A systematic literature review of reported challenges in health care delivery to migrants and refugees in high-income countries - the 3C model

Abstract

Background Migrants and refugees have important health needs and face inequalities in their health status. Health care delivery to this patient group has become a challenging public health focus in high income countries. This paper summarizes current knowledge on health care delivery to migrants and refugees in high-income countries from multiple perspectives. Methods We performed a systematic literature review including primary source qualitative and quantitative studies between 2000 and 2017. Articles were excluded if the study setting was in low- or middle-income countries or focused on skilled migration. Quality assessment was done for qualitative and quantitative studies separately. Predefined variables were extracted in a standardized form. Authors were approached to provide missing information. Results Of 185 identified articles, 35 were included in the final analysis. We identified three main topics of challenges in health care delivery: communication, continuity of care and confidence. All but one study included at least one of the three main topics and in 21/35 (60%) all three topics were mentioned. We further developed the 3C model and elaborated the interrelatedness of the three topics. Additional topics identified showed that the specific regional context with legal, financial, geographical and cultural aspects is important and further influences the 3C model. Conclusions The 3C model gives a simple and comprehensive, patient-centered summary of key challenges in health care delivery for refugees and migrants. This concept is relevant to support clinicians in their day to day practice and in guiding stakeholders in priority setting for refugee and migrant health policies. Electronic supplementary material The online version of this article (10.1186/s12889-019-7049-x) contains supplementary material, which is available to authorized users.

The global COVID-19 response must include refugees and migrants

“…This outbreak of the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) will also shed light on pre-existing challenges, such as the refugee crisis, which are converging with the pandemic [1]. It is now crucial that the unique needs of the refugee and migrant population are included in the global response to COVID-19 [2].…”

Regional primary health care organisations and migrant and refugee health: the importance of prioritisation, funding, collaboration and engagement

“…Almost 30% of Australia’s population were born overseas, 1 and over the past 10 years, Australia has accepted more than 170,000 refugees 2 . While health status may vary somewhat by migrant cohort (and in some contexts be affected by the ‘healthy migrant effect’ 3 ), in general, it is recognised that a combination of pre‐migration, migration and post‐migration factors mean the health service needs of people from migrant and refugee backgrounds are more complex than for many other Australians 4–6 . In particular, people from refugee and asylum‐seeking backgrounds (hereafter ‘refugees’) have worse health outcomes, especially in relation to mental health 7,8 …”

“…2 While health status may vary somewhat by migrant cohort (and in some contexts be affected by the 'healthy migrant effect' 3 ), in general, it is recognised that a combination of pre-migration, migration and postmigration factors mean the health service needs of people from migrant and refugee backgrounds are more complex than for many other Australians. [4][5][6] In particular, people from refugee and asylum-seeking backgrounds (hereafter 'refugees') have worse health outcomes, especially in relation to mental health. 7,8 Primary health care (PHC) plays an important role in addressing the health needs of migrants and refugees.…”

Refugees and Rehabilitation: Our Fight Against the “Globalization of Indifference”

“…7,8 Once refugees and their families arrive in a host country, they have likely been exposed to prolonged periods of forced displacement, long periods of unmet basic needs, and contact with physical trauma, along with exposure to infectious and others diseases. [9][10][11] Additionally, global refugees populations, over half of which are children, have also been exposed to protracted psychological trauma. The collective effect of these events on physical, emotional, and mental wellness is of great concern.…”

“…12 Once they arrive in a host country, refugees experience other challenges such as language barriers, along with new and different cultural norms that can create essential obstacles in meeting basic needs. 9 As a result of their experiences, refugee populations are likely to present with a series of complex and complicated health and wellness manifestations, including impairments, activity limitations, and participation restrictions. The global aggregated rates of disability are known to be approximately 15%; however, given exposure to protracted violence and other factors, refugees are more likely, on average, to experience short-and long-term disability.…”