A Dive into Universal Health Coverage (UHC) for Migrants

UHC for migrants is not only a matter of humanitarian concern but also a strategic and ethical approach that benefits both migrants and host communities. It promotes a healthier, inclusive, and resilient society.

Universal health coverage (UHC) is defined as “all people and communities, having access to the basic health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship” (WHO, 2020).   According to WHO, the objectives of UHC are:

• equity in access to health services – everyone who needs services should get them, not only those who can pay for them;
• the quality of health services should be good enough to improve the health of those receiving services; and
• people should be protected against financial risk, ensuring that the cost of using services does not put people at risk of financial harm (WHO, 2020).

The second Online Sensitisation Series on Migration and Health, organised by the Centre for Health Ethics Law and Development (CHELD), in collaboration with the African Union (AU) and with the generous support of Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH was focused on the inclusion of migrants in the Universal Health Coverage (UHC).

The session highlighted the importance of comprehensive healthcare accessibility for all individuals, regardless of their migration status. Dr. Nsofor, one of the session’s speakers, initiated the session with a participatory exercise using Mentimeter, aimed at understanding the diverse perspectives and knowledge levels regarding UHC.

 

The Vital Question: Who is Covered?

The question of “Who is Covered?” was one of the central focus of discussions surrounding Universal Health Coverage (UHC), defining the scope of “all individuals” under UHC. The word “universal” in UHC emphasizes the idea of universality inherent in the concept.  Migrants, regardless of category, are thought to be included in the concept. The consensus was that health coverage should extend to migrants, irrespective of their legal status, in line with the principle of non-discrimination. Thus, identifying and addressing disparities within African Union Member States (MS) is crucial to achieving true universal coverage in healthcare access. The concept of “basic healthcare services” was explored. It was agreed that services should encompass a wide range, from primary care to specialised services such as maternity and mental health support. The goal is to provide comprehensive care and protection to all individuals.

What is Covered? Access and Challenges for Migrants

The components of UHC include improved access to needed, effective services while protecting users of healthcare systems from financial ruin/hardship. Access to healthcare, especially for migrants, presents distinct challenges. High out-of-pocket expenditures, language barriers and disparities in healthcare provision across different regions were discussed. Prof. Onyemelukwe discussed the importance of healthcare delivery and highlighted the need for intercultural competence and people-centered care in healthcare facilities which should be sensitive to the diverse cultural backgrounds of the people. Throughout the session, she encouraged participants to scrutinize the language used in policies and legislation related to UHC to ensure that it promotes inclusivity and doesn’t exclude migrants. Additionally, Prof. Onyemelukwe provided examples from Kenya, Italy, and Thailand to illustrate different approaches to including migrants in UHC. Some countries struggle to provide adequate healthcare for irregular migrants, underscoring the importance of addressing these issues comprehensively. Mental health was recognized as a vital aspect of healthcare for migrants because people move for various reasons. As a result, mental health services must be included within UHC, acknowledging the unique challenges faced by migrants and refugees.

What health services are most important to migrant populations?

Primary health care remains one of the most important drivers for achieving Universal Health Coverage. It provides the best way to address health comprehensively, including communicable and non-communicable diseases, maternal health & child care, and mental health demographic challenges including those posed by migration.

Experience Sharing from Ghana

Dr Ernest Asiedu, a former head of quality and safety at the Ministry of Health in Ghana and currently at the National Center for Coordination of Early Warning and Response Mechanism (NCCERM), provided an overview of Ghana’s vision and mission for the health sector.

He presented an overview of Ghana’s health system, which is characterized by its pluralistic nature, including both orthodox and traditional alternative medicine, as well as a mix of public and private sectors. He discussed the importance of universal access to health services and the role of the National Health Insurance Scheme in Ghana’s healthcare financing. Dr Asiedu talked about the challenges and bottlenecks facing the Ghanaian healthcare system, including issues related to the availability of CHPS and the migration of healthcare professionals to other countries. He also highlighted the need for better availability of essential medicines, diagnostic services, and medical supplies.

Ghana’s commitment to achieving UHC by 2030 dates back to 1978 when the country committed to the Alma Ata Declaration. Dr Asiedu discussed the role of primary healthcare and the model Ghana is implementing, emphasizing the need for efficient and interconnected healthcare facilities, especially in rural areas. He presented various strategies to address these challenges, including efforts to strengthen governance, engage communities, and improve domestic resource mobilization. Dr Asiedu also shared data on healthcare indicators, showing progress in areas such as maternal health and infant mortality while acknowledging that further improvements are necessary. He went ahead to introduce Ghana’s “community scorecard,” which is a tool used to assess the quality of healthcare services based on nine primary indicators, empowering communities to provide feedback and demand better care. Dr Asiedu emphasized the importance of communities mobilizing themselves to support healthcare facilities, sharing initiatives where communities assisted in building construction, water provision, and other support.

