Partnership on Health and Mobility in East and Southern Africa (PHAMESA) II Annual report 2015
Report to the Swedish International Development Cooperation Agency (Sida) and to the Dutch Minister for Foreign Trade and Development Cooperation Partnership on Health and Mobility in East and Southern Africa (PHAMESA) II 2015 Annual Report
Executing Organization Project Management Site and Relevant Regional Offices International Organization for Migration (IOM) Regional Migration Health Team Regional Offices for East and Horn and for Southern Africa Project Period 01 January 2014 31 December 2017 Date due 31 March 2016 Reporting Period 01 January 31 December 2015 Geographical Coverage Project Beneficiaries Project Partners: Project Identification and Contract Numbers East and Southern Africa Total Confirmed Funding Sida Contribution: $13,250,001 International and internal migrants including refugees, asylum seekers, migrant workers, such as mine workers, cross-border informal traders, fisherfolk and migrant sex workers and their families, be they in a regular and irregular situation, and internally displaced persons; migration-affected communities; health-care personnel; government officials (local, national and regional levels). Regional partners: Regional economic communities and regional bodies, particularly the East African Community (EAC), Indian Ocean Commission (IOC) and Southern African Development Community (SADC). Country partners: Ministries/departments of health at national and local levels, and their related divisions; national AIDS councils and commissions; ministries of sectors dealing with migration (agriculture, home affairs, labour, maritime, mining, public works, transport, etc.), private sector companies and unions; civil society organizations including international and national NGOs and community-based organizations; technical partners including United Nations organisations (ILO, UNHCR, UNICEF, WHO, UNAIDS, UNFPA, etc.); universities and research/academic institutions. Project ID: MA 0299 (Sida); IOM Reference: KEN/FSWE/AL0652/2013 Total operational Funds Received to Date: Total Expenditures (as at December 2015) Sida: $8,591,972 Sida: $5,056,394 Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report i
CONTENT LIST OF ACRONYMS AND ABBREVIATIONS... III 1. INTRODUCTION... VI 2. EXECUTIVE SUMMARY... 1 3. PROGRESS TOWARDS RESULTS... 6 3.1. OUTCOME 1: IMPROVED MONITORING OF MIGRANTS HEALTH TO INFORM POLICY AND PRACTICE... 6 3.1.1. National health information systems incorporate indicators to measure the health of migrants... 8 3.1.2. Increased availability of data and evidence on migration and health generated through research... 8 3.1.3. IOM and partners have improved accessibility to migration health information... 10 3.2. OUTCOME 2: POLICIES, LEGISLATIONS AND STRATEGIES COMPLY WITH INTERNATIONAL, REGIONAL AND NATIONAL OBLIGATIONS WITH RESPECT TO THE RIGHT TO HEALTH OF MIGRANTS... 10 3.2.1. Increased knowledge among policymakers and stakeholders to influence policies, legislations and strategies that address migration-related health issues... 12 3.2.2. Improved coherence of policies among relevant sectors and across borders... 13 3.3. OUTCOME 3: MIGRANTS AND MIGRATION-AFFECTED COMMUNITIES HAVE ACCESS TO AND USE MIGRATION- SENSITIVE HEALTH SERVICES IN TARGETED SPACES OF VULNERABILITY IN COUNTRIES OF ORIGIN, TRANSIT AND DESTINATION... 15 3.3.1. Migrants and individuals in migration-affected communities have increased knowledge on their right to health, priority diseases (HIV, TB and malaria) and available services... 16 3.3.2. Service providers have increased capacity to deliver migration-sensitive services... 20 3.3.3. Improved service provision in targeted spaces of vulnerability... 23 3.4. OUTCOME 4: STRENGTHENED MULTI-COUNTRY/SECTORAL PARTNERSHIPS AND NETWORKS FOR EFFECTIVE AND SUSTAINABLE RESPONSE TO MIGRATION AND HEALTH CHALLENGES IN EAST AND SOUTHERN AFRICA... 26 3.4.1. Partners have the capacity to develop, fund and implement initiatives that address migration and health... 27 3.4.2. Increased multi-stakeholder/multisectoral coordination/collaboration on migration health at all levels... 29 3.4.3. Improved accessibility of tools on migration and health... 30 3.4.4. Increased awareness of migrants' right to health and migration-related challenges at global, regional and national levels... 30 4. PHAMESA II PROGRAMME SUSTAINABILITY... 32 5. CHALLENGES AND MITIGATION... 33 6. CONCLUSION... 34 7. ANNEXES/ATTACHMENTS... 35 Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report ii
LIST OF ACRONYMS AND ABBREVIATIONS ACP AfDB AIDS AMIMO APHRC CA CBO CB-HIPP CCE CEDAW COMESA CNCS CSO CHV CHW DfID DHS DPHK DTM GBV EAC EC ECSA ECWC EIDHR ETRR EU FAO FBO FSW HCT HCW HIV HMIS HSDP HSRC IBBS ICESCR IEC IGAD ILO IOC IP JUPSA JUTA KASF KAIS African, Caribbean and Pacific (ACP) Migration Observatory African Development Bank Acquired Immunodeficiency Syndrome Association of Mozambican Miners African Population and Health Research Centre Change Agent Community-Based Organization Cross-Border Health Integrated Partnership Project Community Capacity Enhancement Convention on the Elimination of all Forms of Discrimination Against Women Common Market for Eastern and Southern Africa National AIDS Council (Conselho Nacional de Combate ao HIV/SIDA), Mozambique Civil Society Organization Community Health Volunteer Community Health Worker Department for International Development, UK Demographic and Health Survey Development Partners in Health in Kenya Displacement Tracking Matrix Gender-Based Violence East African Community European Commission East, Central and Southern Africa Health Community Eastleigh Community Wellness Centre European Commission European Instrument for Democracy and Human Rights Electronic Tuberculosis Recording and Reporting System European Union Food and Agriculture Organization of the United Nations Faith-Based Organization Female Sex Worker HIV Counselling and Testing Health-Care Worker Human Immunodeficiency Virus Health Management Information System Health Sector Development Plan Human Science Research Council Integrated Biological and Behavioural Survey International Covenant on Economic, Social and Cultural Rights Information, Education and Communications Inter-Governmental Authority on Development International Labour Organization Indian Ocean Commission Implementing Partner Joint UN Programme of Support on AIDS, Uganda Joint UN Team on AIDS, Namibia Kenya AIDS Strategic Framework Kenya AIDS Indicator Survey Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report ii
KM KNBS LHR LIN MARP MBOD MCH MH MHD MHF MISAU MITESS MLSS MMTF MOH MOHSS MOHSW MOLSS MOU MOWT MTWSC NAC NACC NASF NGO NSP OHCHR OPM OSBP PHAMESA PHC PSC PSI RBM REC RSA RSC SADC SALGA SAMA SANAC SBCC SCHMT SDG Sida SGBV SMC SOP SRHR Knowledge Management Kenya National Bureau of Statistics Lawyers for Human Rights Luke International Norway Most-At-Risk Population Medical Bureau of Occupational Diseases, South Africa Maternal and Child Health Migration Health Migration Health Division, IOM Migration Health Forum Ministry of Health (Ministério de Saúde), Mozambique Ministry of Labour, Employment and Social Security (Ministério do Trabalho, Emprego e Segurança Social), Mozambique Ministry of Labour and Social Services, Swaziland Mixed Migration Task Forces Ministry of Health Ministry of Health and Social Services, Namibia Ministry of Health and Social Welfare, Tanzania Ministry of Labour and Social Security, Swaziland Memorandum of Understanding Ministry of Works and Transport, Uganda Ministry of Transport Works, Supply and Communications, Zambia National AIDS Council National AIDS Control Council, Kenya National AIDS Strategic Framework Non-Governmental Organization National Strategic Plan Office of the United Nations High Commissioner for Human Rights Oxford Policy Management One-Stop Border Post Partnership on Health and Mobility in East and Southern Africa Primary Health Care Private Sector Constituency, SADC Population Services International Result-Based Management Regional Economic Community Republic of South Africa Resettlement Support Centre, IOM Southern African Development Community South African Local Government Association Southern Mine Worker Association South Africa National AIDS Council Social and Behaviour Change Communication Sub-County Health Management Team Sustainable Development Goals Swedish International Development Cooperation Agency Sexual and Gender-Based Violence Senior Management Committee Standard Operating Procedure Sexual and Reproductive Health and Rights Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report iv
STI SWAMMIWA TACAIDS TB TEBA TOR TWG UAC UK UN UNAIDS UNDAF UNDP UNFPA UNJT UNHCR UNICEF UNPAF USAID USD VOT VSO WHA WHO Sexually Transmitted Infection Swaziland Migrant Mine Workers Association Tanzania Commission for AIDS Tuberculosis The Employment Bureau of Africa Terms of Reference Technical Working Group Uganda AIDS Commission United Kingdom United Nations Joint UN Programme on HIV/AIDS United Nations Development Assistance Framework United Nations Development Programme United Nations Population Fund United Nations Joint Team United Nations High Commissioner for Refugees United Nations Children s Emergency Fund United Nation Partnership Framework, Namibia United States Agency for International Development United States Dollar Victim of Human Trafficking Voluntary Service Overseas World Health Assembly World Health Organization Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report v
INTRODUCTION For over 10 years, PHAMESA has evolved from a small programme, the Partnership on HIV/AIDS and Mobile Populations in Southern Africa (PHAMSA), attracted strategic partnership networks and alliances and has become a complex umbrella programme comprising many projects funded by different donors. By using one common approach, one standardised monitoring system and reporting process PHAMESA, provides the platform for an integrated response to migration and health that is regionally responsive and locally tailored to respond to national priorities and contexts. In 2012, the Government of the Netherlands, in consultation with Sida, funded IOM, through PHAMESA, to address the specific issues related to migration and health within the mining sector of southern Africa. THE GOAL To contribute improved standard of physical, mental and social well-being for migrants and migration-affected communities in the two regions, enabling them to substantially contribute towards the social and economic development of their communities. In 2013, the International Organization for Migration (IOM) received funding from the Government of Sweden to implement the second phase of the Partnership on Health and Mobility in East and Southern Africa (PHAMESA II), from 2014 to 2017. The funds contributions from different donors particularly the Swedish and Dutch governments have and continue to significantly help the programme meet the challenge of make a lasting difference for vulnerable migrants and their host communities. The goal of the programme is to contribute to the improved standard of physical, mental and social well-being for migrants and migration-affected communities in the two regions, enabling them to substantially contribute towards the social and economic development of their communities. To achieve this goal, PHAMESA responds to the public health needs of migrants and communities affected by migration, and aims to support the development and implementation of migration-inclusive, evidence-based policies and legal frameworks, practices and programmes at regional, national and local levels to support equitable access to services that improve health for all. Through PHAMESA, IOM implements an integrated package of interventions that addresses not only direct health needs but also social determinants of health at individual, institutional and structural/normative levels. As a regional programme, PHAMESA addresses region-wide factors that impact the health of migrants and migration-affected communities throughout the different phases of the migration process, at policy and programmatic levels in a coordinated manner. This is critical because most migration in East and Southern 1,2 Africa is intraregional, and often circular. Accordingly, the programme uses one overarching strategy and M&E framework and leverages shared knowledge and tools, tailored to and informed by country contexts. On 1. According to 2010 data, about 65 per cent of international migrants from sub-saharan Africa stay in the region. Of those who do, 47 per cent of migrants from East Africa remained in the East Africa region, while 65 per cent of Southern African migrants remained in the Southern Africa region. In addition, 35 per cent of migrants from Southern Africa moved to East Africa, and 27 per cent of migrants from East Africa moved to Southern Africa. Thus, of those remained in sub-saharan Africa, nearly three-quarters of migrants from East Africa, and nearly all of migrants from Southern Africa stayed within East or Southern Africa. Source: Shimeles, A. (2010). Migration Patterns, Trends and Policy Issues in Africa. African Development Bank Group (AfDB) Working Paper Series No. 119. AfDB, Tunis. 2. Further, regional economic communities including the East African Community (EAC), Southern African Development Community (SADC), Common Market for Eastern and Southern Africa (COMESA) and Intergovernmental Authority on Development (IGAD) have regional integration initiatives to facilitate labour migration, which is expected to result in an increase in intraregional migration. Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report vi
