How a creative mind like Ms. Dabea Gaboutloeloe ended up in the public health arena for two decades is a conversation for another day.  She still dreams of one day retiring into interior designing, but we’ll just have to wait and see about that, because her passion and talents clearly lie right here where she is, as IOM’s Country Coordinator for Migration and Health in South Africa.  We caught up with her for a quick interview.

So, what can you tell me about health in South Africa?

Well, South Africa is one of the countries with the highest burden of diseases such as TB because of the mining industries which have been attracted labour migrants since the early 1950s. The National Department of Health is leading other SADC (Southern Africa Development Community) countries in this regard to find solutions to addressing TB in the Mines.  A new National Strategic Plan on HIV/AIDS /STI and TB covering the period 2012- 2017 has recently been launched.  Migrants have been included in this document as a key population at risk of HIV and TB infection due to the conditions they find themselves in the process of migration and the spaces where they live.

What are the health challenges for migrants?

South Africa experiences both internal migration and cross border migration as people move in search for better opportunities.   Irregular migrants often settle in remote areas like farms close to the border and informal settlements close to big cities.  It’s harder to access health services from remote areas because they are usually very far from clinics, and some migrants would rather spend the day working and earning money instead seeking health advice for treatable conditions. The migrants staying in big cities may avoid clinics fearing that they will be caught and deported or that they will be chased away from clinics or misunderstood because they don’t speak local languages.  While South Africa has a clear policy on migrants’ rights to access to healthcare services, this does not translate that easily into practice.  For example, some migrants may be turned away by security security guards at clinics who demand a South African Identity Document before allowing entry.  There is a need to sensitise and educate staff on migrant rights. Simply put, the challenges are: accessibility, affordability and acceptability of migrants at clinics.

So, what interventions are there to address the challenges?

The Ripfumelo HIV Prevention and Care Project is the IOM’s flagship programme on HIV and Mobility in South Africa. The project targets commercial agricultural workers in selected provinces in South Africa and it has provided a learning space for implementing comprehensive package HIV prevention and care for farm workers and the communities they interact with.

Other interventions IOM interventions are at policy and strategy level, providing technical support and capacity building to government at national, provincial and local level.

What would you do if you had funding?

Well, there are a few gaps, amongst them the need for more research and sharing of knowledge. IOM in South Africa needs to create and support learning centres in migration affected communities, as well as support more research on migration and health in South Africa.

Programmes like the Ripfumelo project need to be expanded to more provinces and other migration affected sectors in the country.

Any highlights?

Opening the dialogue on migration and health is our greatest success to date.  It is wonderful to see people openly engaging on migration and health issues.  In Limpopo, we have a Migrant Health Forum that was established in 2008, here, the local government has taken the lead in holding all stakeholders accountable for their role in realising migrants’ right to health.   Whereas in the past, migrants were overlooked in health policies, last year, we were able to influence the development of the National Strategic Policy and migrants have been identified as one of the key populations most vulnerable to HIV.  The most rewarding experience however, is the continued generation of knowledge through research, which gives better understanding of migration and health issues guides how we respond to migrant settings.

Where to from here?  How do you see the relationship between migration and health unfolding in future?

Now that the issue of migration and health is on the agenda and recognised in relevant policies, the real work begins now.  We need to strengthen the health system through training and sensitisation to ensure that the policy directives issued are not just on paper, but are being implemented.