Strategic Health Policy Directions in Refugee Resettlement

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Strategic Health Policy Directions in Refugee
Resettlement

• Joy Baldwin
• Medical Services Branch
• Citizenship and Immigration Canada
• Vancouver B.C.
• February 20, 2007

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Immigration Health Policy

• Medical Services Branch is committed to
  developing strategic health policy through
  domestic and international partnerships that is
  in keeping with CICs focus of playing a lead
  role within the Government of Canada on
  International migration and protection policy.

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Role of Medical Services BranchCIC

• Protection of public health and public safety
• Prevent excessive demand on the Canadian Health
  Care System
• Mitigate health risk due to migration
• Works to improve health outcomes for immigrants
• Contribute to the successful integration of
  refugees into Canada and the Canadian health care
  system
• Contribute to maintaining sustainable Canadian
  health and social services

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Business lines within MSB

• Immigration Medical Examination Program
• Refugee Health Management (pre-post arrival)
• Management and quality assurance of Designated
  Medical Practitioners (DMPs)
• Public Health Surveillance
• Interim Federal Health Program (IFH)
• Overseas programs

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Areas of Focus

• Building capacity to develop strategic health
  policy that is responsive to current and emerging
  challenges
• Developing effective health risk mitigation
  strategies
• Facilitating a seamless health integration
  framework/continuum
• Providing a client-centered approach to meeting
  health needs for high risk clients

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Evidence Based Policy Change

• Strengthen capacity for policy analysis and
  development through
• Enhanced environmental analysis
• Stakeholder consultations
• Strengthening relationships with existing
  partners, such as Metropolis
• Contributing to research collaboration with key
  national and international partners

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Understanding Global Health Risks and Trends

• International epidemiological and field
  intelligence gathered through consultation with
• WHO
• UNHCR
• IOM
• Other country partners(US-CDC,Australia,UK)
• PHAC
• Regionally CIC-Regional Medical Office)

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Building Canadian Partnerships and Synergies

• Strengthened partnerships with provincial/
  territorial public health authorities (CCMOH)
• Enhanced communication with Canadian health care
  networks
• Identify gaps through environmental scan of
  Canadian health care networks for newcomers to
  Canada
• Linking with local CIC and service provider
  organizations

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Trends and Challenges

• International trend
• Other major immigration receiving countries such
  as U.S. and Australia are enhancing their
  immigration medical screening for high-risk
  population
• Better integration of high risk population for
  mutual benefits of receiving countries and
  immigrants.
• Epidemiological evidence
• Certain population at higher risk to develop
  conditions of public health concerns
• CIC resettlement process refugee group
  processing
• Large movement of population over a short period
  of time
• All coming from high health risk environment
• Significant number of individuals to resettle in
  a location putting pressure on the local halth
  infrastructure

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Current/Emerging International Health Risks

• Increasing MDRTB and XDRTB (extremely resistant
  TB resistant to two second line medications
  plus others)
• HIV/TB co-infection
• Epidemics (measles, polio, SARS, Avian flu)

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RISK MITIGATION

• Pre-departure interventions to optimize health
  outcomes (vaccination, malaria treatment, etc.)
• Urgent referral of complex Pulmonary Tuberculosis
  Inactive required to report to PH within 7 days
  of arrival.
• HIV notification to provinces/territories
  (nominal/non)
• Implementation of an improved process for Refugee
  Claimants (RC) and in Canada applicants in
  November 2003.
• Working with partner countries to standardize
  tuberculosis investigation
• Enhanced post-arrival assessment

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Criteria for enhanced immigration health
management

• Difficult environmental conditions
• Limited health prevention and care in the past
• Epidemiological evidence of high disease rate
• Large Group resettlement process for refugees
• International trend towards enhanced
  interventions

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New initiative enhanced immigration health
management for high risk population

• The Karen refugee experience
  

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Epidemiological evidence of high disease rate

• Frequent outbreaks of malaria, dengue hemorrhagic
  fever, cholera, influenza-like illness over the
  past few years in the camp.
• High Tuberculosis (TB) and MDR-TB
  incidence/prevalence amongst refugees in
  Thailand.

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Tuberculosis statistics amongst refugees in
Thailand

• TB prevalence in Thailand refugee camps over the
  past two years 2,674/100,000 (1)
• MDR-TB (1)
• 76/100,000 for the Burmese refugees - 10 of all
  positive cultures
• 126/100,000 for the Hmong refugees - 30 of all
  positive cultures.
• (1) Reference personal exchange with the IOM
  Regional Medical Official in Bangkok.
• Active TB diagnosed amongst the 805 Karen
  refugees coming in Canada
• 9 cases/805 refugees 745/100,000
• WHO estimated sputum smear positive pulmonary TB
  rate per 100,000 (3 year average for
  2004/2005/2006)(2)
• Thailand 61/100,000
• Myanmar73/100,000
• (2) From the PHAC web site.

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Enhanced immigration health management of Karen
Refugees

• Includes pre-departure and post-arrival
  interventions
• Enhanced TB management
• Shorter validity date of the immigration medical
  examination (IME)
• All children 10 years old referred to Public
  Health (PH) authority
• All cases of Pulmonary TB-inactive (PTI) referred
  to PH authority for an urgent assessment
• Fitness to fly assessment within 72 hours
  pre-departure
• Facilitation of a comprehensive medical
  examination post-arrival in Canada which will be
  covered by the Interim Federal Health (IFH)
  program
• Enhanced coordination and facilitation by CIC
• Strengthened collaboration between PHAC (Public
  Health Agency of Canada), provincial health
  authorities and CIC as well as timely sharing of
  information

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Success of the client centered approach to
enhanced health management for the Karens

• Enhanced collaboration and information sharing
  was positive
• Integrated approach to health management is an
  effective model however refining of the delivery
  is needed

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Karen Experience Lessons learned

• Need for more formalized communication with the
  regions on health issues
• better coordination between public health ,
  primary care and service provider organizations
  in some regions

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Principles of the Client Centered Approach

• Evidence based policy change to meet changing and
  diverse needs of our clients
• Flexible and adaptable client centered service
  provision
• Comprehensive needs focused care
• Integrated and seamless continuum of care
• Consultative and coordinated approach
• Effective

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Challenges

• Information sharing and privacy considerations
• Logistical challenge of moving large groups of
  protracted refugees from high risk environments
• Limitations of Canadian health care infrastructure

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Next steps

• Research and policy development
• Strengthen partnerships with PHAC, P/T and
  municipal PH authorities
• Update of the medical surveillance process
• Ongoing collaboration with partners to facilitate
  linkage and integration of HIV positive
  applicants in the Canadian health care system.
• Ongoing collaboration with partners to develop
  enhanced health immigration management for
  populations with higher health risks
• Enhance partnerships at all levels to facilitate
  clients successful integration into Canadian
  healthcare system and optimize health outcomes

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Integrated policy framework to ensure

• optimal health outcomes