Health is a critical human right for migrant workers, especially those with irregular status. For instance, cross-border workers are often not counted as migrant workers in statistics and have less access to health care (see Labour migration and Health and migration). Health enables a context in which “decent work” can happen. To ensure decent work, health factors are a central consideration (see ILO). Good physical and mental health outcomes, facilitated through equitable access to health services, are essential if societies and communities in both countries of origin and countries of destination are to realize the positive contributions of labour migration. Therefore, the effective management of labour migration must address the health needs and rights of migrant workers, as well as the health needs and rights of their families remaining in the country of origin.

On the topic of labour migration, another key health-related consideration is the international and internal mobility of health workers themselves. According to the WHO report on health employment and economic growth, by 2030 and to achieve the SDGs, there will be a need for 18 million additional health workers. Meanwhile, health workforce shortages continue, particularly in low- and middle-income countries. This section briefly addresses these health-related aspects of labour migration.

 

The health of migrant workers

Many migrants are young, fit and healthy when they embark on their journeys, which is also known as the healthy migrant effect. However, difficult conditions throughout the migration cycle may negatively impact their health. Migrant workers, particularly those in irregular situations or working in informal sectors or without contractual safeguards, may be exposed to hazardous travel, exploitation and poor working and living conditions, including insufficient or absent labour protection and occupational safety. For instance, safety hazards are common in high-risk and dangerous employment sectors, especially manual labour. Many migrants who are low skilled are often employed in the so-called “3D” jobs (dirty, dangerous, degrading), in countries where labour protection and regulatory mechanisms are weak. Mining, construction and agriculture, for instance, have the highest rates of workplace injuries and deaths, and put young migrants at increased risk of occupational accidents and injuries (Migration Data Portal, 2021). Other employment sectors – such as domestic work, especially – put young migrant women and adolescents at risk of exploitation, violence and abuse, due to their isolation and confinement from protection and assistance mechanisms (Rijks, 2014).

This results in significantly higher risk of occupational injury and mortality (further details in Health and migration).

Migrant workers may also have disproportionately less access to health services due to, for example:

  • Legal, administrative, linguistic and socio-cultural barriers resulting from lack of support from employers;
  • Discrimination in the receiving communities;
  • Fear of deportation;
  • Lack of knowledge of their rights pertaining to employment contracts and related visa or immigration status.

Social exclusion and distance from family and support systems may further increase the toll on migrant workers’ health and well-being (see details in Integration and social cohesion and Family and migration). In addition to a combination of legal, sociocultural, behavioural, language and economic barriers, as well as difficult living and working conditions (such as lack of employer provided health insurance or paid sick leave benefits), migrant workers may have limited awareness of their rights or limited access to health and social services, which could impact their health outcomes. In such a situation, migrant workers may not come forward to seek health care and other social services. This may result in critical health conditions remaining untreated, and potentially also undermining overall public health, including during health or other emergencies. Healthy migrant workers are likely to integrate easily, be more productive and achieve positive outcomes for themselves and for their countries of origin and destination.

Many migrant workers undergo some form of health assessment or screening before their departure or upon arrival as a recruitment prerequisite. In many cases, due to poor data collection, testing practices may not be associated with referral for needed treatments and follow-up, making it difficult to assess public health consequences (Wickramage and Mosca, 2014). Mandatory testing for some conditions, such as HIV or pregnancy, and the lack of proper diagnostic practices and case management are of limited public health value and may lead to unnecessary exclusionary practices. For migration and pre-employment health assessments to meaningfully contribute to the greater public health good, and moreover to benefit the health of migrant workers, it is important to strengthen national health systems.

Governments and employers have the responsibility to ensure that migrant workers’ rights are protected. Multisectoral cooperation among, for instance, ministries of health and labour is a starting point for policy coherence regarding the health of migrant workers. The inclusion of migrant workers in national and employer health-care schemes can contribute to positive health outcomes not only for migrants themselves, but also for receiving communities, and can lead to increasing overall social cohesion. Mechanisms for extending social protection in health and increasing social security coverage for migrants and their families can enhance access to health services and avoid both excessive out of pocket payments by migrant workers in need of health services and unnecessary expensive emergency care. For instance, portable health insurance schemes through bilateral labour arrangements between countries of origin and destination offer migrant workers the possibility, in the present, to export their social benefits to families in the country of origin or, in the future, to export social benefits such as health care in old age.

Policy Approaches
Improving health care for migrant workers
  • Strengthen national health systems in countries of origin and destination of migrant workers.
  • Invest in generating evidence on health determinants and outcomes that can support the development of targeted policies for migrant workers’ health in key employment sectors. Engage with ministries of labour and immigration along with other stakeholders in this regard.
  • Engage in bilateral arrangements to establish mechanisms that extend social protection in health and increase social security coverage for migrant workers and their families. These may include health insurance benefits in the country of residence and the possibility, in the present, to export their social benefits to families in the country of origin or, in the future, to export social benefits such as health care in old age.
  • Ensure migrant workers have access to primary health care, as well as access to health information – for instance on health conditions and health care services – through health screening programmes prior to departure and upon arrival to country of destination.
  • Empower migrant workers to take health improvement measures, through access to health information and through counselling, prevention and treatment services, including vacation when needed.
  • When necessary, ensure that migrant workers have access to translators who can provide updated information and support them while accessing healthcare.  
To Go Further

 

Mobility of health workers

Labour mobility in general, and the international migration of health workers in particular, is expected to continue to increase. The health sector, in particular, is a leading source of employment for skilled migrant workers including midwives, nurses, and doctors. The migration of health professionals plays a key role in addressing the global shortage of health professionals through strengthening the capacity of health systems in both countries of destination and countries of origin. It provides countries that have significant health workforce gaps with the ability to respond to population health needs and to improve health outcomes such as child mortality, maternal health and disease prevention. Well-managed migration of health workers can play a key role in development overall, and requires engagement with multiple sectors and partners (see policy approaches below).

