scholarly journals Asylum seekers’ healthcare in Italy: policies and practices among different regions

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
C Milani ◽  
J Bianchi ◽  
P Bordin ◽  
S Bortoluzzi ◽  
V Gianfredi ◽  
...  
Keyword(s):  
Continuity Of Care ◽  
Asylum Seekers ◽  
Health Workers ◽  
Health Needs ◽  
Local Health ◽  
Refugee Status ◽  
The Real ◽  
Italian Law ◽  
Computerized System ◽  
Policies And Practices

Abstract Background The Italian law provides for international protection and universal health-care coverage for asylum seekers (AS). Indeed, they are entitled to be regularly registered at the National Healthcare Service. Before submitting the application for refugee status, medical assistance to migrants is up to local administration. Our aim was to describe and compare policies and protocols regulating AS healthcare from their arrival to their application for refugee status, at national and regional level. Moreover, we investigated the daily healthcare practice addressing potential gaps between policies and practice. Methods The research team is a subgroup of the Inequality working group of the Italian hygiene society and it is composed of public health residents. The research involved also local health workers and other professionals belonging to regional groups of Italian migrant medicine society (SIMM). We collected national, regional and local policies and protocols and we compared them using a specific framework. Furthermore, we achieved a mapping of daily practice implementation at local health organization (LHO) level using a checklist. Results The most relevant findings were that regional policies themselves vary notably from each other and, as regard practices, LHO implement differently the same regional legislation. Furthermore, we found some critical issues: the delayed inclusion in primary care assistance and lack of continuity of care and of a computerized system of recording information. Conclusions The lack of uniformity concerning policies and practices of AS healthcare might also result in unawareness and uncertainty about how to access to healthcare services by migrants. An enhanced cooperation between groups dealing with migrants’ issues may lead to avoid variability at the implementation. Finally, a computerized system for data collection might facilitate the continuity of care and the assessment of the real health needs of the AS population. Key messages It is a priority challenge for health systems to strengthen the interventions aimed at overcoming the linguistic, economic, cultural and administrative barriers to the health services access. It is crucial to improve the recording information system to detect the real health needs of AS, their change and the inequalities in access and to improve collaboration between groups and university.

Health needs, community and network in primary care: an action research program

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Milani ◽  
G Occhini ◽  
C Francini ◽  
G Orsini ◽  
L Baggiani ◽  
...  
Keyword(s):  
Action Research ◽  
Health Workers ◽  
Participant Observation ◽  
Local Population ◽  
Health Needs ◽  
Local Health ◽  
Structured Interviews ◽  
Health Networks ◽  
Comprehensive Primary Health Care ◽  
Health Related

Abstract Issue According to the Alma Ata Declaration, Comprehensive Primary Health Care (C-PHC) addresses the main health problems in the community, promotes participation and involves all health related sectors. In Italy the so called Case della Salute model aims at realizing these principles. The purpose of the project is to understand how this model should be implemented in order to better answer the community needs. In the outskirts of Florence there is an area mostly made of public housing, devoted to people with housing and economic problems. There it is Casa della Salute (a health center where a PHC multidisciplinary team works), which could represent the key to cope with health inequalities and to create a network with the multiple associations rooted in the community. The implementation of an experimental model of C-PHC needs to involve local population, community actors, health professionals and researchers in a process of action-research. Results • An epidemiological study described a heavily deprived population compared with the rest of the city, with a burden of mortality especially affecting those most deprived and women. Mental health and addictions showed a deep need of care. A map of the neighbourhood was created in order to analyse formal and informal resources.The health needs of the community were deepened using social and ethnographic methodologies (semi-structured interviews, participant observation and focus groups with health workers, associations' representatives and individuals).Standing multi professional briefings were launched in order to facilitate the process of taking care of complex situations as a team. Lessons Preliminary results show the need for stronger collaborations with the actors in the community; further exploration of health related topics; community participation in the process of informing and transforming health practices; involvement of health workers in interprofessional practices to create a shared knowledge. Key messages Local health networks need a methodology to expand knowledge of peoples’ needs. Complexity in health and inequalities require a paradigm based on social determinants of health such as PHC.

scholarly journals Medical treatment of patients with gynecologic cancer during the COVID-19 pandemic

