Migration health research and policy in south and south-east Asia: mapping the gaps and advancing a collaborative agenda

Abstract

Migrant health has been the subject of various international agreements in recent years. In parallel, there has been a growth in academic research in this area. However, this increase in focus at international level has not necessarily strengthened the capacity to drive evidence-informed national policy and action in many low- and middle-income countries. The Migration Health South Asia (MiHSA) network aims to challenge some of the barriers to progress in the region. Examples include the bias towards institutions in high-income countries for research funding and agenda-setting and the overall lack of policy-focused research in the region. MiHSA will engage researchers, funders and policy-makers in collectively identifying the most pressing, yet feasible, research questions that could help strengthen migrant and refugee health relevant to the region's national contexts. In addition, policies and provisions for different migrant populations in the region will be reviewed from the health and rights perspectives, to identify opportunities to strategically align research agendas with the questions being asked by policy-makers. The convergence of migration policy with other areas such as health and labour at global level has created a growing imperative for policy-makers in the region to engage in cross-sector dialogue to align priorities and coordinate responses. Such responses must go beyond narrow public health interventions and embrace rights-based approaches to address the complex patterns of migration in the region, as well as migrants' precarity, vulnerabilities and agency.

Full text

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WHO South-East Asia Journal of Public Health | September 2020 | 9(2)
Perspective
Migration health research and policy in south and south-
east Asia: mapping the gaps and advancing a collaborative
agenda
Anuj Kapilashrami1, Kolitha Wickramage2, Nima Asgari-Jirhandeh3, Anns Issac3, Anjali Borharde4, Ganesh Gurung5,
Jeevan R Sharma6, on behalf of the Migration Health South Asia (MiHSA) network steering group*
1University of Essex, Colchester, United Kingdom, 2International Organization for Migration, Manila, Philippines, 3Asia Pacic
Observatory on Health Systems and Policies, World Health Organization Regional Ofce for South-East Asia, New Delhi, India,
4Disha Foundation, Gurugram, Haryana, India, 5Nepal Institute of Development Studies, Kathmandu, Nepal, 6University of
Edinburgh, Edinburgh, United Kingdom
*Details of the membership of the MiHSA network steering group are provided in the acknowledgements
Correspondence to: Professor Anuj Kapilashrami (a.kapilashrami@essex.ac.uk)
Abstract
Migrant health has been the subject of various international agreements in recent years. In parallel,
there has been a growth in academic research in this area. However, this increase in focus at
international level has not necessarily strengthened the capacity to drive evidence-informed national
policy and action in many low- and middle-income countries. The Migration Health South Asia (MiHSA)
network aims to challenge some of the barriers to progress in the region. Examples include the bias
towards institutions in high-income countries for research funding and agenda-setting and the overall
lack of policy-focused research in the region. MiHSA will engage researchers, funders and policy-
makers in collectively identifying the most pressing, yet feasible, research questions that could help
strengthen migrant and refugee health relevant to the region’s national contexts. In addition, policies
and provisions for different migrant populations in the region will be reviewed from the health and
rights perspectives, to identify opportunities to strategically align research agendas with the questions
being asked by policy-makers. The convergence of migration policy with other areas such as health
and labour at global level has created a growing imperative for policy-makers in the region to engage
in cross-sector dialogue to align priorities and coordinate responses. Such responses must go beyond
narrow public health interventions and embrace rights-based approaches to address the complex
patterns of migration in the region, as well as migrants’ precarity, vulnerabilities and agency.
Keywords: health policy, migration, research priorities, south Asia, south-east Asia
Background
Migration is a global phenomenon. Alongside the signicant
benets migration offers to individuals, societies, states and
economies, it also presents critical public policy, humanitarian
and human rights challenges. The health and well-being
of migrants and refugees is a public policy issue and an
emergent eld of scholarship and advocacy. Migrant health
has been the subject of various international consultations and
agreements in recent years, such as the Global compact for
safe, orderly and regular migration1 and the Global compact
on refugees in 2018.2 In parallel, there has been a growth in
academic research on the health aspects of migration. Despite
this increase in focus at international level, the capacity and
opportunities to drive evidence-informed national policy and
action on migration and health remain limited in many low-
and middle-income countries.3 Clearly, migrant health will
need to be more rmly embedded in national agendas if the
overarching aims of global initiatives are to be realized, not
least the call of the 2030 Agenda for Sustainable Development
to “leave no one behind”.4,5
The need to bring together the migration and health research
and policy communities was the catalyst for the establishment
of the Migration Health South Asia (MiHSA) network in 2019.6
MiHSA evolved during a series of consultations, seminars and
policy dialogues held during 2018–2019 in Bangladesh, India,
Malaysia and Nepal. These consultations brought together
local, regional and international institutions to reect on the
current gaps in knowledge on migration and health in south
and south-east Asia and to explore pathways for building
communities of knowledge and practice. The objectives were
twofold: rst, to engage academic scholars, nongovernmental

