Integrating Refugees into National Health Systems: Enhancing Equity and Strengthening Sustainable Health Services for All.

根据联合国难民事务高级专员办事处的数据，截至2017年6月，全球有6560万人被迫流离失所，其中2250万人是难民。历史上，难民人口的保健服务主要是通过设在难民专员办事处或国际非政府组织经营的难民营内的专门保健诊所提供的。然而，随着流动模式和紧急情况持续时间的改变，人们认识到难民营的这些平行保健服务是不可持续的，无法充分惠及周围的收容人口，其中许多人也是弱势群体。相反，难民署呼吁将难民人口融入国家卫生系统，世界银行最近为难民收容国政府设立了一个20亿美元的基金，以支持难民与收容社区的融合，涵盖多个部门，包括卫生部门。这种朝向“人道主义与发展联系”的行动有可能支持难民和国民，同时增加国家系统的能力。关于将难民纳入卫生系统及其对卫生系统的影响的研究有限。因此，国际、区域或国家行动者所能获得的证据有限，无法说明哪种安排在特定情况下最有效。我们将在目前收容大量难民的三个不同国家进行案例研究：黎巴嫩（110万）、约旦（655,624）和乌干达（940,800）。我们计划重点关注在黎巴嫩和约旦的叙利亚难民，以及在乌干达的南苏丹难民。虽然黎巴嫩、约旦和乌干达的政策都在一定程度上将难民纳入卫生系统，但它们的做法和基础卫生系统的结构差别很大。我们将分别分析每个国家的情况，然后设法确定三个情况之间的模式，以便能够得出与其他情况相关的结论。具体而言，我们的研究将寻求了解利益相关者以及东道国和难民人口对难民融入国家卫生系统的看法和经验，包括这些利益相关者如何理解整合的意义并感知其可取性。它将确定影响难民（包括难民卫生工作者）融入国家卫生系统政策的结构、体制和个人/社区因素。该研究还将评估在这三种情况下难民融入社会的模式和程度如何影响难民和收容人口接受的保健服务，以及资金机制和流动如何影响服务的财政可持续性。然后，我们将召集国家、区域和国际政策制定者和决策者反思这些分析的结果，并确定其对未来政策和实践的影响。在这三个国家的案例中，我们将采用一种混合方法，根据当地情况进行调整。我们计划确定制定难民政策的时间表，并将进行政策分析，以了解政策和做法的演变过程及其原因。然后，我们将在地区一级案例中使用现有数据集和主要数据收集，探索难民融入国家卫生系统的不同方面如何随着时间的推移影响可获得性、获得卫生服务和卫生保健质量。在这三种不同的情况下进行比较研究，将使三国的决策者能够学习和考虑难民融入社会的其他办法，但也将提供可转移到其他现有和未来难民环境的证据和政策建议。我们还设法与难民署、世界银行和世卫组织等行为体合作，为这一问题的全球政策和指导提供信息。

According to United Nations High Commissioner for Refugees (UNHCR), until June 2017, 65.6 million people were forcibly displaced worldwide of whom 22.5 million were refugees. Historically, health services for refugee populations have been provided primarily through dedicated health clinics located within refugee camps run by UNHCR or international non-governmental organizations. However, as patterns of mobility and emergency duration have changed, there is recognition that these parallel health services in camps are unsustainable and insufficiently benefit the surrounding host populations, many of whom are also vulnerable. Instead, UNHCR has called for the integration of refugee populations into national health systems, and the World Bank recently established a US$2 billion fund for refugee-hosting governments to support the integration of refugees and host communities, covering multiple sectors, including health. This move towards a "humanitarian-development nexus" has the potential to support refugees and nationals, while increasing the capacity of national systems. There has been limited research exploring the issue of integrating refugees into health systems and its effects on such systems. Thus, there is limited evidence available to international, regional or national actors in terms of which types of arrangements may work best in a particular context. We will conduct case studies in three different countries currently hosting large numbers of refugees: Lebanon (1.1m), Jordan (655,624), and Uganda (940,800). We plan to focus on Syrian refugees in Lebanon and Jordan, and South Sudanese refugees in Uganda. While policies in Lebanon, Jordan and Uganda have all integrated refugees into health systems to some degree, they differ widely in their approach, and in the structure of the underlying health system. We will analyse each country case separately and then seek to identify patterns across the three cases, so as to be able to draw conclusions that are relevant to other contexts. Specifically, our research will seek to understand the perceptions and experiences of stakeholders as well as host and refugee populations towards refugees' integration into national health systems including how these stakeholders understand the meaning of integration and perceive its desirability. It will identify the structural, institutional and individual/community factors that have shaped policies on integration of refugees, including refugee health workers, into national health systems. The study will also assess how the pattern and extent of refugee integration across these three contexts has affected health services received by refugee and host populations and how financial mechanisms and flows affected financial sustainability of services. We will then convene national, regional and international policy and decision-makers to reflect upon the findings from these analyses, and identify their implications for future policy and practice. Within each of the three country cases we will employ a mixed-method approach that will be tailored to match local circumstances. We plan to identify timelines for the development of refugee policies and will conduct a policy analysis to understand how policies and practices evolved and why. We will then use existing datasets and primary data collection within district level cases, to explore how different aspects of refugee integration into national health systems over time has affected availability, access to health services and quality of health care. A comparative study, across these three different contexts, will enable decision-makers within the three countries to learn from and consider alternative approaches to refugee integration, but will also provide evidence and policy recommendations that will be transferable to other existing and future refugee settings. We also seek to inform global policy and guidance on this issue, working with actors such as the UNHCR, the World Bank and WHO among others.