Momentum Builds to Address the Health Needs of Migrants in Honduras
Stakeholders agree on actions to improve migrant access to health care
By Alejandro José Lopez
In Honduras, thoughts of migration are a reality in many communities. For women like Dunia Jackeline Rodriguez Ortez, whose family lost their house, crops, and other belongings in recent tropical storms, migration offers the chance to seek a better life for herself and her family. Others are driven to migrate from Honduras by the desire for family reunification or by push factors such as violence, food insecurity, economic and political instability, corruption, and climate change.¹
Honduras also receives returned migrants and is a well-trodden transit path for people from other countries who make the decision to migrate. The numbers are large, pointing to the humanitarian challenge facing this small country. Since 2014, over 430,000 migrants have returned, according to Honduran National Migration Institute (INM) records (Figure 1).² In the first quarter of 2022 alone there were 72,270 returnees, or approximately 1,500 people per day, nearly 30 percent of whom were children.³ Twenty-seven percent of returnees in 2022 have been women and girls.⁴
How do these vulnerable people — those at risk of migration, those in transit, and those returning — obtain health care, and what barriers do they encounter? Who provides health services for them? Does more need to be done, and if so, what? The USAID Local Health System Sustainability Project (LHSS) has been working with partners on the ground to answer these questions, with a special focus on the health needs of women within these groups.
Figure 1. Honduran Returnees by Year, September 2014* — October 2022**
Diverse Actors … And A Key Coordinator
An LHSS landscape assessment found numerous actors supporting Honduras’s health and migration response. First response centers are strategically located in high-migration areas, providing primary and emergency health services and social services for returning and in-transit migrants (Figure 2). Government institutions and international organizations fund these centers to deliver services per the 2020 Guide to Health Care for the Migrant Population, a publication of the Secretaría de Salud (Health Secretariat, SESAL). Other temporary centers provide intermittent surge support.
Responsible for coordinating this response is the Mesa Interinstitucional, Interagencial de Salud y Migración (Interagency Inter-Institutional Board on Health and Migration, MIISM). Established in 2019 and led by SESAL, MIISM includes 23 governmental, nongovernmental, and international development organizations. Its mandate is to support the rights, health needs, and determinants of health — such as food, housing, and sanitation — of populations in high-migration contexts. While other multilateral bodies within the region, such as the Regional Conference on Migration and the United National Regional Network on Migration for Latin America and the Caribbean, work on similar initiatives, MIISM is unique as a multilateral organization focused solely on Honduras.
Figure 2. Map of the Health and Migration Response in Honduras
Signs of Critical Shortages
We found that the first response centers face a shortage of human resources, infrastructure, and supplies. The centers’ health information systems do not report directly to SESAL’s health registry, and temporary support centers do not coordinate fully with government-funded structures. Lack of data from these centers limits the government’s ability to make evidence-informed decisions on migrant social health protection (SHP) programs. Further, migrants and women at risk of migration are not sufficiently informed of their rights, available services, or the myriad risks they will face while migrating.
At the same time, geographic areas with the highest flows of migrants in transit do not have sufficient shelter capacity or other infrastructure such as administrative offices for staff and medical facilities.
Data and key informant interviews suggest that the departments that most female migrants return to — Cortés, Francisco Morazán, Yoro, Olancho, and Comayagua — are also areas where many originated and where there is a higher risk of migration among women. LHSS’s assessment found that women in these departments often access services outside the public health system, including at private health clinics and others supported by NGOs and humanitarian organizations. These decentralized, externally provided services are more difficult to track, contributing to the paucity of data on the specific needs and gaps in health services for women at risk of migration. However, the fact that many women frequent these providers could indicate inadequate access to public health services.
High out-of-pocket spending in Honduras — 53 percent of current health expenditures — also indicates that there may be financial barriers to access to care for the most vulnerable, including migrants and those at risk of migration.⁵ Governmental and nongovernmental stakeholders agree that public funding for health is inadequate and sustainable financing is needed to meet the health needs of these vulnerable groups.
Plotting A Way Forward
We found that while many challenges exist, MIISM’s work to maximize stakeholder engagement, as well as an increase in political will from the new government (including leadership of SESAL), bodes well for efforts to improve the welfare of these vulnerable populations. Through a series of consultative meetings in September 2022, representatives from USAID, LHSS, MIISM, Save the Children Honduras, SESAL, INM, the Pan American Health Organization, and the International Health Regulations Office validated the LHSS assessment findings and agreed on priorities for action (Box 1). And the workshops themselves have catalyzed renewed energy to combat challenges. These priorities will inform the co-design of a 5-year roadmap to strengthen SHP for women and children in high-migration contexts.
The stakeholders engaged in the health and migration response in Honduras are committed to addressing the needs of vulnerable populations in high-migration contexts. The roadmap they develop — with support from SESAL and facilitation by MIISM — will include commitments from various stakeholder groups as a first step to strengthening SHP for these populations. Honduras’s human rights-based approach, encompassing returning migrants, those in transit, and those at risk of migration, may provide lessons for other countries facing similar challenges.
Notes:
¹ Trichilo, Rosaria, Kulesza, Victoria, and Gonzalez Ruiz, Alejandra. The Local Health System Sustainability Project (LHSS) under the USAID Integrated Health Systems IDIQ. March 2022. Expanding Social Health Protection for Women at Risk of Migration in Honduras. Rockville, MD: Abt Associate
² Instituto Nacional de Migración. Available at http://inm.gob.hn/estadisticas.html (Accessed on July 7, 2022)
³ Observatorio Consular y Migratorio de Honduras (CONMIGHO). (2022). Dirección General de Protección al Hondureño Migrante. Available at https://conmigho.hn/direccion-general-de-proteccion-al-hondureno-migrante/ (Accessed on July 7, 2022)
⁴ The Local Health System Sustainability Project (LHSS) under the USAID Integrated Health Systems IDIQ. Rapid Assessment Report of Social Health Protection for Women at Risk of Migration in Honduras. September 2022. Rockville, MD: Abt Associates.
⁵ Global Health Expenditure Database. Available at https://apps.who.int/nha/database/ViewData/Indicators/en (Accessed on September 27, 2022)
About the Author:
Alejandro José Lopez is a Communications Specialist at Save the Children Honduras who provides communications expertise for the organization’s work on behalf of women migrants in Honduras.
Contributors:
Carlos Dinkel Salazar, Project Management Analyst, LHSS Project, Abt Associates.
Victoria Kulesza, Project Management Analyst, LHSS Project, Abt Associates.
Dr. Alejandra Gonzalez Ruiz, Country Program Manager, Peru and Latin America and the Caribbean Bureau, LHSS Project, Abt Associates.
Lisa Tarantino, Director of Transition and Sustainability and Regional Manager, Latin America, the Caribbean, and Eastern Europe, LHSS Project, Abt Associates.
