The Institute for Global Health and Development
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Item Integrating healthcare financing for refugees into national health systems: findings from a rapid review of the literature(Elsevier, 2025-10-16) Bertone, Maria Paola; Palmer, Natasha; Witter, SophieAs the number of refugees increases and displacement becomes protracted, providing equitable healthcare in sustainable ways is increasingly challenging. The Global Compact for Refugees calls for greater inclusion of refugees in national health systems. However, evidence is limited on the most suitable approaches to achieve integration, including from a health financing perspective. This study reviewed normative and empirical literatures on health financing for refugees, reflecting on existing arrangements, and their level of integration with national health systems. A total of 52 documents were reviewed following a purposeful search of grey and published literature. Data were analysed according to core health financing sub-functions as defined by the WHO, specifically reflecting on pathways and approaches to integration for each. The analysis found that challenges remains in relation to funding for refugee healthcare, and areas of focus concern fair burden-sharing and engagement of development funders. Fund pooling proves to be a potential entry point for integration to reduce fragmentation in health financing through use of existing mechanisms (budgets or social health insurance schemes), despite challenges highlighted in the empirical literature. Fewer documents look at purchasing and benefit packages, and they highlight the importance of tailoring those to the specific needs of refugees. In relation to equity and efficiency, integration is often assumed to lead to improvements, but evidence is limited and issues related to the underlying weaknesses of the national health system might hamper the benefits of integration. Overall, the review findings support the development of hypotheses as to how best support health financing integration processes, and highlight areas for further research.Item Refugee integration in national health systems of low- and middle-income countries (LMICs): evidence synthesis and future research agenda(Elsevier, 2025-09-12) Olabi, Amina; Palmer, Natasha; Bertone, Maria Paola; Loffreda, Giulia; Bou-Orm, Ibrahim; Sempé, Lucas; Vera Espinoza, Marcia; Dakessian, Arek; Kadetz, Paul; Ager, Alastair; Witter, SophieThis paper reviews evidence on healthcare responses for refugees, documenting the different approaches and their effectiveness and impact in particular in relation to supporting integrating refugees into national health systems. The review adopted a purposeful, iterative approach, utilizing electronic databases, grey literature, and reference lists from relevant studies. A total of 167 studies, primarily from low- and middle-income countries (LMICs), focusing on refugees and forcibly displaced persons with empirical data, were included. The review highlights a substantial literature on refugee health and healthcare access, with well-covered areas including delivery models, access barriers, gaps in coverage, and specific health services such as psychosocial care, non-communicable diseases, mental health, and maternal and child health. However, less attention is given to integration models, health system responses, and their impact on system resilience and social cohesion. Few studies examine the costs, feasibility, or sustainability of integration models, and little research focuses on health system perspectives or comparative analyses. Moreover, the host health system's status, capacity, and needs are often underexplored. Some countries are particularly well-represented in studies, e.g. Turkey, Jordan, Lebanon, Bangladesh, Democratic Republic of Congo (DRC), and Uganda. There is however a paucity of data that would provide the basis for more quantitative or analytical evaluation from a systems perspective. This gap highlights the need for further research on effective integration models, their operational aspects, and their long-term impact on local health systems' resilience and sustainability. To support this research agenda, we propose a conceptual framework to provide analytic guidance for future research on healthcare responses for refugees and health system integration.Item Editorial: The role of faith in the mental health and integration of forcibly displaced populations(Frontiers Media S.A., 2025-07-08) Rayes, Diana; Robinson, Courtland; Ahmad, Ayesha; Ager, AlastairItem ‘At some points you feel awful because you are going to start again’: The ambiguous role of education in highly skilled refugee women’s integration experiences(SAGE, 2024-09-25) Baillot, Helen; Fernandes, MarcusIn refugee and migration studies, education has been situated as both a marker of integration and a facilitator of progress in other domains. This paper draws on the accounts of three highly skilled women who have experienced