Memorandum by the International Organization
for Migration (IOM)
SUMMARY
The International Organization for Migration
(IOM) provides health assessments (HA) for resettlement to other
countries, including the United Kingdom (UK). Screening for tuberculosis
(TB) is one of the most important elements of HA. IOM comments
on three inquiry issues related to TB.
Comment on the Inquiry Issue 1
Human mobility impacts on the spread of diseases.
Targeted health surveillance mechanisms and initiatives to overcome
inequalities in accessing health services need to be put in place
at various points of the migration cycle.
Comment on Inquiry Issue 2
Analysis of chest X-ray (CXR) findings and results
of sputum tests among the refugees[27]
resettling in the United States (US) from Thailand and the immigrants
to the United Kingdom (UK) from the countries, where IOM is implementing
the UK TB Detection Programme (UKTBDP) was conducted by IOM. The
rates of CXR finding, suggestive of active TB, were significantly
higher than the prevalence of all forms of TB reported by the
World Health Organization (WHO) in the majority of examined cohorts.
In the US-bound refugees the smear-positivity rate was ten times
higher than the incidence of smear-positive TB cases reported
for Thailand. Smear-positivity in the UK-bound migrants is lower
than reported for the countries. The difference between smear-positivity
rates in refugees and immigrants may reflect different prevalence
of TB in different social strata. Active case detection reveals
less advanced forms of TB than the passive case detection, which
may partly explain lower positivity rate in some cohorts. These
data suggest that the active case detection undertaken in the
framework of the resettlement HA programmes may provide a better
estimate of the magnitude of the problem in different cohorts
and globally. In the setting of resettlement HA sputum smears
alone are inadequate diagnostic tool. Analysis of sensitivity
of sputum smears vs. cultures showed that sensitivity of sputum
smears was 18.7%, which means that a significant number of cases
of active TB, including multi-drug resistant TB (MDR-TB), are
missed if the screening protocol does not include cultures.
Comment on Inquiry Issues 3, 4, 5
Surveillance systems need to be extended into
migrant communities. There is a need for special policies and
initiatives of integration that must take into consideration the
risk for stigma that would hamper effective communicable disease
control.
Comment on Inquiry Issue 6
IOM is uniquely positioned to contribute to
the global fight against TB due to: presence in many countries,
including countries with a high burden of TB, work with large
caseloads of mobile populations, use of standard methodologies
enabling unique epidemiological studies, contribution to cross-border
control of TB through TB detection and treatment, availability
of human resources with significant experience in TB and migration,
growing laboratory services and use of modern tools of laboratory
diagnosis.
Furthermore, IOM collaborates with the immigration
and health authorities of the resettlement countries. IOM is a
member of the Stop TB partnership and has an active role in the
Global Laboratory Initiative. IOM works with other development
partners, WHO, academia and various public and private institutions.
Comment on Inquiry Issue 8
In many low incidence countries with a long
history of migration, the foreign-born population accounts for
a roughly half of all new active TB cases. This high proportion
of TB among foreign born persons therefore creates significant
public health concerns and economic impact. IOM regards the UKTBDP
as an important, albeit not the only, step that could potentially
contribute to the reversal of the trend and suggests a number
of measures to increase the effectiveness of the programme. The
addition of sputum cultures to the screening protocol is expected
to increase the TB detection rate and enable detection of drug-resistant
forms. The public health impact of the programme is likely to
increase if the programme is connected to the public health surveillance
system in the UK. Migrants with CXR findings, suggestive of active
TB, should be followed after arrival to the UK. The effective
cross-border control of TB is impossible without the development
of capacities of the health care systems in the countries of migrants'
origin. IOM is strategically positioned to provide assistance
with capacity-building of National TB Programmes.
Comment on Inquiry Issue 11
The Avian Influenza (AI) preparedness offers
an example of the often neglected need for targeted programmes
that reach migrants and mobile populations. In order to address
this gap IOM has piloted initiatives in South-East Asia and Africa,
supported by the Japanese Government, and well received by local
Governments.
INTERNATIONAL ORGANIZATION
FOR MIGRATION—WHO
WE ARE?
