Governance of health services for asylum-seekers in Finland

Abstract Background In 2015 Finland received the 4th highest number of asylum-seekers in Europe per capita, exceeding numbers of any previous year by ten times. Health services to them are provided in a parallel system with entitlements similar to most Western European countries. Our study explored the governance of this system following a right to health approach, along three dimensions: formal recognition of the right to health, standards, and coordination mechanisms. Methods We were involved in the Finnish policy response as medical specialists on refugee health at the National Institute for Health and Welfare, as physicians within the Finnish Immigration Service and as senior medical officer at the Ministry of Social Affairs and Health. We also conducted a review of academic and grey literature. Results Prior to the “refugee crisis” in 2015, Finland was considered to have a functioning system for providing health services to asylum-seekers. However, the arrival of many new asylum-seekers in 2015-2016 exposed many weaknesses in the governance of the system. We identified three major obstacles in the governance system for health services for asylum-seekers: 1) ineffective and reactive national level coordination and stewardship; 2) inadequate legislative and supervisory frameworks; and 3) discrepancies between constitutional rights to health, legal entitlements to services and available guidance. Conclusions In view of the governance weaknesses related to the parallel system for asylum-seekers, we recommend removing the parallel system and integrating health services for asylum-seekers into the national health system. </jats:sec