Addressing health needs of the homeless in Delhi: Standardising on the issues of Street Medicine practice

ABSTRACT

Due to barriers in accessing and using healthcare services, a large proportion of the care homeless populations receive comes from informal providers. In Delhi, one such informal programme, called Street Medicine, provides healthcare outreach to homeless communities. Clinical practice guidelines are set to be developed for Street Medicine teams in India and form the object of this research. This study uses a social-ecological model to understand the barriers facing Street Medicine teams and the homeless as they attempt to address the latter’s healthcare needs; coupling it with an analytical approach which situates these barriers as the issues within practice through which standardisation can take place. A qualitative inquiry, comprising three months of observations of Street Medicine outreach and interviews with over 30 key informants, was conducted between April and July 2018. The analysis identified novel barriers to addressing the needs of homeless individuals, which bely a deficit between the design of health and social care systems and the agency homeless individuals possess within this system to influence their health outcomes. These barriers – which include user-dependent technological inscriptions, collaborating with untargeted providers and the distinct health needs of homeless individuals – are the entry points for standardising, or opening up, Street Medicine practices .

KEYWORDS:

• Homelessness
• healthcare outreach
• social medicine
• standardisation
• protocol development

Acknowledgements

The authors would like to thank the team at the Centre for Equity Studies who work for homeless and other disadvantaged communities in India, and those who made this work possible, particularly Armaan Alkazi, as well as the respondents for their alliance and insight.

Disclosure statement

There are no financial interests to declare. HM is the founder and director of the Centre for Equity Studies, which runs the Street Medicine programme at the centre of this published work. However, the data, findings and interpretation of these have no influence on this author’s position in the organisation. All other authors declare no competing interests.

Data availability statement

The underlying data of this paper are stored on personal machines with copies limited to the authors. Depositing the data in a publicly available depository would contravene the terms of the informed consent given by participants, and given the research includes vulnerable individuals, there are ethical implications to sharing responses more widely. The authors would be happy to discuss requests for underlying data once the purpose of such secondary data use is known.

Additional information

Funding

This work was supported by the ‘Promotion for Collaboration 2018’ seed grant from the APH Global Health Programme, a thematic sub-group of the Amsterdam Public Health Research Institute.