forced migration to highlight some of the ambiguities of education’s role in pathways to social and economic inclusion. A case study approach allows for a detailed and contextual exploration of how intersections of age, caring responsibilities and immigration status influence women’s ability to engage with education. Participants’ accounts confirm that accessing desired and appropriate educational provision can propel people towards their longer-term goals. However, provision that is inaccessible or perceived to be below women’s skill levels can be experienced as exclusionary and demoralising, with attendant impact on women’s perceptions of integration and hopes for the future. Women deploy several strategies to overcome these obstacles, including leveraging existing social connections and re-evaluating their future career pathways. Yet these strategies are not always fully successful. Our findings point towards the need for improved provision for adult refugees and a concerted effort by educational institutions to tackle continuing systemic barriers to education.Item Walking a tightrope between policy and scholarship: reflections on integration principles in a hostile environment(Taylor and Francis Group, 2024-07-26) Phillimore, Jenny; Morrice, Linda; Strang, AlisonThe term ‘integration’ has received considerable academic attention, much of it critical. Yet it continues to be widely used in policy and practice to capture the processes of change that occur following migration from one country to another. In an environment of increasing hostility and anti-migrant sentiment, we outline the process of working with the UK Home Office and a wide range of stakeholders to revise the original Home Office Indicators of Integration framework [Ager and Strang (2008). “Understanding Integration: A Conceptual Framework.” Journal of Refugee Studies 21: 166–191]. We directly engage with some of the key criticisms of integration by offering four core, co-developed principles: shared responsibility, context, multi-dimensionality and multi-directionality. We believe these principles cut through the institutional cultural bias of policymakers and offer a new framework for thinking about integration policy, practice and scholarship. Our work underlines the importance of scholars taking the opportunity to engage with policy and to present scientific evidence as a mechanism to confront hostile immigration practices and address the social injustices that usually accompany migration.Item “Now we start to make it like home”: reunited refugee families negotiating integration and belonging(Frontiers Media, 2023-11-23) Kerlaff, LeylaThis paper highlights the importance of local and individual context in either facilitating or hindering processes of integration for reunited refugee families settling in unchosen areas. It adds to understandings of integration by analyzing the day-to-day active and processual nature of place-making, from the perspective of families. The findings are based on qualitative interviews with 13 refugee families−21 parents and 8 children aged between 12 and 18, who had recently been reunited in two large cities in the UK: Glasgow and Birmingham. The paper explores the local conditions families identified as conducive to settling in their local area and argues that the process of attaching to their new locales was mediated through the social connections they made. The article contributes to knowledge by demonstrating how families exercised agency and resilience in place-making in unchosen spaces, through the people they met and the relationships they developed. Further, it critiques the tendency to denigrate “exclusive” bonding ties, particularly between co-ethnics and pays attention to the role of friendship in routes to belonging in unchosen spaces.Item “I just try my best to make them happy”: the role of intra-familial relationships of care in the integration of reunited refugee families(Frontiers Media S.A., 2023-09-27) Baillot, HelenMigration through managed routes such as spousal and work visas has been conceptualized as being a pragmatic choice driven by the needs of families rather than individuals. In contrast, studies of refugee integration post-migration have tended to analyse integration processes through the perspective of the individual rather than through a family lens. Drawing from data collection using a social connections mapping tool methodology with recently reunited refugee families supported by a third sector integration service in the UK, in this paper the author makes a valuable contribution to addressing this theoretical gap. The author explores the ambivalent ways in which family relationships, and the care that flows between family members, influence emotional, and practical aspects of refugees' integration. Empirically the inclusion of accounts from people occupying different positions within their families, including from children, adds depth to our understanding of integration from a refugee perspective. Conceptually, the