Use of the map to emphasise that migration is a global reality and that southern Africa is mostly circular migration, most of which takes place within countries.
Key point: Global, regional, and national recognition of the importance of engaging with migration in health, including HIV, responses. Talk to slide as the various images appear Much evidence exists: research, programmatic evaluations, good practices These are based on partnerships, that already exist. So – a lot is known: we know that migration is a critical consideration for an effective HIV response.
A range of rights, including access to basic healthcare, are provided to non-nationals through the Refugee Act (1998) and the South African Constitution. The current HIV/AIDS and STI National Strategic Plan for South Africa (NSP) specifically includes non-nationals – international migrants, refugees and asylum seekers – and outlines their right to HIV prevention, treatment and support. In September 2007, the National Department of Health (NDOH) released a Revenue Directive [i] clarifying that refugees and asylum seekers – with or without a permit – shall be exempt from paying for antiretroviral treatment (ART) in the public sector. A key guiding principle to the successful implementation of the NSP is towards “ensuring equality and non-discrimination against marginalised groups”; refugees, asylum seekers and foreign migrants are specifically mentioned as having “a right to equal access to interventions for HIV prevention, treatment and support” [ii] . [i] Ref: BI 4/29 REFUG/ASYL 8 2007 [ii] Department of Health (2007) HIV & AIDS and STI Strategic Plan for South Africa, 2007 – 2011. April 2007: Pretoria: Department of Health, p56
In September last year, the NDOH released a revenue directive clarifying that refugees and asylum seekers – with or without a permit – have to rhight to access basic health services and ART. They must be assessed according to the current means test, as applied to South African citizens, and must not be charged foreign category fees.
I suggest we state these up front. So that they’re clear from the start.
Migrant friendly or migration aware? The challenges of a key populations approach to migration, HIV and TB
Migrant friendly or migration aware?The challenges of a key populationapproach to migration, HIV and TB Jo Vearey, PhD email@example.com 25th November 2012
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) Therefore, responses to HIV and TB must engage with migration as a key social dynamic. Source: HDRO staff estimates based on University of Sussex (2007) database
The 61st annual World Health Assembly (WHA) adopted Resolution 61.17 on theEmpirical data: existing evidence on migration, Health of Migrants in 2008. health and HIV to inform responses This Resolution calls on member states Partnerships: governmental;to promote (including South Africa) non- governmental; civil society;to health promotion, equitable access international disease prevention and care for migrants. organisations; academia Four priority areas have been identified for Programmesachieving the WHA resolution: and interventions: good practices – HIV interventions with migrant 1. Monitoring migrant health 2. Partnerships and networks populations Migrant sensitive health systems 3. 4. Policy and legal frameworks
1. South(ern) Africa is associated withhistorical and contemporary populationmovements.
44% of 28.1% of 4.4% of the Gauteng’s Western Cape’s South Africanpopulation were population were population were born in a born in a born outside of different different South Africa province province 2,199,871 people were born outside of South Africa Census 2011
Percentage of international migrants living in urban settlement by District Municipality
7,4% of Gauteng’spopulation are non-citizens3.3% of Western Cape’s population are non-citizens 3.3% of theSouth Africanpopulation are non-citizensCensus 2011
Cross-border migrants as share of the population 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: http://esa.un.org/migration/p2k0data.asp
2. There are linkages between migration and healthin South(ern) Africa.
Migrants reflect health characteristics of place of origin ANDadditional influences that result from the process of migration Gushulak & McPherson, 2006
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.
Protective policyThe right to health: internal and cross-border migrants• South African Constitution and The Bill of Rights;• Refugee Act (1998);• National Strategic Plan for HIV, STIs and TB (2012 - 2016);• National Department of Health (NDOH) Memo (2006);• NDOH Directive (September 2007); and• Gauteng DOH Letter (April 2008).
3. A “key populations” approach to migration, HIVand TB has (unintended) negative consequences.
Challenges of a key population approach tomigration, HIV and TB.• Migrant friendly approach: • Individual focus (v’s population focus) • Facility-level responses (v’s health system responses) • Emphasis on language and translation; cultural competency • Exceptionalise: focus on non-nationals• “Right to health” focus • Migrants perceived as sick, a burden on services, and in a larger number than they are• Limited (no) systems response • Client mobility within the health system is not addressed
4. There is a need for “migration aware” healthsystems responses that embed migration as a keysocial process in southern Africa.
Migrant friendly Migration aware•“Right to health” •Mobility-sensitive•Limited systems response •Heterogeneity of migrant•Cross-border/non-national populations: considers internalfocus: an assumed movement •Spaces of vulnerabilityhomogenous group •Systems response•Exceptionalises •Spatially sensitive•Individual level focus •“Health for all” •Public health approach •Regionally-aware
• Migration is a global reality (and a fact of life)• Migration involves the movement of people within a country and, to a lesser extent, the movement of people across borders.• It is the conditions associated with migration that affect vulnerability to HIV and TB, not being a migrant per se.• Engaging with migration will strengthen health responses • Healthcare planning • Continuum of care and referrals• Failure to do so will • Create marginalised groups • Infringe migrants rights • Result in poor public practice• Effectively implementing existing legislation relating to the right to health for migrant groups will improve health for all.