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Background: In order to provide effective primary care for refugees and to develop interventions tailored to them, we must know their needs. Little is known of the health needs and experiences of recently arrived refugees and other migrants throughout their journey through Europe. We aimed to gain insight into their health needs, barriers in access and wishes regarding primary health care. Methods: In the spring of 2016, we conducted a qualitative, comparative case study in seven EU countries in a centre of first arrival, two transit centres, two intermediate-stay centres and two longer-stay centres using a Participatory Learning and Action research methodology. A total of 98 refugees and 25 healthcare workers participated in 43 sessions. Transcripts and sessions reports were coded and thematically analyzed by local researchers using the same format at all sites; data were synthesized and further analyzed by two other researchers independently. Results: The main health problems of the participants related to war and to their harsh journey like common infections and psychological distress. They encountered important barriers in accessing healthcare: time pressure, linguistic and cultural differences and lack of continuity of care. They wish for compassionate, culturally sensitive healthcare workers and for more information on procedures and health promotion. Conclusion: Health of refugees on the move in Europe is jeopardized by their bad living circumstances and barriers in access to healthcare. To address their needs, healthcare workers have to be trained in providing integrated, compassionate and cultural competent healthcare.

This research explored the history, effectiveness and feasibility of primary-level health\ud workers (PHWs) in delivering care for mental, neurological and substance use (MNS)\ud disorders in India, to better inform the organisation and delivery of mental health\ud services at primary care and community levels.\ud This thesis examined evidence for the effectiveness of PHWs in mental healthcare in\ud low- and middle-income countries (LMICs) (Cochrane review – 38 included studies),\ud and then focused on India. Seventeen oral history interviews described the\ud experiences of integrating mental healthcare into primary care and 72 case-studies\ud explored government and non-governmental models of PHW-delivered mental\ud healthcare initiatives and their human resources.\ud PHWs can be effective in delivering care for MNS disorders in LMICs. The case studies\ud identified heterogeneous collaborative care models in India, most of which were\ud delivered through community- rather than government- primary care. Other models\ud (training and referral) which have less evidence for effectiveness were more\ud widespread, and included the government model which was perceived as having\ud ‘failed’. A new model was identified: community outreach services which were\ud specialist-led but PHW-delivered.\ud LHWs and care managers seemed more feasible and appropriate care managers than\ud PHC doctors across models and provided more holistic psychosocial support.\ud Specialists were valuable for PHWs’ and care managers’ training and ongoing support.\ud Barriers to mental health care integration are discussed.\ud Future research priorities are to assess whether variations of collaborative models are\ud similarly effective to those described in HICs and whether these are feasible and\ud effective if implemented at scale. Priorities for improving the DMHP would be to\ud consider deploying care managers and LHWs and reorient as well as incentivise\ud specialists to support them. Better inter-sectoral collaborations, health system\ud strengthening and technical support at central- and state-government levels may\ud improve leadership, implementation and evaluation of mental healthcare integration\ud into primary care across India.