The focus of government approaches to migration and health in the ten countries highlighted in this report has largely been disease-based and frequently centred on screening to detect communicable disease. To date, a general approach to mainstreaming migrant health issues into national health policies has been lacking in the sub-region despite increasing migration flows. Migrants from the subregion to most OECD countries are required to undergo health checks before they are granted a visa, with the detection of TB and HIV being common grounds for exclusion. Similarly, migrant workers seeking to travel through official systems to Western Asia or other destinations in Asia, such as Singapore, are obliged to undergo health checks. In several countries of destination, they also have to take regular health tests and can be repatriated if they are found to have particular conditions. There is some controversy about the compulsory tests, especially those detecting infectious diseases like HIV.
However, globally, the emphasis on migrant inclusive approaches to addressing the health needs of both migrants and their host communities is gaining momentum. An important development in this regard was the adoption by the 2008 WHA of resolution 61.17 on the Health of Migrants.5 This resolution, which called for WHO Member States to develop migrant inclusive health policies, promote equitable access to health care, and support social cohesion, provided a global operational framework6 on how to improve the health of migrants and has received strong support from governments of the sub-region. It is recognized however, that implementing the framework will require high-level commitment and engagement from all stakeholders (WHO 2010).
At the regional level, several migration-specific dialogues have helped to identify recommended approaches to migration health that are specific to Asia and the Pacific. The Regional Dialogue on the Health Challenges of Asian Migrant Workers held in July 2010 in Bangkok, Thailand; the September 2010 Asia-Pacific Regional Preparatory Meeting for the Global Forum on Migration and Development also held in Bangkok; and the Fourth Colombo Process Ministerial Consultation on Overseas Employment and Contractual Labour for Countries of Origin in Asia held in April 2011 in Dhaka, Bangladesh, are recent key examples.
A significant outcome of the Regional Dialogue was the adoption by representatives from ministries of Labour, Health, and Foreign Affairs of a set of Joint Recommendations aimed at improving the health and well-being of migrant workers and their families. The recommendations called for recognition of the feminization of migrant flows and the significant number of migrants working in the informal sector, and of the related health vulnerabilities of these groups emphasized the central place of human rights and the need to address barriers to accessing services. Governments of participating Member States also agreed on the need for data and bilateral approaches in formulating guidelines and minimum standards to assist countries in developing viable interventions that support the health and social protection of migrants. The Joint Recommendations also provided a framework for the roundtable discussions on migration and health that defined the health related articles in the Bangkok Statement on Migration and Development of 31 Member States of the UNESCAP Asia-Pacific Region for the Global Forum on Migration and Development 2010 in Puerto Vallarta, Mexico.
Furthermore, the health challenges of migration were discussed as part of broader discussions on ensuring the wellbeing of migrant workers at the 2011 Colombo Process Ministerial Consultations, during which the Joint Recommendation on the Health Challenges of the Asian Migrant Workers were presented. Acknowledging the challenges to promote and protect the rights of migrant workers and their families, and improving the welfare, dignity and well-being of migrant workers, especially those of women, the 11 Member States recommended the implementation of migrant-inclusive policies to ensure equitable access to health care and services as well as occupational safety and health for migrant workers.
Important models to enhance social protection in health have emerged in some countries of origin, mainly in those that rely heavily on remittances. Such models provide pre-departure orientation, coverage for disability and health services at the country of destination through a compulsory insurance package, and examination and referral when returning home. Although such models may be limited in their scope of coverage and not applicable to those who migrate through informal channels, these efforts recognize the important contribution of migrants to development and the need to ensure the health of migrants as a human right and as part of good public health practice.
5 See http://apps.who.int/gb/ebwha/pdf_files/A61/A61_R17-en.pdf.
6 The Outline for An Operational Framework to implement the principles and priorities expressed in the 2008 WHA Resolution on the Health of Migrants was developed as a main product of the Global Consultation on the Health of Migrants – The Way Forward in Madrid, Spain from March 3 – 5, 2010. The framework is a synthesis of the inputs received from participants representing governments, non-governmental organizations, international organizations, the Red Cross and Red Crescent Movement, academics and experts, as well as professional and migrant associations from all geographical regions.