The engagement of North African refugees with mainstream health services in south east Queensland

The engagement of North African refugees with mainstream health services in south east Queensland

Refugee populations remain as one of the most vulnerable members of society in many countries. People from refugee backgrounds have similar health concerns to the people in host countries. However they may also have health issues specific to their country of origin and their pre-migration, migration and settlement experience. Several challenges have been identified in previous studies as potentially hindering the accessibility to health services. When considering the accessibility of North African refugees to mainstream health services in Queensland, lack of research data stands as a barrier to good, fair and equitable policy making. On the other side of this relationship the health care needs of refugee populations are rapidly changing and their perceptions and experiences of the health systems need to be better understood.

This study is therefore undertaken with the aim of empirically collating and analyzing data using a theoretical framework as the basis for (1) assessing these challenges and providing recommendations to enable better access to healthcare for North African refugees in South East Queensland, by examining the factors facilitating and limiting their access to mainstream healthcare services. The study sought to answer the question, 'What are the experiences that facilitate and inhibit North African refugees’ access to mainstream health care services in South East Queensland?'

A qualitative study was undertaken and a series of in depth semi-structured interviews were conducted with a purposively selected sample of North African refugees in South East Queensland. Thematic analysis was done with the assistance of NVIVO software. Analysis was done based on the conceptual framework developed for this study by following a deductive approach.

A total number of 16 participants took part in the study and represented 4 countries (Algeria, Libya, Morocco and Sudan – Darfur region).

The system-related facilitating factors that were elicited were (1) the need for respect and awareness of culture and cultural needs, (2) better communication of available health issues and management (3) affordability (4) improved of ambulance service (5) more flexible and convenient appointment systems, (6) ready availability of a GP service, (7) availability of better home doctor service, (8) availability of interpreter service and support for on-going communication, (9) access to Medicare, (10) better trained and qualified staff (11) more friendly and empathetic staff and (12) improved government support. Following themes were noted as facilitating factors related to community resources: (1) eliminate racial and religious discrimination, (2) address gender issues and discrimination and (3) English proficiency. The socio-cultural facilitating factors were identified as improvements in support from: (1) support local refugee agents, (2) spouses, (3) family, (4) friends, (5) local community and (6) community and other organizations.

The system-related inhibitory factors that were highlighted were (1) cost of medication and other services, (2) high cost of dental services, (3) lack of familiarity with the service and the complex nature of the process, (4) Complexity of the health care system, (5) bad experiences at the emergency departments, (6) problems with appointment systems, (7) government not doing enough for refugees, (8) difficulties and problems in interpreter services and (9) waiting times in hospitals. However, as the socio cultural inhibitory factors; (1) lack of responsiveness to cultural needs, (2) feeling uncomfortable when examined by the opposite gender and (3) poor English skills were noted.

Participants expressed the following recommendations to strengthen the facilitating factors: (1) increase human resources, (2) design programs to improve the mental health of refugees, (3) improve reception service, (4) create more space in health facilities, and (5) provide more health services targeting refugee populations. Strategies to minimise the inhibitory factors were also highlighted: (1) reduce waiting times, (2) review the interpreter service, (3) extend Medicare cover to dental services, and (4) simplify the procedure. More research is warranted to explore the phenomenon further.