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Migration and health in South Africa: National Consultation on Migration & Health, April 2013


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Migration and health in South Africa: National Consultation on Migration & Health, April 2013

  1. 1. Migration and health in South Africa Jo Vearey, PhD University of the Witwatersrand National Migrant Health Consultation Pretoria, 23rd April 2013
  2. 2. The African Centre for Migration & Society . • Independent, academic research and teaching unit based at Wits University • Policy-relevant research in 11 African countries • Partnerships in Africa, Asia, Europe and the Americas • Post-graduate training • Contract research for government, civil society and international organisations -
  3. 3. Today1. Migration and mobility in South Africa • Mixed migration; diverse contexts2. Migration and health in South Africa• Social determinants of health; spaces of vulnerability2. Legislative frameworks• Policy frameworks and opportunities2. Emerging issues
  4. 4. Approximately 214 million cross-border migrants (around 3% of the world’s population) and 740 million internal migrants globally.“......migration is not a random individualchoice. People who migrate are highlyorganised and travel well-worn paths.” (Harcourt, 2007: 3) Source: HDRO staff estimates based on University of Sussex (2007) database
  5. 5. Increasing recognition of migration as a determinant of health The 61st annual World Health Assembly (WHA) adopted Resolution 61.17 on the Health of Migrants in 2008. Empirical data: existing evidence onmigration, health and HIV to inform responses This Resolution calls on member states (including South Africa) to promote equitable Partnerships: governmental; non- access to health promotion, disease prevention and care for migrants. governmental; civil society; international organisations; academia identified for Four priority areas have been achieving the WHA resolution: Programmes and interventions: good 1. Monitoring migrant health; 2. Partnerships and networks; practices – HIV interventions sensitivemigrant and 3. Migrant with health systems; populations and legal frameworks. 4. Policy
  6. 6. Migration and health in SADC (1)1. SADC is a region of historical and continuing, varied migratory flows.2. Linkages between urban and rural areas through circular migration processes have been identified as critical to the comprehension of health concerns within SADC.3. Cross-border migrants face challenges in accessing public-health services despite the presence of protective legislation.4. There is a strong bias present, with most published research focussing on migration within and into South Africa.
  7. 7. Migration and health in SADC (2)5. The relationship between HIV and migration has emerged as the most researched and published.6. There is a lack of published research that (1) documents and (2) evaluates interventions addressing migration and health in SADC.7. Migration is a central developmental issue for the SADC region.8. Despite the international recognition of the importance of good governance in managing both migration and health, there is very little literature available that considers the governance of health and migration within the SADC region.
  8. 8. Migration is a determinant of health migration  health migration can determine health migration  health health can determine migration
  9. 9. Migration and health e rous angccess t c healt hy d a o ponita migra os ive gio nt determin ants of n Sa lmon eff e ct effect bility health for an in formed positive era eigvuln ris n publdic health selection k sevense re po lopm migration aware ben ent HIV g efits v’ s t raffickin impro grBnt sensitive ved mi T a data exceptionalisation burden
  10. 10. Migrants reflect health characteristics of place of origin ANDadditional influences that result from the process of migration Gushulak & McPherson, 2006
  11. 11. Figure 1: Factors that can affect the well being of migrants during the migrationprocess (IOM, 2008) Pre-migration phase Movement Phase • Pre-migratory events and trauma • Travel conditions and mode (war, human rights violations, (perilous, lack of basic health torture), especially for forced necessities), especially for irregular migration flows; migration flows; • Epidemiological profile and how it • Duration of journey; compares to the profile at • Traumatic events, such as abuse; destination; • Single or Mass movement. • Linguistic, cultural, and geographic proximity to destination. Cross cutting aspects: Gender, age; socio- Migrant economic status; genetic s’ well- factors being Return phase Arrival and Integration phase • Level of home community services • Migration policies; (possibly destroyed), especially after • Social exclusion; discrimination; crisis situation: • Exploitation; • Remaining community ties; • Legal status and access to service; • Duration of absence; • Language and cultural values; • Behavioural and health profile as • Linguistically and culturally adjusted acquired in host community. services; • Separation from family/partner; • Duration of stay.
  12. 12. Mixed migration and mobility in South Africa• Internal migration > cross-border migration• The majority of movement in SADC is associated with livelihood seeking• Temporary migration v’s transit v’s permanent migration• (Lack of) Access to documentation Forced migration Young people Arrest, • Refugees • Asylum seekers detention Students • Returnees and Women • Undocumented deportation Families
  13. 13. Livelihood seeking • Formal and informal • Employed v’s self-employed • Job seekers • Mobility • Cross-border traders • Truck drivers • Seafarers • Miners • Farm workers – seasonality • Sex workers
  14. 14.
