1. HEALTH EQUITY EUROPE JOINT ACTION
IMPROVING ACCESS TO HEALTH CARE AND RELATED SOCIAL SERVICES FOR THOSE LEFT BEHIND
Daniel Lopez-Acuña
Adjunct Professor
Andalusian School of Public Health
Spain
WORK PACKAGE 8
JAHEE EUPHA PRECONFERENCE
Ljubjliana, Slovenia, 28 of November 2018

2. MAIN OBJECTIVE OF WP8
WHAT?
The main objective of this Work Package is to contribute to the goal of "leaving no one behind" in terms of access to health services and related social services in the EU.
HOW?
This will be done through the formulation and implementation of regional, national and local strategies, policies and programs for reducing inequalities in access to health and social services and through building MSs' capacity to effectively advance action

3. Specific objectives
• identify, in the MSs participating in the WP8, the main challenges in securing access to health and related social services to vulnerable populations and to those marginalized from the effective access to certain types of services; • generate case-studies of good practices and/or review of evidence based interventions (e.g. policies, programs, projects) for sharing with the rest of MSs; • generate Policy Briefs on the main challenges identified; • implement and evaluate actions for the reduction of inequities in access to health and related social services; • support the development of national and regional policies, strategies and programs for reducing inequities in access to health and related social services; • foster inclusive policy development processes with the engagement of all relevant stakeholders

4. PARTNERS Spain (Andalusian School of Public Health,EASP) Coordinator
Bosnia and Herzegovina (MoCA and FMoH)
Bulgaria (NCPHA)
Cyprus (MoH CY)
Czech Republic (NIPH)
Denmark (ZEALCO-Bridge to Better Health)
France (MoH FR)
Greece (DYPEDE)
Italy (AGENAS,ISS,ITMoH)
Poland (Jagellonian University Medical College)
Portugal (MS)
Romania (SNSPMPDSB)
Serbia (IPHN)
Sweden (FoHM)

5. AREAS OF CONCENTRATION
VULNERABLE GROUPS
The WP8 concentrates on addressing the health needs of vulnerable groups lagging in access to health and related social services.
”Leaving no one behind” i refers, as it has been defined by the EU funded Vulnerable Project and other developments , to ensuring equitable access to:
those families who are in vulnerable situation (e.g. lone parents with young children),
people who have a physical, mental or learning disability, or poor mental health,
the in-work poor,
the older people who are in vulnerable situations,
people in unstable housing situations (e.g. the homeless),
prisoners (or ex-prisoners in vulnerable situations),
people living in rural/isolated areas in vulnerable situations,
the long-term unemployed/inactive (not in education, training or employment),
survivors of domestic and intimate partner violence, among others.
ethnic minorities
N.B. The irregular migrant’s, asylum seekers, and refugees are also a vulnerable group experiencing serious inequities in access to health and related social services, lagging with respect to the rest of the populations, but this is dealt by in WP7

6. SCOPE OF THE WORK
WP8 consists of formulating and implementing evidence based recommendations on improving the access to health services (preventive and curative) and other related social services for people left behind either because they are vulnerable groups from a social, economic or cultural standpoint or because access to some types of services is hindered for them for one reason or another. .
This WP will address primarily the inequities in terms of access for those who do not benefit from it and will identify the necessary actions for mitigating the bottle necks that hinder it.
To this end it will identify good practices through specific case studies in each participating MSs concentrating on different vulnerable groups and different types of services with unequal access to identify good examples of policies, strategies and programs to promote equal access to health services for those populations lagging in each country

7. MAIN TRHusts (1)
Building a consensus on a Policy Framework for Action focused on mechanism limiting equity in health care (building on the international recommendations, literature and more experienced countries) and ways to overcome them.
This PFA will be translated into a tool for conducting Country Assessments .
The framework will be shared with the governments, professionals, other stakeholders and the public through the web page of the JA and through targeted dissemination, at the end of the period covered by this JA, with the purpose of maximizing the reach of the lessons learned on the reduction of inequalities in access to health and related social services derived from the joint work carried out by MSs in this JA;

