Health system response to large scale migration: the case of Emilia-Romagna region

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Quargnolo ◽  
L Mammana ◽  
G Gherardi ◽  
C Bodini ◽  
D Damosto ◽  
...  
Keyword(s):  
Health Promotion ◽  
Health System ◽  
Asylum Seekers ◽  
Health Needs ◽  
Vulnerable Groups ◽  
System Response ◽  
National Guidelines ◽  
Regional Health ◽  
Health Response ◽  
Emilia Romagna Region

Abstract Background In Italy, recent changes in migration flows posed complex public health challenges. The Emilia-Romagna region (ERR) was one of the first regions to adopt specific policies addressing the health of newly arrived asylum seekers. In our study, we analysed the regional health system response comparing it to the regional and national guidelines, in order to assess its strengths and its critical areas. Methods In 2019, we conducted a survey among the referents of the regional clinics that provide healthcare to asylum seekers, in order to learn about local policies, challenges and best practices. A questionnaire with 35 closed and 11 open questions was administered and analysed through descriptive statistical analysis and text analysis. Results Regional policies showed good responsiveness and Local Health Authorities (LHAs) adhered to the guidelines. A special permit was introduced to grant asylum seekers access to healthcare, which also allowed integration of health data into the regional health information system. However, data integration was done in only 2 clinics out of 14. Instances of discretion in issuing the special permit were reported, due to ambiguity in the rules and inadequate training of office workers. Policies and LHAs protocols focused greatly on the arrival phase and on Communicable Diseases (CDs) surveillance. Other areas - such as protection of vulnerable groups, health promotion, NCDs - were prioritized in the national guidelines, but unevenly considered throughout the region, also due to lack of resources. Some clinics responded autonomously to these gaps with local resources. Conclusions The ERR health response to the influx of asylum seekers was rapid but incomplete. Interventions focused more on CDs surveillance than on responding to asylum seekers' health needs in terms of quality, access and equity. Areas to be strengthened include protection of vulnerable groups, health promotion and NCDs, together with coordination and long-term planning. Key messages The Emilia-Romagna region health response to the influx of asylum seekers reflects an emergency approach focused on communicable diseases, while NCDs and health promotion are relatively neglected. The health system in Emilia-Romagna needs to be strengthened in its capacity to respond to asylum seekers’ health needs. Health policies and practices should be planned to ensure equity and quality.

Regional Health System Response to the Virginia Tech Mass Casualty Incident

2007 ◽  
Vol 1 (S1) ◽  
pp. S9-S13 ◽  
Author(s):  
Lisa Kaplowitz ◽  
Morris Reece ◽  
Jody Henry Hershey ◽  
Carol M. Gilbert ◽  
Italo Subbarao
Keyword(s):  
Public Health ◽  
Mortality Rate ◽  
Health System ◽  
Trauma Center ◽  
Virginia Tech ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
System Response ◽  
Regional Health ◽  
Severity Scores

ABSTRACTBackground: On April 16, 2007 a mass shooting occurred on the campus of Virginia Polytechnic Institute and State University (Virginia Tech). Due to both distance and weather, air transport of the injured directly to a level 1 trauma center was not possible. The injured received all of their care or were initially stabilized at 3 primary hospitals that either had a level 3 trauma center designation or no trauma center designation.Methods: This article is a retrospective analysis of the regional health system (prehospital, hospital, regional hospital emergency operations center, and public health local and state) response. Data records from all of the regional responding emergency medical services, hospitals, and coordinating services were reviewed and analyzed. Records for all 26 patients were reviewed and analyzed using triage designations, injury severity scores (ISS), and critical mortality.Results: Twenty-five of the 26 patients were triaged in the field. Excluding 1 patient (asthma), the average ISS for victims presenting was 8.2. Twelve patients had an ISS of ≥9, and 5 had an ISS score of ≥15. Ten of the 26 patients (38%) required urgent intervention and surgery in the first 24 hours. The overall regional health system mortality of victims received was 3.8% (1 death [excluding 1 dead on arrival {DOA}]/ 26 victims from scene). The regional health system critical mortality rate (excluding 1 victim who was DOA) was 20% (1/5).Discussion: The outcomes of the Virginia Tech mass casualty incident, as evidenced by the low overall regional health system mortality of victims received at 3.8% (1/26) and low critical mortality rate (excluding 1 victim who was DOA) of 20%, coupled with a need to treat a significant amount of moderately injured victims 46% (12/26 with ISS ≥9) gives credence to the successful response. The successful response occurred as a consequence of regional collaborative planning, training, and exercising, which resulted not only in increased expertise and improved communications but also in essential relationships and a sense of trust forged among all of the responders. (Disaster Med Public Health Preparedness. 2007;1(Suppl 1):S9–S13)

