From evidence to action: Exploring missed opportunities for improving cross-border migration and health in Southern Africa
Centro di Permanenza Temporanea, Adrian Paci, 2007. Courtesy of the artist; Peter Kilchmann Gallery, Zurich, Kaufmann Repetto Milano, New York.
Global migration and health: a series of siloed responses
Migration is highly politicised, and little is known about its correlation with health. However, migration impacts health, and vice-versa, as proved in the case of medical tourism, with people moving to seek better healthcare services, and with the global migration of health workers, when skilled migrants move abroad from low to middle/high-income countries to find better job opportunities, thus contributing to the recipient countries’ health systems and economies.
Thinking about the connections between migration and health seems today at the forefront of policymaking, when movements of people are being restricted to contain the coronavirus outbreak. But, in normal times, actions that tackle the opportunities and manage the risks of migration and health have been siloed and insufficient. In fact, by categorising migrants as carriers of ‘foreign diseases’ and threats to national health systems, global actors have chosen a security approach at the expense of universal human rights as the right to move or receive adequate healthcare.
Taking a regional approach makes us understand that, in order to achieve universal health coverage and fulfil all human rights, we need to look at the current state of evidence and at what is happening on the ground.
Evidence in Southern Africa: a double-edged weapon
‘If you want to implement policies, you are going to need to know things we don’t know.’
(Academic expert, 2019)
In the region, a lot of information that would help the implementation of migration and health policies is missing. Initiatives have been undertaken during the Millennium Development Goals to fight infectious diseases (i.e. HIV, malaria), but only limited, if any, evaluations have been produced. Key bottom-level evidence such as health records and demographic data are also part of this gap. Knowing what works at the country level and what are the national health systems’ capacities and needs would prepare policymakers on coordinating and planning a regional response. But the availability of evidence is insufficient.
‘It is not because you have that evidence that you will win the argument and be able to influence policy.’
(Key informant from an international NGO, 2019)
Evidence-based policymaking does not find fertile ground in Southern Africa. In fact, policymakers often use evidence to influence their agendas or the production of evidence itself, and this is particularly true for politically unpopular issues, such as migration, human trafficking and sex work. Rather than talking about ‘having enough evidence’, we should maybe consider how facts are likely to influence a certain policymaking environment. The overarching common objective in Southern Africa is to reduce poverty in the region, and there are some good arguments for putting mobility and health at the core of its policies, starting from healthy migrants that are key contributors to the regional social and economic development.
But in order to ensure implementation of evidence-based policies for migration and health, it is also necessary to look at how the different actors and sectors that are involved in these issues in the region are cooperating (or not).
Regional governance: challenges and opportunities
SADC region. Source: MapChart.com.
To date, the Southern African Development Community (SADC) is the only regional organisation that has the mandate to consult and advise all Member States on mobility and health issues. But ‘good governance’ for migration and health would also see the collaboration of sectors that have an impact and interest in migration and health. Some countries are leading efforts to make this cooperation possible: in South Africa, a migrant focal point has been introduced in the Department of Health. A similar approach could be devised for other sectors such as trade and agriculture.
Another challenge is the absence of a functioning evidence-uptake mechanism: even during the important Migration Dialogue for Southern Africa, a regional consultative process on migration organised with SADC, the exchange between academia and policymakers seems to be difficult:
‘You often have this very short window in which senior experts and officials meet, and evidence is not related specifically to their question… I see there is a real disconnection here, we miss a chance in accurately informing people of what’s happening and what is possible.’
(Key informant from an international organisation, 2019)
Sometimes at the national level, human-rights infringements are other barriers to add to the existing fragmented and inadequate regional governance:
‘You still have very good courts in South Africa. They are independent and they provide good judgements, but they are never implemented. They have closed the refugee reception office in Cape Town, which is where people can apply for asylum. That has been declared unconstitutional and has gone through all courts. There are court orders, but it is already two years that nobody implements them.’
(Key expert from an international NGO, 2019)
Finally, a coherent vision on migration and health should be shared by policymakers and researchers. This vision should consider the real needs of migrants and involve them in their research and policy decisions. There is also a general opinion that when publicly funded, health systems should only serve a specific location. But these locations are also where migrants are working and living, thus health systems should become universally accessible.
‘Global health should be conceptualised as the health of the global population, with a focus on the dense relationships of interdependence across nations and sectors that have arisen with globalisation’
(Julio Frenk and Suerie Moon, 2013)
The call for ‘more evidence’ and more ‘evidence-based policymaking’ for migration and health is already on the global health agenda. But to implement evidence-based, sustainable solutions for migration and health, much more is needed. A regional approach shows that it is necessary to consider all the actors, beliefs, legal aspects and understandings of the issues that will determine whether or not a certain policy is implemented.
With the coronavirus pandemic, migration and health have gained global attention and this momentum must be seized. More than ever, regional and national policymakers and researchers should engage with migration and health through a human rights lens and be given a space to discuss their needs and priorities. As we imagine new solutions for global health, let’s ensure mobility and health are at the core of policymaking.
Sarah Talon Sampieri
Sarah Talon Sampieri has a background in interdisciplinary life sciences from Paris Descartes University and holds an MSc in Global Health Policy from the University of Edinburgh. Her area of interest and work is in global health policy and governance, with a particular focus on migration and sexual and reproductive health. She can be reached at email@example.com and @saraholympia_ on Twitter.