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AHEAD: action for health and equity - addressing medical deserts

The AHEAD project reduces health inequalities in Europe by addressing the challenge of medical deserts. Our goal is to achieve better access to health services, especially in underserved areas, and more equitable access to sufficient, skilled and motivated health workers. We do this by building knowledge, encouraging innovation in health service delivery, and applying a participatory approach to public health policymaking.

Various European countries’ health care systems are becoming overburdened, due to the demographic and epidemiological transition: an ageing population in combination with an increase in chronic diseases and multi-morbidities that require long term care. Furthermore, the health workforce itself is ageing, resulting in waves of retirement of health personnel, adding to the strain on the health workforce. These challenges occur within the context of persistent budgetary constraints and financial cutbacks that compound broader migration patterns and are causing severe health workforce shortages.

In this context, several EU regions are facing the issue of ‘medical deserts’: isolated or depopulated areas with such significant falling numbers of medical practitioners and overall health workforce shortages that they hamper health worker availability and exacerbate health inequalities in the population, especially among vulnerable groups. 

AHEAD aims for better access to health services, especially in those underserved areas, and more equitable access to sufficient, skilled and motivated health workers, starting with the countries involved in the project: Italy, Moldova, the Netherlands, Romania and Serbia. 

We provide knowledge and tools to a group of relevant policymakers in European member states and neighbouring countries. They can use these tools to define, design, and implement evidence-based reforms in the health sector that specifically aim to counteract medical deserts. 

In this project, we follow a 3-step plan:

  1. Generating evidence - Research into the different manifestations of medical deserts contributes to the development of an interactive tool that can be used to diagnose and monitor medical deserts in project countries and beyond.
  2. Consensus building - We ensure inclusiveness of perspectives of different groups in policy development. This part consists of participatory method guideline development and phased ‘consensus building sessions’, both at local and national level.
  3. Discussing policy options - Once locally relevant policy options are ready, policy discussions are facilitated. National and EU level key stakeholders and decision makers (e.g. policy makers, health professionals, patient organisations and citizens) are engaged to ensure joint reflection on effective, feasible and acceptable policy measures.

Over the course of the project, we share knowledge and evidence around medical deserts, possible policy solutions, and lessons learnt. With that, we hope to inspire policy makers to take action, which will benefit affected populations and ultimately, the country as a whole. By spreading knowledge and good practices, we also hope to inspire policy makers outside the AHEAD project countries.

Athena’s role
The Athena Institute is especially involved in step 2: building consensus on various policy measures enabling countries to counteract medical deserts. Based on our experience in participatory mehods, we ensure thatthe  perspectives of all different stakeholders are included in policy development.

The Athena Institute developed a “Guidance document/Methodology for Participatory Consensus Building”. It provides the following practical recommendations to improve participatory consensus building methodology to counteract medical deserts:

    1. A comprehensive and resource intensive recruitment phase will help to engage highly relevant stakeholders who can meaningfully contribute to consensus building sessions. 
    2. Purposefully encouraging persons with marginalized background to participate will improve inclusivity and diversity.
    3. Carefully choosing a facilitator who can create an environment conducive to constructive dialogue.
    4. Planning the logistics of the consensus building sessions will ensure smooth sessions. 
    5. Continual assessment of consensus building activities allows the flexibility to address challenges. 

A formative evaluation of the consensus building methodology by the Athena Institute identified three key dimensions that influence the implementation of consensus building methodology: 

    1. Inputs - How do power dynamics influence the consensus building sessions?
    2. Process - How to ensure optimal operationalisation of the consensus building methodology?
    3. Context - How does the local context influence the consensus building methodology?

The Athena Institute also took the lead in organizing a webinar with consortium partners to discuss how participatory consensus building can contribute to effective collaboration on policy options that tackle medical desertification in Europe.    

Project details