They are examined in one country, certified in another and cared for somewhere else again. Their health records rarely make the same journey. Here is where they get left behind, and how to fix it.
Some of the world's most essential workers spend their careers crossing borders. Seafarers keep global trade moving, and migrant workers build, clean, care for and staff economies far from home. Both groups are examined more often than most workers: before they are hired, before they travel, on arrival and at regular intervals afterwards.
Yet the records from all that testing rarely travel with them. Results sit with clinics in the country of origin, with screening centres, with port doctors and with employers, in different languages and formats. When a worker falls ill at sea or in a new country, or simply wants to keep track of their own health, the history they need is often out of reach.
This guide sets out nine gaps in how these health records are held and shared, and practical ways to close each one. It is written for maritime health and telemedicine providers, crew management companies and the clinics that examine seafarers, migrant worker health and screening providers, insurers covering mobile workforces, and the organisations that support workers' welfare. Throughout, we take the view that better health data should serve the worker first: their care, their continuity and their rights.
For many migrant workers, health screening starts before they leave home. Workers heading to the Gulf states are examined in their country of origin at health centres accredited by the Gulf Health Council, under a programme known as Wafid, which now covers 29 countries and 574 accredited centres.2 Other destinations examine workers again after they arrive. In Singapore, for example, Work Permit holders must complete a medical examination within two weeks of arriving, and before their permit is issued, covering tuberculosis, HIV, syphilis, malaria and fitness to work.3 Seafarers are typically examined by a doctor recognised by the authority of the ship's flag state, which may be in a different country from both their home and their ship's next port.1
Each examination has its own purpose and its own rules. The difficulty is that the results from one rarely inform the next, so a worker's history is split across several countries before their first day of work.
Figure 1. Two journeys, one pattern. The worker moves on, and each record stays where it was made.
What a seafarer carries is a medical certificate, and by design it says very little. It states whether the seafarer is fit for duty, fit with limitations or restricted to certain waters, and personal medical information should not appear on certificates or other documents given to others. The examination records themselves are marked confidential and kept by the health establishment that issued the certificate.1 Migrant worker screening follows a similar pattern: the fitness certificate is what moves on, and the clinical detail stays with the centre.
This protects privacy, and that matters. But it also means the clinical record ends up in the files of whichever clinic happened to examine the worker, sometimes in a country they may never return to.
Figure 2. The certificate is designed to say little. The history that matters for care stays behind.
Seafarer medical certificates are designed to be renewed often. They are valid for a maximum of two years, or one year for seafarers under 18, while a certificate covering colour vision can last up to six years. If a certificate expires during a voyage, it remains in force only until the next port where a recognised doctor is available, for no more than three months.1 Migrant workers in many destinations face periodic examinations too.
Frequent renewal keeps people safe, but over a career of ten or twenty years it can mean a dozen examinations at a dozen different clinics. Each one holds a piece of the worker's health story, and no one holds the whole of it. A slow rise in blood pressure, a gradual change in hearing or an abnormal result that needed follow-up can easily slip between examinations.
A crew can include seafarers from half a dozen countries, and a single employer may hire migrant workers from several origin countries at once. Their records come from clinics with different forms, different laboratory reporting and different conventions for names, dates and units. Some reports are typed, some are handwritten, many are scanned, and not all are in English or in the language of the country where the worker now lives.
For the doctor or care team receiving these records, the result is slow, manual reading, with real room for error. A medication name in one language, a laboratory value in an unfamiliar unit or a date written in a different order can all be misread under time pressure.
When a seafarer falls ill at sea, there is usually no doctor on board. Most merchant ships carry no medical personnel, and crew changes and quarantine rules can make getting help ashore difficult. Remote medical advice services fill that gap, and demand for them is substantial: one long-standing international service assisted more than 3,900 seafarers in the first six months of 2020 alone, up from around 2,400 in the same period of 2017.4
The advising doctor works from what the crew can describe and measure on board. Knowing whether the patient has a chronic condition, takes regular medication, has an allergy or had an abnormal result at their last medical can change the advice given. That history is usually sitting in a clinic file in another country.
