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This study was conducted in order to understand the dynamics of each country in Southern Africa by documenting barriers facing refugees in accessing health care services and aiming to make policy recommendations based on findings. A desktop search was conducted through which papers using both qualitative and quantitative methods were gathered for a...
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Background
Gender disparities exist in the scale-up and uptake of HIV services with men being disproportionately under-represented in the services. In Eastern and Southern Africa, of the people living with HIV infection, more adult women than men were on treatment highlighting the disparities in HIV services. Delayed initiation of antiretroviral tr...
Citations
... However, migrants face a number of barriers in accessing SRH care in the region. Common barriers reported in the literature include stigma and discrimination by healthcare providers, language barriers, inadequate or inaccurate knowledge of services, and a lack of financial resources to pay for care (Human Rights Watch, 2009;Veary et al., 2010;Zihindula et al., 2015). Furthermore, the legality of migrants' status in the country of destination can determine the level of access they have to health and other social services (Davies et al., 2006). ...
Migrants in Southern Africa often lack access to adequate sexual and reproductive healthcare (SRH), which deepens their vulnerability to poor health outcomes. This paper highlights results from a rapid assessment undertaken in six countries in the Southern African Development Community (SADC) region to inform the implementation of the “SRHR-HIV Knows No Borders” project. In-depth interviews were conducted with 16 adult foreign migrants residing in 10 high migration communities where the project was implemented. Data were analysed thematically using an inductive approach. Respondents were found to have good knowledge about HIV, STIs, and male condoms, although they lacked awareness about other contraceptive methods. Many respondents reported barriers to accessing SRH services, mostly as a result of a lack of legal documentation and due to discrimination from healthcare workers. SRH interventions among foreign migrant populations in the Southern African region should focus on developing awareness about contraceptives and ensuring inclusivity within the healthcare system.
... Other factors include experiences of discrimination and lack of social support [16-18]; attitude of health care practitioners [12,[19][20]. ...
... Lack of access to government health facility is consistent with previous qualitative studies among immigrants in South Africa, which indicate barriers to accessing SRH services by immigrants [19][20][21]. The observed gender differences with more males than females lacking KFP and lower access to SRH services in government health facilities may be because more females seek SRH information and services due to pregnancy and childbearing needs. ...
Background: For countries to achieve the Sustainable Development Goals (SDGs) especially SDG3.7- universal access to Sexual and Reproductive Health (SRH) care services including information and education for family planning, immigrant youth must be ensured access to SRH services. This study examines the determinants of knowledge about family planning (KFP) and access to SRH services by sexually active immigrant youth in Hillbrow, South Africa.
Methods: This cross-sectional study of 467 immigrant youth aged 18-34 years used a multistage-sampling technique. Data were collected using interviewer-administered questionnaires on socio-demographic, migration, KFP and access to SRH services from government health facilities. Unadjusted and adjusted logistic regression models were used to determine levels of KFP and access to SRH services among 437 sexually active youth.
Results: The main sources of information on SRH issues were radio/television (38.7%) and friends (22.8%). Over half of the respondents have adequate KFP, while two out of five indicated a lack of access to SRH services from government health facilities. In the adjusted models, the determinants of having KFP were being a female (AOR= 3.85, CI: 2.33–6.35, belonging to the age groups 25–29 years (AOR=2.13, CI: 1.12–4.04; and 30–34 years (AOR=3.88, CI: 2.00–7.53); belonging to the middle and rich wealth index (AOR=1.84, CI: 1.05–3.20) and (AOR=2.61 (1.34–5.08) respectively. Not having received information about family planning (AOR=0.16, CI=0.09–0.28) and not using a contraceptive at the time of the survey (AOR=0.36, CI: 0.18–0.70) were associated with reduced odds of KFP. The determinants of having access to government health facility for SRH services were being a female (AOR=2.95, CI: 1.87–4.65), being 30–34 years of age (AOR=1.91, CI: 1.08–3.39), and not having received information about family planning (AOR=0.44, CI=0.27–0.73).
Conclusion: Majority of the survey respondents lack access to information about family and SRH services provided by government health facilities, which resulted in them depending on unreliable sources of information about SRH issues. There is a need to advocate for universal access to SRH services, inclusive of immigrant youth in South Africa, to curb negative SRH outcomes and to achieve SDG 3.7.
