Health Services For Migrants Research Articles

Get out of life on the edge: The role of urban public health services on migrants’ social integration in China

AbstractPublic health services for migrants are not only related to their health status, but also crucial to their social integration in the host cities. Using data from the 2017 China Migrants Dynamic Survey, we examine the impacts of urban public health services on migrants’ social integration. We find a positive correlation between the accessibility of public health services among migrants and their social integration. Research on the mechanisms reveals that obtaining public health services contribute to social integration by improving migrants’ health status, fostering the alignment of hygiene practices with those of local residents and promoting family migration. Heterogeneity analysis shows that the positive impact of public health services on social integration is notably pronounced among migrants engaged in informal employment, lacking social security, holding rural hukou and having a relatively brief duration of residence in the host cities. This paper presents valuable insights into migrants’ social integration which is a critical issue for policymakers. By improving the accessibility of public health services, migrants will better integrate into host cities. The findings may be instructive for promoting urbanization in China and other countries.

Health Care Access and Equity Among Migrants: A Literature Review

Background: Health inequality often occurs among disadvantaged population groups, including migrants. Currently, the migrant population does not always receive adequate health services. In addition, the health care system is not optimized for migrants, especially in terms of language, access, genomic data and the expertise of medical personnel. The health condition of these migrants is a global problem that needs attention if countries want to meet the Sustainable Development Goals (SDGs) targets by 2030. Purpose: to map the latest existing research on the topic of migrant health, both qualitative and quantitative. Methods: narrative literature review and literature search were carried out using an electronic database with the automatic selection feature used in the electronic database according to the specified inclusion criteria. Results: Obtained an overview of inequality in [1] access to health services for migrants in general, [2] utilization of health services and health-seeking behavior, [3] health literacy, [4] health services related to the COVID-19 pandemic, and [5] maternal and child health services. All authors agree on this division of groups. Conclusion: Migrants who do not have documents or are illegal, skin color (black migrants) who migrate to western countries, languages ​​that are not the same, and do not understand their own health conditions due to lack of health education due to language barriers, these factors are obstacles for migrants to achieve equality in countries where migrants have migrated.

Factors Influencing Thai Health Workers’ Attitudes toward Providing Health Services to Migrants

Many migrants currently use local Thai healthcare services while living and working in Thailand. Health workers’ attitudes toward providing health services to migrants significantly influence the quality of their healthcare. This study aimed to describe and compare health workers’ attitudes toward providing health services to migrants between health professionals and supportive health workers and examine the personal and system factors that predict health workers’ attitudes towards health services. A cross-sectional design was applied in this study. A total of 1,356 health workers in Thailand were selected using multi-stage random sampling. The research instruments included the Migrants’ Cultures and Contexts Questionnaire and the Health Workers’ Attitudes toward Providing Health Services to Migrants Questionnaire. Data were analyzed using the Mann-Whitney U test and binary logistic regression.Most health professionals (91.05%) and supportive health workers (91.71%) had positive attitudes toward health services for migrants. The appropriateness of health workers’ numbers and knowledge about migrants’ cultures and contexts could mutually influence the health workers’ attitudes, accounting for only 3.6% of the variance. Reinforcing positive attitudes among health workers can be done by providing praise for good health services. However, further studies on the accessibility, quality of care services, cost, and migrants’ satisfaction are needed before appropriate intervention and policy can be improved.

Migrant Health Policy in European Union (EU) and a non EU country: Current situation and future challenges for improvement

Aim: The influx of refugees, asylum seekers and migrants in Europe is an ongoing reality and migrant health has become very important public health problem. The aim of this paper is to analyze and compare the health profile, migrant situation and migration integration health policy in Spain as a European Union (EU) country and Republic of North Macedonia as a country in process of European Union accession. Methods: Migration Integration Policy Index (MIPEX) Health strand questionnaire (2015) was applied to compare health policies for migrant integration in both countries. Results: There are differences between Spain and Macedonia in health care coverage and access to health services for migrants. Spain has health strand total score of 52 and is in the same group with Austria, Ireland, Belgium, Netherlands, Denmark and Sweden. Macedonia has lower health strand total score 38 and is in the same group with Turkey, Cyprus, Slovakia. Targeted migrant health policies are stronger and services more responsive in Spain compared to Macedonia which offers migrants legal entitlements to healthcare, but health services should be more culturally responsive to migrant health needs. Conclusion: Health migration policy in both countries is closely tied to the general immigration policy.

