Healthcare interventions for low-wage migrant workers: A systematic review

Low-wage labour migrants often face health-damaging living and working conditions, but are frequently excluded from healthcare. The othering of migrants, bordering of healthcare and simple oversight and negligence create widening health inequalities for a societys essential workers. This review aimed to identify the forms and effectiveness of healthcare interventions designed to make services accessible for migrant workers . We searched for literature through Medline, Embase, Global Health, Web of Science, and Global Index Medicus (from 1 January 2000 till 9 June 2023), focussing on some of the most common sectors for forced labour (domestic work, construction, manufacturing, agriculture, mining). Primary research, reports, and grey literature from 2000 onwards containing descriptions or evaluations of healthcare interventions exclusively targeting low-wage migrant workers and their families were included. We excluded interventions focussing only on specific health conditions or disease screening. Quality appraisal was based on JBI tools. We produced a narrative synthesis separately for the interventions characteristics and effects. This review follows the PRISMA reporting guidelines for systematic reviews and is registered with PROSPERO (CRD42023459360). Identified studies included 21 interventions targeting low-wage migrant workers in six countries (China, Dominican Republic, Italy, Qatar, South Africa, USA) in three sectors (agriculture, manufacturing, domestic work). Interventions included established medical facilities (e.g., general hospital care, semi-permanent primary healthcare (PHC) services); mobile clinics for PHC; and telehealth services. Interventions were provided by governmental, non-governmental, academic, and private actors. Most targeted migrant farmworkers and were primarily located in the United States. Common healthcare barriers were addressed, for example, via free care, outreach, or non-traditional hours. However, the interventions effects on health, access and uptake, patient satisfaction, and acceptability were largely unclear, as only six studies offered some fragmentary evaluative evidence. Few healthcare interventions targeting migrant workers have been documented and evaluated, especially in LMICs. Although migrant workers are deemed to be mobile populations, once in the destination location, many are quite immobile when it comes to accessing healthcare. Thus, in the face of multidimensional exclusion of migrant workers, health systems cannot simply rely on the ability of this vital workforce to seek and use preventative or curative care, but healthcare services must be actively designed to be accessible to this mobile population in order to ensure health as a human right. Highlights- What is already known on this topic: Many migrant workers are exposed to occupational health risks and substandard living-conditions. Due to the intersection of socioeconomic disadvantage and migrant status as well as bordering of healthcare and other services, low-wage labour migrants often face multi-dimensional exclusion from health systems. To inform policy, practice and research, we systematically reviewed evidence on targeted healthcare interventions globally for migrant workers. - What this study adds: This review identified healthcare interventions for migrant workers, including: established clinics (e.g., general hospital, p healthcare centres); mobile clinics (delivering primary healthcare); and telehealth services (for chronic disease management and mental health. Common tactics to overcome exclusion from healthcare were applied via e.g., outreach, free care or language mediation. Most included interventions targeted agricultural workers. - How this study might affect research, practice or policy: Findings offer several examples of approaches designed to surpass borders to healthcare commonly faced by low-wage migrant workers with prevention and treatment interventions. To improve health equity for migrant workers, budget-holders need to invest in diverse interventions that are specifically designed to reach migrant workers vs waiting for migrant workers to navigate their general exclusion from the healthcare system. Because labour migration and hazardous labour conditions are especially prevalent in low- and middle-income countries (LMICs), there is an urgent and substantial need to assess migrant workers health needs and access options to develop and test targeted health interventions specifically designed to reach migrant workers.