The health professional’s role is to provide high quality health care to patients including equity and social justice. This complex approach requires the necessary knowledge and skills which come through the working experience and specific training on the topic of Migration and Health to health care providers and stakeholders working with migrants. The ultimate objective is to promote cultural competence among health and social care service providers. The cultural mediator is an instrument whereby he/she will provide a good understanding of the existing cultural differences/behaviours of migrant patients when seeking health care services. Moreover, differences are probed into and conveyed to the health professional.

- Unemployed migrants willing to learn and work, thus facilitating integration and inclusion
- Migrant patients: Somali and Eritrean migrants make up the majority of the whole migrant population in Malta (1% of the total Maltese population which currently stands at 450,000).
- Health professionals who encounter migrants on a daily basis in thier work. Since the start of the service over 350 health and social care professionals have been trained on the topic of migration and health.

The elements of the project “Cultural mediators in health Care” are:
> The development of the training programme: Cultural mediators in Health Care which consists of:
- 8 taught sessions
- Role plays
- MCQ test
- Certificates to successful candidates
> The delivery of the training programme through an open call to migrants residing in Malta and who are fluent in English language;
> Trained cultural mediators are also involved in assisting in health education sessions and in the drawing up of translated materials;
> Health and social care professionals training on the topics such as: Cultural Competence and Migration Issues, which benefit from the presence of the cultural mediator from his experience as a migrant and also as trained member of staff.

The main acute hospital in Malta and one of the eight mainstream health services in Malta have been providing a cultural mediator’s service funded by the state since 2010. Following an in-service study carried out by the Migrant Health Liaison Office in 2009, “Overcoming language barriers at Mater Dei Hospital” amongst all personnel working at the main acute hospital, the management team organised a working group to devise the formulation and specification of needs for the procurement of the cultural mediation services. Following this work, an open call was issued to engage Somali and Eritrean cultural mediators at the hospital due to the latter being the highest population migrant groups in Malta.

Moreover, the Migrant Health Liaison Office (Primary Health Care Department) is currently a partner of SOS Malta within the LEAP! Project, whereby other cultural mediators have received the training “Cultural Mediators in Health Care” following which they been allocated both at the main hospital and at the Health Centre in Floriana, thus increasing the cultural mediators’ pool in the health sector. The idea of the project is to provide the trained migrants with a skills passport. Health Centre in Floriana receives an average of 500 migrants per month.

Another similar project will be offering internships to migrants some of who will be allocated to health care services to upgrade their skills through an education and training programme.

Migrants in Malta often apply for resettlement programmes where they could be given the opportunity to reside in another EU/Non-EU country. This often disrupts the continuity of the rapport that would have been built overtime with health professionals and migrant patients.

Thanks to the enthusiasm and engagement shown among the trained cultural mediators working at the main hospital and the Floriana Health Centre a number of migrants have illustrated that:

‘Most interviewees confirmed that they were generally able to access public health centres without major problems. Overall, the quality of health services received was considered very good.’ (Nitkellmu, 2013)

Moreover, since the new LEAP! Project started, the Somali cultural mediators assisted in over 270 clinical encounters. In so doing, the cultural mediator’s integration and inclusion is facilitated through this work experience both on a professional and a personal level.

Elements that allow us to evaluate the “success” of the work done are:
- An internal in-service study conducted at the health centre in Floriana entitled, “One Year On: Triadic communication in Primary Health” in 2010 whereby after a year of the recruitment of the trained cultural mediators within the health sector a questionnaire was distributed to health professionals to assess their perception of this support service. The main findings were:
- The service of the cultural mediator is necessary for their work;
- The service increases their ability towards coming to a diagnosis, the management of chronic conditions, pain management, the understanding of recommendations given to the patient and arrangements for follow-ups;
- migrants were more compliant when assisted by a trained cultural mediator.
The high turnover of cultural mediators who apply for resettlement programmes results in re-training of new cultural mediators and a start-from –scratch’ procedure to engage new ones into the system

The project was funded by :
- The state: which includes training and a procurement of service
- The LEAP! Project. This project aims to give unemployed individuals a paid training and working experience.