HPH TF MFCCH Task Force on Migrant-Friendly and Culturally Competent Health Care INTERNATIONAL STANDARDS FOR ASSESSING EQUITY IN HEALTH CARE: The project of the HPH-Task Force MFCCH Antonio Chiarenza Bernadette Nirmal Kumar Workshop of the Task Force MFCCH (room 203) XX International HPH Conference Taipei,11th-13th April 2012 HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE 1 1

Migrant-Friendly Hospitals (2002-2005) www.mfh-eu.net PROJECT OUTCOMES OUTCOMES For hospitals OUTCOMES For health policy OUTCOMES For networking 12 national models for MFH: ”how to do it” interventions Organizational development Interpreting services Staff training on cultural competence Patient information and education AT DE DK EL ES FI FR IT NL PT SV UK IR WHO-HPH TASK FORCE MIGRANT FRIENDLY AND CULTURALLY COMPETENTE HEALTH CARE HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE 2

The aims of Task Force on MFCCH The HPH Task Force is co-ordinated by AUSL Reggio Emilia (HPH Regional Network Emilia Romagna). TF web site: 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 and initiate the development of quality tools To foster co-operation and alliances between healthcare organisations and other networks To support health care organisations in the HPH in becoming MF & CC organisations as indicated in the Amsterdam Declaration HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE 3 3

PROJECT TO DEVELOP STANDARDS FOR EQUITY IN HEALTH CARE Project aim: The project aim at developing a comprehensive framework for measuring and monitoring the capacity of healthcare organisations to improve accessibility to appropriate and effective health services; health promotion and preventive care for migrants and other vulnerable groups. Principles and values: acknowledge that inequities in health care must be redressed; promote the principle of universal coverage; focus on prevention and health promotion as well as treatment across the continuum of care; acknowledge and value multiple diversity and the existence of differences as well as commonalities across all populations; acknowledge the uniqueness of all individuals, the right to self-determination and respect for individual identity. aim at reducing inequity in access to services and quality of care; HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE 4

PROJECT GROUP ITALY: Antonio Chiarenza (coordinator) HPH Emilia-Romagna UK (Scotland): James Glover and James Robinson (NHS Lothian) NORWAY: Bernadette Nirmal Kumar (NAKMI, Oslo) THE NETHERLANDS: Conny Seeleman and Marie-Louise Essink-Bot (Amsterdam Medical Centre) SWEDEN: Manuel Fernandez Gonzales (Uppsala University Hospital) CANADA: Elisabeth Abrahams (University Health Network, Toronto) and Marie Serdynska (Montreal Children's Hospital ,The McGill University Health Centre) SPAIN: Manuel Garcia Ramirez (University of Seville) EXPERTS: David Ingleby; Sandro Cattacin; Dagmar Domenig HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE 5

DEFINITIONS Health inequality and inequity (WHO) Health inequalities can be defined as differences in health status or in the distribution of health determinants between different population groups. E.g.:, differences in mortality rates between people from different social classes. Health inequities Some health inequalities are attributable to the external environment and conditions mainly outside the control of the individuals concerned. In this case, the uneven distribution may be unnecessary and avoidable as well as unjust and unfair, so that the resulting health inequalities also lead to inequity in health. HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE

DEFINITIONS Equity in Health: is concerned with creating equal opportunities for health and with bringing health differentials down to the lowest possible. Equity in Health Care: is defined as equal access to available care for equal need; equal utilization for equal need; equal quality of care for all. M. Whitehead, (2000). The concepts and principles of equity and health, WHO-Copenhagen HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE

Five main standards (domains) EQUITY IN POLICY EQUITABLE ACCESS AND UTILISATION EQUITABLE QUALITY OF CARE INCLUSIVE USER AND COMMUNITY INVOLVEMENT PROMOTING EQUITY HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE

A self-assessment tool standard definition Sub-standard definition measurable element HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE

5 Main standards 18 Sub standards 51 Measurable elements HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE

1 Standard Equity in Policy Objective of the standard To define how the organisation should develop policies, governance and performance monitoring systems which promote equity. HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE 11 11

1 Standard Equity in Policy 4 Sub-standards The organisation can ensure that its plans, policies and decisions promote equity in all aspects of its activities. The organisation’s research, monitoring and evaluation systems can measure equity performance. The organisation has a plan, resources and budget to promote equity. The organisation ensures that staff at all levels has awareness and competence to address inequities in health care. HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE 12 12

2 Standard Equitable Access and Utilisation Objective of the standard To encourage the health organisation to address barriers which prevent people from accessing and benefiting from health care services. HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE

2 Standard Equitable Access and Utilisation 4 Sub-standards The organisation ensures that accessibility and availability of health services are equitable. The organisation develops initiatives to reduce communication and information barriers The organisation develops initiatives to increase user trust. The organisation is able to ensure that healthcare is provided where eligibility rules compromise human rights. HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE 14 14

3 Standard Equitable Quality of Care Objective of the standard To assist the organisation in developing the following areas so that they respect the uniqueness of patients: patient assessment; staff / patient interactions; safe environment; discharge and continuity of care HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE 15 15

