Summer Institute on Migration and Global Health
U C Berkeley, June 26th, 2012
Good Practices and efforts to address Migration and Global
Health Issues: an Operational Framework
International Organization for Migration (IOM)
Dr.K.Wickramage
Head, Health Programs, IOM SRI LANKA
Learning Objectives &
Presentation Outline
• Contextualize migration health
in view of global health goals
• Review some good practices
in light of the four main ‘pillars’
of action set by the Madrid
IOM-WHO Consultation
• Lessons learnt in
implementation of the WHA
resolution on health of
migrants
1. The WHA resolution and
the IOM-WHO Global
Consultation in Madrid
2. Putting WHA resolution
into action – examples
from around the Globe
3. The Sri Lanka Case Study
Global Migration Trends
1 Billion Migrants World Wide
215 million international migrants (UNDESA)
740 million internal migrants (UNDP)
(includes 15 million refugees (UNHCR)
by 2050 ...405 million international migrants
(World Bank)
“Human mobility has been
identified as one of the most
important geo-phenomena of
our era. Today, there are
more people on the move
than at any other time in
recorded history” - GFMD
Overview of Asian Migration Trends
• Some of the countries/areas that
are most affected by international
migration are in Asia.
• Approximately 2.5 million Asian
migrant workers leave their
countries every year to work
abroad.
• 760 every day leave SL!!
4
• Countries in Asia can be roughly classified
Migration
according to their international
migrationStatus
status
– “mainly sending”...(COLOMBO process)
– “mainly receiving”.. (Abu Dhabi Process)
– “both receiving and sending”
eg. Sri Lanka & Thailand
5
Remittances to Asia (by year)
4.1Bn to 5.1Bn 2011
• Migration Heath agenda addresses the physical, mental and
social needs of migrants, and the public health needs of
hosting communities through polices and practices
corresponding to the emerging challenges facing mobile
populations today”
Migration Health for the Benefit of All. IOM Council Session,
Migration as a Social Determinant of Health
• Policy and strategy
across sectors
• Availability of
strategic data for policy
change
• Language and cultural barriers
• Health literacy
• Immigration status
• Health-seeking behaviours
•service access barriers
• Lack of targeted
health information
• Gender norms
• Service availability,
location, hours of
operation
• Safety & security
• Relationship with
“host” community
• Community
leadership
• Sensitivity of
services
• Living and working
conditions
• Stigma, xenophobia,
social exclusion
8
Potential health consequences of migration
Sexual & Reprod
Emotional Functional
Social impact
Occupational risks
Health
consequences
Mental Health
Psychological
substance
abuse
Infectious &
unattended
chronic conditions
Physical trauma
determine health status via SDH lens...
HOW TO IMPLEMENT THIS STRATERGY??
World Health Assembly Resolution on Health of
Migrants (WHA 61.17)
Calls upon Member States:
“to promote equitable access to health promotion and care for
migrants”
“to promote bilateral and multilateral cooperation on migrants’
health among countries involved in the whole migration
process”
World Health Assembly Resolution on Health of
Migrants (WHA 61.17)
Calls upon Member States:
“to promote equitable access to health promotion and care for
migrants”
“to promote bilateral and multilateral cooperation on migrants’
health among countries involved in the whole migration
process”
IOM Conceptual Framework for Migration Health Action at Country level (Mosca & Wickramage)
OUTBOUND
emigration
INTERNAL
migration
4 pillars of WHA resolution
Cross
cutting
issues
Multi-sectoral action (e.g. health, labor, social
protection, development, security ….)
Public Health aspects (e.g. communicable disease,
NCDs, Mental Health, social and health burden…)
Economic and Financial Aspects (remittances, who pays?, resource costs for health system, insurance
schemes, private/public..)
13
Migrant FLOWS* and STAGES of migration
Pre-departure
In transit
Migrant and
Mobile
Populations
•Resident Visa applicants
At destination
Families
of left
behind
migrants
1.
2.
3.
4.
Upon return
Out bound migration: Refers to the movement of people out of the country and encompasses categories such as Labor migrants, irregular
migrants, trafficked victims, unregistered workers etc.
In bound Migration: Refers to people moving into the country, and encompasses categories such as students, foreign migrant workers,
tourists, returning refugees and failed asylum seekers etc.
