Nobody left outside: practical guidance and policy solutions to promote equity of access for vulnerable and underserved communities to integrated health and social services, including addiction care



Many marginalized communities at high risk of poor health require multifaceted care – often including harm reduction and drug/substance use interventions – and yet are among the least likely to receive healthcare owing to a complex interplay of social, organisational and legal barriers. Policy and service design responses, informed by these communities, are needed to address this widespread but under-recognised source of inequity. The Nobody Left Outside initiative (NLO: is a unique collaboration between organisations representing many such groups facing common or inter-related access challenges, including people who inject drugs (PWID), prisoners, sex workers, migrants, homeless and LGTBI people.


United under the NLO banner, member organisations work together to identify shared challenges and best practices and to offer policy guidance to improve access to integrated healthcare and social services for the communities they represent. The NLO Service Design Checklist has been developed to help service providers and policymakers design and deliver services that are accessible to underserved, marginalized people, and for community advocacy use. The Checklist resulted from NLO project meetings, literature research and a policy incubation workshop at the Gastein European Health Forum 2017.


The NLO Checklist provides a structured series of questions that service providers and policymakers should consider to ensure that services are accessible to target underserved groups and to foster community engagement. Following the WHO Health Systems Framework, the Checklist comprises six sections on A) service delivery, B) health workforce, C) health information systems, D) Medical products and technologies, E) financing, and F) leadership and governance. Service delivery items support the design and delivery of an easily accessible, people-centred service that meets the diverse needs of target communities and overcomes existing barriers. The aim is to promote integrated or linked care that includes harm reduction services (e.g. opioid substitution therapy, needle and syringe exchange, and alcohol and substance abuse interventions), testing and linked care for infectious diseases, plus sexual health, mental health, maternal health, housing and social services. Adaptation measures toward target communties, peer support and community involvement in needs assessment, design, delivery, service evaluation, and governance are vital. The NLO initiative is a 2019 Thematic Network under the EU Health Policy Platform and will publish a Network Joint Statement in November 2019.


The NLO initiative aims to incubate practical guidance and policy solutions toward equity of access to integrated health and social services for vulnerable and underserved groups. The NLO Service Design Checklist is useful both at the policy and local implementation levels to improve access to such services, in alignment with the Sustainable Development Goals and equity principles.


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