Population mobility and migration in health policies: policy as discourse analysis of Zambias Neglected Tropical Disease Masterplans 2011-2022.

BackgroundDespite population mobility being on the rise globally, it remains neglected in the development of national health policies. This study sought to examine how population mobility is problematized in National Neglected Tropical Disease Masterplans and how these representations shape policy implementation within 4 NTD endemic districts in Zambia. MethodsWe used Policy as discourse analysis by guided by Bacchis "Whats the Problem Represented to be?" (WPR) approach. We reviewed all four NTD Masterplans that have been developed in Zambia between 2011 and 2022. Interviews on everyday implementation experiences were conducted with key policy actors (n=20), community health workers (n-34) and community members (n=35) guided by the Consolidated Framework for Implementation Research. Data was analysed using critical discourse analysis informed by the WPR approach. ResultsAcross all four Masterplans, the construction of migration and its role in NTD prevention, control and treatment was scant indicating limited recognition of the role that migration plays on health. Migrant groups recognized were forced migrant (refugees) or voluntary migrants (foreign tourists), labour migrants (fishing or farming) or environmental migrants. Assumptions underlying these constructions of migration include territoriality and associated internalization practices, medical nativism, migrant deservingness and universalization. Silences in the Masterplans included failure to account for local migration patterns, lack of migrant sensitive services and lack of clarity on entitlement of health services. ConclusionsThough the mobility is poorly problematized in the Masterplans, through policy design and implementation can strengthened such as using more comprehensive and standardized definitions of migration and migrant groups in public policies, capturing migration data and using it to inform decision making as well as establishing accountability mechanisms for policy actions, training of frontline workers using standards and engagement of migrant and mobile populations in migration governance. AUTHOR SUMMARYZambia has a robust migration governance framework aimed at enhancing population mobility. In order to identify if the policy intent of these governance frameworks in bringing about orderly, safe regular and responsible migration and mobility of people was being translated into health, we examined the problem representations of population mobility in National NTD Masterplans. We found that across all four Masterplans, the construction of migration and its role in NTD prevention, control and treatment was scant indicating limited recognition of the role that migration plays on health. There was an absence of data on the magnitude of migration related inequalities and how migration interacts with other dimensions of social identity. Key assumptions underlying these representations of mobility include territoriality where the Masterplans view borders as fixed orderings of space with cross border migration being seen as responsible for new diseases that are non-endemic in Zambia (onchocerciasis) or reintroduction of NTDs which have been eliminated (leprosy). The failure of the Masterplans to establish strong links between migration and NTD prevention, control, and treatment could be linked to a broader policy agenda surrounding migration nationally, regionally and internationally.