Sociodemographic disparities in the establishment of health records among 0.5 million migrants from 2014 to 2017 in China: a nationwide cross-sectional study

BackgroundMigrants account for a large part of China’s population. Many policies and inventions have been taken to improve access to public health services and the health of migrants. China’s Basic Public Health Services(BPHS) are a series of public health services in this policy domain, which aims at promoting the access of public health sevices and improve health equity of residents. The establishment of health records is the fundamental service of BPHS. However, there is little known about the establishment of health records among migrants in China, which hinders the more efficient provision of health services for migrants, and health equity is difficult to achieve. Based on the research gap, this study aims at showing the sociodemographic disparities in the establishment rate of health records, and identifying priorities and recommendations for promoting health equity of migrants in China.MethodsThis study used national data from China Migrants Dynamic Survey (CMDS) from 2014 to 2017 to evaluate the sociodemographic disparities in the establishment rate of health records and utilization of relevant public health services. The study included 539,926 respondents. Following the descriptive statistics of migrants, we showed the establishment rate of health records by sociodemographic characteristics and migrating related characteristics. Multivariate analysis was conducted to explore the associations between sociodemographic charicteristics, migrating related charicteristics and the establishment of health records.ResultsThe establishment rate of health records among migrants in the sampled years were 22.99, 38.44, 27.29% respectively, and 29.18% in general, and there existed heterogeneity in the establishment rate of health records by sociodemographic charicteristics and migrating related charicteristics. Female migrants who were older, from middle age, married or living with partner, with higher educational attainment, with urban household registration, migrated for longer time, migrated for the reason of studying or family issues, migrated in province were more likely to establish health records.ConclusionThere existed sociodemographic disparities in the establishment rate of health records and inequalities in the utilization of health records services among migrants in China. Migrating related characteristics also had impact on the establishment status. Policies should take both supply side and demand side of health services to improve the health equity of migrants, which means that relative departments should continue to invest in primary healthcare centers to improve their ability to provide services as well as migrants’ health literacy.

Associations of Elements of Parental Social Integration with Migrant Children's Vaccination: An Epidemiological Analysis of National Survey Data in China.

Our study explored the effects of parental social integration on migrant children’s vaccination status in China. Using data obtained from the 2014 China Migrants Dynamic Survey, a total of 4915 participants were included in this study. Social integration was measured by economic, social, cultural, and internal identity. Univariate chi-square testing was used to calculate associations between all variables and migrant children’s vaccination status. Binary logistic regression was employed to calculate the impacts of social integration on migrant children’s vaccination status. In total, 94.7% of migrant children had complete vaccinations for their age. Migrants who had medical insurance, spoke the native language when communicating with locals, lived mainly with locals, and did not perceive discrimination were more likely to have their children completely vaccinated. Social integration was positively associated with migrant children’s vaccination status. Our study indicated that to improve vaccination coverage of migrant children, more policy support for migrant employment and housing, promotion of health services for migrants, and language support in health institutions is needed.

Health education services utilization and its determinants among migrants: a cross-sectional study in urban-rural fringe areas of Beijing, China

BackgroundDomestic migration poses a challenge for China as migrants have little access to preventive healthcare services and are vulnerable to certain risks and diseases. This research sought to unveil and explore the determinant factors associated with health education utilization as a key aspect in basic public health services for migrants in Beijing, China.MethodsA sample of 863 inter-provincial migrants, 18 years old and above, was selected by three-stage stratified cluster sampling method in urban-rural fringe areas of Beijing during 2016 to 2017. Face-to-face structured interviews were conducted in the questionnaire survey. The effects of the explanatory variables on health education utilization from predisposing, enabling, health behaviors and need variables were used to demonstrate by Anderson health service utilization model.ResultsThe study revealed that 61.6% migrants desired to receive health education, while only 53.8% of them received in the past year. There were differences in the utilization and needs of health education among the migrants in different ages and genders. Many migrants desired to gain access to various types of health education information from the internet. Chi-square independence test lists such major determinant factors in migrants whole health education as age, “Hukou” registration system, marital status, education level, long-term residence plan in Beijing, one or more children in Beijing, employment status, housing source, average daily working time, exercises, health knowledge, smoking, self-rated health. The binary logistic regression indicates that the migrants with younger age, high education level, one or more children in Beijing, exercises and good self-rated health were more likely to receive whole health education. The results also show that average daily working time of enabling variables and exercise of health behavior variables were the strong and consistent determinants of three types of health education utilization, including communicable, non-communicable and occupational diseases.ConclusionGaps exist between the needs and utilization in health education and more attention should be given to the migrants with heavy workload and low education level. Feasible policies and measures, such as multiple health information channels, should be vigorously implemented to ensure equitable and easy access to health education for migrants.

