Dr Paul Bukuluki is a migration and health researcher and member of the MHADRI steering committee. Paul is based in Kampala, Uganda where he works as an Associate Professor in Makerere University’s Department of Social Work and Social Administration. Paul is helping to establish a Centre for Migration and Health at Makerere University and is engaged with various migration health initiatives and studies across Uganda, Sudan and the East African region more broadly. Being part of the MHADRI network has enabled Paul to connect with other migration and health researchers, and while the network is still young, Paul is optimistic about the potential for MHADRI to improve the representation of researchers from the global south. He believes that north-south and south-south collaborations are essential for sharing resources and ideas, and thinks that MHADRI could become a powerful tool for improving research on, and responses to, pressing migration and health challenges.
The research Paul is involved with concentrates on migrant access to health care and migrant experiences of sexual and gender-based violence. Though Paul’s focus on migration and health issues only began six years ago, he has already worked with a diverse range of migrant populations across East Africa. Originally trained in medical anthropology and social work, – he holds a PhD in Social Anthropology – Paul began his career investigating health issues from a behavioural and anthropological perspective. However, in recent years, as the number of internally displaced persons (IDPs) and refugees in East Africa has increased, his research has been shaped by a burgeoning need to focus on refugee health and health risks linked to forced migration. Paul has been involved in several studies including a study jointly-commissioned by the World Bank and the Office of the Prime Minister (OPM) in Uganda; Assessment of Gender Based Violence Prevention and Response and Child Protection Services in 11 Refugee Hosting Districts in Uganda. He has also been involved in studies that investigate the “relationships between violence against women (particularly IPV) and violence against children in East Africa”.
Paul explains that the porous nature of borders in East Africa poses a significant migration and health governance challenge. Cross-border issues are some of the most critical as the informality of borders and lack of policing severely complicates public health management. Discrimination experienced by migrants attempting to access healthcare, and general difficulty and ineligibility in accessing health services, is also a cause for concern. Paul calls for increased portability of health insurance cover in a region characterised by mobility and migration as the way in which existing health insurance schemes are structured often inhibits people who move from accessing health services in other areas.
In order to improve awareness and action on these key governance issues, Paul and his colleagues at Makerere University regularly engage with policy makers to push for the consideration of public health issues in migration management and governance, and to encourage a greater recognition of migration in public health policy and planning. Paul and his team collaborate across borders with other institutions and agencies in the migration and health space, taking care to ensure that when they engage in projects there are actors involved who can take these projects forward and use the research to inform effective action.
“Knowledge alone is not enough. We need more than knowledge to shift the norms, because policy itself is influenced by social norms.”
When it comes to sourcing migration and health data and resources, Paul says that the International Organisation for Migration (IOM) and the United Nations High Commission for Refugees (UNHCR) and WHO have some useful data available but it is mostly drawn from small-scale studies. For Paul, universities and independent organisations are also a source of data, as they commission and release research that is not linked to national or international agencies. However, Paul experiences difficulty in finding data on adolescents across various groups such as mobile populations, refugees and internal migrants, particularly in relation to those living in urban environments. The limited focus and lack of data available on the health of adolescents across different migrant populations in the region concerns Paul as he believes this group is significantly underrepresented in migration health research. He also noted that there is limited research focus on Female Genital Mutilation (FGM) in the context of mobility and internal migration, internal displacement and cross border movements particularly in (FGM) high prevalence countries in the Global South.
The School of Social Sciences, College of Humanities and Social Sciences (CHUSS), Makerere University in conjunction with the International Organization for Migration launches a training programme in Migration Health.
To stay up to date with other research being conducted in the migration and health sphere, Paul reviews content published in academic journals, checks websites with a migration and health focus, and reads publications from the UNHCR, the Ministry of Health in Uganda and the East African Community (EAC) which relate to his research interests. Unfortunately, access to journals and reports is often obstructed by a pay wall, meaning that access to information is largely determined by the wealth of universities who can, or cannot, afford to pay a myriad of subscription fees. Paul believes this obstruction in accessing academic literature disproportionately disadvantages global south institutions in comparison to their global north counterparts.
“[The inability to access academic literature that is hidden behind pay walls] is a very big barrier. Most of our master’s and PhD students interested in migration and health are studying these areas but getting peer reviewed literature and information on current debates is a real challenge because of this.”
Paul has an established personal network of fellow migration and health researchers as well as ongoing partnerships with institutions such as the University of Edinburgh, Georgetown University and Maastricht University. Paul utilises these networks to overcome the barriers mentioned above, communicating information about new migration and health research with colleagues and gaining greater access to literature that will be useful to his students. For example, in collaboration with colleagues from the University of Edinburgh, Paul and team at Makerere University have developed a pilot project on “improving quality of care of reproductive health services for adolescent refugees in host communities in Uganda and Jordan”. Similarly, in collaboration with the University of Maastricht University (UM) and Wageningen University, they have developed a project on “Strengthening social protection and cohesion for refugees, migrants and host communities in Uganda”.
Publications of the WHO and the IOM are, in Paul’s opinion, extremely important and provide not only guidelines but a framework which can be used to improve migrant health in different regions. While Paul thinks that the Global Compacts, on Refugees and on Safe, Orderly and Regular Migration, are a step in the right direction, he has reservations about their ability to affect any real change.
“The issue is that they are global… they suffer from [a lack of] context specificity and need adaptation to [different] contexts. Yes, it is ok to think globally, but you need to act locally. The adaptability of the Compacts is one issue, because there is no one-size-fits-all solution and not enough is being done to adapt them to the contexts of different countries.”
The Global Compacts may lack “tools for adaptation” and necessary guidelines on how to apply them at the local level, but Paul suggests that the inclusion of case studies illustrating how the statements made in the Compacts can be adapted into realisable policy could improve their relevance and effectiveness. Despite the limitations of the Compacts, Paul believes that supranational actors, such as the WHO, IOM and the UN, have the capacity to encourage the conception and implementation of migration-friendly health policies that promote access to healthcare for all. This should then be reinforced by internal action from civil society and academia, to demonstrate the danger of not providing health access to migrants and improve education and action on this issue. Paul reasons that “diseases know no borders” and the idea of access to health for all (in the context of Universal Health Coverage promoted by WHO) needs to be embraced in order to address health and migration challenges in the region.
Paul suggests creating a platform for sharing migration and health research and hosting online seminars and courses. Makerere University is currently running short courses on migration and health and courses such as these could be shared online through a network like MHADRI so that other early-career researchers in the global south can participate. Creating a learning platform, and encouraging the publishing of special journal issues focused on migration health research could also be helpful. Paul thinks that the individuals involved with MHADRI can play a role in building a network of institutions and organisations working with migration and health issues, taking care to include regional universities and smaller organisations across the global south.
However, Paul recognises that improving access to research and data on migration and health will not be enough on its own. He suggests that exchange visits to different countries and institutions implementing effective migration and health governance, using research to inform effective policy, combined with the distribution of best practice examples of how migration and health challenges can be managed, are essential to improving health for all.
You can find out more about migration and health related courses available at Makerere University here.
Dr Paul Bukuluki can be contacted here.
Celebrating the winning of a seed grant on strengthening migration health research and training – a collaborative project between Makerere University, the IOM and the University of Vienna.
Dr Bukuluki was interviewed in November 2018 by MHADRI Research Assistant and intern Holly McCarthy as part of a scoping exercise with leading migration and health researchers based in the global south.
The scoping exercise aims to
We envisage publishing a summary of this initial scoping in some form, and will be posting more profiles on the work and reflections of leading migration and health researchers.
If you are interested in taking part in this exercise please contact us.