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Pilot study to reduce inequalities in health and healthcare services in Slovenia
Under the EEA and Norway Grants, Slovenia’s Public Health Initiatives programme aims to reduce inequalities in health. The project Together for Health (2013–2016) is directed by the National Institute of Public Health (NIJZ). The Norwegian Institute of Public Health is Donor Programme Partner for the Public Health Initiatives programme in Slovenia.
New models and approaches
The goal of the project has been to establish new models and approaches in the field of preventive health care, contribute to better health and reduce inequalities in health for all population groups. Through cross-sectoral cooperation and increased capacity, one has sought to increase the accessibility of preventive health care for vulnerable groups.
Two key products of the project are:
- an upgraded programme of preventive health care for children and adolescents (Work package 1) and
- an upgraded programme to prevent chronic non-communicable diseases in adults (Work package 2).
Over 60 experts from the NIJZ and more than 100 experts have participated in the project Together for Health. They represented different fields ranging from paediatrics, gynaecologists and obstetrics to psychiatrists, nutritionist, anthropologists and physical educators. In addition, institutions from several sectors have contributed to the project, such as local social work centres, employment services, Health Insurance Institute and NGOs.
An example of a sub-project under Work package 2 is the pilot study in Celje, the third-largest town in Slovenia, located northeast of the capital Ljubljana and by the river Savinja. The project employed an intercultural mediator for the Albanian speaking community.
A team of anthropologists
The National Institute of Public Health in Slovenia invited a team of anthropologists from the Institute for Multicultural Research to participate in the project. The team of anthropologists included Simona Jazbinšek, Sara Pistotnik and Uršula Lipovec Čebron, PhD.
They identified vulnerable groups in the Slovenian health care system in addition to various legal, administrative and practical obstacles with regard to their access to healthcare services. One of these groups is a large Albanian speaking community in Celje. There has been an increase in the number of men from Kosovo coming to Celje to find jobs as construction workers. Their wives and children eventually join them through family reunification processes. The men work long hours and the women are usually unemployed and at home taking care of their children. Thus, the women are marginalised and have little opportunity to learn the language. These women became the target group of this pilot study.
The main obstacle identified relates to language and cultural barriers. Solutions to this challenge exist already but none are systematically organized, so the patients and health care professionals are mainly left to themselves to find innovative solutions. Some of these include patients accompanied by informal mediators who can translate for them (usually spouses or children). Also, health care professionals ask colleagues familiar with Albanian culture and language to assist in communication.
Other solutions involve health care providers who resort to non-verbal communication like writing and drawing or adjusting their schedule to meet patients when someone who can translate can accompany them.
This pilot study was introduced in the Community Health Centre in Celje, an important partner in supporting the community approach. An intercultural mediator participated in three workshops in the Health promotion centre at Celje and at individual prevention examinations in family medicine ‘model practice’ in Vojnik, a town just north of Celje. A total number of 54 women participated in the workshops and nine users at individual examinations. The team used qualitative and quantitative methods for evaluation, such as questionnaires, interviews and participant observation.
Results and recommendations
The results of the pilot study showed that:
- patients who were unresponsive in the past now came to examinations
- the health care professionals obtained more reliable data
- patients were able to understand health care professionals and express themselves more easily and clearly
A crucial factor for this success is that the mediator Vera Haliti is herself a member of the Albanian community of Celje. She could translate but was also able to bridge the cultural barrier, motivating people, gaining their trust, which built on previous social capital she has in the community.
The pilot study recommends the introduction of intercultural mediators into the Slovenian health care system and integrating this into a community collaboration approach. This approach can lower the costs of and increase the effectiveness of healthcare services.
Several questions need further clarification to obtain good integration and organization within the community. For example, the degree of autonomy and responsibility of the mediator, training of mediators and healthcare professionals and financial issues that ensure the mediators’ independence. An added value of the study is that the methods and questions addressed can be used in other countries with similar contexts and challenges with large minority populations.