Overall, Dr Asiedu discussed Ghana’s approach to achieving UHC through the “network of practice,” strengthening primary healthcare and interconnected healthcare facilities. He also underlined the role of telemedicine and emergency transport in enhancing healthcare delivery. His presentation provided insight into Ghana’s efforts to achieve UHC and its challenges, along with strategies and initiatives to improve healthcare services and ensure that all residents, including migrants, have access to quality care.

Challenges to UHC Identified During the Session Plenary

• The diversity of backgrounds and cultures among migrants. Different groups may have specific health needs and cultural beliefs to be considered when developing healthcare programmes. Generally, participants emphasized the heterogeneity of migrant populations. Migrants come from various countries and regions, and they have diverse backgrounds and experiences. This diversity can make it challenging to create one-size-fits-all healthcare programs.
• Language barriers were identified as a significant challenge. Migrants often speak different languages, making it difficult for healthcare providers to communicate effectively and provide the necessary care. Overcoming language barriers is crucial for ensuring migrants receive adequate healthcare.
• Participants noted that migrants may face stigma and discrimination, both within the healthcare system and in society at large. Stigma can deter migrants from seeking healthcare services and negatively impact their well-being.

• Socioeconomic factors were identified as playing a role in migrants’ access to healthcare. Migrants, particularly those in irregular situations or with limited financial resources, may face additional barriers to accessing healthcare services.
• Participants emphasized the critical role of human resources in health. Even if funding is available, the expertise and healthcare professionals are essential for providing healthcare to migrants. The shortage of healthcare workers is a significant challenge that needs to be addressed.
• The issue of brain drain, where healthcare professionals migrate from African Union Member States (MS) to other countries, was raised. It was mentioned that strategies and policies to address brain drain would be discussed further in the next session of the meeting.
• The challenge of undocumented migrants who often face extreme difficulty accessing healthcare services. Their undocumented status can result in exclusion from healthcare systems, putting their health and well-being at risk.

Tackling the Limitations of UHC in Africa

Participants highlighted the need for coordination between different ministries and agencies, such as those responsible for health and humanitarian affairs. Effective collaboration is essential to ensure that policies and programs address the complex needs of migrants. Recognizing the heterogeneity of migrants, the importance of tailoring healthcare programs to specific migrant groups was emphasized and programs are required to consider factors such as language, culture, and socioeconomic status. Healthcare providers should receive training and support to develop cultural competence, enabling them to understand and address the unique needs of migrant populations. Cultural competence can help healthcare workers build trust and rapport with migrants.

Participants discussed the importance of including migrants in healthcare data. They stressed the need to recognize migrants as part of the population when collecting healthcare data and formulating policies. Data should reflect the diverse groups of migrants. It was noted that ensuring access to basic healthcare should be seen as a shared responsibility among member states of the African Union and the global community. Providing basic healthcare is a fundamental human right and a duty that transcends borders.

Insights from Experience Sharing

1. Policy Reform and Implementation: To continue dialogue on healthcare policies and best practices, with an emphasis on encouraging governments to adopt successful UHC models from African Union Member States (MS) that have excelled in Universal Health Coverage and consider implementing similar strategies in their respective countries.
2. Stakeholder Collaboration: Fostering collaboration between governments, NGOs, international organizations and relevant stakeholders will ensure a holistic approach to addressing migrant healthcare needs.
3. Advocacy and Funding: We ought to encourage advocacy for increased funding and resource allocation for migrant healthcare services. Increased funding will support migrant healthcare initiatives and lead to the launch of collaborative research projects to gather more data on migrant healthcare challenges, outcomes, and best practices.
4. Community Engagement: There is a need to engage local communities and migrant groups to gather insights and feedback on their healthcare experiences by leveraging their skills and involving them in healthcare delivery. To also establish community-led initiatives to bridge gaps in healthcare access and provide culturally sensitive support.
5. Feedback Loop: create a feedback mechanism for participants and stakeholders to continuously provide input, share experiences, and report on the effectiveness of key steps taken to improve migrant health.

The Online Sensitisation Series is intended to provide a platform for collaboration, learning, and advocacy to ensure the well-being of migrants within the African Union Member States (MS). Together, we strive for a future where the health of migrants is not just a priority but an integral part of our shared pursuit on the African continent.