d4 cz-national report providers in englishnational report providers: czech republic 6 the interview...

Funded by the European Commission, DG Health and Consumers, Public Health Nationally funded by Fonds Gesundes Österreich (Austria) and The Netherlands Organisation of Health Research and Development (ZONMW) (Nether-lands). Coordinated by Forschungsinstitut des Roten Kreuzes, Austria

Providers’ perspectives on participation of migrants in health promotion in the Czech Republic Empirical Analysis I: Interview with providers

Hana Janatova National Institute of Public Health July 2009

Healthy Inclusion

National report Providers: Czech Republic

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Table of contents

Table of contents..................................................................................................................................2

1. Introduction......................................................................................................................................3

1.1. General introduction of the project ......................................................................................3

1.3. Health promotion in the Czech Republic..................................................................................7

1.4. Migrants in the Czech Republic..............................................................................................10

1.5. Health promotion providers and interventions........................................................................14

2. Participation of migrants in the health promotion interventions (provider/intervention level) .....20

2.1. Actual participation of migrants in the interventions..............................................................20

2.2. Hindering or conducive factors on the intervention level.......................................................22

3.1. Organizational policies ...........................................................................................................26

3.2. Hindering or conducive factors on the organisational level ...................................................26

4. Governmental policies to improve participation of migrants (institutional level).........................28

4.1. Governmental policies ............................................................................................................28

4.2. Hindering or conducive factors on the institutional level .......................................................28

5. Conclusions....................................................................................................................................30

5.1. Provider/intervention level......................................................................................................30

5.2. Organisational level ................................................................................................................31

5.3. Institutional level.....................................................................................................................32

6. Summary ........................................................................................................................................34

References ..........................................................................................................................................38

Appendix............................................................................................................................................39


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1. Introduction

1.1. General introduction of the project

“Healthy Inclusion” is an international project carried out within the Public Health Programme

2003-2008 and co-funded by the European Commission, DG Health and Consumers, Public

Health (EAHC). The project commenced in July 2008 and will finish in May 2010.

Migrants belong to the most vulnerable and exposed social strata in society and require spe-

cial consideration in public health strategies.

The overall health status of migrants is significantly poorer than that of the general population.

This is related to the fact that migrants are more exposed to risks which have an impact on

health; these include (not exclusively) poverty, poor living conditions, restricted access to the

labour market and health services.

Additionally, lack of information and importantly communication problems create barriers for

getting access to health promoting interventions. Thus, equal accessibility and quality of the

general health services are essential for enhancing the health level of migrants. This does not

only apply only to health care services, but also to prevention strategies and health promotion

interventions.

The project is concerned with improving the access of migrants to health promotion interven-

tions.

The project is coordinated by Forschungsinstitut des Roten Kreuzes, Austria, participating

national partners are following: National Institute of Public Health (Czech Republic), Mhtcon-

sult (Denmark), Institut für Soziale Infrastruktur (Germany, project evaluator), Studio Come

S.r.l. (Italy), Verwey-Jonker Instituut (The Netherlands) and Trnava University, Faculty of

Health Care and Social Work (Slovakia).


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Project objectives:

• Provide information about migrants’ perceived barriers for participating in health promo-

tion interventions as well as about facilitating factors.

• Provide examples of good practice and suggested means of enhancing migrants' par-

ticipation in health promotion interventions.

• Develop specific recommendations on how health promotion interventions at the com-

munity level can be adapted to better meet the needs of migrants.

• Disseminate findings and results to the health promotion community and to policy mak-

ers in each partner country.

The project objective will be achieved by the following methods:

• Literature review of national documents concerned with specific situations regarding

migration and health promotion in each country involved in the project.

• Interviews with representatives of organisations providing health promotion interven-

tions.

• Interviews with migrants who do and who do not have access to these interventions.

The main terms used in this report are Health promotion and Migrants. To ensure clarity,

they are defined below:

According to the WHO, “Health promotion is the process of enabling people to increase

control over, and to improve their health. Health promotion represents a comprehensive

social and political process- it not only embraces actions directed at strengthening the skills

and capabilities of individuals, but also action directed towards changing social, environmental

and economic conditions so as to alleviate their impact on public and individual health. Health

promotion is the process of enabling people to increase control over the determinants of health

and thereby improve their health.

For this research project, we will use the following general definition of migrants:

Persons who have been born in another country, who have lived in the host country for

at least five years, and who intend to work and stay permanently in the host country.


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1.2. Methods

Literature analysis

A search and a review of national data and research results were made for the period of July

to September 2008.

First, a mapping exercise through the internet was carried out to discover more sources of in-

formation on written publications and to find the experts, researchers and professionals work-

ing with migrants and refugee, then to contact them to obtain more information.

A total of 36 written sources of information on migration and health (research reports and stud-

ies, presentations from seminars, demographic publications, statistical publications, informa-

tion sheets ) were found for the period between 1998 and 2008. No information on health pro-

motion interventions or health promotion relating to migrants were mentioned in the reviewed

literature sources.

Two very useful sources of information were identified on the web:

www.mighealthnet.cz (Czech Wiki), outputs of the EU projects MIGHEALTHNET)

www.migraceonline.cz

The both portals have text in Czech and English.

Interview analysis

Interviews with health promotion services providers were carried in February and March 2009

after preparatory and pre-testing phases.

An interview guide-a questionnaire for qualitative interviews was the basic tool. It explained

how to obtain health promotion providers' perspectives and experience on both hindering and

conducive factors to encourage participation of migrants in health promotion interventions.


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The interview was a semi-structured qualitative interview that was directed to the professional;

his or her experiences that are preferably inter-subjective or evaluated. This interview guide

included topics and questions that should be addressed. It recommended to “Try to be as

concrete as possible by asking further open-ended-questions (what, how, why?) and asking

for examples” in order to maximise useful information.

The goal was to get the provider’s point of view, expressed as research questions:

• What are health promotion service providers' experiences with migrants as participants

in health promotion interventions?

• What are the characteristics of health promotion interventions with migrants?

• What are examples of good practice?

• What is the influence of images of health/ disease on the use of Interventions?

• To what extent are migrants considered as a target group for health promotion up to

now?

• What have been the health promotion service provider’s activities?

• How have they tried to reduce barriers for participation by migrants?

• What suggestions can be made to enhance interventions accessibility for migrants?

Selection of providers:

Candidates for interview were selected based on the literature review, their experience in the

field of health promotion and according to the selection criteria developed by the WP4 leaders

and partners. Considering that no proper health promotion has ever been designed specially

for migrants in our country, I decided to address the interview at two main groups of providers:

general health promotion providers and social and legal services providers. They both

provide health promotion in the wider sense of empowerment and participation. Slightly differ-

ent approaches were using to engage the two groups in the interview to get the best results.

