Population mobility and migration in health policies: policy as discourse analysis of Zambia’s Neglected Tropical Disease Masterplans 2011-2022.

Background Despite population mobility being on the rise globally, it remains neglected in the development of national health policies. This study sought to examine how population mobility is problematized in National Neglected Tropical Disease Masterplans and how these representations shape policy implementation within 4 NTD endemic districts in Zambia. Methods We used Policy as discourse analysis by guided by Bacchi’s “What’s the Problem Represented to be?” (WPR) approach. We reviewed all four NTD Masterplans that have been developed in Zambia between 2011 and 2022. Interviews on everyday implementation experiences were conducted with key policy actors (n=20), community health workers (n-34) and community members (n=35) guided by the Consolidated Framework for Implementation Research. Data was analysed using critical discourse analysis informed by the WPR approach. Results Across all four Masterplans, the construction of migration and its role in NTD prevention, control and treatment was scant indicating limited recognition of the role that migration plays on health. Migrant groups recognized were forced migrant (refugees) or voluntary migrants (foreign tourists), labour migrants (fishing or farming) or environmental migrants. Assumptions underlying these constructions of migration include territoriality and associated internalization practices, medical nativism, migrant deservingness and universalization. Silences in the Masterplans included failure to account for local migration patterns, lack of migrant sensitive services and lack of clarity on entitlement of health services. Conclusions Though the mobility is poorly problematized in the Masterplans, through policy design and implementation can strengthened such as using more comprehensive and standardized definitions of migration and migrant groups in public policies, capturing migration data and using it to inform decision making as well as establishing accountability mechanisms for policy actions, training of frontline workers using standards and engagement of migrant and mobile populations in migration governance.