the ground, PHAMESA utilizes the spaces of vulnerability approach, which enables it to prioritize geographical areas within a country or region with significant migration health needs; as such, the programme operates where it is needed most, targeting not just migrants or people on the move but also the local communities they interact with. PHAMESA s strategic objectives are derived from World Health Assembly (WHA) Resolution 61.17 on the 4 Health of Migrants. The PHAMESA II results framework, which follows a results-based management (RBM) approach, was revised in August 2015 in light of baseline assessment recommendations and practical lessons from previous years of implementation. The PHAMESA II programme outcomes reflective of WHA Resolution 61.17 are as follows: 1. Improved monitoring of migrants health to inform policy and practices; 2. Policies, legislations and strategies comply with international, regional and national obligations with respect to the right to health of migrants; 3. Migrants and migration-affected communities have access to and use migration-sensitive health services in targeted spaces of vulnerability in countries of origin, transit and destination; and 4. Strengthened multi-country/sectoral partnerships and networks for effective and sustainable response to migration and health challenges in East and Southern Africa. To achieve these outcomes, IOM collaborates with strategic partners at local, national and regional levels including relevant government departments of IOM Member States, particularly ministries of health, as well as regional economic communities (RECs), United Nations agencies, the private sector, academia, civil society and community structures. This PHAMESA II 2015 Annual Report highlights progress towards realizing programme results during the period of January to December 2015. It also addresses challenges, mitigating actions and programme sustainability. Significant stories of change are mainstreamed in the report to illustrate PHAMESA s tangible positive changes among beneficiaries. The annex includes the programme s 2015 financial report and Performance framework progress to date. 3 3. Spaces of vulnerability are geographical areas where migrants and communities interact, such as where migrants live, work, pass through or originate. These include, for example, land border posts, ports, truck stops or hotspots along transport corridors, fishing communities and landing sites, mines, commercial farms and informal urban settlements. In such spaces, health vulnerability stems not only from individual but also from structural and environmental factors specific to a location. 4. WHA Resolution 61.17 was endorsed by Member States of the World Health Organization (WHO) during the 61st World Health Assembly in May 2008. It promotes the development and implementation of migration-sensitive health policies and practices and equitable access to health promotion, prevention and health-care services. It recommends action along four pillars, as follows: monitoring migrant health, policy and legal frameworks, migrant-sensitive health systems and partnerships, networks and multi-country frameworks. The pillars were further operationalized during the Global Consultation on the Health of Migrants organized by WHO, IOM and the Government of Spain (Madrid, 2010), and serve as the basis of the results framework of PHAMESA II. Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report vii
EXECUTIVE SUMMARY The International Organization for Migration (IOM) implements the Partnership on Health and Mobility in East and Southern Africa (PHAMESA) II in 11 countries. PHAMESA works with its network of partners in East and Southern Africa to champion policies and programmes that are responsive to the health needs of vulnerable migrants and their host communities, making sure that everyone has equitable access and is using available services. For over 10 years, PHAMESA has evolved from a small programme, the Partnership on HIV/AIDS and Mobile Populations in Southern Africa (PHAMSA), attracted the strategic partnership networks and alliances and has become a complex umbrella programme comprising many projects funded by different donors to make a lasting difference for vulnerable migrants and their host communities. The goal of the programme is to contribute to the improved standard of physical, mental and social well-being for migrants and migration-affected communities in the two regions, enabling them to substantially contribute towards the social and economic development of their communities. Four interdependent outcome areas contribute to this goal, namely: 1 2 Improved monitoring of migrants health to inform policies and practices Policies, legislations and strategies comply with international, regional and national obligations with respect to the right to health of migrants 3Migrants and migration affected communities have access to and use migration sensitive health services in targeted spaces of vulnerabilities in countries of origin, transit and destination 4Strengthened multi-country/sectoral partnerships and networks for effective and sustainable response to migration and health challenges in East and Southern Africa This PHAMESA II 2015 Annual Report highlights progress towards realizing programme results during the period of January to December 2015. The following is a summary of key highlights for 2015. Outcome 1: Improved monitoring of migrants health to inform policy and practice PHAMESA interventions for achieving this outcome is premised on the belief that availability of quality evidence demonstrating to policy and decision makers the link between migration, health and development and how creating an enabling environment for vulnerable migrants to access health services benefits their citizens and societies. Hence, our aim is to advocate with and sensitize governments on the need to ensure the next generation of national and stakeholder health monitoring systems incorporate population mobility as public health imperative and a commitment to human right principles. In 2015, PHAMESA advocacy lead to the inclusion of migration variables in the 2015 key health monitoring surveys in South Africa, Kenya and Namibia. The Kenya national Tuberculosis (TB) prevalence survey initiated in 2015 incorporated two migration variables - nationality, and duration of stay of over 30 days at current residence; and the South African 2015 Demographic and Health Survey (DHS) incorporated three variables. Moreover, Kenya and Namibia initiated pilot projects incorporating migration variables in health management information systems, for health facilities and social welfare services, respectively. The 2016 census instrument in Lesotho now has multiple mobility-related variables. Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 1
Fruitful groundwork was laid in several other countries with results expected in the coming years. Our target is to see at least one key data collection instrument in each of the 11 countries including migration variables by the end of the programme, which will generate much needed evidence on migration and health making it relevant in health and development debate across East and Southern Africa. In addition to the inclusion of migration- related variables in key national surveillance instruments, PHAMESA own research completed in 2015 are expected to be useful tools for health for health advocates, programme developers and policy makers. At the regional level, IOM and Oxford Policy Management (OPM) SADC-funded study on the SADC financing mechanisms for mobile populations completed in 2015 highlighted the investment return in the health of mobile populations and is expected to inform health programme design and implementation within the SADC region. In East Africa, the East African Community (EAC) health service mapping completed in 2015 already informed the EAC strategy on access to health services along the transport corridor. The SADC port study, which assessed the health vulnerabilities faced by migrants and seafarers in selected SADC ports, completed in early 2015, was disseminated in all the 4 four participating countries, namely, Mozambique, Namibia, South Africa and Tanzania. At country level, in 2015 PHAMESA completed 9 research studies. In Uganda for example, the study findings on HIV vulnerability in the mining and other extractive industries informed interventions for the Karamoja Sub-Region under the Joint UN Programme of Support on AIDS (JUPSA). The report has also informed the development of the National Action Plan for HIV and Mobility/Migration and led to a strengthened collaboration between IOM and Uganda s Ministry of Energy and Minerals Development. other countries also conducted research on migration and/spaces of vulnerability, including, amongst others, the planning for the execution of the integrated HIV/tuberculosis biological and behavioural study among migrant mine worker communities funded by the SADC HIV Special Funds, which will be carried out in 2016 in Lesotho, Mozambique, and Swaziland. Some of these research have ignited meaningful dialogues among health development actors on the importance of population mobility as a public health imperative. Outcome 2: Policies, legislations and strategies comply with international, regional and national obligations with respect to the right to health of migrants PHAMESA is determined to contribute to the achievement of a better life for all including vulnerable migrants and other hard-to-reach population groups such as informal cross border traders, sex workers, etc. in East and Southern Africa. Such overarching goal cannot be achieved when there are still policies and legislation that restrict access to citizens only. PHAMESA continued to work with its network of partners built over the years and policy makers and influencers to champion political will and, ultimately, the removal policy and legislation barriers in all PHAMESA countries. Through IOM and partners advocacy and technical support to regional economic communities in various policy dialogues and initiatives, significant strides were made both in East and Southern Africa. For example, through PHAMESA advocacy and involvement, the EAC Regional Strategy on Integrated Health and HIV Programming along Transport Corridors 2015 2020 and accompanying minimum package of health services and fisherfolk framework and the EAC s HIV and AIDS/STI and TB Multisectoral Strategic Plan and Implementation Framework 2015 2020 developed in 2015 are responsive to migration health. In Southern Africa, PHAMESA was part of the development of the SADC draft HIV, SRH, TB and Malaria Integration Strategy (2016 2020) which also recognizes population mobility among key priority issues. In addition, the migration and health strategy for the South West Indian Ocean Countries was completed and validated by the IOC members states and will be launched in 2016. Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 2
Progress made through PHAMESA country teams advocacy for policies that are responsive to migration and health includes: Kenya: with technical support from IOM Kenya, the revised Busia County Health Strategy included migrants among its target populations; South Africa: IOM South Africa supported the inclusion of migrants in national guidelines for HIV counselling and testing; Uganda: through advocacy with and technical support to the Uganda Ministry of Health, IOM Uganda ensured that the National Health Sector Development Plan (2016-2020) developed in 2015 captured migration aspects. Zambia: the IOM Zambia policy advocacy led to the recognition of migrants as key population in the revised Zambia National AIDS Strategic Framework developed and launched in 2015 and through IOM support, three border Zambia border districts affected by migration developed and launched their district HIV strategic plans. Tanzania: with the support from IOM, the Technical Working Group (TWG) on TB and Mining developed a three year work plan to operationalize the Tanzania National TB Strategic Plan. In addition to the above, more progress were made in several other countries towards migration and health inclusive policies and strategies and related documents. For example, IOM provided technical support for the development of a labour migration policy in Lesotho, a national migration and development policy in Mauritius and migration policies in South Africa and Uganda, all of which are ongoing efforts which, we believe, have the potential to lasting positive changes in the health of migrants and their host societies. Outcome 3: Migrants and migration-affected communities have access to and use migration-sensitive health services in targeted spaces of vulnerability in countries of origin, transit and destination In 2015, IOM continued with through implementing partners (IPs) in spaces of vulnerability in seven countries. This outcome is realized through increasing knowledge of migrants and individuals in migration-affected communities on their right to health, priority diseases and available services; increasing the capacity of service providers to deliver migration-sensitive services; and improving service provision in targeted spaces of vulnerability. Interventions are designed to respond to local needs and thus vary within and between countries. Some notable results include the following: Health education for migrants and populations affected by migration took many forms including door-to-door visits, community dialogue, and outreach events and others. In total, 404,291 beneficiaries were reached, including 84,506 cross-border migrants. Education on sexual and reproductive health and rights (SRHR) reached 34,882 beneficiaries. IOM also improved the knowledge and skills of nearly 1,733 change agents in 2015, enabling them to better serve their communities. To improve service delivery, 213 individuals in key stakeholder organizations and 1,400 members of the health workforce were capacitated on migration and health. For example, in Kenya, IOM sensitized 20 health-care workers in Nairobi on migrant-sensitive services and sexual and gender-based violence (SGBV) in the context of migration and human trafficking, and a module on Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 3
