79-275 / RIU-T: Approach of a national health strategy to vulnerable contexts and populations

GOP Information
Organisation sharing the GOP
Related practices from PaSQ database
Ministry of Health, Social Services and Equality (MSSSI) and
Centro Superior de Investigación en Salud Pública (CSISP-FISABIO)


Patient empowerment

GOP Description
Implementation level
Clinical settings
Community Health, Primary Healthcare Services, Sexual and Reproductive Healthcare and Public Health Preventive Programs
-To qualify community leaders to perform actions oriented to attain accessibility and proper use of healthcare services in vulnerable contexts and populations
-To involve healthcare professionals in this education action process
-To develop tools for the transfer to other contexts
-To create a national net of experiences
Spanish native –including Romani- population and migrant people (mainly from Morocco, Rumania and Latin America) living in vulnerable contexts; districts with high unemployment levels, school failure, urban fragility and cultural/physical distance from healthcare services and their professionals
-Political, executive and technical support has to be obtained
-3 professionals drive the process and create a cross-sectoral net of professionals who select the community members (12 women and 3 men) according to their leadership profile and their belonging to different cultural groups of the district.
-The leaders participate in a learning process as health agents. In this process professionals are involved and visits to different community services (primary healthcare, sexual and reproductive healthcare, public health, hospital -mainly emergency and mother&child; areas) are included.
-The group of health agents carries out different kind of activities: individual, for groups (workshops on self-care, access and use of services, use of medicines…), in the community or dissemination. They receive some economic incentive for their commitment.
-Process and results are evaluated using quantitative and qualitative methodology
-Education-action process takes 150 hours during 9 months. Cycles follow one another in a continuous way.
Timeframe implementation
2-4 years depending on the previous support for program development
We consider the program has been implemented if at least two cycles of selection, education action and evaluation have taken place
Implementation tools available
-Checklist with 21 criteria to select the district where to begin the program
-List of abilities and responsibilities for each professional involved in the implementation
-Education bundle for professionals to learn how to implement the education action model:
-Leaders selection method
-Action plan document
-Training methods
-Types of activities
Implementation cost
-Human resources: 90,000 €/year.
-Incentives for health agents: 18,000 €/year
-Evaluation studies: 12,000 €/year
-Overheads: 6,000 €/year
-Total: 126,000 €/year
Method used to measure the results
-Qualitatively analysed personal and group interviews to community leaders about their perceived changes.
-Community leaders’ social nets analysis using UCINET and SPSS programs
-Group interview to professionals from the community services about their perceived changes after program implementation
-Indicators on the socio-demographic profile of districts and towns and on the use of services
-The program started in 2008 and takes places in 3 towns, covering around 100,000 people: Algemesí (4 editions), Alzira (2 editions) and Sueca (1 edition).
-39 agents (33 female and 6 male) have been qualified and they have reached 1,723 people.
-Knowledge change, access to services and preventive programs and a higher trust in professionals have been identified.
-In each town maps of health assets have been developed and a net of 35-40 professionals agreeing with the health agents’ perceived changes has been constituted
Analysis of the results
RIU has shown to be useful to get people belonging to different cultural groups from these contexts be qualified as health agents and have positive influence in the access to and use of services and programs.
This process also generates changes in the professionals and the organisation and achieves that proper information circulates thus providing an approach between healthcare services (mainly primary healthcare and sexual & reproductive health) and the population.
Professionals -although they do not incorporate community work in a continuous way- get closer to vulnerable people and contexts, feel satisfied and mutual confidence increases
Implementation barriers
Did you find implementation barriers?
Please describe implementation barriers
-Lack of coordination between healthcare levels and other sectors (social, education and the third sector)
-Professionals’ lack of skills and abilities for community work
-Professionals’ belief that changes in these contexts are difficult and unlikely
-Lack of resources to guarantee the sustainability of the intervention and the evaluation
-Difficult access to healthcare indicators. Disaggregation at district level is complex.
-Needs in these contexts exceed the answers that can be provided from the program
Describe the strategies used to overcome the barriers (If needed)
-The creation of the Program’s cross-sectoral net and the work performed mean a significant step towards coordination and qualification for joint work between healthcare professionals and those from other sectors.
-The elaboration of an education bundle to increase professionals’ qualification and make it possible to spread the experience to other districts.
-Professionals are sensitized in the health assets model which complements the problems and needs centred model.
-Cross-database is enabled in order to facilitate disaggregation of district data and indicators.
Other information
Other information about the GOP that you would like to add (Link or attached document)
RIU has been initially carried-out in Valencia_Region. In the framework of the National_Sexual_and_Reproductive_Health_Strategy, several tools have-been-designed in 2010-2011 in order to transfer the program to other Spanish_Regions.
Although RIU has-been-developed in vulnerable_contexts, this experience can also help to increase participation/mutual-commitment/joint-production of population’s/professionals’/organization’s_actions oriented to equity-in-access-and-use-of health-services-and-programs regardless of the subject and the people they are aimed at.
An added value is that RIU links intervention to participatory research, and thus obtains innovative products that can be transferred to quality improvement in the Health System such as the participatory analysis of health, the map of assets and the participatory evaluation.
Paredes-Carbonell JJ et al. Projecte RIU: Un riu de cultures, un riu de salut. Una_propuesta_de_intervención_en_salud_en_entornos_vulnerables. Comunidad. 2011; 13: 34-7Comisión para Reducir las Desigualdades Sociales en Salud en Espana. Avanzando_hacia_la_equidad. Propuesta_de_políticas_e_intervenciones_para_reducir_las_desigualdades_sociales_en_salud_en_Espana. Madrid: MSPS; 2010.Paredes-Carbonell J et al. Herramientas de transferencia de un modelo de buena práctica para desarrollar la Estrategia de Salud Sexual y Reproductiva en Población Vulnerable en el Sistema Nacional de Salud. Valencia: CSISP, 2010 (Report for MSSSI)

Paredes-Carbonell JJ et al. Desarrollo de un programa de formación-acción para aproximar la Estrategia de Salud Sexual y Reproductiva a entornos de elevada vulnerabilidad. Valencia: CSISP, 2011 (Report for MSSSI)