The COVID-19 pandemic has had direct and indirect consequences for vulnerable populations. For this reason, given the difficulties Traveling People face in accessing testing and healthcare, as well as the challenges of conducting contact tracing remotely, the Nouvelle-Aquitaine Regional Health Agency (ARS) developed a Covid-19 response plan specific to this population as early as March 30, 2020.

To this end, local stakeholders were surveyed regarding:

• support initiatives undertaken for Travellers,

• the involvement of health mediators and community liaisons in raising awareness among this population,

• adaptations to contact tracing and testing based on their specific living conditions,

• health outcomes, etc.

Strong local action and the stakeholders involved

To identify the types of actions perceived by local stakeholders as facilitating contact tracing, testing, and the implementation of prevention measures to combat COVID-19 among Travellers, Santé publique France, in collaboration with the Fnasat (National Federation of Solidarity Associations for Action with Gypsies and Travellers), conducted a qualitative study from June to September 2020 among local stakeholders in six departments of Nouvelle-Aquitaine: Gironde, Charente, Dordogne, Pyrénées-Atlantiques, Vienne, and Lot-et-Garonne.

According to the study’s findings, this response plan was implemented thanks to a strong commitment from the Regional Health Agency (ARS), which enabled coordination and cooperation in public action at the local level. This reportedly facilitated the establishment of a COVID-19 care pathway adapted to the living conditions of Travellers. Information, education, and communication initiatives, supported by community engagement and mobilization, also bolstered efforts to combat Covid-19. This analysis highlighted the role of health mediation in identifying complex clusters of Covid-19 cases, taking a holistic approach to health into account.

What lessons can be learned?

According to stakeholders, the plan mobilized the five beneficial intervention areas to promote population health while strengthening health equity through the integration of best practices and the ethical approaches of health mediation to engage with a population that is disconnected from the healthcare system.

The study highlights that health mediation is a promising intervention for addressing the challenges faced by people who are disconnected from the healthcare system. An evaluation of its effectiveness is currently underway through a research project involving Santé publique France, the Fnasat, and the University of Bordeaux.

To facilitate the integration of health mediation into interventions, a theoretical overview and a technical guide titled “Ecosystemic investigation of clustered COVID-19 cases within a vulnerable population” accompany the report. These documents identify the stakeholders who can be mobilized, outline the conditions for the approach’s success, and include a flowchart to assist in implementing clustered case investigations.