Resource of health system actions on socially determined health inequalities

[ Log In ]
Category / Field Definition / Source
1. Country Italy
2. National / subnational / local or mixture Subnational, Local
3. European Union status Member
4. Title of example Integration of social and health services for immigrants the case of Padua
5. Summary

This case study describes the work of the High Professional Immigration Body of Local Health and Social Authority No. 16 in the municipality of Padua in the Veneto Region of Italy. As a result of its economic success, the Veneto is one of the regions attracting the most immigrants (5% of the population, according to the most recent national statistics). Padua has a diverse, significant and growing migrant population. The work of the High Professional Immigration Body is both inter- and intrasectoral and aims to improve the integration of health and social services.

The High Professional Immigration Body is the main organization providing social and health care services for documented and undocumented immigrants in Padua. It was set up as a result of collaboration between various institutional and non-institutional bodies that had implemented a coordinated system of plans and activities. Services created specifically for foreigners are: the Listening Centre, which provides information and health and social orientation services; a multi-ethnic unit for obstetrics and gynaecology; a dermatology unit and community paediatric units. The Municipality of Padua has signed a memorandum of understanding with Local Health and Social Authority No. 16 on the management of health services for unaccompanied foreign minors (1). The voluntary sector in Padua also responds to the health needs of immigrants through a network of outpatient services. The implementation of such services is possible precisely because of the integration of health and social services. Since 2004, the High Professional Immigration Body has coordinated a monthly roundtable meeting on immigration issues between institutional and non–institutional bodies, which deals with projects, analyses and surveys of immigrants’ needs.

6. Why is this example potentially of interest to policy-makers?

This case study will be of interest to policy-makers as an example of how, under the auspices of the High Professional Immigration Body, processes have been successfully used to build collaboration and coalitions that have led to improved health service provision for immigrants in Padua, as well as to safeguard their right to health. The High Professional Immigration Body of Local Health and Social Authority No. 16 of Padua is the first model of this kind of service in Italy and is very important at regional and national levels.

The case study showcases the creation and use of health information to improve health outcomes. Immigrants have the right to use health and social services in accordance with their legal status, but this is only possible when they can get clear and unambiguous information as to how to obtain the health card and health assistance. By investing in the training of administrative and medical staff and cultural and linguistic mediators, the programme is integrating the challenges posed by immigration into the mainstream work and understanding of the health and social services and encouraging a more informed mindset to deal better with issues relating to immigration and the needs of immigrants.

The case study provides an important example of how to reorient the health and social services system at local or subnational level so as to remedy the health disadvantage experienced by immigrants. It shows how stewardship in particular, as well as related activities pertaining to the delivery of health services and generation of resources in the health system, can be strengthened to improve health and wellbeing in a specific population group. It further highlights the importance of having governance processes in place that enable both inter- and intrasectoral work for delivery of integrated health and social services. In this way, it echoes WHO’s “systems thinking in the health system” approach (2), that is, understanding and appreciating the relationships within systems and considering in the design of an intervention what might be the positive and negative interactions with the various parts of the overall health system. Finally, this case study shows how the process of collaboration and coalition-building can lead to change and help to remedy health disadvantage experienced by immigrants (2,3).

7. Description Policy

The case study describes a unique form of collaboration between health and social services to (i) promote the social integration of legal and irregular immigrants by improving and increasing their access to social and health care services, and (ii) improve receptivity through, for example, training administrative and medical staff to understand the socioeconomic and psychological challenges faced by this vulnerable group and thus respond to specific needs. This is achieved primarily through the High Professional Immigration Body of the Local Health and Social Authority No. 16, the main body providing social and health services for immigrants in Padua.

Health and social activities are largely divided into two groups (see Section 8 for more details).

  1. The first group concentrates on health care from a social perspective, health promotion, prevention of illness and the control and limitation of disabling, congenital or acquired diseases. Such services are provided through the districts by the Local Health and Social Authority and organized by the High Professional Immigration Body.
  2. The second group concentrates on social services that are relevant from a health care perspective. It supports individuals who require support because of disability or exclusion that affects their state of health. Such services are handled by the municipalities with the High Professional Immigration Body.

Adherence to policy is assured through regulatory mechanisms such as the 2003 Memorandum of Understanding between the Social Service Department of the Municipality of Padua and the High Professional Immigration Body concerning the health care of unaccompanied foreign minors who arrive in Padua (1). In 2006, Local Health and Social Authority No. 16 and Padua Municipality signed another memorandum of understanding for political refugees asking for asylum in Padua (the Rondine Project) (4,5).

