The Italian Roma, Sinti and Travellers Health Project for equity in access to care

Abstract Issue In 2015, Italy approved the National Action Plan for Health for and with Roma, Sinti and Travellers (RSC); however, it is still not fully applied at a local level. The INMP (funded by the National Operational Programme for Social Inclusion), implemented the “Health Project - Promotion of strategies and tools for equity in access to health care for RSC”, aimed to support the implementation of the Plan by Local Health Authorities (ASL). Description The project lasted from March 2019 to December 2021. INMP worked with 7 ASL to design interventions and develop tools to address RSC health needs. The SODA (Strategic Options Development and Analysis) method as a participatory process aimed at identifying strategies and models for the execution of the Plan among relevant stakeholders was used. Moreover, RSC communities’ engagement strategies and a community-based Proximity Public Health (PPS) approach were adopted in designing and developing health promotion interventions. Results INMP performed 38 interviews with ASL health operators highlighting barriers and strategies in the local implementation of the Plan. Tools orienting to social and health services and health education materials for hard-to-reach groups were produced. A training course for 14 RSC facilitators and 5 training courses attended by over 200 NHS operators have been organized. ASL were supported in developing health promotion initiatives, based on the engagement of both local RSC communities and third sector entities. Lessons The project has enabled the ASL to develop local protocols for the implementation of the Action Plan. In line with this capacity-building activity, the project trained both health operators and RSC facilitators fostering the dissemination of the PPS culture in designing and providing care for hard-to-reach groups. Given the positive results obtained, INMP is still collaborating with both ASL and the Third Sector on additional activities related to the Project in 2022. Key messages The project has strongly promoted the Proximity Public Health (PPS) approach and the enrollment of RSC communities in designing equity-oriented health interventions. The SODA methodology and the training of operators have resulted effective in capacitating ASL in the implementation of the Plan.


Issue:
In 2015, Italy approved the National Action Plan for Health for and with Roma, Sinti and Travellers (RSC); however, it is still not fully applied at a local level. The INMP (funded by the National Operational Programme for Social Inclusion), implemented the ''Health Project -Promotion of strategies and tools for equity in access to health care for RSC'', aimed to support the implementation of the Plan by Local Health Authorities (ASL).

Description:
The project lasted from March 2019 to December 2021. INMP worked with 7 ASL to design interventions and develop tools to address RSC health needs. The SODA (Strategic Options Development and Analysis) method as a participatory process aimed at identifying strategies and models for the execution of the Plan among relevant stakeholders was used. Moreover, RSC communities' engagement strategies and a communitybased Proximity Public Health (PPS) approach were adopted in designing and developing health promotion interventions.

Results:
INMP performed 38 interviews with ASL health operators highlighting barriers and strategies in the local implementation of the Plan. Tools orienting to social and health services and health education materials for hard-to-reach groups were produced. A training course for 14 RSC facilitators and 5 training courses attended by over 200 NHS operators have been organized. ASL were supported in developing health promotion initiatives, based on the engagement of both local RSC communities and third sector entities.

Lessons:
The project has enabled the ASL to develop local protocols for the implementation of the Action Plan. In line with this capacity-building activity, the project trained both health operators and RSC facilitators fostering the dissemination of the PPS culture in designing and providing care for hard-toreach groups. Given the positive results obtained, INMP is still collaborating with both ASL and the Third Sector on additional activities related to the Project in 2022.

Key messages:
The project has strongly promoted the Proximity Public Health (PPS) approach and the enrollment of RSC communities in designing equity-oriented health interventions.
The SODA methodology and the training of operators have resulted effective in capacitating ASL in the implementation of the Plan.

Background:
Even though large urban areas have been researched in the context of COVID-19, evidence on how COVID-19 impacted migrants -a particularly vulnerable group-in these settings is still limited. Objective: To explore exacerbating and mitigating factors of large urban areas on migrants' vulnerabilities during the COVID-19 pandemic.

Methods:
We conducted a systematic review of peer-reviewed literature published between 2020-2022 and focused on migrants (foreign-born individuals who have not been naturalized in the host country, regardless of immigration status) in urban areas with a population >500.000. After screening 880 studies, 29 studies were included and categorized within the following thematic framework: 1) Underlying structural inequities, 2) governance and economic structure, 3) urban design, and 4) engagement of civil society organizations (CSO).

Results:
Exacerbating factors include pre-existing inequities (e.g., unemployment, financial precarity, and barriers to healthcare access), exclusionary government responses (e.g., relief funds or unemployment benefits), and residential segregation. Mitigating factors include the engagement of CSOs and the implementation of innovative governance strategies such as egovernance and use of teleservices. Recommendations: We recommend increased attention to pre-existing social inequities faced by migrants, inclusive governance strategies, and partnerships between government and CSOs to improve the design and delivery of services to migrants in large urban areas. More research is needed on how urban design can be utilized to mitigate the COVID-19 impacts on migrant communities.

Conclusions:
The factors identified in this systematic review should be considered as part of migrant-inclusive emergency preparedness to address the disproportionate impact of similar public health crises on migrant communities. Key messages: Pre-existing inequities, exclusionary governance strategies, and residential segregation led to a disproportionate impact of COVID-19 on migrants living in large urban areas.
iii380 European Journal of Public Health, Volume 32 Supplement 3, 2022