Abstract

BackgroundA Primary Care Model Programme was implemented in Hungary between 2013 and 2017 in order to increase access of disadvantaged population groups to primary care and to offer new preventive services for all clients. In a country with single-handed practices, four group practices or GP clusters were created in the Programme. Six GPs comprised one cluster who together employed nonmedical health professionals and nonprofessional health mediators, the latter recruited from the serviced communities, many of them of Roma ethnicity. Health mediators were tasked by improving access of the local communities – including its vulnerable Roma members – to existing and new services. Health mediators were interviewed about their work experiences, motivation, and overall opinion as members of the clusters as part of the Programme evaluation.MethodsAs part of the Programme evaluation, structured interviews were conducted with all 40 health mediators employed at the time in the Programme. Interviews were transcribed and content analysis was carried out.ResultsThree themes emerged from the transcripts. The first focused on the health mediators’ personal characteristics such as motivation to join the Programme, the way their job increased their self-esteem, social status and health consciousness. Domains of the second theme of their work included importance of on-the-job training and of their insider knowledge of local communities, as well as their pride to have become members of the primary care team. The third theme covered overall functioning of the Programme of which they had mostly positive opinions, notwithstanding some criticism regarding procurement.ConclusionsHealth mediators had earlier worked in various European countries specifically to improve access of Roma ethnic groups to health services but the Hungarian Model Programme was globally the first in which health mediators as non-professional workers became equal members of the primary care team as employees. Their contribution and overwhelmingly positive experiences, along with their useful insights for improvement call for the establishment and funding of health mediator positions in primary care especially in areas with large numbers of disadvantaged Roma populations.

Highlights

  • A Primary Care Model Programme was implemented in Hungary between 2013 and 2017 in order to increase access of disadvantaged population groups to primary care and to offer new preventive services for all clients

  • Access to and utilization of primary health care services has been laden with problems among vulnerable Roma population groups, such as lack of health insurance and/or necessary documentation, financial constraints, discriminatory attitudes experienced from health care staff, lack of trust in health care providers, and difficulties in handling the complexities of the health care system that result in the underutilization of services [5,6,7,8]

  • The present paper describes the experiences of health mediators employed in a large-scale primary health care model Programme in Hungary which was created in the framework of a bilateral agreement between the governments of Switzerland and Hungary, and was funded by the

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Summary

Introduction

A Primary Care Model Programme was implemented in Hungary between 2013 and 2017 in order to increase access of disadvantaged population groups to primary care and to offer new preventive services for all clients. Six GPs comprised one cluster who together employed nonmedical health professionals and nonprofessional health mediators, the latter recruited from the serviced communities, many of them of Roma ethnicity. Health mediators were tasked by improving access of the local communities – including its vulnerable Roma members – to existing and new services. Healthcare was identified by the Council of Europe as a critical area that was addressed in a Council recommendation on better access to health care for Roma and Travellers in which, among others, governments of member states were requested to ensure geographically accessible and affordable health care [2]. In order to bridge the gap between healthcare providers and vulnerable Roma groups, health mediation was introduced and tested in several countries with positive experiences [9]. Mediation has been widely used in business and law as an alternative method of dispute resolution leading to a concrete agreement [10]

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