The social services for immigrants in Padua have three priorities, which are promoted through this programme:

  1. to favour and promote partnership work via a network involving all actors in the field of immigration;
  2. to promote interventions that respond immediately to individuals’ primary needs;
  3. to create a flexible network of frontline services for new immigrants.
8. Examples of specific activities

There are three broad domains of activity resulting from the collaboration fostered under the High Professional Immigration Body, including several interventions from partnerships in the public sector as well as public-private partnerships. These are the development of specific health services, the development of formal processes for managing unaccompanied foreign minors, and the training of health and other professionals.

    1. Development of specific health services
    Through the work of the High Professional Immigration Body, specific services for helping foreigners have been identified and developed. The Listening Centre uses properly trained cultural mediators to help immigrants use the health and social services and provides information on these services, including how to get social, health and legal advice and how to access specific services such as obtaining a foreigner’s short stay permit. The multi-ethnic unit for obstetrics and gynaecology provides care for female immigrants. In addition a dermatology unit, a social worker, a health visitor and a psychologist are available.

    The University College for Aspiring Missionaries and Missionary Doctors (CUAMM) and the Catholic charity Caritas run the CUAMM-Caritas polyclinic. The Municipality of Padua is responsible for planning the work of the polyclinic, while Local Health and Social Authority No. 16 grants the necessary legal authorizations and health permits required for its activities.

    Caritas staff assess immigrants’ suitability to use the services according to their socioeconomic status, and issue cards valid for six month entitling those eligible to free access to them. The cards cease to be valid when individuals obtain residence permits giving them access to the National Health System. The cards can be extended beyond six months if individuals still need care.

    In the last few years, the growing number of minors in the Padua municipal area has led to an increase in paediatric health assistance for irregular and nomadic minors who have no access to general practitioners in the area controlled by Local Health and Social Authority No. 16. This is a consequence of efforts to strengthen the Multi-ethnic Health Unit, including holding specific consulting hours for minors aged 0–18 years; it has been made possible with the help of the monthly roundtable meetings on immigration which include a delegation from the Provincial School Office of Padua.

    CUAMM doctors volunteer services in paediatrics, gynaecology, neurology, cardiology, dentistry and primary care.

    2. Formal processes to manage the care of unaccompanied foreign minors

    The High Professional Immigration Body collaborates with the Municipality of Padua (Social Service Department) under a Memorandum of Understanding signed in November 2003 to provide protection and accommodation in a reception centre or foster family for unaccompanied foreign minors when they arrive in Padua.

    An intervention model guaranteeing prevention, diagnosis and treatment of ill health has been developed and implemented by Padua’s Health and Social District No. 1, which has experience of dealing with a high level of mother-and-child enquiries from immigrants. Districts Nos. 2 and 3 have similar memoranda of understanding following an increase in the arrival of unaccompanied minors in their areas. In the last two years, this intervention model has been extended to the area under Local Health and Social Authority No. 16.

    On arrival, the minor is accompanied by a social worker to a full health check-up and is then given a National Health System card and personal health booklet. The expenses for his or her use of any district health and social services are covered by the local health and social authority. Since 2006, there has been a Memorandum of Understanding for Political Refugees asking for Asylum in Padua, signed by Local Health and Social Authority No. 16 and Padua Municipality (the Rondine Project) (4,5). This is useful for checking and analysing health conditions in particular cases (specified by the Ministry of the Interior) when immigrants have serious diseases and/or who come from difficult backgrounds and, last but not least, for giving them health assistance.

    3. Training for health and other professionals

    Training courses have been designed to improve and fine-tune the work and responses of various staff involved in the integration of immigrants through the health and social services. These include: training cultural and linguistic mediators in the socioeconomic and psychological challenges faced by immigrants; training administrative employees working at Local Health and Social Authority No. 16 and police headquarters in specific issues relating to immigration; and general training courses on immigration for general practitioners and the social and health care personnel of Local Health and Social Authority No. 16. There has also been an increase in the Listening Space’s consulting hours from Monday to Friday, including during the afternoon. Local Health and Social Authority No. 16 and other partners have produced a guide, Health assistance for strangers, to help the medical and administrative staff manage immigration issues (6). In this way, immigrants receive better and more appropriate help when they use the health and social services. Training courses for different health professionals in how to manage immigration issues have also been held (3).

9. Status of example

The programme started with activities carried out by the High Professional Immigration Body in 2003 (formalized in April 2004). This Body collaborates with the Social Services Department of the Municipality of Padua under a memorandum of understanding signed in November 2003 to provide protection and accommodation in a reception centre or foster family for unaccompanied foreign minors when they arrive in Padua (the Rondine Project) (4).

