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Improving Access to HIV Services for Mobile and Migrant ...

Improving Access to HIV Services for Mobile and Migrant ...

Chapter 2: General

Chapter 2: General Information 1. In a world defined by profound disparities, migration is a fact of life and governments face the challenge of integrating the health needs of migrants into policies and programmes. For some societies migration is essential to compensate for demographic trends and skill shortages. In addition, migrants assist home communities with remittances. For example, the World Bank estimates that in 2009, migrants sent 414 Billion US$ in remittances, making positive contributions to household welfare, nutrition, food, health and living conditions in their places of origin. 2. Despite existing and ratified international human rights standards and conventions that protect the rights of migrants, including their right to health, many migrants lack access to health services and financial protection in health for themselves and their family members. Especially migrants in an irregular situation have little or no access to health and social services although they are exposed to many health risks including exploitation, dangerous working- and substandard living conditions. Lack of coverage can lead to excessive costs for migrants many of whom pay out of pocket for health services. This prevents many from accessing services, which exacerbates health conditions that could have been prevented, often at reduced costs, if services had been available. Self diagnosis and -medication are frequently used alternatives that can endanger individual and public health such as in the case of Multiple Drug Resistant tuberculosis. 3. The most often cited reason for not including migrant health considerations in health systems and social security schemes is the fear that it is 'costly'. However, neglecting access to primary health care and leaving migrants' health to be managed at the level of emergency only, runs counter to economic and public health principles. Late or denied treatment, with loss of productivity is costly, does not respect human rights principles and is a threat to public health. Studies on the usage of health services in countries where health services are available at no cost indicate that migrants make less use of such services as compared to nationals. 4. Specific Activities/Scope of Work of the Consultancy a. This consultancy took into consideration recommendations and guidance produced by the regional consultancy on component 2. b. The consultant worked in close collaboration with: i. The regional and the national group of Experts for Component 2 ii. The Project Team Leader 14

c. The consultant was required to: d. Gather data at country level about financing mechanisms and prerequisites in Trinidad and Tobago and constitute a database on this data. e. Provide a methodology for conducting the feasibility study including a time-based workplan which will assist in meeting the objectives of this consultancy. f. Provide estimations of: Number of persons from the target population that this mechanism would assist with coverage Cost for the implementation of the selected instruments/mechanisms. g. Provide recommendations and methodology for the piloting of the instruments/mechanisms based on results obtained from the feasibility study. 5. Background to the Consultancy a. National consultancies have been conducted in four (4) pilot countries – Antigua & Barbuda, Sint Maarten, Suriname, Trinidad & Tobago – to obtain detailed information on health financing for the project, as applicable to the country, which shall be used to develop mechanisms and strategies for regional application. b. The National Consultant has elaborated sources of funds for each of the identified HIV/AIDS services. c. Gaps in services have to be further identified, with particular attention to the mobile and migrant population. Gaps would have to be established with respect to coverage of the target group, range of services provided and quality of care. The National Consultants has determined whether such gaps in services result from limited/ the absence of financing. d. Although a costing exercise is not part of the National Consultants’ scope of service, data about costs of HIV/AIDS services have been established from secondary research. Thus, a literature review from credible sources formed part of the National Consultants’ activities. e. The extent of mobile and migrant populations for each country and the prevalence of HIV/AIDS in this population segment have to be established based on reliable estimates from credible sources. f. The National Consultant is responsible for providing a contextual basis to suggested financing instruments, i.e. finding out which scheme(s) is/are feasible considering realities on the ground. 15

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