paper argues that a focus on familial relationships of care re-positions refugees not as passive recipients of care, but active and agentive subjects who offer care to others. The paper ends with a call for integration to be understood in a family way that fully encompasses the opportunities and limitations offered by familial care.Item Traditional and complementary medicine use among Ebola survivors in Sierra Leone: A qualitative exploratory study of the perspectives of healthcare workers providing care to Ebola survivors(BMC, 2020-05-06) James, Peter Bai; Wardle, Jon; Steel, Amie; Adams, Jon; Bah, Abdulai Jawo; Sevalie, StephenBackground: Considerable number of patients, including Ebola survivors, in Sierra Leone, are using traditional and complementary medicine (T&CM). Healthcare providers’ (HCPs) views about T&CM is crucial in addressing the increased need for T&CM among patients. However, healthcare providers’ views about T&CM in Sierra Leone is unknown. Our study explores healthcare providers’ knowledge of and perception towards T&CM and how that influence their personal and professional T&CM use, communication with Ebola survivors about T&CM as well as its integration into the healthcare system in Sierra Leone. Methods: We employed a qualitative exploratory study design using semi-structured interviews to collect data from 15 conveniently sampled HCPs in all four geographical regions of Sierra Leone. We analysed our data using thematic network analysis framework. Results: Healthcare providers perceived their knowledge about T&CM to be low and considered T&CM to be less effective and less safe than conventional medicine as well as not evidence-based. HCPs perception of T&CM as non-scientific and their lack of knowledge of T&CM were the key barriers to HCPs’ self-use and recommendation as well as their lack of detailed discussion about T&CM with Ebola survivors. HCPs are open to T&CM integration into mainstream healthcare in Sierra Leone although at their terms. However, they believe that T&CM integration could be enhanced by effective professional regulation of T&CM practice, and by improving T&CM evidenced-based knowledge through education, training and research. Conclusion: Changing HCPs’ negative perception of and increasing their knowledge about T&CM is critical to promoting effective communication with Ebola survivors regarding T&CM and its integration into the healthcare system in Sierra Leone. Strategies such as educational interventions for HCPs, conducting rigorous T&CM research, proper education and training of T&CM practitioners and effective professional regulation of T&CM practice could help in that direction.Item An intervention to optimise the delivery of integrated tuberculosis and HIV services at primary care clinics: Results of the MERGE cluster randomised trial(Elsevier, 2018-07-25) Kufa, T.; Fielding, K. L.; Hippner, P.; Kielmann, Karina; Vassall, A.; Churchyard, G. J.; Grant, A. D.; Charalambous, S.Objectives: To evaluate the effect of an intervention to optimize TB/HIV integration on patient outcomes.Item A cluster randomised trial to evaluate the effect of optimising TB/HIV integration on patient level outcomes: The merge- trial protocol(Elsevier, 2014-10) Kufa, T.; Hippner, P.; Charalambous, S.; Kielmann, Karina; Vassall, A.; Churchyard, G.; Grant, Alison D.; Fielding, K.Introduction We describe the design of the MERGE trial, a cluster randomised trial, to evaluate the effect of an intervention to optimise TB/HIV service integration on mortality, morbidity and retention in care among newly-diagnosed HIV-positive patients and newly-diagnosed TB patients. Design Eighteen primary care clinics were randomised to either intervention or standard of care arms. The intervention comprised activities designed to optimise TB and HIV service integration and supported by two new staff cadres-a TB/HIV integration officer and a TB screening officer-for 24 months. A process evaluation to understand how the intervention was perceived and implemented at the clinics was conducted as part of the trial. Newly-diagnosed HIV-positive patients and newly-diagnosed TB patients were enrolled into the study and followed up through telephonic interviews and case note abstractions at six monthly intervals for up to 18 months in order to measure outcomes. The primary outcomes were incidence of hospitalisations or death among newly diagnosed TB patients, incidence of hospitalisation or death among newly diagnosed HIV-positive patients and retention in care among HIV-positive TB patients. Secondary outcomes of the study included measures of cost-effectiveness. Discussion Methodological challenges of the trial such as implementation of a complex multi-faceted health systems intervention, the measurement of integration at baseline and at the end of the study and an evolving standard of care with respect to TB and HIV are discussed. The trial will contribute to understanding whether TB/HIV service integration affects patient outcomes.