How to fight medical deserts in southern Italy

“Small healthy Communities” project aims to offer proximity services and social-health care, at home and remotely, to people in fragile conditions in the provinces of Benevento and Foggia, ensuring the care of 160 new patients.

Furthermore, the project intends to reduce the phenomenon of healthcare migration in some internal areas of Campania and Puglia, encouraging the construction of an inclusive and community welfare based on collaboration between institutional subjects and the world of volunteers.

The intervention context is characterized by territorial isolation due to a high fragmentation of the settlement elements and a condition of economic marginality which has caused the progressive exodus of the active population (with a 26% reduction of residents between 1971 and 2010) and the increase in the average age.

The process of rationalization of healthcare spending has led in recent decades to a drastic reduction in available healthcare services, determining the migration to other provinces and regions. This is a typical phenomenon of small communities in internal areas, even though these are the ones with the highest rate of old age and most in need of social welfare services. This is demonstrated by the data relating to the Sole24Ore Health Index, according to which the province of Benevento is 103rd in the general ranking, 42nd among the provinces for cancer mortality (14.2 deaths per 1000 inhabitants), 100th for mortality for acute myocardial infarction (2.9 deaths per 1000 inhabitants), in 74th and 86th place respectively for the consumption of drugs against diabetes and those against hypertension, 92nd for the presence of geriatricians in the area (0.2 active professionals per 1000 inhabitants over 65).

Another interesting data is related to hospital emigration, for which the province of Benevento ranks 79th, despite being tenth for hospital receptivity. The rebalancing between services offered by hospitals and specialist territorial units, clinics, laboratories and general practitioners in territories with these characteristics has long been among the objectives of national and regional policies, including the current National Recovery and Resilience Plan (PNRR); However, in the absence of concrete actions and above all investments in the territory, the consolidation of the initiatives occurs with many difficulties.

In the Municipalities involved in the “Small healthy Communities” project, the healthy life expectancy of the over 65 population (around 28% of the total) is lower than the national average. The change in the structure of the population requires a careful reading of the phenomenon and the development of new responses and strategies, to break the vicious circle that links old age to illness, dependence and loneliness. The correlation between old age and poverty remains, which unfortunately adds economic non-self-sufficiency to functional non-self-sufficiency. The situation becomes worse if we consider the reduced presence of health services. Furthermore, essential welfare services (daytime and semi-residential) are insufficient, with particular reference to services for the elderly, early childhood, young people and people with disabilities.

As emerges from the PNRR, to manage the specific critical issues of territories with unfavorable demographic characteristics, the reorganization and innovation of health services is required, with the implementation of technological solutions, such as telemedicine, capable of guaranteeing accessibility and quality of service, accompanied by the strengthening of social-welfare support services. The project was therefore born from the need to create an infrastructure and an integrated operational network between healthcare facilities and the actors who operate in the social-welfare sector in the area, leading to the reduction of the process of marginalization to protect the dignity of the elderly and to valorise of the human and social heritage it bears, through the provision of quality and truly accessible services for those at risk.

The project takes place in the internal areas of the provinces of Benevento and Foggia, and intends to offer, through an integrated and innovative approach, proximity services and socio-health assistance dedicated to the most fragile sections of the population, with particular attention to the elderly.

1. Setting up “Small Health Centers”: they are organized as territorial centers for guidance and remote healthcare (outpatient teleconsultation and teleconsultation). Those centers are aggregations of primary care, “home” to support home care, services provided in proximal areas with respect to the “Diagnostic Therapeutic Assistance Paths” and with the aim of overcoming the usual booking mechanisms.
2. Provision of socio-health and healthcare services (telemedicine): those activities of socio-health services are coordinated by the Italian Red Cross (committees of Benevento and Foggia) and are  guaranteed with the support of the partners. The Italian Red Cross, with the Benevento Local Health Authority and the involved municipalities, is active in identifying the specific needs of the territories and in contacting the future beneficiaries of the project.

Through contact with the public utility number 1520 (active 24/7), beneficiaries can request services such as:

• Distance psychological support;
• Simple medical transport for medical visits and/or therapies;
• Delivery of medicines for people with reduced mobility or difficulty in moving;
• Telemedicine services, both at home and at the “Health Centers”, provided by the ASL (local health company)  in the form of remote specialist diagnostics.

3. Training and start-up of Community Cooperatives for the quality of life of the internal areas: has activated new Community Cooperatives in the socio-health sector, which are involved in proximity services and local welfare. The multidisciplinary and multifunctionality of Community Cooperatives allows them to deal with the socio-health needs of small communities on a broad scale, based essentially on relationships of proximity and trust; for example, home care and social inclusion services (hour bank, home services for daily life operations, such as shopping at home, paying utilities, etc., psychological training activities and gentle gymnastics).
4. Training for the provision of socio-health services at home: training courses have been held for 60 people, selected from Italian Red Cross volunteers and operators of the partners who will be responsible for the provision of socio-health services at home or at the Health Centers.

The project is expected to have a positive impact on the quality of life of the beneficiaries, helping to reduce social exclusion and improve access to healthcare in the internal areas of the provinces of Benevento and Foggia.

The project is currently underway and it has already reached 160 people and 360 services have been provided. Furthermore, 9 agreements were stipulated with external stakeholders and 48 hours of training were carried out for all 60 volunteers involved in the activities.