2023-07-28 09:01:16
Despite its relevance in the fight once morest social inequalities in health, health mediation comes up once morest various obstacles. A mission of the General Inspectorate of Social Affairs (Igas) declines 10 proposals to promote its deployment on the territory, which notably involves better training and recognition of the profession of health mediator.
The members of the mission on health mediation, Alexandre Berkesse, Philippe Denormandie, Emilie Henry and Nolwenn Tourniaire, accompanied by Farida Belkhir (Igas), submitted their report on July 17, with the ambition of contributing to the objective of improving access to healthcare for all.
Health mediation is a relational process that contributes to the reduction of social inequalities in health thanks to its function as an interface between vulnerable groups and health actors. From an associative initiative and historically targeted at marginalized groups (HIV, prostitution, travellers, etc.), health mediation is now aimed at groups in situations of vulnerability for various reasons, whether endogenous (socio-economic precariousness , fear of stigma, disability, etc.) or exogenous (complexity of the healthcare system, difficulties and delays in access, etc.). Under different models, health mediation makes it possible to intervene at the different stages of a patient’s journey.
individual in order to prevent shortages, while producing beneficial effects for the entire healthcare system (prevention, access to healthcare, etc.).
Obstacles identified…
The mission notes that “despite the empirical demonstration of its relevance and usefulness in the fight once morest social inequalities in health, health mediation comes up once morest three obstacles in particular” that limit its effectiveness and efficiency:
– the absence of statutory recognition, which maintains the semantic ambiguity around what “health mediation” covers and limits its proper understanding by the public concerned and the institutional actors and
partners of mediators;
– an accumulation of professional and institutional power relations that are unfavorable to good cooperation between actors and to the recognition of the relevance of these actions often carried out outside establishments;
– public funding perceived as complex and unsustainable.
and solutions…
In this context, the mission recommends that the public authorities act to remove these obstacles. To do this, it proposes a roadmap articulated around three projects and accompanied by a management method which constitutes the essential complement. Indeed, considering that the fragmented and secondary nature of the management of health mediation issues within the social ministries is likely to compromise the operationalization of this roadmap, the mission recommends the establishment of an ad hoc committee. task force responsible for steering, in conjunction with the actors concerned, the concrete progress of the recommendations. It also proposes to entrust this committee with a budget envelope whose purpose, in conjunction with Public Health France, is to finance the undertaking of research-action work with a view to establishing health mediation on a “high level of evidence”. , to quantify the costs avoided and to determine relevant indicators for measuring its impact both for beneficiaries and for the healthcare system.
As a priority, the mission recommends completing the professionalization and recognition of health mediation professions. Indeed, while it is in fact an activity that falls fully within the scope of health actors, the absence of a statutory framework and symbolic recognition by the ministry in charge of these subjects complicates the positioning of mediation as an interface in health. Consequently, the mission recommends confirming the existence of the profession of health mediators by including it in the public health code. This legislative consecration will also have to be accompanied by the registration of the profession in the appropriate directories (professional reference of the hospital public service, operational directory of professions and jobs of Pôle emploi, etc.) and the formalization of a deontological framework.
Correlatively, the mission recommends building inclusive access and training paths to the profession of health mediators. Indeed, if certain training courses and DUs already exist, the mission considers that the recognition of a specific profession requires the structuring of a training course likely to guarantee adequate professionalization. To do this, it recommends the establishment of two paths, one relating to initial training, the other to continuing training.
Alongside the statutory work, the mission recommends rationalizing and perpetuating the architecture of the funding allocated by the State to health mediation.
10 recommandations concrètes – Recommandation n°1. Engager des travaux de recherche-action en vue d’évaluer l’efficacité de la médiation permettant d’assoir la médiation en santé sur un « haut niveau de preuve », de quantifier les coûts évités grâce à la médiation en santé et de déterminer des indicateurs pertinents de mesure de l’impact de la médiation en santé tant pour bénéficiaires que sur le système de soins. – Recommandation n°2. Faciliter l’accès à des formations sur la médiation en santé à l’instar de ce qui a été développé dans le champ de la santé mentale avec les premiers secours en santé mentale et examiner les modalités d’une extension du congé pour activités civiques aux individus dûment formés. – Recommandation n°3. Consolider l’outillage et l’accompagnement des médiateurs.ices ainsi que des équipes au sein desquelles ils évoluent dans le cadre de programmes régionaux de la médiation en santé incluant notamment de l’analyse de pratiques et des modalités de structuration des échanges avec les partenaires (remontées des dysfonctionnements du système de santé, identification d’un réseau de référents, conditions d’accès au dossier médical partagé) – Recommandation n°4. Consacrer l’existence du métier de médiateur.ice en santé, assorti d’un cadre déontologique, par son inscription idoine dans le code de la santé publique et les répertoires métiers. – Recommandation n°5. Créer un diplôme de médiateur.ice en santé de niveau licence également accessible par la voie de la validation des acquis personnels et professionnels (VAPP). – Recommandation n°6. Créer une certification professionnelle de médiation en santé enregistrée au répertoire national des certifications professionnelles (RNCP) permettant d’accéder au métier par la voie de la formation continue ou par la reconnaissance d’une VAE. – Recommandation n°7. Prévoir des sensibilisations à la médiation en santé tant dans le cursus de formation initiale que dans la formation continue des professionnels de santé, des cadres et dirigeant du secteur sanitaire, médico-social et social. – Recommandation n°8. Rationaliser l’architecture financière de la médiation en santé en actant le principe d’un canal de financement majoritaire stable par typologie de structures (financement conventionnel, engagements pluriannuels du FIR, dotations hospitalière, ONDAM spé) – Recommandation n°9. Expérimenter sur un ou plusieurs territoires volontaires une démarche d’expression directe des besoins des personnes concernées en lien avec les professionnel.le.s de ces territoires – Recommandation n°10. Mettre en place dès septembre 2023 un comité paritaire de suivi de l’opérationnalisation des recommandations de la présente feuille de route. Confier un budget dédié à ce comité afin d’assurer le lancement de l’étude recommandée ainsi que l’évaluation de la mise en œuvre des mesures.
• Mediation in health: a relational lever in the fight once morest social inequalities in health that needs to be consolidated. Report submitted by A. Berkesse, P. Denormandie, E. Henry, N. Tourniaire, with F. Belkhir, July 2023, in pdf.
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