Kapilashrami et al.: Migration health research in south and south-east Asia
108 WHO South-East Asia Journal of Public Health | September 2020 | 9(2)
organizations and advocacy groups to collectively assess
the evidence base and identify the main gaps in knowledge;
second, to engage key policy stakeholders to assess the utility
of current research outputs and identify their key evidence
requirements for improved policy-making.
In this paper, we synthesize key lessons learnt to date and
identify core values and priorities to advance a collaborative
agenda that can shape future research and practice to improve
migration, health and rights in south and south-east Asia.
What do we know – and what are the
gaps?
Quantifying the bias in what is researched, and by whom
The production and use of knowledge or evidence on
migration is entrenched in gross global inequities. Research
funding, agenda-setting and practice disproportionately
favour institutions in high-income countries. A bibliometric
analysis of global migration health research papers published
during 2000–2016 in the peer-reviewed literature revealed
that the vast majority of articles on migration were authored
by research institutions in high-income migrant destination
countries.7 This analysis by Sweileh et al. also showed that
the research output on migrant health from Asia was relatively
low, despite the region having “the most dense international
migration corridors and the largest numbers of international
migrants whose country of origin is in Asia”.7 In addition,
analyses limited to the formal research literature largely fail
to capture the insights of the civil society organizations that
work closely with migrants and displaced populations. These
groups have limited access to funding and tend to publish their
ndings in less formal outlets, such as reports and briefs, that
may not be captured by systematic reviews and bibliometric
analysis.
As noted in the International Organization for Migration’s
2020 annual report, more sustained effort is needed to support
research institutions and researchers in low- and middle-income
settings, including by confronting some structural impediments
to gaining funding and building capacity.8 Part of MiHSA’s
role will be to examine the power inequalities in international
knowledge networks and aim to rebalance them by creating
and sharing new opportunities through collaborative research,
writing and joint webinars for more knowledge generation and
leadership situated in south and south-east Asia.
Addressing the lack of prioritization in the region
Migration health continues to be a relatively underexplored
topic within south and south-east Asia, with limited attention
given to the health and social care needs of migrants, who are a
highly transient, diverse and heterogeneous population group,
or to the peculiarities of the geopolitical context of the region.
For example, the health of internal migrants in the region is
poorly understood, despite their high numbers. The Global
report on internal displacement 2020 estimated that south Asia
experienced 30% of the world’s internal displacement in 2019,
mostly triggered by population exposure to disasters including
oods and droughts, as well as to unresolved conicts and
violence.9 There were 5 million new disaster displacements
in India alone in 2019, the highest number in any country in
the world, resulting from factors such as increasing hazard
intensity, high population exposure to oods, cyclones and
violence,9 and high levels of social and economic vulnerability.
An unpublished subset analysis of the global dataset
produced by Sweileh et al. by one of the authors (KW) found
that migration health research for south and south-east
Asia was disproportionately focused on infectious diseases
and mental health (by health theme) and on undocumented
migrants and refugees (by migrant category). MiHSA is
supporting researchers in the region to build on this work
using robust bibliometric analysis to more fully understand
the gaps in published and unpublished research. In addition,
the broader context of migration and the conditions in which
migrants work and live shape their health and well-being.
Yet insufcient attention has been given to studying the role
of structural inequalities in determining low-income migrants’
poor access to health care and vulnerability to ill health.10
Analysis of vulnerability and agency across different stages of
people’s mobility and settlement is critical to inform inclusive
and effective policies and institutional responses.5,11,12
Research in south and south-east Asia therefore needs to
capture not only the factors that place migrants at risk but also
those that facilitate thriving and resilience. Such a focus is core
to MiHSA’s capacity-building workshops in the region, which
provide early-career scholars with the necessary conceptual
and methodological skills and insights to undertake research
in this eld, and which emphasize the intersections of gender
and other social inequalities in such research.
Unlocking the capacity to identify feasible, impactful
research
Migration health research globally is characterized by glaring
methodological and data gaps, and thus this is also the case
for south and south-east Asia. There continues to be a lack
of disaggregated baseline information on migrants based on
factors such as their gender, livelihood, religion and ethnicity.
The omission is particularly striking for internal migrants, as
these factors determine different needs of different migrant
populations across socioeconomic contexts. This dearth of
information hampers effective policy development and may
even undermine the impact of any actions taken. With respect
to design, research in this area is dominated by cross-sectional
studies, which cannot take account of the temporal and spatial
dimensions of mobility and the circularity of migration that
is characteristic of the south and south-east Asian context.
With respect to focus, there is a need for more operational
research on neglected topics including remittances and their
utilization for nutrition and food security, and portability of
social protection, health and welfare schemes.
MiHSA recognizes the need for (i) country-level mapping
of existing sources of data such as the national Demographic
and Health Surveys and sources compiled by non-government
initiatives, (ii) identifying gaps in evidence and (iii) more
targeted commissioning of research in key priority areas. In
parallel, building the capacities of local research institutions
to advance more in-depth research on experiences and
outcomes is essential. This exercise is currently under way,
and involves identifying and dening research priorities using
the Child Health and Nutrition Research Initiative approach
to research priority setting.13 This brings together funders,
researchers and policy-makers in deciding the most pressing
yet feasible research questions that could help strengthen

