THE LOCAL HEALTH AUTHORITY OF REGGIO EMILIA an … · tackle the social determinants of health) Improve migrants’ engagement and participation Develop partnership in the community:

1DIREZIONE GENERALE - STAFF RICERCA & INNOVAZIONE AUSL DI REGGIO EMILIA

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THE LOCAL HEALTH AUTHORITY OF REGGIO EMILIA

an integrated approach to the development of culturally competent healthcare services

Antonio ChiarenzaAzienda USL di Reggio Emilia

RICERCA E INNOVAZIONE

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Why has migration become an important issue for Reggio Emilia?

DIREZIONE GENERALE - STAFF RICERCA & INNOVAZIONE AUSL DI REGGIO EMILIA

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The MF strategy of the Local Health Authority of Reggio Emilia: a global approach to reduce inequalities in

health and barriers in the access to services for migrants


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Reducing health inequalities and inequities in the access of health services

Inequalities in health

• Occupational health• Mother and child health• Mental health• Diabetis (nutrition, smoke, alchool..)

• Infectious diseases


Inequitiesin the health services

• Communication problems• Inappropriate use of services• Lower level of quality of care• Inadequate organisation and delivery of

health care services

Socio-economic status

• Condizioni di lavoro• Condizioni di vita fisica e sociale• Condizioni abitative• Carenze nutrizionali• Emarginazione

Disparities in the access and quality of care

• Legal barriers• Lingiustic barriers• Cultural barriers• Lack of adequate information• Organisational barriers

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Key challenges

■ The challenge for public service providers is to en sure that services are accessible, responsive and appropriate to all patients

■ We need to respond to a changing patient/user profi le with differing perceptions & expectations of how health & social services are organised and delivered.

■ We need to ensure that we have a workforce with the right skills and knowledge to deliver sensitive and equit able services.

■ We need to provide leadership and plan how to integ rate diversity into the transformation of the health sys tem


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OUR STRATEGY: a global approach

IMPROVE KNOWLEDGE ON MIGRANTS HEALTH AND CONDITION.

� Collect data on migrants living condition that have an impact on health (Community health profile)

� Collect data on migrants’ health status (Migrants’ health profile)� Qualitative research on migrants’ needs and priorities.

DEVELOP CULTURAL COMPETENCE FOR THE STAFF AND THE ORGANISATION (whole organisational approach)

� Ensuring the implementation of human rights (irregulars, asylum seekers, Roma)

� Improving equity of access and quality of care (Communication, Information and Education)

COMMUNITY DEVELOPMENT (Health System Approach)

� Prevention (vaccinations, screening..) and health promotion interventions (to tackle the social determinants of health)

� Improve migrants’ engagement and participation� Develop partnership in the community: Local Authority, Networking, NGOs and

Migrants’ communities.


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Adoption of a whole organisational approach:todevelop Migrant-friendly and culturally competent

health care in Reggio Emilia

Effective interventions:

� Develop and implement MFCC specific policy and stra tegy (Top-management commitment; provide for resources)

� Integrate principles of cultural competence in the quality management system (specific standards and indicator s)

� Establish a management structure for MFCC (mainstre aming)

� Develop specific MFCC services (cultural mediation) and adapt organisational processes and procedures

� Systematic training of staff on migration and cul tural competency

� Monitor health and access to care across diverse gr oups

� Include community in priority setting, planning and evaluating


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Migrant-Friendly Hospitals (2002-2005)A European Initiative to Promote Health and Health Literacy Migrants and Ethnic Minorities

Kaiser-Franz-Josef-Spital, Vienna, AustriaImmanuel-Krankenhaus GmbH, Rheumaklinik Berlin-Wannsee, Berlin, GermanyKolding Hospital, Velje-Kolding, DenmarkHospital ”Spiliopoulio Agia Eleni”, Athens, GreeceHospital Punta de Europa, Algeciras-Cádiz, SpainTurku University Hospital, Turku, Finland Hôptial Avicenne, Paris, FranceJames Connolly Memorial Hospital, Dublin, IrelandAzienda Unità sanitaria Locale di Reggio Emilia, Reggio Emilia, ItalyAcademic Medical Centre, Amsterdam, The NetherlandsUppsala University Hospital, Psychiatric Centre, Uppsala, SwedenBradford Hospitals NHS Trust, Bradford, U.K.

