-       Their aim is to strengthen primary health care through delivery system integration 

o   Enhancing primary care 

o   Using co-payment’s 

o   Raising payments for critical care 

o   Strengthen partnerships between hospitals and clinics

o   Enhance public capabilities in self-care 

o   Governance of hospitals 

-       Integrating health and social care services for vulnerable populations are being worked on 

-       Equal healthcare system 

-       3 Million people in Taiwan have access to the NHIs

-       Interest free loans to help those who are unemployed, or have a low income 

-       They have lowered the threshold to allow more people on premium 

-    Health literacy, providing education around correct health decisions
-    Health promotion, what tools to use. 
-     Providing health care with equity

-       Taiwan has a lot of money towards healthcare, and allows everyone access to health care, by subsidising those with lower incomes 
-       Higher rates of metabolic syndrome, obesity & poor health behaviours in their indigenous population (similar to Australia) 

 

The government has also pledged 8billion NZD to help achieve these innovations 

2. “Whānau Ora” – a policy designed to integrate health and social services. The aim of this is to incorporate multi-disciplinary teams to integrate health and social services, overall to achieve joint responsibility for outcomes. 

 

Data is collected regularly and reported regularly to analyse the disparities and how policies are changing them. Furthermore, all health boards have to report on Maori health plans and to consult with them on annual plans 

3.In rural and small towns of NZ, GPs often are not present and only work on call, so nurses are required for first contact care. 

 

24hr care is provided to individuals via consultations with nurses, who provide advice in relation to peoples health questions. This is often more favourable for individuals as after hour clinic charges are higher than regular, and often not affordable. 

 

Nurse will be responsible for patient literacy and empowerment, early intervention and community care and also integrating collaborative health care. 

 
4.-  The maori and pacific island population have shorter life expectancies – similar to the indigenous people in Australia   

-  Act on a public and private system – NZ has larger amount of their hospitals being public, and greater range of care within the public system. 

-  However, NZ hospitals can only have intensive care or emergency at a public hospital, so if a patient is requiring going into intensive care they must transfer to public. 

·      Improving the quality of life, 

·      Promoting equal opportunity and self-responsbility

·      Ensuring and enhancing the quality of care

·      Creating more transparency, better governance and closer coordination

 

·      Calling for improving health opportunities for the most vulnerable population groups such as children, people with low income or poor educational backgrounds, elderly and immigrants.  This allows for easier access to important health care services. 

·      Federal Office of Public Health supports initiatives to strengthen the health literacy of disadvantaged people and the competence of health professionals. 

·      Focusing on health equity. In addition, health and health access variations are measured and reported publicly by Swiss Health Survey.

Providing Person centred care, educating person cen Community education

Primary care tends to be physician based with nurses playing a relatively small role. 

 

·      Second-highest healthcare cost in the world. 

·      Accessible and affordable healthcare

·      Accidents and emergency rooms are rarely overwhelmed.

·      Get to choose your doctor

·      The are no free state-provided health services, but private health insurance is compulsory for all persons residing in Switzerland.

- In 2018 they increased the scope of practice for nurses to aid to alleviate pressure on primary physicians 

- Improving continuity of care by bridging the gap between inpatient and community healthcare 

- In 2019 they expanded dental care coverage for people aged 75+

 2. What is being done to reduce disparities?

 3. What is the role of the nurse in advancing health in these countries?

1What are the major innovations and reforms have recently been introduced?

The government is also rolling out several strategies through 2022, including a youth mental health and well-being program, an antibiotic-resistance initiative, and a mental health program aimed at adults. 

The government has started a process to decriminalize drug use as well as possession of minor quantities of drugs. The aim is to transfer the societal responsibility for handling minor drug offenses from the jurisdictional sector to the health care sector.

2What has been done reduce disparities?

Emphasis on individual health behavior rather than social determinants of health

National strategy- equality and equity in Health care- Good Health for all

Recent studies have shown no evidence of disparities between immigrants and Norwegian r between any indigenous and Norwegian.

 

3 What is the role of nurses?

Helping patients receive preventative services such as counselling, screenings and precautionary procedures and medication 

4 compared to Australia 

Norway has universal health and social insurance coverage, known as the National Insurance Scheme (NIS) but Australia has Medicare for all public health care services. Norway health coverage are funded by the general taxes and payroll contributions shared by employers and employees. 

Introduced bill to reduce the amount individuals pay in statuary health insurance every month 

Minimum staffing requirement of nurses in hospitals 

- Health monitor - national not for profit organisations and sickness funds. To assess healthcare performance of healthcare system conducted studies from patients perspective (e.g. availability of info, experiences) 

- Strategies to reduce health disparities are delegated mainly to public health services 

Primary preventative care is mandatory by law for sickness funds - include strict guidelines regarding need, target groups and access 

- Advanced practice nurses have not yet prevailed in primary care there is an increasing number of medical assistants who complete further training as care managers - improves quality of care

- Nursing homes are assessed by a regional medical review board for care deficits - provide nursing care scores - helps nurses identify areas for improvement 

What surprised you about your findings and how does this compare to your own countries? 

