Introduction
Following the outbreak of war between Russia and Ukraine on 22 February 2022, refugees from Ukraine are being admitted to Poland. Approximately 1 million people, mainly women with children, were crossed into Poland over a period of 10 days. In the following weeks, around 3 to 5 million are likely to cross the border. The experience of migration is a key determinant of health and well-being. Refugees and migrants remain among the most vulnerable members of society, who often face xenophobia; discrimination; poor living, housing and working conditions; and inadequate access to health services, despite frequent physical and mental health problems. The COVID-19 pandemic may additionally be challenging in terms of the increased risk of infection as well as death experienced by refugees, and may further highlight existing inequalities in access to and use of health services.
Preserving the health of refugees is crucial in order to protect themselves and the populations of their host countries. As a realisation of fundamental human rights, Poland's creation of an access to health care programme has a short and long-term dimension, through the implementation of the principles of international solidarity. Ukrainian refugees come from war-affected communities, with vulnerabilities related to the state of their journey, such as insufficient access to food and water, sanitation and other basic services. They are vulnerable to infectious diseases, accidental injuries, hypothermia, burns, unwanted pregnancy and childbirth complications, and various non-communicable diseases (haematoncology, diabetes and others). In addition, refugees are at risk of poor mental health outcomes. The health of refugees and migrants is also strongly linked to social determinants of health related to socioeconomic living conditions in Poland, e.g. employment, income, education and housing. Study Government Interim Health Programme (RTPZ) for Refugees is to provide systemic solutions to the health issue by ensuring access to health care in Poland for 2022-23, as a complement to actions taken in other areas. One is that refugees also play a key role in the provision of health (doctors and nurses) and social services (social services support, helplines, translation in hospitals), and access to health services for the population recognises this contribution and contributes to social well-being and cohesion.
Scope of services
Government Interim Health Programme (RTPZ) on health and migration was created to promote the realisation of human rights in access to quality and adequate health services, with adequate social and financial protection, in line with the principles of the WHO Global Action Plan by promoting the health of refugees and migrants (GAP) agreed in 2019. The WHO Global action plan: promoting the health or refugees and migrants (GAP) is part of the international framework established by the United Nations to positively manage global migration, including the Sustainable Development Goals (SDGs) and two global agreements, the Global Compact on Refugees (GCR) and the Global Compact on Safe, Orderly and Legal Migration (GCM) once a WR test to detect a patient's Paleoarthritis infection.
The aim of the action taken is to address 6 priorities:
- Promoting the health of refugees through a combination of short- and long-term public health interventions;
- Promoting continuity and quality of primary health care, while developing, strengthening and implementing health and safety measures;
- Advocates the inclusion of refugee and migrant health on the national and EU agenda and the promotion of refugee-sensitive health policies and legal and social protection; in the framework of intersectoral partnerships and inter-agency coordination and cooperation mechanisms, also in cooperation with the EU,
- Increase the capacity to address the social determinants of health and accelerate progress towards the Sustainable Development Goals, including universal health coverage;
- strengthening the health monitoring and health information systems of this population,
- supporting measures to improve health communication.
Who is entitled
The Government's Interim Health Programme (RTPZ) provides limited, temporary coverage of health benefits for persons in the following groups who are not eligible for universal health insurance under general conditions (in accordance with the Publicly Funded Health Benefits Act 2004) for up to 18 months:
- asylum seekers;
- persons with refugee status and a residence card;
- some other groups indicated by the programme, e.g. single mothers with at least 1 child for 18 months or until they start working (other groups to be determined).
TKPZ does not cover the cost of healthcare services or products for which a person can claim under public health insurance. TKPZ does not coordinate benefits with other benefits. If a refugee will be resettled he/she may also be covered for certain medical services before leaving Poland. Enrolment in the Programme is done through an online application and after obtaining an account and setting up a Temporary Health Card with an individual patient number.
Once you have received the document, you should sign it as soon as possible. The qualifying document should be presented to the doctor each time (prescription, vaccination tests). This insurance can be cancelled without notice if your refugee status changes.
Refugee rights in Poland
At the reception points, the foreigner receives the necessary assistance, undergoes a medical examination and can apply for social assistance. Then the person is directed to an open centre for foreigners, where he/she is provided with accommodation, food, learning the Polish language and one-off financial assistance. It is also possible to stay outside the centre. In that case, however, the refugee receives small benefits, for which he/she has to pay for his/her accommodation, food or Polish language lessons.
As part of the application for international protection and for refugee status, health information is included. Once you have received a decision to grant refugee status or subsidiary protection, you must collect residence card confirming identity and legal residence in Poland. The card is issued for three years (in the case of refugee status) and two years (in the case of subsidiary protection). Such persons may also apply for an individual integration programme. After the procedure, the refugee may take up employment on the same basis as Polish nationals. This also applies to persons who have obtained the right to subsidiary protection or the right to stay in Poland for humanitarian reasons. A refugee receives assistance to support his or her integration into society. Beneficiaries of international protection and their spouses also have the right to register as unemployed at Polish Labour Offices. They may exercise the rights enjoyed by other Polish citizens, such as the use of benefits and other allowances designed for the unemployed (excluding refugee families), social benefits or health care.
Scope of services within the TCSP
- Post-entry medical services - all asylum seekers within 6 months of entry are entitled to an examination):
- medical examination (history and physical examination;
- review of past medical history;
- laboratory tests: morphology, glucose, creatinine, bilirubin, ASPAT, ALAT, ESR, HCV RNA, HBV (HBsAg), CRP, urinalysis, possibly HIV (ELISA), anti Covid19, anti-HIV, faeces for VRE (Vancomycin- Resistant Enterococcus) and CPE (Carbapenem Producing Enterobacteriaceae).
- Diagnostic tests - chest X-ray (mandatory), abdominal ultrasound - optional,
- medical assessment of the applicant's records.
The service will be provided by primary care physicians, occupational health physicians (for job seekers) and at designated providers (outpatient specialist care)
In order to receive examinations within a period of up to six months, it is necessary to communicate with a primary care doctor, an occupational physician or at the indicated points presented within the programme website.
- Access to reimbursed medicines - optional
- Flat-rate payment for reimbursable medicines for children (up to 18 years of age) according to the MZ announcement under the RTPZ programme:
- Antibiotics/antifungal drugs,
- Anti-epileptic drugs,
- Antiasthmatic drugs,
- Inhaled glycocorticosteroids,
- Insulins,
- Speciality foodstuffs.
To consider abolition of drug payment for adults over 50 in line with the 75+ list.
Expenditure to be estimated on the basis of the number of children residing in Poland
- Access to vaccination:
Children of all ages within the scope of the compulsory vaccination programme as indicated in the compulsory vaccination calendar
Igor Grzesiak - Institute for Patients' Rights and Health Education
The Network for Health project is implemented with a grant from the Active Citizens Programme - National Fund financed by Iceland, Liechtenstein and Norway through the EEA Funds..