2021 ◽  
pp. ijgc-2020-002288
Author(s):  
Eleonora Palluzzi ◽  
Giacomo Corrado ◽  
Claudia Marchetti ◽  
Giulia Bolomini ◽  
Laura Vertechy ◽  
...  
Keyword(s):  
Continuity Of Care ◽  
Health Workers ◽  
Patient Flow ◽  
Gynecologic Cancer ◽  
Security Protocol ◽  
Local Health ◽  
Healthcare Staff ◽  
Gynaecologic Cancer ◽  
Time Periods ◽  
Hospital Visits

BackgroundDuring the COVID-19 pandemic, cancer care had to be reorganized; national and international recommendations were published to manage anticancer treatments safely and to reduce the risk of SARS-CoV-2 infection for patients and health workers.ObjectiveTo evaluate whether the adoption of recommendations for the management of patients with gynaecologic cancer receiving treatment during the pandemic resulted in containment of infections and continuing oncologic care.MethodsBased on the published recommendations, and according to the local Health Direction guidelines, we developed and drafted a security protocol to modify access of patients with gynaecologic cancer to the “Fondazione Policlinico Agostino Gemelli-IRCCS, Rome” between February 1 and April 30, 2020 and compared results with the corresponding 3 months of 2019.ResultsBetween February and April 2019, we registered 3254 admissions, including 2253 patients receiving intravenous chemotherapies, 298 receiving oral therapies, and 703 having hospital visits. Between February and April 2020, we registered 3213 admissions, including 2221 patients receiving intravenous chemotherapies, 401 receiving oral therapies, and 591 having hospital visits. Oral treatments and general visits were different in the two time periods (p<0.001). Despite the elevated patient flow, only one patient (0.1%) tested positive for COVID-19 and there were no cases among healthcare staff.ConclusionsBased on the adopted security protocol we provided continuity of care for all patients and limited the spread of the COVID-19 infection.

Stakeholders’ Perspectives on the Unmet Needs and Health Priorities of the Urban Poor in South-East Nigeria

2021 ◽  
pp. 0272684X2110334
Author(s):  
Ifeyinwa Arize ◽  
Daniel Ogbuabor ◽  
Chinyere Mbachu ◽  
Enyi Etiaba ◽  
Benjamin Uzochukwu ◽  
...  
Keyword(s):  
Urban Areas ◽  
Urban Poor ◽  
Health Workers ◽  
Cost Of Care ◽  
Health Needs ◽  
Health Priorities ◽  
Primary Health Care System ◽  
Dual Practice ◽  
Double Burden ◽  
Primary Health

Relatively little is known about readiness of urban health systems to address health needs of the poor. This study explored stakeholders’ perception of health needs and strategies for improving health of the urban poor using qualitative analysis. Focus group discussions (n = 5) were held with 26 stakeholders drawn from two Nigerian states during a workshop. Urban areas are characterised by double burden of diseases. Poor housing, lack of basic amenities, poverty, and poor access to information are determinants of health of the urban poor. Shortage of health workers, stock-out of medicines, high cost of care, lack of clinical practice guidelines, and dual practice constrain access to primary health services. An overarching strategy, that prioritises community-driven urban planning, health-in-all policies, structured linkages between informal and formal providers, financial protection schemes, and strengthening of primary health care system, is required to address health needs of the urban poor.

scholarly journals Examining local perspectives on the influence of climate change on the health of Hamer pastoralists and their livestock in Ethiopia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Samuel Lumborg ◽  
Samuel Tefera ◽  
Barry Munslow ◽  
Siobhan M. Mor
Keyword(s):  
Climate Change ◽  
Water Scarcity ◽  
Health Workers ◽  
Animal Health ◽  
Disease Outbreaks ◽  
Vulnerable Groups ◽  
Local Health ◽  
Framework Analysis ◽  
Healthcare Facilities ◽  
Grazing Lands