human trafficking was integrated in the health worker training curricula on SGBV through IOM advocacy after which IOM collaborated with the Ministry of Health to train 25 health workers in Busia County, which borders Uganda; Uganda capacitated 136 health workers from private and public health facilities along transport corridors and in fishing communities; and Zambia trained 255 stakeholders on SGBV, gender and migration. Through PHAMESA, more than 12,471 people identified during the health education campaigns were referred for health and other relevant services; 3,688 were confirmed to have received services at the referral destination. Outcome 4: Strengthened multi-country/sectoral partnerships and networks for effective and sustainable response to migration and health challenges in East and Southern Africa Outcome 4 is realized through building the capacity of partners to develop, fund and implement initiatives that address migration and health, increasing multi-stakeholder/multisectoral coordination and collaboration on migration health at all levels, improving accessibility of tools on migration and health and increasing awareness of migrants right to health and migration-related challenges at national, regional, and global levels. Partners include among others government structures at local, national and regional levels, United Nations agencies and joint teams, local IPs and academia. Significant highlights from 2015 include the following: IOM supported the development and implementation of several migration-inclusive initiatives including: 1) the SADC E8 Global Fund Malaria Initiative 2) the SADC Global Fund Response to TB in the Mining Sector of Southern Africa 3) the Roll Back Malaria Initiative 4) the EAC strategy on Health and HIV in Transport Corridors 5) the MOSASWA (Initiative for Malaria Elimination in Southern Mozambique, South Africa and Swaziland ) Global Fund proposal 6) the East, Central and Southern Africa (ECSA) Health Community Global Fund Initiative supporting Uganda Supranational and other ECSA Countries to Improve TB Diagnosis in the Region 7) the Cross-Border Health Integrated Partnership Project (CB-HIPP). These initiatives have secured multi-million dollar funding, IOMS role in ensuring that vulnerable migrants were incorporated, demonstrates broader ownership and sustainability in initiatives tackling the health risks associated with migration. PHAMESA moreover made significant strides in integrating migration and health into the curricula of universities and training institutions. IOM worked closely with Makerere University in Uganda to develop the curriculum for a postgraduate certificate on migration health, which will be finalized and piloted in 2016. In addition, IOM developed and strengthened relationships with the following universities: Muhimbili University in Dar es Salaam and Catholic University of Health and Allied Sciences in Mwanza, Tanzania; University of Zambia; and UniZambeze and the Catholic Universities in Mozambique. These relationships are expected to be formalized and result in the integration of migration health in the curricula in 2016 and 2017. Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 4
Finally, through PHAMESA, IOM participated in multiple conferences in 2016, increasing awareness of migration health and related challenges. These included the International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA) in Harare, Zimbabwe, where IOM presented six research posters and co-hosted a satellite session with the theme: Linking Leadership and Technology for Equitable Access to Health Care among Migrants in the Southern Africa Region; the African Conference on Key Populations in Dar es Salaam, Tanzania, where IOM presented four studies and co-chaired a round table session on: Migrants, A Key Population Left Behind in the HIV Response: Turning Theory into Action in East and Southern Africa; and the 5th Annual East African Health and Scientific Conference in Kampala, Uganda, for which IOM supported the EAC in presenting the aforementioned regional mapping study. Moreover, IOM Mauritius, and the Joint UN Programme on HIV/AIDS (UNAIDS) co-organized a satellite event, AIDS in the City, in the context for the 14th Regional HIV/AIDS Colloquium. IOM uses such fora to advocate for political will to address migration related health issues within the Indian Ocean Commission region. Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 5
PROGRESS TOWARDS RESULTS Sustainable improvement in the physical, mental and social well-being of migrants and communities affected by migration requires progress in each of the interdependent result areas described above. This section of the report thus documents achievements made towards realizing the second phase of PHAMESA s four interrelated outcomes and their associated outputs, at both country and regional levels. The report is organized by outcome. However, the interventions and their outputs are designed to lead to multiple intermediate and long-term outcomes along the programme change pathway, according to the programme s dynamic theory of change and its underlying assumptions. 3.1 Outcome 1: Improved monitoring of migrants health to inform policy and practice ntra- and inter-regional mobility of vulnerable men, women and children between East and Southern Africa due to conflict or in search of improved livelihoods is a historical phenomenon that continues to affect the health and well-being of those on the move and the local populations with whom they interact. However, due to lack of reliable data on these populations, the phenomenon remains poorly understood. PHAMESA intervention strategies for achieving Outcome 1 are dependent on the premise that sustainability of initiatives addressing the health challenges in migration-affected communities requires national governments buy-in and commitment to these often forgotten populations in the national health monitoring systems. 12 10 The intervention for achieving this outcomes are carefully packaged to respond to the sensitivity surrounding migration related data in Sub-Saharan African countries where government are still struggling to meet the basic needs for their citizens. Our strategies for achieving this important outcome is premised on the belief that availability of quality evidence demonstrating to policy and decision makers the link between migration, health and development and how creating an enabling environment for vulnerable migrants to access health services benefits their citizens and societies. Hence, our aim is to advocate with and sensitize governments on the need to ensure the next generation of national and stakeholder health monitoring systems incorporate population mobility as public health imperative and an inclusive health development agenda in line with international human right principles. Signs of such political commitment can be seen in the extent to which governments are willing to mainstream these populations into their national health monitoring initiatives such as surveillance mechanisms, periodic nationally representative surveys, health management information systems (HMIS) and other relevant tools. The graph on Outcome 1: Monitoring on Migrant Health, provides a snapshot of cumulative achievements 8 6 4 2 0 11 Outcome 1 Target 3 No. of instruments with migration variables 9 12 No. of research finished Achieved 1 0 Operational KM platform Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 6
towards the realization of improved migrants health monitoring. Improving availability and accessibility of quality data and evidence on migration health is a critical step to effective and sustainable programmes and policies which address the health challenges associated with migration. Such data is lacking because key routine national health monitoring data collection instruments often do not include variables on population mobility. Through PHAMESA II, IOM advocates with relevant bodies such as national research, surveillance and survey departments/units for the development of health research, monitoring and surveillance instruments that incorporate population mobility to generate evidence to inform all-inclusive, effective health and development planning. In addition, IOM together with its partners undertakes research to generate strategic information regarding health vulnerability, health status and available services for migrants and affected communities to support inclusive policy and programme development. Countries in East and Southern Africa are at different stages in terms of the achievement of this outcome. The aim is that at the end of PHAMESA II, each of the 11 PHAMESA countries will have incorporated variables on migration in at least one key national data collection instrument. Country teams faced obstacles gaining buy-in for incorporating migration in health surveillance systems and periodic health surveys mainly due to political sensitivity mentioned above and myths surrounding migration in countries and the low prioritization of migration and health in government agendas. Nevertheless, in 2015, the following results were achieved: In South Africa, through the partnership with Statistics South Africa, IOM successfully advocated for the inclusion of migration-related variables into the 2015 South Africa DHS instruments. The data was collected towards the end of 2015 and is expected to reveal if there are any health disparities between migrants and their local hosts, which will be critical, new information. The Kenya National Tuberculosis Prevalence Survey that is currently underway incorporated migration variables, including nationality, and duration of stay of over 30 days at current residence. In addition, IOM Kenya supported the Ministry of Health in drafting a facility level register to use for collecting data on migrants utilizing services at health facilities in selected migrant-populated locations in the country. The tool will be piloted in 2016 jointly with the Division of Monitoring and Evaluation, Health Research Development and Informatics to assess the feasibility of collecting such data and the type of indicators to be included in national HMIS data collection tools. This is encouraging because Kenya and South Africa are the main destination countries for vulnerable migrants from East, Central and Southern Africa. In Namibia, IOM advocated with the Ministry of Health and Social Services (MOHSS) for the inclusion of migration in the client intake form for the Social Welfare Information System, which will generate critical statistics on migrants accessing services in Namibia. This information is vital for evidence-based service delivery and planning, especially in areas highly affected by mobility. The advocacy for inclusion of migration variables in national data collection continues in other PHAMESA countries, and tangible results are expected during 2016.The form will be piloted in 2016 with all regional social workers to enhance programme planning and improve service delivery in areas affected by population mobility. The variables include place of residence and place of birth (internal or international). Migration variables are being discussed in the Health Information System Technical Committee and advocacy is ongoing for inclusion in the system in 2016. The experience in Namibia and Kenya suggest that piloting such tools in select areas to gather evidence for scaling up at the national level is a strategy that can potentially succeed programme-wide. The subsections below present progress made towards the realization of outputs that are the precondition for improving monitoring of migrants health. Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 7
