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www.migration.org.zaExploring migration, mobility and healthin South Africa:key public health imperativesJo Vearey, PhDUni...
www.migration.org.zaThe African Centre for Migration & Society.• Independent, academic research andteaching unit based at ...
Migration, mobility and health in South Africa:4 key concerns1. South(ern) Africa is associated with mixed migration flows...
www.migration.org.zaSource: HDRO staff estimates based on University of Sussex (2007) database“......migration is not a ra...
www.migration.org.zaThe 61st annual World Health Assembly(WHA) adopted Resolution 61.17 on theHealth of Migrants in 2008.T...
www.migration.org.zaMigration and health in South AfricariskvulnerabilityhealthymigranteffectpositiveselectionburdenHIVdev...
www.migration.org.zaMigration and health in SADC (1)1. SADC is a region of historical and continuing,varied migratory flow...
www.migration.org.zaMigration and health in SADC (2)5. The relationship between HIV and migration hasemerged as the most r...
www.migration.org.zaThe Immigration Act• Governs immigration into South Africa• Restrictive• Recent amendmentsRepublic of ...
www.migration.org.zaThe Refugee Act• South Africa has an integrative asylum policy:• Refugees and asylum seekers are encou...
www.migration.org.zaProtective legislation:the right to health, including ART1. South African Constitution;2. Refugee Act ...
www.migration.org.zaLivelihood seeking: spaces of vulnerability1• Formal and informal• Employed v’s self-employed• Job see...
www.migration.org.za
www.migration.org.za
www.migration.org.zaPercentage of internationalmigrants living in urbansettlement by DistrictMunicipality
www.migration.org.zaCensus 20117,4% ofGauteng’spopulation arenon-citizens3.3% ofWesternCape’spopulation arenon-citizens3.3...
www.migration.org.zaCross-border migrants as share of thepopulation1990 2010Namibia 7.9 6.3Botswana 2.0 5.8South Africa 3....
www.migration.org.zaMigration is a determinant of healthmigration  healthmigration can determine healthmigration  health...
www.migration.org.zaSocial Determinants of Healthhttp://www.who.int/social_determinants/en/
Overlapping vulnerabilities:gender; food insecurity; lack of cash; living on the periphery;struggle to meet basic needsThe...
www.migration.org.zaCommunicable diseases•Transmission•Predominantly move fromlower to higher HIV/TBprevalence•Treatment c...
www.migration.org.zaSpaces of vulnerability:social determinants•Urban areas•Informal settlements•Farms•Detention centres•I...
www.migration.org.zaPolicy opportunities?
www.migration.org.zaMigration, mobility and health in South Africa:what is needed?Migration and health is more than migrat...
www.migration.org.zaExploring migration, mobility and healthin South Africa:key public health imperativesJo Vearey, PhDUni...
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Exploring migration, mobility and health in South Africa: key public health imperatives

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Exploring migration, mobility and health in South Africa: key public health imperatives

  1. 1. www.migration.org.zaExploring migration, mobility and healthin South Africa:key public health imperativesJo Vearey, PhDUniversity of the Witwatersrandjo.vearey@wits.ac.zaBrocher Foundation25thJune 2013
  2. 2. www.migration.org.zaThe African Centre for Migration & Society.• Independent, academic research andteaching unit based at Wits University• Policy-relevant research in 11 Africancountries• Partnerships in Africa, Asia, Europe andthe Americas• Post-graduate training• Conduct research for government, civilsociety and international organisations
  3. 3. Migration, mobility and health in South Africa:4 key concerns1. South(ern) Africa is associated with mixed migration flows:internal > cross-border; livelihood seeking > forced migration; urban refugees;marginalised and hidden migrant groups; spaces of vulnerability; negative assumptionspersist2. Current public health responses do not engage with migrationand mobility: implications for communicable disease control (TB and HIV, malaria);chronic treatment continuity; challenges in accessing the public system for non-nationals3. The South African public health and social welfare systems areoverburdened and struggling: challenges are raised in a context of highinequality where nationals are also struggling to access their basic rights (healthcare,housing, water, sanitation)4. South Africa is associated with anti-foreigner and xenophobicattitudes: migration management is associated with increased securitisation; a lackof regional responses; a restrictive immigration act; limited understanding of migrationdynamics; violence; fear
  4. 4. www.migration.org.zaSource: HDRO staff estimates based on University of Sussex (2007) database“......migration is not a random individualchoice. People who migrate are highlyorganised and travel well-worn paths.”(Harcourt, 2007: 3)Approximately 214 million cross-border migrants(around 3% of the world’s population) and740 million internal migrants globally.
