International Health Faculty to Co-Lead Project on Integrating Refugees into National Health Systems

Faculty in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health received an award from a consortium of UK funders, through the Joint Health Systems Research Initiative, to co-lead a project on integrating refugees into national health systems. The project, which is being led by the American University of Beirut in Lebanon (AUB), will examine how refugee health services are integrated into the host country’s national health system in Jordan, Lebanon and Uganda.

Professor Fadi El-Jardali from the Health Management and Policy Department of the Faculty of Health Sciences at AUB is leading the project, entitled, Integrating Refugees into National Health Systems: Enhancing Equity and Strengthening Sustainable Health Services for All. Professors Sara Bennett and Paul Spiegel from International Health are co-leads.

With numbers of displaced persons reaching a global high of 70.8 million, there is a need for innovative approaches to health care for refugee populations. Due to the record numbers of displaced persons and longer periods of displacement, refugees are more likely to reside outside of the temporary camps that have traditionally been used to host them. While health services for refugee populations have typically been provided through separate facilities in refugee camps, operating in parallel to the national health system, this approach may be unsustainable and does not serve the needs of populations outside of the camps. Substantial inequities exist with refugee populations often having poorer access to health services than host populations in most cases, while in other contexts, they may actually receive better care. The disparities in health service access may often result in feelings of resentment between the two communities. Little research, however, has been done to explore issues around integrating refugees into national health systems, such as which factors facilitate integration and what types of arrangements work best. 

This project aims to address this gap in evidence and will focus on integration, examining the extent to which a host country provides equal access to health services and facilities to refugees and national populations, and how these arrangements have come about. The study will focus on Syrian refugees in Jordan and Lebanon and South Sudanese refugees in Uganda. All three countries have integrated refugees into their health system; however, their approaches differ widely. The project will examine four research areas in each country:

• Perceptions and experiences of stakeholders, host populations and refugee populations on integrating refugee health services into existing health systems and structures
• Factors that have affected policy adoption and implementation—or lack thereof—of country policies that support the integration of refugees into health systems
• The extent to which refugees are integrated into a host country’s health system, and how this has affected availability, access and quality of health services for both refugee and national populations
• Financial mechanisms and flows that have been employed to support the integration of refugees into health systems and how this has affected the financial sustainability of health services

Professor Bennett, who is also director of the Health Systems Program within the Department of International Health, will provide expertise in health systems, financing and policy. Professor Spiegel, who is director of the Johns Hopkins Center for Humanitarian Health, brings expertise in preventing and responding to complex humanitarian emergencies. The Johns Hopkins research team also includes Department of International Health faculty Assistant Scientist Yusra Shawar and Research Associate Ummekulsoom Lalani, and Professor Sarah Parkinson from the Krieger School of Arts & Sciences. The award is for a period of 3 years.

The Joint Health Systems Research Initiative is jointly funded by the Medical Research Council, the Wellcome Trust, the Department for International Development and the Economic and Social Research Council.