Title: Covid-19 deaths among migrant health care workers: risks and responses
Funder: Economic and Social Research Council

Abstract: The overarching aim of this project is to give proper attention to the place of migrants in health care workforces during the Covid-19 pandemic. It does this by strengthening the empirical evidence base of migrant health and care workers' risks of Covid-19 infection and death and of stakeholders' responses to those risks and pressure points on global health workforces more generally. Our objectives are therefore to: 1. Develop a method for enumerating migrant health care worker deaths and trial it for selected OECD and non-OCED countries. 2. Collect data on government, employer, trade union, and NGO responses to C19 threats to MHCWs and to the goal of HCWF-strengthening for universal health care (SDG 3, targets 3.8, 3C; SDG 8, target 8; SDG 10, targets 10.3, 10.4 (UN, 2015)). 3. Use findings to: influence stakeholders' understanding of MHCWs' risks of C19 infection and death, and their responses to pressure points on global health workforces. Securing this data could help strengthen public and private policy measures to protect health care workers, reduce workplace harms and increase staffing capacity to deliver essential Covid-19 (and other) care and health services (see also: Academic Beneficiaries; Case for Support). The project organisation and workplan to realise these objectives are based on clear roles and responsibilities of each staff member, matched to time allocation on the project (see: Justification of Resources, Staff Duties). Time-bound aims, resources, milestones and deliverables will be defined and regularly reviewed. The project is wholly online and undertaken through desk-based research: team communication uses video conferencing, telephone and email. Dedicated project e-workspace supports project coordination, provides a secure data repository, document storage, and a collaborative writing facility. Proven research skills, combined with cross-cultural sensibilities, appropriate delegation, flexibility and adherence to equality, diversity and inclusion will be core features of the team ethos and working practices and of project management.

Lay abstract: There is a paucity of robust empirical evidence about whether migrant health care workers have the same level of exposure to Covid-19 infection and deaths as non-migrant health care workers, and whether variations exist between sectors (as between the health and social care sectors) and countries (as between higher income and lower income countries). Such empirical evidence on what responses have emerged in the face of threats to the resilience of health and care workforces and to realising the global goal of universal health coverage worldwide is also weak. Weak surveillance systems and fragmented reporting systems mean that special investigations to properly monitor Covid-19 impacts on health care workers and workforces are required by national and international decision-makers. This project aims to give proper attention to the place of migrants in health care systems during the Covid-19 pandemic. Migrant workers are of substantial and growing significance in many countries' health and care systems and are key to realising the global goal of universal health care so it is vital that we understand much better how Covid-19 is impacting on them. The project's overarching research question is, in the relation to Covid-19, what risks do migrant health care workers experience, what are the pressures on resilient and sustainable health care workforces, and how are stakeholders responding to these risks and pressures? In addition to strengthening the empirical evidence base on the risks of Covid-19 infection and death among migrant health care workers our project also tracks collective responses to such risks and challenges to sustainable health workforces for universal health coverage. We collect qualitative and quantitative data on Covid-19 risks, pressures and responses using different methods and techniques. We undertake a systematic literature review (SLR) of academic and non-academic publications using hybrid review methodologies to search for data and content analysis methodology to extract data of interest and evaluate the methods and findings of studies and publications. Coverage of three global languages - English, Spanish and Arabic - ensures greater ethnolinguistic reach and inclusivity of the SLR. We also develop a research method to estimate Covid-19 migrant health care worker mortality rates and trial the method, undertaking statistical analysis and modelling using quantitative data drawn from WHO and OECD data and other demographic and bio-statistical data as available. In addition, we collect data through interviews and documentary analysis on the responses of stakeholders (employers, trade unions, NGOs) to chart emerging patterns of response relating to health care worker training, recruitment, retention, deployment, international migration, and challenges for migrant health care worker protection at work consistent with international recruitment and employment norms. We involve key stakeholders from diverse communities of policy and practice during the research process, designed to have demonstrable potential for impact by meeting their time-critical requirements for robust empirical and analytical evidence about the multidimensional impacts of Covid-19 on health care workforces. This project is attuned to the urgent need for high quality data and for 'real world' solutions-focused Covid-19 research forged from collaboration. We are focused on the immediate application of proof-of concept findings to a rapidly-evolving global health crisis.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: INFECTION