New migratory health policy in the offing

By Manjula Fernando

Sri Lanka last week became the first country to launch a National Migratory Health Policy to ensure safe and healthy migration for inbound and outbound travellers, especially the two million expatriate worker population.

The Newly Appointed Health Services Director General, Dr. Palitha Mahipala spoke to the Sunday Observer to shed light on the new policy. The International Organization for Migrants (IOM) noted that this was a significant achievement for the Government at the policy launch last week.

Excerpts of the interview:

Director General, Dr. Palitha Mahipala

As you know migration is an 'on phenomena' now with an estimated one billion people worldwide travelling from one place to another every year. This is one sixth of the world population.

With the end of the conflict and Sri Lanka positioning itself as a rapidly developing nation, migration has become an important phenomena for Sri Lanka as well.

Outbound migration of skilled and unskilled labour to the Middle East, is one of the major foreign income earners for the country now with Sri Lanka having nearly two million expatriate workers.

There has been a major increase in inbound migration also because of the construction boom the country is experiencing. There is a inbound travel by labourers from India and China.

Tourist arrivals too have seen a gradual increase in the past few years. The situation in the country has also had a positive impact on internal migration.

Globally, the WHO and the UN has identified that migration is one of the principal means for disease spreading. Sri Lanka was one of the affected countries of the outbreak of Avian flue. To contain the disease, we had to install temperature screening units at the BIA. Different strategies were employed to fight further cases of Avian flu.

Migration, is basically an economic phenomena, it involves export of labour and foreign exchange. But it is an important segment of the country's health as well. The WHO has identified this fact and a special UN agency - International Organization for Migration (IOM), has been set up to look after the interests of migrants including their health interests.

In Sri Lanka there are many programs targeting outbound migration. For instance, the SLBFE and the Labour Ministry in collaboration with the Health Education Bureau create awareness among workers going out of the country for employment. It is part of the foreign employment training. Before departure they have to undergo health screening, to fulfill the concerns and of the countries that employ them.

When they return too it is important to do a health assessment. Studies so far indicate that these expatriate workers when they return, have health issues such as diabetes and hypertension. There may be different factors that are responsible like , the new environment, change in dietary habits and stress. Being one of the key foreign exchange earners for the state we have understood the need to help this sector of workers and their families. There needs to be a screening process to identify and address these issues in a proactive manner.

With an outstanding public health system, Sri Lanka has already eliminated many life threatening diseases. For instance we are near elimination of Malaria. Our objective is to eliminate Malaria from Sri Lanka by 2015. Hence, we are vigilant of cross border migration. In the past months, there have been very few local cases (indigenous transmissions). But there have been cases of people contracting Malaria from overseas and carrying it over here especially from the African countries such as Madagascar. Travellers to such destinations bring the parasites to the country. This is a major setback.

The new Migratory health policy will supplement the on-going efforts in a big way to keep the country safe while helping the migratory population to stay healthy. There will be strict and constant surveillance at entry points such as the airport. We did not feel the need for a migratory health policy before but with the end of the conflict Sri Lanka has positioned itself as a labour receiving country, increasing cross border travel several fold. Now the need to have a mechanism to contain disease spreading due to migration and travel has been felt strongly.

The people who have left the country due to the conflict and those who are living in India as refugees have begun to return. This is another aspect why we thought such a policy was necessary. We need to screen them from carrying new diseases into the country. There will be a mechanism in place once this policy is implemented, to screen all cross border migrants in a systematic manner.

When the health situation in a country has improved and we are on the brink of eliminating some of the major diseases, we need to be vigilant of disease-carrying travellers.

Some countries have a high disease burden but we have eliminated a lot of diseases and some others like Malaria are near elimination.

The new policy document was launched last week by the Health Minister Maithripala Sirisena. The next step would be putting it in the public domain to invite public views. Then it will be presented to the Cabinet for approval and subsequent implementation. This policy implementation will be a multi-agency, multi-sectoral effort. Agencies under 14 Ministries will be involved in the implementation including Immigration and Emigration under the Defence Ministry, Labour Ministry, Foreign Employment Bureau and External Affairs Ministry.

Sri Lanka is the first country to propose a comprehensive policy on Migration Health, showing progress on the resolution proposed at the UN World Health Assembly.

At the policy launch the IOM Chief of Mission, Richard Danziger said 'Sri Lanka is the first country who has came out with such a comprehensive document'. We are leading the region and the world. This is a long-felt need and we have done it.

The legal framework to support implementation is more or less in place. The Quarantine and other health-related acts have the provisions to back this policy. The next step would be to publish the document for public views. Subsequently it will be submitted to Cabinet for approval.

Then it will be ready for implementation as a policy. If the need for change to the existing law is felt at the implementation stage, the legal draftsman will be consulted after which the draft bill will have to be presented in Parliament before implementation.

Certain activities in the policy can be started straight away. And some have already been set in motion like the screening of in bound and outbound travellers and expat-workers.

We are screening returnees, especially those from Tamil Nadu under a 'healthy return and reintegration program'. The Ministry is also in the process of making health assessment compulsory for resident visa applicants under the new Migratory Health Policy.