Feature

More than a research problem

Communities from the Horn of Africa have had enough of being researched – they want practical support. Elfneh Bariso reports

The Horn of Africa Health Research Project (HAHRP) was launched two years ago at a time when cynicism about research projects was so strong that it took some time to win the full support and involvement of the Eritrean, Oromo, Ethiopian and Somali communities.

HAHRP was initiated by Healthy Islington, Camden Healthy Cities and Camden and Islington health authority in response to the findings of earlier surveys which had revealed the difficulties refugee communities experience obtaining healthcare. HAHRP’s aim was to identify barriers to accessible and appropriate healthcare for refugees in Camden and Islington, and to make recommendations to improve services.

HAHRP applied both qualitative and quantitative research techniques. The qualitative aspects focused on community consultation and focus group discussions with 80 individuals, while the quantitative research was conducted through a face-to-face questionnaire interview with 639 service users or potential users from the four communities in Camden and Islington. A focus group discussion was also held with 20 health service purchasers and providers in the district, on refugees and asylum seekers’ access to healthcare and the appropriateness of services.

The issues covered included: demographic information; access to hospital, GP, dental, optical, child and women’s healthcare services; and community-based refugee health projects. The appropriateness of services and familiarity with the NHS complaints procedure were also examined.

The research showed that there was no information available in the main Horn of African languages, such as Amharic, Oromiffaa and Tigrigna, on the structure of health services, how to access services or the complaints procedure. The local NHS interpreting and advocacy service was under-used by the majority of Horn of African communities. Respondents reported that these services did not have interpreters and advocates who spoke their languages, and that it was very difficult to obtain interpreters at the right time. As a result, most respondents requiring interpreting and advocacy services depended on voluntary health advocates and interpreters from their communities or used their friends, even though the majority of respondents preferred professional advocates and interpreters to friends or relatives.

Over five-sixths of the respondents did not know how to make complaints about healthcare services, even though nearly half had complaints. Only one per cent of the respondents had made a formal complaint and all of this group reported that they had been very dissatisfied with the outcome.

The findings also indicated that among the Horn of Africa communities, non-registration with a GP was comparatively high (15 per cent), compared to the UK general population (one per cent). Reasons for non-registration included language problems, lack of awareness of the need for GP registration, fear of the consequences for asylum application, and GPs’ reluctance to register people who did not speak English or could not find interpreters for themselves. Some health professionals and support staff were reported to be unsympathetic to refugee and asylum-seeking patients. Healthcare professionals’ and administrative staff’s lack of awareness of the cultures of their patients was found to be a serious barrier to service uptake.

Uptake of preventive services for women was low; only a few women respondents had used family planning services or had had a cervical smear.

But encouragingly, a high proportion, about 90 per cent, of respondents’ children were immunised. Similarly, most respondents reported that they were aware of optical services, although awareness and uptake of dental care was lower than most other preventative health services.

Partnership between the health authority and refugee community organisations needs to be promoted. The current lack of such partnerships results in under-utilisation of health workers’ expertise to address the health needs of refugees. The respondents high level of satisfaction with community-based refugee health projects suggests that this could be an effective strategy.

The HAHRP identified various barriers to health care services experienced by members of the Eritrean, Ethiopian, Oromo and Somali communities in Camden and Islington. These barriers included the lack of English language, professional interpreters and advocates, knowledge of NHS, confidence in the services, fear of authority and type of accommodation and service providers negative attitudes to refugee and asylum seeking patients.

The health authority and other organisations such as local government need to acknowledge the magnitude of the problems identified here and co-ordinate efforts to address them. A one-off response, such as provision of a short-term interpreting service, will not be effective; long-term sustainability is crucial. The Eritrean, Ethiopian, Oromo and Somali communities have a high proportion of skilled human power. Building their organisational capacities to be self-sufficient by offering continuous financial or material support is more appropriate.

‘If the government supported our communities financially, our communities could improve their voluntary services and offer us more,’ said one female respondent.

Otherwise, the communities’ cynicism about being an everlasting research problem (but it never leading to solutions and support) will remain. Winning trust and collaboration again will not be easy; prompt, practical action is essential.

The full report and summary document is available from Healthy Islington, 159 Upper Street, London N1 1RE. Tel 0171 477 3035. Fax 0171 477 3029.