... Despite the importance of healthcare for displaced persons, to the best of our knowledge, the accessibility of healthcare in the LCB is yet to receive scholarly attention. In the African context, attempts at studying refugees' healthcare access have been made only in neutral states far away from the battlefield (Carasso et al. 2012;Crush and Tawodzera 2014;Meyer-Weitz, Asante, and Lukobeka 2018;Muyembe 2007;Oucho and Ama 2009;Zihindula, Meyer-Weitz, and Akintola 2015). Although some refugees have been accepted in new communities and have been guaranteed fundamental rights to basic services, they are consistently denied or are unable to access healthcare (Zihindula, Meyer-Weitz, and Akintola 2015). ...
... In the African context, attempts at studying refugees' healthcare access have been made only in neutral states far away from the battlefield (Carasso et al. 2012;Crush and Tawodzera 2014;Meyer-Weitz, Asante, and Lukobeka 2018;Muyembe 2007;Oucho and Ama 2009;Zihindula, Meyer-Weitz, and Akintola 2015). Although some refugees have been accepted in new communities and have been guaranteed fundamental rights to basic services, they are consistently denied or are unable to access healthcare (Zihindula, Meyer-Weitz, and Akintola 2015). The barriers to refugees' access to healthcare include lack of healthcare facilities, poverty, culture and discrimination (Carasso et al. 2012;Crush and Tawodzera 2014;Meyer-Weitz, Asante, and Lukobeka 2018;Muyembe 2007;Oucho and Ama 2009;Zihindula, Meyer-Weitz, and Akintola 2015). ...
... Although some refugees have been accepted in new communities and have been guaranteed fundamental rights to basic services, they are consistently denied or are unable to access healthcare (Zihindula, Meyer-Weitz, and Akintola 2015). The barriers to refugees' access to healthcare include lack of healthcare facilities, poverty, culture and discrimination (Carasso et al. 2012;Crush and Tawodzera 2014;Meyer-Weitz, Asante, and Lukobeka 2018;Muyembe 2007;Oucho and Ama 2009;Zihindula, Meyer-Weitz, and Akintola 2015). This raises serious questions with respect to the accessibility of healthcare facilities for the displaced persons in the LCB, which has witnessed protracted conflict amid scarcity of resources, and lends support to the study of the lived experiences of the displaced persons in the LCB in their effort to access healthcare. ...
For a decade, the Lake Chad Basin (LCB) region, which is at the intersection of four countries and home to ethnic groups in Cameroon, Chad, Niger and Nigeria, has been occupied by Boko Haram. The lax borders and deprivation in the region contributed to the emergence and expansion of Boko Haram's insurgency. While much is known about the human casualties of the invasion, little is known about the accessibility of healthcare for the displaced persons. This qualitative study adopted Penchansky and Thomas' ([1981]. “The Concept of Access: Definition and Relationship to Consumer Satisfaction.” Medical Care 19 (2): 127–140) theory of access as its conceptual framework (with the following components: geographical accessibility, availability, financial accessibility, acceptability and accommodation) to explore the experiences of the displaced persons in the LCB with respect to access to healthcare. One-on-one interviews (n = 51) and two focus group discussions (n = 16) were conducted with 67 refugees and internally displaced persons recruited from nine host communities in Nigeria and Cameroon, who shared their perceptions of their healthcare access. The displaced persons faced barriers to their access to the healthcare in the LCB. It was found that for each of the components of the theory of access, the study participants encountered barriers to healthcare access. For example, with regard to financial accessibility (affordability), poverty was identified as the main personal barrier to the displaced persons’ healthcare access, and with regard to acceptability, it was communication that was reported to be a barrier. The limitations of the study, the recommendations for future research and the implications of the findings are discussed in detail.
... Hence, it is possible that any poor treatment experienced accessing health care can easily be associated with 'medical xenophobia' . The term 'medical xenophobia' has been used several times in the literature, referring to the negative attitudes and experiences that migrants encounter when accessing health care (Crush and Tawodzera, 2014;Zihindula et al., 2015;Munyaneza and Mhlongo, 2019). ...
