The Second National Intracultural Health Strategy (NIHS) 2018–2023 has been published by the Health Service Executive (HSE).1 It will enable the HSE to better address the needs of service users of all ethnic and cultural backgrounds. The strategy is in response to the increasing diversity of people living and accessing health services in Ireland. Census 2016 showed that 17% of the population were not born in Ireland, representing 500,000+ individuals from 200 different countries (p. 13).1 

This strategy was developed through a process of consultation with community networks and sections within the HSE. The subsequent submissions were analysed and eight areas were identified, ranging from access to interpreting and translation, gender-based violence, and implementation of the second NIHS.2 

Focus of first NIHS

The second strategy aims to build on the achievements of the first NIHS (2007–2012).3 The first NIHS (2007–2012) looked to target access to services, develop the cultural competence of staff, and improve the evidence base around intracultural health needs. It was a comprehensive document that covered many of the key issues related to meeting the health needs of ethnic minority service users. Unfortunately, its publication coincided with the economic recession and significant restrictions on funding for many areas. Despite this, in 2016, a review of the strategy showed that 20 of its 43 actions had been completed. Achievements were made, for example, in capacity building, cultural competence of staff, and development of culturally appropriate resources. The least progress was made in the key area of data collection and analysis, even though this was identified as a key pillar of the first strategy. Of note, the National Drug Treatment Reporting System (NDTRS) is one of the few national data collection systems to successfully collect aggregated data on ethnicity (including Roma), country of birth, and main language.4 

Focus of second NIHS

The focus of the first strategy was concentrated on newly arrived ethnic minority people, often seeking international protection. This second strategy seeks to address the healthcare needs of migrants5 who have made Ireland their home not only in recent times but over the past few years, as well as members of the Traveller and Roma communities. In 2017, the Department of Justice and Equality published the National Traveller and Roma Inclusion Strategy, 2017–20216 specifically for these communities and, while the NIHS does not seek to duplicate actions, Roma in particular are also highlighted in this strategy in relation to their health needs. 

Implementation: goals and objectives

There will be a detailed implementation plan for the strategy with the aim of reviewing progress mid-term in 2020/2021. The goals and objectives of the second strategy (2018–2023) are reproduced below (p. 21).

Goal 1

Enhance accessibility of services to service users from diverse ethnic, cultural and religious backgrounds.

Strategic objectives:

• Provide information in accessible, culturally responsive ways.
• Develop a model for interpreting provision across the HSE.
• Develop an evidence-informed system of translating information.

Goal 2

Address health issues experienced by service users from diverse ethnic, cultural and religious backgrounds.

Strategic objectives:

• Implement cross-government obligations in respect of health needs of service users.
• Implement national obligations in relevant cross-departmental strategies.
• Promote a model of health screening and prevention.
• Address health inequalities relevant to service users in relation to oral health, sexual health, reproductive health, children and young people, LGBTI+, disability, men, mental health and palliative care.

Goal 3

Ensure provision of high-quality, culturally responsive services to service users from diverse ethnic, cultural and religious backgrounds.

Strategic objectives:

• Provide intercultural awareness training to all relevant staff, and take into account the needs of staff who work with a diverse population.
• Ensure that services are planned and delivered in a context of cultural competence and in line with requirements of the public sector duty and related obligations.

Goal 4

Build an evidence base.

Strategic objective:

• Work towards the development of high-quality data collection, monitoring and evaluation to build an evidence base on minority ethnic health and ensure evidence-informed practice.

Goal 5

Strengthen partnership working to enhance intercultural health.

Strategic objective:

• Actively promote participation of service users from minority ethnic groups in the design, planning, delivery and evaluation of services.

1    Health Service Executive (HSE) (2018) Second National Intracultural Health Strategy 2018–2023. Dublin: HSE. Available online at: https://www.drugsandalcohol.ie/30767/

2    An overview of the consultation process can be found on pages 38 and 39 of the strategy, along with a summary of the submissions and analysis of the consultation in Appendix 4 (p. 100).

3    Health Service Executive (HSE) (2008) National Intracultural Health Strategy 2007–2012. Dublin: HSE. Available online at: https://www.hse.ie/eng/services/publications/socialinclusion/national-intercultural-health-strategy-2007---2012.pdf

4    For further information, visit: https://www.hrb.ie/data-collections-evidence/alcohol-and-drug-treatment/how-data-is-collected/

5    The term ‘migrant’ is defined by the International Organization for Migration (IOM) as ‘any person who is moving or has moved across an international border or within a State away from his/her habitual place of residence, regardless of (1) the person’s legal status; (2) whether the movement is voluntary or involuntary; (3) what the causes for the movement are; or (4) what the length of the stay is’. For further information, visit: https://www.iom.int/who-is-a-migrant

6    Department of Justice and Equality (2017) National Traveller and Roma Inclusion Strategy 2017–2021. Dublin: Department of Justice and Equality. Available online at: https://www.drugsandalcohol.ie/31029/