Category: Conference

MHADRI member Dr Roomi Aziz reflects on her participation in a week’s worth of migration and health events, co-hosted by MHADRI, that took place at the University of the Witwatersrand, Johannesburg at the end of July 2019. This post was originally published here.

Just got some time to review and recap the last week of July 2019, which was everything Gender and Migration and South Africa, beginning with a research workshop, having the privilege of being on an all-female panel on decolonizing global migration and health research, weaving a high level policy dialogue, closing with the UCL-Lancet Commission Launch of report on Migration and Health, and a symposium on gender, migration, health and public policy at the dynamic University of the Witwatersrand and the African Centre for Migration & Society.

We also went through some existential questions, of what does it even mean to be a migrant? What does health access imply? Especially since health often gets short-handed for the biomedical healthcare system, and this understanding is one of the many structural determinants leading to health inequities. For example, health insurance is not universal health coverage, but one of the many factors contributing to it. At the end of it, what stayed with me was the birth-right of a human, to live a meaningful life, and create a home.

Just want to record my five key Points-to-Ponder from the week, one for each day:

P1 | CHANGE THE PERSPECTIVE: It is important to step outside the box we live and operate in, to understand and grasp a broader, ‘helicopter’ vantage point of the situation and the context. Unlearn. Couldn’t be more truer for migration and health, and their bidirectional journey. There was a lot of discussion on the need to look at both systems response and global governance, and be conscious of the rhetoric of migrants’ health. Current public health policies do not engage with migration or mobility of populations, which raised some pertinent questions, on whether the local conversations are reflective of global realities? And about the drivers of policy-making? Is it fear or rights-based approach? Then again, as long as health is discussed in humanitarian paradigm where migration is discussed in securitization paradigm, challenges will continue to grow. We must remember Ellis Island. Exceptionalism in policy frameworks can further hurt a cause. #Mobility is the new normal. It is time that we accept it. We also need to know what we do not know, to truly understand and learn. It is important that we acknowledge the lack of evidence, rather than pretending that we have all the answers/ solutions. We need more data, better data to feed into politics and decisions, and understand the issue enough to take action.

P2 | WHO HOLDS THE POWER: Are we aware of what the rights-based arguments may drive away, and what are the most effective ways to make our case on policy tables? We have limited orientation as to who holds the power in the global discourse. Who has the loudest voice and who is determining the global or the national agenda? While we are continuously dealing with complexities, we must find levers of change within the system that are on our side, and learn to influence them. We must also not forget the key role of national treasury, which can make or break our comprehensive action plans. We religiously talk of evidence-informed decision making, when we also need to remember that sometimes this evidence is not politically correct, and sometimes lack of evidence is desirable for scape-goat-ing. More importantly, how do we make sure that the research generated is responding to the evidence need and who needs it. In either case, we need to be cognizant of our complicity and role in this system of control, and our responsibility towards challenging the global narrative.

P3 | AFFILIATIONS AND IMPLICATIONS: We are very trigger-happy when it comes to the use of adjectives like ‘vulnerable’ and ‘marginalized’, but are we aware of the implications that assignment of such adjectives has? We speak of biometrics and blockchain, without realizing the cost to personal security and implications for non-nationals as well as nationals. These discussions are critical today, when we are still grappling with the idea of profiling people on the basis of their looks, professions, languages, socio-economic status, beliefs and nationalities.

P4 | STAYING AWARE: By virtue of things beyond our control, like the country we were born in, the family we were born into, the skin color we inherited, we hold unequal power and privilege. It is critical that we do not centralize our agenda or usurp the central stage and remember the ‘invisible’. That is the crux of the bone of contention we have with Eurocentric understanding of migration and health and inequalities vis-à-vis Global South being reinstated. This goes back to the ‘changing the perspective’ point, where we must endeavor to visibilize the invisible, profile them to understand what can be done for them, since they cannot be passive actors in the society, lest they are left behind. We must remain acutely aware of the danger of propagating a single narrative, recognize the associated complexities and contestations associated with it.

P5 | CREATE OPPORTUNITIES: Not always there is a demand and supply match. Sometimes one must push and manipulate situations and strategize for interest. There are important advocacy windows all around us. There is a need to identify these strategic windows, the sticking points, and realize the power of our personal networks, to push forward our agendas. There is no time to wait for tailor-made opportunities.

MHADRI member and doctoral candidate, Thea de Gruchy, reflects on a week of activities, co-hosted by MHADRI – that were held at the University of the Witwatersrand, Johannesburg in early August. This article was originally published on the International Health Policies Network (IHP Network) website on 6th August: ‘A week of migration & health in Joburg: Where are we? Where do we go?‘

Last week, the Lancet Commission on Migration and Health’s Report – The health of a world on the move – was formerly launched in South Africa at the University of the Witwatersrand (Wits). Using the attention drawn by this event, the African Centre for Migration & Society (ACMS), alongside colleagues in Demography and Public Health, held a series of events for those of us working on migration and health in the region – to come together, reflect on current realities, and think about the way forward.

