Challenges

This initiative addressed the challenge of migration in the Colombian Panamanian Darién region, which intensified after the COVID-19 pandemic. Between 2020 and 2024, there was a significant increase in migratory transit to Central and North America, including people from South America, Asia, Europe, and Africa. Mainly children, pregnant women, breastfeeding mothers, people with chronic illnesses, disabilities, and more passed through this area. Currently, the migration flow is in the opposite direction. 

 This influx increases the pressure on health systems, in terms of structure, organization, and financing. Health needs are urgent due to high rates of morbidity, mortality, and disability from avoidable factors. Border territories have limited capacities due to structural factors and share geographical, social, cultural, and economic characteristics. An intersectoral and cross-border approach is crucial with the participation of the state, private sector, civil society, academia, and national and international cooperation. 

Toward a Solution

The initiative focused on supporting countries to strengthen their coordination mechanisms at the cross-border levels to jointly address the impacts of transit migration in the Darién region, with an emphasis on addressing the vulnerabilities of the migrant population and host communities, promoting access to accessible and quality health services. 

Its main focus is aligned with SDG 3 by promoting universal access to healthcare for the migrant population, while contributing to SDG 10 by prioritizing populations with pre-existing inequalities. The interventions were implemented through a multisectoral approach, articulated through cross-border health tables between Colombia and Panama. These tables were energized based on six lines of action: 

1. Monitor the situation, improve communication and exchange of information, good practices, and lessons learned for strategic decision-making among countries.
2. Define agreed protocols and guidelines among different countries for health response.
3. Consolidate a response strategy to improve access to health services for the migrant population and host communities, recognizing particularities related to gender, ethnicity, age, and disability. It includes case management at the border.
4. Strengthen capacities for preparedness, anticipatory action, response, and comprehensive migration management at the border.
5. Establish and strengthen health surveillance and information systems, including the implementation of the international health regulations strategy. 
6. Jointly adapt policies and frameworks for health response to populations in greater vulnerability. 

 In addition to the above, the strategy promoted the implementation of innovative technologies, such as information management systems, Health in Transit App, and platforms for case management, which allowed for identifying actors, opportunities for coordination, and gaps in access for the design of a coordinated strategy on both sides of the border. The initiative involved governments, international cooperation, civil society, and academia, promoting the exchange of information, coordinated response, and evidence-based decision-making. 

 This model stood out for its cross-border collaboration, facilitating the transfer of knowledge and practices between both countries. Its integration into cooperation agreements ensured medium-to-long-term sustainability, strengthening health governance in both countries. In addition, its replicable structure with a participatory approach, use of technology, and contextual adaptability positions it as a reference for other South-South scenarios with similar migration challenges. 

Among the main results are: 

a) Coordination among 32 consolidated organizations, including health authorities, international cooperation, and civil society, to assist the migrant population in transit at the border;

b) More than 100,000 people received health care in the Panamanian Darién thanks to coordination in the health tables of the project;

c) Georeferencing tool to improve health coordination and design case management protocols to respond in critical situations;

d) More than 474 cases with imminent risk of death from preventable causes were managed within the framework of the health strategy along the route, mainly for chronic diseases, mental health, trauma, and communicable diseases;

e) Trilingual application that guides the migrant population on health prevention and access to services;

f) Accompaniment in the formulation of public policies and health protocols for the care of migrants, including a proposal for public mental health policy based on the analysis of existing legal and institutional capacities;

g) Institutional and community systems of epidemiological surveillance to manage health information, detect early warnings and respond to epidemic outbreaks and promote binational exchange;

h) Support to laboratories in the collection, analysis, and dissemination of samples;

i) Six communities strengthened their capacity for public health response;

j) Systematization of experiences in psychosocial care and publication of a study on the gaps in access to health for the refugee and migrant population in the Darién region. The report had a regional scope and included key decision-makers (Retos en el acceso a la salud de los migrantes en la región del Darién).