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Migrant-friendliness – What does it mean?

1. Acceptance of people with diverse backgrounds as principally equal members of society – formal equality

2. Sensitivity to different needs of people with diverse backgrounds; service development to take account of specific needs related to diverse backgrounds – equal opportunity

3. Compensation for particular differences hindering participation and integration (in an empowering and enabling way) – substantial equality


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What is a migrant-friendly hospital?Accepting “migrant-friendliness (MF)” as an essential principle of the

hospital’s quality policy

Sensitivity and responsiveness to diversityin the needs of patientsin the needs of staff

Utilising and developing specific competencies among hospital staff

for working with a diverse clientele (cultural competence)for staff members with a migrant and/or ethnic minority background

MFH = Patient Orientation

MFH = Staff Orientation

MFH = Improving Quality of Care

Starting with a specific target group – developing strategies, routines and competencies of benefit fo r all


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-Migrant-friendly

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Include “migrant-friendliness into policyEstablish a management structure for MF

Monitor health status and accss to services

Top-management

Interpreting and intercultural

mediation services

Adapted Information and education interventions

Staff training on cultural competence


WHOLE ORGANISATIONAL APPROACHMIGRANT-FRIENDLY HOSPITAL

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-Migrant-friendly

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HEALTH SYSTEM APPROACHMIGRANT-FRIENDLY COMMUNITY

Include “migrant-friendliness into policyEstablish a management structure for MF

Monitor health status and accss to services

Top-management

Interpreting and intercultural

mediation services

Adapted Information and education interventions

Staff training on cultural competence


Prevention and health promotion

interventions

Engagement and participation of

migrant communities

Partnerships between health services and

local authorities

Partnership with the voluntary

sector

Integration of health status and socio-demographic data

Integrated policies and shared social

responsibility

WHOLE ORGANISATIONAL APPROACHMIGRANT-FRIENDLY HOSPITAL

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Example of integrated activity in the communityHealth care provision for irregular migrants in Reggio Emilias

Serviziodedicato

CSFS

Serviziodedicato

CSFS

AmbulatorioCARITAS

AmbulatorioCARITAS OSPEDALEOSPEDALE

Punti di accesso

Dip.SanitàPubblica

Dip.SanitàPubblica

Distrettosanitario

Distrettosanitario

AUSL Reggio Emilia

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SET UP OF A LCM service for the whole province of Reggio Emilia by:

•Community-based intercultural mediation as a shared resource for all healthcare services

•Connecting the needs of hospitals, primary care and social services

•Using professional intercultural mediators

•Developing partnerships in the community with local authorities

Implementation of a Linguistic & Cultural Mediation service for all health care services of Reggio Emilia


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Intercultural mediation services provided

Languages: Arabic, Chinese, Hindi, Urdu, Punjab, Albanian, Russian, Ukrainian, Turkish, Romanian..

20 intercultural mediators

Type of interventions for clinical encounters and health promotion activities:

• On site presence of the intercultural mediator (in hospital)

• Weekly scheduled intervention

• Urgent intervention (within 2/3 hours)

• Intervention over the phone

• Written translations

• Patient information and education

• Community information and education


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Information and education for migrant patients and communities

Information is provided in a simple and culturally adequate way in order to better respond to migrants’ health literacy.