  5. 5. www.migration.org.zaThe 61st annual World Health Assembly(WHA) adopted Resolution 61.17 on theHealth of Migrants in 2008.This Resolution calls on member states(including South Africa) to promote equitableaccess to health promotion, diseaseprevention and care for migrants.Four priority areas have been identified forachieving the WHA resolution:1. Monitoring migrant health;2. Partnerships and networks;3. Migrant sensitive health systems; and4. Policy and legal frameworks.Increasing recognition of migration as adeterminant of health in South AfricaEmpirical data: existing evidence onmigration, health and HIV to inform responsesPartnerships: governmental; non-governmental; civil society; internationalorganisations; academiaProgrammes and interventions: goodpractices – HIV interventions with migrantpopulations
  6. 6. www.migration.org.zaMigration and health in South AfricariskvulnerabilityhealthymigranteffectpositiveselectionburdenHIVdevelopmentbenefitsdangerouscontagionTBexceptionalisationtraffickingforeignaccess to positivedeterminants ofhealthSalmon effectmigration awarev’smigrant sensitiveimproveddataan informedpublic healthresponse
  7. 7. www.migration.org.zaMigration and health in SADC (1)1. SADC is a region of historical and continuing,varied migratory flows.2. Linkages between urban and rural areasthrough circular migration processes have beenidentified as critical to the comprehension ofhealth concerns within SADC.3. Cross-border migrants face challenges inaccessing public-health services despite thepresence of protective legislation.4. There is a strong bias present, with mostpublished research focussing on migrationwithin and into South Africa.
  8. 8. www.migration.org.zaMigration and health in SADC (2)5. The relationship between HIV and migration hasemerged as the most researched and published.6. There is a lack of published research that (1)documents and (2) evaluates interventionsaddressing migration and health in SADC.7. Migration is a central developmental issue forthe SADC region.8. Despite the international recognition of theimportance of good governance in managing bothmigration and health, there is very little literatureavailable that considers the governance of healthand migration within the SADC region.
  9. 9. www.migration.org.zaThe Immigration Act• Governs immigration into South Africa• Restrictive• Recent amendmentsRepublic of South Africa (RSA) (2002) Immigration Act — Act 13 of2002. Pretoria, South Africa, Government Printers.Republic of South Africa (RSA) (2004) ImmigrationAmendment Act — Act 19 of 2004. Pretoria, South Africa,Government Printers.
  10. 10. www.migration.org.zaThe Refugee Act• South Africa has an integrative asylum policy:• Refugees and asylum seekers are encouraged to self-settle and integrate.• A range of rights are afforded:• Policies exist that assure the right to health – includingART – for refugees, asylum seekers and other cross-bordermigrants.• However, recent amendments may affect this.Republic of South Africa (RSA) (1998) Refugees Act — Act 130 of1998. Pretoria, South Africa, Government Printers.
  11. 11. www.migration.org.zaProtective legislation:the right to health, including ART1. South African Constitution;2. Refugee Act (1998);3. National Department of Health (NDOH) Memo (2006);4. NDOH Directive (September 2007);5. Gauteng DOH Letter (April 2008); and6. HIV & AIDS, STI and TB National Strategic Plan for SouthAfrica, 2012 - 2016 (NSP).
