Migration as a Structural Determinant of Health Systems Performance

Authors

DOI:

https://doi.org/10.66636/gmj.v1.i2.a30

Keywords:

Migration, Health systems performance, Structural determinants, Universal health coverage, Health governance, Resilience, Digital health interoperability

Abstract

International migration reached approximately 281 million people worldwide in 2024, while forced

displacement exceeded 114 million individuals — the highest level recorded in modern history [1,2].

Although migration is frequently framed as a humanitarian or demographic phenomenon, it increasingly

functions as a structural determinant of health systems performance. Mobility exposes institutional fragility

across governance architecture, entitlement frameworks, financing models, workforce distribution and digital

interoperability. Operational data from international agencies illustrate the systemic scale of migration-

related health activity, including millions of consultations in crisis settings, extensive vaccination campaigns

and cross-border health interventions [3]. This paper advances a structural analytical framework in which

migration operates as a continuous systems-level stress test, revealing embedded design contradictions

within territorially organized health systems. Drawing on international governance, financing and operational

evidence, the analysis reframes migration from episodic emergency response toward institutional

transformation aligned with universal health coverage (UHC), resilience and global health governance.

Recognizing migration as a structural determinant is essential for designing adaptable, equitable and

performance-stable health systems in an era of sustained demographic mobility.

Keywords Migration; Health systems performance; Structural determinants; Universal health coverage;

Health governance; Resilience; Digital health interoperability

References

. International Organization for Migration. World Migration Report 2024. Geneva: IOM; 2024. https://worldmigrationreport.iom.int/wmr-2024.

2. United Nations High Commissioner for Refugees. Global Trends: Forced Displacement in 2023. Geneva: UNHCR; 2024. https://www.unhcr.org/global-trends-report-2023.

3. International Organization for Migration. Migration Health 2024 Impact Overview. Geneva: IOM; 2025. https://www.iom.int/migration-health.

4. Abubakar I, Aldridge RW, Devakumar D, Orcutt M, Burns R, Barreto ML, et al. The UCL–Lancet Commission on Migration and Health: the health of a world on the move. Lancet. 2018;392(10164):2606–2654. https://doi.org/10.1016/S0140-6736(18)32114-7.

5. World Health Organization. The Sixth WHO Global School on Refugee and Migrant Health: leadership from policies to action. Geneva: WHO; 2026. https://www.who.int/news/item/31-01-2026-the-sixth-who-global-school-on-refugee-and-migrant-health--leadership-from-policies-to-action.

6. Wickramage K, Vearey J, Zwi AB, Robinson C, Knipper M. Migration and health: a global public health research priority. BMC Public Health. 2018;18:987. https://doi.org/10.1186/s12889-018-5932-5.

7. Rechel B, Mladovsky P, Ingleby D, Mackenbach JP, McKee M. Migration and health in an increasingly diverse Europe. Lancet. 2013;381(9873):1235–1245. https://doi.org/10.1016/S0140-6736(12)62086-8.

8. Legido-Quigley H, Pocock N, Tan ST, Pajin L, Suphanchaimat R, Wickramage K, et al. Healthcare is not universal if undocumented migrants are excluded. BMJ. 2019;366:l4160. https://doi.org/10.1136/bmj.l4160.

9. World Health Organization. Promoting the health of refugees and migrants: Global Action Plan 2019–2023. Geneva: WHO; 2019. https://www.who.int/publications/i/item/WHA72-2019-REC-1.

10. Organisation for Economic Co-operation and Development. International Migration Outlook 2023. Paris: OECD Publishing; 2023. https://doi.org/10.1787/b0f40584-en.

11. Kluge HHP, Jakab Z, Bartovic J, D’Anna V, Severoni S. Refugee and migrant health in the COVID-19 response. Lancet. 2020;395(10232):1237–1239. https://doi.org/10.1016/S0140-6736(20)30791-1.

12. United Nations High Commissioner for Refugees. Health interventions in emergencies. In: UNHCR Emergency Handbook. Geneva: UNHCR; 2025. https://emergency.unhcr.org.

13. World Bank. Migration and Development Brief 38. Washington (DC): World Bank; 2023. https://www.knomad.org/publication/migration-and-development-brief-38.

