Despite multiple efforts made by its government to improve public health, Niger still regularly faces numerous disasters including epidemics. Between 2017 and 2019, a consortium was established between Doctors of the World and Veterinarians Without Borders to implement a “One Health” project. This approach aims to reduce the populations' vulnerabilities to health risks related to environmental disasters and improve the health system's resilience at several levels. By promoting interdisciplinary between human, veterinary and environmental health issues, it aims to tackle emerging diseases with pandemic risk. The project was implemented in 2 municipalities: Sakoira and Ingall. For the first time, a program focused on preventing health and environmental risks rather than responding to a crisis. An external evaluation based on 278 interviews identified 5 project's achievements: (1) the increase in availability and accessibility of human and veterinary pharmaceutical products which improved vaccination coverage and medicalization while lowering treatment and prevention costs; (2) the mobilization and coordination of human and animal health professionals, national authorities and municipalities; (3) the strengthening of joint epidemiological surveillance through professional and community actors in order to reduce the response time to epidemics and disasters; (4) the strengthening of communities' understanding of health risks and how to prevent them; (5) the capacity building of professionals regarding the One Health approach at national, regional and local level. Coordination between human and animal health professionals has made possible the design and implementation of joint actions. These actions have enabled to: build capacity for 43 health providers, 116 community health workers and 41 livestock auxiliaries, vaccinate, de-worm and treat 24311 small and 7590 large ruminants, give primary health care to 4190 people, sensitize 2268 people on human and animal health. Key messages The project is innovative as it focuses on preventing epidemic risks instead of responding to crisis. Collaboration between human and animal health actors is the main success factor of the project.
Objective The risk for cognitive impairment is greater in individuals with low SES and limited education. In rural areas, distance and economic concerns preclude individuals from accessing care. In Alachua County, 23% of residents live below poverty and 16% are uninsured. The Neurocognitive Screening Initiative (NSI) attempts to reduce disparities in Alachua by offering free neurocognitive screening. NSI also aspires to promote cultural competence through unique training opportunities for clinical neuropsychology doctoral students. Method Patients learned about NSI through flyers, word of mouth, or referrals. Appointments include a clinical interview, cognitive testing, and mood questionnaires. Patients receive feedback, brain health recommendations, and referrals to community resources. Phase 1 began in November 2017 and involved selection of appropriate cognitive measures, development and dissemination of advertising materials, identification of resources, and trainee recruitment. From February 2018 to August 2018, phase 2 involved administration of cognitive screeners. Phase 3 involved continued provision of clinical services, expansion of the NSI team and increased culturally relevant outreach. Outcomes NSI’s greatest challenge is recruitment of the appropriate demographic. Since phase 2, we have evaluated 10 patients with diverse racial, socioeconomic, and clinical characteristics. NSI has recruited an ethnoracially diverse cohort of trainees comprised of 4 graduate students and 2 postdoctoral fellows supervised by a clinical neuropsychologist. Discussion Efforts to provide services to marginalized individuals have uncovered challenges in attracting patients who might benefit from these services. NSI is forging community partnerships with churches, libraries, and local organizations to reach the targeted audience. Via weekly meetings, participation in community events/outreach, and clinical work, NSI provides unique training for emerging neuropsychologists.
In order to address the growing needs of the undocumented migrant population living in the Maximilian Park in Brussels, Médecins du Monde and 8 other organisations created The Humanitarian Hub in January 2018 where migrants can access medical care among other services. From January to February 2018, only 5 women out of 1483 patients visited The Humanitarian Hub regarding sexual & reproductive health and none asked about contraception. In response, a voluntary demedicalized midwifery clinic was implemented to build trust with the women and offer them contraception. At our field teams’ request, operational research was conducted. We used a mixed methodology, including retrospective quantitative analysis of patient files and field observations made during participant observation sessions. These observations helped us better understand the barriers women face in accessing contraception and how migration complicates its usage. By implementing gender-sensitive consultations, the number of women patients rose from 5,4% to 10,6% in 2018. Between March 2018 and March 2019, 144 women consulted midwives regarding their sexual & reproductive health. Quantitative analysis on pre-exposure contraception on 52 files showed that 4 used a contraception, 25 women requested one, 4 refused it, 19 discussed it with the midwife, and among them, 8 agreed to try it. The most common reasons for the 80 consultations analysed were requesting contraception (62,5%), including morning-after pills (12,5%) and fear of pregnancy (32,5%). The most common contraceptive method was the pill (63,6%) followed by injections (30,3%). Our medical team saw 29 women with unwanted pregnancies, which confirms the importance of focusing on contraception options for migrant women, although addressing this may be difficult in medical consultations. It also supports the need to implement demedicalized midwifery consultations to facilitate sensitive discussions with migrant women. Key messages Our research shows that contraceptive use is a particularly sensitive challenge in the irregular migrant women population due to the particularities of their lives. The development of demedicalized midwifery consultations helps professionals give irregular migrant women feasible advice on contraception in regard to their unique situations.
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