Refugees arriving in New Zealand can have complex health needs. A suite of refugee pathways developed by the New Zealand HealthPathways team, Health New Zealand, and the Ministry for Business and Innovation is helping refugees receive the specialised care they need, no matter where they settle in the country.
New Zealand is one of around 37 countries that take part in the UNHCR (the UN Refugee Agency) regular refugee resettlement programme. In 2020, New Zealand’s annual refugee quota was increased from 1000 to 1500.
All refugees arriving through the quota programme arrive in Auckland and spend at least five weeks at Te Āhuru Mōwai o Aotearoa, Immigration New Zealand’s Refugee Resettlement Centre. During their orientation, a Refugee Health Screening Service identifies and treats any personal health conditions before the refugees are settled in one of 13 locations around New Zealand. From this point, the expectation is that community GPs will provide ongoing health checks for them.
Dr Karen Chung, a clinical editor and GP at the Māngere Refugee Resettlement Centre, saw the need to create a support package and nationally consistent pathways that would help guide GPs through the particular health needs for refugees.
Dr Justine Lancaster, regional group clinical advisor and clinical lead for the Health New Zealand national pathways programme, facilitated this to become a nationally supported HealthPathways project.
“Often, refugees come with a background of complex health issues - many problems will have been untreated or unaddressed,” says Dr Lancaster.
Some refugees will arrive with post-traumatic stress disorder. Children may have incomplete immunisation or poor nutrition. They may have arrived from a place which has endemic parasites. They have increased risk from diseases like tuberculosis. Once they arrive, there are significant challenges navigating a new culture and a new complex health system while facing language barriers.
“Part of the reason for screening refugees for health conditions on arrival is to minimise the infection risk to the rest of the New Zealand population,” says Dr Lancaster, “But we also have a moral and ethical responsibility to care for the people we’ve welcomed into our society.”
The refugee pathways were developed to align with the work being done by the Refugee Health Community of Practice working group to eliminate any unnecessary variation in care while also respecting the specifics of local health system services.
The pathways reflect agreed best practice for refugee health and are published with local variation to express specific information on services. Local details include where to get tests done, locally available funding and any support beyond the health system, such as refugee or local community support.
“What that means for clinicians who use the pathways is that there is a standardised process for caring for the health of people who’ve arrived as refugees to support them over the first year or so, as well as key information about specific testing, screening, and needs they may have, with links to locally available resources and services,” Dr Lancaster says.
“We’re quite excited about the support this provides for stretched primary care providers, especially in rural areas where it can be hard to attract GPs and practices may be staffed by a string of locums who may lack local system knowledge.”
The refugee pathways cover a range of health conditions from making sure patients are enrolled in bowel and breast screening programmes to checking that their sexual health needs are being met with appropriate screening.
“There can be very specific needs depending on what’s happened or the situation they find themselves in. They may need to be screened for family violence or may need mental health screening. They may need support for living with disabilities or there may be specific complex needs around LGBTQi+ patients. And then there are very specific needs for certain populations, for example those that have experienced female genital mutilation.”
“There might be malaria and oral health problems, limb amputations, brain injuries - it’s a very extensive list. So there are lots of very specific needs that the pathways address for conditions that are not commonly encountered in New Zealand. Especially for GPs who haven’t worked outside of New Zealand, they may not be experienced or familiar with many of these conditions and so the pathways are designed to support them safely through consultations and remind them to be particularly sensitive to the fact that these patients often have missed preventative care opportunities and are playing catch-up.”
More information
If you’re a member of a HealthPathways programme team and would like more information about the refugee pathways, please contact your community success manager.
If you’d like to know more about HealthPathways, or if your health jurisdiction hasn’t yet joined, please:
- See HealthPathways Global for an overview
- Email info@healthpathwaysglobal.org or phone:
- Within the United Kingdom: +44 20 3519 1964
- Within Australia: +61 7 3559 2744
- Within New Zealand: +64 3 595 2830