The economic meltdown and worsening levels of poverty in Zimbabwe led to a
significant increase in the number of women migrating to South Africa from 2005 to
2010 (Crush et al., 2015: 367). A Southern African Migration Programme (SAMP)
survey in 1997 found that 61% of Zimbabwean migrants were male and 39% were
female (Crush et al., 2015: 367). This suggested that there was an increase in the
number of women migrating to South Africa compared with other countries in
Southern Africa. This gives us reason to ‘speculate’ that the numbers could have
increased a decade later because of the economic crisis that resulted in large numbers
of people migrating out of Zimbabwe. Most Zimbabwean women are now moving
across borders independently of their spouses and partners in search of better and
sustainable livelihoods (Dzingirai et al., 2015: 13; Mbiyozo, 2019). Whilst some have
valid immigration documents, a large number of these women are undocumented,
which heightens their vulnerability to various structures of violence (Bloch, 2010;
Rutherford, 2020: 172).
... These findings were supported by Frenz & Vega (2010) in their study of refugees, which revealed that they face serious financial constraints that do not enable them to afford their basic needs. Refugees are economically disempowered and affording healthcare services is a challenge; as a result they become vulnerable to health-related problems (Zihindula et al. 2015a). ...
Background: Reproductive health services are essential for everyone worldwide. In South Africa, the available literature does not address reproductive health as a full package for women refugees and their experiences. This study addressed women refugees in relation to reproductive healthcare services they receive from public healthcare facilities.
Aim: The aim of the study was to document the day-to-day experiences of women refugees and uncover their challenges regarding utilisation of reproductive health services in public institutions of Durban, KwaZulu-Natal.
Setting: The study was conducted in eThekwini district, Durban, KwaZulu-Natal, and did not consider participants who are located beyond the above-mentioned city’s borders.
Methods: A qualitative, descriptive design was used. A semi-structured interview guide was used to collect data through face-to-face in-depth interviews with eight women refugees. Thematic content analysis guided the study.
Results: Two major themes emerged: negative experiences or challenges, and positive experiences. The most dominant negative experiences included medical xenophobia and discrimination, language barrier, unprofessionalism, failure to obtain consent and lack of confidentiality, ill-treatment, financial challenges, internalised fear, religious and cultural hegemony, and the shortage of health personnel and overcrowding of public hospitals. The positive experiences included positive treatment and care and social support.
Conclusion: The findings revealed that women refugees in Durban, KwaZulu-Natal, face many challenges such as medical xenophobia and discrimination in their attempt to seek reproductive health services in public healthcare facilities, making them even more vulnerable. Assisting women refugees with their reproductive health needs will remediate the challenges they face.
... Other studies show lack of access to healthcare services is often a barrier to HIV treatment among migrant populations, who are typically socioeconomically disadvantaged. [26] In our study, only 29% of migrants had personal health insurance or could self-pay for HIV care and one percent had accessed HIV care through a refugee camp. Given the Maipelo Trust supports only a minority of migrants living with HIV in Botswana, with many migrants unaware of the NGO's support, and others unable to afford visits and VL testing, many migrants in Botswana lack access to HIV care and treatment. ...
The aim of the study was to evaluate the human immunodeficiency virus (HIV) treatment cascade and mortality in migrants and citizens living with HIV in Botswana.
Retrospective 2002 to 2016 cohort study using electronic medical records from a single center managing a high migrant case load.
Records for 768 migrants and 3274 citizens living with HIV were included. Maipelo Trust, a nongovernmental organization, funded care for most migrants (70%); most citizens (85%) had personal health insurance. Seventy percent of migrants and 93% of citizens had received antiretroviral therapy (ART). At study end, 44% and 27% of migrants and citizens, respectively were retained in care at the clinic (P < .001). Among the 35% and 60% of migrants and citizens on ART respectively with viral load (VL) results in 2016, viral suppression was lower among migrants (82%) than citizens (95%) (P < .001). Citizens on ART had a median 157-unit [95% confidence interval (CI) 122–192] greater increase in CD4+ T-cell count (last minus first recorded count) than migrants after adjusting for baseline count (P < .001). Five-year survival was 92% (95% CI = 87.6–94.8) for migrants and 96% (95% CI = 95.4–97.2) for citizens. Migrants had higher mortality than citizens after entry into care (hazard ratio = 2.3, 95% CI = 1.34–3.89, P = .002) and ART initiation (hazard ratio = 2.2, 95% CI = 1.24–3.78, P = .01).
Fewer migrants than citizens living with HIV in Botswana were on ART, accessed VL monitoring, achieved viral suppression, and survived. The HIV treatment cascade appears suboptimal for migrants, undermining local 90-90-90 targets. These results highlight the need to include migrants in mainstream-funded HIV treatment programs, as microepidemics can slow HIV epidemic control.
