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ADB

27th August, 2015


Dr Patrick Duigan
Disclaimer: The views expressed in this paper/presentation are the views of the
author and do not necessarily reflect the views or policies of the Asian
Development Bank (ADB), or its Board of Governors, or the governments they
represent. ADB does not guarantee the accuracy of the data included in this paper
and accepts no responsibility for any consequence of their use. Terminology used
may not necessarily be consistent with ADB official terms.

Migration
Importance of Migrants Journeys
Social Determinants of Migrant Health
Approach to Addressing Migrant Health

Monitoring Migrant Health


Policy and Legal Framework
Migrant Sensitive Health Systems
Partnerships, Networks, Multi-country frameworks

The Way Forward


Q+A

International Intergovernmental Organization


158 Member States Executive Council
Part of UN system, but not UN Agency
Annual operating expenditure $1.5 billion
97% voluntary contributions to projects

Globally, there are 232 million international


migrants, along with 740 million internal
migrants(2). 1 in every 7 persons on the planet is
on the move
Two fifths the worlds migrants live in Asia and
the Pacific - the majority of them migrated within
the region(3)
Out of an estimated 105 million migrant workers
worldwide, 30 million are in Asia(4)
(1) World Bank, 2012, Migration and Remittances Factbook 2011, 2nd Edition. http://data.worldbank.org/data-catalog/migration-and-remittances

(2) UNDP, 2009, Human Development Report 2009: Overcoming barriers: Human mobility and development. http://hdr.undp.org/en/media/HDR_2009_EN_Complete.pdf
(3) UNESCAP, 2013, International migration and development in Asia and the Pacific, http://www.unescapsdd.org/files/documents/SPPS-Factsheet-migration-v4.pdf
(4) ILO, 2013, Trends and Outlook for Labour Migration in Asia, http://www.adbi.org/files/2013.01.23.cpp.sess1.2.baruah.labour.migration.asia.pdf

In 2014, 54 per cent of the worlds


population lived in cities
By 2050, two thirds of the worlds population
will be residing in cities around five billion
people
Urbanization is driven mainly by rural-urban
migration and migration between cities

Migrant

Regular (legal) migrant

Internal/domestic migrant

Irregular (illegal) migrant

International migrant

Families/children left behind

Mobile population

Accompanying
families/children
Unaccompanied minor (child)

Seasonal migrant worker


Job seeker migrant

Assisted migration
Spontaneous migration
Smuggled person
Trafficked person
IDPs
Refugee

The health of migrants and host communities is not only


determined by the conditions of living and working, but
can be affected throughout all phases of the migration
process
Migrants move with their epidemiological health profiles
influenced by the conditions of migration, as well as the
social determinants of health.
The working and living conditions of migrants at the place
of destination largely depend on the migration-related
policies that are enforced there (eg legal status,
employment, housing, health access)

Temporal dimension of shifting determinants of health


that a migrant may encounter.

healthy migrant effect

However, with increasing length of residence in the new


country, immigrants health often deteriorates.

Does not necessarily hold true for all migrants (forced


migration)

Hu, Cook and Salazar (2008:1718) summed up findings for


Chinese rural-to-urban migrants and concluded that [i]n

health screening of migrants prior to immigration


healthy behaviour prior to migration,
positive self-selection

essence, the countryside is exporting good health and


reimporting ill-health, pointing to a positively selected
outmigration and a negatively selected remigration.