10. Equity categorization Not specified (Remedying Health Disadvantage)

The equity objective is not specified as the initiative is part of a policy approach made up of partnerships in the public sector (intra-institutional partnerships) and between the public and private social sectors (inter-institutional partnerships). These partnerships focus on integrated health and social planning rather than seeking to increase health equity. However, because of the focus on immigrants (documented and undocumented) as a specific population group, this policy can be understood as seeking to remedy health disadvantage. The initiative is based on a commitment to provide health and wellbeing services for everyone, including both legal and irregular immigrants, and to safeguard their right to health. Information is provided about access to health services for immigrants in the area, including both universal access and selective/specific services. During the last six years, the High Professional Immigration Body has collected information about equity gaps between regular and irregular immigrants and European Union (EU) and non–EU citizens. These data are being analysed.

11. Type of health systems action Combination (addressing inequalities in access to health services, preventing or ameliorating damage to health, stewardship/governance role)

This is a combination of all categories.

  1. The health system is addressing inequalities in access to health services that contribute to observed inequalities in health status. For example, having identified a lack of awareness among immigrants of the services available, the High Professional Immigration Body launched a communication campaign, including specific brochures and the establishment of a Listening Centre for foreigners, aimed at informing immigrants about their right to health care and  improving their access to health services.
  2. It is preventing or ameliorating damage to health caused by living in disadvantaged circumstances. For example, the CUAMM-Caritas polyclinic, in conjunction with Local Health and Social Authority No. 16, delivers a wide range of services to immigrants who would not otherwise have legal access to regular services.
  3. The health system is exercising its stewardship/governance role by tackling poverty and other wider social determinants of health more directly, including through advocacy with other sectors for change. For example, through the establishment of the collaborative High Professional Immigration Body, the health sector has recognized the interrelated nature and knock-on effect of many health and social problems facing immigrants, and has established partnerships (intra- and intersectoral as well as public/private) to tackle these issues through integrated initiatives and different collaborations and partnerships.
12. Health systems functions addressed by the example Combination (Creating Resources + Service Delivery + Stewardship)

Primarily, this is an example of health systems stewardship in action. The health sector works in collaboration with other sectors to influence policies and activities affecting the health of the population. In this case, a wide range of actors work in partnership to implement activities aiming to improve the health status of Padua’s immigrant population, including through cultural mediators trained to help immigrants deal with the health and social services. Through participation in monthly roundtable meetings, representatives of the health sector, the Local Government Office of Padua, the Police General Headquarters, Padua Municipality, the Provincial School Office and other institutional and non–institutional bodies such as private associations, non-profit organizations and nongovernmental organizations contribute to the formulation of strategic policy direction and future interventions. This partnership has enabled improved planning, better services (including integration of health and social services), and increased information for immigrants about their eligibility for health and social services.

In fulfilling its stewardship role in this way, the health system, in collaboration with other sectors, addresses other functions of the health system through specific activities, as follows.

  1. Service delivery

The interventions described present examples of service delivery. For example:

  • the CUAMM-Caritas polyclinic, which delivers a wide range of health services to immigrants who would not otherwise have legal access to regular health services;
  • local health services for foreign citizens including the multi–ethnic childbirth and women’s clinic, the dermatology clinic, the teenagers clinic (for unaccompanied children) and the child care clinic
  1. Creating resources

Resource generation is addressed in that (i) existing human resources are used, such as medical professionals delivering health services, and (ii) people with an appropriate skill mix and adequate training in specific issues relating to the social and health integration of immigrants are placed throughout the social and health system and beyond to ensure improved performance by the health service, in this case targeted at the specific needs of a growing and vulnerable group in the local population.

13. Critical features of the health system that address health inequity Combination (Participation and Engagement + Intersectoral action + Universal Coverage)

A combination of three of the critical features of the health system addressing health inequity can be seen in this example.

  1. Intersectoral action

The initiative has brought together all actors working with the immigrant population in Padua to deliver, in partnership, improved social and health care services to this group. Health and social integration had already been implemented through local authorities in the area but a further network was necessary specifically to address the social and health care needs of immigrants. The monthly roundtable meeting allows for the development of innovative projects and programmes between institutional and non-institutional bodies to protect the health and social life of women, children, immigrants or Italian families with social diseases.

  1. Participation and engagement

The case study highlights the facilitation of participation and engagement of Padua’s immigrant population in the social and health care services. This is achieved through training the relevant administrative, medical and specialized cultural mediation staff to improve their understanding of the specific socioeconomic and psychological challenges facing this population group and thus provide more tailored services. Greater participation and engagement is also achieved through activities such as the establishment of a Listening Centre and publication of booklets addressing specific health issues relevant to the immigrant community, which are designed to ease immigrants’ access to information about the social and health services and ultimately facilitate their access to these services, regardless of health status.