Percepción de los derechos de salud para la población migrante en Chile: análisis desde Twitter

ObjectiveTo describe the different perceptions about health rights for migrant population in Chile published on Twitter, concerning the first liver transplant carried out in Chile to a foreign national woman from Haiti, in September 2018. MethodQualitative study, case analysis. The case corresponded to the first emergency liver transplant in a migrant woman in Chile. Opinions expressed on Twitter regarding this case were collected between September 29 and November 17 (n=339). Thematic analysis was performed using NVivo12 software, with codes defined conforming to the objective. ResultsAccording to the perceptions raised on Twitter, the right to access health services of the migrant population in Chile should be limited, and priority should be given to nationals. These opinions coexist with viewing health as a human right. There are also feelings of racism and discrimination towards this group. ConclusionsIn Chile, there are different perceptions of what should grant rights of access to migrant health services. This situation can generate a worsening of stigmatization and vulnerability faced by migrants and a barrier to the policy's implementation, further exacerbating the presence of health inequities.

Improving the utilization of essential public health services by Chinese elderly migrants: strategies and policy implication.

BackgroundThe concept of healthy aging has become a global health strategy in response to the population aging. In China, old-aged migrants are facing serious health care challenges due to the obstacles in the utilization of health services, social integration and ignored public policies. We aimed to examine the old-aged migrants’ utilization of the essential public health services and its underlying factors on account of change of residence, and social support.MethodsData came from the senior sample (aged over 65 years, n = 11 161) of the 2015 National Migrant Dynamic Monitoring Survey in China that employed Probability Proportionate to Size method as a sampling strategy. χ2 tests and binary multilevel model were conducted to analyze the difference and the underlying factors of the utilization of essential health services among old-aged migrants.ResultsApproximately 66.2% of old-aged migrants did not receive free physician examination services from health institutions in the past year, and 34.6% of old-aged migrants with chronic disease have been followed up by doctors. There were significant differences in the utilization of essential public health services among old-aged migrants across different individuals and families. It showed that exercise time, migrating range, migrating reason, physical health condition, chronic disease, local friends, health insurance, household expenditure, and income were significantly associated with the elderly migrants’ utilization of essential public health services.ConclusionsThe utilization of essential public health services among old-aged migrants was insufficient in comparison with the general population. The government should launch targeted policies such as production and work-related injuries for the floating population. The supply side should promote the equalization of essential public health services for migrants. Social organizations and community should undertake the responsibility in social support for old-aged migrants.

Current status of the intercultural opening at hospitals and rehabilitation centres for psychosomatic medicine and psychotherapy in Bavaria.

Objectives: Intercultural opening of the health care system is supposed to optimize health services for migrants. It is part of the National Integration Plan and promoted by medical societies in Germany. This study examines its state of implementation at hospitals and rehabilitation centres for psychosomatic medicine and psychotherapy in Bavaria. Methods: A written survey was conducted using a modified version of the questionnaire for the implementation of intercultural opening in the mental health care system IKÖ-P (Penka et al. 2012a). Results: Altogether 18 institutions responded. Migrants were underrepresented among patients and employees excluding physicians. Specialized psychotherapeutic interventions for migrants were rarely available, but frequently used when offered. Conclusions: Intercultural opening was poorly implemented in a structural level. Due to the low response-rate of 21.7 % the survey is not representative. Participation of institutions interested in intercultural opening could have led to biased results. To provide adequate psychosomatic medical care for migrants, intercultural opening should be further developed.

Health for all? A qualitative study of NGO support to migrants affected by structural violence in northern France.