Internal Migration: Refers to the flow of people within a country’s internal borders, and includes categories such as free-trade zone
workers, those workers in Board of Investment (BOI) industrial zones, seasonal workers, internally displaced people and students.
Families left behind – either spouses and/or caregivers, children etc of left migrants and mobile population.
*Wickramage, Peiris, Perera, Mosca (2010)
Stakeholders by stage of migration
Pre-departure
In transit
At destination
Upon return
15
IOM Conceptual Framework for Migration Health Action at Country level (Mosca & Wickramage)
OUTBOUND
emigration
INTERNAL
migration
4 pillars of WHA resolution
Cross
cutting
issues
Multi-sectoral action (e.g. health, labor, social
protection, development, security ….)
Public Health aspects (e.g. communicable disease,
NCDs, Mental Health, social and health burden…)
Economic and Financial Aspects (remittances, who pays?, resource costs for health system, insurance
schemes, private/public..)
16
1. Monitoring Migrant Health
4 pillars of WHA
resolution
a.
Develop health information systems
b.
Standardization & comparability of migrant
health data
c.
Migrant health research
a. Migrant health information systems
• IOM Health Assessment Program - (Migrant Management
Operational System Application) includes all health data for
the US Refugee Admission Program for timely dissemination to
CDC, US Dept of State.
- understand morbidity trends (nutritional
status of children under 5)
-standardized data collection
- comparability of data using ICD10
Classification
-Electronic real time-transfer of quality
information to partners
c. Migrant health research
• Research provides an EBM model for developing
migrant health policies and programs
• Recommended objectives of migrant health research
are, to
– increase data collection on health status and outcomes for
migrants
– monitor migrants’ health seeking behaviours
– access to and utilization of health services
2) Policy and legal frameworks
4 pillars of WHA
resolution
Development and review of a. Global, Regional and
National [policy & legal]
frameworks on migration
health
b. Capacity building,
Guidance and standards
for countries
c. Social protection in health
for migrants
a. Global frameworks
• The International Convention on
Protection of Rights of all Migrant
Workers and Members of their
Families, Articles 28, 43, 45
• International Covenant on
Economic, Social and Cultural
Rights, Article 12.1, general
comment no. 14
• UN General Assembly Special
Session on HIV/AIDS (UNGASS,
2001) – Call for strategies to
facilitate HIV/AIDS prevention
programmes for migrants and
mobile workers.
a. Regional frameworks
1. 15 nations in Southern Africa: “SADC framework on
population mobility and communicable diseases
(CDs)” Provides guidance on the protection of the
health of cross- border mobile population
2. “Council of Europe Committee of Experts on
Migration, Mobility and Access to Healthcare” on
migrants’ living conditions, entitlement to and
access & quality of healthcare, as well as general
guidelines for migrant health action in the EU Member
States.
a. National frameworks
Zambia
In September 2010, a new HIV policy
for the transport sector by the
Ministry of Communications and
Transport (MCT)
addresses HIV for mobile workers in
the transport sector.
b. Social protection policies for migrant’s
health
Model of a funding/insurance system for migrants in the
Philippines Philippine Overseas Workers Welfare
Administration (OWWA):
•
Fully-funded by a mandatory membership fee of US$25
per contract for migrants going abroad as temporary
workers.
• Memorandum of Instructions No. 006, Series of 2009 establishment of Medical Rehabilitation Program for
eligible mentally ill and physically disabled OFW members
3) Migrant Sensitive Health Systems
4 pillars of WHA
resolution
a. Migrant Inclusive
Health Policies
b. Migrant-friendly
health services
a. Migrant Inclusive Health Services
Mexico
Developed and is implementing the Comprehensive Health
Care Strategy for Migrants, with a designated focal point
in the Ministry of Health responsible for its implementation.
Includes
• Health Informational Booths (ventanillas de salud)
• Leave Healthy, Return Healthy (vate sano regressa sano)
• Repatriation of gravely ill countrymen
• Health promotion on the northern border
• Insurance schemes at low costs
a. Migrant Inclusive Health Services/Policies
Spain: The Strategic Plan for Citizenship and Integration 2007–
2010 (Plan Estratégico de Ciudadanía e Integración).
• Each region of Spain has a specific plan adapted to the local migrant
typologies and needs.
• For example, in Almeria:
– sensitization and training of health professionals,
– community mobilization/campaign
– promotion of equitable access to health services.
