Humanitarian Assistance or System Strengthening? Both Are Needed for Migrant Health

By Sarah Insanally

Amidst highly active migration flows across the Latin America and Caribbean (LAC) region, a robust, multisectoral humanitarian response has arisen to help countries meet migrants’ urgent needs. Largely driven by development partners, the effort is helping overwhelmed host countries provide health care – among other immediate humanitarian services -- to migrants primarily from Venezuela, Haiti, El Salvador, Guatemala, and Honduras. That’s a good thing.

But emergency humanitarian assistance can only go so far. Migrant health care needs, like for other individuals, are diverse and continuous across the life course. A person with a chronic disease like HIV requires ongoing care and treatment to stay healthy. A woman who is pregnant needs high-quality prenatal, delivery, and post-natal attention to reduce her risks, and her child will need regular health care. Actions to promote health and control disease must reach the entire population to be effective. For countries facing a large influx of migrants, the best way to ensure that these new members of society have sustained access to essential health services is to have a long-term strategy – one that builds on existing health platforms to integrate them into the health system and host community health services. In other words, they need a health-system-strengthening solution that goes beyond emergency assistance.

The Case for System Strengthening

In many LAC countries, however, long-term health strategies for migrants are nonexistent or underdeveloped. It’s hard to imagine a worse time to be without health system strengthening solutions. Recent migration flows from Venezuela are the largest human movement in recent history, with approximately 4.6 million migrants now living across the region.^[1] An estimated 458,233 Haitian migrants live in the Dominican Republic,^[2] and population movement within and from the Northern Triangle countries of El Salvador, Guatemala, and Honduras intensified again in early 2021.^[3] Between October 2020 and May 2021, U.S. Customs and Border Protection apprehended 898,000 irregular migrants, 85 percent (763,300) of whom began their journeys in Northern Triangle countries.^[4] This massive movement of people, combined with the crisis of the COVID-19 pandemic, greatly exacerbates health inequities throughout the region.

In the long run, health system strengthening is more cost-effective than providing emergency medical services.

Evidence suggests that, in the long run, a system-strengthening approach will prove more cost-effective for governments than providing emergency services to migrants currently excluded from regular medical attention.^[5] Consider this telling finding from Colombia: Migrants mainly access health services through emergency rooms, where the cost of care is steep and health workers are at risk of becoming overloaded, hampering the quality of care.^[6]  Meanwhile, migrants’ inability to access primary care – either because they cannot afford it or because they lack a government-issued identification card – often results in delayed treatment,  leading to worse health outcomes.^[7]

System strengthening approaches that include both migrants and host communities in decisions and processes can also help defuse political and social tensions in host countries and improve opportunities for tailored, sustainable responses.

USAID’s System Strengthening Approach

In the LAC region, USAID’s Local Health System Sustainability Project (LHSS) is supporting health system resilience, while balancing immediate responses to health needs with long-term solutions that integrate migrants, promote equity, and improve health outcomes. We are working alongside local partners to analyze system bottlenecks; co-develop clear strategies and durable policies for delivering comprehensive, high-quality health services for migrants and host populations; and ensure adequate resources to sustain health services amid rapidly evolving, complex contexts. In this way, we aim to help countries realize the economic and social development benefits of integrating migrants into host communities.^[8]

Rather than create separate programs, LHSS works with countries to integrate migrants into existing health systems.

• In Colombia, LHSS helps the government to develop and implement sustainable, long-term policies to integrate migrants into the health system and improve the responsiveness of care. We are working with the government, private sector, civil society, and community partners to strengthen technical and operational capacity at all levels of the health system, for example by improving the competency of health workers to provide non-stigmatizing, high-quality care and the program and budget management skills of local authorities.
• In Peru, LHSS collaborates with the Ministry of Health, development partners and civil society to assess health system pain points that prevent migrants from accessing care and identify and implement impact-oriented actions. For example, we are strengthening the national HIV program’s capacity to ensure that migrant needs are considered in planning for HIV services and the procurement of HIV medicines.
• In the Dominican Republic, LHSS is supporting an inclusive effort by government, the private sector, civil society, and migrant community organizations to agree on approaches to improve the coverage and quality of health services for the benefit of both migrants and host communities. LHSS is also helping strengthen community and mobile HIV services to ensure sustainable, high-quality, and client-centered services tailored to the needs of people of Haitian descent residing in the DR.
• In Honduras, LHSS will work through a local partner to engage relevant stakeholders from the government, private sector, and civil society to build consensus on steps needed to improve health protection for women at risk of migration.

Across these country activities, LHSS supports capacity development at the system and institutional levels. We strive to align with local priorities and needs and integrate processes, tools, and practices into national system structures. And because we ourselves are part of a vital, interconnected system of actors working on migration and health in the LAC region, we will share our findings and experiences so all can benefit from what we learn. Stay tuned!

_Notes

_{[1] https://www.r4v.info/en/document/r4v-latin-america-and-caribbean-venezuelan-refugees-and-migrants-region-september2021
[2]https://reliefweb.int/sites/reliefweb.int/files/resources/IcSP_Flow%20Monitoring_Monthly%20Report%201_February%202021.pdf
[3] https://www.cfr.org/backgrounder/central-americas-turbulent-northern-triangle
[4] https://www.migrationdataportal.org/regional-data-overview/migration-data-central-america#recent-trends
[5] https://fra.europa.eu/sites/default/files/fra_uploads/fra-2015-cost-healthcare_en.pdf
[6] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00509-2/fulltext?rss=yes
[7] https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30560-6/fulltext
[8] https://www.bloomberg.com/news/articles/2021-03-24/imf-says-venezuelan-migrants-boost-colombia-s-economic-potential}

About the author: 

Sarah Insanally, DrPH, is a health systems specialist on the USAID Local Health System Sustainability Project. She is originally from Guyana and has worked with health systems throughout the LAC region. Read Blog 2 of this series, Five Steps to Strengthen Health Access for Migrant Women.