Towards a migration-aware health system in South Africa: A strategic opportunity to address health inequity [Open Access]
Vearey, J., Modisenyane, M. and Hunter-Adams, J.
Similar to the rest of the region, South Africa has a high prevalence of communicable diseases, an increasing non-communicable disease burden, and diverse internal and cross-border population movements. Healthy migration should be good for social and economic development, but in South Africa current health responses fail to address migration adequately. A review was done of the available data in order to provide recommendations for improved health-systems responses to migration and health in the country, and we drew on our experience in relevant policy processes.
The findings show that addressing migration and health is a priority globally and locally. The number of people moving internally within South Africa far exceeds the number of cross-border migrants. Contrary to popular assumptions, internal migration presents greater governance, health-system, and health-equity challenges than cross-border migration, but current responses do not recognise this. Our findings show why recognising migration as a determinant of health assists in addressing associated health inequities. Data suggest that a healthy migrant effect, and subsequent health penalty, is at play in South Africa. Evidence shows that both non-nationals and South African nationals who move within the country face challenges in accessing health care; of particular concern is the lack of a co-ordinated strategy to ensure continuous access to treatment, and care and support of chronic conditions.
Migration impacts the South African public healthcare system but not in the ways often assumed, and sectors responsible for improving responses have a poor understanding of migration. The need for better data is emphasised, existing policy responses are outlined, and strategic opportunities for intervention are suggested. Recommendations are made for migration-aware health systems that embed population movement as central to the design of health interventions, policy, and research. Such responses offer strategic opportunities to address health inequity, both nationally and regionally, with resulting health and developmental benefits for all.