INFORMATION•Translated leaflets and

•Information material in various languages

•Information events with the communities (i.e. how to access and

use the healthcare services)

EDUCATION Healthcare education courses

addressed to target groups of the population

(i.e. pre and post natal courses)


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Systematic training of staff on migration and cultural competency

CONTENTS2°Module :Intercultural communication

4°Module: Patients’information and education

3°Module:Cultural competence in healthcare practice


Variazione % della popolazione immigrata residente a Reggio

Emilia per genere e classe di età - Anni 2003-2008

0 50 100 150 200 250 300 350

<1

15-24

45-64

Maschi Femmine

1°Module:Migrants’ health status and access to services

Task Force Migrant-Friendly and Culturally Competent Healthcare of the Health Promoting

Hospitals and Health Services

International activities

DIREZIONE GENERALE - STAFF RICERCA & INNOVAZIONE MEDIAZIONE LINGUISTICO CULTURALE NEI SERVIZI SANITA RI DELLA PROVINCIA DI REGGIO EMILIA

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Migrant-Friendly Hospitals (2002-2005)www.mfh-eu.net

PROJECT OUTCOMES

OUTCOMESFor health policy

WHO-HPHTASK FORCE

MIGRANT FRIENDLY AND CULTURALLYCOMPETENTEHEALTH CARE (coordinated by Reggio Emilia)

12 national models for MFH:”how to do it” interventions:

1. Interpreting/mediation services

2. Staff training on cultural competence

3. Patient information and education

4. Whole organisationaldevelopment

OUTCOMESFor hospitals

OUTCOMESFor networking


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The aims of Task Force on MFCCH

• To create a framework for continuity after the conclusion of the MFH project

The HPH Task Force is co-ordinated by HPH Regional Network Emilia Romagna, AUSL Reggio Emilia (WWW.AUSL.RE.IT)

• To foster co-operation and alliances between healthcare organisations and other networks

• To share and disseminate best policies and practice

• To support health care organisations in becoming MF & CC organisations as indicated in the Amsterdam Declaration


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• HOME “ Health and Social Care for Migrants and Ethnic Minorities” a COST/Action project (2007-2010). www.costhome.eu/management

• NOWHERELAND: To improve equity of access to healthcare for UDM in Europe (DG SANCO)(2008-2011) http://www.nowhereland.info/

Partnerships & Research projects

European Cooperation in the field of Scientific and Technical Research

www.cost.esf.org

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TASK FORCE MFCCH WEBSITEwww.ausl.re.it


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TASK FORCE MFCCH WORKPLAN2011-2012


PROJECT TO DEVELOP STANDARDS FOR ASSESSING EQUITY OF ACCESS AND QUALITY OF HEALTH CARE FOR

MIGRANTS AND ETHNIC MINORITIESTime frame1. November 2010 – Establishment of the project group2. November 2010 – January 2011 - Development of the c onceptual

model3. November 2010 – January 2011 – Review of the liter ature and existing

standards4. March 2011 - Identification of 5-6 primary domain s5. April– May 2011 – Development of preliminary standa rds6. June 2011 – Presentation of the preliminary standa rds and

Identification of pilot institutions (HPH conferenc e)7. July – December 2011 – Pilot testing8. June 2012 development of the final standards (end of the project)

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Information and documents

http://[email protected]

Azienda Unità Sanitaria Locale di Reggio EmiliaDirezione GeneraleRicerca e InnovazioneVia Amendola, 242100 Reggio Emilia


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A Whole Organisation Approach to “migrant-friendliness” ensures inclusive, diversity sensitive strategies are devel oped and practiced

Whole Organisation Approach

Leadership and commitment

from Top Management

Establish a management structure for

MFCC

Implement MFCC specific

policy and strategy

Partnership between health

service and MEC groups Staff training

through learning strategies

Services that respond to

Migrants’ needs

Integrate cultural competence in the

quality management system


Documents

THE LOCAL HEALTH AUTHORITY OF REGGIO EMILIA an … · tackle the social determinants of health) Improve migrants’ engagement and participation Develop partnership in the community: