Migration Health & Development-Sri Lankan Experience

Dr Susie Perera

Director Policy Analysis & Development

Ministry of Health

Focal point for Migration Health policy development

Asia Pacific Preparatory Meeting for the 2013 UN General Assembly High-Level Dialogue on Migration and Development, May 29 - 31, 2013

Presentation outline

• Migration health policy process

• Challenges

• Way forward- national, regional, global

Migration in Sri Lanka

} Population in Sri Lanka 20,277,597 (Population census 2012 – Department of Census and Statistics)

} Out bound migration

§ Sri Lankans employed overseas - approximately 1.9 Million§ 730 people leave the country daily**

§ Annual out migration through SLBFE 266,445 (SLBFE Annual Statistics Report 2010)

§ Students migrated to Australia, Canada, UK, USA, Bangladesh, India and Pakistan accounted for little more than 10, 000 in 2008 (International Migration Outlook IOM 2008)

} Inbound migration § Resident visa holders 35,826 in 2011 (Department of Immigration and Immigration 2011)

§ Returning Sri Lankan Refugees from South India - 2300– (UNHCR 2011)

§ Tourists to Sri Lanka –predicted to increase up to 2.5 million by 2016 (SLCB Report 2011)

} Internal migration § EPZ – 122,000 (BOI Sri Lanka),

§ University students – 21,541 (UGC Annual Statistics 2010)

Migration health policy process

• High level commitment – following World health Assembly resolution in 2008

• IOM support requested by MoH to develop migration health policy

• Focal point in the Ministry of Health

• Establishment of Migration Health Secretariat with support from IOM

• Rapid Situation Analysis

Framework for RSA developed

Dimensions of migration in Sri Lanka

Families left behind

Inbound migration

Internal migration

Outbound migration

Initial advocacy

• 10th IEA , Colombo– symposium on Migration Health development

• Discussion on the process with a wider group of interested stakeholders, academia

-Consensus reached on the policy process

-Consensus reached on the technical support

National Steering Committee on

Migration Health(NSC)

NationalMigration

Health Task Force(MHTF)

Migration Health

Secretariat(Housed within the Ministry of Health, supported by IOM)

Comprised of Secretary/ Director General level representatives of the key Ministries such as Ministry of Health, Ministry of Foreign Affairs etc. Meets 2-3 times per year (or as per need) to decide on National policy decisions and inter-ministerial coordination issues forwarded by the MHTF

Comprised of Secretary/ Director General level representatives of the key Ministries such as Ministry of Health, Ministry of Foreign Affairs etc. Meets 2-3 times per year (or as per need) to decide on National policy decisions and inter-ministerial coordination issues forwarded by the MHTF

Comprised of technical focal points from each stake holder agency (Key Ministries, UN agencies, NGOs , Academics , Civil Society) that contributes actively to development and planning of the sectoral/ministry policies and programmes related to Migration Health. Meets once in 2 months

Comprised of technical focal points from each stake holder agency (Key Ministries, UN agencies, NGOs , Academics , Civil Society) that contributes actively to development and planning of the sectoral/ministry policies and programmes related to Migration Health. Meets once in 2 months The dedicated hub that

coordinates the National migration health agenda for Government of

Sri Lanka

The dedicated hub that coordinates the National migration health agenda for Government of

Sri Lanka

Inter-Ministerial & Inter-Agency Coordination Framework for Migration Health Development in Sri Lanka

Migration health policy process…..

• Drafting of TORs for National Steering Committee and Technical task force

• First NSC- approval of TORs

• Preliminary findings of RSA presented and the need for a National research agenda identified

Key government ministries

• Ministry of Health

• Ministry of Defense and Urban Development

• Department of Immigration

• Ministry of Social Services

• Ministry of Labor Promotion and Welfare

• Ministry of Finance and Planning

• Ministry of Economic development

• Board of Investment

• Ministry of External Affairs

• Ministry of Labour and labour relations

• National Institute for Occupational Safety and Health (NIOSH)

• Ministry of Education

• Ministry of Higher Education

• Ministry of Child Development and women’s Affairs

• National child Protection Authority

• Women’s Bureau

• Ministry of Justice

• Ministry of Civil Aviation

• Department of Census and Statistics

• National Child Protection Authority

• Sri Lanka Bureau of Foreign Employment

•

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Following the Rapid Situation Analysis….

