Creating better healthcare for refugees and migrants

Photo by Ahmed Akacha on Pexels
16 January 2023

This article first appeared in Research Australia's INSPIRE Magazine and has been republished with permission.

This century has seen the number of migrants who are forcibly displaced grow. People who are forcibly displaced are no longer only people fleeing persecution and war. They now include a growing number of people displaced due to the impacts of climate change. Increased weather events such as flooding, bushfires and droughts are affecting people’s food security, housing stability, and livelihoods, forcing them to become climate refugees.

Refugees often arrive to a country of destination with physical and mental health issues associated with the danger in the country they left, or because of the circumstances they faced in transit. They can also develop health issues because of the living and working conditions, and cultural barriers they experience in the new country.

Additionally, a large migrant workforce moves between poorer countries to richer countries to provide domestic, manufacturing, construction or agricultural labour. This results in large numbers of people trying to access, often restricted health services, and navigate unfamiliar health care systems in a new country.

In fact, 281 million people (3.6% of the world’s population) live outside the country they were born in, and many have difficulty accessing the health care they need. As a result, there is a growing need to ensure refugees and migrants receive equality of care.

The introduction of Global Competency Standards for health care workers working with migrants and refugees released by the World Health Organisation (WHO) earlier this year, does just that. The standards provide guidelines for operationalisation, and guidance for health organisations to build the standards into curricula.

The evidence-informed Global Competency Standards are the first ever global competency standards in this area, and are a collaboration between the Australian National University (ANU) and the Migration Council of Australia - which auspices the Australian Migrant and Refugee Health Partnership.

Utilising the WHO Global Competency Framework for Universal Health Coverage, the standards for health workers were developed under five domains: people centredness, communication, collaboration, evidence-informed practice, and personal conduct.

Global Competency Standards in action -  A case study

Ivan is one of the at least 12 million people who is displaced due to the ongoing war in Ukraine. He has arrived in a neighbouring country with his only son remaining in Ukraine to fight. He is 75 years old and diabetic. Just prior to the Russian invasion, his wife of 40 years passed away. His wife and son managed his medication when they lived in Ukraine so he is unfamiliar with how much medication he takes.

Upon examination, the health care worker notices he has high blood pressure. They initially try to communicate in Russian, however, the young health worker isn’t fluent in Russian so calls upon a Ukrainian interpreter to help with the consultation. Through the consultation they realise that Ivan will need instructions and support in administering his medication. He is also struggling psychologically because of his wife’s passing. He is feeling isolated and lonely and unsure about his or his son’s future.

The health worker discusses with Ivan the foods he’ll need to eat to lower his blood pressure, ensures he has written instructions and understands how to measure his glucose and administer his medication, and advises where he can access the medications he needs for free. The health worker also refers Ivan onto psychology and social support services.

After the consultation, the workers debrief. The interpreter who is originally from Ukrainian has grandparents who are in the conflict zone. The consultation with Ivan has made her think about her own grandparents. The health worker provides the interpreter an ear to share her feelings providing her emotional support.

The case study, adapted from a case provided by the WHO, demonstrates the Global Competency Standards, as follows:

People centeredness relates to the importance of quality care and continuity of care. It reflects behaviours from the health worker to empower refugees and migrants to be the agents of their own health care by arming them with knowledge about the health system and information to increase their health literacy.

Communication behaviours ensure health workers are mindful of language, cultural, gender and age differences and take these into account when working with migrants and refugees. Employing appropriate aids, such as an interpreter, to ensure the patient understands the medical information provided to them.

Collaboration encourages health workers to engage appropriate community and social supports, including legal, education, employment, and housing – all of which lead to better outcomes for the migrant or refugee. It also calls for workers to recognise that surges in demand for services need a flexible and team approach.

Evidence-informed practice promotes the reliance on evidence, or generating evidence, when responding to a migrant’s or refugee’s health needs in planning and delivery of care.

Personal conduct highlights the need for ethical and culturally sensitive behaviour towards migrants and refugees, and the need for self-care (physical and mental) and mutual support between health care workers.