France hosts approximately 368,000 'persons of concern' (e.g. refugees, stateless, people in refugee-like situations, asylum-seekers). Northern France has become a focal area, due to its proximity to the Dover entry-point to the UK and larger numbers of migrants. This study used a structural violence lens to explore the provision of health services to migrants in Calais and La Linière in northern France, to contribute to discourse on the effects of structural violence on non-state service providers and migrants in precarious conditions and inform service provision policies. Our qualitative study design used semi-structured key-informant interviews, conducted in summer 2017 with 20 non-governmental service-providers, 13 who had worked in Calais and 7 in La Linière migrant camp. We analysed interviews thematically, using inductive coding. Themes from analysis were: (i) power dynamics between NGOs and the state; (ii) resource allocation and barriers to accessing services; and (iii) effects of structural violence on social determinants of health. NGO service provision varied due to tense power dynamics between state and NGOs, shifting state requirements, and expanding roles. Interviewees described ongoing uncertainties, and inherent disempowerment associated with humanitarian aid, as negatively affecting migrant health and wellbeing, increasing illness risks, and providing unequal life chances. Structural realities including violence appeared to negatively affect migrant social determinants of health, reducing healthcare access, social inclusion, and sense of empowerment. The role of NGOs in providing migrant health services in northern France was complex and contested. Structural violence negatively affected migrant wellbeing through restricted services, intentional chaos, and related disempowerment. The violence exerted on migrants appeared to diminish their life chances while being an ineffective deterrent, indicating better approaches are needed.

Advocating migrant and minority health in Bulgaria through an innovative education subject

Abstract Introduction Migrants and ethnic minorities often face serious inequities concerning their access to good quality health services. The Statement by the European Public Health Association on migration, ethnicity and health addresses the need of supporting public health policy makers by providing education courses. The objectives of the teaching course “Migrant and minority health”, established in Medical University-Pleven in Bulgaria as optional additional subject, is to extend the specific knowledge of students (bachelors and masters of public health) and to develop competencies and skills of future public health practitioners and policy makers. Results The unique for Bulgaria course consists of 15 academic hours of the curriculum and ends with an electronically based test. Teaching methods include lectures, seminars and individual practical assignment and stresses on practice rather than theory. The training advocates migrant and minority health by presenting: the most important migrant’s social and health problems; impact of migrants’ health status on public health; the organization of healthcare in the recipient countries of migrants. The lecture course provides information for the main challenges facing healthcare professionals and the health system regarding the health of the migrants and main minorities groups, in particular the Roma as a predominantly ethnic minority in Bulgaria and Europe. The result of exam until now is good in 42.8% of students, very good in 14.2% and excellent in 42.8%. The curse enable public health professionals to acquire knowledge regarding to the international situation, critical assessment skills and the ability to implement appropriate strategies to address specific health problems. Conclusions The training meets the needs of in-depth knowledge of public health specialists in relation to the medical and social problems of migrants and minorities in Bulgaria. The positive experience gives ground to include it as part of basic curricula. Key messages The subject “Migrant and minority health” enhances student’s competencies as public health practitioners. Knowledge and skills are relevant to the EUPHA Statement on migration, ethnicity and health. By the subject “Migrant and minority health” public health practitioners may work to establish friendly health system with good quality of health services for migrants and Roma population in Bulgaria.

Cura della salute e sistemi sanitari: il caso dei migranti in Europa

In these globalization times, one of the most compelling challenges is the adaptation of welfare systems, especially health systems, to the requests that migration and mobility impose. The European Union (EU) presents in its Member States (MS) highly differentiated situations in terms of healthcare systems, models, financing systems and policies of integration adopted towards foreign citizens. Compared to other countries with a longer migrant tradition, there are still significant differences in access and use of health services by intra-EU migrants and migrants from third countries in the EU, further diversified according to the legal status of the latter. In parallel, the historical hypothesis of the healthy migrant effect - which states that migrants have a better state of health than natives and second generation in their countries of destination, has been replacing by the exhausted migrant effect. Concurrent mechanisms - such as poverty, discrimination suffered in the labor market, the journey undertaken and the living conditions offered by the host countries or the delay and exclusion from civil and political rights - can influence the opportunities of migrants in terms of healthcare received and diseases suffered, influencing the deterioration of their state of health over time and at every stage of the migration project. Looking at the relationship between the Migrant In-tegration Policy Index (Mipex) carried out by the Migrant Policy Group in 2015 and the values extracted from Eurobarometer (2014): on the vertical axis, the health policies in support of migrants in the EU MS are reported while the percent-ages of people who replied Good to the question: How do you evaluate the overall quality of your healthcare system? are on the horizontal axis. As it can be seen, clusters of countries emerge: from those we will try to analyze the economic-financial peculiarities of health systems to the adaptation to new health needs of migrant citizens, reporting the empirical evidence related to some case studies (in particular, Germany, Italy, United Kingdom and Spain). Starting from the traditional types of health systems, a more specific aim of this contribution is to estab-lish a relationship with the costs and performance of the response to the assistance request of migratory origin. In health economics, it is becoming more and more evident that the health of migrants is a major challenge. Health poses a serious problem of inequality and social exclusion in destination societies: understanding the variables, founders and co-founders, is a fundamental exercise to study the determinants of access, use and quality of health services for migrants. The de-fense of the sustainability of health systems on the funding side is a prerequisite for this great challenge to be tackled and won in Europe.