All of the selected providers agreed to be interviewed and were interested in the project’s fu-

ture development and results.

Health promotion was defined as a broad field of services:

• Health promotion is directed to the promotion of health: improving lifestyle, living condi-

tions, the physical and social environment, and quality of life. It is not, directly or indi-

rectly focused on prevention of disease (both risk factors and symptoms).


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• Health promotion includes participation as both a means and a goal.

• Health promotion includes the strategy of enabling all people to achieve their full health

potential (empowerment).

• Important strategies for health promotion (providers/services) include strengthening

community action, developing personal skills and re-orienting health services.

1.3. Health promotion in the Czech Republic

Health Promotion (HP) is understood to be a part of health care. It is very close to primary pre-

vention in practice and is often misinterpreted by policy makers and public as screening and

vaccination only.

The policy of health promotion services has been the responsibility of the Ministry of Health,

while the actual practice and research has been a task of the National Institute of Public

Health and its regional health promotion branches. Legally, health promotion has been based

on the Public Health Act (2000) and its later amendments.

Health promotion is officially defined as a service to give people information and knowledge

about health determinants and to support their healthy behavior and health choices. In practice

it is oriented mostly towards life style and possible behavior changes, such as how to reduce

some of the risk factors for chronic non-communicable diseases. This is related with the

official health policy that each person is responsible for their own health. This approach

means higher empowerment of individuals through information, knowledge and changing be-

haviour.

It is important to note that HP is based on biomedical knowledge which could be a cause of

neglect of social and psychological health determinants in intervention practice.

Main topics of HP: Healthy diet, nutrition, exercise and physical activity, smoking cessation,

moderate alcohol intake, illicit drug prevention, AIDS/HIV prevention.

Main settings of HP: schools, workplaces, seniors’ homes, community.


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Main methods of HP: local, regional, national intervention projects and intervention projects

for vulnerable groups within the population, “Health Days” for general public ( will be de-

scribed in details later), health education projects.

Main tools: leaflets, brochures, videos and DVDs, consultancy, campaigns, lectures,

seminars, physical examination, and physical and bio-chemical parameters to asses health

status and individual risks for future poor health.

Providers:

Regional branches of National Institute of Public Health (14), National Institute of Public Health

itself, a few NGOs (HP is a part or a by product of their main activities), health insurance com-

panies (to a limited extent) and private companies ( e.g. food producers offering health infor-

mation and projects in collaboration with health professionals in the field of healthy diet and

healthy life style). Other organizations, both governmental and non-governmental (including

agencies specifically devoted to migrants) play a limited role in the field of health promotion

services.

An ongoing health care reform, which has started about one year ago, has not been friendly to

HP: it was one of the first services which was a “victim”. Health promotion counseling centers

(parts of Regional Institutes of Public Health) were designated and some of professionals

in HP became employees of the National Institute of Public Health in its regional branches.

Many experienced HP professionals left the field.

The new health care reform considers national health promotion only as strategies for regional

and local HP providers, which are supposed to be created as private companies. Other HP

providers are physicians - GPs and clinicians. The idea is sensible, but HP is understood as

prevention of diseases, irrespective of participation and empowerment. More training and edu-

cation, a new accreditation system and competencies control should be provided to achieve

effective “new “health promotion.

The health promotion organization and system is now part of reform and interventions, and

services are based on personal enthusiasm and experience of professionals who provide

them, rather than on a governmental policy.


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HP projects as the main methods for health promotion are often co-financed by the Ministry of

Health and its funding arm, the National Programme for Health - Health Promotion Pro-

jects. The calls are open for all type of organizations (governmental, private, NGOs, civic so-

cieties, etc.) and they have been launched every year since 1993. Projects have been pro-

posed for 1 – 3 years. The percentage of financing is up to 70 % of the overall budget. The

completed projects are evaluated by experts of the Ministry of Health, according to set crite-

ria. Priorities of the programme do not change every year. For example, priorities for 2008

were:

• Healthy diet and increasing physical activity to reduce obesity

• Smoking cessation and reducing abuse of alcohol

• Complex projects targeting a wide spectrum of risk factors for chronic non-

communicable diseases in the entire population ( awareness campaigns ), and

specific groups in specific settings

There has been no priority for migrants’ health promotion since 1993, when the Pro-

gramme started.

“Health Days”

This method is based on a free offer of services in the community or in special settings, in-

cluding schools, senior homes and workplaces. They are often organized as a part of other

events for the public (such as exhibitions and cultural and sporting events). The HP profes-

sional’s offer of a free service varies according personal, technical and financial resources.

They principally consist of:

• measurement and examination of health indicators, including blood cholesterol,

• glucose, body fat, body mass index and blood pressure;

• determination based on the objective measurement of the individual’s health status

and risks in life style;

• consultation on smoking cessation;

• consultation on HIV/AIDS prevention

• injury prevention programs for children

• free overall consultation and advice on how to improve lifestyle, where to get more

• information, or referral to medical help if measured indicators are over prescribed limits.


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Health information and education through free dissemination of brochures, leaflets, poster etc

are provided for all interested persons.

More managers of private firms are asking HP providers to run a “Health Day” for their em-

ployees. It is a new approach which could be identified as a public-private partnership.

A “Health day” for communities can be financed from providers’ budgets and co-financed by

local authorities or fully financed by private sector clients.

HP for migrants

Health promotion in its broader definition as empowerment and participation is provided for

migrants by agencies (governmental and non governmental and local and regional authori-

ties). Services offered are mainly social and legal consultancy, information about the health

care system and health insurance options, Czech language courses ( an exam on the ability

to communicate in Czech is an essential condition to obtain Czech citizenship), and other

education and training to get a better job and facilitate integration of migrants to the main so-

ciety.

Generally, health promotion in its health part of the definition as a service to give people infor-

mation and knowledge about health determinants and to support their healthy behavior and

health choices. is provided for migrants in very limited extent and mostly by chance if they

participate in “Health Days” in enterprises on in communities.

1.4. Migrants in the Czech Republic

Since 1990 little was known about migration, despite the fact that the Czech Republic was a

source of migrants from other countries. Many foreigners who lived here were students under

intercultural exchange programmes, frequently from “communist” countries or countries

where communism was not the ruling ideology, but strongly supported. Some of these stu-

dents stayed in the country, and a second generation of migrants, especially from Vietnam,

have become a resident subculture.


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When borders were opened and democracy installed, the country became an increasing target

for migrants - first as a transition country to go to the “West”, but soon as a host country.