Figure 3. Remote advice at sea is only as good as the history the advising doctor can see.
Where a certificate decides whether someone can travel or work, its integrity matters to everyone, including the worker. The Gulf Health Council's programme uses an electronic link that lets embassies and consulates verify health results before visas are issued, and its fitness certificates carry a barcode that some embassies use to reduce forged reports.2
Verification works best when it can be traced back to real, structured results from an accredited source. When the only evidence is a scanned page, checking it is slow, and genuine workers can face delays while their documents are questioned.
Employers, manning agencies and authorities need to know whether a worker is fit for a role. They do not need, and should not see, the clinical detail behind that decision. The maritime guidance is clear that seafarers' medical records may only be used to determine fitness for work and to improve their health care, and may not be disclosed without the seafarer's prior written informed consent.1 For migrant workers, screening often includes results such as HIV or tuberculosis status that carry real stigma if they are handled carelessly.
When outcome and detail sit together on the same scanned form, it is hard to share one without exposing the other, and sensitive information can travel much further than it should.
Seafarers have the right to access their personal medical data and to receive a copy.1 Many migrant workers have similar rights under the privacy laws of the countries where they are examined or employed. In practice, the copy a worker receives, if they ask for one at all, is often a paper report or a PDF in a language or format they cannot easily use, and it is easily lost over years of travel.
This matters because the worker is the one constant across every employer, clinic and country. A worker who holds a usable record of their own health can carry their history to any doctor they see.
Pre-employment and pre-departure screening exists to answer a narrow question: is this person fit for this job, and do they meet entry requirements? Along the way, these examinations often pick up findings that matter for the worker's own health, such as raised blood pressure, high blood sugar or reduced hearing, that are not a reason to stop them working but do need attention.
Because the result is recorded as a pass or fail and the detail stays in a clinic file, those findings can easily go unaddressed. For workers far from home, with limited access to care, that is a missed opportunity to prevent problems later.
Put together, closing these gaps means a record built around the worker rather than around any one clinic, employer or country. It holds structured results from every examination, moves only with the worker's consent, and shares exactly what each party needs.
Figure 4. One record, many views. Each party sees only what it needs, and the worker decides who sees what.
Workers who cross borders for a living deserve health records that can keep up with them. Making that possible is a data problem as much as a policy one, and there are two ways we can support you.
Under the Maritime Labour Convention, 2006, a seafarer's medical certificate is valid for a maximum of two years, or one year for seafarers under 18. A certificate relating to colour vision can remain in force for up to six years. The examining doctor can set a shorter period where justified.
The examination records are marked confidential and kept by the health establishment that issued the certificate, in line with national regulations. The seafarer carries the certificate, which states their fitness for duty without personal medical detail.
Wafid is the Gulf Health Council's programme for the medical examination of expatriate workers travelling to Gulf Cooperation Council countries. Workers are examined in their country of origin at accredited health centres, and results are linked electronically so embassies can verify them before visas are issued.
Work Permit holders in Singapore must complete a medical examination, generally within two weeks of arriving and before the permit is issued. It screens for tuberculosis, HIV, syphilis and malaria, and assesses fitness to work.
Yes. Guidance under the Maritime Labour Convention states that seafarers have the right to access their personal medical data and to receive a copy. In practice, that copy is often on paper or in a format that is hard to use, which is why a structured, portable record matters.
By sharing only with the worker's informed consent, separating the fitness outcome from confidential clinical detail, controlling access by role, and processing data where local law requires. A structured record makes it possible to share exactly what is needed and nothing more.
This article is for general information and is not legal or medical advice. Organisations should confirm the requirements that apply in each country they work in.
Suhina Singh is a physician, the Founder and CEO of Jonda Health, and a health data strategist working at the intersection of artificial intelligence and clinical information systems.