3.1.1. National health information systems incorporate indicators to measure the health of migrants In Kenya, apart from the provision of technical support to the Ministry of Health (MOH), particularly the head of the National Tuberculosis Leprosy and Lung Disease Programme and the national tuberculosis (TB) survey technical advisory committee in the development of the national TB prevalence survey tools, which incorporated migration issues, In 2016, IOM will analyze migration variables included in the previous Kenya AIDS Indicator Survey through PHAMESA advocacy. In South Africa, IOM initiated discussions with the Planning, Monitoring and Evaluation Unit of the National Department of Health on the recognition of migration variables into the district health information collection tools. Moreover, IOM continued to advocate for the inclusion of migration variables in the HIV/AIDS Household Survey and the National Strategic Plan review under preparations. In Lesotho, IOM s engagement with the Bureau of Statistics resulted in the inclusion of migration variables in the Census survey tool, including the following: history of movement in the past five to ten years, length of time of residence in a district, movement out of the country in the past five to ten years, including reason for movement and family members born in Lesotho residing abroad. In Mozambique, IOM lobbied with UNFPA for inclusion as part of the 2017 Census technical committee, which provides the opportunity to advocate for the inclusion of additional migration variables into the census data collection instruments. In Mauritius, in the context of the development of a national migration and development policy, a sub-committee comprising the technical representatives from the IOC member states on statistics has been established and is considering the importance of systematic inter-ministerial data collection and analysis for the development of evidence-based interventions, programming and policies. Relatedly, in Zambia, through the UN Joint Programme on Sexual and Gender-Based Violence (SGBV), IOM continued to support the police force to develop an electronic national database to capture victim-related crime statistics that will enable real-time data on SGBV and human trafficking disaggregated by migration status, to facilitate planning and improved service provision. The database is due to be rolled out to pilot stations in 2016. 3.1.2. Increased availability of data and evidence on migration and health generated through research Apart from advocacy with key government departments for the incorporation of migration into their health monitoring systems, IOM and partners also undertake research activities to generate further useful evidence on migration and health. Key regional-level research activities completed included the following: Conducting a study on Southern African Development Community (SADC) financing mechanisms, to assess the benefit of investing in health financing for migrant populations. This was a joint venture between IOM and Oxford Policy Management (OPM). In November 2015 the study was presented to SADC Ministers of Health who referred it the SADC Finance Ministers for consideration. The study was requested by SADC Ministers of Health to assist them make an informed decision on the 2009 Draft Policy Framework on Population Mobility and Communicable Diseases in the SADC Region. Finalization and dissemination of the regional mapping of all health facilities along transport corridors in the five countries comprising the East African Community (EAC), commissioned by EAC and conducted in 2014. IOM finalized and disseminated the regional synthesis at the East African Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 8
Health and Scientific Conference. The study has informed the EAC Regional Strategy on Integrated Health and HIV Programming along Transport Corridors 2015 2020 and accompanying minimum package of health services. The completion of the Regional Synthesis on Patterns and Determinants of Migrants Health and Associated Vulnerabilities in Urban Settings of East and Southern Africa. IOM accomplished this in partnership with the African Population and Health Research Centre (APHRC). Furthermore, the SADC-funded study on the health vulnerabilities of mobile and migrant populations in selected ports of Southern Africa completed in 2014 was shared with stakeholders including government, United Nations agencies, health development partners and donors to increase knowledge and facilitate evidence-based planning in multiple countries including Lesotho, Mozambique, Namibia, South Africa and Tanzania. Research highlights at the country level include the following: In South Africa, five studies were concluded. These include. size estimation of the population of selected migrant populations including farm workers, mine workers, informal cross-border traders and long-distance truck drivers; an analysis of international migration dynamics in the country, drawing from the Census Report of 2011, conducted with the government; and a qualitative report of vulnerability assessment in three metropolitan areas of Gauteng Province in partnership with the Department of Social Development, which will be officially launched in 2016. In addition, work was undertaken with the KwaZulu Natal Department of Health as part of a bigger study to understand migration trends in South Africa to further unpack the knowledge, attitudes, practices and behaviours among migrants and the community at large. IOM also collaborated with the South African National AIDS Council (SANAC) to review and document emerging and good practices on HIV/AIDS, other sexually transmitted infections (STIs) and TB in the commercial agricultural sector. In Uganda, IOM conducted several operational research initiatives including a rapid assessment on access to health care for urban migrants in Kampala and a study on HIV vulnerability in mining and other extractive industries. The latter will inform prevention efforts in Uganda to address the HIV and health risks associated with internal mobility dynamics in local communities in mining sites while embracing a space of vulnerability approach to migration-affected areas. The mining study has already been used to inform the design of interventions for the Karamoja sub-region under the upcoming third generation of the Joint UN Programme of Support on AIDS (JUPSA), and is informing the development of the National Action Plan for HIV and Mobility/Migration. The research initiative moreover led to the development of a bilateral relationship between IOM and the Ministry of Energy and Minerals Development. IOM Uganda supported an assessment that identified key HIV and mobility issues; the findings were integrated into the national action plan for most-at-risk populations (MARPs). IOM Zambia collaborated with the Columbia University School of Social Work to conduct a qualitative study on migration-related stressors, psychosocial outcomes and HIV risk behaviours among truck drivers. The study findings were disseminated to key national stakeholders in the transport sectors and at the African Conference on Key Populations held in Dar es Salaam, Tanzania. Looking ahead In 2016, PHAMESA plans to conduct regional research which will focus on sexual and reproductive health and rights (SRHR). The aim of the study is to understand SRHR perceptions, practices and priorities in migration-affected communities as well as assessing differences in contextual barriers to contraceptive benefits in selected migration affected sites. The study will be undertaken in two phases: a situational analysis on SRHR followed by field research on SRHR, focusing on particular selected spaces of vulnerability. Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 9
3.1.3. IOM and partners have improved accessibility to migration health information At the regional level, IOM aims to develop a knowledge management (KM) platform to improve accessibility of knowledge on migration and health. This platform will enable both internal (i.e. IOM) and external users (e.g. government and other partners) at country, regional and global levels to access information and also capture, develop, share and use knowledge on migration health. A working relationship is being pursed between IOM and the John Hopkins University Centre for Communication Programs to support the design of a PHAMESA knowledge management and exchange platform and build capacity of KM champions within the PHAMESA programme. At the country level, accessibility of migration health research fosters tangible programmatic and policy results. In Tanzania, for example, following baseline dissemination meetings on TB in the Geita and Kahama mining areas, two mining companies (ACCASIA and GEITA) committed to provide two Gene X-pert machines to enhance TB testing in the mines. The media also committed to raise awareness of TB, HIV and silicosis in the community, with three radio programmes broadcasted thus far. Effectively planned dissemination of research findings is one of the PHAMESA s strategies to continuously engage stakeholders at all levels to ensure that evidence generated is meaningfully used to influence programmes, policies and practices, ensuring that all-inclusive programme planning and implementation. 3.2. Outcome 2: Policies, legislations and strategies comply with international, regional and national obligations with respect to the right to health of migrants Evidence-based advocacy in partnerships and alliances with key civil society and development actors at all levels targeting key policy- and decision-makers has proven to be an effective strategy for the realization of migration-inclusive policies, legislations and strategies, leading to better health outcomes for all. This outcome is realized in part through increasing knowledge among policymakers and stakeholders to influence polices, legislations and strategies that address migration-related health issues, and improving coherence of policies among relevant sectors and across 12 10 8 6 4 2 0 Outcome 2: Policies and Legal Frameworks Target Achieved 12 Non-health sectors incorporating migration health Policies, laws, strategies made migrant inclusive borders. IOM and its partners advocacy efforts continued to add value to stakeholders including governments and RECs, as well as larger ecosystems, in terms of ensuring that policies, strategies and legislations comply with obligations with respect to the right to health of migrants. This is done through participation in various policy discourse and dialogues, for example to provide relevant rationale for why migration-sensitive health policies and legislations are key steps towards the achievements of the Sustainable Development Goal (SDG) targets in the two regions. The graph on Outcome 2: Policies and Legal Frameworks, summarizes the cumulative achievements for PHAMESA as at the end of 2015. 3 2 9 Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 10
To promote migration-inclusive policies, strategies and legislations at the regional level, IOM and its partners provided technical support to RECs and were part of various policy dialogues and initiatives, including the following: The EAC Regional Strategy on Integrated Health and HIV Programming along Transport Corridors 2015 2020 and accompanying minimum package of health services and fisherfolk framework. These documents were finalized in 2015 with technical support from IOM s East Africa Regional Support Team; official adoption by governments is expected in the first half of 2016. EAC s HIV and AIDS/STI and TB Multisectoral Strategic Plan and Implementation Framework 2015 2020. The SADC HIV, SRH, TB and Malaria Integration Strategy (2016 2020), was presented to the SADC Ministers of Health in November 2015 for approval. As the strategy was deferred for revision, IOM will continue to support SADC in its finalization. The Indian Ocean Commission (IOC) regional migration and health strategy for the South West Indian Ocean countries focusing on SRHR, including HIV/AIDS and other STIs. The strategy will serve as a tool for effective long term development of initiatives addressing migration health. To date, the strategy has been developed and has been validated in Comoros, Madagascar and Seychelles. It is expected to be officially launched in 2016. The Regional Minimum Standards and Brand for HIV and other Health Services along the Road Transport Corridors in the SADC Region which was drafted in 2014 was endorsed by the SADC Ministers during the year under review. Moreover, IOM used various approaches to advocate for inclusion of migration health, particularly vulnerable migrant populations, in health policies, strategies and programmes at national and local levels. These included participation in key strategic partnership forums, such as the Development Partners in Health in Kenya (DPHK), where MOH policies and strategies are presented for partners to identify areas of support, including direct input of content in documents under development. Other approaches involved one-on-one meetings with key decision-makers to determine progress in development of relevant documents and potential entry points for technical assistance. The country level progress with regard to advocacy aimed at influencing health policy, strategy and legislative changes include the following: IOM Kenya supported the review of the Busia County Health Strategy to include interventions that benefit migrants, in alignment with the Kenya constitution, which guarantees health for all persons in Kenya. In Uganda, IOM provided technical inputs in the development of the Uganda National Health Sector Development Plan (2016 2020) and successfully ensured that it captures migration health. In Zambia, the revised National AIDS Strategic Framework (NASF) to which IOM successfully advocated for the recognition of migrants as a key population was launched in 2015. IOM and the National AIDS Council supported three priority border districts (bordering Botswana, Democratic Republic of Congo and Namibia, respectively) to develop district HIV strategic plans, launched at the end of 2015. This followed training of 51 officials from Sesheke and Kazungula District AIDS Task Forces on HIV, migration health and planning and a stakeholders breakfast meeting co-convened with the National AIDS Council. In South Africa, migrants were included in the national policy guidelines for HIV counselling and testing (HCT), demonstrating that the department is making tangible policy shifts towards inclusion of migrants. Moreover, IOM engaged with the National Department of Health towards the development of a migration and health strategy. Moreover, South Africa recognized migration as a key developmental issue impacting population health including HIV in Limpopo, Mpumalanga and Kwazulu Natal provinces led to the inclusion of migration in Strategic Plans on HIV/STI/TB. Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 11