scholarly journals COVID-19 and health promotion in Brazil: community health workers between vulnerability and resistance

2021 ◽  
pp. 175797592110123
Author(s):  
Gabriela Lotta ◽  
João Nunes
Keyword(s):  
Health Promotion ◽  
Health System ◽  
Community Health ◽  
Community Health Workers ◽  
Working Conditions ◽  
Health Workers ◽  
Online Discussions ◽  
Vulnerable Groups ◽  
Middle Income ◽  
Middle Income Countries

Health promotion in Brazil relies on community health workers (CHWs), frontline providers linking the health system with vulnerable groups. Brazilian CHWs are overwhelmingly women from poor backgrounds, with precarious and sometimes hazardous working conditions, as well as fragmented and unsystematic training. This paper evaluates how the COVID-19 pandemic exacerbated pre-existing vulnerabilities of CHWs (pertaining to low salary, precarious and hazardous working conditions and inadequate training) and created new ones, with a profound impact on their ability to carry out health promotion activities. Drawing on testimonials of dozens of CHWs and online discussions promoted by their unions, the paper reveals that during the pandemic CHWs were asked to continue their work without adequate training and protective equipment, thus exposing themselves to the risk of infection. It further shows how the pandemic rendered dangerous the close interaction with patients that is at the heart of their health promotion role. Nonetheless, CHWs sought to adapt their work. In the absence of leadership and coordination on the part of the federal government, CHWs mobilized different forms of resistance at the national and individual levels. Despite this, COVID-19 contributed to a trajectory of erosion of health promotion in Brazil. Findings from this case signal the difficulties for health promotion in low- and middle-income countries relying on CHWs to bridge the health system and vulnerable users.

scholarly journals Community engagement for health system resilience: evidence from Liberia’s Ebola epidemic

2020 ◽  
Vol 35 (4) ◽  
pp. 416-423 ◽  
Author(s):  
Kathryn M Barker ◽  
Emilia J Ling ◽  
Mosoka Fallah ◽  
Brian VanDeBogert ◽  
Yvonne Kodl ◽  
...  
Keyword(s):  
Health System ◽  
Community Engagement ◽  
Empirical Literature ◽  
System Response ◽  
Group Discussions ◽  
Low Resource ◽  
Critical Gap ◽  
Health Authorities ◽  
Health Response ◽  
System Resilience

Abstract The importance of community engagement (CE) for health system resilience is established in theoretical and empirical literature. The practical dimensions of how to operationalize theory and implement its principles have been less explored, especially within low-resource crisis settings. It is therefore unclear how CE is drawn upon and how, if at all, it facilitates health system resilience in times of health system crises. To address this critical gap, we adapt and apply existing theoretical CE frameworks to analyse qualitative data from 92 in-depth interviews and 16 focus group discussions collected with health system stakeholders in Liberia in the aftermath of the 2014–15 Ebola outbreak. Health system stakeholders indicated that CE was a crucial contributing factor in addressing the Ebola epidemic in Liberia. Multiple forms of CE were used during the outbreak; however, only some forms were perceived as meaningful, such as the formation of community-based surveillance teams. To achieve meaningful CE, participants recommended that communities be treated as active participants in—as opposed to passive recipients of—health response efforts and that communication platforms for CE be established ahead of a crisis. Participant responses highlight that meaningful CE led to improved communication with and increased trust in health authorities and programming. This facilitated health system response efforts, leading to a fortuitous cycle of increased trust, improved communication and continued meaningful CE—all necessary conditions for health system resilience. This study refines our understanding of CE and demonstrates the ways in which meaningful CE and trust work together in mutually reinforcing and beneficial ways. These findings provide empirical evidence on which to base policies and programmes aimed at improving health system resilience in low-resource settings to more effectively respond to health system crises.