Evaluation of the Medical Interpreter and Patient Guidance Training in the Migrant Health Services: The Case Study in Turkey

Turkey is a country that embraces many migrants from Africa and the Middle East especially in the last 10 years due to its geopolitical position. The number of Syrian refugees in Turkey as of February 2019 is reported to be 3.644.342. In particular, benefiting from the most basic human rights such as nutrition, education and health of migrants is an issue given the importance by the Republic of Turkey. In this context, important cultural differences arise for the immigrants. Language is an important obstacle to access to health services, especially in Arabic speaking patients. In order to facilitate access to health services and to improve the quality, a project has been developed covering the training and employment of medical interpreters and patient guides by the Turkey’s Ministry of Health and the World Health Organization. With this project, 960 medical translators were employed and trained 2016 to 2019. The research provides an evaluation covering the training phase of this project. In this context, the aim of the study is to evaluate the effectiveness of the training program. In the study, an interactive training program, including medical terminology, health sector organization of Turkey, communication skills and medical ethics was implemented to the bilingual interpreters and patient guides. Participants completed a 50-question pre-test and post-test designed to evaluate the effectiveness of the training. Training was deemed successful as all participants scored higher on the post-test than the pre-test. The results obtained from the research include important lessons that guide the planning of similar trainings.

Access to health care for migrants in the Greater Mekong Subregion: policies and legal frameworks and their impact on malaria control in the context of malaria elimination.

The launch of the Global compact for safe, orderly and regular migration in December 2018 marked the first-ever United Nations global agreement on a common approach to international migration in all its dimensions. The global compact aims to reduce the risks and vulnerabilities migrants face at different stages of migration, by respecting, protecting and fulfilling their human rights and providing them with care and assistance. A key example of the intersection of the right to health and migration is seen in the Greater Mekong Subregion (GMS) - comprising Cambodia, Lao People's Democratic Republic, Myanmar, the People's Republic of China (Yunnan Province and Guangxi Zhuang Autonomous Region), Thailand and Viet Nam. The GMS has a highly dynamic and complex pattern of fluctuating migration, and population mobility has been identified as an important concern in the GMS, since five of the six GMS countries are endemic for malaria. Based on the concept of universal health coverage, and as endorsed by the 61st World Health Assembly in 2008, migrants, independently of their legal status, should be included in national health schemes. This paper summarizes work done to understand and address the legal obstacles that migrants face in accessing health services in the GMS countries, and the impact that these obstacles have in relation to elimination of malaria and containment of artemisinin resistance. Despite efforts being made towards achieving universal health coverage in all the GMS countries, no country has current health and social protection regulations to ensure migrants' access to health services, although in Thailand documented and undocumented migrants can opt for acquiring health insurance. Additionally, there is a lack of migrant-inclusive legislation in GMS countries, since barriers to accessing health services for migrants - such as language and/or socioeconomic factors - have been scarcely considered. Advocacy to promote legislative approaches that include migrants' health needs has been made at global and regional levels, to overcome these barriers. Assistance is available to Member States for reviewing and adopting migrant-friendly policies and legal frameworks that promote rather than hinder migrants' and mobile populations' access to health services.

The Study of Welfare Level of Migrants in Malaysia

The purpose of this study was to determine the level of understanding of migrant communities in Malaysia. This research used descriptive qualitative technique by using interviews and documentation of the data. The type of data is primary data and secondary data. Primary data is collected by interviewed of resourcers and observation or open observations related to the welfare of migrants while Secondary data is obtained by searching through the internet in relation to information about the welfare situation of newcomers and documents that have been published by the relevant agencies. The results are obtained as follows: 1. For the income of migrants, they felt that their income is sufficient to fulfill their needs, some migrants could send money to their home countries 2. The Malaysian government paid attention to the education of immigrant children by allowing them to attend public schools except foreigners without permit. Malaysia also gave permission to foreign countries to establish expatriate schools for residents who live in Malaysia so that they can obtain education in accordance with the curriculum and language of the country of origin. 3. In general, the place of residence of migrants is in a place far from the center of the crowd, because they want a cheaper rental price. In term fulfilling food or consumption needs, the migrants claimed to have no problems, because the consumption costs were quite cheap 5. Health services for migrants were relatively cheap at around RM15 for those who became Unlicensed Foreigners