1. The International Organization for Migration
(IOM) (www.iom.int) is
the leading inter-governmental organization in the field of migration
and works closely with governmental, intergovernmental and non-governmental
partners. IOM works in the four broad areas of migration management:
— Migration and development
2. Migration health is one of the IOM activities
that cuts across these areas of migration management. Other cross-cutting
activities include the promotion of international migration law,
policy debate and guidance, capacity building, public information
and education, integration, protection of migrants' rights, the
gender dimension of migration and environmental degradation and
migration.
3. The United Kingdom (UK), as one of 122
Member States of IOM, utilizes the services provided by the Organization
in various fields, including movement management, resettlement,
cultural orientation, assisted voluntary return, capacity building,
counter-trafficking, migration and development, and health.
HEALTH ASSESSMENTS
4. One of the largest services, provided
by IOM's Migration Health Department (MHD) is health assessments
(HA) for people settling in other countries. HA are conducted
at the request of receiving countries, tailored to fulfill national
immigration legislations and follow national guidelines/technical
instructions. In 2006, IOM provided HA to more than 120,000 migrants
in 46 countries (Migration Health Annual Report, 2006);
in 2007—to more than 189,000 migrants, including about 90,000
migrants to the UK (unpublished data).
5. The objectives of HA programmes include:
— detection of conditions of public
health importance: infectious tuberculosis (TB), other communicable
diseases;
— detection of other conditions, requiring
follow up and/or treatment after arrival, facilitation of integration
of migrants;
— off-shore treatment of certain Sexually
Transmitted Infections, TB, malaria, intestinal parasites;
— counselling and health promotion;
— fitness-to-travel checks; and
— medical escort and evacuation.
HEALTH ASSESSMENT
PROGRAMMES FOR
THE UNITED
KINGDOM
6. At the UK's request, IOM carries out
two HA programmes:
— HA of refugees within a framework
of the Gateway Protection Programme. The programme encompasses
various aspects of health (communicable and non-communicable diseases,
mental health, and fitness for travel). It is relatively small
(less than 1,000 entrants per year).
— The United Kingdom Pre-Departure
Tuberculosis Detection Programme (UKTBDP). UKTBDP focuses
on the TB screening of the applicants for UK visas for stays in
the UK of more than six months. Currently the programme is implemented
in eight countries of origin with a high TB burden as defined
by the World Health Organization (WHO).
UNITED KINGDOM
TUBERCULOSIS DETECTION
PROGRAMME
7. UKTBDP started in October 2005 and was
piloted in 2006 in five countries: Bangladesh, Cambodia, Sudan,
Tanzania and Thailand. On 21 November 2006, the main phase of
the programme involving nine other counties (China, Ethiopia,
Ghana, Kenya, Nigeria, Pakistan, Philippines, South Africa and
Zimbabwe) was announced in the UK Parliament. Within the first
quarter of the year 2007, three of the nine countries (Ghana,
Kenya and Pakistan) started the screening. The others were put
on hold at the request of the UK.
8. The key objective of the programme is
to address public health concerns about the spread of infectious
TB in the UK by preventing the entry of people suffering from
the disease until they have been successfully treated, and to
facilitate the access to diagnosis and treatment of TB in the
countries of migrants' origin. The programme is part of the UK
Action Plan to reverse the rise in TB (Stopping Tuberculosis
in England: An action plan from the Chief Medical Officer, 2004).
9. BENEFITS OF
THE UKTBDP
— UK visa applicants suffering from
infectious tuberculosis are diagnosed early and referred for treatment
to local clinics adhering to international standards of treatment.
— Expected to reduce the risk for communities
in the UK of contracting infectious TB from newly arrived migrants.
— Generates data on TB infection among
travellers to the UK, enabling the UK Government to better understand
the problem and respond with effective health policies.
— Countries of origin benefit from
the sharing of best practices of TB testing and strengthening
of laboratory capacity.