The majority of people came from the former Soviet Union countries: Ukraine, Byelorussia and

Afghanistan, with Ukrainians constituting the largest proportion of migrants. Registered mi-

grants are now 4% of the population, which is still below the EU average. However, according

to an OECD report in 2006, the Czech Republic has the highest increase of immigrants in

OECD countries. This trend continues.

The main migrants groups in 2008 composition is:

Ukraine 30 % (131 965)

Slovakia 17 % (76 034)

Vietnam 14 % (60 258)

Russia 6 % (27 178)

Others: 33 % (143 326)

This proportion of nationality of migrants has been effectively stable since 1990.

Ukrainians constitute nearly the one third of all migrants. Slovaks are EU citizens and have the

same access to health care as the Czech people. Because of the similarity of language and

culture, we will not deal with them in this project, although they constitute the second largest

migrant group.

The total number of registered migrants (without refugees and asylum seekers) in 2008:

428 761 (4,2 % of the Czech population)

” What could be better proof [of economic

prosperity] than the fact that we are not going off into the world in larger numbers, even though we could now, and, on the other hand, the fact that our country is becoming a place people come to from elsewhere?" the Czech president Václav Klaus, New Year's speech on 1.1.2008


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The gender proportion is approximately the same as the Czech population (40 % are

women).

The number of migrants is actually higher because between 30 000 to 250 000 unregistered

migrants stay in the country; this estimate is not accurate for obvious reasons. If the higher

estimated total number were accurate, then the percentage of migrants increases to nearly 7

% of the Czech population.

Permanent residency permission is granted to 39 % of migrants (47 % are women). Perma-

nent residency permission can be obtained after a minimum of five years of permanent stay in

the country; this legal status is very similar to citizenship rights: Citizenship can be obtained

after five years of permanent residency status. A Long term residency permission (Visa) is

necessary for any stay longer than 90 days and has to renewed every year under strict ad-

ministrative requirements, define by law. The most frequent causes to become an unregistered

migrant is to simply miss an administrative deadline or to cross a border illegally, since it is

generally believed that it is quite easy to get into the country, but it is difficult to maintain legal

status.

Age structure of migrants (2007 data)

20-60 years: 87 %

Children and youth under 18: 10 %

65+ years: 3 %

Economic activity (2008 data)

Working migrants comprise 87 % from all migrants, with 22 % employed as tradesmen.

Schools (2008 data)

The total percentage of 2.2 migrants from all migrants with legal status attend schools. More

than half are University students who do not always meet the project criteria. One quarter at-

tend high schools and 12 % attend elementary and secondary schools; 6 % attend maternity

schools.

Health care is based on public or commercial insurance. Public insurance is obligatory for all

Czech citizens and for whose working here. It is partly paid by employers and partly by em-


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ployees, based on a percentage of their salary. If an individual has no employment because

their personal status (e.g. child, parent on parental leave, retired, disabled or temporarily un-

employed) then fees are paid by the government. When a person is in serious debt or is not

able to pay health insurance fees, this does not affect health care provision. This can be a le-

gal matter between an insurance company and the insured person: commercial insurance is

contract based and is more expensive than public health insurance. The criteria for health in-

surance are based on the actual health status of an insured person. The vast majority of un-

documented (illegal) migrants have no health insurance and they pay cash for health care or

they return to their original country for treatment (especially for dental care). It is important to

note that health promotion services are not covered b health insurance.

Health of migrants

According to a survey, migrants from the Ukraine feel more healthy than the main population,

especially at the beginning of emigration, and are apparently more healthy than the undocu-

mented migrants (IZPE, 2004). They require less health care and treatment and do not partici-

pate in prevention programmes and screenings. One hypothesis is that these migrants’ atti-

tude to illness, pain or when they need treatment is different from the mainstream public.

The longer they stay in the CR, with better access to health care and more frequent use, their

health either becomes the same or worse than the health of the majority population. One ex-

planation is that their life style is worse than in their home country because they work longer,

often under bad working conditions, deterioration in their living habit: smoking, alcohol and

unhealthy diet. Another explanation is that they changed their norms on health and illness

along with the majority population.

The main inequality in health care for migrants

New-born babies of migrants (including those with legal status, but not yet Czech citizen ) are

not covered by health insurance, unlike Czech citizens. Expenses in hospital are significant

during delivery and the early stages of life. Life threatening situations can occur if a newborn

child has some defects or inherited diseases. But commercial insurance contracts are the only

possibility for such parents to have their child insured and this is very expensive. Commercial

insurance company can refuse to sign an insurance contract if a child is suspected to need

high cost treatment. In this case, health care should be paid in cash, at a cost that few migrant

parents can afford.


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Since a migrant woman is not a Czech citizen, it is dangerous for her to have a child. There is

another hindering factor aspect when pregnant: migrants often have poor knowledge of em-

ployment law and pregnancy means job loss, followed by loss of any legal status.

The main health problems of unregistered migrants (2003 survey)

• Work related injuries

• Mental disorders (alcohol abuse consequences and post-traumatic stress disorders and

acute psychotic disorders)

• Infectious diseases

• Dental health (the major cause to use health care among all groups of migrants)

Official statistics are collected only for hospital admission of foreigners, regardless of their

status.

1.5. Health promotion providers and interventions

The results are summarised in the table 1 below. Table 1. Providers Type of Or-ganisation

Health promotion units NGOs and civic organisa-tions

Regional Authorities

Number 14 3 1 Target group General population Migrants Migrants and refugees Main inter-vention

Healthy life style, nutrition, non smoking, physical activity, HIV/AIDS

Social, legal consulting, integra-tion

Healthy life style, drugs, smok-ing, alcohol

Main forms Lectures,leaflets,campaings, special projects

Lectures, individual consulting, seminars, leaflets, training and education

Consultancy, special projects

Settings Schools, enterprises, commu-nity

Community, individuals Community

Number of migrants participating

Unknown cca 2700/year No follow up

How many organisations in which category (type of organisation) were interviewed?

A total of 18 providers were interviewed. The main provider of health promotion services is the

National Institute of Health and its 14 regional branches. Representatives from all regions


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were interviewed. The collected results can be taken as representative and describing the

situation in the country. These results are a good source of information for future recommen-

dations.

Most of providers of health promotion (NIPH) have no or very limited experience with migrants

and their opinions often reflected this situation. Only two of the interviewed professionals at

regional branches had experience with health promotion where migrants participated as a

group of workers. Only one of the interviewed providers had been educated in multicultural

nursing; others were not trained to recognise special migrants needs.