Addressing healthcare for migrants and ethnic minorities in Europe: A review of training programmes

Background: The global phenomenon of migration has dramatically changed the social context in which healthcare professionals operate. European states are facing a growing need to effectively train healthcare professionals to understand and respond appropriately to the diverse needs of migrants and ethnic minorities. While many European Union (EU) countries have adopted specific initiatives, there is considerable variation in these activities and few examples of evaluation of the quality of these training courses. Aims: This article describes findings from a review conducted as a part of the ‘Training packages for health professionals to improve access and quality of health services for migrants and ethnic minorities, including the Roma (MEM-TP)’ project, which sought to identify and assess training programmes for health professionals delivered in Europe between 2004 and 2013. Methods: The review and analysis of training materials comprised three components: (1) a review of the published and unpublished literature, (2) a survey addressing national contact persons, and representatives of international organisations and non-governmental organisations and (3) an assessment of the quality of the training programmes identified. Results: The review showed that training programmes tend to be characterised by low levels of participant involvement in training development, delivery and evaluation. Training programmes often lacked an explicit pedagogical approach, did not systematically focus on outcomes in training design, implementation and evaluation, and were poorly linked to key organisational and policy support. Finally, while cultural competence continues to be the broad conceptual approach used in training programmes, alternate approaches such as intersectionality, equity and person-centred care are emergent. Conclusion: Training programmes in Europe can be further improved in order to ensure an effective response to the diverse needs of patients, carers, health professionals and the community.

Utilization of prevention and health promotion among migrants

Abstract The uptake of existing preventive and health promotion offers by migrants in Germany is rather heterogeneous, and major information gaps are noted. Current results provide limited evidence that migrants and their children seem to use prevention and health promotion services less frequently than non-migrants. In order to improve access to preventive and other health services for migrants, a combination of migrant-specific and migrant-sensitive approaches seems to be useful.

1.10-P15Health providers in France: how do they find a way to meet migrants' needs?

Background: The Mig-HealthCare project aims to strengthen a community based care model to minimise health inequalities and improve the integration of vulnerable migrants and refugees into local communities. The project is funded by the European Commission for three years and has been deployed in ten European Countries. Firstly, the health profile of vulnerable migrants is described, and then need for health services is defined. A roadmap for a community based care model and pilot health services are developed. We present findings from interviews and focus groups discussions (FGDs) with health providers in facilities receiving vulnerable migrants in France. Methods: As a pilot we interviewed four professionals in the field. From these preliminary results we developed a hypothesis that we tested in FGDs. We conducted three FGDs with health providers (doctors, nurses, social workers, cultural mediators) in different settings in France (Paris, Calais, Nantes) with both NGOs and hospital providers who receive migrant patients. We focused on needs, expectations and capacities of health services. We interviewed 21 health professionals in total and performed a qualitative content analysis. Results: Health providers explained the difficulty of providing care for migrants in the context of increasing patient numbers and decreasing funding. In order to develop a coherent route for migrant patients, they highlighted the support of a shared common culture based on protocols and shared values, and the importance of interinstitutional and interprofessional work. Moreover, professionals highlighted the interpersonal, informal and trusted links between health providers and other professionals that allow them to meet migrants’ needs. Conclusion: In a difficult context, professionals providing health services for migrants base their practices on the construction of trusted links and social networks. This however involves the continuous activation of networks, formal and informal. In order to meet migrants’ needs, health providers tend to base their practices on networking and trusted links.

Health concerns of migrants and refugees

Migration is a process of social change during which a person moves from one cultural setting to another in order to settle for a longer period of time or permanently. If internal and international migrants are being taken in to account, it would be the third most populous country in the world, just after China and India. The collective health implications of this sizeable population are considerable and are not often in accordance with their need, thus raising concerns with regard to equity, social inclusion and cohesiveness. During different phases of migration, Linguistic, cultural and legal factors are amongst the major barriers in accessing basic health services for migrants. Hence a migrant sensitive inclusive health system equipped with trained work force should be formally established by inter country, inter regional and international framework to address this complex issue-Migration.