10. The TB screening protocols of all countries
requesting HA prior to resettlement include chest X-ray and sputum
tests: the majority of protocols require both sputum smears and
sputum cultures, some require only sputum smears. The UKTBDP screening
protocol includes chest X-ray for applicants of 11 years old or
older, and laboratory diagnostics (sputum smears for Acid Fast
Bacilli—AFB ) for those whose X-ray is suggestive of TB.
The applicants who either have normal chest X-ray or abnormal
chest X-ray but negative sputum smears receive a certificate which
allows them to continue with the visa application procedure. As
of November 2007, the screening protocol in three countries (Bangladesh,
Kenya and Thailand) includes sputum cultures for Mycobacterium
tuberculosis.
11. This response to the Call for Evidence
will mainly focus on the IOM's vision of some aspects of the global
problem of tuberculosis from the point of view of the health service
provider implementing HA of migrants globally. Some additional
notes, though less supported by quantified evidence, will refer
to the IOM assessment of trends with regards to communicable diseases
and human mobility particularly in developing countries.
THE EVIDENCE
Inquiry Issue 1. Progress made in reducing the
spread of diseases vs. possible deterioration
12. The equilibrium between infectious diseases
control and spread remains an unstable and dynamic one, highly
dependent on multiple human and microbial factors. Human mobility
has traditionally been associated with the spread of diseases,
and manifestly migration and mobility are nowadays on the increase
globally. In many instances the same causes that sustain mobility
(eg poverty, conflicts, human rights abuses, natural and man-made
disasters with their corollary of disrupted health services) are
also associated with risks and vulnerabilities for the growth
and spread of communicable diseases. In this context, growing
urbanization in crowded slum areas of various large cities of
the world, and the existence of various site multipliers or `hot
spots' that sustain concentrated epidemics, represent potential
risks for the insurgence and spread of communicable diseases:
people with very different back-grounds, legal status, culture,
knowledge, attitudes and behaviours vis-a"-vis health share
poor and insalubrious environments and have limited access to
health care, yet they often remain determined to cross borders
in seek of greener pastures, or engage in circular migration between
urban and rural settings bringing with them their epidemiological
profiles. Targeted health surveillance mechanisms and initiatives
to overcome inequalities in accessing health services need to
be put in place at origin, transit and destination in the migration
cycle whatever the legal status of the migrant is.
Inquiry Issue 2. What reliable data exist regarding
the numbers of people infected globally?
13. The main source of information about
the global burden of TB is the WHO publications, in particularly,
the annual report "Global Tuberculosis Control: Surveillance,
Planning, Financing". Every year, WHO requests information
from the National TB Programmes (NTPs) or relevant public health
authorities in 212 countries or territories via a standard data
collection form (WHO REPORT 2007 Global Tuberculosis Control.
Surveillance, Planning, Financing, p 10). The reporting is
predominantly based on passive case detection.
14. Active case detection undertaken by
IOM in migrants in the course of pre-resettlement HA may allow
more accurate in-depth analysis of the prevalence of TB cases
in certain cohorts.
15. The following is the analysis of some
TB indicators in two cohorts of migrants examined by IOM: the
United States (US)-bound refugees in Thailand and the UK-bound
immigrants in the countries where IOM implements the UKTBDP.
16. Two critical elements in the US and
UK TB screening protocols are chest X-ray (CXR) and sputum AFB
microscopy (AFB smears). In 2005 sputum cultures were added to
the US protocol. We analyzed associations of smear-positivity
with the CXR findings in the US cohort. We found that those with
cavitary lesions, infiltrates, non-calcified pulmonary nodules
and pleural effusions were more likely to have positive sputum
smears (Table 1).[28]
Similar data were reported earlier (Chest 1999; 115:1248-1253).
Realizing that not all of these CXR lesions represent TB, we named
them as CXR findings, suggestive of active TB. Considering that
these findings, detected in migrants from high-burden countries
should prompt immediate investigation for TB, we sought to assess
the prevalence of such findings.
