Novel health systems service design checklist to improve healthcare access for marginalised, underserved communities in Europe

Abstract

BackgroundMarginalised communities such as homeless people, people who use drugs (PWUD), lesbian, gay, bisexual, transgender and intersex people (LGBTI), prisoners, sex workers and undocumented migrants are at high risk of poor health and yet face substantial barriers in accessing health and support services. The Nobody Left Outside (NLO) Service Design Checklist aims to promote a collaborative, evidence-based approach to service design and monitoring based on equity, non-discrimination and community engagement.MethodsThe Checklist was a collaborative project involving nine community advocacy organisations, with a focus on homeless people, PWUD, LGBTI people, prisoners, sex workers, and undocumented migrants. The Checklist was devised via a literature review; two NLO platform meetings; a multistakeholder policy workshop and an associated published concept paper; two conference presentations; and stakeholder consultation via a European Commission-led Thematic Network (including webinar).ResultsThe NLO Checklist has six sections in line with the WHO Health Systems Framework. These are: (1) service delivery, comprising design stage (6 items), services provided (2 items), accessibility and adaptation (16 items), peer support (2 items); (2) health workforce (12 items); (3) health information systems (7 items); (4) medical products and technologies (1 item); (5) financing (3 items); and (6) leadership and governance (7 items). It promotes the implementation of integrated (colocated or linked) healthcare services that are community based and people centred. These should provide a continuum of needs-based health promotion, disease prevention, diagnosis, treatment and management, together with housing, legal and social support services, in alignment with the goals of universal health coverage and the WHO frameworks on integrated, people-centred healthcare.ConclusionsThe Checklist is offered as a practical tool to help overcome inequalities in access to health and support services. Policymakers, public health bodies, healthcare authorities, practitioner bodies, peer support workers and non-governmental organisations can use it when developing, updating or monitoring services for target groups. It may also assist civil society in wider advocacy efforts to improve access for underserved communities.

The impact of the COVID-19 pandemic on harm reduction services in Spain

“…In a recent study measuring the public’s perception of government COVID-19 pandemic response efforts, Spain was ranked low with 44 out of 100 points, indicating that the Spanish government needs to improve its communication with all of its constituents, and according to the results of the study, in particular, in protecting the welfare of vulnerable populations, which includes PWUD [ 36 ]. Pandemic preparations and response should include making the health system more people-centred through improved engagement and communication with all key stakeholders [ 37 , 38 ], not least the clients of harm reduction services.…”

Patient‐reported outcomes of the Treatment and Prevention Study: A real‐world community‐based trial of direct‐acting antivirals for hepatitis C among people who inject drugs

“…Further, our findings echo the ongoing drive to implement novel community‐based and people‐centred healthcare systems. 44 Whilst treating hepatitis C is undoubtedly efficacious, important for individual liver health and the broader public health, there is a need to also address underlying social factors that also contribute to quality of life. It is particularly important to upscale integrated hepatitis C treatment programmes, where individuals are offered support for other complex social, physical and mental health concerns alongside hepatitis C treatment.…”

Improving the care management of trans patients: Focus groups of nursing students’ perceptions

“…They are a key element to support and guide nursing professionals and students in their practice and professional development, which includes LGBTQ+ individuals’ needs. In the end, these patients usually attend health services with fear and shame, and there is where the importance of having well‐educated professionals and a good management lies (Korpaisarn & Safer, 2018; Lazarus et al., 2020).…”