  15. 15. 44% of Gauteng’s 28.1% of Western 4.4% of the South population were Cape’s population African populationborn in a different were born in a were born outside of province different province South Africa 2,199,871 people were born outside of South Africa Census 2011
  16. 16. Percentage of international migrants living in urban settlement by District Municipality
  17. 17. 7,4% of Gauteng’s population are non-citizens 3.3% of Western Cape’s population are non-citizens 3.3% of the South African population are non-citizensCensus 2011
  18. 18. Cross-border migrants as share of thepopulation 1990 2010 2011 Namibia 7.9 6.3 Botswana 2.0 5.8 South Africa 3.3 3.7 3.3 Swaziland 8.3 3.4 Mozambique 0.9 1.9 Malawi 12.2 1.8 Zambia 3.5 1.8 DR Congo 2.0 0.7 Lesotho 0.5 0.3 Source:
  19. 19. Key migration and health concerns (1) Communicable diseases Mental health and •Transmission psychosocial concerns •Predominantly move from •Trauma lower to higher HIV/TB •Daily stressors prevalence •Violence: direct and •Treatment continuity structural •Referrals •Harmonisation of protocolshome/pre-departure  transit/journey  interception  destination  return
  20. 20. Key migration and health concerns (2) Sexual and reproductive Spaces of vulnerability health •Urban areas •Family planning/contraception •Informal settlements •Testing, treatment for STIs •Dense inner-city (including HIV) •Farms •Safe termination of pregnancy •Detention centres •Antenatal care •Informal workplaces •Delivery choices •Refugee camps •PMTCT •RROs •Border spaceshome/pre-departure  transit/journey  interception  destination  return
  21. 21. The social determinants of health (SDH)  The SDH are the conditions in which people are born, grow, live, work and age, including the health system.  These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices.  The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries.
  22. 22. Social Determinants of Health
  23. 23. Governing migration in South Africa
  24. 24. The Immigration Act• Governs immigration into South Africa• Restrictive• Recent amendments Republic of South Africa (RSA) (2002) Immigration Act — Act 13 of 2002. Pretoria, South Africa, Government Printers. Republic of South Africa (RSA) (2004) Immigration Amendment Act — Act 19 of 2004. Pretoria, South Africa, Government Printers.
  25. 25. The 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 – including ART – for refugees, asylum seekers and other cross-border migrants.• However, recent amendments may affect this. Republic of South Africa (RSA) (1998) Refugees Act — Act 130 of 1998. Pretoria, South Africa, Government Printers.
  26. 26. Cross-border migration into South Africa Asylum seekers (Section 22 permit); Refugees (Section 24 permit); Other:work permits, study permits; visitor permits; Undocumented migrants; and Unaccompanied minors.
  27. 27. South African legislation•Cross-border migrant access to healthcare
  28. 28. Protective 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 South Africa, 2012 - 2016 (NSP).
  29. 29. National Strategic Plan (NSP) for HIV & AIDS, STIs and TB 2012 - 2016Recognition of: • Migration – internal and cross-border. • Migrants recognised as a key population. • Indicators for key populations include migrants (e.g. early initiation of ART and TB treatment).However: • No framework or guideline for how to implement responses to HIV and migration.
  30. 30. Developmental local government“local government committed to working with citizens and groups within the community to find sustainable ways to meet their social, economic and material needs and improve the quality of their lives” (RSA, 1998: 23)
  31. 31. The role of local governmentSource: INCA CBF MRC DPLG Handbook
  32. 32. Policy opportunities?
  33. 33. Emerging issues• Cross border collaborations• Human rights, migration and sexuality (including LGBTI asylum)• TB/HIV in the mines: role of the private sector• Malaria and mobility• Sex work and migration• Work, informal work, migration and health• Local responses: migrant health forums• New legislation: NHI; PHC Re-engineering
  34. 34. Recommendations for action (1)Migration and health is more than migration and HIV and/or TB. • Psychosocial and mental health; sexual and reproductive health; determinants of healthApply a social determinants of health lens. • Engage with the informal workplace as a space of vulnerabilityImproved data on migration and health is needed. • Numbers of migrants; numbers of HIV and TB clients who are mobile; strategies employed 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, and are often worse off than cross-border migrants
  35. 35. Recommendations for action (2)Mobilise a renewed – and revised - regional conversation for developing acoordinated response to health and migration. • SADC Consultancy on Regional Financing Mechanisms; social rights portability: state and non-state actors; internal and cross-border mobilityLearn from the SADC Declaration on TB in the mining sector. • Political leadership; private sector; naming and shamingMigration as a key developmental issue • The role of developmental local governmentEngage with national AIDS councils to ensure migration and mobilityacknowledged in NSPs. • Beyond migrants as a ‘key population’; work towards a migration-aware responseLearn from and upscale simple interventions. • Health passports; roadmaps for treatment access; referral letters; treatment packs for planned movements; patient-held records
  36. 36. Migration and health in South Africa Jo Vearey, PhD University of the Witwatersrand National Migrant Health Consultation Pretoria, 23rd April 2013