In 2017, MSD reached out to NGOs representing some of the most marginalized communities and proposed to create a single voice to advocate together for better access to health services for their communities.  This resulted in the launch of the “Nobody Left Outside” (NLO) initiative, a collective of organisations representing some of the most marginalised communities in Europe, including homeless people, LGTBI people, people who use drugs, prisoners, sex workers and undocumented migrants.

While the people in these groups suffer from higher risk of poor health than the general population, they face numerous barriers in accessing healthcare both in how health services are designed, but also as a result of discrimination.

Through advocacy and policy briefs, the NLO coalition has been instrumental in raising awareness of the challenges faced by underserved and stigmatized communities in access to healthcare.  This took the form of numerous events at public health conferences, articles in medical journals, a photo exhibition, detailed proposals to improve health system’s responsiveness, and reports to WHO and the European Commission.

In 2019, the NLO initiative was recognized by the European Commission as a Thematic Network. In 2020, the NLO coalition collaborated with the WHO to produce a report on COVID-19 from the perspective of marginalized groups, and recently launched an open letter to EU leaders on equitable access to COVID19 vaccination.

A key learning from the NLO initiative is the power of joining forces across marginalized groups on a single public health issue. Today, the NLO coalition is recognized as a single voice for marginalized communities and has an open dialogue with major European health organizations and institutions to advance the cause of access to health for underserved communities.

This is well illustrated in a recent WHO podcast on “Building fairer, healthier societies” featuring members of the NLO coalition who could raise the importance for health systems to address the challenges faced by different communities and also share the specific challenges faced by both homeless people and LGTBI.

As shared by Dr. Vytenis Andriukaitis, goodwill ambassador for Nobody Left Outside (NLO) and former European health commissioner, When you see homeless people and other groups on the margins of society on the streets, in subways and in public squares, please remember that our promise to “leave no one behind” is about them. And it is really the litmus test of our humanity, our consciousness and our confidence.”  

Key source material:

www.nobodyleftoutside.eu

• NLO developed and published a Service Design Checklist tool to help providers deliver targeted and accessible health and social services, help policymakers create frameworks that encourage inclusivity and equity of access and enable community representatives advocate for improved access. The checklist was featured in an article in an article in the prestigious British Medical Journal: https://bmjopen.bmj.com/content/10/4/e035621.

• Responding to a request from the World Health Organization (WHO), NLO produced a policy paper exploring how COVID-19 has impacted marginalized people in Europe and providing policy recommendations on pandemic responses, recovery and preparedness. The paper will inform WHO’s recommendations to its member states. It can be viewed at the following URL: https://nobodyleftoutside.eu/wp-content/uploads/NLO-COVID-19-Briefing-paper-Final-August-2020-updated.pdf.

• In October 2020, MSD organized the “Nobody Left Outside Week,” including a series of podcasts with prominent stakeholders on the impact of the pandemic on underserved groups and a webinar featuring the EU Health Commissioner and the Director General of WHO European Office.

• The Nobody Left Outside Week also provided the opportunity to present the “Point of View,” photo exhibition featuring pictures taken by people from marginalized communities sharing their access to health challenges. The exhibition is available here: https://nobodyleftoutside.eu/nlo-photo-exhibition/.

• The Nobody Left Outside initiative published an open letter calling on European policymakers to ensure equitable access to COVID-19 vaccination among marginalised communities.