1 Professional synergies for interventions with Excluded Population an experience from some illegal settlements in Madrid (Spain) Arantxa Santa-Maria Morales Carlos Sanz Acera
2 Spain - Madrid–(Area 1 – Villa de Vallecas District) Excluded Population in illegal settlements Interventions and services Professional synergies Shredding the title: Four axis
3 AXIS 1: Madrid – Health Areas
4 AXIS TWO: EXCLUDED POPULATION SOCIOCULTURAL DIFFERENCIES Lack of DOCUMENTATION ISOLATION LACK OF MOBILITY ACCESS APROPRIATE USE MANTAIN AND INCREASE SOCIAL EXCLUSION HEALTH RESOURCES EDUCATION RESOURCES SOCIAL RESOURCES needs out of the usual assistance scope
5 POPULATION Citizens of illegal settlements Cañada Real, Barranquillas MAIN CHARACTER PROFESSIONALS TECHNICIANS WORKING IN: RESOURCES TERRITORY: Barranquillas and Cañada Real INTERVENTIONS PERFORMANCE SCIENTIST KNOWLEDGE REALITY KNOWLEDGE ADMINISTRATION POLITICIANS Delegate goverment of the people -Local -Regional -State MAKE PRIORITIES ASSING 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)
6 REGIONAL SERVICES AXIS THREE PROFESSIONAL INTERVENTIONS SEVERAL SERVICESSPREAD OUT ACTIONS DIFFERENT INSTITUTIONS HARD TO COORDINATE MUNICIPALITY COUNCIL SERVICES ANTIDRUG AGENCY NGOs HP PUBLIC HEALTH Epi TOWN PLANNING IRIS PRIMAR Y CARE CARE HP EDUCATION SOCIAL SERVICES SW & SE Council Health Centre UP TO 1997
7 “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
8 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
9 METHODS Monthly meetings Workgroups Combined actions Routine contact Democratic and consensus decision-making Resource-optimisation mentality Informal moments – interpersonal relations
10 SOME HISTORIC RESULTS Several 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…
11 SYNERGETIC EXAMPLES 1. ACCESS TO SANITARY CARD 2. CAÑADA REAL NEEDS ASSESSMENT report
12 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 LINES 1. 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.
13 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
14 …AND NOW MADRID CITY COUNCIL APROVE TO WORK ON A INTERVENTION PLAN FOR CAÑADA REAL POLITICIANS 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?
15 SOCIAL INTERVENTIONS Individual intervention Groupal intervention Street work COMUNITARY WORK SOCIAL CONDITIONS: EDUCATION EMPLOYMENT 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
16 “ CPE STRENGTHS “ (quoted) Life experience (Personal development) Provoques both personal and groupal reflection To meet excellent persons and professionals Multitude of problems being solved: Vaccination, TBC, MEDICAL CARDS PROVISION... MOBILISATION of important number of RESOURCES Incrementally improving the access of population absolutely marginal to mainstream professional social/health services (vic). (GOAL) Synergetic Forum (space to meet and converge)
17 COMBINATION, COOPERATION, INTERACTION ACTION OF FORCES, AGENTS, POWER. GREATER EFFECT: ABOVE AND BEYOND THE SUM. THINGS ARE MUCH EASIER…. FROM PRACTICE TO REFLECTION. THEORY FORBBIDEN HARD TO DO, BIG WORDS TO EXPLAIN. AXIS FOUR : SYNERGIES
18 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
19 PERSEVERANCE AWARENESS OF DIFFERENT TIMING “Synergetic Habits” UNDERSTANDING THE SYNERGY VALUE COMPETENCE BIG COMMUNICATION FLOW TERMS OF REFERENCE FLEXIBILITYLISTEN AND VALUE COMMON ORIENTATION OF WILLINGNESS RESPONSIBILITY METHODS CREATIVE APPROACH OBJECTIVES
20 “Sólo lo que se ve se mira, y sólo lo que se mira se tiene en la mente” (Bertillon) “Have the SYNERGY option always in mind, and you will discover new path-ways for “impossible” things.....”
21 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. NGOS ACCEM (Asociación Comisión Católica de Migración) Mercedes Bernardino Rodríguez. Trabajadora Social ASOCIACIÓN BARRO Mª Antonia Martín García. Educadora CRUZ ROJA Alicia Esteban. Trabajadora Social ISIDROBUS Virginia Ruescas Mecinas. Trabajadora Social UNIVERSIDA Jaime Alvarez Presidente. ASOCIACION EL FANAL Rosa 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
22 MADRID 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
23 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’ SERVICES EDUCATION 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 GETAFE Cristina 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)
24 GRACIAS Carlos Sanz-Acera Arantxa Santa-Maria Morales [email protected] [email protected] drid.org