National migrant health policies: gaps, strengths and solutions

¶ … international attention towards migrant health, reflecting acknowledgement of the need for improved and modified health systems to acclimatize to increasingly varied populations. Nevertheless, reports from numerous health policy experts in European nations suggest that by the year 2009, only 11 countries (in Europe) established national policies that improve migrant health and go beyond migrants' constitutional or legal right to care. The aim of this essay is examine policies of various countries from around the world concerning migrant health and strategies to address improving migrant healthcare and analyze their limitations and strengths in order to create a strategy that will identify gaps in current policies as well as offer a solution. The analysis from the research suggests that the majority of national policies concerning migrant health target either migrants including more well-known ethnic minorities.

Nations must address the varied needs of both groups. Those wishing to change and implement new policies could learn from successful "intercultural" health care programs in Ireland and (in the past) the Netherlands. Some policies in numerous countries priorities specific illnesses or conditions, nonetheless these vary and it is not distinct whether they precisely reflect real changes in need among nations. "Policy initiatives typically involve training health workers, providing interpreter services and/or 'cultural mediators', adapting organizational culture, improving data collection and providing information to migrants on health problems and services" (Mladovsky, Rechel, Ingleby & McKee, 2012, p. 1).

A few countries stick out for their mission to upsurge migrants' health savvy and their contribution in the development as well as implementation of policy. Broadminded migrant health policies may not always be sustainable as they may become destabilized or even upturned when political circumstances change. "The analysis of migrant health policies in Europe is still in its infancy and there is an urgent need to monitor the implementation and evaluate the effectiveness of these diverse policies." (Mladovsky, Rechel, Ingleby & McKee, 2012, p. 1). Europe, Africa, and Asia have still only touched the surface of addressing migrant health problems and migrant care.

Solution for Policy Gap in Migrant Healthcare

Migrants have difficulty finding adequate healthcare in countries they migrate and work in. This is because the country may have difficulty speaking the migrant person's language, understanding their culture and traditions, and treating the migrant person without health insurance. Therefore, the solution lies not just in implementing programs that address migrant health problems, but also raising cultural awareness and improving communication among medical staff with migrant people. Nurses often are the first line of care when patients come into any medical facility. Therefore, nurses must be trained in cultural awareness and communication techniques in order to improve migrant healthcare. Things like index cards and diagrams for common ailments may help nurses improve their ability to communicate with migrant people that do not speak the same language. One other option is hiring migrant volunteers that are bi-lingual and can help with translation and encouraging trust and confidence.

Migrant health problems have largely been ignored in many countries with gaps identifying need for more information on health status of migrant people and so forth. However, as the number of growing immigrants becomes more apparent, healthcare policies must adapt to meet the increasing demands of changing populations. "Immigrants account for 40.5% and 57.8% of the adult population of Cayenne and St.-Laurent du Maroni, respectively. Most of them (60.7% and 77.5%, respectively) had been living in French Guiana for more than 10 years. A large proportion were still undocumented or had a precarious legal status" (Jolivet et al., 2012 p. 53).

Many migrant works travel to countries like China to get jobs to provide for their families. Some work for small to medium sized enterprises or SMEs. Underuse of health services among migrants employed in these SMEs could be related with the 'healthy migrant' effect. Nevertheless, when measured among the sick migrants in the SMEs, "the utilization rate was still low mainly due to their poor health awareness. Improving their risk perception and integration of occupational and general health service is crucial to improve the health conditions and utilization of service among migrants in the SMES (Zou, Zeng, Chen & Ling, 2015, p. 00189).

Since communication remains low among migrant workers and people in the country, they work in, they may be too afraid to go to the doctor for help with an illness or pain. That is why nurses are excellent vehicles for establishing effective communication. They are the ones that promote confidence and trust among migrant people and their health problems. Feeling comfortable enough to go to medical facility for treatment or assessment will increase their ability to perceive potential health problems and pursue medical care.

A report from Sirilak et al. (2012), examined a large-scale application of migrants as health volunteers within a migrant primary-healthcare type program. The program enlisted migrants who agreed to serve their communities. The study explores the characteristics of such volunteers, their connection with program management, as well as their attitudes. It also investigates the influence of the migrant helpers, from the migrants' and healthcare workers' viewpoint. The researchers conducted the study in two provinces, Tak and Samut Sakhon (northern Thailand and central Thailand). Primary and secondary info was collected.

The quantitative study assessed 260 migrant volunteers as well as 446 migrants. The results established that less than 5% of migrant volunteers were chosen by the community. Nearly all attended some kind of training course. The majority were assigned the role of health communicators with four stating they did nothing. "Volunteers' attitudes were very positive. Most migrants reported that the volunteers' work was useful. It was concluded that the migrant health-volunteer program did help deal with migrant health problems. However, management of the program should be closely considered for more effective outcomes (Sirilak et al., 2012, p. 658).

Of course, this type of program could use some improvements. The first would be letting the migrant community choose good volunteers. The second would be having them interact more with nurses during the preliminary phase of assessment with migrant patients. The third, ensuring none of the volunteers are left with no work, as this would be wasted effort and time.

It is important to assess problems in managing migration health problems. Although countries may not wish to engage in helping sick migrants, migrant health problems could reach an extreme level with some illness possibly affecting an entire country. One such illness is malaria. Many migrant populations come from areas that have malaria patients and malaria infected mosquitoes.

