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    The response of health systems to the needs of migrants and refugees in the COVID-19 pandemic: A comparative case study between Mexico, Colombia and Peru
    (Elsevier Ltd, 2024-12-01)
    Protecting the health of migrants and refugees during the pandemic was a significant challenge in the Latin American region. We aimed to describe and contrast the response of the health systems of Mexico, Colombia and Perú to migrants' and refugees’ health needs during the COVID-19 pandemic, and to situate the response in the context of the migration and health policies of each country. Methods: We conducted case studies of the three countries. The data collected for each case included: 1) policy documents; 2) peer-reviewed and grey literature; 3) qualitative interviews with key informants. Findings: The three countries issued policies to detect COVID-19 cases among migrants and refugees, and granted them access to COVID-19 care regardless of their migration status or facilitated regularization as a way to improve access to care. However, other health care needs were not considered, some groups of migrants remained invisible in the policies, and policies rarely considered the increased social and economic vulnerability of migrants and refugees during this period. Pre-existing barriers to care were made worse during the pandemic. All three countries’ response to migrants was reliant on non-governmental organizations, with international cooperation being especially active in Colombia, and local civil society organizations in Mexico. Interpretation: The response of each country was a continuation of their previous approach to migration and health. Developing plans for pandemic response that consider migrants and refugees’ particular needs will be important to improve response capacities in the future. Funding: Funding was provided by USA for the International Organization for Migration (IOM) under an agreement with the Johns Hopkins Center for Humanitarian Health.
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    Hear My Voice: Understanding How Community Health Workers in the Peruvian Amazon Expanded Their Roles to Mitigate the Impact of the COVID-19 Pandemic Through Community-Based Participatory Research
    (BMJ Publishing Group, 2023-10-13)
    The COVID-19 pandemic led to the collapse of the Peruvian health system, disrupting healthcare access for indigenous communities in the Amazon. Our study analysed how community health workers (CHWs) from indigenous communities in the Peruvian Amazon expanded their roles to mitigate the effects of the COVID-19 pandemic. Methods Fourteen CHWs from Loreto, Peru, participated in a community-based participatory research project using Photovoice, a technique encouraging vulnerable groups to take photos and develop stories illustrating their lived experiences. Participants were recruited from Mamás del Río, a local university-based programme, through purposive sampling. CHWs were asked to photograph how the pandemic affected their lives and work. Participants met four times over 5 months to share photos and develop action items. Data were organised into key themes using thematic analysis. CHWs shared photo galleries with policy-makers in Loreto and Lima. Results CHWs produced 36 photos with 33 texts highlighting their roles during COVID-19. Three core themes emerged: the (1) collapse of health infrastructure, (2) use of medicinal plants versus pharmaceuticals and (3) community adaptations and struggles. The leadership of CHWs emerged as a cross-cutting theme as CHWs supported COVID-19 efforts without government training or resources. CHWs asked policy-makers for formal integration into the health system, standardisation of training and management of community pharmacies. Conclusion CHWs demonstrated their leadership and expanded their roles during the pandemic with little to no training from the government. Global investment in robust CHW programmes can fortify healthcare delivery.
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