• Technical task force – Identification of a national research agenda

• National steering committee approval to commission research studies on inbound, outbound, internal migration and of families left behind

The National research studies January to July 2011

1. Inbound study-

§Qualitative study using 31 Key informant interviews of employers in multinational companies, administrators and the foreign employees §Quantitative comparative study of 700 returning Sri Lankan refugee families, IDPs and host population

2. Families left behind study (Health issues pertaining to left behind family members)875 adults (care givers and spouses) and 820 children (420 migrant and 420 non migrant family children matched for age and sex, 295 school teachers

3. Outbound study- (Health issues pertaining to out bound migration)§Quantitative study of 1100 pre departure/potential labour migrant workers and 1150 returning labour migrant workers §Focus Group Discussions with GAMCA pre departure medical assessment centers, instructors of the SLBFE training centers, relatives attending family day, trainees at SLBFE training centers§Key informant interviews of Labour attaches and counselors from 7 Sri Lankan Missions abroad, Medical Doctor from receiving countries, MoH

4. Internal migration study (Health issues pertaining to Internal migration §Comparative study of 400 internal migrant workers and 200 non migrant workers in EPZ zones (Katunayake, Biyagama, Koggala, Seethawake)§200 migrant university students§125 school migrant students§75 agriculture workers

National research studies

• Conducted in 2011

• Research findings presented to a wider forum in October 2011

• Presentation of research findings followed by a discussion on recommendations ( actions, policies etc)

Migration Health policy

• Drafting of the policy

• Technical task force involved

• Finalized after presentations in several forums and made available for public comment

• Now forwarded for approval of the Cabinet of Ministers

Addressing issues relevant to migration health whilst the policy

process was ongoing

• Health assessment of inbound ( resident visa applicants)

• Strengthening IHR for Yellow fever

• Health issues of returning Sri Lankan refugees in India – steps taken to ensure access to PHC

• Health issues of stranded trafficked Sri Lankans

Health assessment of inbound ( resident visa applicants)

• Cabinet decision to implement Health assessment for Inbound resident visa applicants

• ( This decision was given even before the Migration Health policy for the three types of migration was finalized)

The approach/es

• Inclusive of all three types of migration• Involvement of key government ministries• Lead by Ministry of Health• Evidence based – rapid situation analysis, migration issues

and policy gaps, national research agenda• Responsive action to migration health challenges-

maintained the interest of stakeholders • Announcing our actions in global events

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REPORTING PROGRESSon WHA RESOLUTION

• www.migrationhealth.lk

Challenges• In the policy process – Advocating the leadership at

different levels in MoH ( bureaucratic hurdles when there are several departments , ownership, ….)

• for ministry of health - new area of work !

• focal point – has to be with public health background

• Technical support – lack of migration health development experience at country level – IOM support was crucial

• Implementation –– Permanent focal point within the MoH needed ( Where in the existing

departments can migration health be housed?- MCH/ Family health?, Quarantine? International health? Or do we need a separate department?)

– multi sector approach needs to be mainstreamed – cant stop at Policy development.

Challenges ……• Beyond country level - Implementation not possible

in isolation – some areas of concern may need a ‘one voice from a Region’ !

• facilitating bilateral meetings – generally not a health sector mandate but external affairs will have to work closely with Health sector

Monitoring

• Country level monitoring – should it be at a higher level than the MoH?. Note the large number of ministries involved – (eg MDG monitoring was housed in ministries of Finance as it was based on poverty alleviation)

• The data sources ? Currently routine health information systems do not capture

Way forward- national, regional, global

• National-

• Importance of national focal point within the ministry of health ( development/ implementation )

• Make necessary changes to the legal framework to adopt the policy . ( work in progress)

• defining indicators to measure progress of migrants health, health impact on country due to migration, social impact due to migration ( of families left behind) , ( gender analysis is important ,,,,,)

Way forward- national, regional, global

• Regional – Create opportunity to discuss common issues , learn from each others experiences, negotiate together where relevant

• Global – source and destination countries ( SL is both)

• Monitoring health of migrants and the impact of migration on countries public health is important – selection of indicators would depend on the migration profile of the country but there are common indicators i.e. monitoring access to primary health care , monitoring occupational injuries in migrant populations, monitoring of country level specific health outcomes that are potentially at stake due to health conditions of migrants, monitoring the freedom to migrate/ in a healthy way

Global advocacy – change in mind set!

• Health as a public good !

Thank you