17. The rate of the CXR findings, suggestive
of active TB, was higher than the prevalence of all forms of TB
reported by WHO among the UK-bound migrants in five out of eight
countries. In Bangladesh, Pakistan, Tanzania and Thailand this
difference was several times higher,[29]
though the rate of smear-positivity was lower in seven out of
eight countries (Table 2). The prevalence of the CXR findings,
suggestive of active TB, in the US cohort in Thailand was 25 times
higher the prevalence of all forms of TB, reported by WHO, and
the smear-positivity rate 10 times higher (Table 3). It is noteworthy
that the US caseload represents one of the most destitute social
stratum (refugees), while the UK caseload are mainly presented
by the representatives of the middle and upper classes (students,
fiancées and spouses of the UK citizens, and to a lesser
extent working holiday makers), which can partly explain the difference
in smear-positivity rates between these cohorts and lower than
WHO-reported smear-positivity rate in the UK cohort. Of note though,
is that in the UK cohort the highest smear-positivity rates were
seen in the countries where IOM performs laboratory testing using
its own laboratories (Bangladesh, Kenya and Thailand) as opposed
to those countries, which use non-IOM laboratories.
18. Realizing the limited methodological
validity of such a comparison, we believe that this data may indicate
that the TB prevalence officially reported by the NTPs shows only
the tip of the iceberg of the TB burden.
19. In the context of mandatory testing
for migration purposes, the diagnostic yield of AFB-microscopy
is lower than would be in a clinical setting due to several factors,
including, but not limited to, lower level of cooperation (resulting
in a production of inadequate sputum specimens), intake of anti-tuberculosis
drugs, available in some countries over-the-counter, prior to
testing and, possibly, lower bacterial load, which characterizes
earlier stages of the disease detected through the active screening
(International Journal of Tuberculosis and Lung Diseases 2001;
5(5):419-425). The addition of sputum cultures, which is a
standard of diagnosis in the UK (National Collaborating Centre
for Chronic Conditions. Tuberculosis: clinical diagnosis and management
of tuberculosis, and measures for its prevention and control.
London: Royal College of Physicians, 2006), but has not been
included in the current UKTBDP screening protocol until recently,
would increase the sensitivity of testing. In one of the studies,
patients with smear-negative culture-positive tuberculosis appeared
to be responsible for about 17% of TB transmission (The Lancet
1999; 353:444-449).
20. We analyzed the sensitivity of sputum
smears among the US-bound refugees in Thailand (Table 4) and found
that the sensitivity of AFB smears assessed against cultures was
only 18.7%, the specificity was 99.3% and the positive predictive
value was 53.7%.
21. The sensitivity of sputum microscopy
in this study is lower than reported by other investigators (Phil
J Microbiol Infect Dis 1987; 17:33-35; Phil J Microbiol infect
Dis 1995; 24(2): 33-36), which may reflect a higher proportion
of cases with lower bacterial load detected actively as compared
to the passive case detection. On the other hand, these results
show that sputum microscopy alone cannot be regarded as an adequate
TB detection tool in the resettlement programmes (and possibly
in other programmes, using targeted active case detection; this
hypothesis, however, needs further confirmation). The importance
of wider use of sputum cultures for TB diagnosis is further illustrated
by the fact that in the IOM analysis of drug-resistance, out of
30 cases which showed resistance to at least one anti-tuberculosis
drug, 22 were smear-negative. These cases, including five with
multi-drug resistant TB (MDR-TB), would have been missed if sputum
cultures had not been included in the screening protocol.
Inquiry Issue 3, 4, 5. Surveillance systems, trends,
gaps
22. In the context of migration and health,
surveillance systems need to be extended into migrant communities
involving members of the community itself so as to overcome language,
cultural, gender and other barriers. Such community actors need
to be integrated into national health systems and programmes.
Messages, programmes and initiatives often do not reach migrants
communities, and particularly those that, because of their legal
status, might be afraid to interact with institutions. Xenophobia,
stigma and politically motivated attitudes towards migrants risk
driving underground people that would otherwise need medical attention.
This represents a potential multiplier factor for the growth and
spread of communicable diseases. While human mobility is recognized
as associated with health risks and vulnerabilities, no segregated
data are widely available that provide evidence for specific policies
and programmes development. The need for knowledge to sustain
initiatives of integration and not exclusion, must take into consideration
the risk for stigma that would hamper effective communicable disease
control. Formulation of these policies requires involvement of
various governmental and non-governmental actors in this field.
