1. 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
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2. 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
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3. 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:
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
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4. 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;
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5. 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
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6. 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.
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7. 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
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8. Five main standards (domains)
EQUITY IN POLICY
EQUITABLE ACCESS AND UTILISATION
EQUITABLE QUALITY OF CARE
INCLUSIVE USER AND COMMUNITY INVOLVEMENT
PROMOTING EQUITY
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9. A self-assessment tool
standard definition
Sub-standard
definition
measurable
element
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10. 5 Main standards 18 Sub standards 51 Measurable elements
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11. 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.
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12. 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.
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13. 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.
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14. 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.
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15. 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
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16. 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.
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17. 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.
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18. 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.
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19. 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.
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20. 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.
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21. 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)
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22. 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)
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23. 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?

24. 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.
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25. 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)
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26. 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.
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27. PILOT-TEST: REVIEW FORM
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28. PILOT-TEST: REVIEW FORM
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29. Information and material
The guidelines and the review form can be downloaded from the
TF MFCC website
The Review Form can be filled in on line at the HPH website:
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