In Tanzania, the National TB Strategic Plan was operationalized with a three-year work plan developed by the Technical Working Group (TWG) on TB and Mining, with IOM s technical assistance. In Lesotho, IOM is supporting the development of the Lesotho National Migration Health Strategy, informed by the PHAMESA baseline assessment. This country-led strategy is being developed through a consultative process involving key line ministries including Health, Planning, Home Affairs, Labour as well as civil society organization (CSO) partners. The development of a national migration health strategy aims to ensure sustainable health development planning that addresses the health risk associated with migration within and across Lesotho borders. In Mozambique, IOM through its advocacy and participation in the development of the Mozambique United Nations Development Assistance Framework (UNDAF) successfully advocated for the inclusion of migrants as one of the key target population groups for the UNDAF 2017 2020. Looking ahead The revised PHAMESA II results framework increases emphasis on ensuring operationalization of policies and strategies as well as accountability, including at the community level. A new outcome-level indicator, it measures the extent to which accountability mechanisms are in place and utilized. The minimum target is for at least three countries to establish or utilize existing accountability mechanisms. Planning is underway to achieve this new result. One of the key strategies IOM is using is the establishment of partnership with paralegal organizations and strengthening community-based paralegal initiatives in migrant-populated areas in at least three countries (Kenya, South Africa and Zambia). These programmes will train and support migrant and non-migrant community paralegals to promote accountability regarding implementation of policies and laws and ensure access to services at the community level. Paralegals support provision of legal aid services and referrals, generally for vulnerable and marginalized population groups, and, in many contexts, go beyond legal aid to advocate with communities for public services (including health) and other community concerns. The section below briefly describes the progress made on outputs which are preconditions for achieving Outcome 2. 3.2.1. Increased knowledge among policymakers and stakeholders to influence policies, legislations and strategies that address migration-related health issues PHAMESA interventions to achieve migration-inclusive policies, strategies and legislations are premised on the extent to which policymakers and influencers have knowledge on the importance of migration issues in the development of policies and strategies, in relation to international migrant law to which governments have committed. Below are key country level highlights of results achieved through the sensitization of government and other stakeholders including CSOs. Such capacitation is aimed at influencing change in policies, legislations and strategies: In Uganda, IOM held a workshop with various partners and stakeholders, including MOH and other ministries, to validate and disseminate the findings of the urban rapid assessment and the EAC mapping study. A workshop was also held to validate its migration health strategy. The meeting provided a platform for IOM to create awareness and increase knowledge of key national stakeholders in migration health and their ability to influence policies, legislations and strategies that address migration-related health issues. Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 12
In Swaziland, IOM in partnership with the Swaziland Ministry of Labour and Social Services (MLSS) and Swaziland Migrant Mine Workers Association (SWAMMIWA) convened a multi-stakeholder policy dialogue on TB and Silicosis, HIV, portability of social security benefits and compensations for current and ex-mine workers. The aim of the dialogue was to share lessons learned on how to effectively tackle the complex vulnerability to TB and silicosis in the mines and its effect on Swazi people. The stakeholders agreed to the establishment of mechanisms for addressing policy inconsistencies and to facilitate improved access to compensations and other social security benefits for those affected. Moreover, IOM in partnership with Voluntary Service Organization (VSO) strengthened the capacity of the Southern Mine Worker Association (SAMA) and six of its affiliates to effectively advocate for and implement initiatives that respond to the rights of their members as regards HIV/TB and sustainable livelihoods. SAMA membership includes worker-sending communities of Lesotho, Mozambique and Swaziland. In Mozambique, Association of Mozambican Miners (AMIMO) paralegals were trained and participated in the piloting of the legal manual developed by Lawyers for Human Rights (LHR). During the holiday campaign in Gaza province, AMIMO paralegals used the tools developed by LHR in partnership with IOM to raise awareness of current and ex-mine workers on labour rights, focusing on compensations due to TB contracted in the mines. This training gave them knowledge that they can use at different platforms at national and regional levels to advocate for policies and strategies that are sensitive to health issues affecting them and their families. In Tanzania, 25 law enforcement officials from the police force, immigration and prison services were trained on national and international human rights standards, migrants right to health, IOM s approach to migration health and best practices and practical experiences in addressing migrants rights in the Tanzanian context. In Zambia, 56 frontline immigration officials were trained on similar issues. The assumption is that the trained officials and CSOs will use the knowledge to influence policy change in their contexts. In Lesotho, IOM partnered with the Ministry of Labour to develop a joint proposal to build the capacity of policymakers in managing migration in the labour sector; the project will be implemented in 2016. Moreover, country migration profiles inclusive of health were validated by key stakeholders in Kenya and Namibia; these profiles will serve to support advocacy for migration inclusive policy and legal frameworks. 3.2.2. Improved coherence of policies among relevant sectors and across borders The health risks associated with migration are complex and require multispectral and multi-level partnership, networks and collaboration. The health sector cannot address health challenges and social determinants of health alone; thus, PHAMESA advocates for policy and legislative change targeting not just health sector but other relevant sectors such as labour, social development, immigration, and transport among others. Progress made towards this output at country level is highlighted below: In Uganda, IOM provided technical guidance and financial resources towards the development of National Migration Policy, which is currently under final review before Cabinet Approval. The development and adoption of this policy reflects government commitment towards harnessing the challenges of migration into opportunities for national transformation. IOM is also contributing to the amendment of the Diaspora and Citizenship and Immigration Control Acts. In Mauritius, IOM is providing technical support to the government in the development of a National Migration and Development Policy that includes health. It is doing so by increasing government officials understanding of the link between migration, health and development; and highlighting the importance of mainstreaming migration within health and development. Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 13
In South Africa, migration issues entered the spotlight as a result of violence against non-nationals, specifically in KwaZulu-Natal and Gauteng provinces. Several initiatives were undertaken by the government, including the establishment of an Inter-Ministerial Committee on Migration, assigned to oversee the development of a migration policy. IOM has been engaged to provide technical inputs and support to ensure that health is taken on board in these development agendas. In Zambia, IOM supported the Ministry of Transport, Works, Supply and Communication in the review of the transport sector HIV policy. Furthermore, IOM, in conjunction with the United Nations Development Programme (UNDP), UNAIDS and other stakeholders, provided technical and financial support to the same ministry to revise and finalize the national Environmental Impact Assessment clause for capital projects. A national consultation was also held for policymakers in the transport sector to get their buy-in prior to submission to the Minister of Transport for endorsement as a statutory instrument. In Lesotho, IOM has been engaged with the Ministry of Labour in the development of a national labour migration policy. One of the focus areas is on migration and health in relation to migrant workers. Validation is expected to take place in 2016. As noted above, in Swaziland, IOM with MOLSS and SWAMMIWA hosted a Policy Dialogue on TB, Silicosis, HIV, Portability of Social Security Benefits and Compensations. The meeting resulted in among other things, high-level political commitment from MOLSS, MOH and other partners to address portability of social security benefits and other forms of compensation. The key outcome was recommendation for the establishment of a central coordinating mechanism to address the challenge of incoherencies and lack of synergy among the various actors mandated to manage policy, mechanisms and procedures for claims, payments and reporting. IOM Mozambique, in partnership with the cross-border mine worker associations for Mozambique, Swaziland and Lesotho, led the development of a regional advocacy strategy targeting policymakers and key stakeholders in all three countries and in South Africa (as the country of destination) to improve conditions of social protection for migrant mine workers and their families. The strategy focuses on addressing the barriers to accessing employment benefits for ex-mine workers and their families in Southern Africa; operationalization of the SADC Declaration on TB in the Mining Sector; and enhancing recognition of the contribution of migrant mine work to development. While these issues are not all directly related to health, they have implications on this populations health outcomes. In addition in Mozambique, the Working Group for the Harmonization of the Assistance to Miners, was composed of IOM, the MOH, Ministry of Labour, Employment and Social Security, National AIDS Council, UNAIDS, WHO, AMIMO and the Employment Bureau of Africa (TEBA), was revitalized during the first quarter of 2015. It aims to find mechanisms for harmonization of medical assistance to Mozambican miners living with HIV and working in South Africa. An Action Plan for Miners is in the final stages, and engagement for a MOU between the Ministries of Health in Mozambique and South Africa is ongoing. Moreover, IOM provided technical support to the development of Swaziland-South Africa Joint Bilateral Labour and Employment Cluster MOU and its accompanying Joint Bilateral Technical Cooperation Agreements on labour migration, benefits and conditions of employment, including occupational health and workmen s compensation issues. Once endorsed by both countries, this will help to improve the access and adherence to treatment and for medications for chronic conditions such as TB and HIV and, ultimately, the health status of communities. Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 14
