Professional synergies for interventions with Excluded Population

an experience from some illegal settlements in Madrid (Spain)

Arantxa Santa-Maria Morales

Carlos Sanz Acera

• Spain - Madrid–(Area 1 – Villa de Vallecas

District)

• Excluded Population in illegal settlements

• Interventions and services

• Professional synergies

Shredding the title: Four axis

AXIS 1: Madrid – Health Areas

AXIS TWO: EXCLUDED POPULATION

SOCIOCULTURAL DIFFERENCIES

Lack of DOCUMENTATION

ISOLATIONLACK OF MOBILITY

ACCESS

APROPRIATE USE

MANTAIN AND INCREASE

SOCIAL EXCLUSION

HEALTH RESOURCES

EDUCATION RESOURCES

SOCIAL RESOURCES

needs out of the usual assistance scope

POPULATIONCitizens of illegal

settlements• Cañada Real,

Barranquillas

MAIN CHARACTER

PROFESSIONALS

TECHNICIANS WORKING IN: RESOURCES

TERRITORY: Barranquillas and Cañada Real

INTERVENTIONS PERFORMANCE

SCIENTIST KNOWLEDGE

REALITY KNOWLEDGE ADMINISTRATIONPOLITICIANS

Delegate goverment of the people

- Local- Regional

- State

MAKE PRIORITIESASSING RESOURCES

PLAN INTERVENTIONS

VILLA DE VALLECAS DISTRICT’S ILLEGAL SETTLEMENTS Communities part of a bigger one

ACTORS (Each of them have a rol in the community)

REGIONAL SERVICES

AXIS THREE PROFESSIONAL INTERVENTIONS

SEVERAL SERVICES SPREAD OUT ACTIONS

DIFFERENT INSTITUTIONS

HARD TO COORDINATE

MUNICIPALITYCOUNCIL SERVICES

ANTIDRUG AGENCY

NGOs

HP

PUBLIC HEALTHEpi

TOWN PLANNING

IRIS

PRIMARY CARE

CARE HP

EDUCATION SOCIAL SERVICES

SW & SE

Council Health Centre

UP TO 1997

“COMISIÓN DE POBLACIÓN EXCLUIDA”

Excluded Population Commission (CPE)

Emerged as an initiative from Villa de

Vallecas District Health Council (Área 1 –

Madrid)

Its primary aim was to tackle some social

and health needs out of the usual assistance

scope

BIG PROBLEMS....

FROM 1997….

………...CHANGES STARTED

CPE OBJETIVOS

To Analyse the social and health situation

To improve the coordination (P & I already

involved)

To optimise existent resources

To prioritise interventions

To research within Excluded Population

To raise healthcare professionals’

awareness of an unknown or ignored reality

To sensitise the public towards the socially

excluded

METHODS

Monthly meetings

Workgroups

Combined actions

Routine contact

Democratic and consensus decision-making

Resource-optimisation mentality

Informal moments – interpersonal relations

SOME HISTORIC RESULTSSeveral illegal settlements in the district :

•La Rosilla (1998-2000)

•El Pozo del Huevo (1998-2001)

•Cañada Real 1998-(…)

•Barranquillas 1999-(…)

• Situation analysis and needs assessment

• Vaccination campaigns

• Guide for Mediators (edition) and design of other specific training

materials

• Health workshops (Women, drug users…)

• Access to medical card

• Coordinated combined interventions: Contact studies for

Tuberculosis, Hepatitis A clusters

• Coordinated efforts in scholarship process

• Inform the institutions about the urgency to tackle some situations,

lack of resources for tuberculosis management, arrival of the emergency

care services to the settlements…

SYNERGETIC EXAMPLES1. ACCESS TO SANITARY CARD

2. CAÑADA REAL NEEDS ASSESSMENT report

1. ACCESS TO SANITARY CARD

STARTING POINT

– A IMPORTANT PART OF THE POPULATION (CHILDS, PREGNANT WOMEN, TBC, VIH …) CAN´T ACCESS TO SANITARY CARD

– THIS POPULATION CAN´T USE THE HEALTH RESOURCES NORMALLY, THEY CAN´T EXERCISE THEIR HEALTH ASSISTANCE RIGHTS.