Kapilashrami et al.: Migration health research in south and south-east Asia
109
WHO South-East Asia Journal of Public Health | September 2020 | 9(2)
migrant and refugee health in national contexts in south and
south-east Asia.
Engaging in researcher–policy-maker collaboration from
the outset
A stark disconnect exists between the production of knowledge
by researchers and its use by policy-makers. On the one hand,
the rich information and analysis produced by researchers may
not be synthesized in a way that is accessible to policy-makers.
Researchers often tend to see policy-makers as a community to
engage with after ndings are generated and published, rather
than as potential collaborators. On the other hand, meaningful
engagement and consultation with migration scholars,
advocates and practitioners, as well as migrants themselves,
is often lacking in the development and implementation of
national and subnational policies. Whatever the reasons, the
lack of perspective on migrant health in national task forces
and policy work results in important omissions. For example, a
review of the pandemic inuenza preparedness plans in place
in 21 countries of the Asia Pacic region in 2016 found that only
three countries – Maldives, Papua New Guinea and Thailand
– identied at least one migrant group in their national plan.14
Tackling the knowledge–policy gap prompted intersectoral
working being adopted as a core principle in the work and
mandate of the MiHSA network, with an emphasis on prioritizing
engaging with policy actors at every stage. Rather than taking
an instrumental role in linking research and policy, MiHSA seeks
to enable researchers, policy-makers and other stakeholders to
collaborate on dening the analyses needed to design effective
responses. This approach requires researchers to be alert to
political and policy opportunities that might arise and to respond
with evidence on critical issues. To address health issues and
determinants stemming from various migration ows, a whole-
of-government approach was adopted by Sri Lanka to advance
the National Migration Health Policy and an interministerial
action plan.15 This was guided in large part by the evidence
generated through a national research agenda commissioned
by the Ministry of Health with technical cooperation from the
International Organization for Migration. Health risks and their
consequences were identied through rigorous research, and
policy was then developed based on the evidence generated.
The collaborative approach used by Sri Lanka offers important
insights into how health policy-makers, local researchers and
civil society can meaningfully work together in driving a research
agenda that leads to national policy-making and priority-setting
on migration and health.16
Addressing the broader structural impediments to
progress
Despite migration being a major issue for many south and
south-east Asian countries, migrants are not prioritized in
policies and resource allocation. Benets could accrue from
greater cooperation among countries, and states within
countries, from improvements in bilateral relations on mobility
and from political commitment to universalize health and social
care and allow its portability. At global level, the two disciplines
of health governance and migration are beginning to converge.
However, at national level, policies continue to be developed
in silos such as immigration, humanitarian aid, security, labour
and public health, which can have distinct and often conicting
goals.16 A central challenge in developing an integrated agenda
for migration and health is that the driver for examining this
interface is not migrants’ health needs; rather, it is preservation
of population health by containing disease outbreaks that
are often associated with migrant populations. Such a focus
counters any attempts to redress violations in relation to the
health and well-being of migrants that are evident in current