Traditional
approach:

Modern
approach:

EXCLUSION

INCLUSION

Security

Reduction of inequities

Disease control

Social health protection

National focus

Multi-country &
inter-sectoral policy
development

Conditions

Sanitation, Hygiene, crowded living conditions

Infectious
Access to prevention and treatment, immunization
Diseases
Access and availability to Sexual Health services

(un)Availability of (un)healthy lifestyles

NCDs

Environmental and occupational health impacts

Access to Maternal and Child Health


Workplace injuries (3D jobs)

Trauma

Traffic accidents
Violence including SGBV

Mental
Health

Isolation, stigmatization, discrimination


Forced migration (IDPs, refugees, victims of trafficking)
Stressors, exploitation, legal status, threat of eviction

1990: IOM/WHO First International Conference on the


Health Needs of Refugees, Migrant Workers, other
Uprooted People and Long Term Travelers
2004: IOM/WHO/CDC Seminar on Health and Migration
(2004), Geneva, Switzerland
2007: Portuguese European Union Presidency: Migrant
health, better health for all
2008: 61st World Health Assembly: Health of Migrants
Resolution

2010: IOM/WHO/Spanish Government: Global


Consultation on Migration and Health

In 2008, the United Nations World Health Assembly Resolution


on the Health of Migrants (61.17) called upon members to:

promote migrant-inclusive health policies and to


promote equitable access to health promotion and
care for migrants

Health outcomes can be influenced by the multiple dimensions of migration;

Noting that some groups of migrants experience increased health risks;

Recognizing the need for additional data on migrants health and their access to
health care in order to substantiate evidence-based policies;

Taking into account the determinants of migrants health in developing


intersectoral policies to protect their health;

Mindful of the role of health in promoting social inclusion;

Acknowledging that the health of migrants is an important public health matter


for Member States;

Noting that Member States have a need to formulate and implement strategies for
improving the health of migrants;

Noting that policies addressing migrants health should be sensitive to the specific
health needs of women, men and children;

Recognizing that health policies can contribute to development and to


achievement of the Millennium Development Goals

Promote migrant-sensitive health policies;


Promote equitable access to health promotion, disease
prevention and care for migrants, subject to national laws and
practice, without discrimination on the basis of gender, age,
religion, nationality or race;
Establish health information systems in order to assess and
analyse trends in migrants health, disaggregating health
information by relevant categories;
Devise mechanisms for improving the health of all
populations, including migrants, in particular through
identifying and filling gaps in health service delivery;
Gather, document and share information and best practices
for meeting migrants health needs in countries of origin or
return, transit and destination;

Raise health service providers and professionals


cultural and gender sensitivity to migrants health
issues;
Train health professionals to deal with the health
issues associated with population movements;
Promote bilateral and multilateral cooperation on
migrants health among countries involved in the
whole migratory process;
Contribute to the reduction of the global deficit of
health professionals and its consequences on the
sustainability of health systems and the attainment
of the Millennium Development Goals

Migrant Profiles
Daily cross-border
Short stays (up to 1 month)
Seasonal trips
Longer term moves (>3m)
Working in area without mobility
None of the above
Total

Combination of mobility types

Myawaddy

Dont know

Kawkareik

No response
0

10

20

30
%

40

50

HIV knowledge (migrants and host


communities)

Can a person reduce the risk of getting HIV by using a condom

86.6%

every time they have sex?


Can a person get HIV by sharing food with an HIV infected

76.3%

person?
Can the risk of HIV transmission be reduced by having sex

84.3%

with only one uninfected partner who has no other partners?

Can a person get HIV from mosquito bites?

44.8%

Can a healthy looking person have HIV?

43.6%

Composite indicator

18.0%
0%

20%

40%

60%

80%

100%

HIV vulnerability
Sex workers

369

MSM

352

6 12

Injecting drug users

347

18 5

Truck drivers

309

27

34

Yes
No

Drug users

278

Beer girls

52

270

Mobile or migrant men

41

179

Yourself

116

32
0%

40

20%

30%

40%

50%

No response

59
84

323
10%

Dont know

14
60%

70%

80%

90%

100%

Perceived availability of health services


Health education

109

57

Maternal child health

218

253

29

104

Malaria treatment

338

41

Malaria testing

339

40

TB treatment

325

12

49

TB testing

326

11

49

HIV/STI treatment

192

HIV/STI testing

42

217

20%

40%

Dont know

No response

137

376
0%

No

152
32

Primary health care

Yes

09
60%

80%

100%

Assist in bilateral MOU


development
Support MOL in policy
and legal aspects of
labor migration
Promote safe, legal,
humane labour
migration conditions
Mainstream health
within labour migration

