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Description
The predefined project addresses the needs for improving health status and more effective implementation of national health policies in places where there are marginalized communities living in poverty and social exclusion. The health status of marginalized groups is characterized by higher morbidity, lower life expectancy and higher mortality, especially in children. Therefore, this project includes activities in the field of maternal and child health, family planning, prevention of sexually transmitted infections, especially syphilis and congenital syphilis. The implementation of the project will support the measures in the National Program for Improving Maternal and Child Health 2021-2030 and the National Program for Prevention and Control of HIV and Sexually Transmitted Infections, ensuring closer coordination of the national with local authorities. The Covid-19 pandemic confirmed the need for active and effective participation at the local level in the implementation of health policies targeted at vulnerable groups. Poor health status, difficulties in complying with prevention measures, population mobility, prejudices against vaccination make marginalized communities more vulnerable to the virus and increase the risk of epidemics in the existing "poverty pockets". In the implementation of the project, the Ministry of Health in partnership with the Association "National Network of Health Mediators", which unites, trains, coordinates and monitors the activities of health mediators throughout the country, will test mechanisms for better communication between groups at risk and health institutions. local level both for prevention and treatment, as well as for collecting up-to-date data on the real state of health status and the effectiveness of the implementation of health policies on the ground. This will create conditions for facilitating access to health care for marginalized communities and access to health services for all Bulgarian citizens.
Summary of project results
The project aimed to improve the coordination and interaction between the authorities and organizations at the national and local level in the implementation of policies for the health of marginalized communities and to establish the role of the health mediator as an active participant in this process.
The project helped optimize the health mediation system by digitalizing accountability and creating a mechanism for coordination and feedback between the local and central administrations in relation to the health policies aimed at marginalized communities. Within the project framework, the model for the work of health mediators in a hospital was tested. The analysis of the results of the work of 27 health mediators in the teams of 13 medical facilities on the territory of 11 municipalities showed that the model is evaluated as very successful by both medical specialists and patients. In this regard, as an additional activity to the project, 3 three-day trainings were provided for the health mediators outside the pilot municipalities, with which they were prepared for work in a hospital. From the 2023 academic year, the module developed under the project is included in the mandatory program for initial training of new health mediators, held at the Faculty of Public Health of the Medical University in Sofia. At the end of the project, 235 health mediators have successfully completed the upgrade training. The mapping carried out in the pilot municipalities, the analyzes prepared for the implementation of national health policies at the local level, the role of the health mediator, the developed response measures for health crises aimed at marginalized communities, the conclusions, recommendations and proposals for normative and regulatory changes, are available for use in planning measures for promotion and prevention programs at the local and national level.
The project contributed to strengthening the capacity of local authorities and health mediators to implement health policies and measures targeting marginalized communities. Through the project, the status of health mediators was confirmed as trusted persons for the community, to whom its members can turn in case of problems with their own health and that of their family members. With the introduction of mediation activities that health mediators carry out in hospitals, the access to health services of persons from Roma neighborhoods was improved.