The NGOs were selected according to their profile on their websites, followed by tele-

phone contacts and e- mail letters to request participation in the project, together with in-

formation about the project and its aims. The contact on a Regional authority was made

through a regional branch of National Institute of Public Health and the person interviewed was

designated as a coordinator for minorities in the region. The last mentioned person was a

male- all others were women, an illustration of general gender disproportion amongst health

promotion professionals.

All interviewed persons have special education and experience in the field of migration.

The HP providers and NGOs for migrants do not speak with each other. The tasks in this

phase (interviews) with the providers show what is necessary to do in the future. It costs very

little to exchange information between the two groups. NGOs working with migrants need in-

formation about HP activities and they welcomed the possibility to with HPs about their clients.

HP professionals could recruit clients using NGO counselling for participation in HP activities.

Collaboration is the key for a future policy.

”Migrants have large scale of possibilities and also duties to integrate themselves into the all parts of life in the host country, including health promotion services participation offered for the general population. They don ´t need any special approach.”HP provider, Ostrava.”

”A Charity in our town works with migrants and we could use the contact for our activities in health promotion.” HP provider, Brno,”


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Which target groups are addressed by these organisations?

One important activity in health promotion provided by health professionals is the Health

Days. They are organised in a community or in workplaces and are based on free ser-

vices for citizens or employees, consisting of consulting on healthy life style, nutrition,

physical activity and non-smoking, together with examination of body fat and blood choles-

terol level, as described in the chapter Health promotion. Migrants who are well integrated

into the community have used this service as a part of the general population without any

special attention.

Another HP activity is projects targeted at specific populations including information cam-

paigns for special population groups such as children and seniors. Migrants participated in

those projects as members of the majority population.

NGOs provide services specifically for migrants, sometimes for refugees or asylum seekers,

without distinction according to age, sex or legal status.They are based mostly in Prague and

in some other large towns in the country. They offer their counselling services and learning

courses to increase the chance of migrants to gain regular and legal employment, as well as

integration into the main society in order to improve their living conditions and, indirectly,

their health.

Regional and local authorities provide a mixture of both types of services as described above

with emphasis on the social aspect and social assistance for migrants as a part of other mi-

norities.

• The settings in which they work

Workplaces

The majority of migrants work in large factories and from there they have access to HP ser-

vices (Health Days provided by HP professionals).

Schools

NGOs offer learning courses, not only for migrants themselves but also for teachers on how

to integrate migrant children and how to respect their cultural differences. Health education

programmes for children and teachers on healthy life style, including healthy nutrition, im-


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proved physical activity, reduced smoking and alcohol abuse, and illicit drug abuse and

HIV/AIDS prevention are provided by the National Institute of Public Health. Migrant chil-

dren participate as a part of the mainstream school children population. Parents and other

family members can be involved in health promotion through their children.

Cultural and sport facilities

NGOs organise cultural and sport evens for migrants to increase their integration and social

capital and to influence health indirectly in the terms of participation and empowerment.

• How many have migrants as participants

It was said before, the number of migrants who participate in health promotion activities

are not monitored and migrants participating n Health Days and other health promotion

projects are not regarded as special participants.

We interviewed three NGOs and agencies for migrants who reported that about 2 700 peo-

ple used their services per year. One NGO has two branches in Prague and in Ceske Bude-

jovice; one is sited in Prague and one in Brno.

The regional authority from Liberec doesn’t monitor how many client-migrants have been in-

volved.

• How many have policies to improve participation

There are no identified policies on how to increase the participation of migrants in health

promotion services ( NIPH) . The National Public Health strategy and its documents for ac-

tions includes targeting vulnerable groups, but in practice it is implemented in special pro-

jects for Roma people, but not for migrants.

None of the interviewed persons reported a policy which could help to increase migrants’

participation in health promotion. On the contrary, complaints of a non systematic solution,

with no one responsible, and no interest at all levels of policy makers were reported.


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• What are the most important types of HP interventions?

Activities and services provided by NGOs and agencies for migrants are interventions

in the sense of empowerment and participation, but generally they are not health promotion

as is understood in the country because they lead to improving health only indirectly.

The important intervention in which migrants participated are Health days at workplaces

provided by the National Institute of Public Health and its regional branches.

Special projects on one or more life style topics for a special target group ( school children,

seniors, pregnant women, etc.) and for a limited time period (a few months to three years)

are an opportunity for migrant participation.

National campaigns to increase awareness of a healthy life style (e g. “Challenge your

Heart to Move” on increasing physical activity or “Take in-take off” on the importance of

the balance of energy intake from food and physical activity, organised by the National

Institute of Public Health) are targeted on the whole population and will also address mi-

grants.

• In what forms are they offered and how often

Seminars, lectures, learning courses, language courses, individual counselling, and or-

ganisation of sport and culture events, and special projects are provided by NGOs and

agencies for migrants. Written information, published as leaflets and brochures are often

printed in the mother tongue of main migrant groups or in Russian - the official language of

former Soviet Union countries. Consulting and learning courses are provided on a daily ba-

sis, with other events occasionally or according actual needs. Leaflets, brochures and videos

about different aspects of life in the Czech Republic, its legal system, health insurance and

the health care system are in languages of the main nationalities of migrants groups. NGOs,

Regional Authorities provide these documents during visits by migrants to agencies or at

special cultural and sport events.

Information leaflets and brochures as tools for health education, provided by the National

Institute of Public health are published only in the Czech language (a few are published in


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the Roma language, which is almost useless for migrants). They are disseminated during

Health Days or in a course of special HP projects, occasionally as a response to individual or

groups requests.

National campaigns to increase healthy life style use Czech language only and are organ-

ised usually annually for a limited time. Campaigns consist of a competition, articles in

newspapers and journals, interviews with experts on healthy life style for TV and radio

broadcasting, press conferences and a final award ceremony.


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2. Participation of migrants in the health promotion inter-ventions (provider/intervention level)

2.1. Actual participation of migrants in the interventions

Interventions in which migrants participate This is a brief overview for most of the interventions mentioned or described above.

• Health Days at workplaces

Provider: NIPH, regional branch Pardubice and Liberec

Number of participants: unknown

Main migrant groups that participated: Slovakia, Vietnam, Ukraine, Mongolia, Russia.

Health status: In spite of activities targeted at health status indicators, there is no data about

health status of migrants because the services and examination are anonymous.

Workers including migrants visit a transient health promotion workplace in their factory for free

consultation and examination on their health status indicators and life style indicators.

The practice is usually in big cities with large factories, where migrants are a high proportion of

the employees.

• Training and learning courses for workers in China restaurants in food hygiene

and epidemiology

Provider: NIPH regional branch Olomouc


Main migrants groups: China and Vietnam, working in restaurants.

