Healthcare Access and Utilization Among African Migrant Children

Abstract

Over recent decades, many child migrants have been forced to migrate due to conflict, poverty and environmental disasters. Access to healthcare for African migrant children in host countries is often limited. Exploring the barriers and challenges these children face may provide rationale for an intervention that might benefit their health needs.

PubMed and Cochrane Library were searched for literature reviews and empirical studies in English. For each study a summary of characteristics and main findings were reviewed and summarized.

African migrant children are at risk for health problem and needs. Barriers such as legal status, language, and cultural differences limit healthcare access and utilization.

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Health systems often exclude African child migrants from accessing and utilizing healthcare services. Public health interventions that focus on making health services readily available for African child migrants regardless of their status.

Introduction

International migration is a global phenomenon that is growing in scope, complexity, and impact. 1 Defined as the population movement either across an international border or within a state, international migration has contributed to broader development processes and unlocked a host of opportunities for both individuals and countries involved. 1 2 For instance migration represents for people access to employment, acquisition of skills, and improvement of life conditions, while for both countries of origin and destination it is a driver of growth and development. 2 At the same time, political conflicts, poverty, inequality and a lack of sustainable livelihoods have forced people to leave their homes and seek a better future for themselves and their families abroad. 3

Globally, the number of international migrants has grown rapidly in recent years reaching 258 million in 2017. 3 In 2017, of the 258 million international migrants worldwide, 106 million were Asian, 38 million were Latin American and Caribbean, and 36 million were African. 3 In addition, over 78 million of international migrants live in Europe and 58 million live in North America. 3

In 2017, the majority of migrants were between the ages of 20 to 64 years old and the median age of international migrants globally was 39 years. 3 Children make up a significant portion of the world’s migrant population. 4 In 2017, UNICEF has estimated that 37 million international migrants are children. 5 Since the 1990’s, the proportion of child migrants as part has remained remarkably stable at just over 1%, but a rising global population means that the absolute number of child migrants has increased in the past 27 years. 6 Nearly 42% of the world’s child migrants live in Asia and 18% and 10% live in Europe and North America respectively. 6 The share of children among Africa’s migrants is currently the largest for any region globally and nearly one in four international migrants from Africa is a child. 7 This growing number of African child migrants has been a result of current political crisis, conflicts, and riots in many Sub-Saharan countries. 8 According UNICEF, 19.4% of African child migrants are living within Africa, and the other 80% have migrated toward Europe and Americas. 6

Child migrants are a population at risk even after arriving at their destination. 9 The health of migrant children is related to their health status prior to their journey, the conditions during their journey and at their destination. 9 These children may have experienced numerous forms of trauma including war, , separation from family, and exploitation. In addition, they may suffer from malnutrition, communicable diseases and vaccine‐preventable diseases. 9

Due to this crisis, child migrants’ health and access to healthcare services has been the subject of increasing concern. In 2008, the World Health Organization drew attention to the need to promote the health of all child migrants. 10 While the particular needs of child migrants has been highlighted, still, national regulations on access to health care for child migrants vary across host countries. 9 Most host limit health care to emergencies and infectious diseases and as a result, cause negative health outcomes in this population.

The same countries that severely restrict access to health care for child migrants are signatories of or have ratified international conventions enshrining the right to the highest attainable standard of physical health such as the Universal Declaration on Human Rights (1948), and the Convention on the Rights of the Child (1989). 11 According to the UN Committee on Economic, Social and Cultural Rights, the human right to health includes the right to healthcare which must be accessible to all people in a state’s territory without discrimination. 11 In addition, the cost of healthcare services is inextricably linked to the issue of access and utilization of health care services, and this creates difficulties for child migrants and caregivers who are not legal residents. 11 These restrictions to care most affect racial and ethnic minority child migrants. 11 12 The goal of this review is to explore the access and utilization of healthcare services among African child migrants. This literature review can be used to direct future interventions targeting child migrants’ health and further studies in the healthcare services in host countries.