With the integration of migrants every body gains.
We gain in economic growth, quality of life, in cultural diversity
b. Migrant-friendly services
Health ASSESSMENT
Europe – 1,700
Programmes
Asia – 50,000 refugees
Nepal, Thailand, Malaysia
USRAP, Resettlement to Canada, Australia,
New Zealand, EU and other countries
Refugee Population
Africa and Middle East – 38,000
Kenya, Ethiopia,
Jordan, Iraq
43
90, 000 refugees in 2010 including 76, 000 of US
refugees representing around 75% of USRAP
caseload. Overall, about 600, 000 refugees
assisted over the last 10 years
Locations
More than 40 countries worldwide
IOM Major Refugee HA Operations 2010
b. Migrant-friendly health ASSESSMENT
Evolution of HA Programmes
Expanded Health Assessment
Core Health
Assessment
• TB management (Lab, DoT)
• Malaria and De-worming
• Outbreaks Management
• Pre-departure evaluation
• Enhanced data management and
data sharing
• Enhanced HA Protocols
•Preventive care
• Surveillance
• Profiling
• Local system strengthening
and Capacity building
TB reach: Genexpert scale up…..
30
IV. Partnerships, networks and multi country frameworks
4 pillars of WHA
resolution
4. Strengthening inter-country
coordination and partnerships
a. Global level
International migration dialogues
1. UNGA High-level Dialogue on
International Migration & Development
2006
2. Global Forum on Migration and
Development
3. The Global Migration Group
IV.1.Strengthening inter-country
b. Regional level
coordination and partnerships
July 2010, Bangkok, Thailand:
13 nation High Level MultiStakeholder Regional Dialogue
on Health Challenges for Asian
Migrant Workers
–IOM, UNDP, WHO, JUNIMA, Joint
UNAIDS and ILO
Regional Dialogue on the Health Challenges for Asian Labour
Migrants
13 – 14 July 2010 , Bangkok
Joint Recommendations
• At national level:
–
–
–
–
–
Strongly encourage and support relevant government
ministries to review existing policies, laws and practices
related to labour migration and health aiming coherence
among policies that may affect migrant's health and their
ability to access services.
Identify and/or designate a focal entity for migration health
within concerned ministries tasked to initiate interministerial and cross-sectoral dialogue.
Increase participation of migrant workers in all aspects of
their health and welfare including policy formulation and
programme implementation.
Conduct advocacy and public education activities at
national and community levels through participatory and
collaborative efforts between NGOs, international
organizations, governments in order to build support
among stakeholders for migrant-inclusive policies,
national strategies and action plans.
Encourage the inclusion of key migration variables in
national census and surveys, including those used in
national housing, health, labour, education and migration
statistics, in data collection and the proper use and
confidentiality of data.
 At bilateral, regional,
intra-regional:
Governments examine the possibility of bilateral
agreements with a view to ensure social protection,
portability of entitlements, including health
insurance and monitoring of the overall migration
process.
 Conduct multi sectoral advocacy among health and
non-health networks and labour migration
frameworks to build support among public,
government and key stakeholders, including CSOs,
for migrant-inclusive policies and adoption of
regional and international conventions and
standards.
 Develop guidelines and minimum standards to
assist countries of origin and destination, based on
effective practices and existing models, for migrant
workers, including health financial schemes and
social protection in health, ie. mandatory health
insurance, that will benefit migrants as well as their
families, regardless of whether they are joining the
migrant workers or whether they stay behind.

IV.1. Strengthening
c. National
inter-country
level
coordination and partnerships
National migration dialoguesTanzania;
Mozambique; South Africa; Kenya
World Health Assembly Resolution on Health of
Migrants (WHA 61.17)
Calls upon Member States:
“to promote equitable access to health promotion and care for
migrants”
“to promote bilateral and multilateral cooperation on migrants’
health among countries involved in the whole migration
process”
Migration, Health and Development in Sri Lanka
Advancing and evidenced-based approach for Migration Health policy development via an interMinistry framework….
Sri Lanka– Facts and Figures
Emerging from a 30 year civil conflict between GoSL
and LTTE
1. Post-war, 2. Epidemiological (NCD), 3.
demographic, 4. economic(MIC), 5.labour receiving..
 One in ten SL’s are working abroad, an annual outflow of
300,000 persons
 One in 5 of Sri Lanka’s total labour force (23.8%) is
currently employed abroad.
