Transcript Slide 1

Strategic Health Policy
Directions in Refugee
Resettlement
Joy Baldwin
Medical Services Branch
Citizenship and Immigration Canada
Vancouver B.C.
February 20, 2007
Immigration Health Policy
• Medical Services Branch is committed to
developing strategic health policy through
domestic and international partnerships that
is in keeping with CIC’s 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 Branch
CIC
• 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
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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:
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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
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TB prevalence in Thailand refugee camps over the past two years: 2,674/100,000 (1)
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MDR-TB (1):
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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.
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Active TB diagnosed amongst the 805 Karen refugees coming in Canada:
9 cases/805 refugees: 745/100,000
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WHO estimated sputum smear positive pulmonary TB rate per 100,000 (3 year
average for 2004/2005/2006)(2):
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Thailand: 61/100,000
Myanmar:73/100,000
(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
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optimize health outcomes
Integrated policy framework to
ensure
optimal health outcomes