Inquiry Issue 6. What role does your organization
play in combating the four diseases? Do you believe that it is
correctly configured and adequately resourced to do the job? With
which other organizations do you collaborate?
23. IOM is uniquely positioned to contribute
to the global fight against TB. The salient features of the IOM's
current and potential role in combating TB are as follows:
23.1 IOM is working in many countries with
a high burden of TB.
23.2 IOM is dealing with a considerable caseload
of mobile populations globally (Table 5).
23.3 IOM is performing TB detection in different
countries and in different cohorts, using standard methodologies.
This includes standard screening protocols, global standardization
of all aspects of resettlement health assessment through the system
of quality control and quality assurance, standardization of laboratory
practices, centralized standardized data collection with the use
of the institutional databases. All this positions IOM as a potentially
important research partner, able to generate data which will contribute
to the global understanding of the TB burden, monitoring its patterns
and trends as well as be used for planning of targeted interventions:
— in the countries of migrants' origin;
— in the countries of migrants' destination;
and
However, at the present time, the research performed
by IOM is mostly operational; its results are used for the planning
of medical and resettlement activities. Scientific epidemiological
research is not performed consistently due to the lack of specific
funding and dedicated staff.
23.4 IOM contributes to cross-border control
of TB through its early detection and treatment prior to resettlement.
IOM has accumulated significant experience in the management of
TB, including MDR-TB. In some countries IOM established its own
Directly Observed Treatment (DOT) centres, in others the migrants
are referred to the health care providers who adhere to the WHO
standards of care. IOM DOT centres provide treatment for migrants
with various forms of TB, including MDR-TB and TB-HIV co-infection.
IOM has Green Light Committee approval for dispensing second line
TB drugs to patients with MDR-TB.
23.5 IOM has highly qualified human resources
with considerable exposure to diagnosis and management of TB,
including physicians, public health specialists, laboratory specialists,
health information specialists and researchers.
23.6 IOM is currently establishing TB culture
laboratories and/or contributes to the strengthening of the existing
laboratories for mycobacterial culture in several settings worldwide.
These settings include Bangladesh, Kenya, Nepal, Pakistan, Thailand
and Vietnam, with plans to expand TB culture services in other
countries with standardized methodology, reporting and quality
monitoring systems.
23.7 IOM has developed a laboratory diagnostic
algorithm incorporating new diagnostic tools for the rapid detection
of drug resistant strains of M. tuberculosis and the identification
and differentiation of M. tuberculosis from non-tuberculous mycobacteria
(NTM). These new molecular tools are expected to improve both
TB diagnosis and case management. IOM and the Foundation for Innovative
and New Diagnostics (FIND) have concluded a Memorandum of Understanding
which will allow IOM to procure these assays at specially discounted
rates.
24. IOM closely collaborates with the NTPs
in the countries of origin and health authorities in the countries
of destination. The examples include, but are not limited to,
the Centers for Disease Control and Prevention, Atlanta, USA;
Global Migration Unit, Department of Immigration and Citizenship,
Australia; Medical Branch, Citizenship and Immigration, Canada,
and others.
25. IOM is pleased to note a growing convergence
of the approaches to the diagnosis and management of TB in migrants,
however IOM believes that it would be useful if the resettlement
countries continued their efforts in the direction of (1) harmonization
of screening protocols; (2) harmonization of data collection and
reporting; (3) research support and (4) information-sharing.
26. IOM is a member of the Stop TB Partnership
and has an active role in the Global Laboratory Initiative in
developing a strategic plan and roadmap to guide the massive scale-up
of laboratory services as an essential first step in effectively
addressing the diagnostic challenges of TB-HIV and MDR-TB within
the Millennium Development Goals framework.
