (International Symposium Latin American Migrants Health in Lima), followed by another Latin American event in Bolivia (Cochabamba), with a COHEMI Symposium during Chagas Week-Neglected Disease.
Many workshops have been organised also with the migrant population in Madrid and Barcelona (27 workshops, with a total of 67 participants from 14 different Latin American countries) in order to discuss directly with those involved the issues concerning their health. In addition, questionnaires have been used as tools to collect information and data from scientists, policy makers, health professionals in Europe and Latin America (on migrant health policies, health of Latin American migrants, health systems, and neglected tropical diseases), and interviews have been used to collect information from Bolivian migrants.
Much of the work done has been already published (see COHEMI website). COHEMI partners participated in many national and international meetings/congresses to raise awareness of the COHEMI project and LA migrant health and to diffuse, through oral and poster presentations, the work done and the results achieved. The activities carried out by the COHEMI network have also been diffused through the COHEMI website and the periodical newsletter (5 newsletters have currently been made available on the website).
Based on the main results of the work carried out since the start of the project in January 2011, the COHEMI network is now processing the final Policy Briefs and Guidelines/Recommendations, which report the current situation, the gaps to be solved, and the priorities to be addressed in order to suggest/promote specific strategies/initiatives/methods/policies-guidelines/legislative measures to be promoted at the European Union and Latin American levels, both on general aspects and on specific diseases.
The common efforts of European and Latin American countries will build a collaboration in migrant health with improvement of health care, prevention, and treatment of diseases, also in their countries of origin. Improving the knowledge on LA migrant health will contribute to plan interventions and policies focused on the most crucial and urgent gaps to be solved and needs to be addressed.
TABLE 1: LATIN AMERICAN CITIZENS RESIDENT IN SELECTED EU STATES
|EU state||Latin American citizens (thousands)||Year||Source|
|UK||186.5||2009||McIlwaine et al 2009|
|Total EU||2 444.8|
TABLE 2 LATIN AMERICAN MIGRANTS BY COUNTRY OF BIRTH IN SPAIN AND ITALY
|Country of residence||Spain||Italy|
|Country of birth||Population (thousands)|
TABLE 3 STUDY DESIGN
Economic evaluation of Chagas disease screening in the community (Europe)
Update on health policies to control the transmission of Chagas disease in European countries
Design of a validation study of diagnostic methods for Strongyloides stercoralis for screening and treatment follow up
Design of a multi centre, double randomised controlled trial to assess the efficacy of different treatment regimens for strongyloidiasis
Seroprevalence of Taenia solium in migrants
A retrospective study on the management and clinical and epidemiological profile of neurocysticercosis cases seen at three different hospitals in Europe
Seroprevalence of Taenia solium cyst antibodies among adopted children in Italy