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NLO COVID-19 Paper

August 2020

The coronavirus disease (COVID-19) pandemic has created an unprecedented crisis for governments, health systems and societies at large, and has severely impacted the health, lives and livelihood of millions of people worldwide.

Marginalised groups are among people the hardest hit by the COVID-19 pandemic, and yet are among the least protected from it by governmental actions to date. Indeed, the COVID-19 crisis has brought into sharp focus the stark inequities that exist in access to health and social support services for marginalised people who live precariously in Europe, often outside formal healthcare systems and social, labour and legal protection measures.

The Nobody Left Outside coalition has developed this briefing paper for the WHO European Office for Investment for Health and Development to:

  1. Explain to policymakers the particular challenges and impacts of the COVID-19 pandemic and government responses among marginalised groups in Europe. This is done via a unique exercise mapping the inter-related impacts associated with homelessness, sex work, undocumented status, drug use, LGBTI identity and imprisonment according to the framework of the WHO Health Equity Status Report (HESR) essential conditions for a health life
  2. Recommend solutions to help improve government responses, recovery measures and inform preparedness plans
  3. Present the voices and actions of marginalised communities and civil society organisations currently working on the frontlines to support them through the pandemic and beyond. This section signposts to a variety of resources highlighting lived experiences and ongoing community-led responses across Europe

NLO Service Design Checklist published in BMJ Open

A peer-reviewed article reporting the NLO Service Design Checklist has now been published in the BMJ Open journal.

The article explains the rationale for the Checklist to help all stakeholders overcome inequalities in access to health and support services faced by marginalised communities, in alignment with principles of person centricity and universal health coverage. The result of this collaborative project is a versatile, easy-to-use and practical tool that policymakers, public health bodies, healthcare authorities and practitioners, peer support workers and non-governmental organisations are encouraged to use when developing, updating or monitoring action plans and local services for target groups. It is also intended for civil society workers to use in wider advocacy efforts to improve access among underserved communities. The article was downloaded over 1200 times within a month of being published in April 2020, and has particular relevance in light of the impact of the COVID-19 pandemic on marginalised communities. It is freely available here. NLO participants have also published a BMJ Opinion article discussing the Checklist and the NLO Thematic Network Joint Statement in context with international political efforts toward universal health coverage.

Full details:

Lazarus JV, Baker L, Cascio M, et al, on behalf of the Nobody Left Outside initiative. Novel health systems service design checklist to improve healthcare access for marginalised, underserved communities in Europe. BMJ Open 2020;10:e035621. doi:10.1136/bmjopen-2019-035621

Lazarus JV, Onyango D, Spinnewijn F. Leaving nobody outside our healthcare systems - in Europe or elsewhere. BMJ Opinion, 25 Nov 2019

Nobody Left Outside (NLO) initiative statement on COVID-19

The Nobody Left Outside (NLO) coalition calls for national governments to act urgently to protect communities facing high levels of marginalisation, social exclusion and vulnerability during the COVID-19 pandemic. EU and national government COVID-19 responses must reach everyone - including marginalised people. “Let us support those who have no chance to stay home – providing support to those people in hostels, in charities and in shelters helping them survive in time of COVID-19 pandemic”, says Dr Vytenis Andriukaitis, NLO Goodwill Ambassador and former European Union Commissioner for Health and Food Safety.

Read the full text here : NLO statement on COVID-19