Migration and Health in the Americas - PAHO/WHO | Pan American Health Organization

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Migration has been a part of the experience of countries in the Region of the Americas at various moments throughout their history, as countries of origin, transit, or destination. Social and political conflict, food insecurity, natural disasters, climate change, environmental degradation, economic hardship, violence, and other adverse drivers and structural issues have hindered people from building healthy and sustainable livelihoods and compelled them to seek better living conditions elsewhere for themselves and their families. These adverse drivers and structural issues have given rise to evolving dynamics in migration within the Region.

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migrant railroad tracks

Migration has been a part of the experience of countries in the Region of the Americas at various moments throughout their history, as countries of origin, transit, or destination.

Social and political conflict, food insecurity, natural disasters, climate change, environmental degradation, economic hardship, violence, and other adverse drivers and structural issues have hindered people from building healthy and sustainable livelihoods and compelled them to seek better living conditions elsewhere for themselves and their families. These adverse drivers and structural issues have given rise to evolving dynamics in migration within the Region.

Key Documents

— CD57 Side Event - Presentation: Refugee and Migrant Health at WHO
— CD57 Side Event - Presentation: Venezuelan Migration Impacts on Health
— CD57 Side Event - Apresentação: Migração e Saúde: desafios e oportunidades
— CD57 Side Event Agenda - Migration and Health: Challenges and opportunities
— Guidance document on Migration and Health
— Colombia: Meeting of the Measles Rubella Elimination Regional Monitoring and Re-verification Commission (MRE-RMC) with the Colombian Health Authorities
— Regional Ministerial Meeting on Mass Migration and Health
— Health of Migrants (CD55/11)
— PAHO’s Response to Maintaining an Effective Technical Cooperation Agenda in Venezuela and Neighboring Member States, November 2016 to July 2020

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Information Resources

Recommended actions on migration and health in the Americas

Health workers reaching the community

Strategic line of action 1 – Strengthen health surveillance, information management, and monitoring

This line of action focuses on ensuring that national surveillance systems integrate considerations for both host and migrant populations. It seeks to ensure that information and disaggregated data are generated at regional and country levels (national and sub-national), and that adequate, standardized, and comparable records on the health of migrants are available to support policy- and decision-makers to develop more evidence-informed policies, plans and interventions. This will, amongst other things, support the adaptive capacity of health systems of destination countries and guide health interventions to address migrants’ specific health needs.

List of Key Interventions

Establish and/or strengthen early warning alert and response to support the identification of health risks and guide prevention and control interventions.
Strengthen national and decentralized health surveillance and information systems to better capture the health status and needs of migrant populations, including the development of sentinel surveillance systems as necessary, and collection of disaggregated data, such as health-seeking behaviors and access to, and utilization of, health care services.
Strengthen epidemiological surveillance and information management and reporting capacities of host countries within the framework of the IHR.
Develop and share comprehensive profiles on the health status of key migrant populations, including identification of risk factors, to support the adaptive capacity of health systems of host countries and guide equitable health interventions to address migrants’ specific health needs.
Promote the portability of health data in accordance with national law, to ensure that an individual’s health data and information can be available for use in different countries, as necessary.

Child being vaccinated

Strategic line of action 2 – Improve access to health services for the migrant and host population

This line of action focuses on increasing equitable access to comprehensive, timely, quality health services for all people, including the migrant population, without discrimination and with a people- and community- centered approach. It is essential to determine specific barriers to access and define specific interventions, for example, facilitating linguistic, intercultural, and financial support to improve access to health services for migrant and host populations. Existing mechanisms in place should be strengthened to increase health services capacity in areas with a high influx of migrant populations. Services should cover the continuum of care, including promotion, treatment, rehabilitation and palliation based on the health needs ascertained.

In general, migrants do not pose an additional health security threat to host communitiesxxiv. Initial screening— not limited to infectious diseases—can be an effective public health instrument, but should be nondiscriminatory and non-stigmatizing, and carried out to the benefit of the individual and the public; it should also be linked to accessing treatment, care and support. It is unlikely to be necessary if health systems are strong and capable.

List of Key Interventions

Identify health needs of migrants and health systems gaps to respond to these needs, including specific and common gaps related to access and coverage in communities along border areas.
Include health needs in country plans, policies, and programs related to migration, while promoting the participation of the Ministry of Health in their development processes.
Develop health contingency plans and ensure that emergency-affected populations, including migrants, have access to an essential package of life-saving health services.
Scale-up prevention and control interventions, including short term and longer-term responses for the management of communicable diseases, non-communicable diseases, mental health and risk factors, recognizing the importance of integrated interventions based on the different needs of migrants, considering key determinants of health, such as age, gender, education, cultural sensitivity, and the nature of the trauma.
Develop protocols and institute measures to ensure the monitoring and provision of sexual, reproductive and maternal-child health care, as well as specialized care for the survivors of trauma and violence.
Implement strategies within national immunization plans to increase vaccination coverage for hard-toreach populations, including migrant communities.
Provide adequate resources to enhance continuity and quality of care, and ensure health services are accessible and inclusive for all, including populations with mental, physical and sensory impairments.
Provide access to comprehensive, high-quality health services on a continuing long-term basis, if required, supported by referral processes and an Integrated Health Service Delivery Network (IHSDN), with an inclusive approach that integrates the health needs of the migrant population (including relevant health care providers, NGOs and civil society organizations).
Provide health workforce training to develop inter-professional teams at the first level of care with combined competencies in comprehensive care and an intercultural and social determinants approach to health. Training on health equity and human rights-based approaches is a key element for health professionals and relevant non-health actors.
Include, if feasible, qualified migrant health workers in the design, implementation and evaluation of migrant-sensitive health services and educational programs.
Ensure core capacities for national and international implementation of the International Health Regulations (2005).
Make available information on health care services provided to migrants by all relevant actors, at national and local levels (including NGOs and civil society organizations), to avoid duplicating efforts.