Successful Campaign to Prevent an HIV-Related Deportation of a Migrant, Mauritius IOM contributed to successfully appeal to the Government of Mauritius (GoM) to advocate for a human rights-based approach to the health of migrants in the context of a specific deportation case. Mauritius remains among the 44 countries imposing HIV-related restrictions on entry, stay, and residence. According to the Immigration Act of Mauritius, people with HIV are considered as contagious or infectious and likely to be a burden to the State. HIV-positive non-nationals applying for a work, residential or student permit are refused on that basis. Non-Mauritians who test positive for HIV are refused their work/residential or study permit and deported. This is in contradiction to the HIV/AIDS Act of Mauritius, where it is stipulated that no discrimination shall be made on the basis of HIV status. In March 2015, a young female student who was registered on a two-year' Diploma in Hospitality Management at a private tertiary institution in Mauritius, received a letter from the Passport and Immigration Office, under the aegis of the Prime Minister s Office, informing her of the rejection of her study visa application and requesting her deportation as her HIV test was positive. Working in close collaboration with the office of the UN Resident Coordinator in Mauritius, the UNAIDS, ILO, UNFPA and the UNODC offices in Madagascar, a joint letter of appeal was sent to the attention of the Prime Minister of Mauritius to stop the immediate deportation of the student and allow her to complete her studies. IOM also liaised with the Office of the High Commissioner for Human Rights (OHCHR), an international accountability mechanism, to inform them of this particular case and requesting their support to also send an urgent appeal to the GoM. In April 2015, the student lodge a case at the Supreme Court of Mauritius and in September 2015, she was granted permission to stay until the completion of her studies but the latter decided to quit studying because of the stress she went through. To follow up and advocate for the amendment of the immigration law, IOM is organizing a bilateral learning visit for the Mauritius government to meet with that of Namibia, which recently removed HIV-related travel restrictions, and is working with UNAIDS on ongoing advocacy. 3.3. Outcome 3: Migrants and migration-affected communities have access to and use migration-sensitive health services in targeted spaces of vulnerability in countries of origin, transit and destination Equitable access to and use of health and other services by all is a key prerequisite to achieving healthy lives and well-being for all, at all ages, as stipulated in the health related SDGs. This ambitious goal depends on a number of factors, including health literacy among communities to inform healthy choices and positive health-seeking behaviour, availability and accessibility to services within an enabling environment for all and recognition and action to address social determinants of health. Outcome 3 is realized in part through Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 15
increasing knowledge of migrants and individuals in migration-affected communities on their right to health, priority diseases and available services; as well as increasing the capacity of service providers to deliver migration-sensitive services and improving service provision in targeted spaces of vulnerability. IOM working with implementing partners (IPs) in seven countries on the ground Kenya, Lesotho, Mozambique, South Africa, Swaziland, Uganda and Zambia continued to strengthen community-level health systems through capacity building of stakeholders on the importance of delivering equitable services accessible by all. Some of evidence of results realized under this outcome was observed during site visits; however, the mid-term evaluation planned for 2016 is expected to provide more reliable evidence of intermediate results. Progress on each output at the end of 2015 is presented below. 3.3.1. Migrants and individuals in migration-affected communities have increased knowledge on their right to health, priority diseases (HIV, TB and malaria) and available services This output is achieved through community mobilisation and education by increasing knowledge on the right to health, priority diseases and available services. It also prioritizes reaching reproductive-age individuals through IOM s education package that includes HIV-SRHR and TB while fostering community-led initiatives to address social determinants of health. PHAMESA teams working with IPs continued to conduct health education campaigns in migration-affected communities, primarily focusing on HIV/AIDS, SRHR, SGBV, TB and social determinants of health. Various approaches to community education are used including social and behaviour change communication (SBCC), mainly facilitated by the trained change agents (CAs). The overall target for the programme is to reach 750,000 beneficiaries with comprehensive education to improve their health literacy and knowledge of their health related rights and available services. In 2015, a total of 404,291 were reached, with Kenya and South Africa reaching the highest numbers. These individuals were reached through door-to-door, small groups, one-on-one and outreach events. The graphs below show the distribution of number of beneficiaries reached with health education and on SRHR. Uganda Zambia Mozambique Lesotho 30 9,607 No. of beneficiaries reached with heatlh education 20,770 28,566 796 No. of individuals reached with SRHR education 2,307 Kenya Mozambique Zambia RSA Swaziland RSA 32,061 136,693 5,016 Kenya 176,654 26,733 0 50000 100000 150000 200000 0 5000 10000 15000 20000 25000 30000 Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 16
Country-level highlights include the following: In Kenya, 176,564 individuals were reached with health education on HIV/AIDS, SRHR, GBV, TB, maternal, new-born, child and adolescent health, hygiene and sanitation and disease outbreaks in Nairobi. In addition, through community mobilization and outreach education, IOM Kenya provided support to the MOH to control a cholera outbreak in the migrant-populated Kamukunji area of Nairobi and to surpass polio immunization targets. Kamukunji Sub-County National Immunization Days Polio Campaign, Kenya In recent years, Kenya has experienced a resurgence of polio after being declared free of the disease almost three decades ago. This is partly due to the presence of migrants, in particular refugees and asylum seekers, from neighbouring countries with low immunization coverage among children, due to breakdown in the health systems in their countries of origin. The MOH, with the support of partners including IOM, Polio Core Group, Catholic Relief Services, Eastleigh Resident Communication Association and UMMA, conducts annual national immunization campaigns for polio and measles in selected counties, including border areas, to increase vaccine coverage of hard-to-reach children under five years age in vulnerable population groups, including migrants. In 2015, IOM continued to provide technical support and capacity building of the Kamukunji Sub-County Health Management Team (SCHMT) to ensure access to migration-sensitive health services. For instance during the December 2015 National Immunization Days campaign, IOM supported the Kamukunji SCHMT to meet its annual targets for polio vaccine coverage. IOM mobilized the community through migrant and host community leaders to create demand for the immunization services, and provided health education and individual SBCC interventions. Health messages were translated into the Somali and Oromo languages to reach migrants, and campaigns were led by migrant community health volunteers. As a result, the sub-county surpassed its performance targets, reaching 106 per cent. 5 Kamukunji, which has a population of 261,855, is located in the eastern part of Nairobi County. The sub-county has four divisions Eastleigh North, which has 18,000 children below five years, Eastleigh South, Kamukunji and Pumwani. The sub-county is home to most of the migrants in Nairobi. In addition, it has poor maternal and child health outcomes, including low immunization coverage; for instance, in 2014, immunization coverage was less than 75 per cent 6 of the local government target. The success factors for surpassing our targets were team work, commitment from teams, support from partners, and involvement of administrative, religious, community leaders and private facilities, posters in the local language (Somali), use of Somali and Oromo translators and adequate supplies, James Angawa, Kamukunji Sub-County Disease Surveillance Coordinator. 5. Kenya National Bureau of Statistics (KNBS, 2010). The 2009 Kenya Population and Housing Census, Vol. 1B: Population Distribution by Political Units. KNBS, Nairobi. 6. Nairobi City County (2014). Health Sector Review Report for October 2014 at Committee Room, Monday 10th November 2014. Available from http://www.nairobi.go.ke/assets/documents/sectoral-review-meeting-nov-10th-2014-final.pdf. Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 17
In Lesotho, IOM s IP Phelisanang Bophelong HIV/AIDS Support Centre in partnership with the District Health Management Team carried out a festive season campaign to reach migrant mine workers crossing the border from South Africa with health services at Maputsoe Boarder Post. Services rendered included TB/HIV health education, TB/HIV screening, blood pressure and diabetes screening, distribution of information, education and communication (IEC) materials and condoms and HIV/TB drug re-fills. Of 424 migrants screened for TB, three were tested positive and were referred to the nearest health facilities. Change agents were assigned to follow them up in their respective communities to ensure integration into care. In Mozambique, a total of 20,770 individuals were reached with community health education through the partnership of IOM and its IPs VSO and Pfuka Lixile. During the year, there were seven community mobilization events that provided various services and activities, including health education, HCT, condom distribution and dramas focusing on gender and SGBV. In addition, among a variety of school activities at the Ressano Garcia High School, IOM held 45 roundtable discussions reaching about 1,500 students on topics such as SRHR, SGBV, early marriage, contraception and drug use. An additional 27 seminars were held on issues such as alcohol and drugs, relationships and marriage, reaching 832 students. A simple visit makes a difference... Change Agents in Ressano Garcia, Mozambique 7 Maria is proof that a simple visit makes a difference... Maria is one of the beneficiaries of PHAMESA s project in Mozambique, which started in April 2014 in the administrative post of Ressano Garcia, Mozambique. The community component is implemented by Pfuka Lixile Association, IOM s community-based IP. One of the main activities is home visits for people living with HIV. There are 591 beneficiaries of home visits by the project s change agents. Home visits consist of medication adherence counselling, information about HIV/AIDS and other illnesses and referrals to the health centre, among other services. Maria first moved to Ressano Garcia on her own in search of better economic opportunities. She was diagnosed with HIV five years ago. Although initially she planned to keep her diagnosis a secret, she ultimately decided to tell her brother because she started having symptoms and worried about living alone. When Maria s health started to fail, she travelled to Chokwe district in Gaza to be with her family and seek medical services. Maria recounts thinking she would die while hospitalized in Gaza, but she recovered and went back to Ressano where she started receiving regular home visits from a change agent named Esperança from Project Pfuneka. Maria faced two major challenges: self-stigma, and difficulty securing a steady income because of health problems. With the help of Esperança, Maria started to regain confidence and realize her HIV-positive status was not something to be ashamed of, nor was it something to define her. Maria stated, I am proud for knowing my serological status and I know who I am, and I can do my things without any health related problems or complaints. I feel healthier because I comply with the treatment. 7.Name changed to protect the respondent. Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 18