14. International Organization for Migration. IOM Strategic Plan 2024–2028. Geneva: IOM; 2024. https://publications.iom.int/system/files/pdf/pub2023-159-strategic-plan-2024-2028-en.pdf.

15. World Health Organization. Noncommunicable diseases fact sheet. Geneva: WHO; 2023. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases.

16. Chiesa V, Chiarenza A, Mosca D, Rechel B. Health records for migrants and refugees: a systematic review. Health Policy. 2019;123(9):888–900. https://doi.org/10.1016/j.healthpol.2019.07.018.

17. Faturiyele I, Karletsos D, Ntene-Sealiete K, Musekiwa A, Khabo M, Mariti M, et al. Access to HIV care and treatment for migrants between Lesotho and South Africa: a mixed methods study. BMC Public Health. 2018;18(1):668. https://doi.org/10.1186/s12889-018-5594-3.

18. World Health Organization. Global strategy on digital health 2020–2025. Geneva: WHO; 2021. https://www.who.int/publications/i/item/9789240020924.

19. World Health Organization. WHO Global Code of Practice on the International Recruitment of Health Personnel. Geneva: WHO; 2010. https://www.who.int/publications/i/item/wha68.32.

20. Mills EJ, Kanters S, Hagopian A, Bansback N, Nachega J, Alberton M, et al. The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis. BMJ. 2011;343:d7031. https://doi.org/10.1136/bmj.d7031.

21. International Committee of the Red Cross. Health Care in Danger: Making the case. Geneva: ICRC; 2011. https://www.icrc.org/en/publication/4072-health-care-danger-making-case.

22. International Committee of the Red Cross. Health Care in Danger: A study on violence affecting health care. Geneva: ICRC; 2012. https://www.icrc.org/en/publication/4072-health-care-danger-making-case.

23. World Health Organization. Refugee and migrant health: Global competency standards for health workers. Geneva: WHO; 2021. https://www.who.int/publications/i/item/9789240038790.

24. Kruk ME, Myers M, Varpilah ST, Dahn BT. What is a resilient health system? Lessons from Ebola. Lancet. 2015;385(9980):1910–1912. https://doi.org/10.1016/S0140-6736(15)60755-3.

25. Blanchet K, Nam SL, Ramalingam B, Pozo-Martin F. Governance and capacity to manage resilience of health systems: towards a new conceptual framework. Int J Health Policy Manag. 2017;6(8):431–435. https://doi.org/10.15171/ijhpm.2017.36.

23. International Committee of the Red Cross. Health Care in Danger: A study on violence affecting health care. Geneva: ICRC; 2012. Available from: https://www.icrc.org. Accessed 26 Feb 2026.

24. Kruk ME, Myers M, Varpilah ST, Dahn BT. What is a resilient health system? Lancet. 2015;385(9980):1910–1912. doi:10.1016/S0140-6736(15)60755-3.

25. Blanchet K, Nam SL, Ramalingam B, Pozo-Martin F. Governance and resilience of health systems. Int J Health Policy Manag. 2017;6(8):431–435. doi:10.15171/ijhpm.2017.38.

Cover of the Georgian Medical Journal (GMJ), Volume 1, Issue 2 (2026), titled “Health Systems Performance and Quality of Care: Measurement, Improvement, and Outcomes,” with a blue world map background representing global health connectivity. Includes the themes “Quality, Safety, Results” and the publisher Public Health Institute of Georgia.

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Published

05/06/2026

How to Cite

Inaishvili, S., Pkhakadze, G., Pkhakadze, I., Talakvadze, T., & Glonti, S. (2026). Migration as a Structural Determinant of Health Systems Performance. Georgian Medical Journal, 1(2), 1–6. https://doi.org/10.66636/gmj.v1.i2.a30

Issue

Vol. 1 No. 2 (2026): Health Systems Performance and Quality of Care

Section

Systematic Reviews & Analysis

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Copyright (c) 2026 Sulkhan Inaishvili, Giorgi Pkhakadze, Irine Pkhakadze, Tamar Talakvadze, Salome Glonti

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