2008
Barbara MacLaren
FOCALPoint
7
Guatemalan migrant workers who travel to Canada for work receive provincial healthcare coverage, but the families they leave behind have little or no access to healthcare of comparable standards.
The Guatemala office of the International Organization for Migration (IOM) has launched an independent health program with a private healthcare provider to address this gap for migrant workers to Canada.
Initiated from a partnership between the IOM and private Guatemalan health care provider Empresa Promotora de Servicios de Salud, the program was created in order to improve access to basic health care services for migrant families, while empowering the migrant workers to improve their financial skills and know-how.
Families of migrant workers often spend a large proportion of the remittances received to pay outstanding loans and buy food and clothing. Finding the money to meet family health and education needs can often be difficult.
Families have the choice of three health care plans. The basic plan, which costs US$36 per year, covers medical visits, paediatric care and gynaecology. The premium plan, for a considerably higher fee of US$450, covers maternal and specialist care. By comparison, it costs a Guatemalan worker US$150 to apply for a Canadian work visa. Guatemalan workers must enrol with the service provider and pay for their health packages before they leave for Canada. The program is also offered to Guatemalan families of migrants to the U.S. who have the additional perk of not having to pay upfront for their families’ health coverage.
The IOM’s head of mission Gunter Müssig said this program is innovative for three reasons.
First, a key principle underlying the program is to ensure equity of access to basic health supports between dependents of migrant workers and the migrants themselves. This means that the families of temporary workers who enjoy provincial health coverage in Canada deserve the same type of care at home. This is no small feat: virtually all of the Guatemalan migrant workers applying to work in Canada under the guest worker program come from rural areas that have poor or no public health care services.
Second, since the vast majority of Guatemalans who work abroad are men, the beneficiaries of the health program are mainly women, the wives of migrant workers who remain at home with their children.
Third, through the technical assistance offered by the IOM, migrant workers can learn about the health options available to them through migration and how to go about the application process.
The program’s first evaluation is underway, and, if successful, the IOM hopes to extend the program to include a component on educational savings that would save a portion of each remittance transfer into a separate fund. When their children reach the age for secondary school or post-secondary education, the investment can be put toward partial or full coverage of school fees.
Nevertheless, some risks and practical barriers exist to achieving the program’s goals. First, is the question of whether or not inclusion in the program is premised uniquely on participation in Canada’s Temporary Foreign Worker Program. If this is the case, there is the real risk of exacerbating inequalities and hostility between the families of migrant workers and the non-migrant population in local Guatemalan communities.
Second, there is the question of migrants becoming ineligible after joining the program, such as those who develop long-term health problems or are injured on the job in Canada. Workers wishing to come to Canada undergo a two-day medical screening process on an annual basis, and can be inadmissible based on risks posed to Canada’s “public health”, such as being tuberculosis-positive. If refused on this basis, what happens to the families of workers who fall short of such screenings?
Third, there is no guarantee that all migrants will be able to pay for the coverage offered by the program, particularly since they must pay upfront for the whole year’s coverage. Then there are also cultural barriers, such as the preference for traditional health remedies (shaman visits, for instance) that reduce the likelihood that families of migrant workers will use private clinics.
Another important question is whether or not this type of program takes the pressure off the Guatemalan government to provide and improve health services in rural areas.
Although migration is a decision that is premised on many different factors, the program could conceivably help create dependence on sending family members away for part of each year in order to sustain these higher standards of living and family expectations. If health care services are lacking locally, should it not be offered to every resident and not just part of the population? These questions need to be addressed sooner or later.
For the time being, however, the IOM is making an earnest attempt to address a pressing need among the migratory population in Guatemala, and those interested in managed migration and public policy affecting migrants should continue to watch this initiative closely.
annual_report2008_e.pdfAgriculture and horticulture workers, General farm workers, and Harvesting labourers
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