While Maria had relocated to Ressano Garcia in search for better economic opportunities, she struggled to secure a steady and safe job. She worked as a cross-border trader and sold goods near the road in Ressano Garcia and across the border in South Africa. However, this work was not reliable and was physically taxing. Esperança assisted Maria in acquiring a space to sell vegetables at the central market in Ressano Garcia, which allowed Maria to have a steady income. This was important as it helped Maria adhere to her HIV medication, allowed her access to a nutritious diet and helped increase her self-esteem. HIV stigma in Ressano still exists and many people go to Maputo City to receive HIV care so that no one will recognize them. Maria hopes this will change and has offered to tell her story openly in Ressano to help combat HIV stigma. Maria is an example of what can be accomplished with simple home visits from caring and knowledgeable change agents. In Maria s words, the home visits are very important because they help us see life in a new perspective with hope. Today, Maria is an example of the efficacy of HIV treatment and how a life can be changed when barriers to treatment such as stigma and food insecurity are eliminated. While Maria is grateful for the assistance from Project Pfuneka, she asked for more people to be reached. Don t just visit me alone, she says, visit also those who are in the same health conditions like me or worse. Encourage them to continue with the treatment, since many fail to visit the health centre, and instead seek out traditional sources that do not help them. IOM South Africa reached 136,693 individuals in 152 farms with a package of services that includes biomedical HIV prevention such as HCT, TB screening, referral to voluntary medical male circumcision and prevention-of-mother-to-child transmission of HIV The numbers include those reached through USAID, Sida and Dutch funding through the work of six locally-based implementing partners. Over 81,042 of those reached were international migrants. Condoms remained a key prevention strategy; 91,160 female condoms and 3,048,290 male condoms were distributed. The demand for both male and female condoms increased, whichis a good indicator for behaviour change. In Swaziland, a total of 32,061 individuals were reached through outreach events, door-to-door home visitations and cross-border festive season activities targeting migrant workers returning home in December. IOM, it s IP, the MOH, the Swaziland National Network of People Living with AIDS, Médecins Sans Frontières and Population Services International (PSI) jointly organized outreach events to bring services to the people and maximize advocacy and education for miners and ex-miners on TB and HIV in the mining sector. The festive season cross-border health campaign was held at the Shiselweni and Mahamba border; 34 condom points were established from which 54,922 condoms were distributed. In Zambia, PHAMESA has strong on the ground presence in selected spaces of vulnerabilities through six well-trained IPs. Through the UN Joint Programme on SGBV, PHAMESA reached 9,607 individuals including 5,016 with SRHR education. A total of 304 SGBV survivors identified and referred for psychosocial support and protection. Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 19
3.3.2. Service providers have increased capacity to deliver migration-sensitive services Capacity Building of Change Agents Improving access to health and other services to marginalized groups such as vulnerable migrants and communities they interact within underserved spaces of vulnerability requires not only the uninterrupted supply of health products and commodities but also that services are tailored towards the needs of these groups. Working with county/district health teams and IPs on the ground, IOM strengthened local service delivery coordination and referral systems between and among various health and Uganda Mozambique Lesotho Swaziland Kenya Zambia RSA Changes agents trained to facilitate community engagement and health education 30 39 176 209 213 244 812 non-health service delivery points. Change agents were key resources in reaching out to communities and improving community attitudes towards their health. Through its IPs, IOM 0 200 400 600 800 1000 capacitated CAs to facilitate community engagement and education on priority health issues. As it can be seen in the graph above, a total of 1,723 change agents were trained and mentored. Many of these were existing CAs who underwent follow-up training to enhance their knowledge and community education facilitation skills. The graph shows the distribution of change agents trained to facilitate community engagement and health education per country. IOM Kenya conducted refresher training for 36 community health volunteers (CHVs) attached to the Eastleigh Community Wellness Centre (ECWC) IOM s clinic that offers free, non-discriminatory and comprehensive health care to urban migrants and the host community in a migrant-populated area of Nairobi on community mobilization for communicable and non-communicable diseases and conditions, including SRHR. In Uganda, as part of the United Nations Joint Programme on Aids, IOM trained 30 female sex worker peer educators on family planning was conducted with the Rakai District Health Team. The IOM-trained peer educators conduct community mobilization and sensitization to create demand for health services in fishing communities and at landing sites. Pre- and post-test assessments showed a significant increase in the acquisition of knowledge and skills about family planning use following the training compared to pre-training assessment knowledge. In Zambia, 244 CAs were trained to educate their peers on topical issues in the community including SGBV, HIV and TB. In Lesotho, IOM trained 150 CAs on migration and health, gender and related skills, e.g. income generation for self-employment opportunities. In Swaziland, continuous interaction between change agents and community members improved interpersonal relationships and proved vital for a successful health service provision in all project sites. IOM provided training on migration and health as well as HIV/AIDS treatment, literacy and other skills, such as those related to income generation, to 196 change agents. Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 20
In Mozambique, IOM supported several trainings for community members and change agents on the following topics: construction of keyhole gardens for nutritional support for people living with HIV, in collaboration with the Ministry of Agriculture; IOM s Gender, Migration, and HIV manual, in collaboration with the Ministry of Interior; community support groups; TB; a training of trainers on SRHR; and a peer educator refresher training for 17 high-school change agents on human rights and SRHR, using contraceptives, adolescence/puberty and gender-sensitization. Post-tests from the latter indicated improved knowledge in all areas. Addressing Migration Health and SRHR/HIV with Students in Mozambique IOM has been capacitating teachers and students in the only secondary school in the border town of Ressano Garcia regarding migration and health, SRHR/HIV, TB and gender since 2014. Twenty change agents trained by IOM conduct weekly health talks and debates with students on topics related SRH, SGBV, gender roles and STIs. In 2015, 1,005 students were reached through this programme. For the change agents, training followed IOM s Gender, Migration and HIV manual, and emphasized power and privilege, human rights, community mobilization, types of abuse and counteracting violence towards women and children. Through IOM s engagement, the school established a dedicated Healthy Youth Corner that provides health information and condoms. Even though condom distribution at schools is not common practice, the school principle agreed to make male and female condoms available. The Healthy Youth Corner has also established a very strong link with the local health care centre, whereby students are referred there for further diagnosis and a health technician spends 1-2 hours per week offering advice at the Healthy Youth Corner. In South Africa, bottom-up SBCC remains a core approach, particularly in addressing societal and structural factors related to HIV/AIDS, STIs and TB. In 2015, capacity building via community dialogues using the Community Capacity Enhancement (CCE) process continued. The methodology demonstrated great success in allowing communities to understand the key social drivers of the HIV epidemic and other socioeconomic determinants of health and find solutions. The dialogues also raised issues that further informed the peer-led education conducted by CAs. Capacity building and re-skilling of change agents is an ongoing process, and during this reporting period they were capacitated on several issues including community dialogue facilitation skills. Empowering Communities with Community Capacity Enhancement in South Africa In Umgugundlovu, KwaZulu-Natal Province, a challenge to the HIV response identified during community dialogues was insufficient access to antiretroviral drugs due to the long distance to the nearest clinics, and the costs involved. Community members took it upon themselves to make a submission to the district authorities and the matter has been escalated to the provincial department of health. While these are not rapid solutions, the essence of CCE is that communities are empowered to take action. As a result of the dialogue process, a Community Action Team has been constituted to follow through on agreed resolutions. Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 21
In Mpumalanga Province, the dialogue process resulted in the mobilization of key departments to come and listen to the concerns of the community in the informal settlement of Mjejane. This session was aired on one of the radio stations, and it was a notable moment for the municipality as it had a platform to reach down to the community level. In Mooiplaas, an informal settlement completely populated by internal and international migrants outside Pretoria in the City of Tshwane, the Khuluma Migration Health and Social forum was established as a result of community dialogue processes. The forum developed an action plan that included capacity building on human trafficking, migrant rights and migration health, carried out in collaboration with Lawyers for Human Rights and local organizations that are providing various services to the community. Capacity Building of the Health-Workforce Poor or misunderstanding of the effects of mobility on community health as well as service provider attitude to marginalized groups is one of the barriers to equitable access to and use of health and related services in migration-affected areas. IOM together with its IP continued to sensitize key service providers including the community-based and facility-based health workforce on the importance of providing equitable services that are tailored to the needs of vulnerable migrants and their host communities. Since 2014, IOM has built the capacity of 1,613 individuals from stakeholder organizations and the health work force in target migration-affected communities, which remains relatively low compared to the programme target of a total of 4,400 reached by the end of 2017. This is due in part to the re-definition of this indicator during the 2015 revision of the PHAMESA results matrix. The graph above shows the achievements on the capacity building of service providers against the PHAMESA overall target. Country level highlights are summarized below: In Kenya, 20 health-workforce members from various health facilities in Kamukunji Sub-County, Nairobi that IOM sensitized on migration-sensitive services and SGBV in the context of migration and human trafficking, demonstrated improved knowledge. Furthermore, IOM then collaborated with the MOH Reproductive and Maternal Health Services Unit to train 25 health workers including doctors, nurses, pharmacists and laboratory staff in Busia County using the same curriculum. Busia County, which is at the border of Kenya and Uganda, is a transit point for many victims of trafficking (VoT). The service providers demonstrated 30 per cent improved knowledge and skills on management of SGBV, as well as provision of health services for VoT, in the pre-post test results. In South Africa, IOM integrated mobility issues within the Department of Health malaria trainings of locally based health-care professionals including nurses, doctors and health promoters. IOM also conducted capacity building of IPs with regard to addressing gender, HIV and migration, HIV/AIDS and TB and establishing support groups through integrated access to care and treatment (I-ACT). In Uganda, IOM capacitated 186 health workers from private and public health facilities along transport corridors and in fishing communities in four trainings on the provision of migration-friendly health services. The training topics included family planning and HIV care and treatment. The pre-test results showed knowledge and skills gaps that remarkably improved in the post-test results. IOM Uganda also provided migration health gap training to primary health-care workers in two refugee camps with the aim to improve mental health among the refugees they serve. Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 22
