Emerging Good Practices in Migration and HIV Programming

Free State SABCOHA Conference on HIV & AIDS, TB and Wellness Welkom, August 2011

International Organization for Migration (IOM)

• Intergovernmental organization established in 1951 • Committed to the principle that “humane and orderly migration benefits migrants and society”. • 132 Member States and 94 observers • More than 450 field locations • IOM Office in Pretoria started operations in 1996 • Two offices based in Pretoria : 1) Regional Office for East & Southern Africa 2) Country Office for South Africa

International Organization for Migration (IOM)

• IOM established in 1951 • 132 member states and over 450 field locations worldwide • Mandate is to facilitate migration and is committed to the principle that “humane and orderly migration benefits

migrants and society”

• Pretoria office covers East and Southern Africa region • Movements and assisted returns • Counter-trafficking • Migration and health • Migration and development • Counter-Xenophobia • Humanitarian and Post crisis management and • Migration Management and policy

Introduction

• Since 2004, IOM has been implementing a migration & health programme –

Partnership on Health and Mobility in East and Southern Africa (PHAMESA)

•

Components

: Advocacy for policy development; Research and information dissemination; regional coordination and Service Delivery and Capacity Building.

• The overall goal of which is :

To contribute to the improved standard of physical, mental and social well being of migrants by responding to their health needs throughout all phases of the migration process, as well as the public health needs of host communities using IOM’s network of regional and country missions and partnerships with RECs, NACs, MoH, relevant line Ministries, Private Sector, Unions, UN Partners, and Intl and local NGOs.

Migrants – Who are they…

• Internal or international (cross boarder) • Forcibly displaced – (natural disaster /conflict) – IDPs, refugees, asylum-seekers, returnees • Workers – formal / informal / (seasonal/ contract) • Regular and irregular – Legal migration status, identity documents – Within a formal system (e.g. detained, deported)

Globalization of Migration Doubled over the past 25 years 190 million world-wide in 2005 for many, livelihood is increasingly based on mobility

Situational Analysis related to Migration & HIV

•

Mobility and Migration

impacts on HIV and AIDS vulnerability in SA.

• The NSP identifies migrants as one of the key populations to be targeted with prevention, care and treatment interventions and this should be included provincial strategic implementation plans. – Agriculture, mining, fisheries, construction, transport, Informal boarder traders, domestic workers, • Free State – Economy depends on the agriculture and mining industries. – Seasonal and contract employment for surrounding communities and Lesotho nationals – Seasonal employment often involves moving from farm to farm spending lengthy periods of time away from families – Change in migration patterns - from male to feminization of Migration

Migration and HIV

– shares borders with Lesotho, internally with Provinces of KwaZulu-Natal, Mpumalanga, Gauteng, North West, Northern Cape and Eastern Cape. – Longest road network (N1 links Free State to Gauteng, and east and Western Cape).

• Changing economic landscape: retrenchments and closure of mines, (most people remaining in the Province, move towards manufacturing industry, more women seeking employment in the agricultural sector, poverty and development of informal settlements increasing demand for service delivery • Mobility and migration not only increase vulnerability to HIV among mobile individuals, but also sending and receiving communities.

Who is affected by the Migration Process?

Transit communities: Communities migrants pass through

Border officials, informal traders, transport, sex workers,

Pre-departure

Home communities

Spouses, children, community

Return Movement

Host communities

“migrants partners”, colleagues, local community, health & other services

Destination

Transit communities: Communities migrants pass through

Border officials, informal traders, transport, sex workers,

IOM’s Approach to Addressing HIV and Migration Challenges

• Advocacy for Policy Development • Research and Information dissemination • Regional coordination; and • Service Delivery and Capacity Building – Building capacity of key stakeholders at national and regional level including government & CSO – Promoting and implementing the Health Promotion & Service Delivery Framework (HPSD) – Sharing best practices and lessons learned – Partnerships with regional and key stakeholders

HPSD FRAMEWORK

Figure 4 The IOM Health Promotion And Service Delivery Framework WHAT HOW STRUCTURAL Addressing gender dynamics in the context of health and migration ENVIRONMENTAL Strengthening of local implementing partner Facilitating access to health services, programmes and products Creating an enabling local environment Addressing gender dynamics in the context of health and migration Addressing contextual barriers to behaviour and social change INDIVIDUAL Peer-led communication, information and education on health CAPACITY BUILDING EVIDENCE BASED LOCAL ACTIVE PARTICIPATION COMMUNICATION PARTNERSHIPS MAINSTREAM GENDER AND CULTURE INVOLVEMENT OF KEY POPULATION

Sharing of Best Practices Field Work

• 2007 – 2010 Projects were implemented in six different sites in southern Africa (Lesotho, Mozambique, Solwezi, Katete, Swaziland, SA) – Mine sending communities and workplace focused – Targeted migrants, their families and communities with which they live and work – Commercial agriculture and mining sectors. – The projects all implemented the HPSD framework • 2010 projects were assessed using SADC Framework for Best Practices (2008)

• • • • • • • •

Key findings

A common framework helped to guide and structure health responses in migration-affected communities Bottom up approach to Social & Behaviour Change Communication built local ownership and ensured activities responded to real needs Change Agents are a dynamic approach to Peer Education Critical to mainstream and prioritise gender – esp involvement of men Sharing of lessons across the region and amongst implementing partners strengthened the network of partners and their localised responses Taking a sectoral approach (mining and agriculture) allowed for common challenges and vulnerabilities to be identified, thereby building regional knowledge on HIV and migration in each sector/migration affected communities By building strategic partnership service provision was more collaborative and made better use of limited resources Advocacy based on the lessons learnt from the ground helped highlight migration-health related issues at the local, national and regional levels

“Change Agents” the next

generation of peer educators

• Move beyond didactic (peer education) to bottom up (change agent) approach

Who are “change agents”?

• CAs are members of the target community (chosen by their peers)

What is their role?

• To engage in dialogue with their peers in a participatory manner to identify challenges and together coming up with solutions

What capacity do they need?

• Capacitated with skills to enable them to engage with their peers in a structured manner (gender, migration and HIV/health, home based care, facilitation, communication skills) • They facilitate in dialogue on key social issues; (outreach activities) • Provide care as DOTS supporters (HIV and TB) • Develop strategies to address challenges (exchange visits) • Advocate for change through collective action.

“Change Agents” the next generation

of peer educators…

• Disseminate HIV/health-related information using different communication tools (drama, radio, songs, murals, billboards etc) • Promote adoption of healthier and positive behaviours and practices •

What have we learnt from this approach?

• The involvement of CA has resulted in increased ownership greater understanding of HIV/health issues; • Workplace programmes are strengthened • Strengthened capacity gap of health services • Bringing services to beneficiaries through partnerships (primary health care, condoms, support groups, economic empowerment) • Men embraced the caring role (home based carer’s &DOTS) • Involvement of traditional leaders/healers as CA’s is crucial • Increased uptake of services such as counseling and testing; • Increased awareness and challenging of gender norms (male gender advocates) • Growing recognition that individual behaviour change occurs within a social context.

THANK YOU

Maria Moreriane

Migration Health Project Officer Office: +27 12 342 2789 Fax: +27 12 342 0932 Mobile: +27 82 569 6721 Email: [email protected]

Internet: www.iom.org.za

; www.iom.int

‘Migration for the Benefit of All’