AbstractThis study explores the perceived influence of climate change on the health of Hamer pastoralists and their livestock in south-western Ethiopia. A combination of focus group discussions and key informant interviews were conducted with Hamer communities as well as local health workers, animal health workers and non-governmental organisation (NGO) staff. Thematic framework analysis was used to analyse the data. Reductions in rangeland, erratic rainfall, recurrent droughts and loss of seasonality were perceived to be the biggest climate challenges influencing the health and livelihoods of the Hamer. Communities were travelling greater distances to access sufficient grazing lands, and this was leading to livestock deaths and increases in ethnic violence. Reductions in suitable rangeland were also precipitating disease outbreaks in animals due to increased mixing of different herds. Negative health impacts in the community stemmed indirectly from decreases in livestock production, uncertain crop harvests and increased water scarcity. The remoteness of grazing lands has resulted in decreased availability of animal milk, contributing to malnutrition in vulnerable groups, including children. Water scarcity in the region has led to utilisation of unsafe water sources resulting in diarrhoeal illnesses. Further, seasonal shifts in climate-sensitive diseases such as malaria were also acknowledged. Poorly resourced healthcare facilities with limited accessibility combined with an absence of health education has amplified the community’s vulnerability to health challenges. The resilience and ambition for livelihood diversification amongst the Hamer was evident. The introduction of camels, increase in permanent settlements and new commercial ideas were transforming their livelihood strategies. However, the Hamer lack a voice to express their perspectives, challenges and ambitions. There needs to be collaborative dynamic dialogue between pastoral communities and the policy-makers to drive sustainable development in the area without compromising the values, traditions and knowledge of the pastoralists.

Impact of Covid-19 on the mental health needs of asylum seekers in Australia

2021 ◽  
pp. 103985622110054
Author(s):  
Sarah Mares ◽  
Kym Jenkins ◽  
Susan Lutton ◽  
Louise Newman AM
Keyword(s):  
Mental Health ◽  
Human Rights ◽  
Social Isolation ◽  
Asylum Seekers ◽  
Health Needs ◽  
Human Rights Violations ◽  
Mental Health Needs

Objective: This paper highlights the significant mental health vulnerabilities of people who have sought asylum in Australia and their additional adversities as a result of the Covid-19 pandemic. Conclusions: Australia’s policies in relation to asylum seekers result in multiple human rights violations and add significantly to mental health vulnerabilities. Despite a majority being identified as refugees, people spend years in personal and administrative limbo and are denied resettlement in Australia. Social isolation and other restrictions associated with Covid-19 and recent reductions in welfare and housing support compound their difficulties. The clinical challenges in working with people impacted by these circumstances and the role of psychiatrists and the RANZCP in advocacy are identified.

Riforma psichiatrica e psicoterapia sistemica. Continuitŕ, sviluppi, problemi aperti

PSICOBIETTIVO ◽  
2009 ◽  
pp. 47-64
Author(s):  
Luigi Onnis
Keyword(s):  
Public Services ◽  
Health Workers ◽  
Psychiatric Hospitals ◽  
Mental Health Workers ◽  
Basic Principles ◽  
Psychiatric Reform ◽  
The Public ◽  
Italian Law ◽  
New Interpretation ◽  
Systemic Psychotherapy

- The Author, in this paper, first of all reconstructs the essential historical phases of the theoretical and practical renewal process which preceded and accompanied the 180 law approval, that established the psychiatric hospitals closing. He then describes the Italian psychiatric reform characteristics, underlining how it produces the emerging of needs of new interpretation and intervention methods about psychic sufference: in this perspective psychotherapy has a crucial role and the italian law in psychotherapeutic training regulation is a further support. Particularly systemic psychotherapy proposes common basic principles with regard to the psychiatric reform and can represent an useful instrument for developping innovative concepts and practices. Finally the Authors put critically in evidence the problems still unresolved, not only concerning the need of a full application of the reform law, with the creation of territorial services and structures where they are still lacking or insufficient, but, over all, promoting the diffusion into the public services of a psychotherapeutic culture and practice.Key Words: Italian Psychiatric Reform, Law 180, Systemic Psychotherapy, Psychotherapeutic Culture, Public Services, Mental Health Workers Formation.Parole chiave: riforma psichiatrica italiana, legge 180, psicoterapia sistemica, cultura psicoterapeutica, servizi pubblici, formazione degli operatori.

scholarly journals The Electronic Health Insurance Card for Asylum-Seekers in Berlin: Effects on the Local Health System