The intervention has finished recently; the contact person is no longer working in HP. Informa-

tion about it was obtained from an interviewed person as “second hand information” from her

previous job without any possibility to get more data. I have mentioned it here because very

few interventions for migrants were identified and even the idea could be stimulating.


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• Education for Ukraine workers (women) in textile industry about vaccination for

their children: affordability, risks, benefits)

Provider: NIPH, regional branch Zlín


Main migrants group: women from Ukraine

The intervention has not been provided now- the contact person is engaged in different tasks

in HP and she has no more support to work with the migrant target group.

• Social, legal and labour consultancy, Czech language courses

Provider: Centre for Integration of foreign, NGO, Prague, and Ceske Budejovice

Number of participants: not followed

Main migrants group: Afghanistan, Vietnam, Iran, Iraq, Sudan, Cuba, and Bulgaria, Romania

• Czech language courses, social and legal consultancy, sport and culture events

Provider: SOZE – Coalition of citizens for emigrants, Brno

Number of participants: not followed

Main group of migrants: Ukraine, Russia, Kazakhstan, Mongolia, Sri Lanka, Nigeria, Congo

Age: pre-school children, productive age, seniors

Education: basic to university

Church: Orthodox, Muslims, Buddhists, Christians

Other interventions are not targeted at migrants (more in the chapter on Health promotion

in the CR). They are not regarded as special participants, so there is no data describing

them.

Even for interventions and other similar activities, the persons interviewed reported that mi-

grants were not identified because those who participated on interventions were not described

in more details than nationality, few by age and religion. I can conclude that migrants popula-

tion in our country looking for services is not homogenous and use of services is rather

by chance and depends on individual preferences and interests and the most importantly

on access to information.


22

Interventions in which migrants do not participate:

General public interventions that are targeted at a special population group (seniors, children,

pregnant women) have not been followed with respect to migrant. It is a cause and a conse-

quence expressed by some of HP providers: “there are no obstacles for migrants to partici-

pate”. As it is not known how many migrants are amongst participants of intervention targeted

on the whole population, it is not possible to describe any special intervention in which mi-

grants do not participate.

That is why no specific methods to reach migrants were identified.

2.2. Hindering or conducive factors on the intervention level

Which characteristics of the intervention could be hindering or conducive? And how?

Most of the providers agreed that migrants need special care to be involved in intervention,

relative to the general public. Reasons and opinions from provides from different organisations

and sectors on the question “why migrants did not participate on HP interventions” were very

similar. The following reasons are listed according to frequency:

1. Lack of information, especially in national languages of migrants

2. Dramatic decrease in offer of services in health promotion recently

3. Language barrier

4. No interest, it is not important for them now; they faced more problems even in health

care services

5. Health care treatment is the priority, not health promotion

6. Fear to use them

7. Disbelieve in official structure

8. General shyness and low self-confidence

9. Societal barrier – low integration


23

Intervention characteristics and hindering and conductive factors

Each characteristic could be in practice be both hindering and conductive. The very good con-

ductive characteristics could be supportive if one is hindering. An effective intervention for mi-

grants should be designed and provided with respect to all characteristics.

• Intervention setting: work places seem to be a very good conductive factor on how to

reach migrants and to provide them access to health promotion activities.

• Intervention methods (e.g. directed to participation and empowerment): individual

consultancy, privacy, free of charge, feeling safety and secure and trust in a person and

organisation are conductive factors

• Communication and recruitment strategies: leaflets can be distributed in national

languages with active recruitment at cultural and sporting events organised for mi-

grants. Only active strategies can support participation: to go directly with an offer of in-

tervention to migrants and not to wait for their participation.

Which characteristics of the provider are hindering or conducive? And how?

Providers from NIPH and regional branches are not trained in communication with different

cultures with very little exception. About 20% of them are not aware of any need of special

health promotion of migrants. This is a hindering factor, because not only do migrants have a

perceived fear of HP professionals but it is true. More knowledge and education in a multicul-

tural approach is needed.

Other suggestions from inteviews:

The best conductive factor is personal experience from work with migrants.

Providers should be the same nationality as migrants or have personal experience with mi-

gration.

An open, warm and friendly person needs no special education.

Which life conditions of migrants could be hindering or conducive? And how?

HP providers have limited experience with working with migrants. The opinions summarised

below are based on their work with the general public rather than from work directly with mi-

grants.


24

Religion: most of the people from the Ukraine, the largest sector of migrants, are Orthodox

Christians and religion does not constitute a serious barrier to their life in our country. Czech

people are mostly Catholics, but 70% of Czechs are in reality atheists and a different religion is

not a source of conflict or xenophobia. People from the Ukraine keep their belief as a private

matter. Vietnamese are mostly Buddhists. Buddhism is a less confrontational religion. There-

fore, religion seems to be a neutral factor for any kind of participation or integration for the

majority of migrants.

Age: Most migrants are aged between 20 and 56 years, being the first wave of migration. The

younger generation – children and teenagers, are mostly Vietnamese second generation of

migrants. Regarding health promotion, there is no age limit, but projects are often aimed at

special age groups in special settings. For example projects on healthy ageing are often pro-

vided in seniors homes, but it is probably true that no elderly migrants live there. If migrant’s

children are aged between 7 and15 years, they could be part of the target group for school

children projects. Adult populations participate in intervention as a target group of workers in

some enterprises. The age could be both a hindering or conductive factor.

Gender: Generally, women care more about health for themselves and their families, chil-

dren, relatives and friends; they have better communication skills and they more easily partici-

pate in societal activities.. It could be different for Muslim women, but the proportion of Mus-

lims is very low amongst migrants in the Czech Republic.

To be a woman is conductive factor. On the contrary, male mentality could be a hindering fac-

tor for participation in intervention, if they follow the experience with participation of Czech

men.

Socio-economic status (unemployment, poverty): The very low social economic status and

illegal status is one of the strongest hindering factors: these people have worries about daily

living resources, are under immediate and long term stress and find health promotion outside

their daily interests. Illegal migrants live in danger of discovery by the authorities. They make

contact with any official service including health care professionals only if necessary. They can

be reached through leaflets or by general health campaigns. Their personal participation on

interventions could be expected only if it would be strictly anonymous and they could feel safe.


25

Housing: In spite of the little information on migrant housing, it is assumed that housing is

related to social economic status and a low standard of housing and often insecurity of it

could have the same hindering impact as social economic status.

Family situation: Migrants who live in a family or similar relationship could feel more safe with

more social support. Together with a responsibility for a family life, living in a family could be a

conductive factor for participation rather, as opposed to living alone.

