Building a comprehensive refugee health screening program

Refugee health screening is an important yet often misunderstood area of public health practice at the local health department (LHD) level. Given the multi-faceted nature of refugee resettlement in America, refugee health screening is a complex interplay of various agencies. Essential to this interplay, the LHD is charged with protecting the health and well-being of the individual refugee as well as the overall public's health. These two responsibilities are constrained by cultural and linguistic barriers, socio-economic issues, and other key challenges for the newly arriving refugee during the initial resettlement process.

The Harris County Public Health & Environmental Services (HCPHES) Refugee Health Screening Program (RHSP) is the largest refugee health screening program in the State of Texas – serving 1700-1800 refugees yearly. This long-established program previously fulfilled its mission via use of community medical provider subcontractor(s) who would perform the refugee medical assessments.

In November 2007, the HCPHES RHSP underwent significant change by transitioning this model of health screening in the community to provision of screening within HCPHES' own facilities. In making this transition, multiple issues had to be addressed, including establishing protocols for quality health screening, reviewing and updating equipment, linking refugees to ongoing care, and ensuring provision of culturally appropriate health care to populations from ever-changing areas of the world.

Utilizing this case example of practice transformation, essential components for “building” a sound refugee health screening program will be highlighted and proper standards of care for refugee health screening will be considered.