Context, issues : In 2012, a study conducted by students of the DU "Health and Precariousness" of the Faculty of Medicine of Clermont-Ferrand, alert on the difficulties of access to care for people in precarious situation in rural Auvergnat. The Médecins du Monde association takes the subject and completes the territorial diagnosis. In May 2013 starts the Rescorda program which is part of the Local Health Contract of the country Combrailles under the axis "Fight against insecurity and exclusions of the health care system. "
The Rescorda program is a health mediation device located in the north-west of the Puy-de-Dôme department; it covers the territory North-Combrailles. This rural area is a mid-mountain area with dispersed housing that is characterized by a significant level of precariousness and a disengagement of public services, particularly regarding public transport networks and the provision of care.
Goals : General Objective: "Promote and facilitate access to the rights and care of people in precarious situations"
Specific objectives :
- Identify and accompany people in difficulty in the implementation of their rights and care procedures and relay them with common law devices
- Promote prevention and screening by organizing thematic days of health promotion.
- Strengthen the network between social services, health professionals and other partners by setting up a network that enables multidisciplinary, transversal and comprehensive care of the patient.
- Improve knowledge of the characteristics of precariousness in rural areas as well as the state of health of people in precarious situations and demonstrate the difficulties of access to rights and care.
Targeted audience : The program aims to support the public in a situation of precariousness, remote or out of step with the prevention and care systems.
These are people with many vulnerabilities: geographical, family or social isolation, risky practices, unfavorable legal and health environment, precariousness, lack of knowledge of the health system, digital barrier ... All these factors contribute to the remoteness of care circuit
Through health mediation, the program is also aimed at the institutions and professionals involved in the care of these people, in order to raise their awareness of the obstacles that may be encountered by vulnerable groups and to improve the response that can be provided. brought to their difficulties. It's about recreating the link between audiences and professionals.
Actions implemented : - Approach "to go towards": through especially permanences in the local solidarity associations during the distribution of food packages. The target audience is often "non-claimant", in a situation of geographical and social isolation, so it is important to go to meet them and re-connect.
- Health mediation interviews: implementation of support in the circuit of care and assistance in the process of access to health rights. Interface with common law.
- Realization of TROD (HIV / HCV screening)
- Physical accompaniment of the less autonomous people to the health structures.
- Psychological consultations: Faced with the mental health problems encountered by the target audience and when access to common law systems is complicated, psychologist volunteers offer a "buffer" monitoring pending the support if necessary by external relays.
- Promotion of prevention and screening in health, the program organizes days "to your health": bringing together many partners of the medico-social field, these days free and open to all allow to propose information and screenings on many topics of health.
- Role of "testimony" and relay information on the difficulties encountered in the access to care of people in precarious situations living in rural areas: contribution to the training of health and social professionals on issues of precariousness in the middle rural (E-learning, intervention DU ...) / participation in regional, inter-associative bodies / data collection / exchange of practices ...
Project's start year : 2013
Global cost (in Euros) : 155914 €
Regional Health Agency Auvergne-Rhône-Alpes : 48627 €
Primary Health Insurance Fund of Puy-de-Dôme : 5000 €
Fund for the Development of Associative Life : 1500 €
Private Funds : 6750 €
Médecins du Monde : 94037 €
Technical and human resources, partners : 2 FTE employees: a health coordinator and mediator.
Support from the regional delegation; Regional coordinator and delegation assistant.
A team of about ten volunteers (doctors, nurses, support staff, psychologists).
This program is multi-partnership. Teams work on a daily basis with many partners in the health system, the social sector and solidarity.
Conditions of success
Points of vigilance, difficulties to pass through, success factors : • Do with the person and not in his place, go at his own pace
• Work in partnership with local actors; insert and reinforce the territorial network
• Not to substitute for common law, to direct and accompany towards this common right
• Go to / move; in rural areas it is essential to be able to be mobile and to develop actions to go to isolated publics that do not move. It is necessary to provoke the encounter, to weave bonds while remaining discreet.