Accessing health services in India: experiences of seasonal migrants returning to Nepal

Abstract

Background Migration to India is a common livelihood strategy for poor people in remote Western Nepal. To date, little research has explored the degree and nature of healthcare access among Nepali migrant workers in India. This study explores the experiences of returnee Nepali migrants with regard to accessing healthcare and the perspectives of stakeholders in the government, support organizations, and health providers working with migrant workers in India. Methods Six focus group discussions (FGDs) and 12 in-depth interviews with returnee migrants were conducted by trained moderators in six districts in Western Nepal in late 2017. A further 12 stakeholders working in the health and education sector were also interviewed. With the consent of the participants, FGDs and interviews were audio-recorded. They were then transcribed and translated into English and the data were analysed thematically. Results The interviewed returnee migrants worked in 15 of India’s 29 states, most as daily-wage labourers. Most were from among the lowest castes so called-Dalits. Most migrants had had difficulty accessing healthcare services in India. The major barriers to access were the lack of insurance, low wages, not having an Indian identification card tied to individual biometrics so called: Aadhaar card. Other barriers were unsupportive employers, discrimination at healthcare facilities and limited information about the locations of healthcare services. Conclusions Nepali migrants experience difficulties in accessing healthcare in India. Partnerships between the Nepali and Indian governments, migrant support organizations and relevant stakeholders such as healthcare providers, government agencies and employers should be strengthened so that this vulnerable population can access the healthcare they are entitled to.

Low-Wage Agricultural Migrant Workers in Apulian Ghettos, Italy: General Health Conditions Assessment and HIV Screening

“…Few data are available on the health status of migrant workers in Europe, but previous studies in Nepal, Tanzania and Ethiopia have documented a low prevalence of HIV in migrant farm workers, low condom use, high risk of risky sex and high prevalence of malnutrition, and reinforce the need for screening for diseases related to a poor quality of work and life, which is strongly correlated with tuberculosis and non-communicable diseases, such as hypertension and diabetes, and overwork illnesses, such as rickets, asthenia, muscle/fatigue pain and mental health illnesses [ 11 , 12 , 13 , 14 ].…”

Specification of Policy for the Barriers to Care and Treatment of Nepali Migrants Living with HIV/AIDS in India

“…A recent qualitative study conducted by Adhikary et al (2020) found that "migration to India continues to be livelihood strategy for Nepali male workers, especially unskilled migrants. The researchers concluded that most migrants had di culty accessing healthcare services in India and low wages, lack of documentation, identity card, the now ubiquitous Aadhar, biometrics, lack of insurance, apathy of employers and discrimination in Indian healthcare facilities were some of the reasons that acted as barriers to healthcare and low healthcare utilization.…”

“…The researchers concluded that most migrants had di culty accessing healthcare services in India and low wages, lack of documentation, identity card, the now ubiquitous Aadhar, biometrics, lack of insurance, apathy of employers and discrimination in Indian healthcare facilities were some of the reasons that acted as barriers to healthcare and low healthcare utilization. The authors conclude that institutional ties between the two governments have to be strengthened and more migrant support organizations with support for health care and employer accountability must be enhanced (Adhikary et al, 2020).…”

Use of telehealth services among Nepali living overseas during Covid-19 pandemic: The opportunities, limitations, lessons learned and recommendations

“…In accordance with the well-recognized global disease burdens, Nepali migrants suffer from several health issues that include but are not limited to heart diseases, renal diseases, mental health issues that lead to suicidal ideation and attempts. 6 , 7 , 8 , 9 Unpublished data from the Middle East show the health seeking behavior is low among Nepali migrants as they tend to be of younger population demographics and they do not visit a doctor or clinic until the health situation is serious.…”