Health mediation serving the people in precarious situation and distant from the health services in High Valley of Aude

France Occitanie
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Short presentation

Health mediation action aimed at the most vulnerable (creation of proximity links with the aim of facilitating access to rights, prevention and care).


General objective: participate to fight against the social and territorial inequalities in term of health, by contributing to the improvement of the health state of the people in precarity situation living in the rural environment on the High Valley of the Aude’s territory.

Specific objectives:
-Promote the health autonomy of the people in precarity situation on that territory and reinforce their capacities to access to rights and to a health system of common rights.
-Improve the access to the prevention and detection for people in precarity situation living on that territory.

Contexte (territory issues, targeted audience)

The High Valley of the Aude is a middle mountain rural zone, locate in the South West of the Aude department, at the limits of the Ariège and the Audoise Pyrenees and a part of the Limouxin’s ones (The ex Couiza country). That represents 86 municipalities spread on more than 1200 km² and gathering more than 19000 people. It corresponds to the low density of the population of 16 inhabitant per km². The most important city regroups 3400 inhabitants. Only three other municipalities count more than 1000 inhabitants.

Doctor of the World realized in 2015, a territorial diagnostic work which highlight many vulnerability health factors : isolation and difficulty of the moving ; failing of the wages on the territory; low density of care and prevention offers; withdrawal of the public services which grant access to rights; people distant from the health services.

The health mediation is aimed at:
-Any person in precarity situation presenting difficulties to the access to rights, prevention and care systems. Geographic, family or social isolation, dangerous jobs, unfavourable sanitary environment, precarity, ignorance of the health system, difficulty linked to the digital barrier… constitute as many vulnerability factors which could conduct to a breaking of the access to the common right. Among the welcomed people, profiles are varied: recipients of social help, single people, retired, young people wandering, neo-rurals, users of psychoactive products…
-To the institution/professionals who are involved in the health of these populations, (ignorance of the precarity, administrative complexity, difficulty in term of adaption of the system, service constraint…) The mediation’s objective is to sensitize the health actors to the barriers met by the public for a better understanding of their specificities.

Actions implemented

The health mediation creates a proximity link which goal is to facilitate the access to rights, to the preventions and to the care of the most vulnerable people and to contribute to the improvement of the devices and the welcoming of these persons in the health system.

1.Spot and accompany the people in precarity situation in their steps to the health access
•Organization of medical and social proximity hotlines, decentralized on different points of the aimed territory
•To propose in the decentralized hotlines a social consultation to health rights and a health interview
to exchange around the breaking in the health course and remobilized on health subject that were neglected.
•To anticipate the farthest people of the health system and who can’t come during the decentralized hotlines (possibilities of home travel, attendance during the distribution of food packages, perambulation on the public space)
•Once the link is established, evaluation of the social and health needs to identify, with the person, his difficulty to the health access, and find solutions.
•Orientation of the welcomed people towards suitable local structures, with the possibility to help with the obtention of an appointment and to prepare the person of the expression of his needs.
•Physical accompaniment, if necessary, the person the suitable local structures.

2. Promote the primal prevention, the screening and the reduction of risks
• Deliverance of the personalized prevention advice during health interview, with a particular attention on the Sexual and Reproductive Health (SSR) and the consumption of psychoactive products.
•Proposal of realization of the TROD (Rapid Test of Diagnostic Orientation) VIH and VHC, linked with the CeGIDD, the service of the infectious disease and the PASS of CH
•Creation with the users of collective and promotive actions of the health, in partnership with territory’s actors.

3. Develop the implication of the welcomed public to the health access
•Organization of exchange spaces with the welcomed people to promote the expression on the troubles met in the health system.
•Identification of resource people which can become communal relay
•Support with the creation of a representative users of the health system group.

4. Foster the coordination of the health professionals, the social workers and the associative actors.
• List the supported possibilities on the medical and social aspects by the local actors and to fuel a partnership file to guide the users with much more precision.
•Identify the orientation difficulties of the individual situations.
•To create the link with the social and health actors involved on the individual followed situations
•Organize regular exchange times with local partners: acquaintanceship meeting, information sharing, feedback and co-construction of common actions.
•Participate to the structuration and the animation of a Precarity Health Network

5. Improve the knowledge of the precarity characteristics in rural environment and to promote the understanding by the institutional actors.
•Implement a collection of medical and social data
•Collect anonymized expression of individual situation on the difficulties to the health access.
•Analyse the principle brakes and barriers to the health access of people in precarity situation on the aimed territory and their consequences on the health.
•Document the consequences in term of health of the withdrawal of the public services from the rural zone
•Take actions of advocacy with the health authorities and territorial municipalities


Département de l'Aude 10 000 €
Caisse régionale Crédit Agricole Languedoc 4 000 €
Fondation Michelin 38 500 €
Fondation NEHS 49 000 €
Global cost (in Euros) : 162 000 €

Human resources and partners

Humains :
2 salariés à temps plein (1 coordinatrice et 1 médiateur santé), appui de la délégation régionale (0,1 coordinateur régional et 0,1 assistante de délégation)
une équipe pluridisciplinaire d’une quinzaine de bénévoles (médecins, infirmières, "TRODeur", travailleurs sociaux, accueillants, chargés d’accompagnement)

Matériels :
1 véhicule
2 téléphones portables, qui peuvent être mis à disposition du public pour contacter les partenaires
3 ordinateurs portables, qui peuvent servir à accompagner les personnes dans leurs démarches
1 imprimante

Other information

Project's start year : 2016

Points of vigilance, difficulties to pass through, success factors

The mediation program in health facilitate the health access to the people in precarity situation but doesn’t directly act on the care offers of the territory. The health interviews are time of mobilization around the health but aren’t medical consultation.
Stake of the posture to promote the health autonomy. Take interest in our health state, gather knowledge prior to the change of behaviour, to accept to seek treatment, be in capacity to establish satisfactory relationship with the caregivers and the social workers are steps that are registered in the duration. The reinforcement of the capacities is at the rhythm of the individual who must feel confident.


Médecins du Monde (Non profit organization )
rue Carnot
Contact : Flavienne Mazardo-Lubac