“ON CPE TABLE”PROFESSIONALS NOTE THERE ARE SIMILAR SITUATIONS BETWEEN DIFFERENT

SETTLEMENTS (BARRANQUILLAS AND CAÑADA)

WORK IN DIFFERENT LINES1. JOINT PROTOCOL TO SANITARY CARD FOR :

– PREGNANT WOMEN

– CHILDREN

– CHRONIC ILLNESS

2. EMERGENCY SITUATIONS: CONTACT PERSON IN CHARGE OF REGIONAL SERVICES FACILITATES MEDICAL CARD.

3. COMMISSION FROM REGIONAL SERVICES WORKING IN A HEALTH DOCUMENT PATHWAY FOR THE REST OF PEOPLE WITHOUT IDENTIFICATION.

1. CAÑADA REAL SITUATION ANALYSIS AND NEED ASSESSMENT

STARTING POINT

•MULTI-PROBLEMATIC REALITY (Childhood and human rights are violented)•INTERVENTIONS AND REALITY KNOWLEDGE WERE PARCIAL. Each resource know and

interacted with its piece.•INSTITUTIONS DIDN’T TACKLE THE PROBLEM.

NEED TO STUDY THE REALITY RAISE UP TO “CPE TABLE” (APRIL 2005)

TECHNICIANS STARTED THE NEEDS ASSESSMENT PROCESS- Gathering information

- Circulate a questionnaire among the resources operating - Fieldwork investigation

-Institutional data collection- Workgroup- Meetings

- Document set up and edition

A REPORT IS COMPLETED (JULY 2005)

DOCUMENT DISTRIBUTION • RESOURCES (PROFESSIONALS)• INSTITUTIONS (TECHNICIANS AND POLITICIANS)

PRESS TO GET THE PROBLEM TACKLED

…AND NOW

• MADRID CITY COUNCIL APROVE TO WORK ON A INTERVENTION PLAN FOR CAÑADA REALPOLITICIANS USE THE NEED ASSESMENTS BUT DON´T CONSULT TO TECNICIANS NEITHER TO POPULATION

• KNOWLEDGE AND PERCEPTION OF REALITY IS MORE INTEGRAL

• SYNERGIC PROCESS GROW, COORDINATION IS GETTING BETTER

• WE HAVE A PRODUCT, ANOTHER STARTING POINT

• WORK AROUND POSSIBLE INTERVENTION TRACKS

• HOW TO SUM MORE RESOURCES TO THE PROCESS?HOW TO ENGAGE EDUCATIONAL RESOURCES?

• HOW TO INVOLVE THE PEOPLE IN A PARTICIPATORY PROCESS?HOW DOES THE PEOPLE PERCEIVE THEIR OWN REALITY?

• HOW TO CREATE COMMUNICATION CHANNELS AMONGST THE THREE ACTORS?

SOCIAL INTERVENTIONS

• Individual intervention• Groupal intervention

• Street work• COMUNITARY WORK

• SOCIAL CONDITIONS:• EDUCATION

• EMPLOYMENT• HEALTH

HEALTH

• Primary care• Specialised care

• (…)• PUBLIC HEALTH –

HEALTH PROMOTION

• HEALTH CONDITIONS:• BIOLOGICAL

• PSICOLOGICAL• SOCIAL

INTERVENTION AREAS

INTERVENTION SUBJECT: THE COMMUNITY

GOAL : TO IMPROVE COMMUNITY’S CONDITIONS

ULTIMATE OBJECTIVES

- To reduce inequities -To promote better living conditions- To make easy the access to the

resources

- To promote social & participatory processes- To develop social and health policies

-To promote sustainable environments that facilitate people to live healthy

TIME 4 PROCESS

OPEN KNOWLEDGE

HONESTY

MUTUAL TRUST MUTUAL

RECOGNITION

ALTRUISM

SHARED EFFORTS

SHARED FRUITS

NEED TO SOLVE

TANGIBLE FRUITS

COMMON GOAL COLEADERSHIP

SWING HARD NUCLEUS

+ FRESH AIR

INSTITUTIONAL UMBRELLA

SPACE FOR ALL+ RYTHM

COMMITMENT

HUMAN RELATIONSHIPS

PERSEVERANCEAWARENESS OF DIFFERENT TIMING

“Synergetic Habits”

UNDERSTANDING THE SYNERGY VALUE

COMPETENCE

BIG COMMUNICATION FLOW

TERMS OF REFERENCE

FLEXIBILITY LISTEN AND VALUE

COMMON ORIENTATION OF WILLINGNESS

RESPONSIBILITY

METHODS CREATIVE APPROACH OBJECTIVES

HEALTH SERVICES

Yolanda Bonilla Palomares. Trabajadora social Centro de Salud

Rivas

Ruth Cabras Sánchez DUE C.S. Villa de Vallecas

Adriana Sarries Urzurrum Enfermera EAP Villa de Vallecas Marta

Fernández Núñez. Trabajadora Social. C.S. Entrevías

María García Onieva. Pediatra C.S. Entrevías

Ana Isabel Gudiño. DUE C.S. Villa de Vallecas

Concha Pozo Pino. Trabajadora Social C.S. Villa de Vallecas

Encarnación Ruipérez Rodríguez. DUE C.S. Villablanca

María Jesús Calvo Mayordomo Directora Enfermería Atencion Primar

Julia Cecilia Navazo Subdirectora Médica Atencion Primaria.