8. MAIN TRHusts (2)
Identify in each participating MS the national priorities in terms of reduction of inequities in the access to health services for specific vulnerable groups.
This will provide a “repertoire” of issues that warrant focused attention and further development.
These priorities should be expressed in terms of vulnerable groups lagging in access to quality health services as well as in terms of access barriers than can be tackled and mitigated.
Once this mapping of priority bottlenecks in access to health services is completed, identify which undertakings could benefit from a JA platform, so common work can act as a catalytic force for change and effective progress.
This may include not only national actions but also contemplate the possibility of advancing cross-border actions for improving access to health services in Europe

9. MAIN TRHusts (3)
Consolidate available evidence on key barriers hindering access to health services of the vulnerable groups lagging, which are amenable to interventions.
These should be specific to different vulnerable groups and access barriers to services in each country and should generate a repertoire of actionable recommendations.
Good practices for improving access to health services for those lagging behind will be suggested and implemented.
This will be translated into policy briefs on successful policies and programs.
It will encompass putting together a package of case studies to advance this stream of work in the interested Member States.
Several specific case studies according to countries preferences and good practices will be developed. These case studies should be comparable and follow a standard methodology.

10. MAIN TRHusts (4)
Identify key elements for capacity building that ought to be contemplated for building Member States institutional capacity to advance policies and programs for reducing inequities in access to health services.
Developing training materials on Improving Access to Health and Social Services for those Left Behind and organizing a generic training package that may be adapted to national circumstances

11. TASKS
Task 8.1
Policy Framework for Action and Country Assessment development
Task 8.2
Identification and documentation of best practices for reducing inequities in access to health services
Task 8.3
Implementing feasible and complex actions
Task 8.4
Consolidating lessons learned and developing policy processes for reduction of inequities in each participating country
Task 8.5
Developing capacity building instruments

12. TASK 8.1 PFA and CA development
A consensual PFA on mechanism limiting equity in health services delivery (building on the international recommendations, literature and more experienced countries) will be developed.
This policy framework will be translated into a tool for conducting CAs in MSs participating in WP8 on mechanisms limiting equity in access to health services.
MSs will identify which undertakings in their respective country could benefit from a joint European action platform, so common work can act as a catalytic force for change and effective progress.
MSs will map and identify the national priorities in terms of reduction of inequities in the access to health and related social services for specific vulnerable groups.
This will provide a repertoire of issues that warrant focused attention and further development. MSs, coordinated by Spain (EASP) will consolidate available evidence on key barriers hindering access to health services of the vulnerable groups lagging, which are amenable to interventions.

13. TASK 8.2
Identification and documentation of best practices for reducing inequities in access to health services
MSs will identify good practices for improving access to health services for those left behind.
This will be translated into policy briefs on successful policies and programs.
MSs will develop case studies on the reduction of inequities in the access to health and social services.
These case studies will be comparable and will follow a standard methodology.
They will cover salient vulnerable groups and access barriers in different types of services according to countries priorities

14. TASK 8.3 Implementing feasible and complex actions
Participating MSs will implement actions for reducing inequities in the access to health services and develop a case of good practices.
Those countries interested in implementing the suitable best practices will receive policy and technical support from WP8 leader to do it.
Implementation will be evaluated in a comparative way so European-wide best practices can be suggested.
WP leader will assists each participating MS choosing, focusing and setting in motion their implementation actions along the JA period by:
arranging dialogue/consultation via video-conference, s, etc.
arranging peer support e.g. webinars among relevant participating MS or finding relevant expertise.
offering a template for reporting the results (implement a feasible (‘easy’) action / or a complex challenge), either at local, regional, or national level, or at mechanisms linking these levels, taking account the possibilities and interests in each MS.

15. TASK 8.4
Consolidating lessons learned and developing policy processes for reduction of inequities in each participating country
A final Policy Framework for Action, elaborated according to the lessons learned in the development of the WP8 activities will be produced.
The framework will be shared with the governments, professionals, other stakeholders and the public

16. TASK 8.5 Developing capacity building instruments
The participating MSs will identify key elements for capacity building that ought to be contemplated for building MS institutional capacity to advance policies and programs for reducing inequities in access to health services.
Training materials will be developed by EASP and distance- learning pilot course focused on ”reducing inequalities in access to health and related social services” for those left behind will be organized for all MSs.
Two persons for each participating MS will be part of the piloting of the course. The course will be run from EASP.
The pilot training may be opened to a wider audience if resources permit