Guyanese family

Strategic line of action 3 – Improve communication and exchange of information to counter xenophobia, stigma, and discrimination

This line of action focuses on the provision of accurate information and dispelling of fears and misperceptions among migrant and host populations about the health impacts of migration and displacement on mobile populations, and on the health of local communities and health systems. It also seeks to build a culture of inclusion, solidarity and diversity, promoting the exchange of information (including epidemiological information), protocols, communication material and strategies, national plans, and relevant policy instruments among Member States.

List of Key Interventions

Collect and exchange relevant information on migrants’ health, especially among neighboring countries where there is active human mobility along the borders, to foster collaborative and targeted health actions.
Share positive experiences, best practices, policy instruments, successful tools and lessons learned in promoting and protecting the health of migrants, among countries, agencies, and other relevant actors involved to support transregional learning and the adaptation and replication of successful interventions in other countries of the Region, or even outside of the Region.
Develop gender and culturally-sensitive material for awareness-campaigns that inform migrants and host communities about the rights of migrants (including their right to health), while dispelling negative perceptions surrounding this population.
Conduct sensitization/awareness trainings, with health care providers and other government officials, about the health needs of migrants and the services available for appropriate referral, considering intercultural differences.
Develop periodic progress reports and country profiles, to monitor health-related aspects of the movement of people, disease-risk distribution and risk reduction, in the context of the Sustainable Development Goals.
Develop, subject to national contexts and legal frameworks, cross-border approaches and databases to share information about health risks in countries of origin, transit and destination, as well as portable health records and health cards, including the possibility of a health card for population groups in movement, thereby promoting continuity of care.

Providing health services

Strategic line of action 4 – Strengthen partnerships, networks, and multi-country frameworks to understand the status and promote and protect the health of migrants

This line of action seeks to ensure that the determinants affecting migrants’ health are addressed through joint action and coherent multi-sectoral public health policy responses, including differentiated impacts among women and girls, children, and indigenous and afro descendant communities. It promotes synergy and efficiency through partnerships and intersectoral, intercountry, and interagency coordination and collaboration mechanisms, including with agencies within the United Nations System, such as PAHO, IOM, UNHCR, and UNWomen.

List of Key Interventions

Enhance inter-sectoral collaboration, including with education, social welfare, amongst others, to facilitate the planning of response interventions and the assignation of resources with a comprehensive short-, medium-, and long-term vision.
Improve multi-country dialogues and cooperation, aimed not only at identifying common interests, but also at creating common protocols and treatment schemes, avoiding duplication of efforts, and ensuring a more effective use of resources.
Establish or reactivate intercountry partnerships and alliances to strengthen ongoing efforts to address trans-border health issues related to migration. Such agreements could also foster multi-sectoral cooperation along borders, with greater participation from sectors such as health and education.
Develop binational coordination mechanisms and plans of action to more effectively address common health challenges linked to this migratory crisis.
Participate in regional needs assessment and prioritization efforts to facilitate the planning of response interventions and the assignation of resources with a comprehensive short-, medium-, and long-term regional vision.
Identify solutions and financing mechanisms for the mobilization of resources for health, to support host countries’ increased healthcare demands related to large-scale international migration.

Strategic line of action 5 – Adapt policies, programs, and legal frameworks to promote and protect the health and well-being of migrants

This line of action targets the mainstreaming of migrant’s health in national agendas, and promotes migrant- sensitive health policies and legal and social protection, and the health and well-being of women, children and adolescents living in migrant settings. Given that gender and ethnicity can affect the reasons for migrating, as well as the social networks migrants use to move in host countries, there is a need to ensure equality approaches in national programs and policies, including the empowerment of migrant women and girls and gender equality.

It also advocates for the inclusion of migrant health in national and local policies and programs, as well as the development or modification of legal frameworks to address migrants’ right to the highest attainable standard of physical and mental health, in accordance with international human rights obligations, relevant international and regional instruments, and by working to lower or remove physical, financial, information and discrimination barriers in accessing health care services, in synergy with WHO’s partners, including non- State actors.

List of key interventions

Strengthen/scale up interventions to ensure the effective promotion, respect, and fulfillment of the human rights of migrants, while upholding their right to health and principles of non-discrimination.
Apply a gender sensitive, intercultural and rights-based approach to the preparation and review of national health policies, strategies, and plans at national or subnational level to protect the right to health and respond to the health needs of migrants.
Address discriminatory processes, health barriers affecting migrants and support modifications of legal frameworks that ensure the effective promotion, respect, and fulfillment of the human rights of migrants, while upholding their right to health and principles of non-discrimination.
Develop social protection policies and actions to address health inequalities and barriers to access services throughout the migration process.
Generate evidence of the impact on health systems if the health needs of migrants are not addressed, as well as, to develop targeted interventions to reduce health risks and health inequities among migrants.
Participate in the establishment of a research agenda on migration, mobility, and health.