Concepción Pozo Pino Trabajadora Social EAP Villa de Vallecas

Ana Miquel Gómez Directora Médica SUMMA 112

Arantxa Santa-Maria Morales. MIR de M. Preventiva y Salud Pública

Jose Zarco Montejo. Jefe de la Unidad Docente de Medicina de

Familia. Representante en la CPE de la Gerencia de Atención Primaria.

NGOSACCEM (Asociación Comisión Católica de Migración)

Mercedes Bernardino Rodríguez. Trabajadora Social

ASOCIACIÓN BARROMª Antonia Martín García. Educadora

CRUZ ROJAAlicia Esteban. Trabajadora Social

ISIDROBUSVirginia Ruescas Mecinas. Trabajadora Social

UNIVERSIDAJaime Alvarez Presidente.

ASOCIACION EL FANALRosa Gómez Jiménez Paloma Jover de Celis

TOWN PLANNING: INSTITUTO DE REALOJO E INTEGRACIÓN SOCIAL (IRIS)Javier Alonso Diez. Coordinador CPC Madrid Sur, UTS Santa Catalina y Barranquillas

Héctor Fernández de Carrascosa. Educador Social Santa Catalina y Trigales

Mª José Muñoz Pedregal. Trabajadora Social Santa Catalina y Trigales

Carmen Paniagua Marcos. Trabajadora Social Cañaveral

Carolina Parra Simón. Trabajadora Social Barranquillas Y Cañada Real

Carlos Roca Sierra. Educador Social Barranquillas y Cañada Real

STARRING

STARRINGMADRID COUNCIL

SOCIAL SERVICES

Carlos Sanz Acera. Educador Social. SS SS. Junta Municipal de Villa de Vallecas

Gemma Pau Ruiz. Educadora Social. Servicios Sociales. Junta Municipal de Villa de Vallecas

Concha Martín Gayubo. Trabajadora social. Servicios Sociales. Junta Municipal de Villa de Vallecas

Belén Ruiz Cubero. Trabajadora Social. Servicios Sociales. Junta Municipal de Villa de Vallecas

Rosa Cerviño de la Fuente. Jefe del Departamento de Servicios a la Ciudadanía de Vicálvaro.

Montserrat Díaz Palacios. TS del Centro SS SS Entrevías. Junta Municipal de Puente de Vallecas

MUNICIPALITY HEALTH CENTRE

Luz Carmelo Martínez. Trabajadora social del CMS Vicálvaro

Carmen Barcenas Gutiérrez. Pediatra CMS (Centro Madrid Salud) Villa de Vallecas

Javier Capdepon Serrano. Coordinador CMS Villa de Vallecas

Laura Pérez. Trabajadora social de los CMS de Puente y Villa de Vallecas

STARRING

PUBLIC HEALTH & HEALTH PROMOTION - AREA 1

Victoria Cid Deleyto. Jefa de Sección de Sanidad Ambiental e Higiene Alimentaria.

Margarita García Barquero. Jefa de Sección de Prevención y Promoción de la Salud.

Mª José López Limiñano. Técnico de Sección de Prevención y Promoción de la Salud.

Silvia de Ramón de Zarate. Técnico de Sección de Prevención y Promoción de la Salud.

Silvia Sánchez Buenosdías. Técnico de Sección de Prevención y Promoción de la Salud.

Félix Villarreal del Pozuelo. Técnico de Sección de Prevención y Promoción de la Salud.

OTHER COUNCILS’ SERVICESEDUCATION

Pablo Fernández Díaz. Técnico de educación (Rivas)

Vito Martínez Latorre. Equipo Directivo. CENTRO ENSEÑANZA INFANTIL Y PRIMARIA (CEIP) JULIAN BESTEIRO

Mar Jiménez Crespo EQUIPO DE ORIENTACIONPSICOPEDAGOGICA GETAFECristina López Cantebrán EQUIPO DE ORIENTACIONPSICOPEDAGOGICA GETAFE

SOCIAL SERVICES

Montserrat López Bayona. Educadora social. Servicios Sociales Municipales

MUNICIPALITIES HEALTH SERVICES

Jose Luis Sánchez Fernández. Jefe de Servicio de Sanidad (Rivas Council)

GRACIAS

Carlos Sanz-Acera

Arantxa Santa-Maria Morales

arantxa.santamaria@salud.madrid.org