 49% percent of ILMs are women, and out of these, 86%
are ‘domestic housemaids’.
 Over 93% were employed in the Middle Eastern
countries.
 730 of registered migrant workers depart Sri Lanka each
day3.
Migration
 ILMs contributed 5.1bn USD (8% of GDP) to the Sri
Lankan economy in 2011, with foreign remittances
earning expected to increase to 7bn USD in 20162.
 76% of the total remittance received to the country
was from garment industry and employments overseas
(Central Bank, 2008)
 Sri Lanka becoming a labour receiving country not just a
labour sending one: 44,400 Resident visas issued for
workers (9000 Chinese and 9000 Indians, mainly on
construction related development projects)
High level political
commitment is
essential for
meaningful
programming at
country level…
Ongoing policy process in Sri Lanka
• Approach adopted by Government:
1. Identified the need in addressing all three types
of migration: outbound, inbound & internal
2. A Multi-stakeholder approach adopting an InterMinisterial process
3. An evidence-based research agenda to inform
policy process enabled
Migration
Where does migration health ‘fit’?
1DDG/PHS I
2DDG/PHS II
3Airport Health Authority
8. Policy directorate
9. Non-Communicable
disease directorate
10. Mental Health
Directorate
4Port Health Authority
5Family Health Bureau
6Health Education Bureau
7Epidemiology Unit
1Department of Immigration and
Emigration
2Department of Registration of
Persons
Sri Lanka National Migration
Health Taskforce
1Department of Probation and
Childcare Services
1General Treasury
2Department of Census and Statistics
3Central Bank of Sri Lanka
1Board of Investment of Sri Lanka
2National Child Protection Authority
3Sri Lanka Women’s Bureau
2Sri Lanka Tourism Promotion Bureau
3Sri Lanka Tourism Development Authority
Mapping – an essential first step!
 Problem/Issues identification – e.g. don’t limit to only labour
migration!
 Stakeholder Mapping within GoSL* + Academia, NGOs, Civil Society,
UN, Development partners
*Selection of Technical focal points within each Government Ministry (contested). Political mapping – also
involved in this step of stakeholder mapping.
 Mapping of existing domestic legal and policy frameworks linked to
MHD
 Mapping for advocacy - regional forums (Colombo Process) and global
fora (GFMD- Mexico) to push MHD agenda
 Service mapping (e.g. health, legal and social protections offered to Labour
Migrant workers)
Inter-Ministerial Coordination Framework for
Migration Health Development in Sri Lanka
National
Steering
Committee on
Migration Health
(NSC)
Migration
Health Task
Force
(MHTF)
Comprised of Secretary/
Director General level
representatives of the key
Ministries such as Ministry of
Health, Ministry of Foreign
Affairs etc. Meets 2-3 times
per year (or as per need) to
decide on National policy
decisions and inter-ministerial
coordination issues forwarded
by the MHTF
Migration Health
Secretariat
(Housed within the Ministry
of Health)
The dedicated hub that coordinates the
National migration health agenda for
Government of Sri Lanka
Wickramage, Peiris, Perera (2010)
Comprised of technical focal
points from each stake holder
agency (Key Ministries, UN
agencies, NGOs , Academics ,
Civil Society) that contributes
actively to development and
planning of the
sectoral/ministry policies and
programmes related to
Migration Health.
Meets once in 2 months
determine health status via SDH lens...
WHAT IS THE SOCIAL COST?
WHAT IS THE HEALTH CONSEQUENCE?
Migrant and
Mobile
Populations
I’m only presenting data
from 1/5 national studies
here due to time
constratints…
Assessment of mental health and physical wellbeing of ‘left behind’ family members of
international labour migrants: a national comparative study in Sri Lanka
Wickramage, K., Siriwardana, C., Sumathipala, A., Siribaddana, S., Adikari, A, Peiris, S., Perera, S., Mosca, D.
Aim and Methods :

This national study utilized both quantitative and qualitative research methods to determine the associations between health status of the left-behind spouse,
children and caregivers, for comparison with families having no history of migration. A multi-stage random sampling method was used to capture 62% of the total
migrant worker population in Sri Lanka. We surveyed a total 1,625 adults (from 410 migrant and 410 non-migrant families) and 820 children, matched for both age
and sex, within a pediatric and adolescent group. Socio-demographic, and health status data were derived from a range of standardized pre-validated health
instruments measuring quality of life and mental health status (adult and child). Anthropometric data on childhood development was also obtained. Univariate and
multivariate analyses were used to estimate the differences in health outcomes between migrant and non-migrant families.
Findings:
 Children from migrant families have a higher risk potential to develop psychopathology and
sustain poorer nutritional development outcomes than children from non-migrant households.
 Just over two-in every five ‘left-behind’ children (44%) reported as having any psychiatric diagnosis.
 A quarter of all left-behind children under 5-years were severely underweight (25.4%).
 Nearly one-in-three migrant families were also single-parent households. Multivariate models
revealed the association of emotional disorders and psychiatric diagnosis was strongest within singleparent households, and was exacerbated where the sole parent was the migrant worker [OR
0.75(0.34-1.64)].
 Significantly high levels of depression were found in caregivers [12.3% (CI: 12.23-12.31)] and
spouses from left-behind families [25.5% (CI:25.47-25.60], than those comparative non-migrant
group [7.32% (CI: 7.29-7.34)]; with physical health status profile also showing similar trends.
“families left behind”
• The absence of parent has a
negative impact on overall
health and development of
children left behind:
• Growth and development:
25% of the children in the
families with migrant parent
are “under-weight” (- 2 SD Zscore)
• Child-psychopathology: All
domains in SDQ were higher
among the children in migrant
families
(Wickramage. et al. IOM, 2011).
Mental and physical health of the left behind spouses
and care-givers were also significantly poor
General health status – SF 36 score
(Wickramage. et al. IOM, 2011).
Prevalence of Common Mental Disorders
of left behind families by standardised Scale for
Depression using PHQ
Disorder
Migrant family
spouse
Somatoform
Family (spouse)
caregiver
N
Prevalence
N
Prevalence
N
Prevalence
277
(95% CI)
188
(95% CI)
410
(95% CI)
10
3.61 %
22
11.70%
12
2.93%
(3.59-3.63)
Depression
Comparative
34
12.27 %
(2.91-2.95)
(11.65-11.74)
48
(12.23-12.31)
25.53%
30
7.32%
(7.29-7.34)
(25.47-25.60)
Anxiety
3
1.08 %
(1.07-1.09)
7
3.72 %
(3.69-3.75)
2
0.49%
(0.48-0.50)
(Wickramage. et al. IOM, 2011).
Vulnerabilities faced by Sri Lanka
International Labour Migrants.
Not Allowed to use the telephone at workplace
50.3 %
Not allowed to use own mobile phone
44.6 %
Passport kept by employer
85.8 %
Had no friends outside workplace
52.6 %
More than 3 months to Adapt
85.0 %
Did not inform employer about illness due 60.5 %
to fear of losing job
Experienced an Abusive situation
IOM, Sri Lanka (2012)
17.5 %
Conclusions:
 The finding that almost 1/3 were single parent families,
 that child psychopathology scores were highest in these leftbehind families,
 a growing reliance on elderly care-givers with ill health,
 generational impacts of trans-national parenting,
 lack of an ‘informed choice’ in the migration journey
 that multiple cycles of migration may be needed to achieved
economic goals
the need for a clear and comprehensive policy in addressing
the social determinants of health affecting migrant workers
and their left behind families is evident from the study.
complex challenge for Governments in policy formulation at the nexus of ‘rights,
remittances, geo-political determinants and responsibilities’
State control Vs.
‘Protectionism’
Free market economy
vs.
‘market opportunism’
Right of
SENDING
country to
ensure follow
up of
‘rejected’
caseload
Right of
RECIVING
COUNTRY
to determine
nonadmissibility
criteria for
health
assessment
Elder/
Seniors
Rights
Remittances
Transformation
from ‘unskilled
to skilled’ labour
migration
contribution to
GDP
State to State Bi-lateral agreements
Vs. Regional agreements/dialogue
Wickramage, Peiris, Mosca, (IOM, 2012)
SRI LANKA:
Millstones, progress, future vision
 Conducive legal and policy environment- Immigration act of Sri Lanka
amended to include Health assessment of inbound migrants, right to
health for non-citizens ensured too… Presidential support for this
decision made!
 Government moving towards creation of a singular migration agency to
coordination – act for presentation and debate in parliament.