  12. 12. www.migration.org.zaLivelihood seeking: spaces of vulnerability1• Formal and informal• Employed v’s self-employed• Job seekers• Mobility Cross-border traders Truck drivers Seafarers Miners Farm workers Sex workers1Crush et al (2002); IOM (2010)
  13. 13. www.migration.org.za
  14. 14. www.migration.org.za
  15. 15. www.migration.org.zaPercentage of internationalmigrants living in urbansettlement by DistrictMunicipality
  16. 16. www.migration.org.zaCensus 20117,4% ofGauteng’spopulation arenon-citizens3.3% ofWesternCape’spopulation arenon-citizens3.3% of theSouth Africanpopulation arenon-citizens
  17. 17. www.migration.org.zaCross-border migrants as share of thepopulation1990 2010Namibia 7.9 6.3Botswana 2.0 5.8South Africa 3.3 3.7Swaziland 8.3 3.4Mozambique 0.9 1.9Malawi 12.2 1.8Zambia 3.5 1.8DR Congo 2.0 0.7Lesotho 0.5 0.3Source: http://esa.un.org/migration/p2k0data.asp3.32011
  18. 18. www.migration.org.zaMigration is a determinant of healthmigration  healthmigration can determine healthmigration  healthhealth can determine migration
  19. 19. www.migration.org.zaSocial Determinants of Healthhttp://www.who.int/social_determinants/en/
  20. 20. Overlapping vulnerabilities:gender; food insecurity; lack of cash; living on the periphery;struggle to meet basic needsThe social determinants of health:socioeconomic and political context; structural determinants; intermediary determinantslivelihoodseekingmigrationandmobilityInequalityHIV TBGovernance (response):healthy urban governance; intersectoral action; health in all policies;developmental local governmentInequityAccess to positive determinants of health:basic services; healthcare; housing; education;secure livelihood activities; food securityspaces of vulnerability
  21. 21. www.migration.org.zaCommunicable diseases•Transmission•Predominantly move fromlower to higher HIV/TBprevalence•Treatment continuity•Referrals•Harmonisation of protocolsMental health andpsychosocial concerns•Trauma•Daily stressors•Violence: direct andstructuralKey migration and health concerns (1)home/pre-departure  transit/journey  interception  destination  return
  22. 22. www.migration.org.zaSpaces of vulnerability:social determinants•Urban areas•Informal settlements•Farms•Detention centres•Informal workplaces•Refugee Reception Offices•Border spacesKey migration and health concerns (2)Sexual and reproductivehealth•Family planning/contraception•Testing, treatment for STIs(including HIV)•Safe termination of pregnancy•Antenatal care•Delivery choices•PMTCThome/pre-departure  transit/journey  interception  destination  return
  23. 23. www.migration.org.zaPolicy opportunities?
  24. 24. www.migration.org.zaMigration, mobility and health in South Africa:what is needed?Migration and health is more than migration and HIV and/or TB.• Psychosocial and mental health; sexual and reproductive health; socialdeterminants of health; spaces of vulnerabilityLearn from and upscale simple interventions.• Health passports; roadmaps for treatment access; referral letters; treatmentpacks for planned movements; patient-held recordsImproved data on migration and health is needed.• Numbers of migrants; numbers of HIV and TB clients who are mobile; strategiesemployed by mobile clients; referral systemsAdvocate for a migration-aware public health response in RSA and regionally.• Work with multiple levels/spheres of governance: regional, national, local;involve state and non-state actors; the urban-rural continuumDo not exceptionalise cross-border migrants.• Internal migrants are greater in number and a larger development challenge, andare often worse off than cross-border migrants
  25. 25. www.migration.org.zaExploring migration, mobility and healthin South Africa:key public health imperativesJo Vearey, PhDUniversity of the Witwatersrandjo.vearey@wits.ac.zaBrocher Foundation25thJune 2013

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