27. IOM promotes research, dialogue, policy
review, technical cooperation and implementation of programmes
that focus on the health of migrants and mobile populations. The
Organization's competitive advantage is founded on its direct
exposure through existing programmes to a variety of migrant categories,
its multidisciplinary approach and its mainstreaming of health
into the global role of the Organization in assisting Member States
in meeting the challenge of managing migration. In this endeavour
IOM works with other development partners, notably WHO to which
is linked by a Memorandum of Understanding, with partner governments,
academia and various public and private institutions. The IOM
Migration Health Department intends to further develop this partnership
and seeks continuous donor support to bridge the still existing
gap between awareness and action in the domain of migrant health.
Inquiry Issue 8. Cases of Tuberculosis fell progressively
in the UK until the mid-1980s but started to rise again in the
early 1990s. Around 6,500 cases are now reported each year, an
increase of about a quarter since the early 1990s. What are the
main factors of the revival of Tuberculosis infection in Britain?
And how could intergovernmental action help to reverse the trend?
28. Most migrants travel from countries
where the incidence of active TB is greater than 40 per 100,000
population (high incidence) to countries where the incidence is
less than 25 per 100,000 population (low incidence) (British
Thoracic Society Guidelines. Control and prevention of tuberculosis
in the United Kingdom: Code of Practice 2000. Thorax 2000; 55:
887-901). As a result, in many low incidence countries with
a long history of migration such as the United States, United
Kingdom and Australia, the foreign-born population account for
a roughly half of all new active TB cases. This high proportion
of TB among foreign born persons creates significant public health
concern and economic impact on the annual health expenditure for
TB in industrialized countries (Eur Respir J 2005; 25: 1107-1116).
Screening for active tuberculosis and treatment is therefore an
important component of pre-migration health assessments. It should
be noted that HA programmes capture only a fraction of all mobile
populations. Irregular migrants and those who are visiting their
home countries and returning are not screened.
29. IOM regards the UKTBDP as an important,
albeit not the only, step that could potentially contribute to
the reversal of the trend.
30. However, in its present form the programme
probably produces less public health benefits to both the UK public
and the countries of origin than it could. The reasons for this
are the following:
31. Current screening protocol relies
primarily on chest X-ray screening and AFB microscopy to detect
and exclude only the most infectious cases. AFB microscopy alone
is not as sensitive as mycobacterial culture in detecting active
TB among immigrants.
32. In 2004, LoBue et al conducted
an evaluation of the screening of TB among immigrants to California.
The study found infectious TB cases would arrive in the US despite
pre-departure screening. The reasons for this are either due to
suboptimal sputum collection and laboratory testing, or delays
in the interval between their foreign and US examinations (Chest
2004; 126: 1777-1782). If ineffective screening methods are
used which do not include mycobacterial culture infectious TB
cases will continue to arrive into the resettlement countries.
This is particularly problematic when migrants or refugees harbor
multi-drug resistant TB. MDR TB was reported in several cases
among Hmong refugees resettling from Thailand into the United
States in 2004-05, before the culture was added to the screening
algorithm. This prompted a review of the US pre-migration algorithm
and mycobacterial culture was introduced as part of an enhanced
screening scheme (MMWR 2005; 54: 741-744).
33. The programme, to a certain extent,
is disconnected from the public health surveillance system in
the UK.
34. As mentioned in the response to Inquiry
Issue 2, IOM found a high prevalence of CXR findings that require
follow up and testing for TB.
35. It is known that a certain proportion
of individuals with the bacteriologically negative TB become smear
and/or culture positive. It is also known that even symptomatic
migrants delay seeking medical assistance after the entry into
the country of destination (American Journal of Respiratory
and Critical Care Medicine 1998 (157):1244-1248).
36. Follow up in the UK targeted at the
entrants with significant X-ray abnormalities and negative sputum
smears, especially those who are likely to be in contact with
a community and whose whereabouts can be relatively easily traced
(eg students), would constitute a more effective public health
measure for the resettlement countries than the overseas screening
programme alone.
37. The programme needs to be better
connected to the health care systems in the countries of origin.
