Input made at the IOM/Save the Children Technical Meeting on the SADC project: SRHR-HIV Knows No Borders, November 2018

1. Jo Vearey, PhD
Associate Professor
African Centre for Migration & Society
University of the Witwatersrand
20th November2018
jovearey@gmail.com
Leaving no-one behind?
Responding to migration, mobility and health in southern Africa
www.mahpsa.org

2. A renewed focus on
migration and health
• SDGs: leave no-one behind
• World Health Assembly; WHO; IOM
• Global Compacts
• Universal Healthcare Coverage
• Justice & public health
• Migration-aware and mobility-
competent health responses
Competing agendas
• Politics and power
• Sovereignty
• Securitisation of migration
• Health security

3. The Southern Africa Development Community (SADC)
Diversity
Heterogeneity
(contexts: migration; urbanisation; health systems;
governance; communicable diseases)

4. Where’s the internal migrant & processes of internal migration?
Do not exceptionalise cross-border migrants & cross-border
migration.
• Internal migrants are greater in number and a larger development
challenge, and in some contexts are worse off than cross-border migrants
• Improved nomenclature is needed
South Africa –
internal mobility
South Africa –
cross-border mobility

5. 1. Southern 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 assumptions persist
2. Current public health responses do not engage with, migration
and mobility: implications for communicable disease control (TB and HIV, malaria); chronic treatment
continuity; challenges in accessing the public system for non-nationals
3. Public health and social welfare systems are overburdened and
struggling: challenges are raised in a context of high inequality where nationals are also struggling to access
their basic rights
4. Structural violence - increasing anti-foreigner sentiments and
xenophobic attitudes: migration management is associated with increased securitisation; a lack of
regional responses; a restrictive immigration act; limited understanding of migration dynamics; violence; fear;
securitisation of health

6. What is needed?1. Accountability:
– What’s at stake for who?
– Who is ultimately responsible?
– Non-binding v’s binding agreements; global accountability
– Who has oversight of (e.g. DHA, NDOH)?
– Costing studies
2. Identify strategic opportunities:
– Do not exceptionalise cross-border movements, internal migration as greatest development
challenge in SA; myth-busting approaches
– Changes in legislation; NHI
3. Building of alliances:
– Within government
– Between governance actors
– Who can – and cannot - do what?
– Who can speak out?
4. Research as action:
– Engaged, slow research, personal relationships
5. Action plan

8. Migrant friendly v’s migration aware
Migrant friendly
•“Right to health”
•Limited systems response
•Cross-border/non-national
focus: an assumed
homogenous group
•Exceptionalises
•Individual level focus
•Intercultural / cultural
sensitivity
Migration aware
•Mobility-sensitive
•Heterogeneity of migrant
populations: considers internal
movement
•Systems response
•Spatially sensitive
•“Health for all”
•Public health approach
•Regionally-aware

9. • Calls on member states to promote equitable access to health promotion,
disease prevention and care for migrants.
Four priority areas have been identified for achieving the WHA resolution:
1. Monitoring migrant health;
2. Partnerships and networks;
3. Migrant sensitive health systems; and
4. Policy and legal frameworks.

11. A focus on African Union
processes

13. We need to learn from and upscale simple interventions
developed by healthcare providers
Informal innovation in response to migration; health passports; roadmaps for treatment
access; referral letters; treatment packs for planned movements; patient-held records;
mobile clinics

14. Advocate for a migration-aware approach.
• 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
There is a need for “migration aware” responses to HIV,
TB, SRHR that embed migration as a key social process
in southern Africa.