As such, a two-day Early Career Researcher workshop for postgraduate students working in and around the field of migration and health; a Wits, UCL, UCL-Commission, and Chatham House convened roundtable looking specifically at realizing UHC in this context; a public symposium and the South African launch of the Report; and a regional symposium on gender, migration, health and public policy were all held in Joburg between 29 July – 2 August.

Migration & health in South & southern Africa

Reflecting global trends, issues of migration and health, including whether cross-border nationals should have access to health care in host countries, are incredibly contentious in South and southern Africa. Although countries across both the global North and South have committed to implementing and realizing Universal Health Coverage (UHC), many are reticent to include cross-border migrant populations in their plans. Which, as I have argued in an IHP blog post before, will undermine attempts to realize UHC and meet other global health targets, including UNAIDS 90:90:90.

To give you a broad sense of the migration and health landscape in the region, there are four things worth highlighting.

1. The region is associated with mixed migration flows and as such sees the movement of refugees, asylum seekers, and those looking for work across borders, as well as the movement of a far greater number of people internally, within national borders;
2. Health systems across the region are overburdened and under-resourced, and access to social determinants that could positively impact health, for example decent housing, formal education, well-paid work, and running water, is limited for both nationals and non-nationals;
3. Current public health responses are not migration-aware or mobility-competent. In other words, health systems don’t acknowledge and engage with the reality that people move both within and across borders, with implications for continuity of care and communicable disease control; and, finally,
4. South Africa, a key country to which many within the region migrate, is particularly hostile towards non-nationals. Not only does the state approach migration as an issue of security, but frequent outbursts of xenophobic violence occur across the country. In fact, on Thursday during the launch of the Commission’s report, a few kilometers away in the Johannesburg Central Business District, police raided foreign owned businesses and met resistance to these raids with rubber bullets and accusations of having been attacked by non-nationals.

Key conversations & themes

Within this context, across all four of the events last week three key themes emerged.

The first, which I believe will surprise no frequent reader of this blog, is that the development and implementation of schemes in the name of UHC, in the South African case the National Health Insurance (NHI), do not necessarily mean that UHC will be realized. The exclusion of non-nationals from the NHI is a clear example of this in South Africa. Rather than being a comprehensive system of coverage, the NHI threatens to be one in which a select package is offered to select categories of people.

The second theme was around the increasing securitization of health as a consequence of concerns about migration. The use of healthcare service providers and healthcare facilities as immigration control needs to be guarded against. While communicable disease control and monitoring remain important, these efforts will in fact be undermined if the accessibility of healthcare to non-nationals is further limited and if non-nationals actively avoid healthcare facilities over fears of arrest and deportation.

The third emergent theme was that a rights-based argument for ensuring that non-nationals have equitable access to healthcare does not seem to be working in South Africa, or globally for that matter. Alternatives have been suggested, a global public goods approach that argues that limiting the access to healthcare and wellbeing for non-nationals will ultimately undermine the health and wellbeing of nationals, for example. Increasingly efforts have also been made to recognise the economic benefit that migration and migrants have for their host communities. Whether such arguments will work where the rights-based argument has failed and whether it is desirable to be making these kinds of arguments is however up for debate.

Ways forward and one caveat

Given the particularly depressing nature of these conversations, important questions were asked about the way forward. An obvious point of departure for those of us in South Africa is the need to work to improve the NHI prior to its roll out and once it has been implemented; to ensure that UHC is realized through the scheme, and that key populations are not left behind.

In addition, improved responses are needed for key populations that have traditionally been left behind by the healthcare system, as well as ignored by researchers. Although, as Loren Landau argued, a key example of the latter are in fact policy makers. Researching migration does not simply mean researching migrants and their lived experiences, but also the mechanisms for governing migration and the people who are involved in their development and implementation.

Here, the potential for bibliometrics to illuminate gaps in our research and knowledge, and as such, direct future research emerges. As we know, while most migration happens within the global South, most of the research and literature on migration has been focused on, or at least written, in the global North.

However, while there is a tendency to lament the fact that we need more data, a key tension emerges between the fact that there is this need, but that the data that is already available is often used nefariously and to further anti-migration mechanisms. Making invisible populations visible, quantifying and qualifying migrants, opening up the black box around the mechanisms that migrants use to circumnavigate increasingly restrictive bureaucratic structures may not be in the best interests of those who migrate, and may simply be strengthening the hand of those who are trying to put a stop to migration.

Not a particularly positive note on which to end things, but, given the state of the world, fairly inevitable. As researchers and practitioners, the need to be rigorous and rigorously ethical – to ensure confidentiality and anonymity; to push back against entities that seek to fund work that would improve their efforts at securitization; and to improve research collaborations and partnerships so that research produced reflects local realities rather than a global agenda – in our work has never been more imperative.

[This article was originally published on the International Health Policies Network (IHP Network) website on 6th August: ‘A week of migration & health in Joburg: Where are we? Where do we go?‘, and the images are courtesy of MoVE ( method:visual:explore).