3 Standard Equitable Quality of Care 4 Sub- standards The organisation ensures that individual characteristics, experiences and living conditions are considered alongside the assessment of health needs. The organisation’s workforce is able to deliver care that takes into account individual patients’ ideas and experiences of health and illness. The organisation is able to create an environment that makes the patient feel safe, where there is no threat to his/her dignity or denial of individual identity. The organisation takes into account individual patients’ characteristics, experiences and living condition to ensure effective discharge and continuity of care. HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE 16 16

4 Standard Inclusive User and Community Involvement Objective of the standard To support the organisation in developing involvement processes sensitive to the needs and preferences of individuals and groups so that everybody has an equal opportunity to benefit from these processes. HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE 17 17

4 Standard Inclusive User and Community Involvement 3 Sub- standards The organisation is able to identify and involve users and groups who have an interest in the focus of its involvement process. The organization identifies and overcomes barriers to effective involvement. The organization has an empowering evaluation system of participatory processes in which users and community groups are involved. HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE 18 18

5 Standard Promoting Equity Objective of the standard To support the organisation in promoting equity externally in its wider environment through: advocacy and lobbying; capacity building; disseminating research; developing education and promotional work. HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE 19 19

5 Standard Promoting Equity 3 Sub- standards The organisation is an active participant in networks, think tanks and research initiatives which promote equitable approaches. The organisation actively disseminates the results of research and practice which relates to equity. The organisation ensures that equity is reflected in all partnership agreements and relationships, including contracted services, and partnerships. HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE 20 20

PROJECT WORKPLAN 2011 – 2013 Project roadmap: To revise the 1° draft of the standards after the feedback received at the workshop held at the XIX HPH Conference in Turku, (September 2011) To develop the measurable elements for each sub-standard (November 2011-March 2012) To present and discuss the 2nd draft of the preliminary standards at the International HPH Conference in Taipei, Taiwan (April 2012) To validate the preliminary standards through a consensus process addressed to WHO and other key players. (April-May 2012) To pilot test the preliminary standards in order to assess their clarity and ensure they meet the actual needs of people and services. (April-July 2012) To collect and analyse the findings of the pilot test (September 2012) To discuss the findings of the Pilot-test and Consensus Process at the Task Force meeting in Reggio Emilia (October 2012) To produce the final standards, develop indicators for each sub-standard and implement the final self-assessment tool in pilot organisations. (January 2013) To present and discuss the final self-assessment tool at the international HPH conference in Sweden (May 2013) HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE 21

PILOT TESTING THE STANDARDS IN HEALTH CARE ORGANISATIONS (April-July 2012) Aims: To assess the applicability and clarity of the standards To establish if the standards are accessible and understandable To collect examples of demonstrable evidence (effective practices relating to the measurable elements) HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE

EVALUATION OF SUB-STANDARDS AND MEASURABLE ELEMENTS COMPREHENSIBILITY: is the formulation sufficiently clear? APPLICABILITY: is the sub-standard and the measurable element applicable to the organisation? RELEVANCE: is the sub-standard and measurable element related to an important patient-care issue? COMPLETENESS: are important items missing?

PILOT-TEST TIME SCHEDULE The test period is scheduled from April 15th to June 30th. Results of the test must be returned to HPH TF MFCCH, Reggio Emilia before July 15th 2012. Corrections and amendments that may emerge as a result of the pilot test will be incorporated into the standards and final corrections will be carried out at a workshop to be held in Reggio Emilia in October 2012. HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE

PILOT-TEST: the role of national/regional HPH coordinators Countries who offered to host the pilot-test Identify and contract with 2 – 4 test hospitals / health services. Identify a responsible contact person for each pilot-institution. Provide guidance to organisations taking part in the pilot test implementation. Translate the test material into the national language, where necessary. To collect the completed review forms and send them to the TF coordinator. Italy Norway Scotland Canada Sweden The Netherlands Spain Other WHO countries Denmark (TBC) England (TBC) Ireland (TBC) HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE 25

PILOT-TEST: the role of pilot-organisations It is suggested that the following staff should be involved in the multidisciplinary review team: A contact person responsible for the local pilot-test (responsible for Equality and Diversity or Migrant-friendly initiatives) Hospital/health service management, and staff representatives (nurses, medical doctors, administrative staff) Specific relevant departments/professionals such as quality management, human resources, communication, community health, social work, health promotion. Representatives of service users and the community, selected to ensure coverage of target vulnerable groups. HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE 26

PILOT-TEST: REVIEW FORM HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE

PILOT-TEST: REVIEW FORM HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE

Information and material The guidelines and the review form can be downloaded from the TF MFCC website http://www.ausl.re.it The Review Form can be filled in on line at the HPH website: http://www.hphnet.org/ E-Mail: antonio.chiarenza@ausl.re.it HPH TASK FORCE ON MIGRANT FRIENDLY AND CULTURALLY COMPETENT HEALTHCARE HEALTH PROMOTING HOSPITALS NETWORK OF EMILIA – ROMAGNA AZIENDA USL DI REGGIO EMILIA – DIREZIONE GENERALE 29 29 29 29