scholarly journals Roma health mediators in Serbia – good example of multisectoral cooperation in health promotion

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
B Kilibarda ◽  
M Vasic ◽  
V Knjeginjic
Keyword(s):  
Health Promotion ◽  
Health System ◽  
Service Providers ◽  
Health Indicators ◽  
Target Population ◽  
Lessons Learned ◽  
Vulnerable Groups ◽  
Roma Population ◽  
The Republic ◽  
Roma Health

Abstract Issue Within the framework of the JA CHRODIS plus participants of the WP5 worked on identification of factors that contribute to collaboration within healthcare and between the broader health system and other sectors, as well as their enablers and barriers. In Serbia, practice that was identified and elaborated was aimed at improvement of health of Roma population. Description of the problem Based on available data, health indicators among Roma population in Serbia were two to three times worse than national averages. In order to tackle this issue, government of the Republic of Serbia, started with implementation of the project of education and inclusion of Roma health mediators in the health system. This project has been implemented in Serbia since 2009. Roma Health mediators (Roma ethical minority females) were trained for fast and efficient provision of support to Roma families. Results As a result of the project there was increased number of visits to health institutions and preventive check-ups of target population. Established cooperation between Roma health mediators and other health professionals in centers for primary health care, social care, and local self-government helped them in fulfilling their tasks, but also built capacity of other service providers to work in Roma communities. Through trainings they increase knowledge on various health, social and child care topics. Lessons Capacity building and inclusion of memebrs of vulnerable population into health promotion of the own to this population in terms of better acceptance of specific population population is useful to access groups as they can better understand and adapt to the needs of groups they want to reach. They should have opportunity to share their experience and lessons learned with experts involved in planning interventions for other vulberable groups. Key messages Building capacity of Roma mediators empowers them for integration into society beyond the scope of the Project. Lessons learned should be used for planning further actions for vulnerable groups.

scholarly journals Southeast Asian health system challenges and responses to the ‘Andaman Sea refugee crisis’: A qualitative study of health-sector perspectives from Indonesia, Malaysia, Myanmar, and Thailand

PLoS Medicine ◽  
2020 ◽  
Vol 17 (11) ◽  
pp. e1003143
Author(s):  
Helena Legido-Quigley ◽  
Fiona Leh Hoon Chuah ◽  
Natasha Howard
Keyword(s):  
Southeast Asia ◽  
Health System ◽  
Health Systems ◽  
Asylum Seekers ◽  
Southeast Asian ◽  
Health Needs ◽  
Andaman Sea ◽  
Forced Displacement ◽  
Displaced People ◽  
Refugees And Asylum Seekers

Background Southeast Asian countries host signficant numbers of forcibly displaced people. This study was conducted to examine how health systems in Southeast Asia have responded to the health system challenges of forced migration and refugee-related health including the health needs of populations affected by forced displacement; the health systems–level barriers and facilitators in addressing these needs; and the implications of existing health policies relating to forcibly displaced and refugee populations. This study aims to fill in the gap in knowledge by analysing how health systems are organised in Southeast Asia to address the health needs of forcibly displaced people. Methods and findings We conducted 30 semistructured interviews with health policy-makers, health service providers, and other experts working in the United Nations (n = 6), ministries and public health (n = 5), international (n = 9) and national civil society (n = 7), and academia (n = 3) based in Indonesia (n = 6), Malaysia (n = 10), Myanmar (n = 6), and Thailand (n = 8). Data were analysed thematically using deductive and inductive coding. Interviewees described the cumulative nature of health risks at each migratory phase. Perceived barriers to addressing migrants’ cumulative health needs were primarily financial, juridico-political, and sociocultural, whereas key facilitators were many health workers’ humanitarian stance and positive national commitment to pursuing universal health coverage (UHC). Across all countries, financial constraints were identified as the main challenges in addressing the comprehensive health needs of refugees and asylum seekers. Participants recommended regional and multisectoral approaches led by national governments, recognising refugee and asylum-seeker contributions, and promoting inclusion and livelihoods. Main study limitations included that we were not able to include migrant voices or those professionals not already interested in migrants. Conclusions To our knowledge, this is one of the first qualitative studies to investigate the health concerns and barriers to access among migrants experiencing forced displacement, particularly refugees and asylum seekers, in Southeast Asia. Findings provide practical new insights with implications for informing policy and practice. Overall, sociopolitical inclusion of forcibly displaced populations remains difficult in these four countries despite their significant contributions to host-country economies.