 Successful completion of 5 National research studies for EB approach
 Currently Drafting “National Migration Health Policy” – via InterMinisterial coordination , using EBM
 Sri Lankan Government with IOM support will host Governments of 8
nations to undertake regional dialogue to advance WHA framework
(SL model is still a work in progress..)
4 pillars of WHA
resolution
ESTABLISHMENT OF A NATIONAL COORDINATING FRAMEWORK FOR MIGRATION
HEALTH DEVELOPMENT IN SRI LANKA
IOM assisted the Ministry of Health to establish: a permanent Migration Health Unit which acts as
a ‘hub’ for administrative and technical coordination; a Migration Health Task Force which
comprises of technical advisors/senior administrators from more than 9 Government departments
and other stakeholders; and a high level National Steering Committee chaired by the Health
Secretary to serve as the main policy making body in related to migration health development in Sri
Lanka.
IOM-MOH led 5 NATIONAL
MIGRATION HEALTH STUDIES
HEALTH PROMOTION FOR MIGRANT WORKERS
Enhance health promotion and education material for
outgoing and returning migrant workers with the Sri Lanka
Bureau of Foreign Employment, especially at pre-departure
orientation, and developing strategies for health and social
protection in sending countries.
IRREGULAR MIGRANT FLOWS
IOM supported healthy return of irregular migrants from
West Africa
HEALTH ASSESSMENT FOR RESIDENT VISA
APPLICANTS
Upon request of the Controller General for Immigration
and Emigration, and the MOH, IOM assisted in the
development of technical guidelines and protocols for
“Health requirements for long stay visa applicants” , and for
the development of a Visa Health Unit for the Ministry of
Health.
SOME KEY
ACHIEVEMENTS
OF THE
MIGRATION
HEALTH
DEVELOPMENT
PROJECT
SUPPORTED BY
IOM
SRI LANKA:
ENSURING
A
“HEALTHY
RETURN”
RETURNING SRI LANKAN REFUGEES
FOR
With the technical support of IOM, the Ministry of
Health convened an expert subcommittee headed by
the Additional Secretary of Health to develop a national
plan for ensuring health protection to approximately
87,000 Sri Lankan refugee returnees from Southern
India. A major element was for ensuring returnees are
provided with health information in collaboration with
the Indian Government and are linked to primary health
care services upon return to Sri Lanka. Close
observation of International Health Regulations and
ensuring non-discrimination on health grounds were
hallmarks of the ‘healthy return’ plan.
2009—2012
Post-conflict Health systems recovery – assisting
populations of forced migrants (war affected IDPs) to
return to place of origin
Wickramage, K.* and Galappaththy, G.**
Author affiliations:
* Head, Health Programs, International Organization for Migration (IOM), Sri Lanka.
** Director, GFATM, Ministry of Health, Sri Lanka.
Abstract
Three cases of P.falciparum and one P.vivax malaria were detected in 287
returnees who were part of people smuggling operations. Facilitating ‘safe
return’ with active surveillance for irregular migrant flows becomes important
as Sri Lanka advances towards the goal of Malaria elimination. We present the
first such report of malaria in human smuggling operations.
7 Key Programming principals: lessons from the Sri
Lankan Model
1. Adopts an inclusive approach in addressing all typologies of migrant flows
2. Adopts a participatory ‘whole of Government Approach’
3. Adopts a strong ‘evidence-based approach’
4. Adopts structural reform to ensure that policy and legal environment is conducive.
5. A responsive to emergent needs and gaps
 E.g. refugee return program.
 E.g. West African smuggling operation
 E.g. Development of health regulations and a ‘Visa health unit’ resident visa applicants.
6. Moving the MHD agenda at regional and global level.
7. Tracking progress+ knowledge hub
Wickramage, K, Peiris, S & Mosca, D (2011)
Cautions in ‘adapting’ country models
• No ‘one size fits all’
• 61st World Health Assembly Resolution on Migrant Health is an
excellent advocacy too
• Need for evidence based reseach
• Engaging labour sending and receiving countries a key
• WHO and IOM have an advantage to guide in defining the scope
of action globally and at the member state level. ..however
member states commitment, funding scarce
Migration, Health and Development
in Sri Lanka
Advancing and evidenced-based approach for Migration Health policy
development via an inter-Ministry framework….
www.migrationhealth.lk
THANK YOU!