The current healthcare system in Savannah for the uninsured has several gaps that limit how efficiently chronic diseases among this group are treated.   

First, in the past, no attempt was made to coordinate among healthcare providers who directly render primary healthcare to the uninsured to coordinate services.  Recently, groups, such as the Chatham County Safety Net Planning Council, have worked to promote and coordinate health care services among different organizations. However, these efforts only work when health providers and organizations agree to work together.

Secondly, there is no effective plan to help uninsured people gain entry into the health system for proper treatment and follow-up.  Healthcare providers rely on patient's willingness to seek treatment.  Therefore if an individual does not consider his/her illness as dangerous or understand the importance of having preventive healthcare, such as a regular Pap smear he/she will not seek a health care provider.  The lack of knowledge of when and how to seek care for conditions that are chronic, lack of a regular health care provider, and lack of knowledge of how to avoid complications are critical deficiencies.  Consequently, the uninsured will continue to use the emergency room as their primary source of health care.

Third, management of chronic diseases among the uninsured has concentrated on treatment and has not effectively included prevention and education as part of the clinical approach.  No action has been given to develop more comprehensive management of chronic diseases, such as diabetes and hypertension.

Fourth, while the availability of diagnostic tests are present for the uninsured (health fairs, free blood sugar and blood pressure screenings) there is no consistent strategy of what to do when an abnormal screening test result is given to someone who does not have a regular health provider or is uninsured.

Finally, health care providers have not adapted services to deal with cultural and language barriers of the rapidly growing Hispanic population. 

The program that is proposed in this document is a health program for the control of chronic diseases among adult uninsured 16-64 years of age, living in Savannah GA and surrounding areas.  Its focus is to deliver a culturally and linguistically appropriate service consistent with CLAS standards from the Federal Office of Minority Health and language accessibility standards from the Office of Civil Rights. Community Health Workers (promoters de salud, lay health workers) will be used as part of the medical treatment that the uninsured patients will receive at Community Health Mission (CHM).  Health promoters will help to facilitate medical outreach.  They will identify and monitor chronic health conditions among the target population by helping with timely screening and follow-up.  They will also participate in patient education, give referrals to other resources in the community and provide individual support. Health promoters have a long history of providing public health services in many cultures and countries.  The advantages of using health promoters are that they come from the community; they are defined by their active stance within the community, and are well-trained.  They are not doctors or nurses, but may help deliver primary health care and preventive services within a limited scope of practice.  The incorporation of community health workers into any health intervention is culturally appropriate, increasing the acceptability, accessibility and compliance of the program.  Because of this approach, our program represents a new model of community outreach and health care delivery in a free clinic that tries to reduce the ethnic and linguistic mismatch between the community and the healthcare system.  

Our program has three components: 

Phase I:  Identification and referral to CHM of adult uninsured individuals without a primary healthcare provider in Savannah GA and surrounding areas.

Phase II:  Clinical treatment and follow-up of chronic diseases for patients referred to CHM, as well as assessment of life-style behaviors.  Patient will receive preventive as well as screening procedures (e.g. pap-smears).  

Phase III: Patients will be encouraged to participate in one of our four bilingual wellness programs:  Women's Health, Smoking Cessation, Amigos en Salud/Friends in Health self- management Diabetes, and Nutrition.  Each individual entering into our program will be tracked using our database, and we will document changes in clinical outcomes and life-style behaviors among these patients. We feel that our program will secure a much higher level of appropriate care in the appropriate setting than occurs currently.  If we are successful in implementing these services we anticipate that the targeted indigent population of Chatham County will be healthier. They will require fewer emergency room visits, fewer hospitalizations, have less disability and ultimately, require less health care. We hope that the Nobody is left behind; reaching across the community program can be used as an example of how outreach activities can be combined with primary healthcare services to assure better care for the uninsured of Savannah, Georgia.