Medication plans for those with more than 3 prescribed drugs 

Sickness funds (care contracts)  and disease management programs for chronic illness 

- patient safety program
- in the last 10 years introduced 2 accreditation systems to track quality of care. 
- introduction of e-SUS software to integrate services 

- 1994 the family health strategy promoted holistic care with the inclusion of multidisciplinary teams 

2. What is being done to reduce disparities? 

- Minorities not needing proof of residency to access health care. 
- greater SUS ID card information for minorities  
- Covered gender reassignment surgery

- Indigenous health teams
- health services on river floats  
- mobile clinics. 
- Long-term fiscal austerity policies were introduced in 2016

3. What is the role of the nurse in advancing health in these countries?

- patient centred care 
- family networking 
- improving quality of care through simulations and training
- collaboration in strategy innovation for health care roll out

4. What surprised you about your findings and how does this compare to your own countries?

- gender reassignment covered under universal health care (ahead of other countries)
- pharmaceutical benefit scheme
- universal health care 
- telehealth 
- minorities and indigenous population affected more by health and have greater need for health services

-          Partnering with local café

-          Working with local supermarket to create food/activity boxes

-          Providing recipe boxes with ingredients for families to cook together

-          Collaborating with local youth groups 
- Providing culturally safe information

-       Emergency relief packages

-       Dietician/nutritionist to provide fun recipes that everyone can make and share

-       Encourage physical activity through zoom- Physio

-       Parent education- nurse

-       Competition- push up, steps ect.

-       Movement breaks in the middle of class- local YMCA

-       Fresh fruit

-       Activity groups

Goals of initiative

-          To provide affordable and nutritious food to Angelo and his family during lockdown

-          Nutrition education

-          Enable Angelo and his family to cook together with culturally appropriate ingredients

Would it work? 

-          Yes, but depends on having right services and partnerships, and capability to deliver the food with volunteers etc. 

Who do we need to engage with?

-          Local businesses: cafes, supermarkets, etc.

-          Local community members – potential donations?

How would we evaluate?

-          Feedback survey (paper-based)

-          Look at amount of food delivered

What resources do we need?

-          Food

-          People to deliver and put together the kits, deliver kits, create recipe cards
- donations from community

 

Would It work  - it would work if the amenities were there to provide the service, such as getting the food to the children, if someone is willing to host the cooking class or provide instructions on how to prepare the food 

 

Engage with – Parents, teachers/school staff, nutritionist, community (to deliver food) 

 

Evaluation – ask: Did the students build the skills and education of preparing food? Were all children engaged in the activity? Were the classes consistent/ were the resources available to keep the program consistent? Are the staff providing the classes, educated themselves of food nutrition?

 

Interventions – Money to provide food, money/resources to deliver the food, students to have their own device, engaging parents in the importance of why the students are doing this 

To fulfill the nutritional diet for children in the community over the lockdown period.

To utilize the school bus for the supply of food packages in their home 

Ø  Volunteers

Ø  School teachers

Ø  Dietician

Ø  Community Nurse

By conducting online surveys

 By asking for feedback or asking any suggestions or rating

By making follow up the parents’ response

Allocating appropriate budget plans 

Fundraising

Adequate Human resources like bus drivers, food packagers, distributors, 

Financial challangees

Cultural differences impacting on the choice of food 

Interventions: mental health support like counseling, food delivery, online forum for them to choose the recipe, join the local market to get cheaper healthy food option, have dietitian to review the meal plan for food delivery, community nurse to educate the kids about healthy diet and, counsellor to have online zoom or facetime regarding how to be mentally and spiritually positive for life during lockdown, school teacher can organize a zoom class to have sports activity together at a fixed organized time 

Who else involves: dietitian, kitchen staff, school teacher, counsellor, school bus, community nurse

Evaluate: By asking for the feedback from the children, parents and observations from all other health professional members.

Resources: sample food, cooperation between school teacher, education and counselling, feedback form. 

Keeping the children and community involved in healthy eating and physical activity. Provide food to communities in need during lockdown period. The plan is implemented during lockdown but can be prolonged until after.

·      Would the intervention work from last week? Why or why not? 

Possibly, provided there was enough access to resources and parents were happy to get involved. Support and volunteer is required. Lockdown restrictions may make it difficult for people to help out. It may be difficult to attend to all people's cultural needs. 

·      Who else do you need to engage with for your strategy to work? 

Community nurse, parents, teachers, food suppliers, volunteers,

·      How would you evaluate your strategy?

Ottawa Charter, check back in about a month to assess the progress, 

Part of the needs assessment would be sending out online surveys.

·      What resources do you need to make your intervention sustainable? 

Fresh and healthy food readily available, through markets and different organisations, possible NGOs.

Volunteers and Funding.