Number of years migrant has lived in host country: The longer that migrants stay in the

host country the more they use the health care service. There is a higher probability that they

would participate in intervention projects because better orientation in PH activities offers bet-

ter knowledge of the Czech language, more assimilated life style and similar values as the

majority population, resulting in a higher degree of integration. An exception is unregistered

migrants. They will always be passive consumers of health promotion services (leaflets and

other written information) than active participants. More years spent in the host country for this

group will eventually be a conductive factor.

Ability to speak the language of the host country: Almost all migrants from the biggest mi-

grant group (Ukraine) can communicate in the Czech language after 3-5 years of living here.

Migrants from Vietnam are the biggest group of second generation of migrants and their

Czech language ability is good. A law requests a presence of interpreter on local, regional and

national administrative (not all types) authorities. Migrants from Vietnam often have their own

interpreters if necessary for communication, for example in hospitals or other health care facili-

ties. Having in mind that the target group of the project are migrants living and working in the

Czech Republic more than five years, the language barrier is less important. Even if Czech

people are not friendly to somebody who doesn’t speak fluently in Czech and it is true for pro-

fessionals, too. Ability to speak and understand is a strong conductive factor.

Acculturation / cultural orientation: Very little is known about health/ disease profiles and

health needs and other values of migrants living in the Czech Republic. The Ukraine culture

has to some extent a similar background as the Czech culture since the Ukraine was a part of

the Soviet Union. Differences exist but they are subtle. Mentality and temperment could make

problems, but only under excessive conditions (highly emotional or life threatening situations,

etc.). Cultural orientation could be both hindering and conductive.


26

3. Policies of organisations to improve participation of

migrants (organisational level)

3.1. Organizational policies

No special organisational policy to increase migrant’s participation in HP services and activi-

ties was identified during the interviews. This is due to a lack of awareness that migrants

need health promotion and need to be supported by special approaches.

3.2. Hindering or conducive factors on the organisational level

I have little information from interviews to answer this section. All mentioned factors are sug-

gestions from providers or their wishes, not their direct experience. Most HP professionals

were asked to share their experience about migrants for the first time in their professional life.

Even if we have rather negative results, I see the great benefit from participation on the project

because they start to think about migrants in relation to health promotion.

Ethnic diversity of staff: It would be a very strong conductive factor if health promotion is

provided by professionals with the same nationality as the target group.

Training in cultural competence: All providers with health care or public health education

background would welcome more possibilities for education and training in this field. It was

identified as the very strong conductive factor. On the contrary, lack of knowledge about mi-

grants as a vulnerable group is a strong hindering factor. Providers feel helpless and afraid of

contact with migrants.

Communication and recruiting strategies: Leaflets and brochures in native languages,

special projects and campaigns for migrants are conductive factors

Procedures, guideline, professional standards: There are no guidelines for HP providers

on how to deal with migrants; this it is a hindering factor.


27

Monitoring of health status and (effectiveness): Evaluations of health promotion inter-

ventions: It is difficult to evaluate outcomes of health promotion activities according the

health status of the population. The most frequently used method of evaluation is evaluation

of HP projects: the number of participants, their satisfaction and improved knowledge about

life style risk factors and changes in self-estimated health. Improvement of accessibil-

ity/participation of migrants could be a good indicator for effectiveness of intervention because

we have a significant lack of data on participation of migrants in HP activities. It would a good

beginning for a more deep evaluation of the effectiveness of HP services on migrants’ health

and evidence for policy makers to support intervention for migrants.


28

4. Governmental policies to improve participation of mi-

grants (institutional level)

4.1. Governmental policies

There is no governmental policy on access of migrants to health promotion, identified by pro-

viders. A policy on integration of migrants is accompanied by funding programmes, but priori-

ties are far from health promotion. As mentioned in the Chapter on Health promotion in the

Czech Republic, the health system is under reconstruction and health promotion organisation

(institutional and in content) is changing. The following list includes suggestions for inter-

viewed HP providers.

4.2. Hindering or conducive factors on the institutional level

Which characteristics of the health promotion system and (local) government are hindering or

conducive? And how?

Free access, financial hindering: Generally, HP services are free of charge, while individual

consultations together with examination of risk factor indicators are a paid service. Services

free of charge are a conducive factor but the more supporting for participation is interest of a

person who is considering to use health promotion services.

Organization of health promotion: If an organisation is comprehensive then it is a strong

conductive factor. Our existing network of 14 HP regional providers is a good basis for re-

gional, local and national activities. The hindering factor is dissemination of information on HP

services and ongoing changes of the organisation of health promotion services.

”There is a governmental policy for integration of migrants but it is very unsufficient. Provider, Multicultural Centrum, Praha”


29

Content of health promotion: If content is not clear then it is the most hindering factor for

people to use the HP services and intersectorial collaboration. Content needs be defined

more in the sense of empowerment and participation and to be related to wider social determi-

nants of health. An offer of services should be clear and comprehensive, together with listed

benefits following participation in interventions.

Continuity of health promotion: It is believed that only long term intervention is effective. On

the contrary, some providers experienced that even participation in a single HP event, e.g.

Health Day could be the kick of momentum for life style improvement.

Monitoring of health status and evaluations of health promotion policies: This is a con-

ductive factor. A provider’s opinion is that monitoring, together with dissemination of results will

gain support of migrants. They should not only believe that participation in intervention can

improve their health, but that they would be given the objective proof. It could be stimulation

for their continual participation.

Participation of migrant communities: It is a conductive factor – social support and sharing

and exchanging experiences could increase participation. Providers recommend that as

much of the migrant community as possible should be included.


30

5. Conclusions

A total of 18 providers were interviewed from two groups of providers with different facilities.

The first group were providers from the National Institute of Health and it’s 14 regional

branches. Representatives from all regions were interviewed. Thus the obtained results could

be taken as representative and describing the situation in the country and they could be a very

good source of information for the future recommendations for practice in health promotion.

However, interviewed persons reported their experience from health promotion, but they had

little experience of working with migrants.

The second group of providers were principally agencies and NGOs, experienced to work with

migrants but had no knowledge and information about health promotion.

The obtained results could be taken as representative and describing the situation in the coun-

try and they could be a very good source of information for future recommendations for prac-

tice in health promotion.

Collaboration between different groups of providers is necessary to install health promotion

services for migrants in the Czech Republic and their active participation.

5.1. Provider/intervention level

The HP providers and NGOs for migrants don’t know about each other’s activities and ser-

vices. The interview phase with providers shows what is necessary to do and the costs are

minimal: a simple exchange of information. NGOs for migrants need information about HP ac-

tivities and they welcome possibility to refer them to their clients. HP professionals could re-

cruit clients using NGO counselling for participation on HP activities. Collaboration is the key

for a future policy on local and regional level.

