Covid-19 deaths among migrant health care workers: risks and responses

关于移徙卫生保健工作者与非移徙卫生保健工作者接触Covid-19感染和死亡的程度是否相同，以及部门之间（如卫生和社会保健部门之间）和国家之间（如高收入国家和低收入国家之间）是否存在差异，目前缺乏强有力的经验证据。面对卫生和保健工作人员的复原力以及实现全球全民健康覆盖目标所面临的威胁，关于采取何种应对措施的经验证据也很薄弱。薄弱的监测系统和零散的报告系统意味着，国家和国际决策者需要进行特别调查，以适当监测Covid-19对卫生保健工作者和劳动力的影响。该项目旨在在2019冠状病毒病大流行期间适当关注移民在卫生保健系统中的地位。移徙工人在许多国家的卫生和保健系统中发挥着重要且日益重要的作用，是实现全民医疗保健全球目标的关键，因此，我们必须更好地了解Covid-19对他们的影响。该项目的首要研究问题是，就Covid-19而言，移民卫生保健工作者面临哪些风险，对具有复原力和可持续性的卫生保健工作者的压力是什么，利益攸关方如何应对这些风险和压力？除了加强基于移民卫生保健工作者中Covid-19感染和死亡风险的经验证据外，我们的项目还跟踪了对可持续卫生工作者实现全民健康覆盖所面临的此类风险和挑战的集体应对措施。我们使用不同的方法和技术收集有关Covid-19风险、压力和应对措施的定性和定量数据。我们对学术和非学术出版物进行系统的文献综述（SLR），使用混合综述方法来搜索数据和内容分析方法来提取感兴趣的数据，并评估研究和出版物的方法和结果。覆盖三种全球语言——英语、西班牙语和阿拉伯语——确保了SLR更大的民族语言覆盖面和包容性。我们还开发了一种研究方法来估计Covid-19移民卫生保健工作者的死亡率，并对该方法进行了试验，使用来自世卫组织和经合组织数据以及其他可用的人口和生物统计数据的定量数据进行了统计分析和建模。此外，我们通过访谈和对利益攸关方（雇主、工会、非政府组织）回应的文献分析收集数据，以绘制与卫生保健工作者培训、招聘、保留、部署、国际移民以及符合国际招聘和就业规范的移徙卫生保健工作者工作保护挑战相关的新回应模式。在研究过程中，我们让来自不同政策和实践领域的主要利益攸关方参与进来，旨在通过满足他们对Covid-19对卫生保健工作人员的多方面影响的强有力实证和分析证据的时间紧迫要求，展现出明显的影响潜力。该项目旨在满足对高质量数据的迫切需求，并通过合作开展以“现实世界”解决方案为重点的Covid-19研究。我们的重点是立即将概念验证结果应用于迅速演变的全球卫生危机。

There is a paucity of robust empirical evidence about whether migrant health care workers have the same level of exposure to Covid-19 infection and deaths as non-migrant health care workers, and whether variations exist between sectors (as between the health and social care sectors) and countries (as between higher income and lower income countries). Such empirical evidence on what responses have emerged in the face of threats to the resilience of health and care workforces and to realising the global goal of universal health coverage worldwide is also weak. Weak surveillance systems and fragmented reporting systems mean that special investigations to properly monitor Covid-19 impacts on health care workers and workforces are required by national and international decision-makers.This project aims to give proper attention to the place of migrants in health care systems during the Covid-19 pandemic. Migrant workers are of substantial and growing significance in many countries' health and care systems and are key to realising the global goal of universal health care so it is vital that we understand much better how Covid-19 is impacting on them. The project's overarching research question is, in the relation to Covid-19, what risks do migrant health care workers experience, what are the pressures on resilient and sustainable health care workforces, and how are stakeholders responding to these risks and pressures? In addition to strengthening the empirical evidence base on the risks of Covid-19 infection and death among migrant health care workers our project also tracks collective responses to such risks and challenges to sustainable health workforces for universal health coverage.We collect qualitative and quantitative data on Covid-19 risks, pressures and responses using different methods and techniques. We undertake a systematic literature review (SLR) of academic and non-academic publications using hybrid review methodologies to search for data and content analysis methodology to extract data of interest and evaluate the methods and findings of studies and publications. Coverage of three global languages - English, Spanish and Arabic - ensures greater ethnolinguistic reach and inclusivity of the SLR. We also develop a research method to estimate Covid-19 migrant health care worker mortality rates and trial the method, undertaking statistical analysis and modelling using quantitative data drawn from WHO and OECD data and other demographic and bio-statistical data as available. In addition, we collect data through interviews and documentary analysis on the responses of stakeholders (employers, trade unions, NGOs) to chart emerging patterns of response relating to health care worker training, recruitment, retention, deployment, international migration, and challenges for migrant health care worker protection at work consistent with international recruitment and employment norms. We involve key stakeholders from diverse communities of policy and practice during the research process, designed to have demonstrable potential for impact by meeting their time-critical requirements for robust empirical and analytical evidence about the multidimensional impacts of Covid-19 on health care workforces. This project is attuned to the urgent need for high quality data and for 'real world' solutions-focused Covid-19 research forged from collaboration. We are focused on the immediate application of proof-of concept findings to a rapidly-evolving global health crisis.