Collaborating to Assess Regional Health Needs and Resouces: Challenges and Lessons to Date

2001 ◽  
Author(s):  
Sandra MacDonald ◽  
Abraham Ross ◽  
Judith Blakeley ◽  
Donna Best ◽  
Lorna Bennett ◽  
...  
Keyword(s):  
Health Needs ◽  
Regional Health

Identifying Communities’ Perspectives on their Health Needs in Impoverished Villages to Guide Non-government Organizations’ Health Promotion Efforts in Guatemala

2020 ◽  
Vol 7 (5) ◽  
pp. 9-20
Author(s):  
Claudia Bale
Keyword(s):  
Health Promotion ◽  
Community Health ◽  
Health Care Access ◽  
Family Health ◽  
Community Based Participatory Research ◽  
Health Needs ◽  
Health Conditions ◽  
Personal Health ◽  
Structured Interviews ◽  
Non Profit

Objective: The aim of this mixed-methods study is to capture and understand impoverished Guatemalan community members’ perspectives of their own health needs on a community level in order to guide Hope of Life (HOL) Non-Profit organization’s health promotion interventions in the villages they serve. Methods: A modified health needs assessment survey was conducted with 96 participants from four impoverished villages in the department of Zacapa, Guatemala. Survey responses were analyzed for significant differences in 4-item individual, family, and community health scores across demographic variables and significant correlations with reported personal health conditions and children’s health conditions. Five semi-structured interviews were also conducted with community leaders from three of the villages surveyed. Interviews were audio recorded and responses were transcribed verbatim and translated from Spanish to English. Thematic analysis using HyperRESEARCH qualitative analysis software version 4.5.0. was conducted to identify major themes. Results: The mean age of the 96 participants surveyed was 40.4 years and the majority were women, married or in Union, and have children. Women reported a significantly lower individual and family health score than men. The most rural village included in the study had significantly lower family health scores than the three sub-urban villages in the study. Among the personal health problems reported by participants, alcohol consumption, dental problems, and malnutrition were significant predictors of lower individual health scores. Themes that emerged from the interview analysis included the greatest community health needs, perceived negative community health behaviors, barriers to health care access, HOL’s impact, and suggestions for community health promotion.   Conclusion: The results of this study reveal many unmet health needs and barriers to healthcare that Guatemalan village communities face. Community-based participatory research using a mixed approach voices communities’ perspective on their perceived needs and is an important tool to guide non-profit aid and intervention serving impoverished communities.

Managing the effectiveness of the regional health system

2020 ◽  
Vol 26 (3) ◽  
pp. 698-720
Author(s):  
E.V. Lobkova ◽  
A.S. Petrichenko
Keyword(s):  
Public Health ◽  
Health System ◽  
System Analysis ◽  
Health Indicators ◽  
Krasnoyarsk Krai ◽  
Regional Health ◽  
Luenberger Observer ◽  
Efficiency Assessment ◽  
Public Health Indicators

Subject. This article studies the mechanism of State health regulation and methods of management of efficiency of regional healthcare institutions. Objectives. The article aims to analyze the territorial health system in the context of the urgent need to optimize budget expenditures and address public health problems, as well as develop directions to improve the effectiveness of the regional health system of the Krasnoyarsk Krai. Methods. For the study, we used the method of index numbers and calculation of dynamics indicators using official statistics data. Results. We have developed and now present a system of indicators of regional health efficiency assessment, focused mainly on public health indicators and quality of medical services. We also offer our own version of the Luenberger observer modification adapted to the objectives of the regional health system analysis. Conclusions and Relevance. The article concludes that it is necessary to optimize the regional health system using the parameters of medical and social efficiency of the system. The proposed approach to assessing the effectiveness of regional health system can be used as a mechanism to develop recommendations for the management of the network of medical and prophylactic institutions of the region.

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