  1. Universal coverage

Universal coverage can be conceptualized in two ways. Firstly, and critically, it aims to increase eligibility for and coverage by the system. It can also, however, be seen to improve access to a system which, while nominally universal, nonetheless presents barriers to those attempting to access services. In this case study, both aspects are addressed.

The interventions described in the case study are based on the stated aim of the health system to provide universal coverage and standard access to basic health services for all. Laws specifically relating to the integration of immigrants strengthen the basis for planning interventions to promote universal coverage.

In developing processes to improve the relevance of and access to certain services, as well as establishing services for irregular as well as legal immigrants, the High Professional Immigration Body and its partners are ensuring that the universal aim of the health system is more likely to be achieved for one of the more marginalized population groups, thus also ensuring their constitutional right to health. The High Professional Immigration Body and its partners are working hard to improve the management of critical situations regarding serious social diseases in which it is difficult to apply the national laws now in force.

14. Other principles

The right to health is clearly articulated in this example as the basis for using a progressive universalism approach to health care in Padua. Furthermore, the programme builds on National Law No. 40 (7) and Presidential Decree No. 394 (8), which protect immigrants’ right to health care by specifying that all immigrants (both legal and irregular) have the right to emergency health care, basic health care and essential medicines.

Article 12 of the 1966 International Covenant on Economic, Social and Cultural Rights (signed by Italy in 1967 and ratified in 1978) recognizes “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”. Among the steps to be taken by states party to the Covenant to achieve the full realization of this right shall include the “creation of conditions which would assure to all medical service and medical attention in the event of sickness” (9).

The World Health Organization describes how promoting and protecting health and respecting, protecting and fulfilling human rights are inextricably linked, in that health policies and programmes can promote or violate rights in their design or implementation, and that vulnerability to ill health can be reduced by taking steps to respect, protect and fulfil human rights, such as freedom from discrimination and the right to health (10).

In this example, immigrants’ right to health is explicitly taken into consideration by, among other things, improving communication and education relating to the provision of and access to health services by using cultural and linguistic mediators. The Listening Centre and its booklets aim to increase awareness of social and health issues and immigrants’ rights to social and health services.

15. Implementation

The High Professional Immigration Body of Local Health and Social Authority No. 16 of Padua is a multi-stakeholder partnership including representatives from (initially) the Veneto Region, the Local Government Office of Padua, the Municipality of Padua, the Province of Padua, the Civil Hospital of Padua, schools and universities, and nongovernmental and civil society organizations, as well as (later) police headquarters and the Diocese of Padua. These people meet once a month to collaborate in activities, analyse existing interventions, set priorities and plan future services. Nongovernmental and civil society organizations play a particularly significant role in coordinating these monthly roundtable sessions and in providing feedback and contributing to the development of new projects.

The High Professional Immigration Body, which coordinates the monthly roundtable meeting on immigration, carries out activities such as running the Listening Centre in partnership with different actors in the Region. The Body also provides information booklets to help immigrant users, for example Aspetto un figlio [I’m pregnant], a short guide to introduce immigrant mothers to childbirth; La nascita di un figlio [The birth of a child]; and Il Centro Multietnico [Multiethnic Centre].

The activities of the CUAMM-Caritas polyclinic are planned with the Municipality of Padua and with the authorizations given by Local Health and Social Authority No. 16. Caritas staff carry out these activities, including assessing immigrants’ eligibility to access care at the polyclinic and the services of CUAMM doctors (see Section 8) (3).

16. Monitoring and evaluation

The High Professional Immigration Body was chosen by the National Institute for Health, Migration and Poverty as the focal point for the Veneto and Friuli Venezia Giulia Regions for the PASS National Project to help immigrants access health and social services through specific training about these services for selected cultural mediators.

Monitoring and evaluation of the activities is continuing. As far as the CUAMM-Caritas polyclinic is concerned, financial statements and reports are submitted to the Municipality of Padua on a six-monthly basis and funding is allocated annually on the basis of these reports. The reports must clearly address user-flow trends, that is the number, age, gender and country of origin of beneficiaries and treatments requested and administered.

Continuing analysis of information regarding immigrants in the region informs the planning of future services and activities, which is discussed at the monthly multi-stakeholder meetings headed by the High Professional Immigration Body. This Body is obtaining a new electronic system to collect data about immigrant users so as to allow complete monitoring and accurate evaluation reports on the user–flow trends, including information about equity gaps between regular and irregular immigrants and EU and non–EU citizens. These records are being analysed (3).

17. Health systems context Taxation-based

The health care system is a regionally-based national health service providing universal coverage free at the point of service. It is organized on three levels: national, regional and local.