2008: Sri Lanka Ministry of Health forms partnership with IOM

2008-2011:National Research Project on Migration Health and


extensive stakeholder consultations

2010-2014: National Coordinating Framework for Migration


Health Development

2011-2012: Research used to inform policy, launch web-portal


and provide booklets for returnees

2011-2014 Promoting the migration health agenda via regional


and global exchanges

2013-2014: National Migration Heath Policy and Border Health


Strategy

Inter-Ministerial and Inter-Agency Coordination Framework


for the Migration Health Development in Sri Lanka

National Steering
Committee on
Migration Health

Migration Health
Task Force

Migration Health
Secretariat Unit
(Housed within the
Ministry of Health)

http://www.migrationhealth.lk/

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Secretary/Director General level representatives of following key


ministries, which are directly involved in Migration, Health and
Development
Ministry
Ministry
Ministry
Ministry
Ministry
Ministry
Ministry
Ministry

of
of
of
of
of
of
of
of

External Affairs
Economic Development
Defense
Health
Social Services and Social Welfare
Justice, Legal and Governance
Child Development and Womens Affairs
Labour Relations and Productivity Improvement

45

National Migration Health Task Force


Technical focal points from each
stakeholder agency

46

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Table 7: Overview of national legal frameworks and policies for the health of migrants

CAMBODIA
InternalOutbound

LAO PDR

Inbound

InternalOutbound

MYANMAR

Inbound

InternalOutbound

THAILAND

Inbound

InternalOutbound

VIET NAM

Inbound

InternalOutbound

Inbound

Social and Health Protection Laws


Universal Health Coverage
Social security
Occupational Health and
Safety*
Occupational Malaria
Intervention

Migrant Health Examination


Pre-departure Orientation for
Migrants

Labour Laws
Workers compensation
Employment and job seekers
protection

Migrant Health Insurance


National Malaria Strategy

Migrants and mobile populations are a vital population for


malaria control

Migrants can often have:


Greater exposure to malaria (occupation, living conditions)
Less access to health care (cost, distance, language, exclusion,
discrimination)
Less education and knowledge about causes, prevention,
treatment
More difficult to target, reach, monitor, treat (esp cross-border)
May be coming from non-malarious area into malarious area and

vice versa

majority of migration is labour migration ie


people migrate to work in private sector

Migrants may be exposed to malaria from their


work (plantations, mining, road construction)

Responsibility of migrant employers towards


their workforce (and their families)

Healthy workforce = greater productivity

Increasing migration and transport of goods and


people may drive spread of resistance

Migrants may not be included in local plans for


malaria response

Legal status of migrants can affect access to services

Mobile populations are particularly difficult to reach


effectively and consistently

Migrants can be a hidden population

Language, discrimination, culture, knowledge

Willingness/sensitivity of workplaces to be involved

Recognize the importance of the issue, responsibility


towards it, and situation of migrant workforce and
their families

Become engaged in response

Mapping of priority areas can help to focus response

Public Private Partnerships govt, NGO, UN

At head office - CSR, Policy, Advocacy


At worksites - education, prevention, testing+treatment,
referral
With suppliers safe workplace, malaria checklist
Esp border areas, Transport routes, Areas with resistance
Epidemiology + migrants + private sector

JUNIMA - Joint UN Initiative on Migration and


Health in Asia

Migration health + ASEAN integration


Migration Data and GIS (DTM - Displacement
Tracking Matrix)
Malaria Elimination
Private Sector Engagement
Migration Health Assessments
Humanitarian Border Management for
Health/Pandemic Preparedness
Migration Health Policies for all countries