Abstract
Background: People experiencing homelessness (PEH) face several social and health challenges, including stigma and discrimination, and barriers to access healthcare and navigate health systems. While the health and social consequences of homelessness have received considerable attention in the literature, including their elevated risks of infectious and chronic diseases, we know less about how health systems have adapted and reformed to better meet the needs of PEH.
Approach: We conducted rapid literature reviews to identify promising practices and uncover the types of features that may contribute to improved access to primary and social care for PEH in selected high-income countries (Australia, Brazil, Canada, Ireland, United Kingdom, and United States). Findings from academic and grey literature were supplemented with consultations with experts (17 from Canada, 2 from the United States, and 2 from Ireland).
Results: Our review uncovered a diversity of initiatives and services offered by way of three main access points: 1) non-urgent/primary care; 2) social services; and 3) urgent self-referral. Initiatives were multi-disciplinary and often involved many partners, such as community organizations, health centres, public health units, researchers, and shelters. We uncovered common challenges, such as funding and human resources, and facilitators and best practices. Six key considerations for improving access to care were identified.
Implications: These promising features and initiatives are helping to fill gaps in health and social support for PEH. Sustained investment and rigorous evaluation of low-barrier, culturally safe primary and social care programs are urgently needed.