Responsibility for ensuring that the general objectives and fundamental principles of the national health care system are met lies at the national level. The main institution is the Ministry of Health which is responsible for:

  • defining the health targets for the national health service through the National Health Plan;
  • designing framework legislation;
  • ensuring uniform resources among the regions;
  • coordinating the activities of the National Institutes for Scientific Research (IRCCS) and the National Institute of Health (the main scientific and technical body).

Since 1992, the regional level has been in charge of legislation, management and regional planning of health care services as well as monitoring the quality and efficiency of local health units and public and private accredited hospitals.

At the local level, local health units are responsible for assessing needs and for providing comprehensive care. Services are territorially structured in four layers:

  • public hospital trusts, which provide highly specialized tertiary hospital care, have the status of quasi-independent public agencies and fall under the direct responsibility of regional health departments;
  • secondary hospitals, organized and managed at the level of local health units;
  • primary care, ambulatory specialist medicine, residential and day care, which are organized at the level of health districts;
  • health prevention and promotion programmes, which operate within public health divisions.

The National Institutes for Scientific Research and private accredited providers (responsible for ambulatory, hospital and diagnosis services financed by the national health service) complete the network of providers operating at the local level since 1992.

The 1978 reforms, which established the national health service, envisaged universal coverage, a fully tax-based public health care system and an increasingly marginal role for private financing. Although the first was implemented rapidly, the latter two aims were redefined during the 1980s and 1990s. As a result, the national health service is financed primarily through a regional business tax on productive activities (which replaced social health insurance contributions in 1997) and general taxation (value-added tax revenues) collected centrally to ensure adequate resources for each region, along with various other regional taxes and users’ co-payments. In addition, private sources of financing accounted for 33% of total health care expenditure in 1999. This resulted from increased co-payments to the public system, growing use of private providers with direct out-of-pocket payments (covering cost-sharing for such public services as co-payments for specialist consultations; private health care services and over-the-counter drugs) and an increase in the number of people (approximately 15% of the population) with complementary private insurance, either individually or through their employers.

The 1978 reform changed the principle of health care financing: solidarity within professional categories was discarded in favour of intergenerational solidarity, which backed the introduction of universal, free coverage for all Italian citizens. Immigrants were first covered in 1998. Registered immigrants have the same rights as Italian citizens, whereas unregistered/undocumented immigrants only have access to a limited range of health care services, in particular treatment for infectious diseases and health care schemes for babies and pregnant women.

In 1997, reforms aimed at establishing fiscal federalism were introduced, including the devolution of administrative and fiscal responsibilities to the regions and regional resource allocation based on a weighted capitation rate. These have been surrounded by considerable debate. Although intended to promote political transparency and accountability, potential dangers include uneven distribution of resources and the need for large equalization transfers between regions which could reduce the political autonomy of poorer regions. The National Health Plan for 1998-2000 launched a series of measures to guarantee equity of access and treatment across the country (1114).

18. Context for development of example

The city of Padua is situated in the Veneto region in north-east Italy. The Veneto has 4.7 million inhabitants and a prevalence of small and medium-sized enterprises specializing in traditional manufacturing sectors. Padua has 210 000 inhabitants and is home to Italy’s oldest university.

Because the Veneto is one of the wealthiest regions with a continually developing economy, it attracts a large number of immigrants. This number has been steadily rising in recent years and increasing more rapidly than the general population increase. In the Veneto as a whole, there was a twofold increase in foreigners listed as legal residents between 2001 and 2008, with 350 215 foreigners resident in 2008. This means that legally resident foreigners now make up 7.3% of the population – considerably more than the national average of 4.9% and one of the highest percentages in the country.

The city of Padua has a relatively high proportion of resident foreigners. In 2006, the foreign population increased by 10.9%. By 2008 there were 19 661 immigrants, representing 9.35% of the overall population.

There is no fixed pattern as to how many foreigners arrive or how long they stay. Since the early 1990s, however, there has been a notable rising trend in the number of new foreign minors and women in the Veneto, indicating a stabilization of immigrant family structures in the region.

Given the high number of immigrants in Padua and their specific health and social needs, a coordinated system of plans and activities has been implemented to improve social and health services for them and safeguard their right to health. These tie in with existing policies and laws in the Veneto (such as National Law No. 328 (12) and the Codified Law on Immigration (7,16-21) that specifically promote the socioeconomic inclusion of immigrants.

As elsewhere in Italy, immigrants with regular residence permits in the Veneto tend mainly to use the emergency services and to a lesser degree specialist services. The impetus for the initiative came when a senior paediatrician noticed changes in the demographic of patients seeking health and social services, with a significantly high number of undocumented migrants and a large number of cases of social isolation among them. It was deemed imperative to increase immigrants’ uptake of preventive health services as well as to pay attention to the integration of their social, mental and physical wellbeing. The involvement of other institutions was a priority if these issues were to be addressed, because their material resources and knowledge were needed to develop an efficient response (3).

