Разнообразие и равенство в сфере здравоохранения и ухода Открытый доступ

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Standards for Equity in Healthcare Provision and Utlisaton: Pilot Test in Sixteen Countries

Antonio Chiarenza, Dagmar Domenig and Sandro Catacin

Background: Health systems are faced with different needs, conditions and expectations concerning health and healthcare delivery. The most vulnerable groups risk receiving poorer care due to barriers and inequities in health service provision and utilisation. However health care organisations are often not sufciently equipped to effectively recognise and respond to the diverse needs of the population served. To this end, the Task Force Migration, Equity and Diversity (TF MED) developed a set of standards that allow health care organisations to evaluate equity in service provision and implement improvements. A test was conducted in 52 pilot organisations from sixteen countries to assess compliance with the standards, as well as to explore challenges and opportunities for the effective uptake of equity measures.
Methods: Purposeful sampling was utilised to identify participants for the pilot test by national coordinators of the TF MED (The TF MED was previously named Task Force on Migrant Friendly and Culturally Competent Health Care. The new name came into effect in 2016.). Organisations were general and specialised hospitals and other health care providers. Each pilot organisation defned appropriate structure and process to conduct assessment of service performance against the standards. A cross-sectional survey was used for data collection, participants were asked to fll in an online questionnaire with data collected though the self-assessment process. Data were analysed quantitatively as well as qualitatively.
Results: The fndings of the pilot test show that compliance with the standards was low in three main areas: policy, participation and promoting equity outside the organisation. In particular, pilot institutions revealed difculties in engaging management and leaders on equity issues; in promoting the participation of users at risk of discrimination; in developing forms of collaboration with relevant stakeholders in the community. On a more positive side, the pilot test results show that in general organisations do have policies in place to improve access to healthcare, as well as policies to ensure that individual and family needs are taken into account throughout the care process; however their effectiveness and impact are rarely evaluated.
Conclusion: The implementation of the standards for equity contributes to a self-reflective process, involving health professionals and managers, in which gaps and potential improvements are identifed. Many of the pilot organisations utilised the standards as part of a process of increasing their awareness of equity issues and changing the reorganizational culture.