38. The UKTBDP integrates into the National
TB Programmes (NTPs) in the countries of origin through strengthening
diagnostic facilities, in particular TB laboratories, TB treatment
facilities and training personnel. The majority of countries targeted
by the programme, lack capacities in some or all components. One
of the most serious concerns is the poor capacity and limited
availability of TB laboratory services. In order to meet the UKTBDP's
objectives IOM, in close cooperation with the Ministries of Health
(MOHs), NTPs and professional agencies (WHO), is engaged in capacity
development activities, which are focused on, but not limited
to:
— upgrading of the existing laboratories;
— establishment of new laboratories;
— training of the national personnel;
and
— dissemination of the best practices.
39. Currently these activities are targeted
to serve the populations which are ready to migrate and only indirectly
and to a limited extent, benefit the rest of the population. Capacity
building activities in the context of the UKTBDP are also limited
by the scope of investigations required by the screening protocol.
Yet there is a pressing need for the development of diagnostic
modalities enabling detection of drug resistant forms of TB—cultures
and drug susceptibility testing (DST), as well as newer techniques
such as molecular diagnostics and rapid DNA testing for drug resistant
tuberculosis.
40. TB specialists, debating controversies
of the screening programmes, are unanimous in the opinion that
"the most effective (not to mention more just) long-term
solution is to increase our efforts to control TB in developing
countries" (American Journal of Respiratory and Critical
Care Medicine; 2001 (164): 915).
41. IOM has human resources and expertise
to develop capacities of MOHs and NTPs, which could significantly
contribute to the overall strengthening of national and regional
health systems. IOM has a history of successful capacity building
activities for the TB laboratories in South East Asia, Africa
and Eastern Europe, where IOM provided equipment, set up facilities
for TB cultures and DST, trained laboratory personnel and established
a system of quality control.
42. Combining the screening component with
a capacity building component would be beneficial for both countries
of origin and resettlement countries. The infrastructure built
through the capacity development component would enhance the effectiveness
of the TB screening for migration purposes. In turn, the screening
programme is likely to provide an insight into the health care
system and its strengths, weaknesses, needs, identify optimal
strategies and bring the international experience to guide capacity
building activities. The report of the UK All Party Parliamentary
Group on Global Tuberculosis recommends supporting global
partnership and to "continue to provide predictable finance
to WHO, the Stop TB Partnership and other international organizations
involved in global TB control".
43. IOM, with its network of operational
units providing services to the most needy and often hard-to-reach
populations, working hand in hand with the governments, NGOs,
national and international organizations and professional bodies
is strategically positioned for such a partnership, channeling
the resources and provision of technical expertise to the countries
with the high TB burden.
44. Continuation of the capacity building
efforts on a larger scale would hit several targets:
— Improve access to TB diagnosis and
treatment for the population of countries with the high TB burden;
— Facilitate development of diagnostic
tools for detection of drug resistance;
— Contribute to development of human
resources;
— Improve acceptance of the resettlement
programmes by the governments in the countries of migrants' origin
and host communities.
Inquiry Issue 11. Avian Flu
45. The Avian Influenza (AI) preparedness
offers an example of the often neglected need for targeted programmes
that reach migrants and mobile populations. In various countries
campaigns and plans have neglected the reality of today's multiethnic,
multicultural communities. Few countries had included into their
plans specific actions, both in terms of prevention, response
and support to livelihood for migrants and mobile populations
in the context of AI epidemics. With the support of the Japanese
Government and in coordination with UN partners, IOM has piloted
initiatives in South-East Asia and Africa well received by local
Governments. IOM seeks continuous support in this sector and more
globally for policies and programmes that promote the health of
migrants and consequently their contribution to the growth and
development of their host community and origin as well.
IOM appreciates the opportunity to answer this
important Inquiry and hopes that its contribution will be useful.
February 2008
27 According to the 1951 UN Convention, a refugee is
a person who "owing to a well founded fear of being persecuted
for reasons of race, religion, nationality, membership in a particular
social group, or political opinion, is outside the country of
his nationality, and is unable to or, owing to such fear, is unwilling
to avail himself of the protection of that country". Back
28
The data are used with the permission from the Centers for Disease
Control and Prevention, Atlanta, USA. Back
29
The precise magnitude is not specified as the permission to use
the data for this response has not been received from the UK government. Back
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