Most HP professionals were asked to share their experience about migrants for the first time in

their professional life. I see the enormous benefit from participation on the project even now:

they start to think about migrants in relation to health promotion. The interviews have indi-


31

cated an increasing awareness to this topic among HP professionals and amongst pro-

fessionals dealing with migrants in another field.

Interventions in which migrants can participate:

General public interventions or intervention targeted on a special population group (seniors,

children, pregnant women) have not been followed regarding migrants participation. As many

providers said: there are no obstacles for them to participate.

Most of the providers agree that migrants need some kind of special care to be involved in

intervention for the general public. Reasons and opinion of provider’s from different organisa-

tions and sectors were very similar. The following reasons are listed according to frequency:

• Lack of information, especially in the national languages of migrants

• Dramatic decrease in offer of services in recent health promotions

• Language barrier

• No interest-it is not important for them now, since they faced with more problems even

in health care services

• Health care – treatment is the priority not health promotion

• Fear to use health care

• Disbelief in the official structure

• General shyness and low self-confidence

• Societal barrier – low integration

5.2. Organisational level

There is no organisational policy to increase migrants’ participation in HP services and activi-

ties. This is due to a lack of awareness that migrants need health promotion and they need to

be supported. Education, training and courses for providers could increase their knowledge

and make them more efficient to actively involving migrants group to participate in health

promotion. They could also better recognise the special needs of migrants..


32

5.3. Institutional level

There is no governmental policy on access of migrants to health promotion.

Health promotion is a part of the health care system which is under reconstruction based on a

new health care reform. The health promotion organisation (both institutional and in content) is

changing.

However, the network of 14 HP regional providers is a good basis for regional, local and na-

tional activities.

The content of health promotion could be wider, targeting more health determinants: social,

economical, psychological and environmental. Health promotion definition should as concrete

as possible to facilitate collaboration of different agencies. Dissemination of information on

special interventions for migrants could use more channels, such as cultural and sport

events provided for migrants, legal and labour consultancy and Czech language courses.

Overview of results from the providers analysis:

Direct results:

a. mapped situation, data collection, information source identification

b. needs assessment ( dissemination information about migrants for providers in regions,

special training about communication with them)

c. identification of hindering and conductive factors for migrants participation

3 main hindering factors:

• Lack of information on HP services

• Non interest, non awareness of migrants to PH

• Non interest, non awareness of PH providers to migrants

3 main conductive factors

• Information in national language of migrants, leaflets, brochure avail-

able during culture and sport events for migrants’ community

• Comprehensive offer of health promotion services - special for migrants


33

• Collaboration among social services for migrants’ providers (NGOs.

Charity, Regional Authorities) and health promotion services (Health

promotion Units, health care professionals)

d. Involving experts to constitute the Advisory board

Indirect results:

Increased awareness to the topic among providers and readiness for future collaboration

The main conclusions from the analysis of providers experience are:

No special health promotion for migrants is available in our country.

Social consultancy and events to increase integration in society could be adopted as health

promotion activities in the sense of participation and empowerment, but without a direct

health approach.

The collaboration and exchange of information about services of different providers in

different organisation and agencies is the key for the future policy at all levels - national,

regional and local.


34

6. Summary

“Healthy Inclusion” is an international project carried out within the Public Health Programme

2003-2008 and co-funded by the European Commission, DG Health and Consumers, Public

Health (EAHC). The project commenced in July 2008 and will finish in May 2010.

Migrants belong to the most vulnerable and exposed social strata in society and require spe-

cial consideration in public health strategies.

The main objective of the project is improving the access of migrants to health promotion in-

terventions.

Methods:

• A literature review of national literature, concerned with the particular situations regarding

migration and health promotion in each country involved in the project.

• Interviews with representatives of organisations providing health promotion interventions.

• Interviews with migrants who do and who do not have access to these interventions ( the

method is not part of the report but it will be the next stage of the project).

Interviews with health promotion services providers were carried in February to March 2009,

after preparatory and pre- testing phases.

Interview guide, a questionnaire for qualitative interviews, was the basic tool on how to obtain

health promotion providers' perspectives and experiences on hindering and conducive factors

for participation of migrants in health promotion interventions.


35

Results

Literature review:

Health promotion in the Czech Republic Policy of health promotion services in the Czech

Republic has been under responsibility of the Ministry of Health, practice and research has

been a task of National Institute of Public Health and its regional health promotion branches.

Legally it has been based on the Public Health Act (2000) and its later amendments.

Health promotion is officially defined as a service to give people information and knowledge

about health determinants and to support their healthy behavior and health choices. In practice

it is oriented mostly on life style, possible behavior changes and how to influence some of the

risk factors for chronic non-communicable diseases.

Migrants

The percentage of registered migrants is now 4%, which is still below the EU average. How-

ever, according OECD report in 2006 the Czech Republic has been the country with the

highest increase of immigrants in OECD countries. This trend continues.

The main migrants groups in 2008 are from:

Ukraine 30 % (131 965)

Slovakia 17 % (76 034)

Vietnam 14 % (60 258)

Russia 6 % (27 178)

„Health migrants effect“ Migrants from the Ukraine feel more healthy than the main public,

especially at the beginning of their emigration.

The longer the Ukraine migrants stay in the CR, the better access to health care they have,

the more they use it, but their health status is the same or worse than the health of majority

population. One explanation could be that their life style is worse than in the Ukraine because

they work longer days, often under bad working conditions and their behaviour is becoming

more unhealthy : smoking, alcohol and unhealthy diet habits. Another explanation assumes

that they changed their norms on health and illness, matching the majority population.


36

Interview with providers: analysis

A total of 18 providers were interviewed. The main provider of health promotion services is the

National Institute of Health and its 14 regional branches. Representatives from all regions

were interviewed. Results could be taken as representative, describing the situation in the

country and they could be a very good source of information for the future recommendations

for practice.

Most of providers of health promotion (NIPH) have no experience with migrants at all or very

limited experience. Their opinions often reflected this situation. Only two of the interviewed

professionals had experience with health promotion in which migrants participated as a group

of workers. Only one of the interviewed providers had been trained in multicultural nursing as

part of her professional education; others were not trained to recognise special migrants’

needs.

Most of the providers agreed that migrants need some kind of special care to be involved in

intervention for the general public. Reasons and opinion of providers from different organisa-

tions and sectors on the question why migrants did not participate on HP interventions were

very similar. The most important are:

• Lack of information, especially in national languages of migrants

• Dramatic decrease in offer of services in health promotion recently

• Language barrier

There is no organisational policy to increase migrants’ participation in HP services and activi-

ties. This is due to a lack of awareness that migrants need health promotion and they need to

be supported. Education by training courses for providers could increase their knowledge

and make them more efficient to actively involve migrant groups to participate in health

promotion. They could also recognise better the special needs of migrants.

