THE LOCAL HEALTH AUTHORITY OF
REGGIO EMILIA
an integrated approach to the development
of culturally competent healthcare services
Antonio Chiarenza
Azienda USL di Reggio Emilia
RICERCA E INNOVAZIONE
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Why has migration become an
important issue for 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
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Occupational health
Mother and child health
Mental health
Diabetis (nutrition, smoke, alchool..)
Infectious diseases
Socio-economic status
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Inequities
in the health services
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Communication problems
Inappropriate use of services
Lower level of quality of care
Inadequate organisation and delivery of
health care services
Condizioni di lavoro
Condizioni di vita fisica e sociale
Condizioni abitative
Carenze nutrizionali
Emarginazione
Disparities in the access
and quality of care
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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 ensure that
services are accessible, responsive and appropriate to all
patients
■ We need to respond to a changing patient/user profile 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 equitable
services.
■ We need to provide leadership and plan how to integrate
diversity into the transformation of the health system
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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:
to develop Migrant-friendly and culturally competent
health care in Reggio Emilia
Effective interventions:
Develop and implement MFCC specific policy and strategy
(Top-management commitment; provide for resources)
Integrate principles of cultural competence in the quality
management system (specific standards and indicators)
Establish a management structure for MFCC (mainstreaming)
Develop specific MFCC services (cultural mediation) and
adapt organisational processes and procedures
Systematic training of staff on migration and cultural
competency
Monitor health and access to care across diverse groups
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
AT
DE
DK
EL
ES
FI
FR
IR
IT
NL
SV
UK
Kaiser-Franz-Josef-Spital, Vienna, Austria
Immanuel-Krankenhaus GmbH,
Rheumaklinik Berlin-Wannsee,
Berlin, Germany
Kolding Hospital, Velje-Kolding, Denmark
Hospital ”Spiliopoulio Agia Eleni”,
Athens, Greece
Hospital Punta de Europa,
Algeciras-Cádiz, Spain
Turku University Hospital, Turku, Finland
Hôptial Avicenne, Paris, France
James Connolly Memorial Hospital,
Dublin, Ireland
Azienda Unità sanitaria Locale di
Reggio Emilia, Reggio Emilia, Italy
Academic Medical Centre,
Amsterdam, The Netherlands
Uppsala University Hospital,
Psychiatric Centre,
Uppsala, Sweden
Bradford 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 diversity
in the needs of patients
in 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 for all
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WHOLE ORGANISATIONAL APPROACH
MIGRANT-FRIENDLY HOSPITAL
Top-management
Include “migrant-friendliness into policy
Establish a management structure for MF
Monitor health status and accss to services
-Migrant-friendly
Interpreting and
intercultural
mediation services
Adapted Information
and education
interventions
Staff training on
cultural competence
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HEALTH SYSTEM APPROACH
MIGRANT-FRIENDLY COMMUNITY
Partnerships between
health services and
local authorities
Integrated policies
and shared social
responsibility
WHOLE ORGANISATIONAL APPROACH
MIGRANT-FRIENDLY HOSPITAL
Top-management
Engagement and
participation of
migrant
communities
Include “migrant-friendliness into policy
Establish a management structure for MF
Monitor health status and accss to services
Prevention and
health promotion
interventions
-Migrant-friendly
Interpreting and
intercultural
mediation services
Adapted Information
and education
interventions
Integration of health
status and sociodemographic data
Staff training on
cultural competence
Partnership with
the voluntary
sector
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Example of integrated activity in the community
Health care provision for irregular migrants in Reggio Emilias
Servizio
dedicato
CSFS
Punti di accesso
Ambulatorio
CARITAS
Dip.
Sanità
Pubblica
Distretto
sanitario
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OSPEDALE
Servizi Sociali dei Comuni
Terzo Settore
Approccio MFH
Servizio di Mediazione Culturale
Informazioni in lingua
Formazione operatori
AUSL Reggio
Emilia
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Implementation of a Linguistic & Cultural Mediation
service for all health care services of Reggio Emilia
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
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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
EDUCATION
Healthcare education courses
addressed to target groups
of the population
(i.e. pre and post natal courses)
use the healthcare services)
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Systematic training of staff
on migration and cultural competency
Variazione % della popolazione immigrata residente a Reggio
Emilia per genere e classe di età - Anni 2003-2008
45-64
15-24
<1
0
50
100
150
Maschi
200
250
300
350
Femmine
1°Module:
Migrants’ health status and
access to services
CONTENTS
2°Module :
Intercultural communication
3°Module:
Cultural competence in
healthcare practice
4°Module: Patients’
information and education
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Task Force Migrant-Friendly and Culturally
Competent Healthcare of the Health Promoting
Hospitals and Health Services
International activities
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MEDIAZIONE LINGUISTICO CULTURALE NEI SERVIZI SANITARI DELLA PROVINCIA DI REGGIO EMILIA
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Migrant-Friendly Hospitals (2002-2005)
www.mfh-eu.net
PROJECT OUTCOMES
OUTCOMES
For hospitals
OUTCOMES
For health policy
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 organisational
development
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OUTCOMES
For networking
WHO-HPH
TASK FORCE
MIGRANT FRIENDLY
AND CULTURALLY
COMPETENTE
HEALTH CARE
(coordinated by
Reggio Emilia)
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The aims of Task Force on MFCCH
The HPH Task Force is co-ordinated by HPH
Regional Network Emilia Romagna, AUSL Reggio
Emilia (WWW.AUSL.RE.IT)
• To create a framework for continuity after
the conclusion of the MFH project
• To share and disseminate best policies
and practice
• To foster co-operation and alliances between
healthcare organisations and other networks
• To support health care organisations
in becoming MF & CC organisations
as indicated in the Amsterdam Declaration
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Partnerships & Research projects
European Cooperation in the field of Scientific and Technical Research
www.cost.esf.org
• 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/
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TASK FORCE MFCCH WEBSITE
www.ausl.re.it
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TASK FORCE MFCCH WORKPLAN
2011-2012
PROJECT TO DEVELOP STANDARDS FOR ASSESSING
EQUITY OF ACCESS AND QUALITY OF HEALTH CARE FOR
MIGRANTS AND ETHNIC MINORITIES
Time frame
1. November 2010 – Establishment of the project group
2. November 2010 – January 2011 - Development of the conceptual
model
3. November 2010 – January 2011 – Review of the literature and existing
standards
4. March 2011 - Identification of 5-6 primary domains
5. April– May 2011 – Development of preliminary standards
6. June 2011 – Presentation of the preliminary standards and
Identification of pilot institutions (HPH conference)
7. July – December 2011 – Pilot testing
8. June 2012 development of the final standards (end of the project)
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Information and documents
Azienda Unità Sanitaria Locale di Reggio Emilia
Direzione Generale
Ricerca e Innovazione
Via Amendola, 2
42100 Reggio Emilia
http://www.ausl.re.it
[email protected]
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A Whole Organisation Approach to “migrant-friendliness” ensures
inclusive, diversity sensitive strategies are developed and practiced
Leadership and
commitment
from Top
Management
Establish a
management
structure for
MFCC
Partnership
between health
service
and MEC groups
Staff training
through learning
strategies
Whole Organisation
Approach
Implement
MFCC specific
policy and
strategy
Services that
respond to
Migrants’ needs
Integrate cultural
competence in the
quality management
system
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