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Access of migrants to Public Health. An update

Partner Institute: 
University of Barcelona
Survey no: 
(14) 2009
Patricia Fernandez-Vandellos
Health Policy Issues: 
Public Health, Political Context, Funding / Pooling, Quality Improvement, Access
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no yes yes yes yes no


The extension of the TSI (Individual Sanitary Health Card) to all foreign migrants in 2001 was the first step to improve their access to the public health system. After that, in 2007 the Catalan Government launched the Directive Immigration Health Plan as a brand new health policy that also aims to improve their health status. This plan establishes the main objectives to follow and fullfil the main goal. At the same time, it incorporates an educational training for all health professionals.

Recent developments

In 2001, the extension of the TSI to all foreign migrants that registered at the council of their city village was the first step to improve their access to Public Health in Catalonia and in Spain (also see JOSEP M. JANSÀ. "Improving access of migrants to Public Health". HealthPolicyMonitor, 29/10/2004. . This measure was accompanied by specific strategies for maginalized populations in order to get better knowledge of their needs and consecuently to offer them better medical attention.

Following this original idea, in 2004 the Catalonian Health Plan was launched . This plan is the main tool that gives the Catalan regional government the competences to set up priorities in health care for the whole population of Catalonia. One of these goals is immigration so in 2007, the Directive Immigration Plan for Health was developed. This plan aims to define premises and values as well as strategic objectives to improve between 2007 and 2010 the health status of the immigrant population and their access to public health services .

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Characteristics of this policy

Degree of Innovation traditional innovative innovative
Degree of Controversy consensual consensual highly controversial
Structural or Systemic Impact marginal fundamental fundamental
Public Visibility very low very high very high
Transferability strongly system-dependent system-dependent system-neutral
current current   previous previous

This policy is completely new in Catalonia and in Spain. In  fact, several regional governments all over the country have developed their own Immigration Plan in order to offer better access to Publich Health services to immigrants. Although brand new, this policy is strongly dependent on the public health policy and services of each country. 

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no yes yes yes yes no

Initiators of idea/main actors

  • Government
  • Civil Society
  • Scientific Community

Stakeholder positions

The Health Department of the Catalan Government has taken the leadership in the Directive Immigration Plan for Health in Catalonia that was launched in 2007. Different  associations of health professionals, migrants and NGO's strongly supported this idea from the beginning and are part of the Advisory Council. This council has the main responsibility for giving advise to the Monitorig Commission and develop, revise and assess this plan.

Actors and positions

Description of actors and their positions
Health Department of Catalan Govermentvery supportivevery supportive strongly opposed
Welfare and Family Departmentvery supportivevery supportive strongly opposed
Locals Goverrmentsvery supportivevery supportive strongly opposed
Civil Society
Trade Unionsvery supportivevery supportive strongly opposed
NGO'svery supportivevery supportive strongly opposed
Migrants Associationsvery supportivevery supportive strongly opposed
Scientific Community
Scientific Socitiesvery supportivevery supportive strongly opposed
Medical and Nurse Associationsvery supportivevery supportive strongly opposed
Other Health Professionals Associationsvery supportivevery supportive strongly opposed
current current   previous previous

Influences in policy making and legislation

After a process of setting up objetives and priorities from all groups involved in the Advisory Council, the Directive Inmigration Plan draft was evaluated by the Monitorig Comission in order to be aproved by the Catalan Health Department and the Catalan Parliament. This first Immigration Health Plan was approved in 2007 and will be in force until the end of 2010. During this time, the Monitoring Commission will be in charge of revising any change and assessing the new results.

Legislative outcome


Actors and influence

Description of actors and their influence

Health Department of Catalan Govermentvery strongvery strong none
Welfare and Family Departmentvery strongvery strong none
Locals Goverrmentsvery strongvery strong none
Civil Society
Trade Unionsvery strongstrong none
NGO'svery strongweak none
Migrants Associationsvery strongvery strong none
Scientific Community
Scientific Socitiesvery strongneutral none
Medical and Nurse Associationsvery strongstrong none
Other Health Professionals Associationsvery strongneutral none
current current   previous previous
NGO'sScientific Socities, Other Health Professionals AssociationsTrade Unions, Medical and Nurse AssociationsHealth Department of Catalan Goverment, Welfare and Family Department, Locals Goverrments, Migrants Associations

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

This Immigration Health Plan develops three small plans:

  1. The Recepcion Plan aims to integrate the immigrant population in their host society.
  2. The Intervention Plan basically creates the mediator figure who will help migrants and health professionals to interact between each other and also to avoid language and cultural barriers. This mediator is a brand new professional inside the Catalan Public Health Service who could be required anytime by Health professionals in any centre.
  3. The Formation Plan for health professionals has as its goal to teach all health professionals about cultural differences and consecuently allow them to deal with frequent problems due to these differences.

Health professionals (above all from Primary Care Units) and migrant populations are the groups directly affected by this Plan. The implementation of this plan has been and it will be succesful as long as the main obstacles (lack of public health budget and lack of time and interest of health professionals) will not interfere with the main goal.

Monitoring and evaluation

Since the extension of the TSI among the migrant population is already established and its impact on cost and efficiency has not been directly evaluated in health terms, this new Plan incorporates health indicators for immigrants:

  • total access to public health,
  • teenage pregnancy,
  • venereal diseases,
  • TBC impact ,
  • etc…

These indicators (most of them shared indicators with the Catalan Health Plan) will periodically shed a light on the health status of migrants, weakness and strong points, as well as improvements. To develop these indicators, the Health Department has made a big effort to establish and expand new information technologies.

Moreover, a wide evaluation use to be made every year, and results are public and discussed among all groups involved in this Plan.

To sum up, they aim to be a real mesure of this policy impact and its cost and efficiency.


Expected outcome

In general, this policy will achieve its objectives considering the progresses already made, above all regarding the extension of TSI to the whole population. The main objective is to improve health status and equity for all immigrants and - following the Spanish Constitution - to guarantee public health access to the whole of the Spanish population.

However, underfinancing in the health budget, health professionals' demotivation and abusive use of health resources could be real menaces to take into account.

Impact of this policy

Quality of Health Care Services marginal fundamental fundamental
Level of Equity system less equitable system more equitable system more equitable
Cost Efficiency very low high very high
current current   previous previous

The impact of this policy will be strongly positive. It will balance oportunities among different population groups (equity) and also help the vulnerable migrant population to achieve the same level of access to public healthcare as available to the rest of Spanish population.


Sources of Information

  • Josep M. Jansà. Agència de Salut Pública de Barcelona. "Improving access of migrants to Public Health". Health Policy Monitor 29/10/2004.
  • Generalitat de Catalunya.Departament de Salut. Pla Director d'Immigració en l'àmbit de la Salut.[on line]. 1st edition: october 2006, Barcelona. Spain. Online available at [ consultation october the 10th 2009].
  • Ministerio de Trabajo y Asuntos Sociales. Plan Estratégico 2007-2010. Ciudadanía e integración. Ministerio de Trabajo y Asuntos Sociales; 2007.

Author/s and/or contributors to this survey

Patricia Fernandez-Vandellos

Suggested citation for this online article

Fernandez-Vandellos, Patricia. "Access of migrants to Public Health. An update". Health Policy Monitor, October 2009. Available at