Methods

PubMed and Cochrane Library were searched using the following search terms: (“migrants” or “African” or “child”) and (“ migrants” or “health” or “ African”) and (“international” or “migrants” or “African” or “health” ) References from published articles and systematic articles were reviewed for recent studies. The articles included in the review had to meet two criteria. They were

1. empirical studies reporting data generated directly with children aged up to18 years;
2.  articles reporting data on the health experiences of African migrant children, who had migrated across national borders into or within Europe (defined as the EU, Scandinavian countries and Switzerland) during their own lifetimes; and
3.  articles published in English. Studies were excluded if there were in languages other than English.

Abstracts were reviewed for potential inclusion and if appropriate, the article was reviewed. Data from the literature review were abstracted on a structured case report form.

Migration was consistently shown to be associated with specific life conditions and challenges that can impact the health of child migrant especially African child migrants. The Mor et al. study reported that although Maternal and Child Health services provided to Eritrean migrant children were at no charge, the children were still excluded from obtaining the National medical insurance because of their legal status, further preventing them from accessing and utilizing additional health services 13 Klok-Nentjes et al study reported that while general practitioners in Amsterdam had to provide free healthcare services to African migrant children, the patients’ anxiety about authority, unclear governmental regulations, and their’ frequent change of address were the greatest challenges in utilizing health services. 14 In addition, one of the studies found that the key challenges in healthcare utilization for African migrant children were language barriers and cultural differences. 17 This finding was consistent with the Carrasco-Sanz et al. study which reported that 63% of migrants children’s health was worse than non-migrants and that cultural and linguistic factors were the most frequent barriers to healthcare utilization. 16

Apart from the language and cultural challenges, one study found that African migrant children who live in certain EU countries may also face restricted healthcare entitlements which will impede them from using the healthcare system. 15 Healthcare providers also play a significant role in influencing the access of health services for African child migrants. 11 The result of the Ruiz-Casares suggested that health care role or occupation, and institutional location (primary care centers vs. hospitals) shape attitudes towards access to health services for migrant children. 11

Limitations of the review/studies

The main limitation for the reviewed studies were that studies about migrant children is scarce and that little is known about their living circumstances, access to healthcare or utilization of healthcare services. 18 The health of migrant children particularly African migrant children remains under-researched even within the paediatric literature. 19 Other limitations include: difficulties in gathering information about child migrants health, the heterogeneity and small size of migrant communities, and access to some migrant populations. In addition, some EU countries do not ask any questions about ethnic origin or religion in their national census and that might prevent data collection of ethnic origins that can be useful in understanding health issues. 19

Policy Implications/Recommendations and significance for Maternal and Child Health

• The right to health care is a universal and basic social right inscribed in various international treaties and texts. 15 These texts include international State commitments under the United Nations. 15 Children’s right to health care is codified in the Convention on the Rights of the Child (CRC), a convention which has been signed by all nations in the world . 15 The CRC states the right of the child regardless of race, legal status, or origin is entitles to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health.
•  Fear of police or immigration authorities is a major barrier to accessibility and utilization of healthcare services for child migrants. 15 Thus, to make health care truly accessible, health services should be entirely independent from immigration authorities, and the principles of medical confidentiality should be upheld for these patients.
•  The way health care is funded differs considerably around the world. Some countries have a tax-based system while others are funded through insurance programs. 4 Although it is often more administratively complicated to fund health care for migrant children in insurance-based systems, countries like the Netherlands, for instance, have overcome this administrative challenge in an innovative way by the creating a national fund where costs for child migrants can be reimbursed to health care providers. 15 21
•  Providing preventive programs for child migrants can lower the high costs of hospital care. 10
•  Pediatricians can improve the health of migrant children by ensuring access to pediatric healthcare regardless of the child’s legal status. Pediatricians also play an important role in advocating for migrant children in their local communities, and through the international paediatric community. 22 23 National pediatric societies need to prioritize migrant children in discussions with policy and decision makers. 22 24
•  Medical interpreters should be available during healthcare encounters to solve the existing language barriers. 9
•  Creating policies that will reduce the restrictions of access and utilization to health care services for child migrants by identifying and examine health care professionals’ values and attitudes toward access, and the personal and professional factors influencing these. 9

Conclusions

African migrant children face different health challenges compared with local populations due to the stress of the migration process, adverse social conditions and increased exposure to health risks. 5 Excluding african child migrants from accessing and utilizing health care services, not only has a negative impact on the child but on medical practice and the integrity of the public health care system.