health policy initiatives.
Despite these challenges, there are certain enablers and
emerging local initiatives that could inform integrated national-
and regional-level action, such as initiatives to support tribal
migrants in certain states in India17 and, more recently,
targeting of social protection measures at migrants in the wake
of coronavirus disease 2019.
An important planned initiative is for MiHSA to map policies
and provisions for different migrant populations in south and
south-east Asia and to review them from health and rights
perspectives. This analysis should help to identify opportunities
to strategically align research agendas with the questions
being asked by policy-makers, as well as the intersections at
which action to advance an integrated agenda can take place.
Conclusion
The convergence of migration policy with other areas such
as health and labour at global level has created a growing
imperative for policy-makers in south and south-east Asia to
engage in cross-sector dialogue to align priorities and coordinate
responses to migration. Such responses must go beyond
narrow public health interventions and embrace rights-based
approaches to address the complexities of circular migration
in the region, as well as migrants’ precarity, vulnerabilities and
agency. At the heart of this ambitious agenda must lie a vibrant
research community of scholars and practitioners who are
equipped with appropriate skills and opportunities to engage
with diverse communities and voices. Just as policy-makers
need to work across sectors, researchers need to bridge the
gulf between the two ecosystems of migration research and
health policy and systems research.17 Through developing
and supporting these synergies, MiHSA aims to support a
transformative agenda for improving migrants’ health and lives.
Acknowledgements: Members of the Migration Health South Asia
network steering group: M Sivakami, Tata Institute of Social Sciences,
Mumbai, India; S Irudaya Rajan, Centre for Development Studies,
Kerala, India; Shabnum Sarfraz, visiting scientist, Harvard T H Chan
School of Public Health, Boston, United States of America; Roomi Aziz,
Pathways2Impact, Pakistan; Ekatha John, independent researcher
and journalist, India; Pascale Allotey, United Nations University
International Institute for Global Health, Malaysia. Some of the authors
(Anuj Kapilashrami, Jeevan R Sharma, Ganesh Gurung) are also
steering group members.
Source of support: The workshops and consultations were held with
funding support from the British Council.
Conict of interest: Nima Asgari-Jirhandeh and Anns Issac are
employees of the World Health Organization and Kolitha Wickramage
of the United Nations Migration Agency. The opinions expressed
are those of the authors and do not necessarily reect the views of

Kapilashrami et al.: Migration health research in south and south-east Asia
110 WHO South-East Asia Journal of Public Health | September 2020 | 9(2)
the International Organization for Migration and the Asia Pacic
Observatory on Health Systems and Policies.
Authorship: All authors contributed to the discussion and analysis
reported in this article and approved the nal version of the manuscript.
AK conceptualized the paper and wrote the rst draft with inputs from
KW and JRS. NA-J, AI, AB and GG reviewed and contributed to the
paper. AK is founding chair of Migration Health South Asia (https://
mihsa.org), JRS and GG are steering group members, and KW is an
international advisor to Migration Health South Asia.
How to cite this paper: Kapilashrami A, Wickramage K, Asgari-
Jirhandeh N, Issac A, Borharde A, Gurung G, Sharma JR. Migration
health research and policy in south and south-east Asia: mapping the
gaps and advancing a collaborative agenda. WHO South-East Asia
J Public Health. 2020;9(2):107–110. doi:10.4103/2224-3151.294303.
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