MSF completes its primary healthcare project supporting homeless people

Doctors Without Borders/Médecins Sans Frontières (MSF) has provided free primary healthcare to the homeless communities in Hong Kong’s Yau Tsim Mong and Shum Shui Po districts, the majority of whom are aged 50 or above, since August 2023. While the health needs of the people experiencing homelessness will need more concerted efforts from different sectors of society, the growing awareness of and capacity for holistic medical care in the  community were observed. The model developed for this project could be a way forward for different local responders in the future.

Developing and implementing the project offered specific insights. MSF teams observed two major challenges confronting people experiencing homelessness in Hong Kong when receiving adequate healthcare. Firstly, healthcare services are generally not designed with their unique daily lived reality in mind, which translates into unexpected hurdles for them when accessing healthcare. Secondly, their innate motivation to seek healthcare before becoming critically ill is generally low due to lacking adequate resources and having to prioritise other critical concerns.

Responding to these unmet needs, MSF initiated a model of social-medical partnerships with local non-government organisations (NGOs) to deliver holistic patient-centred care, which MSF teams provided by offering regular basic health screenings, health promotion sessions and psychosocial support for people experiencing homelessness, while collaboration partners offered ongoing case follow-up. These local partners also received support in capacity-building to ensure continuity of care for people in the programme as MSF’s project came to an end in December 2024.

To help people experiencing homelessness  to cope with their health needs, the MSF team focused on increasing their awareness and empowering them to take action while offering the necessary support. The goal of our approach was to increase people’s health literacy and motivate them to take charge of their health and wellbeing by linking them to care and services.

After months of consistent activities and steady support from the MSF team, changes in people’s attitudes were apparent. Ming*, who lived in a hostel run by one of our partner NGOs, the Society for Community Organization (SoCO), said that he didn’t pay much attention to the condition of his health before attending MSF’s activities as he didn’t feel anything was wrong and assumed he was healthy. “A quick check by MSF in May showed me that my systolic blood pressure was over 200mmHG!” Ming explained. The healthy blood pressure levels are 140/90mmHg. A reading as high as 200mmHg meant Ming was at serious risk of suffering heart attacks, stroke, or other life-threatening health problems, and could be considered requiring urgent medical care.

Ming was initially hesitant about consulting a doctor, but both the MSF team and SoCO social workers persisted in their encouragements and persuasion. He went to the hospital the next day. When he returned for another MSF health screening in August, he brought with him a record sheet that documented his blood pressure over the three-month period, which showed an improvement. Ming shared with the team that he had adapted his diet and started an exercise routine in addition to taking medication to maintain his health.

Ming was not the only person experiencing homelessness that, with MSF’s help, embarked on the pursuit of better wellbeing despite difficult living conditions. Wai*, who regularly participated in MSF’s weekly psychosocial support group sessions, shared that he seldom felt comfortable or trusting enough to open up about his emotions and struggles to the people around him. The support group, held at places where the homeless community congregates, offered a safe space for him to do so, with peers sharing similar life experiences and social circles.

During these group sessions, MSF counsellors led participants through discussion on topics like loss and acceptance, stress management, and social awareness, which can be difficult to engage with alone. “I started coming because the group was an occasion to see friends. After a few sessions, I realised people were talking about their issues and how they cope. I took inspiration from them on how to handle my own problems,” Wai said. Another participant, Fong*, agreed with Wai: “It’s nice to hear about other people’s experiences, but also to give them support and encouragement.” 

During the 16-month span of the project, the MSF team observed a positive shift in approach not only in the people experiencing homelessness, but also in the support community. Having worked side-by-side with a medical team dedicated to addressing the specific health needs of this population, Eric Kwong, Assistant Programme Manager (Community Development) at ImpactHK, an NGO partner of the project, points out: “There is a culture shift within our team at the community centre.” 

ImpactHK recently developed their own Rehabilitation Team to take over some of the medical and psychosocial support activities the MSF team developed, expanding their services to deliver holistic care to their service users. “I don’t think we would have explored services like these if it weren’t for our collaboration with the MSF team,” Kwong said.

Through this medical-social support partnership model, MSF and our partners recognised that to support this specific population, a holistic and tailored approach that puts patients at the centre of how healthcare is provided, is paramount – especially to ensure their acceptance and trust, revealing specific needs, and facilitating follow-up care and referral into existing public services.

*Names have been changed at the request of patients in order to ensure confidentiality and privacy is respected.