Asia - Migrant health issues have risen on the agenda of policymakers in the Asia-Pacific region in recent years, generating momentum at the very highest levels of government. The challenge now is how to translate this momentum into visible changes on the ground. Despite progress on both policy and programmatic fronts, Asian migrant workers continue to face challenges in accessing health facilities and services at all stages of migration – before departure, while in transit, at destination and upon return.
Moving the policy discourse on migrant health issues forward and ensuring changes on the ground first require disentangling myths from realities. There is a persistent public perception that labour migrants are carriers of diseases or that they are a burden to the health systems of the countries that receive them. The reality, however, is different. Labour migrants are generally young and healthier than the native population and they tend to underutilize health services at destination. Labour migrants' vulnerability to ill health, however, increases during the migration process due to various risk factors such as lack of adequate health insurance, poverty and uncertain legal status. It is important to identify these risk factors as well as the stakeholders at each stage of the migration cycle in order to map out shared goals.
Translating the political momentum requires adopting concrete initiatives aimed at two overarching objectives: strengthening inter-sectoral collaboration at the national level and strengthening cross-border cooperation between countries of origin and destination. To this end, there is an emerging consensus among various actors to: (1) review labour, migration and health policies at the national level to ensure policy coherence; (2) designate migration health focal points within relevant government departments to ensure multi-sectoral coordination on policies and programmes at national and sub national levels of government; (3) pursue bilateral and regional dialogue and cooperation, including through forging bilateral agreements and creating information-sharing mechanisms (4) aim for cross-border standardization in critical areas, from data collection on the legal, social and health aspects of the migration process to medical testing and social protection schemes; and (5) include migrants' views in policy formulation and programme implementation.
The importance of addressing the health and well-being of migrants has been receiving greater attention, at both international and regional levels, in recent years. In 2008 the Sixty-First World Health Assembly Resolution on the Health of Migrants called upon participating nations to “promote migrant-inclusive health policies and to promote equitable access to health promotion and care for migrants.”
At the regional level, members of the Association of Southeast Asian Nations (ASEAN) signed two landmark declarations during the Twelfth ASEAN Summit, held in 2007: the ASEAN Declaration on the Protection and Promotion of the Rights of Migrant Workers and the ASEAN Commitments on HIV and AIDS, which included a focus on migrants and mobile populations.
Likewise, since 2006, the South Asian Association for Regional Cooperation has adopted regional strategies for HIV/AIDS and TB/HIV co-infection, both focusing on migrant-related issues.
Another key milestone was the 2010 Regional Multi-stakeholder Dialogue on Addressing the Health Challenges of Asian Migrant Workers which brought together for the first time health, foreign affairs, immigration and labour officials of Colombo Process Countries to develop a common understanding on the main health challenges and priorities associated with labour migration in and from South and Southeast Asia and particularly to the Arab States. The dialogue recommended specific activities to improve the health and well-being of migrant workers and their families throughout the migration cycle.
These recommendations later fed into 2010 Asia-Pacific Preparatory Meeting for the Global Forum on Migration and Development where participants called for improved migrant health services including the development of guidelines and minimum standards to facilitate provision of health services, such as health financial schemes, social protection in health and mandatory health insurance. In April 2011, during the Fourth Ministerial Consultation for Asian Labour Sending Countries (also known as the Colombo Process), 11 countries adopted the Dhaka Declaration, which includes the recommendation to promote migrant-inclusive health policies to ensure equitable access to health care and services as well as occupational safety and health for migrant workers.
The challenge now is how to translate this momentum – seen at the highest levels of government – into workable policies and programmes that can ultimately create visible changes on the ground.
Many Asian migrant workers, especially those working under temporary contracts, continue to face challenges in accessing health facilities and services. Indeed, as Dr. Chanvit Tharathep, a public health official from the Ministry of Public Health in Thailand, observed during a regional forum on health issues affecting Asian migrants: “There is significant gap between the economic contribution of labour migrants and the poor working conditions and social support that they experience throughout the migration cycle.” Tharathep noted that although Thailand, like many countries that send and receive migrant workers from Asia, has “made many advancements in improving access to health . . . there is still much to be done.”
This Op Ed was is taken from the second paper in the “Issue in Brief” series published by IOM’s Regional Office for Asia and the Pacific and Migration Policy Institute, entitled “Asian Labour Migrants and Health: Exploring Policy Routes” which is available at http://publications.iom.int/bookstore/index.php?main_page=product_info&cPath=35_36&products_id=798
June 2012