February 23, 2024

Nurturing Noble Wellness

Navigate the Path to Nourished Living

Management of health information of nepalese labour migrants | Globalization and Health

4 min read

In this study, we explored the health information management of NLMs and their challenges. The FEB and government-approved private assessment centers are the main stakeholders in keeping the health records of NLMs. The FEB records health data of only those migrants who got labour permit, thus excluding data of undocumented labour migrants. Government-approved private assessment centers records migrants’ health data during pre-departure health assessment. After completing the health assessment, these centers upload the data to the FEIMS. However, these health records have not been systematically kept in one database and shared among governmental health agencies due to a lack of interest in developing a unified online migrant health information system and competent human resources and equipment. The national Health Information management system under the DoHS does not effectively capture the health outcomes and determinants of NLMs despite the growing magnitude of such flows and relevance to contribution to socio-economic development.

Health records of NLMs are generated during pre-departure health assessment for eligibility of work and visa, during the processing of claims of compensation for disability and deaths of NLMs in destination countries, and during screening programs of infectious or mental diseases targeted for returnee NLMs. There is no systematic health record-keeping of NLMs going to India. Similarly, there is no systematic health screening and keeping of health records of returnee NLMs from destination countries. Further, two ministries and their departments are involved in recording migrant health data, for example, the FEB and the DoHS. This can create confusion on recording, duplication of data management, and scattering of data.

There is great potential for the health information system to effectively link with premigration health assessment medical centers where prospective migrant workers visit as a pre-requisite condition for migration to obtain health certificate for employment. The current data sharing practices from such centers are fragmented and have ineffective data sharing, record keeping and data analysis functions. The collected health record of NLMs when entered to central registries do not code for migrant status or characteristics.

There is a need for a centralized and unified information system on migration health linked with the national health information management system, but challenges towards developing such a system in a country like Nepal include technology and human resources; consensus on various health indicators and their reliable assessment; and bringing all stakeholders in one unified online portal. Further, challenges may arise since data needs to be protected for privacy and confidentiality without individual identification.

Electronic health records such as personal electronic health records are efficient and effective tools for monitoring and improving the health of migrants, especially where migrants cross the same or different borders multiple times [10]. Such tools have been developed and tested to mitigate transnational migration health issues in Mexico [11]. The lack of an effective electronic record system with the requisite data protection in Nepal inhibits understanding of health status of migrant workers. We argue that better linkages between national health information system and migrant health assessment processes at the country level are needed to shift these from being limited as an instrument of determining non-admissibility for purposes of visa issuance, to a process that may enhance public health. The importance of providing appropriate care and follow-up of migrants who fail their health assessment and the need for global efforts to enable data-collection and research are highlighted in other studies [12]. We argue that the several hundred thousand health assessments performed every year for the purposes of international labour offer an important opportunity to enhance universal health coverage.

Many high-income countries have started keeping personal electronic health records of immigrants and refugees, including relevant health indicators such as mortality, morbidity, mental health, disability, nutritional, and behavioral factors: medical history, clinical examination, vaccinations, communicable diseases, non-communicable diseases, allergies, clinical measurements, sexual health, child and obstetric care, oral health, medications, tests, follow-up, daily living activities, substance abuse, working conditions, and occupational health problems. For example, eight European countries implemented the electronic personal health record to record every migrant and refugee arriving in those countries, which have been effective in addressing migrant health issues [13]. In china, approximately 30.2% of young migrants had their health records established in inflow communities [14].

Since the FEB in Nepal records the death when death compensation is claimed for approved labour permits, the database likely excludes undocumented NLMs (those who did not obtain a labour permit from the Government of Nepal or had overstayed the contract period in the destination country). The description and categorization of causes of deaths in the database of the FEB, for example, cardiac arrest, heart attack, natural cause, and other or unidentified causes, are not scientific as per classifications of deaths by the International Classification of Diseases [15].

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