AMSTERDAM 9 – 12 december 2004

Health promotion in an InterculturalHospital: some tools

Direzione Distretti EST OVESTResponsabile Progetto Speciale Immigrati

Giovanna Dallari

•6,3% of the Italian population

•more than 190 ethnic groups

10 Countries with the highest number of population in RER

30%

11%

7%

5%

5%

4%4% 4%

8%

22%

Morocco

Albania

Tunisia

Romania

China

Senegal

Philippine

Pakistan

Ghana

India

Bologna’s LHU 1/1/2004

Residents 812.330

City 373.539

Foreing residents in

Bologna as to 30/09/04

48.000 in the province

24.742 (6,6%) in the city

• Male 12.164

• Female 12.578

10 nationalities in Bologna town at 31/12/03 males and females

0200400600800

10001200140016001800

Filippi

ne

Mar

occo

Cina

Alban

ia

Bangla

desh

Roman

ia

Sri La

nka

Serbi

a M

onte

negr

o

Tunisi

a

Pakist

an

Ucrai

na

Mol

dova

Maschi

Femmine

Regione Emilia Romagna year 2003 Admissions 871.180 35.609 (4%) from DC

- 1.000 2.000 3.000 4.000 5.000 6.000 7.000

BANGLADESH

ALGERIA PERU'

SRI LANKA EGITTO

BRASILE RUSSIA

MACEDONIA ECUADOR

FILIPPINE SENEGAL POLONIA

Ex JugoslaviaMOLDAVIA

INDIA GHANA

PAKISTAN UCRAINA NIGERIA

CINA TUNISIA

ROMANIA MAROCCO

ALBANIA

0200400600800

1000120014001600

MAROCCO

ROMANIA

ALBANIA

TUNISIA

JUGOSLA

VIACIN

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BANGLADESH

MOLD

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FILIPPIN

E

PAKISTAN

UCRAINA

Foreing Citizens admissions in Bologna 2003/2004

2003

2004

MDC 2003

Diagnosis

1

10

100

1.000

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NON DEFIN

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11MESI2002

• It is impossible to satisfy the need of each ethnic group.

•Bologna’s LHU has implemented a set of services, focused on individual needs and on the reengineering of health services (more accessible, appropriate and sensitive to all patients and service users).

13. LA POPOLAZIONE TARGET E I PROBLEMI RILEVANTI13. LA POPOLAZIONE TARGET E I PROBLEMI RILEVANTI

Le disuguaglianze di salute nella nostra popolazione, Le disuguaglianze di salute nella nostra popolazione, indipendentemente dall’indicatore di salute e sociale indipendentemente dall’indicatore di salute e sociale utilizzato, sono consistenti: a qualsiasi livello della scala utilizzato, sono consistenti: a qualsiasi livello della scala sociale ci si ponga, il livello inferiore presenta un profilo sociale ci si ponga, il livello inferiore presenta un profilo epidemiologico piùepidemiologico più ……..

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13

1313 POPOLAZIONE POPOLAZIONE IMMIGRATA E ALTRE IMMIGRATA E ALTRE POPOLAZIONI A RISCHIO DI POPOLAZIONI A RISCHIO DI ESCLUSIONE SOCIALE.ESCLUSIONE SOCIALE.

ACTIONACTION PLANPLAN

Actions and Instruments (1)• Law, medical literature and experiences at the

local, national and international level analysis;• involvement of all stakeholders within the

community;• a comprehensive health program and

monitoring process;• patient’s education programs to self health

care;• intercultural mediators (liaison officers)

training courses;• analysis of quality perception in different

health services.

MISSIONMISSION

Garantire Garantire

la rilevazione dei bisogni, la rilevazione dei bisogni,

la pianificazione, la programmazione, il coordinamento, il la pianificazione, la programmazione, il coordinamento, il

monitoraggio e la verifica delle attività monitoraggio e la verifica delle attività

erogate in favore di Cittadini Stranieri Immigrati, erogate in favore di Cittadini Stranieri Immigrati,

sia a livello ospedaliero sia a livello distrettuale, sia a livello ospedaliero sia a livello distrettuale,

attraverso attraverso la messa in rete dei soggetti aziendali e delle Istituzioni la messa in rete dei soggetti aziendali e delle Istituzioni

pubbliche, private e di associazionismo volontariopubbliche, private e di associazionismo volontario che si che si

occupano di quel target di popolazione.occupano di quel target di popolazione.

PROGETTO SPECIALE IMMIGRATIPROGETTO SPECIALE IMMIGRATI

• Multicultural menu;• a web site showing all the information on tools, documents, projects, laws,

activities, news, links, etc. related to the immigrant’s social and health care;

• informative brochures in different languages;

• intercultural liaison officers help bridging the cultural and linguistic gap between patient and healthcare professional - eight linguistic areas covered;

• free telephone line and information centre:– offers counselling and information on health services in eight languages to support foreign

citizens and socio – sanitary professional;– a consultative instrument which enables users to contribute effectively to service

development.

• training courses for social and health professionals, including Dietologists and administrative staff

• Mammographic screening

Actions and Instruments (2)

Particular relevance…

• Progetto Speciale Immigrati

• Liaison officer and free telephone line

• Benchmarking

• Interistitutional and interprofessional network

• Web site

Progetto Speciale ImmigratiProgetto Speciale Immigrati

MISSION

To identify the needs, to plan, to program, to To identify the needs, to plan, to program, to coordinate, to check and to evaluate all the coordinate, to check and to evaluate all the actions proposed and carried out to improve actions proposed and carried out to improve access to health and social services - in the access to health and social services - in the hospital and in the outpatient clinics.hospital and in the outpatient clinics.

The project supports a network involving The project supports a network involving volunteers associations, public and private volunteers associations, public and private sectors.sectors.

Liaison officers (intercultural mediators)

• On 1998 the Liaison officers course, organized by the Local Government (U.E. funds – 350+350 hours) was set up for the first time.

• Liaison officers created AMISS (Associazione Mediatrici Interculturali Socio Sanitarie), the Socio-Sanitary Liaison Officers Organization.

Objectives• To ensure equal access to Health and Social Services

in the Province of Bologna.

• To help in the reengeneering of the hospital structure and activities.

• To implement communication and educational activities to protect migrants from social and cultural differences.

To achieve a better access and a better health situation.

Main subjects

• Information about sanitary assitance rights.• Information about the correct use of services

offered by health service and social services offered by local governments.

• Contribution in the reengineering of the hospital and ward’s services.

• Connection with volunteer services.• Set up of innovative activities.• Teaching in the Multicultural Course for health

and social services providers.

Objectives

• To create a reference point for institutions in charge of access improvement to Health Services.

• To facilitate best practice diffusion.

• To create a net between public and private institutions that are related to access opportunities for migrant citizens.

Future plans

• To enhance all the activities to the entire Azienda

• Enquiry on the health status of 3.500 workers

• Different spiritual care

• Cross-culture communication enhanced by use of translated information cards and pictorial aids, also useful for illiterate people.