The network of 14 HP regional providers is a good basis for regional, local and national activi-

ties.


37

The main conclusions from the analysis of providers experience are the following:

The no special health promotion for migrants is available in our country.

Social consultancy and events to increase integration in society could be taken as health

promotion activities in the sense of participation and empowerment but the health approach

is included.

The collaboration and exchange of information about services from different providers in

different organisation and agencies is the key for the future policy at all levels - national,

regional and local.


38

References

• Arnold, F. 1979. Providing Medical Services to Undocumented Immigrants: Costs and Public Polic. International Migration Review. Vol. 13, No. 4.

• Bosniak, L.S. 1991. Human Rights, State Sovereignty and the Protection of Undocumented Migrants under the International Migrant Workers Convention.

• Dobiášová, K., Angelovská, O. 2005. Podpora integrace cizinců v ČR v oblasti zdravotní péče. Přepis rozhovorů (vnitřní materiál). IZPE, Kostelec nad Černými lesy.

• Dobiášová, K., Křečková Tůmová, N., Angelovská, O. 2005. Zdravotní péče o děti cizinců v ČR. Realita a zkušenost. IZPE, Kostelec nad Černými lesy.

• Duffy, M. M., Alexander, A. 1999. Overcoming language barriers for non-English speaking patiens. ANNA Journal. Potkan. Vol.26, Iss. 5.

• Dwyer, J. 2004. Illegal Immigrants, Health Care, and Social Responsibility. The Hastings Center Report. Hastings-on-Hudson: Vol.34, Iss. 1.

• Espenshade, T. J. 1995. Unauthorized Immigration to the United States. Annual Review of Sociology, Vol. 21.

• Křečková Tůmová, N. 2002. Podpora integrace cizinců v ČR, obsahová analýza • hloubkových rozhovorů s cizinci a s odborníky, kteří s cizinci přicházejí při své práci do

styku. • IZPE, Kostelec nad Černými lesy. • Moore, E. 1986. Issues in Access to Health Care: The Undocumented Mexican

Resident in Richmond, California Medical Anthropology Quarterly. Vol. 17, No. 3. • Nesvadbová, L. (ed) 2003. Péče o cizince v ordinaci lékaře v ČR. IZPE Kostelec nad

Černými lesy. Dostupné na: http://www.izpe.cz/files/aktuality/36.pdf. • Průvodce systémem zdravotní péče České republiky. 2004. IZPE. Kostelec nad

Černými lesy. • Dostupné na: http://www.izpe.cz/files/aktuality/47.pdf. • Schuklenk ,U. 1997. Using medicin to control immigration. The Hastings Centre Report. • Smith, L.S. 2001. Health of America's Newcomers. Journal of Community Health

Nursing, Vol. 18, No. 1. • Zdravotní stav a péče o zdraví občanů bývalého SSSR pobývajících dlouhodobě

v ČR a občanů ČR.Závěrečná zpráva z výzkumu z roku 2003. Sborník č. 1 / 2004 IZPE, Kostelec nad Černými lesy.


39

Appendix Overview of characteristics of the organisations and intervention(s) 18 INTERVIEWS Table 1. Organisations Number Type of organization Main financial resources Groups/populations Settings

1. 2 5, State budget 1,2,6,7,8 1,4,5,6- workplaces 2. 2 5, State budget 1,2,3,6,7,8 1,4,5,6- workplaces 3. 2 5, State budget 1,2,6,7,8 1,4,5,6- workplaces 4. 2 5, State budget 1,2,6,7,8, 1,4,5,6- workplaces 5. 2 5, State budget 1,2,3,6,7,8 1,4,5,6- workplaces 6. 2 5, State budget 1,2,3,,6,7,8 1,4,5,6- workplaces 7. 2 5, State budget 1,2,6,7,8 1,4,5,6- workplaces 8. 2 5, State budget 1,2,3,6,7,8 1,4,5,6- workplaces 9. 2 5, State budget 1,2,6,7,8 1,4,5,6- workplaces 10. 2 5, State budget 1,2,6,7,8 1,4,5,6- workplaces 11. 2 5, State budget 1,2,6,7,8 1,4,5,6- workplaces 12. 2 5, State budget 1,2,6,7,8 1,4,5,6- workplaces 13. 2 5, State budget 1,2,6,7,8 1,4,5,6- workplaces 14. 2 5, State budget 1,2,6,7,8 1,4,5,6- workplaces 15. 8 special for migrants 2,5 EU projects 3 6 16 8 special for migrants 2,5 EU projects 3 6 17 8 special for migrants 2,5 EU projects 3 6 18 8 regional authority 5, state and regional budget 3,5 6 Type of organization: 1. Community centre or association; 2. Health care centre; 3. (adult) educational centre; 4. (Local) Project; 5. Doctor; 6. Church related organisation; 7. Sports association; 8. Other Main financial resources: 1. services; 2. donations; 3. membership fee; 4. payments of courses; 5. others Groups/populations: 1. women; 2. men; 3. migrants (special groups?),; 4. disabled people or people with a chronic disease; 5. socially disadvantaged people; 6. older people; 7. children; 8. employees; 9. other Settings: 1. School; 2. Neighborhood; 3. Sport club; 4. Community centre; 5. Health (care) centre; 6. other Table 2. Interventions Number Type of

intervention Target group Form Frequency Number of partici-

pants Approach

1. Healthy life style education

General population Health Days, seminars, projects, consultancy

According interest and needs

400 health oriented

2. consulting Migrants and public

Information on website, library, special projects

regularly No known holistic


General population Health Days, seminars, presen-tations, project,

regularly Thousands of people

health oriented


40

consultancy 4. Healthy life style General population Health Days,

seminars, projects, consultancy

regularly 10 000 -12 000 health oriented



regularly 5000-10 000 health oriented



regularly 5 000 health oriented

7. Social and legal consultancy

Migrants Seminars, courses, language courses

Regularly and according to inter-ests of clients

500 integration



Regularly 6 000 health oriented

9. Social counsul-tancy

Migrants Courses, counsul-tancy

Regularly 2100 integration

10. Social – health consultancy

Minorities Consultancy, special projects

According needs and interesrs

Not followed Social integration



regularly 1 500 Health oriented









regularly Thousands of people

Health oriented



regularly More than 1 thousand

Health oriented






regularly More than 10 000 Health oriented




d4 cz-national report providers in englishnational report providers: czech republic 6 the interview...

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