19. Related policies, background documents and initiatives

The programme and its aims comply with existing policies and laws that promote the integration of immigrants in Italian society, including:

  • National Law No. 328 (the Social Services Framework Law of 2000), which allows for an integrated system of social interventions and services, provides for activities that aim to eliminate users’ difficulties, and designates municipalities as the main suppliers of these services (15);
  • the Codified Law on Immigration, which covers assistance to foreigners enrolled in the national health system (16)

Immigrants’ right to health care was established by National Law No. 40 (7)  and by Presidential Decree No. 394 (8), which specify that all immigrants (both legal and irregular) have the right to emergency health care, basic health care and essential medicines (3).

20. Funding and resources

The High Professional Immigration Body started its activities without funds and with a health manager, an administrative official and some other medical professionals from Local Health and Social Authority No. 16. Since then the Body has been supported by the  Authority and is the main body providing social and health services for immigrants in Padua. The Body is considered an operational unit of the Authority and receives an annual budget to carry out specific responses to the social and health care needs of the immigrant population.

The Body works through staff in the Authority. Medical specialists are employed by the Authority and provide their services as extra work on the basis of their belief in the mission of the Body. Two paid administrative staff are provided to the Body. In 2009 and 2010, the staff of the Body were increased together with other health and administrative professional individuals. The CUAMM-Caritas polyclinic is funded annually by the Municipality of Padua on the basis of financial statements and reports showing trends in users and services.

The High Professional Immigration Body uses appropriately trained cultural mediators and depends on the cultural mediation cooperative. Services are delivered to local health units and hospitals through a bidding procedure. Thus the cultural mediation cooperatives differ according to the winning bid. In addition, the High Professional Immigration Body of Local Health and Social Authority No. 16 also offers a cultural mediation service specializing in social and health care (3).

21. Capacity-building, existing skills, etc.

Training courses have been designed to improve and fine-tune the work and responses of various staff involved in the integration of immigrants through the health and social services.

Cultural and linguistic mediators, who are used to assist cross-cultural communication and education, are trained to improve their knowledge of specific social and health issues in order to provide informed mediation. This training provides information on the socioeconomic and psychological challenges faced by immigrants.

Annual training courses have been organized since 2006 for administrative staff of Local Health and Social Authority No. 16 and police headquarters. These cover specific issues relating to immigration, for example on legal issues relevant to non-European foreigners.

In 2008, training courses on immigration were established at their request for general practitioners and social and health care staff of Local Health and Social Authority No. 16.

Capacity-building activities have been developed for immigrants themselves in the form of a communication programme aimed at informing them about their right to health care. This has included a number of information activities and booklets (3):

  • establishment of a Listening Centre for foreigners;
  • Are you sick? Remember that health is a right (including information on how to ask for a foreign short stay permit card and which services are offered in the area and where);
  • Aspetto un figlio [I’m pregnant], a short guide to introduce immigrant mothers to childbirth;
  • La nascita di un figlio [The birth of a child].
22. Source(s) of example

The following is the main source used for this summary profile.

One of the series of case studies developed as part of the follow-up to WHO Regional Committee for Europe resolution EUR/RC52/R7 of 2002 on Poverty and Health. The objective of the case studies was to profile a programme or intervention to increase the performance of health systems for one or more of the following groups: immigrants facing poverty and social exclusion, under- and unemployed people, children living in poverty and Roma exposed to poverty and social exclusion. Of the 22–24 case studies, 8 are profiled in this web-based resource. These case studies have been through a process of external peer review and editing.

23. Contact details for technical officer

Dr Mariagrazia D’Aquino
Health Manager, High Professional Immigration Body
Tel.: +39 049 821 4572
Mobile: +39 335 811 3346; +39 333 25 93 663
E-mail: mariagrazia.daquino@sanita.padova.it

Administrative Office, High Professional Immigration Body
Tel.: +39 049 821 4121 or +39 049 821 4728
E-mail: immigrazione.ulss16@sanita.padova.it
Address:
High Professional Immigration Body
Local Health and Social Authority No. 16
Via Enrico degli Scrovegni 14
3513 Padua Italy

