Onsite visit Bari, Italy

The third onsite project visit took place in Bari, Italy, from 28 to 30 June. It focused on the Overcoming Obstacles to Vaccination exemplary practice Su.Pr.Eme, a programme which safeguards the rights of undeclared and/or seasonal migrant workers from third countries, integrating health and social care as a core component. The practice aims to improve access to healthcare, including access to COVID-19 vaccines.  

The Director General of the Apulian Regional Agency for Health and Social Affairs (AReSS) and delegates from the Puglia Region administration welcomed 23 participants from 10 EU Member States. Participants were representatives of health ministries, health institutes, national immunisation offices, and pharmacists. The goal of this visit was to: 

• gather insights into the “Su.Pr.Eme” programme and learn from its success  

• foster mutual learning through exchange of knowledge and experience  

• develop ideas on how health professionals from other Member States can transfer the practice to their own countries 

During the visit, AReSS was awarded a certificate of outstanding practice from the European Health and Digital Executive Agency (HaDEA). 

Aim 

In Italy, several physical, administrative, and practical barriers to vaccination persist. The most significant barriers to vaccination include cultural, linguistic, logistical, and organisational challenges, as well as social factors such as difficulties in taking time off work, particularly for low-income and irregular workers. 

In 2017, the Italian Ministry of Health enacted Law 119/2017 which extended the number of compulsory vaccines to 10. In addition to diphtheria, tetanus, hepatitis B, and poliomyelitis, vaccinations for Measles, Mumps, Rubella (MMR); varicella; pertussis; and haemophilus influenzae type b (Hib) were included. As a result, unvaccinated children are prohibited from attending preschool services until the age of six. To ensure compliance, parents who fail to meet the mandatory vaccination requirements may face fines. 

The "Su.Pr.Eme" Project is part of a national initiative led by the Ministry of Social Policies and Labour – Directorate General for Immigration and Integration Policies. The project aims to combat the labour exploitation, marginalisation, and vulnerability migrant workers face by implementing an integrated action plan. It provides AReSS. with the opportunity to develop a model of health and social care in informal settlements. 

The implementation of the Puglia model began during the early phase of the COVID-19 pandemic, which exacerbated existing challenges faced by migrants and other vulnerable groups due to their socio-economic and legal status, as well as their limited access to healthcare services. 

The project's objectives include ensuring protection and access to health services for vulnerable and disadvantaged individuals, together with improving their overall health and living conditions. In particular, the project aims to: 

• Promote the transformation of settlements into hospitable environments that meet acceptable living standards. 

• Enhance social, health, labour, mobility, and cultural services, as well as encourage the participation of migrants in local communities.  

• Strengthen the capacity to manage the presence of a high number of migrants living in critical conditions, where human rights violations and exploitation may occur. 

Resourcing 

Italy provides universal healthcare coverage (Beveridge welfare system), so every Italian resident can access healthcare without any insurance. Vaccinations are included among the services provided. Most vaccines are part of the Italian National Plan for vaccination, except for the influenza and COVID-19 vaccination.   

Residents who are not Italian citizens may receive the COVID-19 vaccination free of charge. Other vaccinations may be free, but this depends on regional regulations. 

Actors involved and implementation 

The project is part of a national initiative led by the Ministry of Social Policies and Labour Directorate General for Immigration and Integration Policies. Puglia Region is the project leader among five Southern Italy partner regions (Puglia, Campania, Basilicata, Calabria, and Sicily). The project involves other partners, such as the Labour Inspectorate, the National Institute of Social Security, the International Organization for Migration (IOM), the NOVA Onlus Consortium and specialist non-government organisations (NGO). 

Within the project, Puglia Region has delegated health and social healthcare field activities to the Apulian AReSS. 

Results 

A Mobile Outpatient Unit, coordinated by AReSS, conducts various interventions including vaccinations with a focus on prevention, monitoring the health and social status of migrants, and providing care. These interventions are particularly important because migrant populations often face difficulties in accessing the Italian healthcare system. Mobile units are activated through agreements with the local health authorities and third sector entities. These units operate according to a weekly schedule across predetermined locations within rural territories. They function as multidisciplinary teams, combining healthcare and social-health specialists, including psychologists, to address the primary health needs identified on-site, while maintaining constant communication with the local health service. Through the operation of five mobile medical units, the project effectively contained the spread of COVID-19 within illegal settlements and provided support for vaccination activities. 

Currently, the programme supports around 600 people in Puglia. The strong relationship and trust between NGOs and communities is a significant factor in the success of the programme. Some of the organisations involved have experience as humanitarian healthcare organisations in non-EU territories affected by conflict, and in aiding homeless individuals in urban and metropolitan areas of Italy. 

NGOs provide guidance, maintain contact with migrants, and offer support to general practitioners. This collaborative approach helps bridge the gap between migrant communities and the healthcare system, facilitating effective outreach and care provision.  

The project successfully developed an integrated social-health care model, accompanied by guidelines for its application, facilitating comprehensive and coordinated care. 4,000 brochures have been distributed, offering essential information on how to access local social and healthcare services. Approximately 11,280 individuals are estimated to have benefited from the social-health assistance activities of the project in Apulia. Of these, approximately 2,100 people met the project's eligibility criteria and were formally reached.