Challenging common assumptions around migration and health in South Africa: The importance of exploring the urban context

MSF Board Meeting 1 st December 2009 Jo Vearey and Tara Polzer [email_address] [email_address] http://migration.org.za/ Challenging common assumptions around migration and health in South Africa: The importance of exploring the urban context

Migration and health in South Africa:
The importance of the urban context;
A need for a regional view;
Health needs, health access, barriers.
Exploring “urban” and “migration” as central determinants of health.
Responding to migration and health in South Africa.

Patterns :
Linkages to “home”
Health
Determinants of movements.
Place :
Urban and rural origin/destination
Urban - periphery and centre
B order areas .
Data :
Survey datasets
In depth qualitative studies.
Social determinants of health and migration :
Migration as a determinant of health
Health a determinant of migration
Urban as a determinant of health
Livelihoods and health systems.
Socio-cultural dimensions of health :
Culture and religion
Meanings and interpretations
Illness experiences
Strategies and health seeking behaviours.

Internal and cross-border migration:
Different forms of migration and different reasons for migration are found to determine urbanisation experiences; impacts on health.
The need for a regional lens :
Essential to view migration as a connecting process.
Recognising migration as a livelihood strategy that connects the (urban) migrant with another household “ back home ”
Sickness negatively affects this interlinked livelhood system.
Zimbabwean “ humanitarian migration ”:
FMSP Report (Nov 2009): Zimbabwean humanitarian migration into South Africa: Inadequate regional responses

Asylum seekers (Section 22 permit);
Refugees (Section 24 permit);
Other: work permits, study permits; visitor permits; and
Undocumented migrants.
Immigration act makes it difficult for lower-skilled workers to legalise their stay in South Africa. Challenges at Home Affairs: access to documentation is problematic. Zimbabwean migrants struggle to access passports and travel documents within Zimbabwe: presents challenges in crossing the border Special dispensation permits for Zimbabweans have not been made available.

City of Johannesburg UNOCHA & FMSP, 2009

Rapid urban growth ;

World Urbanization Prospects (2005 Revision), United Nations, Department of Economic and Social Affairs By 2030, 50% or more of the African population will be living in a city

High rates of migration ;

Source: HDRO staff estimates based on University of Sussex (2007) database

Increasing pressure on appropriate housing and tenure ;

High urban HIV prevalence – highest in urban informal areas;

Henk Van Renterghem, UNAIDS (2009)

(HSRC, 2005)

Some residents with weak rights to the city;

Dependency on fragile livelihoods located within the informal sector;

Dependency on fragile livelihoods located within the informal sector;
Increasing urban inequalities that impact ‘urban poor’ groups.

(Figure adapted from UN-HABITAT, 2008: 72)

Urban growth
Estimated population of nearly 3.9 million ;
The City has grown by 20.5% since 2001 ;
Average growth rate of 4.16% per year ;
Estimated that the population will reach 5.2 million by 2015 .
(City of Johannesburg, 2008)
Migration
A ‘city of migrants ’:
Rural to urban – internal;
Cross border – external.
Informal housing
Almost 25% estimated to live informally.
HIV

Cross-border migrants and healthcare provision: a global challenge ;
Assumptions prevail that negatively associate migration, health and health-seeking ;
Some data on migrant health in South Africa : this includes (but is not limited to) migrant access to public healthcare services.

Cross-border and internal migrants are affected by poor access to healthcare services – as are those who have always resided in JHB.
Being a cross-border migrant presents additional access challenges : documentation; “being foreign”; language barriers.
Key challenges :
Planning of healthcare service provision based on population size and need. Currently, plans are based on outdated population figures, with no engagement with urban growth or migration in the planning of services.
Local responses to local health and migration needs are lacking.
It is essential to find ways to engage with local government and its “developmental mandate” – whilst migration and the provision of healthcare services are not mandated responsibilities of local government (the nine Metros are responsible for PHC but this responsibility is being moved to Provincial level), they experience the impacts of migration and poor health.

To implement the WHA Resolution on the Health of Migrants:
Consider health within the broader linked agenda of migration and development;
To address the social determinants of migrant health;
Strengthen the availability of data to inform intersectoral, evidence-based, regional policies.
Develop regional frameworks to address migration and health: (draft) SADC framework on communicable diseases and mobility An urgent need to implement a public health approach to the health of migrants: The importance of understanding the urban context There is a need to engage with the “developmental mandate” of local government to address migration and health in urban spaces.

Establish linkages between MSF and FMSP to ensure that research responds to need, and to feed into MSF’s advocacy strategies.
Establish and co-host a joint MSF and FMSP bi-monthly urban migration and health “seminar series”:
To explore the urban context and the importance of ‘place’ within the City: developmental local government; service access; migration patterns; urban HIV prevalence.
To bring together active researchers and practitioners to share and generate research agendas .
To feed into MSF’s advocacy strategies .

All research participants
FMSP/MRMP
Tesfalem Araia
Lorena Nunez
Atlantic Philanthropies
Lawyers for Human Rights & Ford Foundation
RENEWAL & IDRC
Partner organisations involved in the MRMP survey
Nazareth House
Dr. Kerrigan McCarthy (RHRU)
Members of the Migrant Health Forum (RHRU, Johannesburg)
migration.org.za

Challenging common assumptions around migration and health in South Africa: The importance of exploring the urban context

by African Centre for Migration & Society, University of the Witwatersrand on Jan 06, 2010

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Challenging common assumptions around migration and health in South Africa: The importance of exploring the urban context — Presentation Transcript