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Access to Care for Migrants: Focus on NGO-Based Systems

Author(s): K. S. Almeida1
Affiliation(s): 1Medecins du Monde, Neuchâtel, Switzerland

Gateway means of access to the health system for those excluded, medical network, applying the fundamental right to healthcare


NGOs like Médecins du Monde or Médecins sans frontière have experience of access to healthcare for vulnerable people in their projects. In Switzerland, they carried out pilot projects for the most vulnerable populations: the undocumented migrants : RSM, Fri-santé, Meditrina.These projects outline the weakness of the national health system at two levels firstly in the access to the health structures and secondly in the access to the insurance, LAMal. Health is a luxury for certain categories of population.


The medical network is not foreseen as a substitute to the health structures but as facilitated gateway to it. The projects have two objectives: 1: access to health care, 2 : health promotion. They have in common free guidance and treatment at reduced fees.RSM has two components: a health component with a nurse attending the patients and a social component to facilitate administrative work.


Right to healthcare exists but the actual access conditions do not allow the most vulnerable to exercise it.The people who benefit from the NGO structures are a majority of undocumented migrants (asylum seekers, NEM, dedoutés) but also Swiss who can not or do not know how to gain access to healthcare. The barriers are ignorance of the system, fear of being denounced and financial problems. Within the insurance problems, the NGO are the intermediary to assistance with administrative procedures and advise. The advise can be positive to get the insurance but can also be negative if the financial or geographical problems are to important. The need of a special structure is variable and changing according to the size of the canton (therefore the number of undocumented migrants),but still very pertinent.
The population is mixed so its is difficult to have a strait message.Promotion of healthcare is important to improve the beneficiaries environment. and for an improved reception in the existing structures.
The ultimate objective of most NGOs is that the state answers to its responsibilities and thus the projects becomes obsolete. Generally speaking, society accepts the right to good health but it is the application witch is sometime controversial. Financing of the project is difficult. It is often a grey zone with state support but without total financing, therefore a long term planning difficult. The patients have confidence in a NGO structure, but they often give importance in knowing of official support. For the patients as for the NGO the support gives legitimacy.

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