Governance emerges as a new theme in development cooperation; defined as a reform strategy and a particular form to strengthen both public institutions and of civil society with the objective of making them more accountable, open and transparent and more responsive.
This brings together older concepts of stakeholders’ rights and public accountability with recent interpretations of citizenship and policy at global level. The degree of policy responsiveness to the, refugees, poor citizens and migrants and the extent to which there is an impact on poverty are determined primarily by the politics of local-central relations and policy context. The translation of good governance into better migration and health policies is expected to happen via positive participatory and bottom up approaches of public institutions and civil society.
Migrants and refugees are some of the few who go through one of the largest epidemics of lack of healthcare access and coverage. Healthcare allows for coverage of medical services and in most cases, coverage for prescription drugs and sexual reproductive health rights. However, with refugees and migrants living in a different country besides their native one, they are most likely not provided healthcare. This lack of access causes increased susceptibility to disease and infections that migrants and refugees have never been exposed to, that disable the treatment of severe illnesses. Migrants and refugees worldwide should be entitled to have access to one of the most basic human necessities – healthcare. Universal healthcare or the creation of an individualised health system (policies) for migrants and refugees may be a solution to help divert this lack of healthcare access.
Policies
In today’s world, approximately one per cent of the world’s population (7.7 billion) is made up of refugees and migrants. According to Gale Group, there are approximately 68.5 million people who were displaced worldwide, 40 million being forcibly displaced, 25.4 million being refugees, ‘half of whom are children under the age of 18’, and 3.1 million being asylum seekers. Developing responsive migration and health policies that will provide healthcare to medically uninsured immigrants and refugees will not only be human, but will also contribute to development economics in the long-run. Many migrants and refugees are ‘not granted public health insurance in countries that receive them and cannot afford to pay for healthcare expenses out of their pockets.
Many are unemployed, live in deprived neighbourhoods and have an increased risk of ethnic and social vulnerability that influences their health negatively. They are also at a greater risk for an array of health issues due to unsafe travel through unsanitary and poorly resourced settings, which causes exposure to ‘physical and psychological’ dangers. Besides the increased risk for disease and infections, there is a rising concern that refugees and migrants’ health needs are not always adequately met, according to the World Health Organisation, which should be a concern. Migrants and refugees face many challenges in accessing healthcare due to their ‘legal’ status, language barriers, and discrimination. This calls for the development of responsive and positive participatory migration and health policies that provide healthcare services to all migrants and refugees, irrespective of their legal status.
Development
The rhetoric of sustainable development has become the accepted response to challenges faced by immigrants and refugees in contemporary societies. As the concept becomes more widely accepted among international organisations, politicians, policymakers and the public, evidence is building about its practical significance. Attention is increasingly focusing on the relative roles and responsibilities of citizens, individuals and institutions, local and national spaces, in translating statements of intent into practical actions. In the context of immigrants and refugees this demonstrates the existence of wider involvement in the debate of what these important actions mean for national and international debates surrounding sustainability and community.
Although most hosting countries extend a principle of some kind of medical screening upon arrival, many refugees do not benefit from these services and the quality of the screening programmes is questionable. There are also many legal restrictions that impede refugees’ access to healthcare. Access to healthcare is also impeded due to migrants and refugees being excluded from most national health systems designed to address the needs of citizens. This demonstrates that poor access to healthcare services interacts with discrimination and limited social rights thereby reinforcing exclusions as a root cause of ill-health among migrants and refugees, as well as restrictions with great variation in entitlements.
