The health needs and access barriers among refugees and asylum-seekers in Malaysia: a qualitative study.
The health needs and access barriers among refugees and asylum-seekers in Malaysia: a qualitative study.
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DOI：
10.1186/s12939-018-0833-x
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发表时间：
2018-08-15
影响因子：
4.8
通讯作者：
Legido-Quigley H
中科院分区：
文献类型：
--
作者：
Chuah FLH;Tan ST;Yeo J;Legido-Quigley H
在马来西亚，难民和寻求庇护者是一个弱势群体，他们的健康和福祉往往受到损害。这项定性研究旨在通过医疗保健专业人员、方案工作人员和难民和移民健康专家的透镜，研究马来西亚难民和寻求庇护者的主要健康问题和获得医疗保健的障碍。我们对来自马来西亚的联合国机构、公共医疗机构、民间社会组织和学术机构的专家、医疗保健专业人员、项目经理或高管进行了20次半结构化的深入访谈。访谈被转录和分析演绎和归纳使用主题分析。与会者的陈述强调指出，马来西亚境内难民和寻求庇护者的健康需求是复杂的。如报告所述，获得医疗保健的基础是众多的社会、文化和经济决定因素，加上缺乏对难民和寻求庇护者包容性的法律的环境。除了与移民过程相关的健康风险外，抵达后获得全面医疗保健的机会有限仍然是马来西亚难民和寻求庇护者的一个问题。获得医疗保健的主要障碍与以下因素有关：卫生知识普及程度低，对自己的医疗保健权缺乏认识;语言和文化差异;缺乏法律的地位造成的保护问题;以及由于生计不足而无力负担医疗保健。总体而言，人们认为，难以获得医疗保健会对难民、寻求庇护者及其东道国人口的健康状况产生有害影响，从长远来看，可能会给卫生系统带来更大的成本。在实践和研究方面的全面努力，解决健康的社会，文化和经济决定因素，以及更具包容性的卫生政策，对于加强马来西亚难民和寻求庇护者的医疗保健服务至关重要。切实可行的建议包括：提高难民和寻求庇护者的卫生知识水平，以便更好地了解卫生系统;通过翻译支助和跨文化指导，弥合语言和文化差距;执行以人人享有医疗保健权为基础的政策，不论其法律的地位如何，并为公共卫生服务;并建立更大的证据库，以推动马来西亚难民健康政策的制定和实施。
In Malaysia, refugees and asylum-seekers are a vulnerable group that often face circumstances in which their health and wellbeing can be compromised. This qualitative study sought to examine the key health concerns and barriers to healthcare access among refugees and asylum-seekers in Malaysia through the lens of healthcare professionals, program staff and experts on refugee and migrant health. We conducted 20 semi-structured in-depth interviews with experts, healthcare professionals, program managers or executives from UN agencies, public healthcare facilities, civil society organizations, and academic institutions in Malaysia. Interviews were transcribed and analyzed both deductively and inductively using thematic analysis. Participant narratives highlight that the health needs of refugees and asylum-seekers in Malaysia are complex. As reported, access to healthcare is underpinned by numerous social, cultural and economic determinants compounded by a legal environment that lacks inclusivity of refugees and asylum-seekers. Apart from the health risks associated with the migration process, limited access to comprehensive healthcare post-arrival remain a problem for refugees and asylum-seekers in Malaysia. Key barriers to healthcare access are linked to poor health literacy and the lack of awareness on one’s right to healthcare; language and cultural differences; protection issues resulting from a lack of legal status; and an inability to afford healthcare due to inadequate livelihoods. Overall, poor access to healthcare is perceived to have detrimental consequences on the health status of refugees, asylum-seekers and its host population, and may incur greater costs to the health system in the long run. Comprehensive efforts in practice and research that tackle the social, cultural and economic determinants of health, and more inclusive health policies are crucial in strengthening healthcare access among refugees and asylum-seekers in Malaysia. Practical recommendations include improving the health literacy of refugees and asylum-seekers for better navigation of the health system; bridging language and cultural gaps through translation support and inter-cultural orientation; implementing policies grounded in the right to healthcare for all regardless of legal status and in the interest of public health; and establishing a larger evidence base to drive policy development and implementation for refugee health within the Malaysian context.
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