Quality and safety for Sámi users of health and care services: a cross-sectional study from Norway.

Challenges persist in delivering good-quality and safe health care to the Norwegian Sámi population. This cross-sectional study explored system-level factors affecting healthcare services for Sámi people. Specifically, it assessed (1) the extent to which Norwegian municipalities provided good and safe health and care services to Sámi users, as reported by managers, and (2) whether good and safe service provision was associated with selected municipal characteristics. An online survey was conducted in 2019 across 135 municipalities in the four northernmost counties, and 77 responded (57% response rate). Service quality was measured using a single five-point ordinal-scale question, and proportional odds regression models were used to analyse associations with municipal characteristics. Overall, 40% of municipalities reported offering good and safe services to a 'large' or 'very large' extent to Sámi users. More favourable assessments were observed among municipalities located within the Sámi language area and among those with higher net operating surplus. The results suggest that while certain contextual factors may support service provision, there remains considerable potential for improvement across municipalities. Continued policy attention and resource allocation, combined with initiatives to strengthen cultural and linguistic competence, are needed to enhance equitable access to health care for Sámi communities.