|Author(s):||F. Dorobova*1, F. Daya2, V. Kobzeva3, J. Tomaro4, S. Jadavji5|
|Affiliation(s):||1Medical Coordinator, Health Programme, Aga Khan Foundation, Moscow, Russian Federation, 2CEO, Aga Khan Foundation, Moscow, Réunion, 3Monitoring and Evaluation Officer, Aga Khan Foundation, Moscow, Russian Federation, 4Director, Health, 5Programme Associate, Health, Aga Khan Foundation, Geneva, Switzerland|
|Keywords:||Migrants, Russia, Tajikistan, Healthcare|
Following the collapse of the Soviet Union in 1991, several of the newly independent republics, such as Tajikistan, had to rebuild shattered economies and to establish new polices and institutions. In many of these countries, employment opportunities were limited, forcing people to seek jobs elsewhere, especially Russia. Russia needs labour migrants because its native workforce is insufficient. The Russian Federal Service for Migration reports that in 2008, there were about 400,000 labour migrants from Tajikistan in Russia, while other sources estimate the number to be around one million. Some suggest that there are as many as ten million non-registered migrants. From Tajikistan, a landlocked country with limited natural resources and weak systems, more than 600,000 labour migrants move to Russia each year. Remittances provide better lives for Tajik families back home and greatly strengthen the national economy. In 2008, for example, remittances channelled through banks comprised about half of the national GDP. In addition, in 2007, 50% of the poorest households receiving remittances since 1999 rose above the poverty line. Migrants in Russia fall into one of three categories: i) those with Russian citizenship (most of whom arrived before the collapse of the Soviet Union), ii) those legally registered, and iii) those who are not registered. However, regardless of legal status, migrants face discrimination; have difficulty maintaining their registration and securing access to all legally defined benefits (e.g. access to health care and ability to apply for bank loans), and are often harassed by officials. While healthcare is free for Russian citizens and registered migrants with legal employment, those who are not registered must pay. Costs are often too high, forcing most migrants to wait until their illness is severe before seeking medical attention.
|Methods:||In 2008, in response to the health care needs of migrants in Moscow, a group of volunteer doctors from Tajikistan established a network called the Volunteer Ismaili Doctors’ Initiative (IDI) with assistance from the Aga Khan Foundation. The overall objective was to create a structured approach to the provision of health care and psychosocial care and to create awareness of healthier lifestyles among migrants. Since June 2008, the IDI has: i) operated a medical hotline that offers access to a treating physician; ii) carried out complementary home/workplace visits to provide diagnosis and basic health care; and iii) conducted seminars to raise awareness of socially significant diseases (TB, HIV/AIDS, STIs) and reproductive health. In July 2009, a fourth component was launched to address the psychosocial impacts of continuous stress related to financial problems and domestic and legal issues. This is a telephone counselling service that provides psychosocial and emotional support, as well as referrals.|
Please see the Table for number of migrants reached through the IDI. Despite Russia’s need for labour migrants, the attitudes and practices in place are not always favourable for migrants, resulting in discrimination and restricted access to medical care and other social services. The AKF IDI approach, while necessary, is an interim solution; the programme works to engage the Russian public health system and corporate sector, through advocacy and policy influencing initiatives, in the provision of a more sustainable and equitable approach to ensuring access to health care for migrants. As migrants begin to access public health services, the current volunteer programme can phase out of healthcare and focus more on the promotion of healthy lifestyles.