Pavee Point welcome the publication of the report: ‘Beyond the Poverty Trap: A Roadmap for Sustainable Traveller Primary Health Care Projects’. The report marks the culmination of national research conducted by Dr. Stuart Stamp and commissioned by Pavee Point, and establishes a roadmap for sustainable Primary Health Care for Traveller Projects (PHCTPs). It comes in response to key concerns raised by Traveller organisations and PHCTPs around the country in relation to recruitment and retention, workforce planning and welfare and poverty traps that workers experience. The research seeks to identify good practice factors in order to better enable both PHCTP staff recruitment and retention, and which includes shared learning.
The report documents the pilot of the first Primary Health Care for Traveller Project (PHCTP) in 1994/95, which employed Traveller Community Health Workers (TCHW) as a ‘bridge’ between Travellers and mainstream public health services, and it emphasises the centrality of TCHWs for the successful operation of the projects: whereby TCHWs work in a culturally specific role, and with a unique set of skills that extend beyond general advocacy and support functions. While the report stresses the need for standardised and protective employment conditions for TCHWs, what has emerged over three decades is a fragmented employment ecosystem where differing pay rates and working conditions have emerged.
Further to this, findings from the National Traveller Health Advisory Forum (NTHAF) highlighted the inherent contradiction between the inflexibility of the welfare system and the necessary flexibility of TCHWs reliant on welfare support. While a number of recommendations were followed from the NTHAF analysis, with regards to pay, conditions, career development and standardisation, the recruitment and retention of staff across PHCTPs remains a concern.
The current report follows from that NTHAF analysis and the enquiry follows three broad research objectives: to identify the barriers, both perceived and actual, to PHCTP staff recruitment and retention (both systemic and personal factors); to identify best practice that would enable better staff recruitment and retention; and to make associated short, medium and longer-term policy and practice recommendations. Emerging from this enquiry are four key themes: (1) Pay, Terms and Conditions; (2) Recruitment, Training and Career Development; (3) Social Welfare, Medical Cards and Living Costs; and (4) Funding, Structure and Ethos.
The report raises significant concerns in relation to low pay and associated poverty traps for TCHWs, along with concerns regarding imparity of esteem, associated de-motivation, welfare dependency and working unpaid hours. Medical card retention was also highlighted as a key barrier for workers seeking to take up additional hours: sometimes resulting in workers leaving their posts. A standardised operational approach is recommended by the report, underpinned by several key principles: parity (between projects); community development (from the ground up rather than the top down); human rights (supporting individuals and community advocacy); independence (the ability to advocate and challenge policy and practice); complimentary working (with state health services); flexibility (in being able to respond to local need); and autonomy (albeit within a standardised basis or framework).
The research provides useful actions that have the potential to strengthen and sustain PHCTPs into the future in line with key policy commitments from the HSE and Department of Health as reflected in the National Traveller Health Action Plan and the National Traveller and Roma Inclusion Strategy II. The report recommends: nationally consistent and standardised approaches to PHCTPs; affirmative action measures to address social welfare, medical cards and living costs; addressing and standardising funding, structure and ethos