... Nearly 86 percent of the world's refugees are in low-to middle-income countries (UNHCR, 2015). Africa according to the 2015 UNHCR report hosts nearly 29 percent of the world's refugee population while Southern Africa hosts approximately 500,000 refugees, most of whom originating from Rwanda, Burundi and the Democratic Republic of Congo (DRC) (Zihindula et al., 2015). ...
... A substantial amount of research has been published on the needs of the refugees at Tongogara Refugee Camp (Zihindula et al., 2015, Mapiko and Chinyoka, 2013, Mhlanga and Zengeya (2016). Most of these studies have focused on nutritional, economic needs, mental health problems, school enrollment and attendance. ...
Purpose
Social capital is an essential determinant of health that contributes significantly to quality of life. Social capital has potential of improving the health and well-being of refugees. Refugees in Zimbabwe are confined to an isolation camp making social networks a necessity for survival and psychosocial support. The purpose of this paper is to identify if social capital has effects on wellness and well-being (quality of life) of individuals in a confined setting such as a refugee camp.
Design/methodology/approach
A cross-sectional study was conducted at Tongogara Refugee Camp, Zimbabwe. The World Bank Integrated Questionnaire on Social Capital was adjusted to develop data collection tools. The parameters of social capital, economic, social and cultural capital, were used as the framework of study.
Findings
A total of 164 respondents were interviewed (62.8 percent females). A total of 98 percent were affiliated to a religious group and 30 percent of the interviewees stated that at least one member of their household was on social media. Only 18 percent communicated with people in their home country and 75 percent used social media to create new links.
Practical implications
The various opportunities for psychosocial support that exist within refugee populations can be used to formulate interventions aimed at improving health and quality of life of refugees.
Originality/value
This paper offers insight into the effects of social capital on refugee health and quality of life among refugees in Zimbabwe.
Despite the open policy of integration, refugees in South Africa have been experiencing increasing exclusion and discrimination in socio-economic development and from social services. State-sanctioned discrimination contributes to mistrust among marginalized groups toward the government and its institutions. However, public trust towards healthcare authorities and government institutions is critical during pandemic outbreaks to ensure the population’s willingness to follow public health initiatives and protocols to contain the spread of a pandemic. Eleven key informants, including refugee community leaders and refugee-serving NGOs, were virtually interviewed about refugees’ access to healthcare in South Africa during the COVID-19 pandemic and the consequences of inconsistent access and discrimination on their trust of public healthcare initiatives. Interviews were analyzed using critical thematic analysis. The results suggest that refugees’ access to public healthcare services were perceived as exclusionary and discriminatory. Furthermore, the growing mistrust in institutions and authorities, particularly the healthcare system, and misperceptions of COVID-19 compromised refugees’ trust and adherence to public health initiatives. This ultimately exacerbates the vulnerability of the refugee community, as well as the wellbeing of the overall population.
This chapter analyses the protection of health care rights of refugees in the Republic of South Africa from a legal point of view. It does that with a particular focus on the key concepts (i.e. ‘health’ and ‘refugee’); the right to health as contained in the Constitution of South Africa, 1996; international and regional instruments; and pertinent domestic laws such as the National Health Act 61 of 2003, the Refugees Act 130 of 1998, and the National Health Insurance Bill of 21 June 2018. This is followed by a discussion of issues and challenges facing refugees in their quest to access health services in South Africa. These issues and challenges include an imperfect public service and expensive private service; limited ability to enforce the right to health care and related fundamental rights (e.g. access to courts); language barriers; lack of access to information; and ignorance and xenophobia.
This article aims to strengthen the theoretical case for geographical awareness in human rights work, by considering the performance of the right to have access to health care services in section 27(1)(a) of the 1996 Constitution, by particular inhabitants of Johannesburg. It shows how a "performative" understanding of the right to have access to health care services dovetails with the international law approach to assessing compliance with the right to health, and points to certain features of South African socio-economic rights jurisprudence that enable such an understanding of the right.
Thereafter, the article considers some of the geographic aspects of access to health care services in Johannesburg, with a particular focus on the experiences of marginalised groups. Current health system reforms and urban development initiatives in Johannesburg, that relate to the geographical features of access to health care in the city, are then assessed. It is shown that, while many of these measures will have very positive consequences for the progressive realisation of the right to have access to health care services, the interaction of geographic factors with other determinants of access (notably, affordability and quality of care, as well as stigmatisation of certain care seekers) may nevertheless continue to frustrate access to care by marginalised groups.