In Zambia, IOM trained 255 (55.7 per cent female) key service providers on SGBV, gender and migration. This training improved service providers perceptions of migrants and migrants health. In the pre-test, 74 per cent of trainees stated that migrants increase crime in an area, while there was a significant change in these perceptions following the training, with 36 per cent affirming this perception. 3.3.3. Improved service provision in targeted spaces of vulnerability Collaboration, partnerships and networks among service providers on the ground improves efficiency in service delivery and linkage to care through purposeful and well-planned referral chains. At the community level IPs and IOM, support coordination mechanisms; ensuring beneficiaries are referred to and receive necessary health and other services, including for HIV and TB testing and treatment; and ensuring that SGBV survivors are identified by service providers and referred to and receive support and protection. IOM through PHAMESA continued to nurture the coordination and collaboration networks among health and non-health service providers. A total of 12,471 beneficiaries were referred to health and other services. Individuals were referred for various services including HCT, diagnostic work-up for presumptive TB cases, SGBV, family planning, antiretroviral therapy, TB defaulters to resume treatment, CD4 count test for those who tested HIV-positive amongst others. PHAMESA aims to improve access to and use of available services but the reported referral completion rate remained low due to a variety of reasons including structural barriers such as long distance to facilities, fear of deportation especially among undocumented migrants, poor service provider attitude and general low health seeking behaviour. In 2015, 29 per cent (3,688) of the total referred confirmed receiving services at the referral destination. This is low compared to the programme target of 80 per cent. The SGBV referral completion rate was 25 per cent, lower than the overall rate. The referral completion rate significantly varies by country, ranging from 100 per cent in Kenya to 4 per cent in South Africa. This is partly due to population dynamics and service delivery contexts. These low rates are partly due to under-reporting; many patients referred do not report back after they have received services at the destination point due to various reasons. One of the critical challenge learned from the project site is when the referred 6000 5000 4000 3000 2000 1000 0 1200 1000 800 600 400 200 0 RSA 186 5002 RSA Linkage to care: Referral completion rate 1645 3379 Lesotho 510 1887 Swaziland 1213 Kenya Referred for services Received services at referral destination 40 94 1213 894 96 Zambia Addressing GBV in communities Zambia Swaziland Lesotho Mozambique Referred for SGBV services Received SGBV services at referral destination Kenya HIV Testing: Comparing 2014 and 2015 21,843 43,588 1,379 1,298 Mozambique 1,168 Lesotho 272 540 Zambia 1,176 224 Uganda 159 Swaziland 3,052 Kenya 66 2015 2014 Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 23
individual move out of the space covered by the programme particularly crossing the border into other country. PHAMESA is developing tools and mechanisms to not only facilitate referral completion but also to more accurately follow up and document referral completions. The graphs below summarized the referral statistics for 2015. As shown on the graph below, Zambia reaches significantly higher number of SGBV cases because it implements a specific SGBV programme under the UNJT. In total, 47,043 beneficiaries were tested for HIV in 2015, nearly 93 per cent in South Africa. This represents an increase of over 58 per cent compared to the total number tested for HIV in the previous year. The graph on the right shows the distribution of HIV testing in the seven countries 2015 country highlights include the following: In Kenya, a cross-border health committee comprising of health authorities in Busia County in Kenya and in Uganda was established to address emerging health challenges including outbreaks of infectious diseases beyond HIV/AIDS and TB. Kenya also improved referrals, reporting and disaggregation of data by nationality during the last two quarters of 2015. A referral network was established for different health services, including referrals for SGBV survivors, at the ECWC. Migrants constituted a majority (80 per cent) of the referrals. Referrals were made for an array of services including HIV testing and TB screening, child immunization and growth monitoring, reproductive health services including antenatal and postnatal care, family planning and SGBV. There was a 100 per cent referral success rate, with all the persons referred receiving the services for which they were referred. In Zambia, through the UN Joint Programme on SGBV, 304 SGBV survivors were identified, assisted and referred to the relevant authorities. Moreover, during the period under review, a toll-free line was established and publicized to respond to SGBV incidents; 23 call centre counsellors were trained on SGBV and referral mechanisms. Following training, they responded and attended to 1,342 SGBV cases with counselling, education and referral. The toll-free number is expected to improve timely SGBV case notification and management. In addition, 165 people in Sesheke and Kazungula were tested for HIV; those who tested positive were referred to health facilities nearest to them for CD4 count testing. Addressing SGBV in the Context of Migration through the Zambia UN Joint Programme The UN Joint Programme aims to improve access to health and legal services for SGBV survivors, promote comprehensive protection and support and strengthen coordination for an effective multispectral response. IOM strengthens SGBV management for migrants including refugees, bolstering health, social and community workers capacities, and has enhanced case identifications, reporting, and response and referral systems to ensure survivors access timely health interventions, psychosocial support and victim empowerment programmes such as income generating projects and engaging men. Following community mobilization on SGBV and the risks of child marriage in Mayukwayukwa Refugee Camp, communities identified girls who dropped out of school for marriage and intervened; five were successfully readmitted. Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 24
In Mozambique, IOM s TB holiday campaign focused on TB education and sensitization at the Ressano Garcia Border, the busiest border connecting Mozambique and South Africa in the southern region, the main holiday route for mine workers coming back from South Africa and in two districts in Gaza province. During this holiday outreach events, health information, TB and HIV testing and paralegal advice were provided; 11,644 were reached with TB information, 2,406 screened TB, and 1,269 people were tested for HIV (89 positive) and those positive referred for CD4 count testing. In South Africa, this reporting period saw over 50 per cent increase of uptake of HCT, increasing from 21,843 in 2014 to 43,588 in 2015. The Waterberg Migrant Health Forum bringing together various stakeholders and hosted by the district municipality was launched as well as the Ehlanzeni and Vhembe Migrant Health Fora continued and will continue to play key role in tackling various health risks associated with mobility in the two migration-affected provinces of South Africa. In Lesotho, IOM continued to contribute to the improvement of access and use of services through its local IP in Leribe district Several outreach events were conducted in partnership with the Ministry of Health, PSI, Child and Gender Protection Unit (a police unit responsible for protecting women and children) and local clinics in the migrant mine worker communities of origin in Leribe district. A total of 4,730 were referred for HCT but only 24.6 per cent (1,168) reported testing for HIV and receiving their test results. Other individuals were referred for STI testing, TB diagnostics, TB and antiretroviral adherence counselling, SRH services (e.g. maternal health, antenatal care, family planning, and emergency contraceptives), chronic health problems such as hypertension, immunization new-born care and so forth. In Swaziland, there are significant structural challenges to accessing health and other services in Shiselweni where IOM implements HIV/TB response, such as long distance to health services. IOM s IP organized several outreach events in partnership with other players including the Swaziland Ministry of Health, Médecins Sans Frontière, local health centres, PSI and Hand in Hand, a local NGO, to bring services such as HIV testing and other health screening to the hard-to-reach communities in need. At total of 1,887 individuals were referred for health services; 510 confirmed receiving the services at the referral destination. Phoning Out Poverty & AIDS (POPA) Through funding from the Dutch government, the VSO_-IOM has supported the implementation of the POPA project funded by the Dutch government since 2013, which primarily targets the ex-miners widows and other vulnerable women. The objective of POPA is to improve the livelihoods of women beneficiaries by providing them with small business skills and funds to establish and run income generating activities. Some success stories below were collected from the beneficiaries during joint POPA project by IOM, VSO and AMIMO in Mozambique in 2015. One such woman is Rute Manave, her husband worked in the mines before dying in 2000 from a strange illness. She became the bread winner and with no income, Rute had to find ways to survive and take care of her children. Things degenerated when she too started to get sick shortly after her husband s death. A light seeped through her tunnel when she got involved with the POPA project. Today, Rute runs Rute serving a costumer a small business where she sells groceries and vegetables in her community. If you visit Rute, you will find her busy in her shop selling bread and other wares. With income from her shop, Rute has been able to send her son to school and even managed to buy him a Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 25
computer. She has also constructed a better toilet for her family and during a support visit in June 2015, Rute was in the process of extending her house so as to accommodate her extended family. Another success story is that of Nelia Mucavele who also runs a successful shop and is a Troca Aki agent, Nelia is able to make up to 75 USD per month! During a support visit, Nelia had just purchased goods worth 24,800 Meticash (app 656 USD) to stock her shop. Apart from groceries, Nelia stocks condoms, water treatment drugs, condoms and also sells mobile phone airtime. She has also been able to open a shop for her son. Women like Nelia have benefitted from an innovative business between partnership MCell a mobile phone company and PSI s Troca Aki voucher exchange system. Through the voucher system people are able to purchase items such as treated mosquito nets from shops like Nelia s Nelia (second from left) in her shop during using vouchers. a support visit by IOM and VSO staff POPA Women The POPA project is not just for individual women, but also women groups who come together in Mozambique, Lesotho, and Swaziland to start a business venture. Seven other women have also joined forces to start a poultry business, with about 200 chicks, the women have able to organize themselves and share the responsibilities of rearing the chicken from a room they have rented in the community. POPA project has improved livelihoods of beneficiaries, which is contributing to the improvement in health outcomes because with food security adherence on medication improved especially those on ART. 3.4. Outcome 4: Strengthened multi-country/sectoral partnerships and networks for effective and sustainable response to migration and health challenges in East and Southern Africa Sustainable solutions to the health concerns spanning East and Southern Africa among marginalized population groups such as vulnerable migrants require collective efforts involving all stakeholders at local, national and regional levels through multispectral regional approach. Accordingly, forging and nurturing partnership and collaboration networks with and among relevant stakeholders has been one of the key PHAMESA effective strategies for addressing health and non-health factors affecting migrants and host communities. Key interventions include capacity building of partners and stakeholders to ensure that they incorp orate the health consequences of population mobility in their programmes/initiatives, strategies and their implementation. This is especially important because of the ever-changing nature and complexity of migration and associated health risks. Many of the activities and achievements of outcome 4 build on the work undertaken in the other outcome areas for example lessons learned on implementing on the ground Partnership on Health and Mobility in East and Southern Africa (PHAMESA II) 2015 Annual Report 26