Restrictive migration policies in low-income and middle-income countries
Authors: Lavanya Vijayasingham, Emma Rhule, Nima Asgari-Jirhandeh, Pascale Allotey
Journal: The Lancet Global Health (2019)

Sol Pia Juárez and colleagues' analysis1Juárez SP Honkaniemi H Dunlavy AC et al.Effects of non-health-targeted policies on migrant health: a systematic review and meta-analysis.Lancet Glob Health. 2019; 7: e420-e435Summary Full Text Full Text PDF PubMed Scopus (66) Google Scholar of the effects on migrant health of non-health-related migration policies (April, 2019) strengthens the case for policy coherence and for a health-in-all-policies approach to migrant health. The scope of their discussion, however, excluded consideration of the contexts of the global south and of low-income and middle-income countries (LMICs). Aptly highlighted in the linked Comment by Kayvan Bozorgmehr and Rosa Jahn,2Bozorgmehr K Jahn R Adverse health effects of restrictive migration policies: building the evidence base to change practice.Lancet Glob Health. 2019; 7: e386-e387Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar the conversation should also extend to the practical entry points for translation of evidence to influence policy change. In response to these points, we call attention to some dimensions of non-health policies in southeast Asia (to represent the global-south and LMIC contexts), and briefly suggest how national health-system actors could use current global windows of opportunity to advocate for and pursue policy change both within and beyond the health sector. Despite burgeoning international anti-migration sentiments, now is an opportune time for migration-policy advocacy and reform. The Global Compact on Migration3UN General AssemblyGlobal Compact for Migration. United Nations General Assembly, New York (NY)2018Google Scholar has been signed and adopted at a global level—despite some notable opt-outs. There are continuing discussions and programme developments in migrant and refugee health policy within the World Health Assembly (WHA) and WHO. Recent developments include a WHA resolution for member states to prioritise and strengthen migrant and refugee health within national contexts, the establishment of a global framework of priorities and guiding principles (2018),4WHOFramework of priorities and guiding principles to promote the health of refugees and migrants.https://www.who.int/migrants/about/framework_refugees-migrants.pdfDate: 2018Date accessed: April 12, 2019Google Scholar and a Global Action Plan,5WHO Executive BoardEB144/27 Agenda item 6.4: promoting the health of refugees and migrants—Draft global action plan, 2019–2023.http://apps.who.int/gb/ebwha/pdf_files/EB144/B144_27-en.pdfDate: 2018Date accessed: April 3, 2019Google Scholar presented at the WHA 2019. These initiatives promote the mainstreaming of migrant and refugee health in global, regional, and country agendas, including in the pursuit of the Sustainable Development Goals and universal health coverage, which also includes the task of addressing the influences of non-health sectors on health through intersectoral, intercountry, and interagency collaborations. Although these global policy developments offer local and national actors a window of opportunity to drive necessary policy change forward, actors must also be well positioned and skilled to tactfully identify, deconflict, and balance policy dynamics across levels, sectors, and actors. Alignment of relevant socioeconomic policies—such as rights to engage in decent work and income generation, access to health care without risk of catastrophic or impoverishing financial risks through health or social insurance, and structural protection against exploitation, abuse, and harm—is integral to migrants' access to care and health outcomes. For example, in Malaysia, refugees can use public health services at subsidised out-of-pocket costs. Additionally, the Malaysian office of the UN High Commissioner for Refugees negotiated a (currently suspended) voluntary private health insurance scheme for refugees. However, both initiatives are often unaffordable for refugees because they do not have the right to engage in formal-sector work and generate income.6Chuah FLH Tan ST Yeo J Legido-Quigley H The health needs and access barriers among refugees and asylum-seekers in Malaysia: a qualitative study.Int J Equity Health. 2018; 17: 120Crossref PubMed Scopus (65) Google Scholar In this situation, a non-health-related policy undermines the health-sector programmes. Policy change to provide work rights to refugees is required to optimise the benefits of health access and financing arrangements. In the global south, restrictive policies are also imposed by source countries, sometimes for positive reasons, including those of economic strategy and human security. For example, Myanmar and Cambodia have implemented gender-based restrictions on formal routes of migration as a safety measure following reports of abuse and exploitation of their female nationals in destination countries.7Myint G Building labour migration policy coherence in Myanmar. International Labour Organization, Yangon2017Google Scholar In another example, Laos bans migration for work that does not develop skills or knowledge, endangers safety and health, or contradicts traditional Laotian values. Domestic work is considered a grey area of this policy, and government officials tend to reject the applications of their country nationals who seek overseas work through formal channels.8International Labour Organization Regional Office for Asia & the PacificTripartite Action to Protect Migrant within and from the GMS from Labour ExploitationČhulālongkōnmahāwitthayālaiInstitute of Asian StudiesAsian Research Center for MigrationRegulating recruitment of migrant workers: an assessment of complaint mechanisms in Thailand. International Labour Organization, Bangkok2013Google Scholar Whether these policies are successful in preventing migration is debatable. For instance, in Thailand, 90% of migrant domestic workers from Myanmar are registered; by contrast, just 4% of Laotian domestic workers are registered.9Schloenhardt A Trafficking in persons from Cambodia, Lao PDR and Myanmar to Thailand. UN Office of Drugs and Crime Regional Office for Southeast Asia and the Pacific and Thailand Institute of Justice, Bangkok2017https://www.unodc.org/documents/southeastasiaandpacific/Publications/2017/Trafficking_in_persons_to_Thailand_report.pdfDate accessed: March 1, 2019Google Scholar These policy effects are likely to have implications on care-seeking and health-financing arrangements and ultimately, on health outcomes. Further research, advocacy, and capacity-building to support policy change and coherence across sectors are required, including managing the complex broader economic and sociopolitical dynamics that lead to non-health policies that produce negative health consequences in migrants. Ultimately, health system actors need to adopt a health-in-all-policies approach and be active and responsible promoters of policy coherence across national and local levels to ensure the health of migrants. Among the many other requirements necessary to achieve reform, health-system actors cannot only use strong and objective evidence but must also be prepared to engage in the long-term process of identifying mutually beneficial incentives and outcomes across sectors and administrative levels in order to formulate joint and cohesive strategic plans and adapt the policy architecture itself. NA-J reports that Asia Pacific Observatory (APO) on Health Systems and Policies is a partnership that is funded by Asian Development Bank, World Bank, WHO-Regional Office for the Western Pacific, WHO-Regional Office for South-East Asia and the governments of Australia, South Korea, Hong Kong Special Administrative Region (China), Thailand, Philippines, and Singapore. Representatives of these governments sit on the APO Board. The board has approved APO research on migrant health issues but does not influence the methodology or outcome of the research. All other authors declare no competing interest. Effects of non-health-targeted policies on migrant health: a systematic review and meta-analysisRestrictive entry and integration policies are linked to poor migrant health outcomes in high-income countries. Efforts to improve the health of migrants would benefit from adopting a Health in All Policies perspective. Full-Text PDF Open Access