24. Other information
References
  1. Determinazione n. 2003/29/0231 del 18/08/2003: Approvazione Protocollo di Intesa tra il Comune di Padova – Settore Servizi Sociali – e L'az. Ulss N. 16 di Padova per la Realizzazione di un Intervento di Accertamento Sanitario Preventivo a Favore di Minori Stranieri non Accompagnati [Municipality Act No. 2003/29/0231 of 18/08/2003: approval of the Memorandum of Understanding between the Municipality of Padua – Social Service Unit – and the Local Health Authority ULSS No. 16 for preventive medical examinations for unaccompanied foreign minors]. Padua, ULSS 16, 2003 (accessed 18 August 2010, in italian).
  2. Alliance for Health Policy and Systems Research. Systems thinking for health systems strengthening. Geneva, World Health Organization, 2009.
  3. Barzon G et al. Italy (Veneto Region): integration of social and health services for immigrants – the case of Padua. In: Poverty and social exclusion in the WHO European Region: health systems respond. Copenhagen, WHO Regional Office for Europe, 2010.
  4. Progetto Rondine: Accoglienza per richiedenti asilo e rifugiati [The Rondine Project: Assistance to Political Refugees asking for Asylum in Padua] [web site]. Padua, Municipality of Padua, 2010 (accessed 18 August 2010, in Italian).
  5. Deliberazione della Giunta Comunale N. 2006/0419 del 04/07/2006: Servizi di Accoglienza e d'integrazione per Richiedenti Asilo e Rifugiati - Approvazione Protocolli d'intesa con Enti [Municipal Act No. 2006/0419 of 04/07/2006: Reception and integration services for asylum seekers and refugees – Approval of the Memorandum of Understanding with bodies]. Padua, Municipality of Padua, 2006, (accessed 18 August 2010, in Italian).
  6. L’Assistenza sanitaria agli stranieri: guida per gli operatori socio sanitari [Health care assistance for foreigners: guidebook for health and social workers]. Padua, AULSS 16, 2009 (accessed 18 August 2010, in Italian).
  7. Legge n. 40 del 6 marzo 1998. Disciplina dell’immigrazione e norme sulla condizione dello straniero 6/03/1998) [Law No. 40, 6 March 1998. The subject of immigration and the condition of foreigners]. Gazzetta Ufficiale [Official Gazette], 1998, 59 Suppl.40 (accessed 18 August 2010, in Italian).
  8. Decreto del Presidente della Repubblica n. 394, 31 agosto 1999. Regolamento recante norme di attuazione del testo unico delle disposizioni concernenti la disciplina dell’immigrazione e norme sulla condizione dello straniero, a norma dell’articolo 1, comma 6, del decreto legislativo 25 luglio 1998, n. 286 [Presidential Decree No. 394 of 31 August 1999. Regulation of the application of laws governing immigration and the status of foreigners, following Article 1, part 6 of Legislative Decree of 25 July 1998, No. 286]. Rome, Ministry of the Interior, 1999 (accessed 1 September 2008, in Italian).
  9. International Covenant on Economic, Social and Cultural Rights [web site]. Geneva, Office of the United Nations High Commissioner for Human Rights, 1996–2007 (accessed 18 August 2010).
  10. A human rights-based approach to health. Geneva, World Health Organization, 2010 (accessed 18 August 2010).
  11. Decreto Legislativo 28.8.1997 n. 281. Definizione ed ampliamento delle attribuzioni della Conferenza permanente per i rapporti tra lo Stato, le Regioni e le Province autonome di Trento e Bolzano ed unificazione, per le materie ed i compiti di interesse comune delle Regioni, delle Province e dei Comuni, con la Conferenza Stato-città ed autonomie locali” [Law Decree No. 281 of 28 August 1997. Definition and enlargement of the terms of reference of the permanent Conference for the Relationships between the State and the Regions, and the autonomous provinces of Trento and Bolzano; unification with the Conference State-Cities and local autonomies about the subjects and tasks of common interest to the Regions, the Provinces and the Municipalities].Gazzetta Ufficiale [Official Gazette, 1997, 202 (accessed 18 August 2010, in Italian).
  12. D.M. 24 aprile 2000. Adozione del progetto obiettivo materno-infantile relativo al «Piano sanitario nazionale per il triennio 1998-2000» [Ministerial Decree of 24 April 2000. Adoption of the maternal-child objective concerning the National Health Plan 1998-2000]. Rome, Ministry of Health, 2000 (accessed 18 August 2010, in Italian).
  13. European Observatory on Health Systems and Policies. Health Care Systems in Transition. HiT summary: Italy, 2001. Copenhagen, WHO Regional Office for Europe, 2001 (accessed 18 September 2010).
  14. Grosse-Tebbe S, Figueras J, eds. Snapshots of health systems. Copenhagen, WHO Regional Office for Europe, on behalf of the European Observatory on Health Systems and Policies, 2005 (accessed 18 September 2010).
  15. Legge n. 328 del 8 novembre 2000. Legge quadro per la realizzazione del sistema integrato di interventi e servizi sociali [Law No. 328, 8 Novembre 2000. Framework law for the creation of an integrated system of interventions and social services]. Gazzetta Ufficiale [Official Gazette], 2000, 265(Suppl.186) (accessed 18 August 2010, in Italian).
  16. Decreto Legislativo 25 luglio 1998, n. 286. Testo unico delle disposizioni concernenti la disciplina dell'immigrazione e norme sulla condizione dello straniero [Law Decree No. 286 of 25 July 1998. Unified text of procedures related to the disipline of immigration and norms for the condition of foreigners]. Gazzetta Ufficiale [Official Gazette], 1998, 191(Suppl. 139) (accessed 4 August 2010, in Italian).
  17. Circolare 24 marzo 2000 n.5. Indicazioni applicative del decreto legislativo 25 luglio 1998, n. 286. Testo unico delle disposizioni concernenti la disciplina dell'immigrazione e norme sulla condizione dello straniero – Disposizioni in materia di assistenza sanitaria [Circular No. 5 of 24 March 2000. Implementation of Law Decree No. 286 of 25 July 1998 on the unified text of procedures related to the discipline of immigration and norms for the condition of foreigners. Provisions for health care assistance] (accessed 18 August 2010, in Italian).
  18. Decreto del Presidente della Repubblica 31 agosto 1999, n. 394. Regolamento recante norme di attuazione del testo unico delle disposizioni concernenti la disciplina dell'immigrazione e norme sulla condizione dello straniero, a norma dell'articolo 1, comma 6, del decreto legislativo 25 luglio 1998, n. 286 [Presidential Decree No. 394 of 31 August 1999 concerning the regulations implementing the unified text of procedures related to the discipline of immigration and norms for the condition of foreigners, as per article 1, paragraph 6 of the law decree No. 286 of 25 July 1998]. Gazzetta Ufficiale [Official Gazette], 1999, 258(Suppl.190) (accessed 18 August 2010, in Italian).
  19. Decreto del Presidente della Repubblica 28 luglio 2000, n. 272Regolamento di esecuzione dell'accordo collettivo nazionale per la disciplina dei rapporti con i medici specialisti pediatri di libera scelta [Presidential Decree No. 272 of 28 July 2000 concerning the regulations of the national collective agreement on the discipline of relationships with paediatric specialists of free choice].  Gazzetta Ufficiale [Official Gazette],2000, 230 (accessed 18 August 2010, in Italian).
  20. Circolare regionale 6 novembre 2000,  n. 16 su sanità e igiene pubblica [Circular of the Veneto Region No. 16 of 6 November 2000 on hygiene and public health]. Venice, Giunta Regionale della Regione del Veneto [Regional Government of the Veneto Region], 2000 (accessed 18 August 2010, in Italian).
  21. Decreto Legislativo 6 febbraio 2007, n. 30. Attuazione della direttiva 2004/38/CE relativa al diritto dei cittadini dell'Unione e dei loro familiari di circolare e di soggiornare liberamente nel territorio degli Stati membri [Law decree No. 30 of 6 February 2007. Implementation of regulation 2004/38/CE concerning the right of European Union citizens and their family members to free movement in the territory of the Member States]. Gazzetta Ufficiale [Official Gazette], 2007, 72  (accessed 18 August 2010, in Italian).