2021 ◽  
Author(s):  
Nora Gottlieb ◽  
Vanessa Ohm ◽  
Miriam Knörnschild
Keyword(s):  
Health Insurance ◽  
Cost Analysis ◽  
Asylum Seekers ◽  
Inpatient Care ◽  
Local Health ◽  
Healthcare Provision ◽  
Barriers To Healthcare ◽  
Insurance Card ◽  
Local Health System ◽  
And Control

Background: In debates on asylum-seekers’ access to healthcare it is frequently claimed that restrictions are necessary to prevent unduly high health service utilization and costs. Within Germany, healthcare provision for asylum-seekers varies across the different states. Berlin’s authorities removed some barriers to healthcare for asylum-seekers by introducing an electronic health insurance card (HIC) in 2016. We used the HIC introduction in Berlin as an opportunity to investigate the effects of improved healthcare access for asylum-seekers on the local health system. Methods: The study applied a mixed-methods design. A cost analysis compared expenses for outpatient and inpatient health services for asylum-seekers before and after the HIC introduction, based on aggregate claims data and information on expenses for humanitarian healthcare provision that were retrieved from the Berlin authorities. Semi-structured interviews with 12 key informants explored organizational effects like administrative workloads and ethical dilemmas for staff. We performed a content analysis and used respondent validation to enhance the accuracy and trustworthiness of our results. Results: The HIC has reduced bureaucratic complexity and administrative workloads; it has enabled unprecedented financial transparency and control; and it has mitigated ethical tensions. All the while, average per person expenses for outpatient health services have declined since the HIC introduction. However, our cost analysis also indicates a rise in the utilization and costs of inpatient care. Conclusion: The HIC introduction in Berlin suggests that the removal of barriers to healthcare for asylum-seekers can create win-win-situations by reducing administrative workloads, advancing financial transparency, and mitigating ethical tensions, whilst cutting the costs of outpatient healthcare provision. Removing barriers to healthcare thus appears to be a more prudent policy choice than maintaining mechanisms of restriction and control. However, high inpatient care utilization and costs warrant further research.

scholarly journals Control of Aedes aegypti in a remote Guatemalan community vulnerable to dengue, chikungunya and Zika virus: Prospective evaluation of an integrated intervention of web-based health worker training in vector control, low-cost ecological ovillantas, and community engagement

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 598
Author(s):  
Gerard Ulibarri ◽  
Angel Betanzos ◽  
Mireya Betanzos ◽  
Juan Jacobo Rojas
Keyword(s):  
Community Engagement ◽  
Vector Control ◽  
Zika Virus ◽  
Health Personnel ◽  
Mosquito Control ◽  
Health Workers ◽  
Low Cost ◽  
Local Health ◽  
Worker Training ◽  
Integrated Intervention

Objective: To study the effectiveness of an integrated intervention of health worker training, a low-cost ecological mosquito ovitrap, and community engagement on Aedes spp. mosquito control over 10 months in 2015 in an urban remote community in Guatemala at risk of dengue, chikungunya and Zika virus transmission. Methods: We implemented a three-component integrated intervention consisting of: web-based training of local health personnel in vector control, cluster-randomized assignment of ecological ovillantas or standard ovitraps to capture Aedes aegypti mosquito eggs, and community engagement to promote participation of community members and health personnel in the understanding and maintenance of ovitraps for mosquito control. The intervention was implemented in local collaboration with the Ministry of Health’s Vector Control Programme, and in international collaboration with the National Institute of Public Health in Mexico. Findings: Eighty percent of the 25 local health personnel enrolled in the training programme received accreditation of their improved knowledge of vector control. Significantly more eggs were trapped by  ecological ovillantas than standard ovitraps over the 10 month (42 week) study period (t=5.2577; p<0.05). Among both community members and health workers, the levels of knowledge, interest, and participation in community mosquito control and trapping increased. Recommendations for enhancing and sustaining community mosquito control were identified. Conclusion: Our three-component integrated intervention proved beneficial to this remote community at risk of mosquito-borne diseases such as dengue, chikungunya, and Zika. The combination of training of health workers, low-cost ecological ovillanta to destroy the second generation of mosquitoes, and community engagement ensured the project met local needs and fostered collaboration and participation of the community, which can help improve sustainability. The ovillanta intervention and methodology may be modified to target other species such as Culex, should it be established that such mosquitoes carry Zika virus in addition to Aedes.

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