1. 1st World, congress on Migration, Ethnicity, Race and Health
Internal Migration and Health: A Review of Policies and Initiatives in Low and Middle Income Countries (LMICs)
1st World, congress on Migration, Ethnicity, Race and Health
Diversity and Health
EICC, Edinburgh
17-19 May 2018
Dr. Anjali Borhade
Research Scholar, Nuffield Department of Population Health, Oxford University, Oxford, UK
Expert Advisor, WHO SEARO
Director, Disha Foundation, India

2. Literature Review Objectives : To gain an understanding of the :
State of urban migration in low, middle and high income countries
Healthcare services and healthcare needs of urban migrants
Policies to protect and promote the health of urban migrants

3. Definition of Study Population
Migrant workers -
Voluntary internal labour migration for paid work
Within the country - interstate and intrastate
Both permanent (residing in undeclared urban slum areas) and seasonal and circular migration (for 1-12 months in a year)
from rural-semi urban, rural-urban, urban-urban areas of India,
Who do not have legal citizenship of destination cities.

4. Literature Review Databases searched
Pub Med, Medline, Google Scholar, Advanced Google, Popline by K4 Health
Grey literature
Papers, reports from various agencies, regional forums and international conference proceedings, country official websites and government publications were also identified.

5. INCLUSION & EXCLUSION CRITERIA
Inclusion criteria: English
Primary empirical studies matching the objectives of the literature review between 1970 to 2014
Reports of conferences/ meetings matching the objectives of the literature review
Related to labour migrants who make the move for livelihood, within their countries.
Exclusion criteria:
Studies focusing on the following groups were excluded:
- International professional migrants
- Internal professional migrants (within country)
- Refugees/asylum seekers
The review is presented as a narrative synthesis of published empirical research and grey literature.
INCLUSION & EXCLUSION CRITERIA

6. Keywords
Low, middle, high income countries and Health policies for internal migrants, Health care for internal migrants, social inclusion of internal migrants, health problems faced by internal migrants, policies for improvement of health of internal migrants, health of migrant women and children, health of migrant workers, social inclusion policies for internal migrants, rural – urban migration and primary health care for internal migrants.
These keywords were used in combination with different low and middle and high income countries according to the World Bank’s classification of countries.

7. Figure 1: Flow Chart of Literature Review in low and middle income countries

8. Figure 2: Flow Chart of Literature Review in high income countries

9. Figure 3: Flow Chart of Literature Review in India

10. Literature Review – Key Findings
Literature Review is divided into three parts
1. Low and Middle Income Countries
internal migration is prevalent in LMICs. Majority of the LMICs have started addressing migrants’ social security and health needs. Examples include – Sri Lanka, China, Ghana, DRC Congo, Cameroon, and Vietnam
2. High Income Countries
internal migration is not an issue for high income countries, though it takes place, migrants do not face exclusion from social security services due to universalization of the social protection services including health.
3. India: Currently no comprehensive policy on internal migration, but fragmented policies for the protection of migrants do exist
Recently launched National Urban Health Mission plans to cover migrants in health programs, but no framework exist.

11. Key Findings in LMICs Country Policy Initiatives Sri Lanka China
Sri Lanka National Migration Health Policy is developed for internal and international migrants, adopted evidence-based & multi- stakeholder approach for promotion of the right to health for internal, in-bound and out-bound migrants and their families left behind in Sri Lanka.
China
No comprehensive migration policy exists. Reform of Hukou system –registration of urban and rural migrants
Vietnam
No comprehensive migration policy exists. Special efforts made to build a database on internal migration from 2009 census

12. KEY FINDINGS Country Policy Initiatives Thailand Mongolia
National Migration Policy exist but missing sharp focus on internal migrants. Policy emphasis with holistic and multi-sectoral approach for improving health of migrants laying emphasis on social and environmental determinant. Universal coverage of health security has introduced through social security and universal coverage schemes (UCS) to improve access of migrants to health care services
Mongolia
No comprehensive migration policy exists. Reach Every District (RED) strategy adopted for outreach to cover mobile and unregistered remote migrant population for improved access to immunization, maternal and child health and other health services

13. KEY FINDINGS Country Policy Initiatives Philippines Malaysia
No comprehensive migration policy exists. Presence of a legal framework for protection of migrants and IDPs, coordination between different departments, formation of human resource for Health Network- a multi-sectoral organization, special initiatives for migration and HIV, portable national health insurance
Malaysia
No comprehensive migration policies exist. Mandatory HIV Testing, Emphasis on accessibility to health care services in terms of physical, economic & information criteria Vision of Malaysian Govt.
Two tier health system with rural clinics & hospitals at district, state & centre level.

14. KEY FINDINGS Country Policy Initiatives Cameroon Ghana
No comprehensive migration policy exists.
Framework for the Proactive Governance of Internal Migration (F-PGIM) is set up with the goal of transforming internal migration into an engine of balanced national development and equitable and sustainable human development.
Ghana
Recent Creation of a National Migration Bureau (NMB)- an inter-ministerial committee later renamed as Migration Unit (MU)-task is to formulate National Migration Policy to mainstream migration into development plans
Democratic Republic of Congo (DRC)
No comprehensive migration policy exists. But efforts are made by National Government to incorporate migrant health into its overall programs and policies associated with the reform Strategy of the Ministry of Public Health

15. KEY FINDINGS Country Policy Initiatives India
Currently no comprehensive policy on internal migration exists. Comprehensive migration support program for tribal migrants in Maharashtra state started in 2013, to be soon extended in other tribal states of India
Interstate Migrant Workers Act 1979 provides comprehensive protection and welfare services to inter-state migrant workers

16. KEY FINDINGS Country Policy Initiatives India
Few states of India offers state health insurance to migrants
Portable National health insurance program ‘RashtriyaSwasthaBimaYojana’ is available.
Integrated Child Development Scheme provides health care services to migrant women, children and adolescents at destination cities.

17. KEY FINDINGS Country Policy Initiatives India
National urban health mission 2013 plans to cover migrants in the health programs.
Jharkhand and Rajasthan states have made provision for registration of out-migration at source areas.

18. Policy Gaps
Government policies and institutional measures are limited by the perception of that free migration is harmful
LMICs where migration health policies exist, they operate in isolation at national levels
Disconnect between policy and practice. Policy measures are not backed by the requisite research and evidence
Resources are rarely being directed at mobile and displaced populations and their needs are not addressed in national strategies and action frameworks

19. Policy Gaps
Policies overlook the human cost both of migrants and their families
Another major gap is in the form of implementation and regulation of laws, policies and programs

20. Moving the policy discourse on migrant health – from piecemeal efforts to whole government approach
Multi-sectoral approach is crucial to address diverse needs of migrants
Formation of a nodal agency and focal point for welfare of internal migrants
Formation of a database on internal migrants and development of an effective tracking system to counter their mobility
Universal coverage of health and social security program (social insurance, education, livelihood training, and housing) is crucial for migrants to get seamless access before and during their migration
Increase participation of migrant communities, migrants unions, and civil societies for pro-migrant policy formulations and implementation

21. Looking forward to learn from questions, comments and inputs
Thank you
Looking forward to learn from questions, comments and inputs