The global shortage of health professionals – especially the uneven distribution of key professionals such as doctors and nurses per capita of population in developing countries – has resulted in several national and international efforts to address human resources for health (HRH). The International Platform on Health Worker Mobility  recommended health-focused global attention on HRH, particularly in relation to the critical shortages of skilled health professionals (midwives, nurses and physicians) in 57 countries and the centrality of health workers for accelerating progress towards the health-related Sustainable Development Goals.

The World Health Organization (WHO) Global Code of Practice on the International Recruitment of Health Personnel, adopted in 2010, is an especially important document in this regard. The WHO Code, as it is called, provides guidance to countries in the development of their human resources for health in all aspects of education, in improving their retention and fair recruitment practices of health workers, while encouraging technical collaboration and financial support between countries of origin and countries of destination. This is a pragmatic approach to enable countries to maintain a strong and qualified health workforce to make progress in delivering the SDG 3.8 on universal health coverage. The WHO Code provides a comprehensive framework, applies to permanent and temporary mobility and outlines safeguards for vulnerable health systems. Countries are invited to exchange information on issues related to health personnel and health systems in the context of migration, and to report on the measures taken towards the implementation of the WHO Code. The third round of national reporting took place at the seventy-second World Health Assembly in 2019, and showed novel approaches, including more equitable bilateral labour migration agreements for health workers, as well as cooperation between sending and receiving countries to support education and training costs, support for the return of qualified nationals and for rural practices, as well as health technology transfer to sending country health systems. An additional independent stakeholders reporting instrument has also been made available since the second round of reporting to facilitate stakeholder reporting, inviting stakeholders and entities “such as health personnel, recruiters, employers, health-professional organizations, relevant subregional, regional and global organizations, whether public or private sector, including non-governmental, and all persons concerned with the international recruitment of health personnel” (WHO, 2010) to share information.

Good Practice
Drawing on the health professional diaspora to develop the health system

Migration for Development in Africa is a capacity-building programme aimed to mobilize competencies acquired by African nationals abroad for the benefit of the national health system in the country of origin. Somalia is one of the countries that benefited from the support of its health professional diaspora in the development of its health sector. It drew on the support of IOM to facilitate the necessary skills and knowledge transfer.

Source

Source: IOM experience.

The movement of health professionals can be controversial because of its potential negative effects. Countries of origin often express concern that physicians, nurses and other skilled professionals are recruited by medical institutions in wealthier countries, leaving the low-income countries with a depletion of human capital. Research has found the actual situation to be more complex.

Other global health tools like the WHO Code and Health workforce 2030: A global strategy on human resources for health, as well as the relevant 2008 World Health Assembly resolution 61.17 on the health of migrants, provide an evidence-based framework to promote good practices and prevent negative effects of health worker migration. The International Labour Organization (ILO), the Organisation for Economic Co-operation and Development (OECD) and WHO have collaborated since 2017 to establish the International Platform on Health Worker Mobility to work with relevant partners, including IOM, on advancing dialogue, knowledge and cooperation in order to promote effective management of health worker migration, health system capacity-building in source countries and skill transfer from the diaspora.

Policy Approaches
Improving management of health workers’ migration
  • Involve all relevant stakeholders. These will include the health, labour and trade sectors within national governments; international recruitment stakeholders; health professional associations; research experts; and United Nations partners such the World Health Organization (WHO) or the International Labour Organization (ILO).
  • Develop bilateral and multilateral agreements on recruitment of international health professionals. For instance, some countries might favour regional migration and thereby facilitate circular or return migration and the subsequent distribution of critical skills. Such models should, however, respect the freedom of health workers to migrate.
  • Ensure skills recognition of migrant health workers through flexible visa and work permit policies, adopting a holistic approach that considers existing qualifications, as well as ongoing linguistic and cultural training opportunities for health professionals to be able to work in countries of destination and facilitates integration in the labour market.
  • Improve migration statistics on health personnel so as to increase the availability of information and enable both evidence-based policies and international comparability. At the same time, address issues concerning data protection; the complexity and the multiplicity of stakeholders, including countries of origin and destination; and health workers’ training, employment and certification.
  • Exchange information on issues related to health personnel migration, as encouraged in the WHO Global Code of Practice on the International Recruitment of Health Personnel, and consider regular reporting on measures taken to implement the WHO Code.
  • Enhance collaboration between the development and education sectors so that programmes enable migrant health workers to effectively contribute to strengthening the health workforce and enhance the responsiveness of the health workforce to population needs.
To Go Further
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