Migration & Urban Health

2. Migration & Urban Health • Almost 60% of the South African population is estimated to be urban (Kok & Collinson, 2006) and this figure is set to increase (UNFPA, 2007); • Migration places increasing pressure on the ability of local government to respond to the public health needs of urban populations; • The context of HIV in urban environments provides an additional challenge: prevention, testing, treatment, support; • Understanding how to ensure and sustain the public health of urban populations is of increasing importance.

3. Background • Estimated population of nearly 3.9 million; • The City has grown by 20.5% since 2001; • Average growth rate of 4.16% per year; • Estimated that the population will reach 5.2 million by 2015. (City of Johannesburg, 2008) • In certain inner-city neighbourhoods, one quarter to half of residents are estimated to be international migrants: Asylum seekers, refugees, economic migrants, undocumented migrants (Landau, 2006; Leggett, 2003)

4. Right to Health • South African Constitution; • Refugee Act (1998); • HIV & AIDS and STI Strategic Plan for South Africa, 2007 – 2011 (NSP); • National Department of Health (NDOH) Memo (2007); • NDOH Directive (September 2007); and • Gauteng DOH Letter (April 2008). 7. Latest Zimbabwe Immigration regime (90 day visa-free entry & special dispensation permit for 12 mths)

5. A Dual Health Care System • Migrants are referred out of the public sector and into the NGO sector: • Reasons for this include not having a South African identity booklet and ‘being foreign’; • This goes against existing legislation. • A dual healthcare system exists for the delivery of ART: public and NGO, presenting a range of challenges: • Logistical issues: cross-referral, loss to follow up, workload pressure; • Falsification of documents… impact on adherence • The responsibility of the public sector is being met by NGO providers.

6. Letter from GDoH April 2008 Additional clarification that South African identity documents are not required for health care of ART

7. Migrant Health Forum A forum has recently been launched that brings together practitioners, researchers, CBOs, NGOs & advocacy groups who are involved in ensuring that the right to health is achieved for all migrants in South Africa, including refugees, asylum seekers & undocumented migrants. The forum is being coordinated through the Community Care Centre (NGO partnership) & RHRU, based within the Hillbrow Health Precinct in Johannesburg.

8. The Aim of the Forum

9. Forum Aim • To monitor & act upon challenges that migrants face in trying to access public health services within South Africa, • & to work towards improving this. • A Health Access Monitoring Project has been launched that will contribute to the ongoing Migrant Rights Monitoring Project (MRMP) coordinated by the Forced Migration Studies Programme, University of the Witwatersrand.

10. Health Access Monitoring Project • The Health Access Monitoring Project is seeking individuals & organisations involved in the provision of healthcare to work with us to collect information about challenges faced by non-South Africans in accessing health care. • We invite prospective partners to participate in the Migrant Health Monitoring Project. This involves documenting the complaints & difficulties that non-South African migrants, asylum seekers & refugees face in accessing health care services in South Africa.

11. Intentions • We hope to foster a healthy exchange of monitoring data and plan to make all of our research easily accessible through our website: http//migration.org.za. • Over the longer term, we will rely on our partners to help identify other dimensions of the migrant rights agenda which may require our attention.

12. Thanks Jo Veary Migrant Health Forum

13. CONTACT DETAILS • Lauren Jankelowitz • Programme Manager: Special Services & Community Engagement • ljankelowitz@rhru.co.za • www.rhru.co.za