Bibliography

  • Lo Scalzo A et al. Italy: health system review. Copenhagen, WHO Regional Office for Europe, 2009 (Health systems in transition, 11(6):1-216) (accessed 18 August 2010).
  • Grosse-Tebbe S, Figueras J, eds. Snapshots of health systems – The state of affairs in 16 countries in summer 2004. Copenhagen, WHO Regional Office for Europe, 2004 (accessed 18 August 2010).
  • Linkages between health and human rights [web site]. Geneva, World Health Organization, 2010 (accessed 17 August 2010).
  • Carrillo D, Pasini N. Migrazioni Generi Famiglie. Pratiche di escissione e dinamiche di cambiamento in alcuni contesti regionali [Migrations Genders Families. Excision practices and dynamics of change in some regional contexts]. Milan, Franco Angeli Edizioni, 2009 (ISMU Iniziative e Studi sulla Multietnicità [ISMU Initiatives and Studies on Multiethnicity], in Italian).
  • Regional report on the Veneto health system within the frame of the National Health Service. In: Biocca M, Pelaseyed S, Riboldi B, eds. Migrants and healthcare: responses by European regions (MIGHRER). International Report. Copenhagen, WHO Regional Office for Europe (in press).

Disclaimer:
This profile was developed for and included in the WHO web-based resource on health system actions to address socially determined health inequalities. All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its material, in part or in full. The designations employed and the presentation of the material in this web-based resource do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this web-based resource. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization.