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This working paper synthesises the specific understandings of the concept of Health System Resilience and related findings among the projects of the DFG-funded research unit PH-LENS “Refugee migration to Germany: a magnifying glass for broader public health challenges”. The synthesis is based on an interdisciplinary workshop, conducted in March 2022, by the NEXUS project as part of the Research Unit’s coordination measures. Different perspectives on Resilience, related to the individual, the community, the social welfare system, and the research projects themselves were identified and explored. Few projects used the term explicitly as analytical concept, but – despite controversies and the heterogeneity in conceptualising Resilience – a widely used theoretical framework, which distinguishes four capacities (Knowledge, Interdependency, Uncertainties, and Legitimacy) and three levels (Absorptive, Adaptive, and Transformative), turned out to be integrative. Due to the comprehensiveness of the four resilience capacities, all projects could relate to one or more of the four domains. This allowed to “contextualise” the local health systems beyond conventional building blocks by linking the system’s functions to social environments of refugees, such as migration-related challenges, the asylum system, housing conditions, or resource shortages.

Mapping of scientific conceptualisations of "vulnerability" in the context of COVID-19

Background Research on health and healthcare for asylum seekers and refugees (ASR) has focused strongly on accessibility and legal entitlements, with quality of care receiving little attention. This study aimed to assess responsiveness, as non-medical quality of care, in the narratives of ASR patients recently arrived in Germany. Methods 31 ASR with existing medical conditions were recruited in six refugee reception centres and three psychosocial centres. Semi-structured, qualitative interviews were conducted which reconstructed their patient journey after arrival in Germany. Interviews were recorded, transcribed verbatim and evaluated using thematic analysis. Results The experiences of participants throughout the patient journey provided a rich and varied description of the responsiveness of health services. Some dimensions of responsiveness, including respectful treatment, clear communication and trust, resurfaced throughout the narratives. These factors were prominent reasons for positive evaluations of the health system, and negative experiences were reported in their absence. Other dimensions, including cleanliness of facilities, autonomy of decision-making and choice of provider were raised seldomly. Positive experiences in Germany were often set in contrast to negative experiences in the participants’ countries of origin or during transit. Furthermore, many participants evaluated their experience with healthcare services in terms of the perceived technical quality of medical care rather than with reference to responsiveness. Conclusion This qualitative study among ASR analysed patient experiences to better understand responsiveness of care for this population. While our results show high overall satisfaction with health services in Germany, using the lens of responsiveness allowed us to identify particular policy areas where care can be strengthened further. These include in particular the expansion of high-quality interpreting services, provision of professional training to increase the competency of healthcare staff in caring for a diverse patient population, as well as an alignment between healthcare and asylum processes to promote continuity of care.

Objective: Caring for refugee patients places special demands on health professionals. To date, medical students in Germany have rarely been systematically prepared for these challenges. This article reports on the development, conceptualisation, implementation, evaluation, and relevance of a multidisciplinary elective for medical students in the clinical study phase. Methodology: The course content was developed based on a needs-assessment among medical students and in cooperation with medical colleagues working in the field of refugee care. The course consisted of a seminar with medical, legal, administrative and socio-cultural learning content as well as a field placement in the medical outpatient clinic of the local reception centre for asylum seekers, which was accompanied by a systematic reflection process. The evaluation concept contained qualitative and quantitative elements. Results: 123 students completed the elective over six semesters (summer 2016 through to winter 2018). It was continuously evaluated and further developed. The students reported learning progress mainly in the following areas: Legal foundations of the asylum procedure and health care entitlements for asylum seekers; multi-perspectivity through multidisciplinarity as well as professional, ethical, interpersonal, and political insights gained through the practical experience. Summary: To prepare students for the complex challenges to be faced in medical care for refugees, a structured, multidisciplinary teaching programme, which combines theory, practice and reflection helps to foster insights into the many facets of this field of activity. The questions students brought to the seminar, the course contents and evaluation results are intended to inspire the design and implementation of similar courses at other universities., Zielsetzung: Die medizinische Versorgung Geflüchteter stellt besondere Anforderungen an Gesundheitsfachkräfte. Medizinstudierende in Deutschland werden bisher kaum systematisch auf diese vorbereitet. Im Beitrag wird über die Entwicklung, Konzeption, Umsetzung, Evaluation und Bedeutung eines multidisziplinären Wahlfachs für Medizinstudierende im klinischen Studienabschnitt berichtet. Methodik: Die Entwicklung der Kursinhalte erfolgte auf Grundlage von Bedarfsanalysen bei Medizinstudierenden und in Kooperation mit in der Flüchtlingsversorgung tätigen ärztlichen Kollegen. Die Lehrveranstaltung bestand aus einem Seminar mit medizinischen, juristischen, administrativen und sozio-kulturellen Lerninhalten sowie einer systematisch reflektierten Hospitation in der medizinischen Ambulanz des lokalen Ankunftszentrums für Asylsuchende. Das Evaluationskonzept enthielt qualitative und quantitative Elemente. Ergebnisse: Ab dem Sommersemester 2016 bis einschließlich Wintersemester 2018 absolvierten 132 Studierende das Wahlfach. Es wurde fortlaufend evaluiert und weiterentwickelt. Mehrheitlich werden vor allem Lernfortschritte in folgenden Bereichen berichtet: Rechtliche Grundlagen des Asylverfahrens und der Versorgung; Mehrperspektivität durch Multidisziplinarität sowie Erkenntnisse durch die Praxiserfahrung im fachprofessionellen, berufsethischen, zwischenmenschlichen und politischen Bereich. Zusammenfassung: Mittels eines strukturierten, multidisziplinären Lehrangebotes, welches Theorie-, Praxis- und Reflexionselemente verknüpft, kann Studierenden ein Einblick in die vielen Facetten der medizinischen Versorgung Geflüchteter ermöglicht werden, um sie auf die komplexen Herausforderungen dieses Handlungsfeldes vorzubereiten. Die Studierendenfragen, Kursinhalte und Auswertungsergebnisse können Anregung für die Implementierung ähnlicher Lehrveranstaltungen geben., GMS Journal for Medical Education; 38(2):Doc39

El artículo de investigación presenta un análisis en seis provincias argentinas acerca de políticas de cambio destinadas a la educación secundaria. La hipótesis que se postula es que estas reformas pueden encuadrarse en un modelo de política pública sectorial que se encuentra delimitada por un espacio de tres vértices o puntos de apoyo con el fin de incidir en la acción pedagógica en las escuelas: la elaboración de orientaciones político pedagógicas que se plasman en acuerdos federales, el cambio normativo que incide en el modelo organizacional de la escuela secundaria (régimen académico) y la introducción de programas en las escuelas como herramienta para orientar la acción de los actores, en este caso a nivel local. El trabajo incluye una caracterización de las políticas indagadas mediante el análisis de datos recabados en dos investigaciones en las que se relevó normativa, documentos y se entrevistaron a los funcionarios responsables de estas políticas, así como supervisores, directores y profesores. Uno de los argumentos que se desarrolla en el trabajo es que las condiciones de escolarización que dieron forma a la educación secundaria han demostrado su límite para incluir, mantener y promover aprendizajes relevantes para adolescentes y jóvenes de todos los sectores sociales, por lo que resulta necesario modificar esas condiciones. Para argumentar acerca del acceso a la secundaria y sus límites se revisan estadísticas regionales que muestran datos acerca de la matrícula del nivel en las últimas décadas. El otro argumento propone que el mencionado modelo de tres vértices responde a la estructura institucional del federalismo educativo argentino establecida en los años noventa que no ha sido reformulada en sus bases durante los períodos siguientes. Esta estructura institucional condicionaría el campo de posibilidades de la política pública sectorial al establecer una división de tareas entre el gobierno nacional y los ministerios provinciales. Por último, se analiza en las políticas recientes un énfasis no sólo en las condiciones organizacionales de las escuelas, sino también en el modo en que éstas se ensamblan con la organización del curriculum y con un modelo pedagógico, lo que conduciría a un cambio de carácter multidimensional. Dicho énfasis impacta en el debate político y teórico acerca de cuáles son los elementos que posibilitan incidir en las transformaciones efectivas de la educación secundaria.