How Can National Health Systems Absorb Millions of Migrants?

Migration in the Latin America and Caribbean (LAC) region has increased in volume and complexity in the past two decades. Venezuelan migration is the largest human movement in the region’s recent history, with an estimated 5 million people having left Venezuela since 2015. More than 2 million people are estimated to have left El Salvador, Guatemala, and Honduras since 2014.

Population movement of this magnitude places huge stress on health systems in receptor countries. How can health care for migrants be financed? How can health system capacity be expanded? And how can health sector policies and national migration policies be harmonized?

For migrants, stressors include structural and financial barriers to access to care in a new country and the loss of social connections. Personal and household stress, the COVID-19 pandemic, and intersectional factors such as poverty, gender, and ethnicity add to migrants’ vulnerability. Women, who are about half of migrants in the LAC region, are particularly vulnerable to violence and political and socioeconomic instability -- some of the very factors that drive migration in the first place, according to a literature review conducted by USAID’s Local Health System Sustainability Project (LHSS). Xenophobia within host communities, particularly among people who themselves lack access to quality health services, can create tension and affect service delivery to and use by migrants.

Focusing on equity and quality

“An equitable health system affords every individual a fair opportunity to attain their highest level of health regardless of social or demographic factors, with particular emphasis on underserved, socially excluded, and vulnerable populations.” – USAID Vision for Health System Strengthening 2030

The LHSS Project is collaborating with governments and partners in Peru, Colombia, and the Dominican Republic (DR) to sustainably increase access to high-quality, appropriate health care services for migrants and vulnerable host communities. Each country faces unique migrant health contexts and experiences.

The collapse of the public health system in Venezuela – including its HIV treatment program – is a main driver of migration for people living with HIV. In Peru, host to over 1 million migrants, many Venezuelans with HIV have experienced long interruptions in treatment and changes in treatment regimens, both before and during their migration journey, and some arrive with advanced disease. LHSS is collaborating with Peru’s Ministry of Health to ensure adequate, reliable, and sustainable provision of testing, prevention, treatment, and care services for migrants living with HIV.

In Colombia, the government has committed to granting temporary protected legal status to around 1 million undocumented Venezuelan migrants, which will allow them to work legally and access essential social and health services. LHSS recently facilitated participatory action research in La Guajira and Valle del Cauca, to understand the contextual and cultural factors affecting both migrant and vulnerable host communities’ access to primary health care. The latter include indigenous communities, who have traditionally lacked equitable, quality health services. Our findings, to be published this summer, will help the government, civil society, and partners improve primary health care policies and practices at the community level to respond to migrants’ diverse needs while also recognizing the capabilities, resources, and networks that migrants already possess and use to tend to their health.

Quality health systems are “responsive to patient and population needs and utilize data-informed, continuous process improvement to consistently provide safe, effective, trusted, and equitable health care and medical products to improve and maintain health outcomes for all people.” – USAID Vision for Health System Strengthening 2030

LHSS is also collaborating with the Colombia Ministry of Health to improve the quality of care provided to Venezuelan migrants. The ministry’s new Quality Division is aligning its priorities with the National Quality Policy and Strategy and the Migrant Health Policy, with LHSS support. LHSS is also assessing the systemic and individual factors that contribute to stress and burnout among health workers who provide services to Venezuelan migrants; findings will be used to develop strategies to improve the resilience of Colombian health workers and health systems.

The Dominican Republic (DR) is simultaneously an origin, transit, and destination country for migrants. LHSS is supporting efforts by the Ministry of Health, Ministry of Finance, and other government agencies to adapt, sustainably finance, and implement a social health protection platform to provide comprehensive coverage for women migrants. Because Haitians are the DR’s largest migrant group, and because national policy has stripped DR citizenship from descendants of undocumented Haitians, LHSS is assessing the barriers faced by women of Haitian descent and working with local partners to build support for a feasible approach to expanding their access to social health protection.

Stay tuned

Learnings from these USAID-supported activities will help answer key questions: How can governments develop migrant health policies that consider diverse types of migrants and their needs? What factors promote or impede access of migrants to high-quality health services? Stay tuned to the LHSS website for more coverage of these cutting-edge issues.

Rachel Taylor is a Health Systems Strengthening Advisor at the LHSS Project consortium partner Save the Children. She serves as LHSS Senior Technical Advisor for Equity.

Sodzi Sodzi-Tettey is a Vice President at the LHSS Project consortium partner Institute for Healthcare Improvement. He serves as LHSS Senior Technical Advisor for Quality.