Migration is a significant global matter as poorly managed migration may result in an assortment of problems, as well as an increase in possible transmission of illnesses such as malaria. Furthermore, there is evidence that suggests malaria is no more a forest-dependent illness and may principally be affected by populace movements, generally to agricultural areas. Although transnational and internal migration has dissimilar legal inferences in most countries, both kinds of migration happen for the same motives economic and/or care. While migration in itself does not present as a definitive risk for diseases like malaria, numerous factors can put, migrants as well as local communities similarly, in susceptible situations. In particular, rural development and infrastructure, deforestation for logging plus economic farming, potential political movements, as well as natural disasters, which are some of the chief factors that pull and push people in and out of categorized malaria-endemic areas. "Therefore, understanding the changing socio-environmental situation as well as population movements and their associated risks for malaria infection, is critical for malaria control, containment, and elimination. Efforts to address these issues should include advocacy, mapping exercises and expanded / strengthened surveillance to also include migrant health information systems" (Jitthai, 2013, p. 306).

An article from 2014 mentions the need to address cost-effectiveness. This is so nurses, potential volunteers, can all have the resources needed to address migrant patient's health concerns. Financial investment in this area may provide much needed resources for migrant patients. If medical institutions learn to budget effectively, they may have the capital needed to fund such efforts.

Migrant health policies should focus in protects this vulnerable group, especially during economic hardship, taking into account economic and socio-demographic risk factors. There is an especial need for research in the cost-effectiveness of investing in the health care of the migrant population, demonstrating the benefit of such, even in the health of the European native population, and the need for constant intervention despite of resource constraints (Reyes-Uruena, Noori, Pharris & Jansa, 2014, p. 48).

Although migrant healthcare volunteers will address the need for additional funding, it does not address potential ethical concerns. Volunteers work for free. For any of these programs to truly succeed and promote motivation and productivity among volunteers, they must also be given something in return like free education opportunities and training. Since training is already part of most hospitals and clinics, this would not be a huge financial burden on medical and healthcare facilities. Another cost-effective option to allow for better implementation of migrant healthcare programs is implementing existing professional training initiative and guidelines meant to handle migrant health concerns.

A range of proficient guidelines as well as training initiatives already exists that allow for communication within cross-cultural sessions in primary care. Conversely, these are frequently not implemented by medical staff in daily practice. The reason for this is as yet unidentified why professionals do not implement or accept these procedures and interventions, or in what conditions they would do so. Van den Muijsenbergh et al. identified a new study involving 6 European countries, and the RESTORE protocol or REsearch into implementation STrategies to support patients of diverse ORigins as well as language background within a range of European primary care situations, and aims to address aforementioned gaps in knowledge. It utilizes a unique combination of modern social theory, normalization process theory, NPT plus participatory learning and action or PLA, research. "This should enhance understanding of the levers and barriers to implementation, as well as providing stakeholders, with the opportunity to generate creative solutions to problems experienced with the implementation of such interventions" (Van den Muijsenbergh et al., 2013, p. 122).

RESTORE like migrant health volunteers, is a solution that offers cost-effective interventions. It enables growth and participation of medical staff (especially nurses). It promotes further understanding of diversity needs. Lastly, it creates awareness of gaps in research and assessment.

Conclusion

In conclusion, migrant health problems are a growing concern. With diseases like malaria, countries must take action in addressing migrant health problems. Ways to do this are migrant volunteer programs and RESTORE method so nurses can implement effective communication with migrant patients. Healthcare is important and should be given to all.

Project Definition

RESTORE protocol for medical staff training and inclusion of migrant healthcare volunteers.

Problem Statement

Migrant patients have limited communication ability with medical staff.

Mission Statement

To provide improved communication between medical staff and migrant patients.

Project Strategy

RESTORE offers a way to train medical staff in diversity through research and application of theory. Migrant volunteers elected from migrant communities by migrant people can help improve communication by providing translation services for free in exchange for education and training opportunities.

Project Objectives

To improve communication between medical staff and migrant patients.

To increase migrant health problem treatment.

To provide cost-effective solutions.

Financial Objectives

Cost will be reduced or none, especially for the volunteer program. Performance of training and providing educational opportunities for volunteers will be scheduled during the existing schedules of medical staff to reduce potential extra cost. Volunteers can follow and examine what medical staff do in order to acclimate to situations.

Program implementation will take 6 weeks to form and will be continuously assessed every 6

Project Scope Statement

Implementation of RESTORE protocol and volunteer program is included. Technical aspects such as websites and advertisement will be excluded.

First Two Weeks Implementation Plan

Day 1: Research biggest migrant community in the area.

Day 2: Meeting held in medical facility to discuss implementation plan of volunteers and RESTORE protocol.

Day 3: Contact local migrant community leaders.

Day 4: Elect migrant volunteers from migrant community population and feedback.

Day 5: Discuss training protocol for migrant population.

Day 6: Begin implementation of RESTORE protocol in medical facility.

Day 7: Begin contacting volunteers to begin training and explain educational and training opportunities to volunteers.

Days 8-12: Begin training of volunteers (program training) and medical staff (diversity training)

Day 13: Give medical staff (nurses and medical assistants) a volunteer to help with translation.

Day 14: Begin assessments.